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Peripheral Arterial DiseasePhase 3NCT06032065

SMART Exercise for PAD

A Phase 3 study testing Supervised Treadmill Exercise, Home-Based Exercise and Nitrate-rich beetroot Juice in people with Peripheral Arterial Disease and Aging, run by Northwestern University at 3 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Supervised exercise therapy (SET), consisting of treadmill exercise conducted three times weekly at a center while supervised by healthcare personnel, is first line therapy for people disabled by lower extremity peripheral artery disease (PAD). However, travelling three times/week to a center for SET is burdensome. Read more about this study

Who is it for?
Ages 50 years and older
What is being tested?
Supervised Treadmill Exercise, Home-Based Exercise and Nitrate-rich beetroot Juice
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
210 participants
Where
3 sitesUnited States
Study dates
8 Sep 2023to 31 Mar 2029
Phase
Phase 3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 50 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • First, all participants will be age 50 and older. Second, all participants will have PAD. PAD will be defined as either:
  • An ABI <= 0.90 at baseline.
  • Vascular lab evidence of PAD (such as a toe brachial pressure less than or equal to 0.70 or an ankle brachial index less than or equal to 0.90), or angiographic evidence of PAD defined as at least 70% stenosis of an artery supplying the lower extremities.
  • An ABI of >0.90 and <1.00 who experience a 20% or greater drop in ABI in either leg after the heel-rise test.

Who cannot join

  • Above- or below-knee amputation
  • Limb-threatening ischemia defined as an ABI <0.40 with symptoms of rest pain
  • Wheelchair confinement or requiring a walker to ambulate
  • Walking is limited by a condition other than PAD
  • Current foot ulcer on bottom of foot
  • Unwilling to drink beetroot juice
Show all 27Show fewer
  • Unwilling to accept randomization into either group (home based exercise or supervised exercise)
  • Planning to engage in new walking exercise outside of the study or unwilling to refrain from new walking exercise activity during the trial.
  • Already exercising at a level consistent with exercise intervention.
  • End-stage kidney disease (ESKD) associated with the need for dialysis.
  • Planned major surgery, coronary or leg revascularization during the next six months
  • Major surgery, coronary or leg revascularization or major cardiovascular event in the previous three months
  • Major medical illness including lung disease requiring oxygen, Parkinson's disease, a life-threatening illness with life expectancy less than six months, or cancer requiring treatment in the previous two years. [NOTE: potential participants may still qualify if they have had treatment for an early stage cancer in the past two years and the prognosis is excellent. Participants who require oxygen only at night may still qualify.]
  • Mini-Mental Status Examination (MMSE) score < 23 or dementia. However, if the MMSE is < 23 and the Principal Investigator evaluation determines that the lower score is related to language barriers or education level, the Principal Investigator has discretion to allow a participant with MMSE < 23 to participate, as appropriate.
  • Allergy to beetroot juice
  • Currently consuming beetroot juice or oral nitrate or nitrite, or a beetroot supplement, and/or unwilling to avoid these during study participation. Participants currently consuming one cup of beets daily will be asked to discontinue beet ingestion for 30 days before baseline testing and throughout the clinical trial. If the potential participant is unwilling to refrain from daily beet consumption of one cup or more, they will not be eligible for the clinical trial.
  • Unstable angina
  • Abnormal baseline stress test without subsequent clearance for exercise by physician
  • Non-English speaking. The SMART PAD interventions are delivered by interventionists who do not speak non-English languages. The integrity of the clinical trial requires clear and effective communication for data collection and intervention delivery. The trial does not have staff members who are fluent in non-English languages, nor does it have the ability to translate all study materials into other languages.
  • Participation in or completion of a clinical trial in the previous three months. [NOTE: after completing a stem cell or gene therapy intervention, participants will become eligible after the final study follow-up visit of the stem cell or gene therapy study so long as at least six months have passed since the final intervention administration. After completing a supplement or drug therapy (other than stem cell or gene therapy), participants will be eligible after the final study follow-up visit as long as at least three months have passed since the final intervention of the trial.] Participants in a study that involved up to three single doses of nitrate-rich beetroot juice administered on separate days may participate if a month has passed since their last dose of nitrate-rich beetroot juice.
  • Visual impairment that limits walking ability.
  • Baseline blood pressure <100/45.
  • Participation in a supervised treadmill exercise program or cardiac rehabilitation program in previous three months.
  • Using a mouthwash containing chlorhexidine or cetylpyridinium chloride or a mouthwash determined to be bactericidal and unwilling to discontinue.
  • An eGFR value <30 or potassium >5.0.
  • History of kidney stones that requires minimized intake of oxalate. Potential participants who need to minimize oxalate intake will be excluded from the trial.
  • In addition to the above criteria, investigator discretion will be used to determine if the trial is unsafe or not a good fit for the potential participant.

Trial locations and contacts

3 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Mary McDermott, MD contact

312-503-6438

mdm608@northwestern.edu

United States3 sites, 3 recruiting
  • Northwestern University Feinberg School of Medicine

    Chicago, Illinois, 60611

    Kathryn Domanchuk, BS, 312-503-6438, k-domanchuk@northwestern.edu

    Mary M McDermott, MD

    Recruiting
  • University of Chicago

    Chicago, Illinois, 60637

    Tamar Polonsky, MD, 773-702-6153, tpolonsky@bsd.uchicago.edu

    Recruiting
  • University of Minnesota

    Minneapolis, Minnesota, 55455

    Diane Treat-Jacobson, PhD, 612-624-7613, treat001@umn.edu

    Recruiting

Other trials in United States

About this study

Official title: Sequential Multiple Assessment Randomized Trial of Exercise for PAD: SMART Exercise for Peripheral Artery Disease: The SMART PAD Trial

Supervised exercise therapy (SET), consisting of treadmill exercise conducted three times weekly at a center while supervised by healthcare personnel, is first line therapy for people disabled by lower extremity peripheral artery disease (PAD). However, travelling three times/week to a center for SET is burdensome. Compared to SET, home-based exercise is more accessible and less burdensome. Yet, evidence-based guidelines recommend SET over home-based exercise for PAD. Walking exercise is first line therapy to improve walking distance for PAD, but it does not eliminate ischemic leg symptoms in most people with PAD. The investigators' work and that of others showed that nitrate-rich beetroot juice, which increases plasma nitrite, limb perfusion, and skeletal muscle function, significantly improved exercise tolerance and reduced non-response to exercise in people with and without PAD. The investigators will use a 2 x 2 factorial design to address two major barriers to achieving benefits from exercise therapy for PAD: First, guideline recommendations for supervised exercise therapy (SET) as first line therapy for PAD. Second, the inability of exercise therapy to eliminate PAD-related disability in most people with PAD. Participants will be randomized to one of four groups for 12 weeks: Supervised treadmill exercise + nitrate rich beetroot juice; supervised treadmill exercise + placebo, home-based walking exercise + nitrate rich beetroot juice, home-based walking exercise + placebo.

Read the detailed description

Supervised exercise therapy (SET), consisting of treadmill exercise conducted three times weekly at a center while supervised by healthcare personnel, is first line therapy for people disabled by lower extremity peripheral artery disease (PAD). However, travelling three times/week to a center for SET is burdensome. As of 2018, only 1.3% of patients with Medicare and symptomatic PAD had enrolled in SET. Compared to SET, home-based exercise is more accessible and less burdensome. Yet, evidence-based guidelines recommend SET over home-based exercise for PAD. In 2021, the investigators reported that a home-based exercise intervention that incorporated behavioral methods significantly improved six-minute walk in PAD, compared to an attention control group. But no randomized trials have compared SET to a home-based exercise intervention that incorporated behavioral change methods in PAD. However, 45% of people with PAD do not meaningfully respond to exercise interventions, defined as failure to improve six-minute walk by > 20 meters. This phenomenon occurs for both supervised and home-based exercise. The investigators' work and that of others showed that nitrate-rich beetroot juice, which increases plasma nitrite, limb perfusion, and skeletal muscle function, significantly improved exercise tolerance and reduced non-response to exercise in people with and without PAD. Therefore, the investigators will use a 2 x 2 factorial design to address two major barriers to achieving benefits from exercise therapy for PAD: First, guideline recommendations for supervised exercise therapy (SET) as first line therapy for PAD. Second, the inability of exercise therapy to eliminate PAD-related disability in most people with PAD. In this 2 x 2 factorial design, participants will be randomized to one of four groups for 12 weeks: Supervised treadmill exercise + nitrate rich beetroot juice; supervised treadmill exercise + placebo, home-based walking exercise + nitrate rich beetroot juice, home-based walking exercise + placebo.

Being tested
Supervised Treadmill Exercise, Home-Based Exercise, Nitrate-rich beetroot Juice
Keywords
behavior change, patient reported outcome measure
Medical subject headings
Peripheral Arterial Disease, Peripheral Vascular Diseases, Mobility Limitation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Supervised Treadmill ExerciseBehavioural

    This is a 12 week intervention where participants will walk for exercise 3 times a week on a treadmill at a center while being supervised by healthcare personnel.

  • Home-Based ExerciseBehavioural

    This is a 12 week intervention where participants will walk at home for exercise with guidance from a study coach. They will have 4 in person visits in the first four weeks and then have weekly phone calls in the last 8 weeks of the intervention with their coach.

  • Nitrate-rich beetroot JuiceDietary supplement

    Participants will drink one shot of nitrate rich beet-root juice twice daily for 12 weeks.

Study groups in NCT06032065
Study groupRoleWhat they receive
Supervised treadmill exercise + nitrate rich beetroot juiceExperimentalThis group will be participating in Supervised Treadmill Exercise and drinking nitrate rich beetroot juice for 12 weeks.
Receives: Behavioral: Supervised Treadmill Exercise; Dietary Supplement: Nitrate-rich beetroot Juice
Supervised treadmill exercise + placeboPlacebo comparatorThis group will be participating in Supervised Treadmill Exercise and drinking placebo beetroot juice with nitrate removed for 12 weeks.
Receives: Behavioral: Supervised Treadmill Exercise
Home-based walking exercise + nitrate rich beetroot juiceExperimentalThis group will be participating in Home-Based Exercise and drinking nitrate rich beetroot juice for 12 weeks.
Receives: Behavioral: Home-Based Exercise; Dietary Supplement: Nitrate-rich beetroot Juice
Home-based walking exercise + placeboPlacebo comparatorThis group will be participating in Home-Based Exercise and drinking placebo beetroot juice with nitrated removed for 12 weeks.
Receives: Behavioral: Home-Based Exercise

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Six-Minute Walk Distance

    Change in six-minute walk distance

    Measured: Measured at baseline and 12 week follow-up

Secondary outcomes (5)
  1. Walking Impairment Questionnaire (WIQ) Distance Score

    WIQ distance score - Range 0-100, 100 is best.

    Measured: measured at baseline and 12 weeks

  2. PROMIS Mobility Questionnaire Score

    PROMIS mobility score from administered PROMIS questionnaire. Score range is from zero to infinity and a higher score means a better outcome.

    Measured: measured at baseline and 12 weeks

  3. 20-meter Improvement in Six-Minute Walk Distance

    Meaningful response to exercise interventions

    Measured: measured at 12 weeks

  4. Step Count

    Step count measured over seven days with the FITBIT

    Measured: measured at baseline and 12 weeks

  5. Six-Minute Walk Distance

    Change in six-minute walk distance

    Measured: Measured at baseline and 24-week follow up

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 Sep 2023
  2. Study start8 Sep 2023
  3. Primary completion1 Nov 2028 (estimated)
  4. Study completion31 Mar 2029 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Factorial
Model description
The investigators will use a 2 x 2 factorial design to address two major barriers to achieving benefits from exercise therapy for PAD: First, guideline recommendations for supervised exercise therapy (SET) as first line therapy for PAD. Second, the inability of exercise therapy to eliminate PAD-related disability in most people with PAD. In this 2 x 2 factorial design, participants will be randomized to one of four groups for 12 weeks: Supervised treadmill exercise + nitrate rich beetroot juice; supervised treadmill exercise + placebo, home-based walking exercise + nitrate rich beetroot juice, home-based walking exercise + placebo.
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
210 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06032065
Sponsor's protocol ID
STU00218112
Status last verified
Apr 2026
First submitted
22 May 2023
Last updated
15 Apr 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • McDermott MM, Cetlin MD, Domanchuk KJ, Xu S, Whipple MO, Polonsky T, Criqui MH, Guralnik JM, Tian L, Zhao L, Ho KJ, Greenland P, Treat-Jacobson D. Community-based recruitment with ankle brachial index testing to identify peripheral artery disease participants for randomized clinical trials. Am Heart J. 2026 Oct;300:107450. doi: 10.1016/j.ahj.2026.107450. Epub 2026 Apr 24.

    PubMed 42035974

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Supervised Treadmill Exercise, Home-Based Exercise and Nitrate-rich beetroot Juice in people with Peripheral Arterial Disease and Aging, run by Northwestern University at 3 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 27 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 15 Apr 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Mary McDermott, MD (312-503-6438, mdm608@northwestern.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Six-Minute Walk Distance (time frame: Measured at baseline and 12 week follow-up). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06032065, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Apr 2026; AzTrials last refreshed its copy on 27 Oct 2026.

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