Exercise rehabilitation for treatment of claudication.

In Reply. —We fully agree with the statement by Dr Hirsch and colleagues that exercise performance is not solely dependent on large artery blood flow and that intermittent claudication can be improved without revascularization. Our meta-analysis, along with the additional articles cited by Hirsch and colleagues, supports the notion that exercise rehabilitation is an effective treatment for patients with peripheral arterial occlusive disease and disabling claudication pain. Hirsch and colleagues raise another key point concerning the availability of vascular rehabilitation programs in health care facilities. Patients with intermittent claudication frequently have concomitant atherosclerosis in the coronary and cerebrovascular arteries, as well as a host of other comorbidities. Consequently, the risks associated with exercise in patients with claudication are similar to those of patients with cardiac disease, emphasizing the need for a closely supervised program that can only be accomplished in a health care facility. An additional benefit of a supervised