OBJECTIVE: To compare the effect of two training programmes and advice to exercise at home on physiological adaptations in patients with peripheral arterial disease (PAD). DESIGN: 30 patients with a typical history of PAD and intermittent claudication were randomised to either an upper body strength training programme (UBST), a dynamic (walking, cycling, circuit) conventional exercise rehabilitation programme (CER), or advice to 'walk as much as possible at home' (CONT). Before and after intervention groups performed a standard graded treadmill exercise test (GTET) and a 6-minute walk test (SMWT) to determine peak physiological parameters and walking distances. Maximal walking distance (MWD), pain-free walking distance (PFWD), peak oxygen uptake (VO2), heart rate and perceived pain were measured. RESULTS: MWD on the GTET increased significantly in the CER group compared with the CONT and UBST groups (93.9 +/- 79% versus 7.0 +/- 19.8% versus 7.3 +/- 46%; CER versus UBST versus CONT p = 0.003). Similarly, peak VO2 increased with CER compared with the CONT and UBST groups (28.4 +/- 20 versus -6.2 +/- 15 versus -1.0 +/- 21%; CER versus UBST versus CONT p = 0.004). During the SMWT the CER and UBST groups improved in PFWD compared with the CONT group (37 +/- 47% versus 27 +/- 71% versus -30 +/- 29%; CER versus UBST versus CONT p = 0.03), and perceived pain decreased in the CER group compared with the UBST group (-24 +/- 39% versus 27 +/- 48%; CER versus UBST p = 0.01). CONCLUSION: CER improves physiological parameters and walking distances more than UBST does. CER is effective within 6 weeks. Verbal encouragement to exercise is an ineffective form of management.

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