Diet and Exercise Interventions to Treat Claudication

This study seeks to (1) compare the changes in 6-minute walk distance (6MWD) and physical
function quality of life in patients with peripheral artery disease (PAD) following a
combined intervention of the dietary approaches to stop hypertension (DASH) dietary program
plus a home-based exercise program, and following a home-based exercise program alone; and
(2) compare the changes in microvascular function and inflammation in patients following the
combined DASH diet and home-based exercise program, and the home-based exercise program
alone.

The investigators hypothesize that the combined DASH diet and exercise program will result in
greater increases in 6MWD and in the physical function quality of life than the exercise
program alone. Further, it is hypothesized that the combined DASH diet and exercise program
will result in greater improvements in calf muscle oxygen saturation [StO2] following
exercise, and in high-sensitivity C-reactive protein (hsCRP]) than the exercise program
alone.

The home-based exercise program consists of intermittent walking to moderate claudication
pain in a home-based setting. The DASH dietary program consists of the dietary approaches to
stop hypertension diet emphasizing foods rich in fruits, vegetables, whole grains, and
low-fat dairy.

Inclusion Criteria:

1. History of claudication,

2. Presence of PAD, defined by meeting at least one of the following criteria (ABI at
rest < 0.90, or > 20% decrease in ABI following a heel-rise exercise test in patients
with a normal ABI at rest (> 0.90), or history of peripheral revascularization.

Exclusion Criteria:

1. absence of PAD, defined by meeting all of the following 3 criteria (ABI at rest >
0.90), < 20% decrease in ABI following a heel-rise exercise test, and no history of
peripheral revascularization,

2. non-compressible vessels (ABI > 1.40),

3. rest pain due to PAD (Fontaine stage III; Rutherford Grade II),

4. tissue loss due to PAD (Fontaine stage IV; Rutherford Grade III),

5. use of medications indicated for the treatment of intermittent claudication
(cilostazol and pentoxifylline) initiated within three months prior to investigation,

6. peripheral revascularization within one month prior to investigation,

7. active cancer,

8. end stage renal disease defined as stage 5 chronic kidney disease,

9. medical conditions that are contraindicative for exercise according to the American
College of Sports Medicine,

10. cognitive dysfunction (mini-mental state examination score < 24), and

11. failure to complete the baseline tests within three weeks.