Abstract 9292: Effect of High-Pain versus Low-Pain Structured Exercise on Walking Ability in People with Intermittent Claudication: A Systematic Review and Network Meta-Analysis

Abstract

Introduction: Guidance for exercise and pain in intermittent claudication recommends structured exercise programs at moderate-maximum pain, which may overlook the benefit of structured low-pain exercise on walking ability. We undertook a network meta-analysis to determine the comparative benefits of structured high-pain exercise and low-pain exercise, and usual-care control, to identify which has the largest effect on walking ability in people with intermittent claudication. Methods and Results: We searched nine electronic databases; additional trials (RCTs) were identified by hand-searching bibliographies from included studies, relevant reviews and meta-analyses. RCTs were included if: they involved adults with intermittent claudication; included at least two of following arms structured low-pain exercise, structured-high pain exercise or a usual-care control; they had a maximal or pain free treadmill walking outcome. This search resulted in the inclusion of 14 studies (n = 657), reporting the comparison of 9 high-pain arms, 4 low-pain arms, and 13 usual-care arms for maximal walking ability (MWA); and 7 high-pain arms, 4 low-pain arms and 11 usual-care arms for pain free walking ability (PFWA). Results were pooled using SMD. Structured low-pain exercise had a large positive effect on MWA (SMD: 2.23; 95% CI: 1.11 to 3.35) and a large positive effect on PFWA (2.26;1.26 to 3.26) when compared to usual-care control; structured high-pain exercise had a large positive effect on MWA (SMD: 0.95; 95% CI: 0.20 to 1.70) and a moderate positive effect on PFWA (0.77; 0.01 to 1.53) when compared to usual-care control; and structured low-pain exercise, compared to structured high-pain exercise showed a large positive effect in favour of low-pain exercise on MWA (SMD: 1.28, 95% CI: -0.07 to 2.62) and PFWA (1.50; 0.24 to2.75). Conclusions: Our findings support the provision of structured high- and low-pain exercise to improve walking ability in people with intermittent claudication over usual-care alone, with low-pain exercise appearing to have a larger effect. Large head-to-head RCTs are required to confirm the efficacy and safety of different structured exercise programmes prescribed using pain on walking ability in people with intermittent claudication.