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Message: <blockquote data-quote="Bubbleblower" data-source="post: 2489016" data-attributes="member: 540059">That is what the guidelines say, based on this study:<a href="https://sci-hub.se/10.1001/jama.1995.03530120067043" target="_blank">Exercise Rehabilitation Programs for the Treatment of Claudication Pain</a>“The greatest improvement in pain distances occurred with the following exercise program: duration greater than 30 minutes per session, frequency of at least three sessions per week, walking used as the mode of exercise, use of near-maximal pain during training as claudication pain end point, and program length of greater than 6 months”.If you look at table 2 you can see the<a href="https://www.ahajournals.org/doi/epdf/10.1161/01.CIR.36.1.15" target="_blank"> Skinner study</a> from ‘67 (<a href="https://www.ahajournals.org/doi/epdf/10.1161/01.CIR.36.1.23" target="_blank">part 2</a>), one of the only 6 “near maximal” pain studies had a huge impact on the result and the conclusions of the first study. But the subjects didn’t walk to maximal pain at all, but to 75% of a self imposed maximum, which had a very possitive effect:“In every case the greatest reduction in AP (Ankle Pressure) occurred after the initial maximal walk. With repetition of exercise each subject displayed a progressive increase in either the AP level taken 2 minutes postexercise or the rate of recovery of AP to the pre-exercise level.” The term “walk through experience” which they use in the first study comes from this study also.This in turn was based on a previous succesfull therapy:“Schliissel had his patients walk on a level grade until pain first developed and used two thirds of that time as the training load. He emphasized that patients should not increase the tempo of walking above 60 steps per minute or reach the stage of claudication. The patients would walk at two-thirds CPT, stand for 1 to 3 minutes, and repeat for 10 to 20 minutes; this was done three times daily. He gave little data but reported significant increases in CPT and MWT in 20 patients with intermittent claudication.”The study <a href="https://sci-hub.se/10.1016/j.jvs.2012.04.046" target="_blank">Supervised walking therapy in patients with intermittent claudication</a> comments on the first study “Although the present systematic review used results from RCTs only and therefore is less prone to confounding due to selection bias, our results do not support these prior recommendations” which is a nice way to put it. They found “pain free” exercise gained 28%  average walking distance change more than “max pain” (257m vs 177m).Especially for diabetics it is better to walk and exercise pain- and therefore stress free.</blockquote>

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