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Peripheral artery disease (PAD) is the manifestation of atherosclerotic plaque in the larger arteries in the legs, which results in impaired blood flow and oxygen (O 2) delivery to the lower extremities ( 28). Aquatic walking exercise training may be a useful therapeutic intervention for improving physical function in patients with PAD. Aquatic walking exercise training demonstrates relatively high exercise adherence in this population. NEW & NOTEWORTHY The results of this study reveal for the first time that aquatic walking exercise can decrease arterial stiffness and improve exercise tolerance, cardiorespiratory capacity, and muscular strength in patients with peripheral artery disease (PAD). These results suggest that aquatic walking exercise is an effective therapy to reduce arterial stiffness and resting HR and improve cardiorespiratory capacity, exercise tolerance, physical function, and muscular strength in patients with PAD. Interestingly, there was relatively high adherence (84%) to the aquatic walking exercise program in this population. There were significant group × time interactions ( P 0.05) for BP, ABI, RMR, or flexibility after 12 wk. Leg arterial stiffness, heart rate (HR), blood pressure (BP), ankle-to-brachial index (ABI), V̇ o 2max, 6MWD, physical function, muscular strength, body composition, resting metabolic rate (RMR), and flexibility were measured before and after 12 wk. The AQ group performed walking and leg exercises in waist-to-chest-deep water. Patients with PAD ( n = 72) were recruited and randomly assigned to a 12-wk aquatic walking training group (AQ, n = 35) or a control group (CON, n = 37). We sought to examine the effects of aquatic walking exercise on cardiovascular function, cardiorespiratory capacity, exercise tolerance, physical function, muscular strength, and body composition in patients with PAD. It is essential to combat these negative effects on health by incorporating lifestyle interventions to slow disease progression, such as exercise. Peripheral artery disease (PAD) is an atherosclerotic disease that is associated with attenuated vascular function, cardiorespiratory capacity, physical function, and muscular strength.