title: Editor's choice--The effect of supervision on walking distance in patients with intermittent claudication: a meta-analysis.
abstract: BACKGROUND
  A number of reviews have reported the influence of exercise therapy (ET) for the treatment of intermittent claudication (IC). However, a complete overview of different types of ET is lacking. The aim of this meta-analysis was to study the effect of supervision on walking capacity in patients with IC. It was hypothesized that there was a positive treatment effect in relation to the intensity of supervision and improvement in walking capacity (i.e., a "dose-response" hypothesis).
  
  
  METHODS
  A systematic search in the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases was performed. Only randomized controlled trials (RCTs) evaluating the efficacy of an ET in IC were included. Type of supervision, treadmill protocol, length of ET, total training volume, and change in walking distance were extracted. RCTs were categorised according to type of support: no exercise, walking advice, home-based exercise (HB-ET), and supervised exercise therapy (SET). A standardised mean difference between pre- and post-training maximal walking distance (MWD) and pain-free walking distance (PFWD) was calculated for all subgroups at 6 weeks, and 3 and 6 months of follow up.
  
  
  RESULTS
  Thirty studies involving 1406 patients with IC were included. The overall quality was moderate-to-good, although number of included patients varied widely (20-304). The intensity of supervision was directly related to MWD and PFWD. SET was superior to other conservative treatment regimens with respect to improvement in walking distances at all follow-ups. However, the difference between HB-ET and SET at 6 months of follow up was not significant.
  
  
  CONCLUSIONS
  Supervised exercise therapy for intermittent claudication is superior to all other forms of exercise therapy. Intensity of supervision is related to improved walking distance.
authors.affiliation: Catharina Hospital, Department of Vascular Surgery, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands.
authors.forename: L N M
authors.initials: LN
authors.lastname: Gommans
authors.affiliation: Catharina Hospital, Department of Vascular Surgery, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Saarloos
authors.affiliation: Maxima Medical Centre, Department of Vascular Surgery, P.O. Box 7777, 5500 MB Veldhoven, The Netherlands; CARIM Research School, Maastricht University, P.O. Box 606, 6200 MD Maastricht, The Netherlands.
authors.forename: M R M
authors.initials: MR
authors.lastname: Scheltinga
authors.affiliation: Catharina Hospital, Department of Education and Research, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Houterman
authors.affiliation: CAPHRI Research School, Department of Epidemiology, Maastricht University, P.O. Box 606, 6200 MD Maastricht, The Netherlands.
authors.forename: R A
authors.initials: RA
authors.lastname: de Bie
authors.affiliation: Catharina Hospital, Department of Vascular Surgery, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; CAPHRI Research School, Department of Epidemiology, Maastricht University, P.O. Box 606, 6200 MD Maastricht, The Netherlands.
authors.forename: H J P
authors.initials: HJ
authors.lastname: Fokkenrood
authors.affiliation: Catharina Hospital, Department of Vascular Surgery, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands; CAPHRI Research School, Department of Epidemiology, Maastricht University, P.O. Box 606, 6200 MD Maastricht, The Netherlands. Electronic address: joep.teijink@catharinaziekenhuis.nl.
authors.forename: J A W
authors.initials: JA
authors.lastname: Teijink
mesh_terms: D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D006699:Home Care Services; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
keywords: Home-based exercise therapy; Intermittent claudication; Peripheral arterial occlusive disease; Supervised exercise therapy