Exercise Therapy for PAD Using Mobile Health

Eligibility Criteria

• * Age \>40 years
• * Eligible Veteran status
• * Clinically stable intermittent claudication ( 2 months of Rutherford Class II symptoms, no evidence of chronic limb-threatening ischemia)
• * Established PAD diagnosis (abnormal ankle-brachial index or evidence of PAD on prior certified vascular laboratory or radiology imaging)
• * Access to safe location to perform walking exercises
• * Above or below knee amputation
• * critical limb ischemia (rest pain or tissue loss including ulceration or gangrene)
• * inability to walk without a walker
• * wheelchair confinement
• * non-English speaking
• * significant visual impairment that interferes with walking activity
• * hearing impairment that interferes with full study participation
• * unable or unwilling to return to the medical center at the expected visit frequency or unable or unwilling to use the technology required for the intervention
• * Individuals whose walking is limited by a condition other than PAD
• * Any active cardiac condition including unstable angina
• * unstable atrial or ventricular arrhythmias
• * high-grade heart block without a pacemaker
• * active myopericarditis
• * recent venous thromboembolism
• * or recent abnormal baseline stress test suggesting ischemia
• * other high-risk findings (e.g., drop of systolic blood \> 20 mmHg with exercise)
• * Presence of Class III NYHA heart failure or CCS III angina.
• * Major surgery including lower extremity revascularization or orthopedic surgery during the preceding three months or anticipated in the next nine months
• * Major medical illness including lung disease requiring continuous oxygen (patients wearing nighttime oxygen only may still qualify)
• * neurodegenerative disorders such as Parkinson's Disease that impair walking ability
• * cancer requiring treatment in the past 2 years (with exception for non-melanoma skin cancer or if they received treatment for early-stage cancer with an excellent overall prognosis)
• * Heart attack, stroke, or coronary artery bypass surgery in the preceding 3 months
• * Mental health illness that may interfere with the ability to consent and/or participate in the study, including mini-mental status examination score \<24
• * dementia
• * active psychiatric disorder such as schizophrenia or bipolar disorder
• * history of suicidal or homicidal ideation in the preceding six months
• * history of suicidal attempts in the preceding 12 months
• * history of active substance use in the preceding six months that would interfere with study participation (as determined by their primary care or mental health provider)
• * Subjects endorsing SI or HI may be eligible for continued participation with monitoring if approved by their primary mental health provider
• * Currently walking regularly for exercise at a level comparable to the amount of exercise prescribed in the intervention
• * Currently enrolled in another clinical trial or structured exercise program (i.e., cardiac rehabilitation)
• * Deemed to be poorly suited for the study or the study intervention at the discretion of the PI or study staff