Home-based supervised exercise may prove an effective, alternative treatment for leg and muscle pain among people living with peripheral arterial disease

Back M, Jivegard L, Johansson A, et al.  Home-based supervised exercise versus hospital-based supervised exercise or unsupervised walk advice as treatment for intermittent claudication: A systematic review Journal of Rehabilitation Medicine. 2015 October:47(9):801-808.

Review question

Is home-based supervised exercise effective in improving walking capacity and quality of life in people with peripheral arterial disease who experience intermittent leg and muscle pain?

Background

People living with peripheral arterial disease have a chance of experiencing intermittent claudication, which is leg and muscle pain that often leads to limited walking capacity and reduced quality of life.

To deal with this pain, patients may choose to exercise in an unsupervised setting (e.g., home) or in a supervised setting, such as at a hospital with a physiotherapist. Increasingly, researchers suggest the best option could be to offer home-based supervised exercise.  

While home-based supervised exercise is practical for patients and has the added benefit of a trained physiotherapist, it is unclear how home-based supervised exercise compares to hospital-based or unsupervised exercise in improving quality of life and walking capacity for patients.

How the review was done

A detailed search of a number of electronic databases for studies published up to October 2014 was conducted. Studies investigating supervised or unsupervised exercise for intermittent claudication that reported outcomes related to quality of life and different measures of walking capacity were included in the review.

A total of 1,292 studies were identified in searches and nine were included in the review after assessments for eligibility.

The authors did not acknowledge any funding sources for this review.

What the researchers found

Patients enrolled in home-based supervised exercise showed marginal improvements in daily walking performance when compared to patients who underwent unsupervised exercise or hospital-based supervised exercise.

There were no differences in health-related quality of life between the patients enrolled in the different exercise programs.

Conclusion

Home-based supervised exercise can be used as an alternative to home-based unsupervised exercise and hospital-based supervised exercise in improving walking capacity for patients with peripheral arterial disease who experience intermittent leg and muscle pain. However, the low quality of the evidence means more research is needed to establish the optimal treatment.