A Review of the Potential Local Mechanisms by Which Exercise Improves Functional Outcomes in Intermittent Claudication

Amy Elizabeth Harwood, Thomas Cayton, Romesh Sarvanandan, Risha Lane, Ian Chetter

Research output: Contribution to journalReview articlepeer-review

23 Citations (Scopus)
58 Downloads (Pure)


Background Intermittent claudication (IC) is a common condition which is associated with significant quality of life limitation. National Institute for Health and Care Excellence guidelines recommend a group-based supervised exercise program as the primary treatment option for claudication, based on clinical and cost effectiveness. This review aims to assess the mechanisms by which exercise improves outcomes in patients with IC. Methods MEDLINE, EMBASE, and PubMed were searched using the search strategy "claudication" [AND] "exercise" [AND] "mechanisms." Searches were limited from 1947 to October 2014. Only full-text articles published in the English language in adults (over 18 years of age) were eligible for the review. Any trial involving a nonsupervised exercise program was excluded. Abstracts identified by the database search were interrogated for relevance and citations from the shortlisted papers were hand searched for relevant references. Results The search yielded a total of 112 studies, of which 42 were duplicates. Forty-seven of the remaining 70 were deemed appropriate for inclusion in the review. Exercise is the first-line treatment for IC. Supervised exercise programs improve walking distances, endothelial and mitochondrial function, muscle strength, and endurance. Furthermore, it leads to a generalized improvement in cardiovascular fitness and overall quality of life. Conclusions The mechanism by which exercise improves outcome in claudicants is complicated and multifactorial. Further research is required in this area to fully elucidate the precise and predominant mechanisms and to assess whether targeted exercise program modification maximizes mechanism efficacy and patient outcome.

Original languageEnglish
Pages (from-to)312-320
Number of pages9
JournalAnnals of Vascular Surgery
Early online date8 Sept 2015
Publication statusPublished - 1 Jan 2016
Externally publishedYes

Bibliographical note

NOTICE: this is the author’s version of a work that was accepted for publication in Annals of Vascular Surgery. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Annals of Vascular Surgery, 30, (2016) DOI: 10.1016/j.avsg.2015.05.043

© 2016, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine


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