An exercise programme for patients with intermittent claudication: randomised trial of health outcomes and cost analysis
As peripheral arterial disease (PAD) is a chronic, progressive disease with a significant cardiovascular and cerebrovascular risk burden, it has a considerable impact on functional capacity and quality of life (QoL). Exercise programmes result in significant improvements in walking distances but these correlate poorly with patient-reported functioning and QoL and the long-term outcomes are unknown.
The aim of this study was to assess the long-term (one year) effects of participation in a 12-week supervised exercise programme for patients with intermittent claudication (IC). Primary outcome measures were the effects on disease-specific aspects of quality of life, functional capacity and cardiovascular risk factors. Secondary outcome measures were the effects on generic aspects of quality of life and a cost analysis of the exercise intervention. Patients were recruited from the Vascular Clinics (Beaumont Hospital) and randomly allocated to a Control (n= 16) or an Exercise (n=28) group. Data regarding cardiovascular risk factors, functional capacity (Walking Impairment Questionnaire WIQ), disease-specific QoL (Intermittent Claudication Questionnaire ICQ) and generic QoL (SF-36) were collected at baseline, 12 weeks and one year. Costs of participation in the exercise programme were measured. The final numbers available for analysis at 12 weeks were 31 (Exercise n=17 and Control n=14) and at one year were 30 (Exercise n=17 and Control n=13).
At 12 weeks, there was a trend towards improved QoL in both groups, greater in the Exercise group (p=.066) and a trend towards improvement in functional capacity (WIQ Stair-climbing p=.093) in the Exercise group. At one year, improvements in the Exercise group (although reduced from those recorded immediately following completion of the exercise programme) were maintained from baseline. Scores in the Control group at one year reflected a continuing deterioration in QoL and functional capacity.
There were no significant changes in cardiovascular risk factors. Cost associated with the exercise intervention were calculated. The implications for clinical practice and service delivery within the Irish healthcare system are discussed.