The Circulation Foundation and Society of Vascular Nurses Joint Intermittent Claudication Study: An Observational Cohort Study

OBJECTIVE: Despite current guidance, the provision and uptake of supervised exercise therapy (SET) in the UK remains poor for patients with intermittent claudication (IC). The aims of this study were to record barriers to uptake and assess adherence and effectiveness of SET at four geographically different vascular centres in the UK. METHODS: A prospective cohort study was performed, aiming to screen all patients referred to four separate UK vascular centres with IC between 1 January 2018 and 14 March 2020. Uptake and barriers to participation were recorded. In participants undertaking SET the impact on health related quality of life was examined in both generic (EQ 5D 5L, EQ VAS) and disease specific (VascuQoL) domains as well as walking distance at baseline, 3, and 12 months. RESULTS: Screening data on 1 197 participants were returned from three of the four centres. Of these, 957 patients had a diagnosis of PAD (79.9%), of whom 576 were potentially eligible for SET. From these eligible patients, 207 agreed to SET (35.9%). The main barriers to participation were travel, personal reasons, and a preference toward home based therapy. Adherence to SET was poor ((2 003 of 4 560 sessions attended, 43.9%). Walking distance improved from a median of 130 m (interquartile range [IQR] 60, 200) at baseline to 290 m (IQR 130, 555) and 340 m (IQR 110, 485) at 3 and 12 months, respectively (p < .001). There were continued improvements in EQ 5D 5L at 3 and 12 months from baseline (p < .001). CONCLUSION: Many patients with IC in the UK still struggle to access and complete a course of SET despite best practice guidance, with over one third of SET eligible patients agreeing to participate in SET in the current study. Barriers to SET are numerous, with travel distance, personal reasons, and a preference for home based therapy being the most frequent.