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Peripheral Artery DiseasePhase 3IMPACT PADNCT06686121

Improving Mobility After Revascularization in Peripheral Artery Disease

A Phase 3 study testing Home Based Exercise and Nitrate Rich Beetroot Juice in people with Peripheral Artery Disease and Intermittent Claudication, run by Northwestern University at 8 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

Lower extremity revascularization combined with supervised exercise significantly improves walking performance compared to revascularization alone in people who have PAD without limb threatening ischemia. However, supervised exercise is inaccessible or burdensome for most PAD patients. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Home Based Exercise and Nitrate Rich Beetroot Juice
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
386 participants
Where
8 sitesUnited States
Study dates
4 Aug 2025to 1 Aug 2032
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 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Successful lower extremity revascularization for disabling PAD performed at least 30 days before baseline testing and between 30 and 100 days before randomization.

Who cannot join

  • History of leg amputation, not including toe and partial foot amputation
  • Active gangrene
  • Active limb threatening ischemia
  • Already exercising at a level consistent with exercise intervention, using investigator discretion.
  • Unstable angina
  • Unwilling to drink study beverages
Show all 27Show fewer
  • Unwilling to adhere to the interventions and complete follow-up testing
  • Currently taking sildenafil, tadalafil, or related drugs.
  • Unwilling to accept randomization into either group (home-based exercise or attention control)
  • Currently consuming beetroot juice, oral nitrate or nitrite, or a beetroot supplement and/or unwilling to avoid beetroot juice during the study. Participants will be asked to discontinue these items for 30 days before baseline testing and throughout the clinical trial. If the potential participant is unwilling to refrain from taking these items, they will not be eligible for the clinical trial.
  • History of kidney stones that requires minimized intake of oxalate. Potential participants who need to minimize oxalate intake will be excluded from the trial.
  • Baseline blood pressure <100/45.
  • Wheelchair confinement or requiring a walker to ambulate
  • Walking is limited by a condition other than PAD
  • Current foot ulcer
  • Planned major surgery, coronary revascularization, or lower extremity revascularization during the next 12 months
  • Major medical illness including lung disease requiring oxygen, Parkinson's disease, or a life-threatening illness with life expectancy less than six months.
  • Allergy to beetroot juice
  • Currently consuming one cup or more of beets daily. Participants will be asked to decrease beet consumption to less than one cup of beets per day for 14 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 for 30 days before the trial and during the trial, they will not be eligible for the clinical trial.
  • Participation in or completion of a clinical trial in the previous three months, using investigator discretion for trials that may not impact study participation or outcome measures of the IMPACT PAD Trial.
  • Visual impairment that limits walking ability.
  • Unable to communicate in English, unless the participant communicates in Spanish and is enrolled at a site that can deliver the intervention in Spanish. All sites with a Spanish speaking coordinator and interventionist will be able to enroll Spanish-speaking participants. While investigators aim to be as inclusive as possible, resources are not available to allow inclusion of people speaking languages that are not Spanish or English.
  • Using a mouthwash containing chlorhexidine or cetylpyridinium chloride or a mouthwash determined to be bactericidal and unwilling to discontinue.
  • Planning to begin a supervised treadmill exercise program in the next 12 months.
  • Heart attack or stroke in previous three months prior to baseline testing.
  • An eGFR value <30 or potassium >5.0.
  • 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

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

Mary M McDermott, MD contact

312-503-6438

mdm608@northwestern.edu

8 sites in 1 country

United States8 sites, 8 recruiting
  • Emory University School of Medicine

    Atlanta, Georgia, 30307

    Olamide Alabi, MD

    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

    Recruiting
  • Henry Ford Health

    Detroit, Michigan, 48202

    Jonathan Ehrman, PhD

    Recruiting
  • Rancho Research Institute

    Downey, California, 90242

    Tze-Woei Tan, MD

    Recruiting
  • Dartmouth Hitchcock Medical Center

    Lebanon, New Hampshire, 03766

    Philip P Goodney, MD

    Recruiting
  • University of South Florida

    Tampa, Florida, 33606

    Ulka Sachdev, MD

    Recruiting
  • University of Arizona

    Tucson, Arizona, 85724

    Wei Zhou, MD

    Recruiting

Other trials in United States

About this study

Official title: IMProving Mobility After revasCularizaTion in Peripheral Artery Disease: The IMPACT PAD Trial

Lower extremity revascularization combined with supervised exercise significantly improves walking performance compared to revascularization alone in people who have PAD without limb threatening ischemia. However, supervised exercise is inaccessible or burdensome for most PAD patients. Investigators hypothesize that home-based exercise combined with lower extremity revascularization will significantly improve walking performance compared to revascularization alone in patients with PAD undergoing revascularization for disabling PAD.

Investigators further hypothesize that inorganic nitrate, a major source of nitric oxide (NO) abundant in beetroot juice, will improve walking performance after lower extremity revascularization, compared to placebo. In preclinical models, NO inhibits inflammation, neointimal hyperplasia, thrombosis, and vascular smooth muscle cell migration at sites of revascularization. NO increases angiogenesis and perfusion, repairs skeletal muscle damaged by ischemia, and stimulates mitochondrial activity.

In a randomized clinical trial with a 2 x 2 factorial design, the trial will test the following two primary hypotheses in 386 patients randomized within three months of a successful lower extremity revascularization for disabling PAD: First, that home-based exercise combined with lower extremity revascularization will improve six-minute walk distance more than revascularization alone at 6-month follow-up (Primary Aim #1). Second, that nitrate-rich beetroot juice combined with lower extremity revascularization will improve six-minute walk, compared to placebo combined with revascularization at 6-month follow-up (Primary Aim #2).

Read the detailed description

More than 300,000 surgical or endovascular lower extremity revascularization procedures are performed annually for Medicare beneficiaries who have lower extremity peripheral artery disease (PAD) without limb threatening ischemia, and rates of these procedures are increasing. In these patients, revascularization typically improves, but does not eliminate, PAD related walking impairment. Lower extremity revascularization combined with supervised exercise significantly improves walking performance compared to revascularization alone in people who have PAD without limb threatening ischemia. However, supervised exercise is inaccessible or burdensome for most PAD patients. Investigators hypothesize that home-based exercise combined with lower extremity revascularization will significantly improve walking performance compared to revascularization alone in patients with PAD undergoing revascularization for disabling PAD.

Investigators further hypothesize that inorganic nitrate, a major source of nitric oxide (NO) abundant in beetroot juice, will improve walking performance after lower extremity revascularization, compared to placebo. In preclinical models, NO inhibits inflammation, neointimal hyperplasia, thrombosis, and vascular smooth muscle cell migration at sites of revascularization. NO increases angiogenesis and perfusion, repairs skeletal muscle damaged by ischemia, and stimulates mitochondrial activity. A large body of evidence, assembled over more than 25 years, supports our hypothesis that inorganic nitrate (such as that in nitrate-rich beetroot juice) will improve walking performance and other lower extremity outcomes after lower extremity revascularization.

Effective, accessible, and safe therapies are needed to enhance the benefits and improve durability of lower extremity revascularization. Therefore, in a randomized clinical trial with a 2 x 2 factorial design, the trial will test the following two primary hypotheses in 386 patients randomized within three months of a successful lower extremity revascularization for disabling PAD: First, that home-based exercise combined with lower extremity revascularization will improve six-minute walk distance more than revascularization alone at 6-month follow-up (Primary Aim #1). Second, that nitrate-rich beetroot juice combined with lower extremity revascularization will improve six-minute walk, compared to placebo combined with revascularization at 6-month follow-up (Primary Aim #2). In Secondary Aims, the trial will establish whether home-based exercise, compared to control, and whether nitrate-rich beetroot juice, compared to placebo, improve the Walking Impairment Questionnaire and the PROMIS Mobility Questionnaire and prevent hemodynamic failure of the revascularized vessel. In exploratory aims, the trial will test the effects of the interventions on plasma nitric oxide bioavailability. If our hypotheses are correct, results of this trial will have a major impact on improving mobility in the large and growing number of people undergoing revascularization for disabling PAD.

Being tested
Home Based Exercise, Nitrate Rich Beetroot Juice, Attention Control, Placebo Beetroot Juice Without Nitrate
Keywords
Behavior Change, Patient Reported Outcome Measures, Mobility, Revascularization, Peripheral artery disease, Intermittent claudication, 6-minute walk, Oxidative stress
Medical subject headings
Peripheral Arterial Disease, Intermittent Claudication, Peripheral Vascular Diseases, Mobility Limitation

What participants receive

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

  • Home Based ExerciseBehavioural

    This is a six month intervention where participants will walk at home for exercise with guidance from a study coach. They will attend two to four weekly meetings with the coach at the clinical site in the first 4 weeks following randomization, followed by once weekly telephone coaching calls for the remainder of the six-month intervention

  • Nitrate Rich Beetroot JuiceDrug

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

  • Attention ControlBehavioural

    Participants will be asked to participate in weekly meetings with the coach in the attention control group for weeks 1-26. A staff member will present a topic from the National Institute on Aging "age pages" relevant to health, such as cancer screening or blood pressure treatment. Calls will last approximately 5-15 minutes and will focus on educational topics such as diabetes, healthy eating, and Medicare Part D.

  • Placebo Beetroot Juice Without NitrateDrug

    Participants will drink one shot of placebo beetroot without nitrate juice twice daily for six months.

Study groups in NCT06686121
Study groupRoleWhat they receive
Home based exercise + nitrate rich beetroot juiceExperimentalThis group will be participating in home based exercise and drinking nitrate rich beetroot juice for six months.
Receives: Behavioral: Home Based Exercise; Drug: Nitrate Rich Beetroot Juice
Home-based exercise + placeboPlacebo comparatorThis group will be participating in home based exercise and drinking placebo beetroot juice with nitrate removed for six months.
Receives: Behavioral: Home Based Exercise; Drug: Placebo Beetroot Juice Without Nitrate
Attention control + nitrate-rich beetroot juiceExperimentalThis group will be participating in attention control and drinking nitrate rich beetroot juice for six months.
Receives: Drug: Nitrate Rich Beetroot Juice; Behavioral: Attention Control
Attention control + placeboPlacebo comparatorThis group will be participating in attention control and drinking placebo beetroot juice with nitrate removed for six months.
Receives: Behavioral: Attention Control; Drug: Placebo Beetroot Juice Without Nitrate

What is being measured

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

  1. Six-Minute Walk Distance 6-month change

    Distance walked in six minutes

    Measured: Baseline to 6-month follow-up

Secondary outcomes (6)
  1. Walking Impairment Questionnaire (WIQ) Distance Score 6-month change

    Patient reported ability to walk long distances. Score Range 0-100, 100 is best.

    Measured: Baseline to 6-month follow-up.

  2. Walking Impairment Questionnaire (WIQ) Distance Score 12-month change

    Patient reported ability to walk long distances. Score Range 0-100, 100 is best.

    Measured: Baseline to 12-month follow-up

  3. PROMIS Mobility Questionnaire Score 6-month change

    Patient report of mobility in daily living. Score range is from zero to infinity and a higher score means a better outcome.

    Measured: Baseline to 6-month follow-up

  4. PROMIS Mobility Questionnaire Score 12-month change

    Patient report of mobility in daily living. Score range is from zero to infinity and a higher score means a better outcome.

    Measured: Baseline to 12-month follow-up.

  5. Prevention of Hemodynamic Failure of The Revascularized Vessel

    Hemodynamic failure consists of loss of patency of the revascularized vessel. The outcome will be adjudicated as a categorical outcome. Medical records between randomization and final follow-up will be obtained and reviewed by the IMPACT PAD adjudication committee, consisting of field center investigators and an interventional cardiologist. Participants who meet pre-defined criteria for hemodynamic failure of the revascularized vessel.

    Measured: Baseline to 12 month follow-up

  6. Change in 6-minute walk distance

    Change in 6-minute walk distance between baseline and 12-month follow-up

    Measured: 12 month 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 posted13 Nov 2024
  2. Study start4 Aug 2025
  3. Primary completion1 Feb 2032 (estimated)
  4. Study completion1 Aug 2032 (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
Two x two factorial design
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
386 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06686121
Sponsor's protocol ID
STU00222333
Acronym
IMPACT PAD
Status last verified
Sep 2026
First submitted
8 Nov 2024
Last updated
5 Oct 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Yes

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Home Based Exercise and Nitrate Rich Beetroot Juice in people with Peripheral Artery Disease and Intermittent Claudication, run by Northwestern University at 8 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 1 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 5 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 8 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 M 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 6-month change (time frame: Baseline to 6-month follow-up). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 5 Oct 2026; AzTrials last refreshed its copy on 26 Oct 2026.

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