AIM: To assess the efficacy of gait training and physical exercises on the walking distance of patients with intermittent claudication. METHOD: Analysis of randomized clinical trials, with grading of their methodological quality. 'Medline' and the literature database of the Dutch Institute for Professions Allied to Health were accessed with the appropriate keywords (intermittent claudication, arterial occlusive disease, peripheral vascular diseases, walking, physical education, gymnastics, exercise, exercise therapy, running/jogging). The relevant publications were screened for additional randomized clinical trials. A checklist was developed to score the characteristics of the relevant variables. A methodological list was used to grade the quality of the studies (maximum score 100). More than 70 studies were identified. After screening by two independent reviewers, 21 articles were 'blinded' for analysis by the first two authors. RESULTS: Eleven studies were rejected by the two reviewers (duplicate publication, non-randomization of subjects, treadmill exercise not part of the study). Methodological scores for the remaining randomized trials ranged between 47 and 75 (mean +/- SD 62.5 +/- 8.5). The percentage improvement in walking distance or time varied from 28 to 210% (105 +/- 55.8). DISCUSSION: All studies concluded that gait training had a positive effect on walking distance or time. Further research is needed to determine the intensity, frequency, duration, and content of a programme in order to achieve the maximum possible effect.

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