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Cardio & conditioning

Claudication walking workout: walk-rest-walk

This is the walking method the NHS and the National Institute for Health and Care Excellence (NICE) recommend for intermittent claudication, the leg pain on walking caused by peripheral arterial disease. Walk until the leg pain is close to the most you can bear, stop until it has gone completely, then go again, until your walking time adds up to 30 minutes. The guidelines differ on how much pain to walk into: NICE and the NHS say near-maximal pain, while the European Society of Cardiology says moderate to severe pain, with flexibility. Our target of 3 or 4 on a 0 to 4 pain scale is our editorial reconciliation of the two. Do it at least 3 times a week; the pain won't damage your arteries.

45 minBeginner8 movesA wall · Cardio machine · A step · A bench or boxHip flexors · Calves · Quads · Glutes
Follow along: a timer, a cue and the next move, one step at a time.

Warm-up (about 4 minutes)

  1. Standing march2 min
    Beginner · Hip flexors, Abs, Glutes · 3D demoEasy paceHarder: Standing band hip flexion
  2. Ankle circles1 min
    Beginner · Calves, Shins · 3D demoBend and straighten your ankles, then circle them
  3. Slow calf raise1 min
    Beginner · Calves · 3D demoHold a counterEasier: Seated bent-knee calf raise (soleus raise)Harder: Standing dumbbell calf raise

Walk-rest-walk

6 rounds · Rest Stand or sit until the leg pain has gone completely, usually a few minutes

  1. Treadmill walkingUntil the pain reaches 3 to 4 out of 4
    Beginner · Quads, Calves, Glutes · 3D demoWalk briskly enough to bring the pain on within a few minutes. Stop when your walking adds up to 30 minutes; some people need more or fewer roundsHarder: Treadmill jogging

Leg strength (the NHS home circuit)

  1. Low step-up1 min
    Beginner · Quads, Glutes, Hamstrings · 3D demoRail or wall within reachHarder: Step-up
  2. Sit to stand from a chair1 min
    Beginner · Quads, Glutes, Hamstrings · 3D demoUse a firm chairHarder: Bodyweight squat
  3. Tandem stance and heel-to-toe walk1 min
    Beginner · Calves, Hip abductors · 3D demoBeside a wallEasier: Semi-tandem stanceHarder: Single-leg stand

Cool-down

  1. Treadmill walking3 min
    Beginner · Quads, Calves, Glutes · 3D demoEasy pace, below the point where the pain startsHarder: Treadmill jogging
  2. Wall calf stretch (gastrocnemius)20 s, twice each side
    Beginner · Calves · 3D demoKeep your back heel downEasier: Seated calf stretch with a towelHarder: Contract-relax hamstring stretch (PNF)

Tips

  • Rate the pain from 0 (none) to 4 (severe). The wording for the steps between is ours: 1, the pain is just starting; 2, mild; 3, moderate. Walk to 3 or 4, then rest until you're back to 0.
  • Exercising with this pain won't make your circulation worse.
  • If you can't face walking that far into the pain, walk to a moderate level instead: it still helps. Walking only at a comfortable pace without any symptoms didn't improve walking in a large trial.
  • Do it at least 3 times a week, and keep going after 12 weeks: the benefits fade if you stop.
  • Every 1 to 2 weeks, make it a little harder: walk faster or add a gentle slope.
  • Keep a diary of how long you walk before the pain starts and your total walking time.
  • With diabetes, wear well-fitting shoes and check your feet afterwards.
  • Pain in your foot at rest, a wound that won't heal or toes changing colour: don't do this session, and contact a GP immediately.
  • Stop for chest pain, severe breathlessness or dizziness. Call 999 (911 in the US) for chest pain that feels tight or like squeezing, or spreads to your arms, neck or jaw.

The doses are suggested starting points, not a prescription. Choose a range you can control and stop for sharp or increasing pain, numbness or tingling. Get individual advice after an injury or surgery, or if you are pregnant or managing a health condition.

Guides that recommend it

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Questions people ask

How long does the claudication walking workout: walk-rest-walk take?

About 45 minutes, including any warm-up and cool-down listed. Shorten it by doing fewer rounds; lengthen it by adding one.

What equipment do I need?

You need: A wall, Cardio machine, A step, A bench or box. Each move links to its guide, where you can find an alternative if you are missing something.

Is it suitable for beginners?

It is written for beginners. 3 of its 8 moves have an easier option listed beside them if you need one.

How do I make it easier or harder?

Use the easier or harder option listed under each move, change the number of rounds, or adjust the rest. Progress one change at a time.