Quotes

• “At a time where health care costs are appropriately in sharp public focus, this study provides an avenue by which we could – if we choose – achieve a major positive set of health outcomes at low risk and at a lower cost,” says Alan T. Hirsch, M.D., chair of the study from the Lillehei Heart Institute at the University of Minnesota Medical School.
• “This is merely the first report of the results that were achieved within the shortest measurement time, six months,” said Hirsch. “The CLEVER study team continues to monitor study outcomes and we look forward to reporting the long-term, 18 month effects of stenting and supervised exercise on patients with PAD next year.”

Full Text

Supervised exercise may yield better improvements in walking outcomes than placing stents in patients with peripheral artery disease (PAD), according to research released today at the American Heart Association’s annual scientific conference. The study is a joint collaboration of researchers from the University of Minnesota Medical School, School of Nursing, School of Kinesiology, Rhode Island Hospital, and 13 other academic institutions and medical centers.

Peripheral artery disease 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 muscles, limiting one’s ability to walk. Peripheral artery disease is known to affect at least nine million Americans and at least two million have limited mobility due to claudication symptoms.

As a result, researchers suggest that patients, health care providers and health systems consider supervised exercise as a viable and potentially more cost-effective choice for treating PAD. Additionally, researchers look to health insurance companies to strongly consider providing coverage for patients needing supervised exercise.

“At a time where health care costs are appropriately in sharp public focus, this study provides an avenue by which we could – if we choose – achieve a major positive set of health outcomes at low risk and at a lower cost,” says Alan T. Hirsch, M.D., chair of the study from the Lillehei Heart Institute at the University of Minnesota Medical School.

In the “Claudication: Exercise Vs. Endoluminal Revascularization” (CLEVER) study, 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 (a stent is a metal tube placed in a blood vessel to improve artery blood flow). 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 pain-free walking time by an average of 5.8 minutes. Study participants who received stents also increased their pain-free 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.

“This is merely the first report of the results that were achieved within the shortest measurement time, six months,” said Hirsch. “The CLEVER study team continues to monitor study outcomes and we look forward to reporting the long-term, 18 month effects of stenting and supervised exercise on patients with PAD next year.”

The 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. Other University of Minnesota researchers on the project include Diane Treat-Jacobson, R.N., Ph.D. (School of Nursing), Michael W. Steffes, M.D. (Medical School), and Beth Lewis, Ph.D. (School of Kinesiology).