We agree with Jim Reekers that the IMPERIAL trial,1 in both device concept and trial design, as well as in its outcome, was unique and important in the endovascular field. We also wholeheartedly support the use of supervised exercise training in peripheral arterial disease patients as a valuable primary and adjunctive tool to improve symptoms and functional capacity, and we are especially pleased at the decision in 2017 by the US Centers for Medicare & Medicaid Services.