Safety of home-based exercise for people with intermittent claudication: A systematic review

Alexander Waddell, Sally Seed, David R Broom, Gordon McGregor, Stefan T Birkett, Amy E Harwood

    Research output: Contribution to journalReview articlepeer-review

    10 Citations (Scopus)
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    Abstract

    Intermittent claudication (IC) is a classic symptom of peripheral artery disease, with first line treatment being supervised exercise therapy (SET). Despite this, SET is frequently underutilised, and adherence is often poor. An alternative option are home-based exercise programmes (HBEP). Although HBEPs are well tolerated, to the authors’ knowledge, no research has assessed their safety. The aim of this review was to assess the safety of HBEPs in people living with IC. We performed an electronic search of the MEDLINE, CINAHL, and Cochrane Library databases. The main parameter of interest was complication rate, calculated as the number of related adverse events per patient-hours. Subanalysis was undertaken to determine differences in safety for studies that did and did not include pre-exercise cardiac screening, and for studies with exercise at low, moderate, and high levels of claudication pain. Our search strategy identified 8693 results, of which 27 studies were included for full review. Studies included 1642 participants completing 147,810 patient-hours of home-based exercise. Four related adverse events were reported, three of which were cardiac in origin, giving an all-cause complication rate of one event per 36,953 patient-hours. Three of these events occurred following exercise to high levels of claudication pain, and one occurred with pain-free exercise. One event occured in a study without cardiac screening. Based on the low number of related adverse events, HBEPs appear to be a safe method of exercise prescription for people with IC. Our results strengthen the rationale for providing alternative exercise options for this population. PROSPERO Registration No.: CRD42021254581
    Original languageEnglish
    Pages (from-to)186-192
    Number of pages7
    JournalVascular Medicine
    Volume27
    Issue number2
    Early online date20 Dec 2021
    DOIs
    Publication statusPublished - Apr 2022

    Bibliographical note

    This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

    Keywords

    • claudication
    • complication rate
    • exercise therapy
    • home-based exercise
    • peripheral artery disease (PAD)
    • safety

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

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