Supervised Exercise + Stent Revascularization = Better Outcomes for PAD Patients
JACC in a Flash | Both supervised exercise and stent revascularization may provide better outcomes in the quality of life and functional status of peripheral artery disease (PAD) patients with claudication than optimal medical care (OMC) alone, according to a new JACC study.
In the second part of the Claudication: Exercise Versus Endoluminal Revascularization (CLEVER) study, Timothy P. Murphy, MD, et al. evaluated the effectiveness of OMC, OMC plus supervised exercise – which included six months of supervised exercise followed by a year of telephone based exercise counseling – and OMC plus stent revascularization, in 79 patients over an 18 month period. Researchers observed objective treadmill-based walking performance – measured by peak walking time and claudication onset time – and subjective quality of life as primary outcomes of the trial. Patients were over 40 years old with moderate-to-severe claudication due to aortoiliac PAD and were associated with 29 centers in the U.S. and Canada.
The results of the study showed that peak walking time improved most for supervised exercise patients, followed by stent revascularization patients. Claudication onset time increased from baseline to 18 months by 3 minutes (±4.5) for stent revascularization patients and by 3.4 minutes (±3.9) for supervised exercise patients, compared to 0.9 minutes (±1.3) for OMC patients. Further, when examining quality of life at 18 months, researchers found that “improvement in disease-specific scales was statistically superior for stent revascularization and supervised exercise compared to OMC…”The authors add that “the durability of the functional status and quality-of-life improvements in response to provision of a supervised exercise strategy of care should be of particular interest, because this study provides the first data to demonstrate the preservation of this benefit for a full year after formal supervised exercise ended.”
“A final observation is that the trial evaluated a therapy currently unavailable in the U.S. The CLEVER trial established that supervised exercise is at least as effective as endovascular intervention. Despite the existing infrastructure for cardiac and pulmonary rehabilitation programs, exercise therapy remains unavailable for patients with PAD and intermittent claudication, even though it is less expensive than intervention,” observed Piotr S. Sobieszczyk, MD, and Joshua A. Beckman, MD, MS, in an accompanying editorial comment. “The demonstration that the results are durable in patients with claudication in the [study] should spur a change in coverage by federal and private insurers to make supervised exercise therapy and follow-up care available to all patients who need them.”
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