This clinical consensus document, developed by the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases in collaboration with the European Society of Vascular Medicine and the European Society for Vascular Surgery, provides guidance for the management of patients with chronic symptomatic peripheral artery disease (PAD). The document emphasizes the importance of exercise therapy as a cornerstone of treatment, particularly structured programs that include walking training, resistance training, and other modalities. Key recommendations include: 1. **Walking Training**: Walking should be the primary exercise modality, with alternative training methods available for those unable to walk. 2. **Training Frequency and Duration**: At least three sessions per week, each lasting at least 30 minutes, over a minimum duration of three months. 3. **Training Intensity**: Patients should exercise to moderate to high claudication pain, with a flexible approach to prescription based on individual needs and preferences. 4. **Supervised vs. Home-Based Exercise**: Supervised programs are recommended for optimal results, but home-based programs can be effective with proper monitoring. 5. **Long-Term Adherence**: Education, self-efficacy, goal setting, and feedback are crucial for long-term adherence. 6. **Mechanisms of Response**: Exercise induces vascular remodeling, mitochondrial biogenesis, and angiogenesis, improving functional capacity and reducing symptoms. 7. **Exercise and Revascularization**: Exercise is recommended as an initial treatment, with revascularization considered for non-responsive cases. 8. **Health-Related Quality of Life**: Exercise improves both physical and mental health-related quality of life, with greater improvements in physical function leading to better self-perceived HRQoL. The document also highlights disparities in access to supervised exercise programs across Europe and calls for further research to address these gaps.This clinical consensus document, developed by the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases in collaboration with the European Society of Vascular Medicine and the European Society for Vascular Surgery, provides guidance for the management of patients with chronic symptomatic peripheral artery disease (PAD). The document emphasizes the importance of exercise therapy as a cornerstone of treatment, particularly structured programs that include walking training, resistance training, and other modalities. Key recommendations include: 1. **Walking Training**: Walking should be the primary exercise modality, with alternative training methods available for those unable to walk. 2. **Training Frequency and Duration**: At least three sessions per week, each lasting at least 30 minutes, over a minimum duration of three months. 3. **Training Intensity**: Patients should exercise to moderate to high claudication pain, with a flexible approach to prescription based on individual needs and preferences. 4. **Supervised vs. Home-Based Exercise**: Supervised programs are recommended for optimal results, but home-based programs can be effective with proper monitoring. 5. **Long-Term Adherence**: Education, self-efficacy, goal setting, and feedback are crucial for long-term adherence. 6. **Mechanisms of Response**: Exercise induces vascular remodeling, mitochondrial biogenesis, and angiogenesis, improving functional capacity and reducing symptoms. 7. **Exercise and Revascularization**: Exercise is recommended as an initial treatment, with revascularization considered for non-responsive cases. 8. **Health-Related Quality of Life**: Exercise improves both physical and mental health-related quality of life, with greater improvements in physical function leading to better self-perceived HRQoL. The document also highlights disparities in access to supervised exercise programs across Europe and calls for further research to address these gaps.