A patient with arteriosclerosis obliterans begins a treadmill walking program and develops leg pain after two minutes. What is the most appropriate action?

• A. Decrease the treadmill speed by one-half mile per hour and instruct the patient to continue walking
• B. Walk through the pain unless it becomes unbearable
• C. Rest and resume walking when the pain subsides
• D. Discontinue walking and select an alternate exercise

Answer: (C)

In peripheral arterial disease, leg pain during walking is intermittent claudication caused by insufficient blood flow to the working muscles. The best approach during a supervised walking program is to stop walking when claudication begins and rest until the pain subsides, then resume walking at a comfortable pace. This rest–recovery pattern allows reperfusion, prevents worsening ischemia, and gradually builds endurance as the patient reinitiates activity. Pushing through the pain or forcing a longer walk without relief can worsen symptoms and fatigue. Decreasing speed or choosing a different exercise isn’t necessary if pain subsides with rest and the patient can resume walking, which is the standard, progressive method for improving walking tolerance in PAD.