<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Aims</jats:title> <jats:p>Aerobic exercise (AE) is a cornerstone of management for patients with peripheral arterial disease (PAD) due to its benefits for functional capacity and quality of life. While the short-term effects of AE therapy are well documented, the long-term effects remain unclear. Therefore, this study aimed to investigate the long-term effects of aerobic exercise training in patients with PAD.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results</jats:title> <jats:p>A search of six electronic databases from inception to December 2024 was conducted, and studies were screened using the Rayyan AI tool. Randomized controlled trials involving AE interventions lasting more than 8 weeks with a follow-up period of any length were included. Risk of bias and methodological quality were assessed using the Cochrane Collaboration's risk of bias tool and the PEDro Scale, respectively. Six randomized controlled trials involving a total of 2,233 participants were included. Strong evidence indicates that improvements in physical activity levels achieved with lower extremity AE training are not maintained in the long term. However, there is conflicting evidence regarding the long-term maintenance of walking ability, functional status, mobility, and quality of life, as well as weak evidence for improvements in anxiety, depression, and self-efficacy. A meta-analysis could not be conducted due to substantial variation in outcome measures among the included studies.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>This systematic review indicates that the benefits of lower extremity AE training are not maintained at expected levels over the long term. Therefore, it is crucial to promote exercise as a lifelong habit and implement community-based exercise strategies for patients with PAD.</jats:p> </jats:sec> <jats:sec> <jats:title>Registration</jats:title> <jats:p>PROSPERO CRD42024603996</jats:p> </jats:sec>