A combination therapy of endovascular revascularization followed by supervised exercise resulted in significantly greater improvement in walking distances and health-related quality-of-life scores compared with supervised exercise only for 212 patients with peripheral artery disease and intermittent claudication who were randomized 1:1 to the interventions. Researchers determined:

• Combination therapy was associated with significantly greater improvement in maximum walking distance (from 264 m to 1501 m for an improvement of 1237 m) compared with the supervised exercise only group (from 285 m to 1240 m for improvement of 955 m).

• The combination therapy group demonstrated significantly greater improvement in the disease-specific VascuQol score compared to the exercise group (1.34 vs 0.73) and in the score for the Short-Form Health Survey (SF-36) physical functioning (22.4 vs 12.6), respectively.

• No significant differences were found in the SF-36 domains of physical role functioning, bodily pain, and general health perceptions.

Citation: Fakhry F, Spronk S, van der Laan L, et al. Endovascular revascularization and supervised exercise for peripheral artery disease and intermittent claudication. JAMA. 2015;314(18):1936-1944. doi: 10.1001/jama.2015.14851.

Commentary: While it is important to note that surgery plus exercise yielded greater improvement than exercise alone, it is equally important to note the impressive improvement in the exercise alone group. Improving from 285 meters walking to 1240 in the exercise alone group, a greater than fourfold increase in walking distance, is no small task. In fact, the bulk of the improvement in walking distance occurred with exercise, so it is important to emphasize that if patients opt for surgery, then exercise should still be important as a part of treatment for peripheral vascular disease if optimal outcomes are to be achieved. —Neil Skolnik, MD