RT Journal
A1 Hiatt WR
T1 Intermittent claudication revisited: The value of medical therapy
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 1999
FD September 13
VO 159
IS 16
SP 1954
OP 1954
DO 
UL http://dx.doi.org/
AB 
The data presented in their meta-analysis (and others) for exercise training benefits reveal highly consistent results over the last 3 decades. There is now unequivocal evidence that a supervised exercise training program is effective in improving treadmill exercise performance and quality of life and that this is accomplished without any excess morbidity or mortality. Thus, it is difficult to accept their conclusions that "Prescribing expensive supervised exercise programs to these patients remains controversial."1 Further, the data to support an unsupervised home-based program are, in fact, mostly negative as shown in their data; yet at the conclusion of their article they state that "For now, advising patients to walk and stop smoking is likely to be all that is required."1 It is hard to imagine how this conclusion could be supported in the absence of data and yet the overwhelming data supporting supervised exercise were not given more credibility. However, I would acknowledge that the cost-effectiveness of any therapy for claudication remains unproven. Thus, bypass surgery and angioplasty are also effective means to treat some populations of claudicants. However, future studies are required to compare the cost-effectiveness across all these different interventions.