The future of exercise therapy for people with intermittent claudication?

Abstract

National Institute for Health and Care Excellence (NICE) guideline 147 recommends supervised exercise therapy (SET) for all patients with intermittent claudication, consisting of 2 hours of SET per week for a 3-month period.1 This is supported by good evidence from Cochrane reviews2,3 that SET shows improvement in mean walking performance compared with home-based exercise and walking advice, with an increase of 120–210 metres, and also has comparable results to endovascular revascularisation. Despite this evidence and the guidance from NICE, the provision of SET is variable with <50% of UK hospitals providing SET and <25% meeting the NICE dose recommendation.4 With centralisation of services into a hub and spoke model, the spokes are likely to have inferior access to SET. Furthermore, attendance and uptake rates to SET are often less than 25%.5 Barriers associated with provision and uptake include access, time, travel and pain.