Table A

Table B

Figure A

EXACT (exercise versus angioplasty in claudication trial)
 

Extra references

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w2 Silagy C, Mant D, Fowler G, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2000;(3):CD000146.

w3 Holm KJ, Spencer CM. Bupropion: a review of its use in the management of smoking cessation. Drugs 2000;59:1007-24.

w4 Stead LF, Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database Syst Rev 2000;(2):CD001007.

w5 Jonason T, Bergström R. Cessation of smoking in patients with intermittent claudication. Acta Med Scand 1987;221:253-60.

w6 Heart Protection Study Collaborative Group. MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002;360:7-22.

w7 Leng GC, Price JF, Jepson RG. Lipid-lowering for lower limb atherosclerosis. Cochrane Database Syst Rev 2000;(2):CD000123.

w8 Robless P, Mikhailidis DP, Stansby G. Systematic review of antiplatelet therapy for the prevention of myocardial infarction, stroke or vascular death in patients with peripheral vascular disease. Br J Surg 2001;88:787-800.

w9 Caprie Steering Committee. A randomised, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996;348:1329-39.

w10 Balsano F, Coccheri S, Libretti A, Nenci GG, Catalano M, Fortunato G, et al. Ticlodipine in the treatment of intermittent claudication: a 21-month double-blind trial. J Lab Clin Med 1989;114:84-91.

w11 UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837-53.

w12 UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998;352:854-65.

w13 Ramsay LE, Williams B, Johnston GD, MacGregor GA, Poston L, Potter JF, et al. British Hypertension Society guidelines for hypertension management 1999: summary. BMJ 1999;319:630-5.

w14 Whelton PK, He J. Clinical trials in cardiovascular disease. Philadelphia: WB Saunders, 1999:341-59.

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w17 Gardner AW, Poehlman ET. Exercise rehabilitation programs for the treatment of claudication pain: a meta-analysis. JAMA 1995;274:975-80.

w18 Patterson RB, Pinto B, Marcus B, Colucci A, Braun T, Roberts M. Value of a supervised exercise program for the therapy of arterial claudication. J Vasc Surg 1997;25:312-8.

w19 Shephard RJ, Balady GJ. Exercise as cardiovascular therapy. Circulation 1999;99:963-72.

w20 Leng GC, Fowler B, Ernst E. Exercise for intermittent claudication. Cochrane Database Syst Rev 2000;(2):CD000990.

w21 Money SR, Herd JA, Isaacsohn JL, Davidson M, Cutler B, Heckman J, et al. Effect of cilostazol on walking distances in patients with intermittent claudication caused by peripheral vascular disease. J Vasc Surg 1998;27:267-75.

w22 Elam MB, Heckman J, Crouse JR, Hunninghake DB, Herd JA, Davidson M, et al. Effect of the novel antiplatelet agent cilostazol on plasma lipoproteins in patients with intermittent claudication. Arterioscler Thromb Vasc Biol 1998;181:942-7.

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Table A Edinburgh Claudication Questionnaire (posted as supplied by author)

1	Do you get a pain or discomfort in your leg(s) when you walk?		Yes ¨			No ¨
If you answered "Yes" to question (1), please answer the following questions. Otherwise you need not continue
2	Does this pain ever begin when you are standing still or sitting?		Yes ¨			No ¨
3	Do you get it if you walk uphill or hurry?		Yes ¨			No ¨
4	Do you get it if you walk at an ordinary pace on the level?		Yes ¨			No ¨
5	What happens to it if you stand still? usually continues for more than 10 minutes usually disappears in 10 minutes or less				¨ ¨
6	Where do you get this pain or discomfort?  Mark the place(s) with an ‘X’ on the diagrams below	Front		Back
Definition of positive classification requires all of the following responses: "Yes" to (1), "No" to (2), "Yes" to (3), grade 1 "No" to (4), grade 2 "Yes" to (4). If these criteria are fulfilled, a definite claudicant is one who indicates the pain is in the calf, regardless of whether pain is also marked at other sites; a diagnosis of atypical claudication is made if the pain is marked in the thigh or buttock, in the absence of any calf pain. Subjects should not be considered to have claudication if pain is indicated in the hamstrings, feet, shins, joints or appears to radiate in the absence of any pain in the calf

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Table B Components of exercise programme identified as being effective in increasing walking distance^w17,w18

Component	Details
Duration of session	>30 minutes better than <30 minutes
Number of sessions a week	>3/week better than <3/week
Duration of programme	>26 weeks better than <26 weeks
Type of exercise	Walking better than non-walking Walking to near maximal pain better than walking to onset of pain
Supervised or unsupervised	Supervised exercise probably more effective

Figure A

Fig A Coexistence of peripheral arterial disease, coronary artery disease, and cerebrovascular disease in patients in the clopidogrel versus aspirin in patients at risk of ischaemic events trial¹⁵
 
 

EXACT (exercise versus angioplasty in claudication trial)

(Further details are available from www.hta.nhsweb.nhs.uk)

Funding—Health Technology Assessment.

Design—Multicentre randomised controlled trial.

Treatments being compared—Best medical treatment versus best medical treatment and supervised exercise versus best medical treatment and balloon angioplasty.

Number of participants—133 in each arm.

Follow up—Two years.

Outcome measures—Improvement in walking distance, quality of life, cardiovascular morbidity and mortality, and cost effectiveness.

Start and finish dates—Recruitment started September 2002; follow up ends 2005; dissemination of results 2006.