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
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