title: Supervised exercise therapy: it does work, but how to set up a program?
abstract: Intermittent claudication (IC) is a manifestation of peripheral arterial disease. IC has a high prevalence in the older population, is closely associated with other expressions of atherosclerotic disease and often co-exists in multimorbid patients. Treatment of IC should address reduction of cardiovascular risk and improvement of functional capacity and health-related quality of life (QoL). As recommended by contemporary international guidelines, the first-line treatment includes supervised exercise therapy (SET). In several randomized controlled trials and systematic reviews, SET is compared with usual care, placebo, walking advice and endovascular revascularization. The evidence supporting the efficacy of SET programs to alleviate claudication symptoms is robust. SET improves walking distance and health-related QoL and appears to be the most cost-effective treatment for IC. Nevertheless, only few of all newly diagnosed IC patients worldwide receive this safe, efficient and structured treatment. Worldwide implementation of structured SET programs is seriously impeded by outdated arguments favoring an invasive intervention, absence of a network of specialized physical therapists providing standardized SET and lack of awareness and/or knowledge of the importance of SET by referring physicians. Besides, misguiding financial incentives and lack of reimbursement hamper actual use of SET programs. In the Netherlands, a national integrated care network (ClaudicatioNet) was launched in 2011 to combat treatment shortcomings and stimulate cohesion and collaboration between stakeholders. This care intervention has resulted in optimized quality of care for all patients with IC.
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.|Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.|ClaudicatioNet, Eindhoven, The Netherlands.
authors.forename: David
authors.initials: D
authors.lastname: Hageman
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.|Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.|ClaudicatioNet, Eindhoven, The Netherlands.
authors.forename: Marijn M
authors.initials: MM
authors.lastname: van den Houten
authors.affiliation: ClaudicatioNet, Eindhoven, The Netherlands.
authors.forename: Steffie
authors.initials: S
authors.lastname: Spruijt
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.|ClaudicatioNet, Eindhoven, The Netherlands.
authors.forename: Lindy N
authors.initials: LN
authors.lastname: Gommans
authors.affiliation: Department of Vascular Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Scheltinga
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands - joep.teijink@catharinaziekenhuis.nl.|Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.|ClaudicatioNet, Eindhoven, The Netherlands.
authors.forename: Joep A
authors.initials: JA
authors.lastname: Teijink
mesh_terms: D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated; D005081:Exercise Therapy / Q000191:economics / Q000379:methods* / Q000592:standards; D017079:Exercise Tolerance; D019983:Guideline Adherence; D017048:Health Care Costs; D006801:Humans; D007383:Intermittent Claudication / Q000191:economics / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome