• November 16, 2011
  • National Study Shows Exercise Superior to Stents for Improving Walking Ability in PAD Patients

  • Penn clinical trial results may improve treatment options for millions suffering from peripheral artery disease

Philadelphia – Supervised exercise improves walking ability as good as, if not better than, stents in patients with peripheral artery disease (PAD), according to research released at the 2011 American Heart Association Scientific Sessions. The study is a joint collaboration from researchers at the Perelman School of Medicine at the University of Pennsylvania, the University of Minnesota Medical School, Rhode Island Hospital, and 13 other academic institutions and medical centers.

“This study showed that in patients on standard therapy for PAD, adding a supervised treadmill exercise program improved treadmill walking ability significantly better than stenting,” said Emile Mohler, MD, director, Vascular Medicine at Penn and a co-author of the new study.”

PAD restricts blood flow to the extremities, especially the legs and feet. When blood flow is reduced to the legs, “claudication” may occur, resulting in painful and often impaired walking. Peripheral artery disease is known to affect at least nine million Americans, and at least two million have limited mobility due to claudication symptoms. Patients and physicians have traditionally treated claudication with either supervised exercise, medications, or angioplasty and stent placement. Until now, however, the relative effectiveness of each type of treatment was unclear.

In the new study, “Claudicating: Exercise Vs. Endoluminal Revascularization” (CLEVER), 111 patients were offered treatment in three groups representing distinct strategies to improve walking: a group that received instruction in exercise and use of a claudication medication at home; a group that received supervised exercise three times weekly; and a group that underwent angioplasty and stent placement.

After six months, researchers then measured the length of time patients were able to walk on a graded treadmill, and found that patients in the exercise group increased their peak walking time on the treadmill by an average of 5.8 minutes. Study participants who received stents also increased their peak walking time, but by 3.7 minutes.  Quality of life improved for both the exercise and stent groups.  In contrast, participants who were offered the home exercise program and use of a claudication medication did not improve.

“Patients on either additional therapy improved walking ability better than standard therapy alone. Based on these results, supervised exercise programs and stents, used individually or together, are reasonable options for patients with this debilitating condition,” said Dr. Mohler.

The researchers note that this is an initial report and that the CLEVER study team continues to monitor study outcomes, and will report the long-term, 18 month effects of stenting and supervised exercise on patients with PAD next year.  The CLEVER study is funded by the National Heart Lung and Blood Institutes. The six-month results will be published in the November 2011 issue of Circulation.

For more information, please see the American Heart Association news release - http://newsroom.heart.org/pr/aha/_prv-supervised-exercise-markedly-improves-218968.aspx


Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2013 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2013, Penn Medicine provided $814 million to benefit our community.



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