Supervised exercise for intermittent claudication - an under-utilised tool

Abstract

Introduction: The use of supervised exercise in the management of intermittent claudication is well supported by level I evidence upon which are based grade A recommendations by the TASC II Inter-Society Consensus for the Management of Peripheral Arterial Disease and the Scottish Intercollegiate Guidelines Network (SIGN). These include that supervised exercise should be made available as part of the initial treatment for all peripheral arteriopaths.

Subjects and methods: A questionnaire, comprising 10 questions, was drawn up to address the issues pertinent to supervised exercise in intermittent claudication. This was distributed by post, along with a pre-stamped return envelope, to all ordinary members of the Vascular Society of Great Britain and Ireland (VSGBI). All returned and received questionnaires had their responses entered onto a pre-prepared spreadsheet.

Results: Of the 186 questionnaires posted to UK resident surgeons, 84 were returned. This equates to a response rate of 45%. Of the responders, only 24% had access to supervised exercise. There was a large spread in the proportion of eligible patients which were referred to a programme, with only 14% of VSGBI members recommending 100% of eligible patients. Rates of non-compliance varied greatly. Contra-indications to supervised exercise included cardiac (27%), and vascular, musculoskeletal, geographic, and respiratory (8% each). Most supervised exercise sessions (85%) were 1 h in duration. The majority (65%) of programmes comprised one session per week. With regards the duration of programme, 55% were 3 months. Almost all classes were led by either a physiotherapist (41%) or a nurse (48%). In centres where no supervised exercise programme was available, verbal advice was given by 63%, with 34% offering leaflets. A supervised exercise set up has not been achieved due to lack of resource in 72%.

Conclusions: These results are contrary to the recommendations offered by the TASC II Inter-Society Consensus and SIGN, in particular in terms of availability and referral to supervised exercise, as well as frequency of the classes where programmes were in place. The offer of information either verbally or via leaflet is commended; however, this has been shown as inferior to supervised exercise. Quoting resource as the reason for non-implementation goes against the published quality-of-life and pharmaco-economic data, which promote supervised exercise as both functionally and financially effective. This work highlights the importance of translating the results of research into evidence-based clinical practice.