Community Walking Exercise for Patients With Peripheral Artery Disease

Inclusion Criteria: * Men and women diagnosed with atherosclerotic PAD * ≥40 years of age * An abnormal ankle-brachial index (ABI) of ≤.90 * For patients with an ABI \>.90 and \<1.00, a post-exercise ABI drop of 15% or more compared to the resting ABI * Patients receiving lower extremity ET or peripheral open intervention * Patients not receiving lower extremity ET or peripheral open intervention but present with stable claudication and an abnormal ABI Exclusion Criteria: * Lower extremity amputation(s), including a toe amputation, which interfere (s) with walking on the treadmill * Individuals with critical limb ischemia defined by ischemic rest pain or ischemic ulcers/gangrene on the lower extremities * PAD of non-atherosclerotic nature (e.g., fibromuscular dysplasia, irradiation, endofibrosis) * Coronary artery bypass grafts or major surgical procedures within 6 months prior to screening * Individuals whose walking exercise is primarily limited by symptoms of chronic obstructive pulmonary disease, angina, or heart failure * Individuals who are unable to walk on the treadmill at a speed of at least 2 mph for at least 1 minute * Individuals who have had a myocardial infarction within 3 months prior to screening * Individuals who demonstrate symptoms consistent with acute coronary syndrome * Individuals who exhibit ischemia as documented on the 12-lead electrocardiogram including horizontal or down-sloping ST-segment depression ≥0.5 mm at rest and \>1 mm with exercise in 2 contiguous leads, relative to the PR-segment (ST-segment measured 0.08 seconds after the J point, ST-segment elevation ≥1 mm) * Individuals who have had a transient ischemic attack or stroke 3 months prior to screening * Individuals with left bundle branch block or sustained ventricular tachycardia (\>30 sec) during screening * Individuals with uncontrolled hypertension (≥180 systolic or ≥100 diastolic resting blood pressure) during screening * Treatment with pentoxifylline or cilostazol for the treatment of claudication 4 weeks prior to screening; Patients can be reconsidered for study inclusion following a 1 month washout period from these medications * Electrolyte abnormalities (e.g., potassium \<3.3 mmol∙Lˉ1 ) * Pregnancy, fertility without protection against pregnancy (for women of childbearing potential, a serum pregnancy test will be performed at screening) * Incarcerated individuals * Individuals acutely impaired by alcohol or other illicit drugs * Poorly controlled diabetes defined as glycated hemoglobin \>12% * Severely anemic patients (Hgb \<11 g∙dLˉ1 for women and \<10 g∙dLˉ1 for men) * For patients who have not received peripheral revascularization, an ABI of \>0.90 * For patients with equivocal resting ABIs (0.91-0.99), a drop of \<15% in the post-exercise ABI * For individuals with non-compressible vessels (ABI \>1.39) who have a toe- brachial index (TBI) \>0.70 * Inability to speak English * Other clinically significant disease that is, in the opinion of the study team, not stabilized or may otherwise confound the results of the study