For approximately 30 years, supervised exercise therapy, typically consisting of walking for exercise on a treadmill at a health care facility in the presence of an exercise physiologist or nurse, has been first-line therapy for walking impairment in people disabled by lower extremity peripheral artery disease (PAD). In a metaanalysis of 25 randomized clinical trials (RCTs) that included 1054 participants with PAD, supervised walking exercise therapy was associated with an improvement in maximal treadmill walking distance of 180 m (95% CI, 130 m to 230 m) when compared with a control group that did not exercise. 1 Currently, clinical practice guidelines from different countries and medical specialties unequivocally endorse supervised exercise as first-line therapy for PAD.Based on the benefits of supervised walking exercise for PAD, in 2017 the Centers for Medicare & Medicaid Services (CMS) began providing insurance coverage for supervised exercise therapy for patients with PAD. However, most people with PAD do not participate in supervised exercise. 2,3 Among 129 699 people in the CMS Institutional Outpatient File between June 1, 2017, and December 31, 2018, with a diagnosis of symptomatic PAD (intermittent claudication), only 1735 (1.3%) were enrolled in supervised exercise therapy. 2 Even among those enrolled in supervised exercise, only 89 (5.1%) completed all 36 sessions. 2 Reasons for low participation rates include the inconvenience of regular travel to a facility for supervised exercise and a lack of exercise facilities that provide supervised exercise therapy for PAD. 3,4 Home-based walking exercise, defined by walking exercise conducted in or near the home without the presence of an exercise physiologist or nurse, circumvents the requirements for a facility and the inconvenience of traveling to a center for exercise and could increase participation in exercise activity by patients with PAD.However, enthusiasm and evidence for home-based walking exercise for patients with PAD has been modest. In the 1990s, several clinical trials with sample sizes of approximately 20 people with PAD showed no benefits of homebased exercise when patients with PAD were simply given advice to go home and walk. Consequently, clinical practice guidelines in 2005 asserted that there was no evidence to advise people with PAD to walk for exercise at home. 5 Since 2011, at least 7 RCTs of home-based exercise with sample sizes of more than 100 people with PAD have been published. 4 Results of these trials were mixed, with some showing no benefit of home-based exercise on walking impairment in PAD and others demonstrating large gains of as much as a 41-to 53-m improvement in 6-minute walk distance compared with a nonexercise control group. 4,6 In comparison, the most effective