HIT Training in the Frail Elderly.

Study Overview
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Brief Summary
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This pilot study aims to investigate whether high intensity interval training can result in rapid improvements in physical fitness amongst the frail elderly (over 70 years old). Participants will undergo a wide range of physical fitness measures followed by a four week exercise protocol. Determination of improvement will be by repeated testing of the physical measures taken for baseline. The primary outcome measure will be anaerobic threshold. There will also be a subgroup of participants who will undergo muscle biopsy and D2O ingestion to allow an insight into the mechanistic basis behind exercise training response in this age group.

Official Title
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Improvements in Aerobic Performance Following a Four-week Period of High Intensity Interval Training in the Elderly.

Conditions
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Sarcopenia, Aged, Exercise, Preoperative Care

Intervention / Treatment
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* Behavioral: HIIT Device: ergometer


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged over 70 years. Sufficient mobility to be able to exercise on a static exercise bike. Availability for the entire trial period. Sufficient capacity to consent for the trial. Exclusion Criteria: Participants under the age of 70 years. Participants with a significant past medical history of: Myocardial infarction (within last 6 months) Unstable Angina Heart failure (NYHA class III/IV) Uncontrolled Hypertension (BP>160/100) Previous stroke/TIA Severe respiratory disease inc. known pulmonary hypertension(>25 mmHg), Forced -Expiratory Volume in 1 second <1.5l. Brittle asthma / exercise induced asthma Known cerebral aneurysm or abdominal aortic aneurysm. Cognitive impairment, which may reduce individuals' ability to provide informed consent. Inclusion in a recent study which included any form of exercise, taking a drug or ionising radiation. Exclusion criteria pertaining specifically to muscle biopsies: Current use of anticoagulation (i.e. Warfarin/Clopidogrel/Rivaroxaban) Any pre-existing clotting disorders known to the patient (i.e. haemophilia). Family history of severe bleeding requiring medical intervention. Any musculoskeletal deformity or skin conditions making the taking of a biopsy unsuitable as deemed by the medical practitioner taking that sample. Lack of capacity to fully consent for the procedure.

Ages Eligible for Study
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Minimum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Intervention Model: Single Group Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: High intensity exercise training<br>HIT training protocol. | Behavioral: HIIT Device: ergometer<br>* Supervised exercise training.<br>* Other names: High intensity interval training;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean anaerobic threshold improvement following 4 week HIT protocol. | Measured via cardiopulmonary exercise testing (mls/kg/min and absolute value L/kg). Pre-Post testing. | 4 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean VO2 peak improvement following 4 week HIT protocol. | Measured via cardiopulmonary exercise testing (mls/kg/min and absolute value L/kg). Pre-Post testing. | 4 weeks | 
| Muscle protein synthesis | Assessment of D2O evaluated muscle protein synthesis following HIT programme. Using mass spectrometry for analysis of stable isotope uptake during training program (arbitrary units). | 4 weeks | 
| Body composition | DXA changes in body composition (lean muscle mass (%), fat mass (%) and bone density g/cm3)) following a HIT programme | 4 weeks | 
| Muscle architecture | Ultrasound scans used to assess changes in lean muscle mass and architecture following a HIT programme (mm and % pennation angle change). | 4 weeks | 
| Feasibility | Determination of frail elderly patient adherence to HIT programme (number of scheduled sessions successfully completed within 28 days). | 4 Weeks | 
| Quality of life improvement | Quality of life questionnaires to measure subjective outcomes (EQ-5D questionnaire) | 4 weeks | 
| Daily Activity Level | Activity questionnaire to quantify habitual physical activity (IPAQ questionnaire) | 4 weeks | 
| Physical Activity Score | Subjective assessment of physical ability (DASI questionnaire) | 4 weeks |