{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:31:03Z","timestamp":1775694663574,"version":"3.50.1"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2022,5,12]],"date-time":"2022-05-12T00:00:00Z","timestamp":1652313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"George Davies Charitable Trust","award":["1024818"],"award-info":[{"award-number":["1024818"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,7,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The aim was to determine the comparative benefits of structured high-pain exercise, structured low-pain exercise, and usual-care control, to identify which has the largest effect on walking ability in people with intermittent claudication (IC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A network meta-analysis was undertaken to assess two outcomes: pain-free walking ability (PFWA) and maximal walking ability (MWA). Nine electronic databases were searched. Trials were included if they were: RCTS; involved adults with IC; had at least two of the following arms\u2014structured low-pain exercise, structured high\u00ad-pain exercise or usual-care control; and a maximal or pain-free treadmill walking outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Some 14 trials were included; results were pooled using the standardized mean difference (MD). Structured low-pain exercise had a significant large positive effect on MWA (MD 2.23, 95 percent c.i. 1.11 to 3.35) and PFWA (MD 2.26, 1.26 to 3.26) compared with usual-care control. Structured high-pain exercise had a significant large positive effect on MWA (MD 0.95, 0.20 to 1.70) and a moderate positive effect on PFWA (0.77, 0.01 to 1.53) compared with usual-care control. In an analysis of structured low- versus high pain exercise, there was a large positive effect in favour of low-pain exercise on MWA (MD 1.28, \u22120.07 to 2.62) and PFWA (1.50, 0.24 to 2.75); however, this was significant only for PFWA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There is strong evidence in support of use of structured high-pain exercise, and some evidence in support of structured low-pain exercise, to improve walking ability in people with IC compared with usual-care control (unstructured exercise advice).<\/jats:p><\/jats:sec>","DOI":"10.1093\/bjs\/znac134","type":"journal-article","created":{"date-parts":[[2022,4,14]],"date-time":"2022-04-14T11:17:34Z","timestamp":1649935054000},"page":"686-694","source":"Crossref","is-referenced-by-count":13,"title":["Effect of high-pain<i>versus<\/i>low-pain structured exercise on walking ability in people with intermittent claudication: meta-analysis"],"prefix":"10.1093","volume":"109","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3022-8893","authenticated-orcid":false,"given":"Jemma","family":"Perks","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital , Leicester , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2636-6487","authenticated-orcid":false,"given":"Francesco","family":"Zaccardi","sequence":"additional","affiliation":[{"name":"Leicester Diabetes Centre, University of Leicester , Leicester , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3125-9712","authenticated-orcid":false,"given":"Craig","family":"Paterson","sequence":"additional","affiliation":[{"name":"School of Sport and Exercise, University of Gloucestershire , Gloucester , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9159-5307","authenticated-orcid":false,"given":"John S M","family":"Houghton","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital , Leicester , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0562-9580","authenticated-orcid":false,"given":"Andrew T O","family":"Nickinson","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital , Leicester , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1149-8150","authenticated-orcid":false,"given":"Coral J","family":"Pepper","sequence":"additional","affiliation":[{"name":"Library and Information Services, University Hospitals of Leicester NHS Trust , Leicester , 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