Intermittent claudication is the most common manifestation of peripheral arterial disease as well as a lifestyle-limiting disease with a favorable prognosis. Despite societal guideline recommendations, most claudicants do not trial optimal medical therapy (OMT) and supervised exercise therapy (SET) or receive a quality-of-life (QoL) assessment prior to intervention. In this review, we discuss the components of OMT and SET and the trials establishing their clear benefits in claudicants. We assess adherence rates to OMT/SET and qualitative and quantitative studies attempting to understand the barriers to adoption. We also review how patient-reported outcome metrics were developed to assess QoL in claudicants and reasons for their underutilization in daily clinical practice. Last, we describe novel initiatives seeking to improve adherence to OMT, SET, and QoL assessment.