title: Multicenter randomized clinical trial of supervised exercise therapy with or without feedback versus walking advice for intermittent claudication.
abstract: OBJECTIVE
  The initial treatment for intermittent claudication is supervised exercise therapy (SET). Owing to limited capacity and patient transports costs of clinic-based SET, a concept of SET provided by local physiotherapists was developed. We hypothesized that provision of daily feedback with an accelerometer in addition to SET would further increase walking distance.
  
  
  METHODS
  This multicenter randomized trial was set in vascular surgery outpatient clinics and included 304 patients with intermittent claudication. Patients were randomized to exercise therapy in the form of "go home and walk" advice (WA), SET, or SET with feedback. Local physiotherapists provided SET. The primary outcome measure was the change in absolute claudication distance. Secondary outcomes were the change in functional claudication distance and results on the Walking Impairment Questionnaire (WIQ) and Short-Form 36 (SF-36) Health Survey after 12 months.
  
  
  RESULTS
  In 11 centers, 102, 109, and 93 patients were included, respectively, in the WA, SET, and SET with feedback groups, and data for 83, 93, and 76, respectively, could be analyzed. The median (interquartile range) change in walking distance between 12 months and baseline in meters was 110 (0-300) in the WA group, 310 (145-995) in the SET group, and 360 (173-697) in the SET with feedback group (P < .001 WA vs SET). WIQ scores and relevant domains of the SF-36 improved statistically significantly in the SET groups.
  
  
  CONCLUSIONS
  SET is more effective than WA in improving walking distance, WIQ scores, and quality of life for patients with intermittent claudication. Additional feedback with an accelerometer did not result in further improvement. SET programs should be made available for all patients with intermittent claudication.
authors.affiliation: Department of Surgery at Atrium Medical Center Parkstad, Heerlen, The Netherlands.
authors.forename: Saskia P A
authors.initials: SP
authors.lastname: Nicolaï
authors.forename: Joep A W
authors.initials: JA
authors.lastname: Teijink
authors.forename: Martin H
authors.initials: MH
authors.lastname: Prins
mesh_terms: D056044:Actigraphy / Q000295:instrumentation; D000368:Aged; D000554:Ambulatory Care Facilities; D001676:Biofeedback, Psychology; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010349:Patient Compliance; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking