Trial reportJournal of the American College of Cardiology2015
Supervised exercise, stent revascularization, or medical therapy for claudication due to aortoiliac peripheral artery disease: the CLEVER study.
Trial report in Journal of the American College of Cardiology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 88 papers, 13 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
88 citing papers in PubMed, 13 syntheses or guidelines pooled it, 283 citations in OpenAlex.
- 2026 ACC/AHA Clinical Performance and Quality Measures for Patients With Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures.Journal of the American College of Cardiology · 2026Guideline
- 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Journal of the American College of Cardiology · 2024Guideline
- Guideline
- A systematic review of exercise intervention reporting quality and dose in studies of intermittent claudication.Vascular · 2023Pooled it
- Comparing the reporting and conduct quality of exercise and pharmacological randomised controlled trials: a systematic review.BMJ open · 2021Pooled it
- Network Meta-Analysis Comparing the Outcomes of Treatments for Intermittent Claudication Tested in Randomized Controlled Trials.Journal of the American Heart Association · 2021Pooled it
- The Safety of Paclitaxel-Coated Devices for Patients with Peripheral Artery Disease.Current cardiology reports · 2021Pooled it
- Atherectomy for peripheral arterial disease.The Cochrane database of systematic reviews · 2020Pooled it
- ACC/AHA/SCAI/SIR/SVM 2018 Appropriate Use Criteria for Peripheral Artery Intervention: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, and Society for Vascular Medicine.Journal of the American College of Cardiology · 2019Guideline
- Supervised exercise therapy versus home-based exercise therapy versus walking advice for intermittent claudication.The Cochrane database of systematic reviews · 2018Pooled it
- Endovascular revascularisation versus conservative management for intermittent claudication.The Cochrane database of systematic reviews · 2018Pooled it
- Guideline
- Guideline
- Microvascular Function and Ambulatory Capacity in Peripheral Artery Disease.Circulation. Cardiovascular interventions · 2025Trial
- Changes in miRNA expression in patients with peripheral arterial vascular disease during moderate- and vigorous-intensity physical activity.European journal of applied physiology · 2023Trial
- Impact of supervised exercise on skeletal muscle blood flow and vascular function measured with MRI in patients with peripheral artery disease.American journal of physiology. Heart and circulatory physiology · 2022Trial
- Intensive exercise therapy for restenosis after superficial femoral artery stenting: the REASON randomized clinical trial.Heart and vessels · 2022Trial
- Durability of Benefits From Supervised Treadmill Exercise in People With Peripheral Artery Disease.Journal of the American Heart Association · 2019Trial
- Racial Heterogeneity in Treatment Effects in Peripheral Artery Disease: Insights From the CLEVER Trial (Claudication: Exercise Versus Endoluminal Revascularization).Circulation. Cardiovascular quality and outcomes · 2018Trial
- The Role of Home-Based Exercise in the Management of Peripheral Artery Disease.Current treatment options in cardiovascular medicine · 2026Article
28 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
17 authors at 10 institutions in 2 countries.
Funding
Abstract
backgroundTreatment for claudication that is due to aortoiliac peripheral artery disease (PAD) often relies on stent revascularization (ST). However, supervised exercise (SE) is known to provide comparable short-term (6-month) improvements in functional status and quality of life. Longer-term outcomes are not known.
objectivesThe goal of this study was to report the longer-term (18-month) efficacy of SE compared with ST and optimal medical care (OMC).
methodsOf 111 patients with aortoiliac PAD randomly assigned to receive OMC, OMC plus SE, or OMC plus ST, 79 completed the 18-month clinical and treadmill follow-up assessment. SE consisted of 6 months of SE and an additional year of telephone-based exercise counseling. Primary clinical outcomes included objective treadmill-based walking performance and subjective quality of life.
resultsPeak walking time improved from baseline to 18 months for both SE (5.0 ± 5.4 min) and ST (3.2 ± 4.7 min) significantly more than for OMC (0.2 ± 2.1 min; p < 0.001 and p = 0.04, respectively). The difference between SE and ST was not significant (p = 0.16). Improvement in claudication onset time was greater for SE compared with OMC, but not for ST compared with OMC. Many disease-specific quality-of-life scales demonstrated durable improvements that were greater for ST compared with SE or OMC.
conclusionsBoth SE and ST had better 18-month outcomes than OMC. SE and ST provided comparable durable improvement in functional status and in quality of life up to 18 months. The durability of claudication exercise interventions merits its consideration as a primary PAD claudication treatment.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.