OBJECTIVES: Supervised exercise programmes (SEP) are effective for improving walking distance in patients with intermittent claudication (IC) but provision and uptake rates are sub-optimal. Access to such programmes has also been halted by the Coronavirus pandemic. The aim of this review is to provide a comprehensive overview of the evidence for home-based exercise programmes (HEP). DATA SOURCES: Medline, Embase, CINAHL, PEDro and Cochrane CENTRAL were searched for terms relating to HEP and IC. REVIEW METHODS: This review was conducted in according with the published protocol and PRISMA guidance. Randomised and non-randomised trials that compared a HEP to SEP, basic exercise advice or no exercise controls for IC were included. A narrative synthesis was provided for all studies and meta-analyses conducted using data from randomised trials. The primary outcome was maximal walking distance. Sub-group analyses were performed to consider the effect of monitoring. Risk of bias was assessed using the Cochrane tool and quality of evidence via GRADE. RESULTS: 23 studies with 1,907 participants were included. Considering the narrative review, HEPs were inferior to SEPs which was reflected in the meta-analysis (MD 139 m, 95% CI 45 to 232 m, p = 0.004, very-low-quality evidence). Monitoring was an important component, as HEPs adopting this were equivalent to SEPs (MD 8 m, 95% CI -81 to 97, p = 0.86; moderate-quality evidence). For HEPs versus basic exercise advice, narrative review suggested HEPs can be superior, though not always significantly so. For HEPs versus no exercise controls, narrative review and meta-analysis suggested HEPs were potentially superior (MD 136 m, -2 to 273 m p = 0.05, very-low-quality evidence). Monitoring was also a key element in these comparisons. Other elements such as appropriate frequency (>= 3x a week), intensity (to moderate-maximum pain), duration (20 progressing to 60 minutes) and type (walking) of exercise were important, as was education, self-regulation, goal setting, feedback and action planning. CONCLUSION: When SEPs are unavailable, HEPs are recommended. However, to elicit maximum benefit they should be structured, incorporating all elements of our evidence-based recommendations. PROSPERO REGISTRATION NUMBER: CRD42018091248.

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