Exercise-based interventions and health-related quality of life in intermittent claudication: a 20-year (1989-2008) review.
Peripheral arterial disease (PAD) is a chronic, progressive disease with significant cardiovascular risk. Symptoms include pain in leg muscles on walking, relieved by rest (intermittent claudication). Treatment aims to maintain or improve quality of life (QoL) by minimising ischaemic symptoms and preventing progression to vascular occlusion. Management strategies include exercise-based interventions. Research from 1989 to 2008 was systematically reviewed to identify the QoL impact of exercise-based interventions in patients with intermittent claudication. Twenty-three studies were identified. Five were randomized controlled trials. Studies were summarized in terms of exercise interventions, QoL measures used and QoL findings. The majority used a generic QoL instrument; most commonly the Short Form Health Survey (SF-36). Eleven studies reported beneficial effects on the SF-36 Physical Functioning scale. Some also reported positive effects on the scales of Bodily Pain, Role-Physical, Vitality, General Health and the Physical Component Score. In seven studies, a disease-specific measure was used. In six of these, both generic and disease-specific questionnaires were used. Disease-specific measures demonstrated greater improvements across a range of QoL domains. Greater use of disease-specific measures and an extended follow-up period may enable a more definitive picture to emerge regarding effects of exercise on QoL in intermittent claudication.