Eur J Vasc Endovasc Surg. 2026 Jun 30:S1078-5884(26)00624-6. doi: 10.1016/j.ejvs.2026.06.044. Online ahead of print.
ABSTRACT
OBJECTIVE: Supervised exercise programmes are first line treatment for patients with intermittent claudication. Their prescription comprises a combination of components, namely frequency, intensity, time, and type of exercise. However, the optimal prescription (i.e., the most effective combination of these components) remains unknown. This leads to a paucity of comprehensive programme guidelines, poor programme provision, uptake, and completion rates and potentially ineffective programmes. The aim of this systematic review with network and component network meta-analyses was to identify evidence for the optimal supervised exercise prescription for patients with intermittent claudication.
DATA SOURCES: CENTRAL, MEDLINE, Embase, CINAHL, trial registries, and Web of Science.
REVIEW METHODS: Randomised controlled trials of patients with intermittent claudication comparing a supervised exercise programme with an appropriate, non-invasive comparator group or another, alternative supervised exercise programme were included. The primary outcome was mean difference in maximum walking distance between the exercise and control groups. A component network meta-analysis was planned to identify the most effective combination of components. However, the assumption required for a valid component network meta-analysis was violated, requiring alternative primary analyses. This involved initially grouping trials by their common components and undertaking standard network meta-analyses for each group to identify the likely effective levels (e.g., once or twice per week). These results were supported by other analyses to identify a likely optimal prescription.
RESULTS: Searches returned 13 714 unique results. Sixty four trials (n = 3 427) were included in the primary analysis. The likely optimal supervised exercise prescription is intermittent walking, performed three times a week, utilising a pain based prescription (ranging from pain free/pain onset to maximal pain) for 30 - 60 minutes per session, for a period of twelve weeks (moderate to high quality evidence).
CONCLUSION: This study identified the likely optimal supervised exercise prescription for patients with intermittent claudication, which should inform future guidelines, clinical practice, and clinical trials.
PMID:42379346 | DOI:10.1016/j.ejvs.2026.06.044