To the Editor.
—The meta-analysis by Drs Gardner and Poehlman1 serves a critical role in demonstrating the efficacy of exercise rehabilitation as a therapeutic modality for individuals with claudication. Heretofore, cost studies that have evaluated essentially all therapeutic modalities for claudication (whether exercise, angioplasty, or surgery) have been hampered by small sample size or the lack of a randomized, controlled study design. It should be noted that these past limitations have in part been ameliorated by two significant publications that were not included in the JAMA meta-analysis. A randomized controlled trial performed by Hiatt and colleagues2 demonstrated that a 12-week supervised walking program was superior in improving exercise performance compared with a well-described control group, and further validated the use of a graded exercise treadmill protocol to assess functional limitations in patients with claudication. Another randomized trial performed by Creasy and colleagues3 compared the relative efficacy of
Hirsch AT, Haidet G, Creager MA, Hiatt WR, Regensteiner JG, Cooke JP. Exercise Rehabilitation for Treatment of Claudication. JAMA. 1996;275(7):519-520. doi:10.1001/jama.1996.03530310025023