Exercise training improves walking tolerance in patients with peripheral arterial disease (PAD). (1-8) Typically this includes walking as the principal mode of training. (4,5) Patients with PAD who walk with pain have greater improvements in walking distances than those who walk only to the point at which pain begins. (6,7) However, forcing patients with PAD to walk with increasing pain is challenging as because of their personality type they tend to experience negative emotions more readily than people without PAD. (9) They may therefore not tolerate pain well, which could lead to poor attendance at training sessions. However, no studies have specifically examined the relationship between prescription of exercise likely to cause pain and compliance with exercise programmes. Walker et al. found that a 6-week pain-free upper limb cycle ergometry exercise training programme and lower limb cycling training produced equal improvements in maximal walking distance (MWD) and pain-free walking distance (PFWD). (1) Increases in MWD and PFWD are therefore independent of mode of training in patients with PAD. Developing an effective pain-free exercise training programme is important for patients with PAD.