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Peripheral arterial disease (PAD) patients have reduced muscle strength and impaired walking ability. The aim of this study was to examine the effects of maximal strength training (MST) on walking economy and walking performance in PAD patients. Ten patients with mild to moderate-severe claudication, classified as Fontaine stage II PAD and with functional limitations from intermittent claudication were recruited and went through an 8-week control period followed by an 8-week, three times a week, MST period. The patients performed four sets of five repetitions dynamic leg press with emphasis on maximal mobilization of force in the concentric action and with a progressive adjusted intensity corresponding to 85–90% of one repetition maximum (1 RM). After the MST period, leg press 1 RM significantly increased by 35.0±10.8 kg (31.3%). Dynamic rate of force development, measured on a force plate installed on the leg press, increased by 1424±1217 N/s (102.7%). The strength improvements led to a significant increase in walking economy of 9.7% when walking horizontally, and to a significant increase in walking performance of 13.6% measured on an incremental treadmill test to exhaustion. No changes were apparent after the control period. No changes in body mass or peak oxygen uptake were observed. MST increases strength in Fontaine stage II PAD patients and leads to improved walking economy. These results suggest that application of MST could accompany aerobic endurance training as a part of the treatment of PAD patients with mild to moderate-severe claudication. [ABSTRACT FROM AUTHOR]