Exercise therapy is a key component of managing chronic symptomatic peripheral artery disease (PAD). This clinical consensus document, developed by the European Society of Cardiology, European Society of Vascular Medicine, and European Society for Vascular Surgery, outlines guidelines for supervised exercise programmes for patients with PAD. The document emphasizes that supervised exercise should be the first-line treatment for patients with PAD and exercise-induced limb symptoms. It also recommends that supervised exercise programmes be coordinated by vascular physicians and supervised by clinical exercise physiologists or physiotherapists. Before starting exercise training, a complete medical history and examination should be conducted to assess for contraindications. Walking ability, functional status, and quality of life should be assessed at the beginning and end of the programme to evaluate the patient's response to exercise training. Walking training (overground, pole striding, treadmill) is recommended as the first-line exercise modality. If walking is not an option, alternative training modalities such as resistance and strength training, arm-cranking, cycling, and combinations of exercise should be performed. The training frequency should be at least three times per week, with each session lasting a minimum of 30 minutes. The training programme should last a minimum of three months. Claudication pain and exercise intensity should be evaluated during training sessions. Patients should exercise to moderate–high claudication pain, but a more flexible approach may be required based on the patient's needs and preferences. Supervised exercise programmes should include structured education and counselling on cardiovascular and PAD risk factor reduction, with smoking cessation being a cornerstone of risk factor counselling. Following initial exercise training, patients are encouraged to sustain lifelong and high levels of regular physical activity. The document also highlights disparities in access to supervised exercise programmes across Europe and the need for further research on evidence gaps. The document provides recommendations for the assessment of vascular and functional status in patients with PAD, including the use of the ankle-brachial index (ABI) and the six-minute walk test (6MWT). It also discusses the mechanisms of response to exercise in PAD, including vascular remodelling and the role of exercise in improving walking capacity and quality of life. The document concludes that supervised exercise training is a safe and effective treatment for patients with chronic symptomatic PAD, and that home-based exercise training can be a valid alternative for patients who cannot participate in supervised programmes. The document also highlights the importance of long-term adherence to exercise therapy and the role of telemedical monitoring in improving outcomes.Exercise therapy is a key component of managing chronic symptomatic peripheral artery disease (PAD). This clinical consensus document, developed by the European Society of Cardiology, European Society of Vascular Medicine, and European Society for Vascular Surgery, outlines guidelines for supervised exercise programmes for patients with PAD. The document emphasizes that supervised exercise should be the first-line treatment for patients with PAD and exercise-induced limb symptoms. It also recommends that supervised exercise programmes be coordinated by vascular physicians and supervised by clinical exercise physiologists or physiotherapists. Before starting exercise training, a complete medical history and examination should be conducted to assess for contraindications. Walking ability, functional status, and quality of life should be assessed at the beginning and end of the programme to evaluate the patient's response to exercise training. Walking training (overground, pole striding, treadmill) is recommended as the first-line exercise modality. If walking is not an option, alternative training modalities such as resistance and strength training, arm-cranking, cycling, and combinations of exercise should be performed. The training frequency should be at least three times per week, with each session lasting a minimum of 30 minutes. The training programme should last a minimum of three months. Claudication pain and exercise intensity should be evaluated during training sessions. Patients should exercise to moderate–high claudication pain, but a more flexible approach may be required based on the patient's needs and preferences. Supervised exercise programmes should include structured education and counselling on cardiovascular and PAD risk factor reduction, with smoking cessation being a cornerstone of risk factor counselling. Following initial exercise training, patients are encouraged to sustain lifelong and high levels of regular physical activity. The document also highlights disparities in access to supervised exercise programmes across Europe and the need for further research on evidence gaps. The document provides recommendations for the assessment of vascular and functional status in patients with PAD, including the use of the ankle-brachial index (ABI) and the six-minute walk test (6MWT). It also discusses the mechanisms of response to exercise in PAD, including vascular remodelling and the role of exercise in improving walking capacity and quality of life. The document concludes that supervised exercise training is a safe and effective treatment for patients with chronic symptomatic PAD, and that home-based exercise training can be a valid alternative for patients who cannot participate in supervised programmes. The document also highlights the importance of long-term adherence to exercise therapy and the role of telemedical monitoring in improving outcomes.