title: Supervised exercise therapy for intermittent claudication in a community-based setting is as effective as clinic-based.
abstract: OBJECTIVE
  This cohort study was conducted to determine the effect on walking distances of supervised exercise therapy provided in a community-based setting.
  
  
  METHODS
  The study included all consecutive patients presenting at the vascular outpatient clinic with intermittent claudication, diagnosed by a resting ankle brachial index<0.9, who had no previous peripheral vascular intervention for peripheral arterial disease, no major amputation, and sufficient command of the Dutch language. The exclusion criterion was the inability to walk the baseline treadmill test for a minimum of 10 m. The intervention was a supervised exercise therapy in a community-based setting. A progressive treadmill test at baseline and at 1, 3, and 6 months of follow-up measured initial claudication distance and absolute claudication distance. Changes were calculated using the mean percentages of change.
  
  
  RESULTS
  From January through October 2005, 93 consecutive patients with claudication were eligible. Overall, 37 patients discontinued the supervised exercise therapy program. Eleven stopped because of intercurrent diseases, whereas for 10, supervised exercise therapy did not lead to adequate improvement and they underwent a vascular intervention. Three patients quit the program, stating that they were satisfied with the regained walking distance and did not require further supervised exercise therapy. Ten patients were not motivated sufficiently to continue the program, and in three patients, a lack of adequate insurance coverage was the reason for dropping out. Data for 56 patients were used and showed a mean percentage increase in initial claudication distance of 187% after 3 months and 240% after 6 months. The mean percentage of the absolute claudication distance increased 142% after 3 months and 191% after 6 months.
  
  
  CONCLUSIONS
  Supervised exercise therapy in a community-based setting is a promising approach to providing conservative treatment for patients with intermittent claudication.
authors.affiliation: Department of Surgery, Atrium Medical Centre, Heerlen, The Netherlands.
authors.forename: Bianca L
authors.initials: BL
authors.lastname: Bendermacher
authors.forename: Edith M
authors.initials: EM
authors.lastname: Willigendael
authors.forename: Saskia P
authors.initials: SP
authors.lastname: Nicolaï
authors.forename: Lotte M
authors.initials: LM
authors.lastname: Kruidenier
authors.forename: Rob J
authors.initials: RJ
authors.lastname: Welten
authors.forename: Erik
authors.initials: E
authors.lastname: Hendriks
authors.forename: Martin H
authors.initials: MH
authors.lastname: Prins
authors.forename: Joep A W
authors.initials: JA
authors.lastname: Teijink
authors.forename: Robert A
authors.initials: RA
authors.lastname: de Bie
mesh_terms: D000554:Ambulatory Care Facilities; D000842:Ankle / Q000098:blood supply; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology; D015331:Cohort Studies; D003153:Community Health Services; D005081:Exercise Therapy; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D009426:Netherlands; D010349:Patient Compliance; D010352:Patient Dropouts; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking