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I would like to acknowledge the important meta-analysis presented by Girolami et al¹ on the treatment of intermittent claudication in a recent issue of the ARCHIVES. This meta-analysis provides an up-to-date evaluation of the current therapies for claudication, including physical training, smoking cessation, and drug therapies. Their literature search seems to be accurate and comprehensive. However, their conclusions are rather weak and suggest that medical therapies for claudication are not all that effective.

The data presented in their meta-analysis (and others) for exercise training benefits reveal highly consistent results over the last 3 decades. There is now unequivocal evidence that a supervised exercise training program is effective in improving treadmill exercise performance and quality of life and that this is accomplished without any excess morbidity or mortality. Thus, it is difficult to accept their conclusions that "Prescribing expensive supervised exercise programs to these patients remains controversial."¹ Further, the data to . . . [Full Text of this Article]

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