Combined Lower Limb Revascularisation and Supervised Exercise Training for Patients With

Sports Medicine

Combined Lower Limb Revascularisation and Supervised Exercise Training for Patients with Peripheral Arterial Disease: ASystematic Review of Randomised ControlledTrials

Annelise L. Menêses, Raphael M. Ritti-Dias, Belinda Parmenter, Jonathan Golledge, Christopher D. Askew

Corresponding Author:Associate Professor Christopher D. Askew. School of Health and Sport Sciences, University of the Sunshine Coast, Australia. E-mail:

Electronic Supplementary Material

Electronic Supplementary Material Table S1. Search strategy for CENTRAL in The Cochrane Library

#1 / MeSH descriptor: [Peripheral Arterial Disease] explode all trees
#2 / MeSH descriptor: [Intermittent Claudication] explode all trees
#3 / peripheral near/3 disease*:ti,ab,kw
#4 / "claudication":ti,ab,kw
#5 / #1 OR #2 OR #3 OR #4
#6 / MeSH descriptor: [Vascular Surgical Procedures] explode all trees
#7 / MeSH descriptor: [Stents] explode all trees
#8 / "stent":ti,ab,kw
#9 / "endarterectomy":ti,ab,kw
#10 / "angioplasty":ti,ab,kw
#11 / catheter*:ti,ab,kw
#12 / "grafting":ti,ab,kw
#13 / "bypass":ti,ab,kw
#14 / surg*:ti,ab,kw
#15 / vasculari*:ti,ab,kw
#16 / "endovascular":ti,ab,kw
#17 / revasculari*:ti,ab,kw
#18 / "balloon":ti,ab,kw
#19 / "endoluminal":ti,ab,kw
#20 / (#6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19)
#21 / MeSH descriptor: [Exercise] explode all trees
#22 / MeSH descriptor: [Exercise Therapy] explode all trees
#23 / exercis*:ti,ab,kw (Word variations have been searched)
#24 / "isometric":ti,ab,kw (Word variations have been searched)
#25 / "aerobic":ti,ab,kw (Word variations have been searched)
#26 / train*:ti,ab,kw (Word variations have been searched)
#27 / "treadmill":ti,ab,kw (Word variations have been searched)
#28 / "resistance":ti,ab,kw (Word variations have been searched)
#29 / weight next lift*:ti,ab,kw (Word variations have been searched)
#30 / "jogging":ti,ab,kw (Word variations have been searched)
#31 / walk*:ti,ab,kw (Word variations have been searched)
#32 / "cycling":ti,ab,kw (Word variations have been searched)
#33 / "running":ti,ab,kw (Word variations have been searched)
#34 / "endurance":ti,ab,kw (Word variations have been searched)
#35 / ergomet*:ti,ab,kw (Word variations have been searched)
#36 / muscular next exercise*:ti,ab,kw (Word variations have been searched)
#37 / "physical training":ti,ab,kw (Word variations have been searched)
#38 / physical next activit*:ti,ab,kw (Word variations have been searched)
#39 / physical next therap*:ti,ab,kw (Word variations have been searched)
#40 / (#21 OR #22 OR #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33 OR #34 OR #35 OR #36 OR #37 OR #38 OR #39)
#41 / (#5 AND #20 AND #40)
Filters / Trials

Electronic Supplementary Material Table S2. Search strategy for PubMed

#1 / peripheral arterial disease[MH]
#2 / intermittent claudication[MH]
#3 / peripheral arterial disease*[TIAB]
#4 / peripheral artery disease*[TIAB]
#5 / peripheral vascular disease*[TIAB]
#6 / claudication[TIAB]
#7 / #1 OR #2 OR #3 OR #4 OR #5 OR #6
#8 / vascular surgical procedures[MH]
#9 / stents[MH]
#10 / stent*[TIAB]
#11 / endarterectomy[TIAB]
#12 / angioplast*[TIAB]
#13 / catheter*[TIAB]
#14 / grafting[TIAB]
#15 / bypass[TIAB]
#16 / surg*[TIAB]
#17 / vasculari*[TIAB]
#18 / endovascular[TIAB]
#19 / revasculari*[TIAB]
#20 / balloon[TIAB]
#21 / endoluminal[TIAB]
#22 / #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21
#23 / exercise[MH]
#24 / exercise therapy[MH]
#25 / exercis*[TIAB]
#26 / isometric[TIAB]
#27 / aerobic[TIAB]
#28 / train*[TIAB]
#29 / treadmill[TIAB]
#30 / resist*[TIAB]
#31 / weight lifting[TIAB]
#32 / jogging[TIAB]
#33 / walking[TIAB]
#34 / cycling[TIAB]
#35 / running[TIAB]
#36 / endurance[TIAB]
#37 / ergomet*[TIAB]
#38 / muscular exercise*[TIAB]
#39 / physical training[TIAB]
#40 / physical activit*[TIAB]
#41 / physical therap*[TIAB]
#42 / #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33 OR #34 OR #35 OR #36 OR #37 OR #38 OR #39 OR #40 OR #41 OR #42
#43 / #7 AND #22 AND #42
Limits / NOT case reports[PT]
NOT clinical conference[PT]
NOT comment[PT]
NOT guideline[PT]
NOT letter[PT]
NOT meta-analysis[PT]
NOT review[PT]

Electronic Supplementary Material Table S3. Search strategy for EMBASE

#1 / ''peripheral occlusive artery disease'/exp
#2 / ''intermittent claudication'/exp
#3 / (peripheral next/3 disease*):ab,ti
#4 / claudication:ab,ti
#5 / #1 OR #2 OR #3 OR #4 OR #5
#6 / 'vascular surgery'/exp
#7 / 'leg revascularization'/exp
#8 / ''vascular stent'/exp
#9 / 'nonsurgical invasive therapy'/exp
#10 / stent*:ab,ti
#11 / endarterectomy:ab,ti
#12 / angioplast*:ab,ti
#13 / catheter*:ab,ti
#14 / grafting:ab,ti
#15 / bypass:ab,ti
#16 / surg*:ab,ti
#17 / vascular*:ab,ti
#18 / endovascular:ab,ti
#19 / revasculari*:ab,ti
#20 / balloon:ab,ti
#21 / endoluminal:ab,ti
#22 / #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21
#23 / 'exercise'/exp
#24 / 'training'/exp
#25 / 'physical activity'/exp
#26 / 'endurance'/exp
#27 / exercis*:ab,ti
#28 / isometric:ab,ti
#29 / aerobic:ab,ti
#30 / train*:ab,ti
#31 / treadmill:ab,ti
#32 / resist*:ab,ti
#33 / "weight lifting":ab,ti
#34 / jogging:ab,ti
#35 / walking:ab,ti
#36 / cycling:ab,ti
#37 / running:ab,ti
#38 / endurance:ab,ti
#39 / ergomet*:ab,ti
#40 / "muscular exercise":ab,ti
#41 / "physical training":ab,ti
#42 / (physical next/1 activit*):ab,ti
#43 / (physical next/1 therap*):ab,ti
#44 / #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33 OR #34 OR #35 OR #36 OR #37 OR #38 OR #38 OR #40 OR #41 OR #42 OR #43
#45 / #5 AND #22 AND #44
Filters / Publication types: Article, article in press
Study types: Clinical article, clinical trial, comparative study, controlled clinical trial, controlled study, double blind procedure, human, intermethod comparison, major clinical study, multicenter study, clinical article, prospective study, randomized controlled trial
Diseases: Claudication, intermittent claudication, limb ischemia, peripheral occlusive artery disease, peripheral vascular disease

Electronic Supplementary Material Table S4. Search strategy for CINAHL

#1 / peripheral W3 (disease OR diseases)
#2 / claudication
#3 / #1 OR #2
#4 / stent*
#5 / endarterectomy
#6 / angioplast*
#7 / catheter*
#8 / grafting
#9 / bypass
#10 / surg*
#11 / vascular*
#12 / endovascular
#13 / revasculari*
#14 / balloon
#15 / endoluminal
#16 / #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15
#17 / exercis*
#18 / isometric
#19 / aerobic
#20 / train*
#21 / treadmill
#22 / resist*
#23 / "weight lifting"
#24 / jogging
#25 / walking
#26 / cycling
#27 / running
#28 / endurance
#29 / ergomet*
#30 / muscular exercise*
#31 / "physical training"
#32 / physical activit*
#33 / physical therap*
#34 / #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33
#35 / #3 AND #16 AND #34
Filters / Source type: Academic journals
Peer reviewed

Electronic Supplementary Material Table S5. Search strategy for SPORTDiscus

Electronic Supplementary Material Table S6. Search strategy for Scopus

#1 / peripheral PRE/2 disease*
#2 / claudication
#3 / #1 OR #2
#4 / stent*
#5 / endarterectomy
#6 / angioplast*
#7 / catheter*
#8 / grafting
#9 / bypass
#10 / surg*
#11 / vascular*
#12 / endovascular
#13 / revasculari*
#14 / balloon
#15 / endoluminal
#16 / #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15
#17 / exercis*
#18 / isometric
#19 / aerobic
#20 / train*
#21 / treadmill
#22 / resist*
#23 / "weight lifting"
#24 / jogging
#25 / walking
#26 / cycling
#27 / running
#28 / endurance
#29 / ergomet*
#30 / muscular exercise*
#31 / "physical training"
#32 / physical activit*
#33 / physical therap*
#34 / #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33
#35 / #3 AND #16 AND #34
Filters / AND NOT: TITLE(review)
AND NOT: TITLE("case report*)
Document type: Articles
Document type: Articles in press
Subject area: Medicine
Subject area: Nursing
Subject area: Health professions
Source type: Journals
Keywords: Human
Keywords: Humans

Electronic Supplementary Material Table S7. Search strategy for Web of Science

#1 / TS=(peripheral NEAR/2 disease*)
#2 / TS=(claudication)
#3 / TI=(peripheral NEAR/2 disease*)
#4 / TI=(claudication)
#5 / #1 OR #2 OR #3 OR #4
#6 / TS=(angioplast*)
#7 / TS=(surg*)
#8 / TS=(revasculari*)
#9 / TI=(stent*)
#10 / TI=(endarterectomy)
#11 / TI=(angioplast*)
#12 / TI=(catheter*)
#13 / TI=(grafting)
#14 / TI=(bypass)
#15 / TI=(surg*)
#16 / TI=(vascular*)
#17 / TI=(endovascular)
#18 / TI=(revasculari*)
#19 / TI=(balloon)
#20 / TI=(endoluminal)
#21 / #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20
#22 / TS=(exercis*)
#23 / TS=(physical NEAR/1 activit*)
#24 / TS=(physical NEAR/1 therap*)
#25 / TI=(exercis*)
#26 / TI=(isometric)
#27 / TI=(aerobic)
#28 / TI=(train*)
#29 / TI=(treadmill)
#30 / TI=(resist*)
#31 / TI=("weight lifting")
#32 / TI=(jogging)
#33 / TI=(walking)
#34 / TI=(cycling)
#35 / TI=(running)
#36 / TI=(endurance)
#37 / TI=(ergomet*)
#38 / TI=("muscular exercise")
#39 / TI=("physical training")
#40 / TI=(physical NEAR/1 activit*)
#41 / TI=(physical NEAR/1 therap*)
#42 / #22 OR #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33 OR #34 OR #35 OR #36 OR #37 OR #38 OR #39 OR #40 OR #41
#43 / #5 AND #21 AND #42
Filters / Document types: Article
Indexes=SCI-EXPANDED, SSCI

SCI-EXPANDED – Science Citation Index Expanded (1900 to present); SSCI – Social Sciences Citation Index (1900 to present)

Electronic Supplementary Material Table S8Characteristics of excluded studies

Study / Reasons for exclusion
Franco et al. 1980 [1] / Non-randomised trial.Results are presented for all groups together, not separately
Lundgren et al. 1989[2] / Duplicate data (early results) from Lundgren et al. 1989 [3]
Mazari et al. 2010 [4] / Duplicate data (early results) from Mazari et al.2012 [5]
Nordanstig et al. 2011 [6] / This trial compares revascularisation with non-invasive treatment (standard medical care, and standard advice regarding smoking cessation, exercise)
Fakhry et al. 2013 [7] / Patients were randomised to undergo revascularisation alone or SET alone
Jakubseviciene et al. 2014 [8] / Both groups of comparison underwent the same combined therapy and one group underwent an additional period of unsupervised training (R+SET versus R+SET+nonSET). A control group is required to make the trial eligible for inclusion in the review
Bo et al. 2014 [9] / Duplicate data (early results) from Bo et al.2013[10]
Matsuo et al. 2015 [11] / Non-randomised trial. Patients were allocated to SET alone or post-operative SET based on the post-operative change in physical activity levels

SET supervised exercise therapy, R+SET Revascularisation plus supervised exercise therapy, non-SET unsupervised exercise therapy

Electronic Supplementary Material Table S9 Pain free walking distance (m): revascularisation alone/exercise training alone (control) versus combined therapy of revascularisation plus exercise training

Study / Time point (weeks) / Revascularisation or
exercise training
pre / Revascularisation or
exercise training
post / Combined
pre / Combined
post / Between group
MD [95% CI] / Between group
ES [95% CI] / ES p-value / Reported between group p-value
Revascularisation versus combined therapy of revascularisation plus exercise training
Constant load treadmill walking test
Lundgren et al. 1989 [3] / 12 / 85 ± 30 / Δ 320 ± 357 / 70 ± 35 / Δ 489 ± 380 / 169 [-58 to 396] / 0.45 [-0.16 to 1.05] / 0.14 / NR
Mazari et al. 2012 [5] / 12 / 31 ± 32 / 76 ± 66 / 44 ± 23 / 126 ± 245 / 38 [26 to 49] / 1.31 [0.88 to 1.75] / <0.01 / NR
Graded treadmill walking test
Kruidenier et al. 2011 [12] / 24 / 282 ± 293 / 547 ± 264 / 186 ± 116 / 842 ± 478 / 391 [276 to 506] / 1.73 [1.14 to 2.33] / <0.01 / <0.01
Bo et al. 2013 [10] / 12 / 137 ± 128 / 251 ± 405 / 164 ± 120 / 480 ± 563 / 203 [128 to 279] / 1.62 [0.94 to 2.30] / <0.01 / NR
Exercise training versus combined therapy of revascularisation plus exercise training
Constant load treadmill walking test
Lundgren et al. 1989 [3] / 12 / 67 ± 35 / Δ 120 ± 215 / 70 ± 35 / Δ 489 ± 380 / 369 [178 to 560] / 1.17 [0.52 to 1.81] / <0.01 / NR
Greenhalgh et al. 2008[13]a / 24 / 63 ± 30 / 23% Pt PFW≥200m / 71 ± 41 / 32% Pt PFW≥200m / UTC / UTC / UTC / 0.05
Greenhalgh et al. 2008[13]b / 24 / 64 ± 20 / 0% Pt PFW≥200m / 49 ± 38 / 60% Pt PFW≥200m / UTC / UTC / UTC / 0.01
Mazari et al. 2012 [5] / 12 / 43 ± 36 / 74 ± 69 / 44 ± 23 / 126 ± 245 / 51 [39 to 64] / 1.65 [1.18 to 2.12] / <0.01 / NR
Graded treadmill walking test
Fakhry et al. 2015 [14] / 48 / 135 ± 88 / Δ 712 ± 640 / 117 ± 83 / Δ 1120 ± 675 / 408 [230 to 586] / 0.61 [0.33 to 0.89] / <0.01 / <0.01

Electronic Supplementary Material Table S10Maximal walking distance (m): revascularisation alone/exercise training alone (control) versus combined therapy of revascularisation plus exercise training

Study / Time point (weeks) / Revascularisation or
exercise training
pre / Revascularisation or
exercise training
post / Combined
pre / Combined
post / Between group
MD [95% CI] / Between group
ES [95% CI] / ES p-value / Reported between group p-value
Revascularisation versus combined therapy of revascularisation plus exercise training
Constant load treadmill walking test
Lundgren et al. 1989 [3] / 12 / 209 ± 100 / Δ 361 ± 335 / 180 ± 100 / Δ 474 ± 380 / 113 [-108 to 334] / 0.31 [-0.29 to 0.91] / 0.31 / NR
Badger et al. 2007 [15] / 6 / Not assessed / Δ 4% ± 3% / Not assessed / Δ 175% ± 118% / UTC / UTC / UTC / <0.01
Mazari et al. 2012 [5] / 12 / 78 ± 69 / 110 ± 238 / 85 ± 80 / 215 ± 142 / 97 [67 to 127] / 1.29 [0.86 to 1.73] / <0.01 / NR
Graded treadmill walking test
Kruidenier et al. 2011 [12] / 24 / 343 ± 248 / 685 ± 314 / 293 ± 190 / 956 ± 490 / 321 [207 to 435] / 1.44 [0.87 to 2.00] / <0.01 / <0.01
Bo et al. 2013 [10] / 12 / 285 ± 204 / 446 ± 252 / 399 ± 270 / 658 ± 392 / 98 [-46 to 242] / 0.40 [-0.18 to 0.98] / 0.18 / NR
Exercise training versus combined therapy of revascularisation plus exercise training
Constant load treadmill walking test
Lundgren et al. 1989 [3] / 12 / 183 ± 110 / Δ 276 ± 302 / 180 ± 100 / Δ 474 ± 380 / 198 [-14 to 410] / 0.56 [-0.05 to 1.17] / 0.07 / NR
Greenhalgh et al. 2008 [13]a / 24 / 126 ± 62 / NR / 133 ± 77 / NR / UTC / 1.06 [0.80 to 1.41] / ≤0.05 / 0.69
Greenhalgh et al. 2008 [13]b / 24 / 126 ± 53 / NR / 114 ± 87 / NR / UTC / 1.75 [1.02 to 3.02] / 0.04 / 0.04
Mazari et al. 2012 [5] / 12 / 83 ± 61 / 131 ± 105 / 85 ± 80 / 215 ± 142 / 82 [52 to 111] / 1.13 [0.69 to 1.57] / <0.01 / NR
Graded treadmill walking test
Fakhry et al. 2015 [14] / 48 / 285 ± 165 / Δ 955 ± 663 / 264 ± 145 / Δ 1237 ± 703 / 282 [97 to 467] / 0.41 [0.13 to 0.68] / <0.01 / <0.01

Values are mean ± standard deviation unless otherwise stated. a,bGreenhalgh et al. 2008 [13] was divided into two trials as patients were stratified according to the anatomical site of revascularisation (femoropopliteal or aortoiliac) prior to randomisation. Greenhalgh et al. 2008 [13]a and Greenhalgh et al. 2008 [13]b did not report post-intervention data (standard deviation) for each comparison group but did provide between-group effect size data.MD mean difference, CI confidence interval, ES effect size, Δchange from baseline, NR not reported, UTC unable to calculate. Between-group ES = (Δtreatment- Δcontrol)/pooled baseline SD; Significance was determined from p-value reported or confidence interval excluding 0 if no p-value was reported

Electronic Supplementary Material Table S11Six-minute walking distance (m): revascularisation alone (control) versus combined therapy of revascularisation plus exercise training

Study / Time point (weeks) / Revascularisation
pre / Revascularisation
post / Combined
pre / Combined
post / Between group
MD [95% CI] / Between group
ES [95% CI] / ES p-value / Reported between group p-value
Bo et al. 2013 [10] / 12 / 407 ± 99 / 480 ± 77 / 412 ± 94 / 492 ± 82 / 7 [-48 to 63] / 0.08 [-0.49 to 0.64] / 0.79 / NR

Values are mean ± standard deviation unless otherwise stated. MD mean difference, CI confidence interval, ES effect size, NR not reported. Between-group ES = (Δtreatment- Δcontrol)/pooled baseline SD; Significance was determined from p-value reported or confidence interval excluding 0 if no p-value was reported

Electronic Supplementary Material Table S12Resting ankle-brachial index: revascularisation alone/exercise training alone (control) versus combined therapy of revascularisation plus exercise training

Study / Time point (weeks) / Revascularisation or
exercise training
pre / Revascularisation or
exercise training
post / Combined
pre / Combined
post / Between group
MD [95% CI] / Between group
ES [95% CI] / ES p-value / Reported between group p-value
Revascularisation versus combined therapy of revascularisation plus exercise training
Lundgren et al. 1989[3] / 12 / 0.55 ± 0.15 / Δ 0.35 ± 0.14 / 0.59 ± 0.10 / Δ 0.30 ± 0.14 / -0.05 [-0.14 to 0.04] / -0.35 [-0.95 to 0.25] / 0.25 / >0.05
Badger et al. 2007 [15] / 6 / Not assessed / Δ 0.08 ± 0.08 / Not assessed / Δ 0.23 ± 0.11 / UTC / UTC / UTC / 0.02
Kruidenier et al. 2011 [12] / 24 / 0.71 ± 0.18 / 0.93 ± 0.18 / 0.69 ± 0.21 / 0.88 ± 0.19 / -0.03 [-0.13 to 0.07] / -0.15 [-0.65 to 0.34] / 0.55 / 0.75
Mazari et al. 2012 [5] / 12 / 0.71 ± 0.25 / 0.92 ± 0.36 / 0.64 ± 0.24 / 0.98 ± 0.19 / 0.13 [0.03 to 0.23] / 0.53 [0.12 to 0.93] / 0.01 / NR
Bo et al. 2013 [10] / 12 / 0.63 ± 0.30 / 0.82 ± 0.20 / 0.64 ± 0.30 / 0.90 ± 0.15 / 0.07 [-0.12 to 0.26] / 0.23 [-0.37 to 0.83] / 0.45 / NR
Exercise training versus combined therapy of revascularisation plus exercise training
Lundgren et al. 1989[3] / 12 / 0.59 ± 0.15 / Δ 0.04 ± 0.14 / 0.59 ± 0.10 / Δ 0.30 ± 0.14 / 0.26 [0.17 to 0.35] / 1.82 [1.11 to 2.53] / <0.01 / ≤0.01
Greenhalgh et al. 2008[13]a / 24 / 0.69 ± 0.12 / NR / 0.66 ± 0.14 / NR / UTC / UTC / UTC / NR
Greenhalgh et al. 2008[13]b / 24 / 0.66 ± 0.11 / NR / 0.68 ± 0.19 / NR / UTC / UTC / UTC / NR
Mazari et al. 2012 [5] / 12 / 0.72 ± 0.22 / 0.75 ± 0.19 / 0.64 ± 0.24 / 0.98 ± 0.19 / 0.31 [0.22 to 0.40] / 1.32 [0.87 to 1.77] / <0.01 / NR
Fakhry et al. 2015 [14] / 48 / 0.68 ± 0.16 / Δ 0.03 ± 0.20 / 0.71 ± 0.18 / Δ 0.16 ± 0.20 / 0.13 [0.08 to 0.18] / 0.64 [0.36 to 0.91] / <0.01 / <0.01

Values are mean ± standard deviation unless otherwise stated. a,bGreenhalgh et al. 2008 [13] was divided into two trials as patients were stratified according to the anatomical site of revascularisation (femoropopliteal or aortoiliac) prior to randomisation. Greenhalgh et al 2008 [13]a and Greenhalgh et al. 2008 [13]breported only 2-year follow-up data, which revealed a significant effect in favour of combined therapy over supervised exercise trainingin both trials (Greenhalgh et al. 2008 [13]a ES 0.11, 95% CI 0.03 to 0.20; p=0.01; Greenhalgh et al. 2008 [13]b ES 0.14, 95% CI 0.03 to 0.26; p=0.02). MD mean difference, CI confidence interval, ES effect size, Δchange from baseline, NR not reported, UTC unable to calculate. Between-group ES = (Δtreatment- Δcontrol)/pooled baseline SD; Significance was determined from p-value reported or confidence interval excluding 0 if no p-value was reported

Electronic Supplementary Material Table S13Resting calfarterial blood flow (ml.100ml-1.min-1): revascularisation alone/exercise training alone (control) versus combined therapy ofrevascularisation plus exercise training

Values are mean ± standard deviation unless otherwise stated. MD mean difference, CI confidence interval, ES effect size, Δchange from baseline. Between-group ES = (Δtreatment- Δcontrol)/pooled baseline SD; Significance was determined from p-value reported or confidence interval excluding 0 if no p-value was reported

Electronic Supplementary Material Table S14Quality of life (SF-36 Physical Health): revascularisation alone/exercise training alone (control) versus combined therapy of revascularisation plus exercise training

Values are mean ± standard deviation unless otherwise stated. a,bGreenhalgh et al. 2008 [13] was divided into two trials as patients were stratified according to the anatomical site of revascularisation (femoropopliteal or aortoiliac) prior to randomisation. Greenhalgh et al. 2008 [13]a and Greenhalgh et al. 2008 [13]breported only 2-year follow-up data, which revealed that combined therapy had no added effect over supervised exercise training in the femoropopliteal trial (Greenhalgh et al. 2008 [13]aES -0.4, 95% CI -4.2 to 3.4; p=0.82), and a significant effect in favour of combined therapy in the aortoiliac trial (Greenhalgh et al 2008 [13]bES 7.8, 95% CI 1.5 to 14.1; p=0.02). MD mean difference, CI confidence interval, ES effect size, Δchange from baseline, NR not reported, UTC unable to calculate. Between-group ES = (Δtreatment- Δcontrol)/pooled baseline SD; Significance was determined from p-value reported or confidence interval excluding 0 if no p-value was reported

Electronic Supplementary Material Table S15Quality of life (SF-36 Mental Health): revascularisation alone/exercise training alone (control) versus combined therapy of revascularisation plus exercise training

Values are mean ± standard deviation unless otherwise stated. a,bGreenhalgh et al. 2008 [13] was divided into two trials as patients were stratified according to the anatomical site of revascularisation (femoropopliteal or aortoiliac) prior to randomisation. Greenhalgh et al. 2008 [13]a and Greenhalgh et al.2008 [13]b provided 2-year follow-up data, which revealed that combined therapy had no added effect over supervised exercise training in both trials (Greenhalgh et al. 2008 [13]a ES 2.4, 95% CI -1.7 to 6.5; p=0.25; Greenhalgh et al. 2008 [13]b ES 4.9, 95% CI -1.3 to 11.1; p=0.12).MD mean difference, CI confidence interval, ES effect size, Δchange from baseline, NR not reported, UTC unable to calculate. Between-group ES = (Δtreatment- Δcontrol)/pooled baseline SD; Significance was determined from p-value reported or confidence interval excluding 0 if no p-value was reported

References

1.Franco A, Legrand E, Guidicelli H, et al. Results of the physiotherapy of arterial disease at the stage of intermittent claudication by programmed efforts training (author's transl). J Mal Vasc. 1980;5:185-9.

2.Lundgren F, Dahllof AG, Schersten T, et al. Muscle enzyme adaptation in patients with peripheral arterial insufficiency: spontaneous adaptation, effect of different treatments and consequences on walking performance. Clin Sci (Lond). 1989;77:485-93.

3.Lundgren F, Dahllof AG, Lundholm K, et al. Intermittent claudication-surgical reconstruction or physical training? A prospective randomized trial of treatment efficiency. Ann Surg. 1989;209:346-55.

4.Mazari FA, Gulati S, Rahman MN, et al. Early outcomes from a randomized, controlled trial of supervised exercise, angioplasty, and combined therapy in intermittent claudication. Ann Vasc Surg. 2010;24:69-79.

5.Mazari FA, Khan JA, Carradice D, et al. Randomized clinical trial of percutaneous transluminal angioplasty, supervised exercise and combined treatment for intermittent claudication due to femoropopliteal arterial disease. Br J Surg. 2012;99:39-48.

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