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Claudication, a manifestation of systemic atherosclerosis and accompanying peripheral vascular disease, is characterized by pain induced by walking in one or both legs; it primarily affects the calves. Claudication usually does not abate with continued walking and is relieved only by rest. Since the effects of approved medication are usually limited, exercise programs have been developed to treat this painful condition. This review discusses the rationale for an exercise program for the patient with claudication, with a focus on pathophysiology and the effect of training.