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Background: Blood flow restriction caused by peripheral arterial disease (PAD) is reflected in reduced walking capacity. The peripheral mechanisms that may affect the walking capacity of individuals with PAD are not yet fully understood. This study aimed to 1) compare tissue oxygenation and muscle metabolism of individuals with PAD with different walking capacities and 2) evaluate which variables have the greatest potential to explain the variability in distance walked between performance levels., Methods: The sample composed of adults diagnosed with PAD underwent evaluation of microvascular function in the gastrocnemius muscle through Near-Infrared Spectroscopy (NIRS) at two time points: (1) during the arterial occlusion maneuver; (2) on a treadmill test with constant speed and inclination (3.2 km/h, 10 %). The following NIRS parameters were selected: (1) percentage of peripheral tissue oxygen saturation (StO 2 ); (2) StO 2 delta; (3) reoxygenation rate; (4) time to reach lowest StO 2 ; (5) ischemia resistance time; (6) StO 2 in reactive hyperemia. Participants were divided into tertiles (T1, T2, and T3) according to the walking distance in the treadmill test. One-way analysis of variance (ANOVA) was used for comparisons between tertiles and multiple linear regression was used for association analyses., Results: There were no significant differences between tertiles in baseline values or delta StO 2 . The reoxygenation rate and StO 2 in hyperemia of the occlusion maneuver, as well as the time to reach the lowest StO 2 and the ischemia resistance time in the treadmill test, were significantly higher in T3 than in T1 and T2 (p < 0.05). Linear regression demonstrated that the ischemia resistance time is the variable that appears to have the greatest influence on the distance walked (adjusted R 2  = 0.83)., Conclusion: Better walking performance was associated with better dynamic response capacity to ischemia. Factors such as microvascular, endothelial, and muscular dysfunction appear to be decisive in reducing the walking capacity of individuals with PAD., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Peripheral arterial disease (PAD) is increasingly prevalent, and supervised physical exercise programmes are recommended as the first-line treatment. However, these programmes are underused. Alternative delivery models may be able to expand treatment coverage. The objective of this study was to compare a home-based exercise programme (HBEP) and a centre-based exercise (CBE) in terms of their effects on functional capacity, peripheral muscle oxygenation and quality of life in individuals with PAD., Methods and Analysis: This single-blind, parallel randomised clinical trial will consist of two groups: HBEP and CBE. A qualitative analysis will be carried out to investigate acceptability and satisfaction. The primary outcome will be functional capacity, assessed by the incremental shuttle walk test. Secondary outcomes will include functional capacity, assessed by a treadmill walking test; peripheral muscle oxygenation and quality of life; and self-reported functional impairment, risk factors, morbidity, level of physical activity, adherence, acceptability and satisfaction. The intervention protocols will consist of 12 weeks of intermittent walking until claudication symptoms, three times a week. Participants randomly assigned to the CBE group will participate in supervised face-to-face sessions. The HBEP group will perform exercises at home with remote supervision, monitored by a pedometer and heart rate monitor, and subjective perception of effort during each session will be recorded by participants in a training diary; follow-up will be conducted by telephone calls. Statistical analyses will follow the intention-to-treat principle. Participants allocated to the HBEP group will be interviewed about their experience of remote treatment using a qualitative approach., Ethics and Dissemination: Ethics approval was obtained from the Ethics Committee of the Universidade Federal de Minas Gerais. The results will be disseminated in a peer-reviewed journal and presented at international congresses. This research has the potential to improve the care of people with PAD because if home-based rehabilitation demonstrates effectiveness, it could be considered an alternative or support resource to the usual centre-based treatment models, expanding access, coverage and participation in vascular physiotherapy TRIAL REGISTRATION: https://ensaiosclinicos.gov.br/rg/RBR-97vy9n7 on 14 April 2022., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)