The HBET group did not show improvement in MWD/T compared with the WA group ( SMD 0.30 , 95 % CI -0.45 to 1.05 ; P = 0.43 ; moderate- quality evidence ) .Compared with HBET , SET was more beneficial for PFWD/T but had no effect on quality of life parameters nor on self-reported functional impairment .
Compared with WA , SET was more beneficial for PFWD/T and self-reported functional impairment , as well as for some quality of life parameters ( e.g. , physical functioning , pain , and physical component summary after 12 months ) , and HBET had no effect .
Data show no obvious effects on mortality rates .
Evidence of moderate and high quality shows that SET provides an important benefit for treadmill-measured walking distance ( MWD and PFWD ) compared with HBET and WA , respectively .
Although its clinical relevance has not been definitively demonstrated , this benefit translates to increased MWD of 120 and 210 meters after three months in SET groups .
These increased walking distances are likely to have a positive impact on the lives of patients with IC .
Data provide no clear evidence of a difference between HBET and WA .
Trials show no clear differences in quality of life parameters nor in self-reported functional impairment between SET and HBET .
BACKGROUND Although supervised exercise therapy ( SET ) provides significant symptomatic benefit for patients with intermittent claudication ( IC ) , it remains an underutilized tool .
Widespread implementation of SET is restricted by lack of facilities and funding .
Structured home-based exercise therapy ( HBET ) with an observation component ( e.g. , exercise logbooks , pedometers ) and just walking advice ( WA ) are alternatives to SET .
This is the second up date of a review first published in 2006 .
OBJECTIVES The primary objective was to provide an accurate overview of studies evaluating effects of SET programs , HBET programs , and WA on maximal treadmill walking distance or time ( MWD/T ) for patients with IC .
Secondary objectives were to evaluate effects of SET , HBET , and WA on pain-free treadmill walking distance or time ( PFWD/T ) , quality of life , and self-reported functional impairment .
Vascular adhesion molecule-1 and markers of platelet function before and after a treatment with iloprost or a supervised physical exercise program in patients with peripheral arterial disease.
Platelet function and levels of vascular adhesion molecule-1 ( VCAM-1 ) were investigated in 24 patients with peripheral arterial disease at Fontaine stage II undergoing a 2 weeks treatment with iloprost ( 0.5 - 2 ng/kg/h i.v . infused , 6 h/day ) or a 2 weeks supervised physical training , r and omly assigned . Patients were studied before ( T0 ) and after ( T14 ) treatments and 10 days later ( T24 ) . The adhesion of washed platelets to fibrinogen coated microwells was reduced after treatment both with iloprost ( 1.9+/-0.4 vs 6.8+/-0.7 % ; T24 vs T0 ; M+/-SEM ; p<0.05 ) and physical exercise ( 3.0+/-1.0 vs 6.7+/-0.7 ; p<0.05 ) while adhesion to human plasma coated microwells was reduced only after treatment with iloprost ( 1.9+/-0.8 vs 5.8+/-0.9 ; p<0.05 ) . The expression of fibrinogen receptor ( glycoprotein IIb/IIIa ) on platelets , measured by flow-cytometry was also reduced after iloprost treatment ( 17.1+/-1.5 vs 31.8+/-4.8 AU ; p<0.05 ) and physical exercise ( 14.6+/-1.5 vs 34.0+/-3.3 ; p<0.05 ) . Theurinaryexcretion of platelet thromboxane A2 metabolite 2,3-dinor-thromboxane B2 decreased only in patients treated with iloprost ( 154.7+/-97.9 vs 256.2+/-106.4 pg mg creatinine(-1 ) ; p<0.05 ) . Similarly plasma VCAM-1 was lower in patients who were treated with iloprost ( 827.7+/-77.4 vs 999.0+/-83.8 ng ml(-1 ) ; p<0.05 ) . In conclusion , both iloprost and physical exercise seem to act on reversible phenomena such as the expression of adhesion molecules or ex vivo adhesion , whereas only iloprost reduces thromboxane A2 bio synthesis in vivo . This anti-platelet activity seems to be extended in time and to be associated with an improvement in vascular function
The HBET group did not show improvement in MWD/T compared with the WA group ( SMD 0.30 , 95 % CI -0.45 to 1.05 ; P = 0.43 ; moderate- quality evidence ) .Compared with HBET , SET was more beneficial for PFWD/T but had no effect on quality of life parameters nor on self-reported functional impairment .
Compared with WA , SET was more beneficial for PFWD/T and self-reported functional impairment , as well as for some quality of life parameters ( e.g. , physical functioning , pain , and physical component summary after 12 months ) , and HBET had no effect .
Data show no obvious effects on mortality rates .
Evidence of moderate and high quality shows that SET provides an important benefit for treadmill-measured walking distance ( MWD and PFWD ) compared with HBET and WA , respectively .
Although its clinical relevance has not been definitively demonstrated , this benefit translates to increased MWD of 120 and 210 meters after three months in SET groups .
These increased walking distances are likely to have a positive impact on the lives of patients with IC .
Data provide no clear evidence of a difference between HBET and WA .
Trials show no clear differences in quality of life parameters nor in self-reported functional impairment between SET and HBET .
BACKGROUND Although supervised exercise therapy ( SET ) provides significant symptomatic benefit for patients with intermittent claudication ( IC ) , it remains an underutilized tool .
Widespread implementation of SET is restricted by lack of facilities and funding .
Structured home-based exercise therapy ( HBET ) with an observation component ( e.g. , exercise logbooks , pedometers ) and just walking advice ( WA ) are alternatives to SET .
This is the second up date of a review first published in 2006 .
OBJECTIVES The primary objective was to provide an accurate overview of studies evaluating effects of SET programs , HBET programs , and WA on maximal treadmill walking distance or time ( MWD/T ) for patients with IC .
Secondary objectives were to evaluate effects of SET , HBET , and WA on pain-free treadmill walking distance or time ( PFWD/T ) , quality of life , and self-reported functional impairment .