Alpha and Omega of Lifestyle Therapy

Study Overview
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Brief Summary
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The study aims to investigate the effects of double-blinded, randomized placebo-controlled n3-fatty acid supplementation (1000 mg day-1) and 13 weeks of resistance training on muscle function/biology and systemic health in individuals with obesity (BMI>30) and lean individuals (BMI<30)

Detailed Description
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Lifestyle therapy is important for treating lifestyle-related morbidities such as obesity. Such therapy often includes exercise and nutrition, and leads to improved health, functionality and quality of life. Unfortunately, obesity leads to adverse changes in the physiological milieu, including inflammation and altered nutritional status such as reduced omega-3:omega-6 ratios. Indeed, inadequate omega 3 levels are common even among lean individuals. This may negatively affect the outcome of lifestyle therapy with exercise, particularly those involving resistance training, contributing to the large heterogeneity seen in training responses. In accordance with this, many individuals (including both lean and obese subjects) fail to improve muscle biology/functions and health, including failure to increase muscle mass and strength, failure to improve glucose handling and inflammatory status. This makes general lifestyle therapy recommendations ineffective. Here, we investigate effects of double-blinded, randomized placebo-controlled n3-fatty acid supplementation (1000 mg day-1) and 13 weeks of low- and high-load resistance training on muscle growth/function/biology and health in individuals with obesity (BMI>30, n=60) and lean controls (BMI<30, n=60). Each participant will perform two different training protocols, one on each leg. The supplement period will commence 7 weeks prior to the onset of the strength training intervention to ensure adequate omega-3 biology at the onset of training. Analyses include assessment of the separate and combined effects of n3-supplementation and obesity on training responses to resistance training, measured as muscle mass, muscle strength/functionality, muscle biological traits, and systemic health variables such as hormone/inflammation/glucose biology, adipose tissue biology/mass, gut microbiome and health-related quality of life. The project will provide important insight into the feasibility of resistance training and n-3 fatty acid supplementation for treating individuals with obesity, paving the way for personalized lifestyle therapy. The study has two defined main outcome measures, targeting the combined effects of omega-3 and strength training on i) muscle thickness of the thigh (measured using ultrasound; this main outcome measure targets the effects of the intervention on muscle growth), and ii) glucose tolerance (measured using an oral glucose test; this main outcome measure targets the effects of the intervention on improvements in health). In our analytical approach, we will use a mixed model-approach to assess the main effects of the intervention, mainly defined as changes from before to after the resistance training intervention. Importantly, for health variables such as glucose tolerance, analyses will be performed by accounting for individual variation at baseline, as any beneficial effect can be expected to be higher/present only in individuals with a pathological/diseased starting point. Notably, for many variables, we will collect data from two additional time points (pre-supplementation and after two weeks of familiarization to training). These data will provide insight into additional perspectives, such as the effects of omega-3 intake-only on glucose tolerance, which will bring additional depth to our conclusions (these analyses are not necessarily specified in the Outcome Measures section). For other data, such as primary cultivation of skeletal muscle and muscle mitochondrial respiration, data will only be collected from a randomized subset of participants. For analyses of the effects of the intervention on obesity-related pathophysiologies and health-related quality of life, data from a group of non-intervention individuals will act as reference values (data sampled alongside the intervention). Finally, we will use regression analyses to explain individual differences in training responses, with particular emphasis on muscle hypertrophy/glucose tolerance and their mechanistic origin of nature. 2021/08: The number of anticipated participants was increased from 120 to 150 due to circumstances relating to the SARS-CoV-2 pandemic

Official Title
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Alpha and Omega of Lifestyle Therapy - Resistance Training and Ingestion of n-3 Polyunsaturated Fatty Acids to Improve Health and Muscle Functions in Individuals With Obesity and Healthy Controls

Conditions
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Obesity

Intervention / Treatment
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* Other: Resistance exercise
* Dietary Supplement: Omega-3
* Dietary Supplement: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Untrained (less than 2 sessions of resistance exercise per month and less than 3 hours of endurance exercise per week) Exclusion Criteria: Unstable cardiovascular disease Injuries affecting the ability to perform heavy resistance exercise Mental illness Allergy to local anesthesia Smoking Use of medicine or drugs containing steroids the last two months prior to inclusion

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 60 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
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Omega 3<br>Intake of 1 gram omega-3 (capsules) per day for 20 weeks + high-load and low-load resistance exercise two times per week for 10 weeks, preceded by 3 weeks of familiarization to training (high-load training) | Other: Resistance exercise<br>* High-load and low-load resistance exercise two times per week for 10 weeks, preceded by 3 weeks of familiarization to training (high-load training)<br>Dietary Supplement: Omega-3<br>* 1 gram of omega-3 per day for 20 weeks<br>* Other names: N-3 PUFA;|
| Placebo Comparator: Placebo<br>Intake of 1 gram sunflower oleic oil (capsules) per day for 20 weeks + high-load and low-load resistance exercise two times per week for 10 weeks, preceded by 3 weeks of familiarization to training (high-load training) | Other: Resistance exercise<br>* High-load and low-load resistance exercise two times per week for 10 weeks, preceded by 3 weeks of familiarization to training (high-load training)<br>Dietary Supplement: Placebo<br>* 1 gram of sunflower oleic oil per day for 20 weeks<br>|
| No Intervention: Control<br>No intervention | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Muscle thickness, ultrasound | Muscle thickness of vastus lateralis and vastus intermedius measured using ultrasound | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Glucose tolerance | Glucose tolerance measured using an oral glucose tolerance test | Changes from before to after the resistance training intervention (week 8 to 20) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lean body mass | Lean body mass measured using whole-body DXA scan | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Fat mass | Fat mass measured using whole-body DXA scan | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Visceral fat mass | Visceral fat mass measured using whole-body DXA scan | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Muscle mass, MRI | Thigh muscle cross sectional area/volume measured using magnetic resonance imaging (MRI) | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Muscle mass, immunohistochemistry | Fibre type-specific muscle-fibre cross-sectional area measured using immunohistochemistry | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Muscle mass, combined measure | Muscle mass of the legs measured as the weighted average of data from ultrasound, MRI, immunohistochemistry and DXA measurements | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Muscle fibre type composition | Muscle fibre type composition measured using immunohistochemistry | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Myonuclear number | Fiber type-specific myonuclear number measured using immunohistochemistry | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Muscle satellite cell number | Fiber type-specific muscle satellite cell number measured using immunohistochemistry | Changes throughout the course of the resistance training intervention (weeks 8, 10 and 20) | 
| Muscle capillarization | Fiber type-specific muscle capillarization measured using immunohistochemistry | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Fat infiltration (muscle) | Fat infiltration in thigh muscle measured using magnetic resonance imaging (MRI) | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Muscle quality | Muscle strength measured per muscle mass of the legs | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Unilateral lower body maximal strength | The ability of muscles of the lower body to exert maximal force during dynamic movements | Changes throughout the course of the resistance training intervention (weeks 8, 10 and 20) | 
| Unilateral lower body isokinetic muscle strength | The ability of the knee extensors to exert maximal force during isokinetic movements | Changes throughout the course of the resistance training intervention (weeks 8, 10 and 20) | 
| Unilateral lower body isometric muscle strength | The ability of the knee extensors to exert maximal force during isometric actions | Changes throughout the course of the resistance training intervention (weeks 8, 10 and 20) | 
| Peak power output during one-legged cycling | Maximal cycling performance measured as peak power output (Watt) during an incremental one-legged cycling test | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Oxygen consumption during one-legged cycling | The ability to consume oxygen during an incremental one-legged cycling test | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Unilateral lower body muscle endurance | The ability of muscles of the lower body to perform repeated dynamic contractions at a specified submaximal load (70% of 1RM) to exhaustion | Changes throughout the course of the resistance training intervention (weeks 8, 10 and 20) | 
| Waist circumference | Circumference of the waist measured using measuring tape | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Blood pressure at rest | Blood pressure at rest measured using an automated upper-arm blood pressure cuff | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Hemoglobin glycosylation (HbA1c) | Long-term glucose levels measured as hemoglobin glycosylation of the metabolic syndrome such as waist circumference, blood pressure at rest, lipid profile ( hemoglobin glycosylation (HbA1c) and fasting blood glucose | Changes throughout the course of the intervention (weeks 0, 8 and 20) | 
| Fasting blood glucose | Fasting blood glucose measured in serum | Changes throughout the course of the intervention (weeks 0, 8 and 20) | 
| N-3 PUFA (blood) | Omega-3 (DHA/EPA) levels in blood | Changes throughout the course of the intervention (weeks 0, 8 and 20) | 
| Inflammatory characteristics of peripheral blood mononuclear cell (PBMC) | Expression of genes associated with inflammation and lipid metabolism in peripheral blood mononuclear cell measured using quantitative PCR | Throughout the course of the intervention (weeks 0, 8 and 20) | 
| Lipid concentrations in blood | Concentrations of various lipids and lipid metabolites such as triglycerides, LDL, HDL, ceramides, dihydroceramides, glucosylceramides, and lactosylceramides measured in serum using tageted metabolomics | Changes throughout the course of the intervention (weeks 0, 8 and 20) | 
| Nutritent concentrations in blood | Concentrations of nutrients (such as amino acids) and ions (such as iron and calcium) measured in serum | Changes throughout the course of the intervention (weeks 0, 8 and 20) | 
| Hormone concentrations in blood | Concentrations of hormones such as testosterone, growth hormone, thyroid hormones, cortisol and insulin (as well as c-peptide) measured in serum | Changes throughout the course of the intervention (weeks 0, 8 and 20) | 
| Concentrations of inflammatory factors in blood | Levels of inflammatory factors such as IL6, CRP and NFkB in serum | Changes throughout the course of the intervention (weeks 0, 8 and 20) | 
| Muscle fractional synthesis rate | Protein/RNA synthesis rate measured using heavy water (deuterium) and chromatography/spectrometry | Week 18 to 20 | 
| Gene expression in skeletal muscle (intervention) | RNA (e.g. messenger RNA, ribosomal RNA, microRNA, long non-coding RNA) abundances in m. vastus lateralis, measured both as targeted genes and at the level of the transcriptome | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Gene expression in skeletal muscle (familiarization) | RNA (e.g. messenger RNA, ribosomal RNA, microRNA, long non-coding RNA) abundances in m. vastus lateralis, measured both as single genes and at the level of the transcriptome | Changes from before to after familiarization to resistance exercise (week 8 to 10) | 
| Protein abundance in skeletal muscle (intervention) | Levels of proteins and their modification status (e.g. phosphorylation) in m. vastus lateralis, measured at the level of single proteins and at the level of the proteome | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Protein abundance in skeletal muscle (familiarization) | Levels of proteins and their modification status (e.g. phosphorylation) in m. vastus lateralis, measured at the level of single proteins and at the level of the proteome | Changes from before to after the resistance training intervention (week 8 to 10) | 
| Mitochondrial functions in muscle | The ability of muscle mitochondria (extracted from muscle homogenate) to synthesize ATP in vitro | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Gene expression in subcutaneous fat | RNA (e.g. messenger RNA, ribosomal RNA, microRNA, long non-coding RNA) abundances in subcutaneous fat, measured as targeted genes | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Satellite cell proliferation and myotube growth (in vitro) | The ability of muscle satellite cells (extracted from muscle homogenate) to proliferate (rates of cell division), differentiate into myotubes and subsequently grow (rates of change in myotube size) in primary cultures | Changes from before to after N3-supplementation-only (week 0 to 8) | 
| Musculoskeletal pain (Nordic Pain Questionnaire) | Musculoskeletal pain measured using The standardized Nordic Pain Questionnaire | Changes throughout the course of the training intervention (weeks 0, 8 and 20) | 
| Musculoskeletal pain (VAS) | Musculoskeletal pain measured using VAS-scale (1-10) | Changes throughout the course of the training intervention (weeks 0, 8 and 20) | 
| Gastrointestinal symptoms | Gastrointestinal symptoms such as abdominal discomfort and pain, measured using Rome IV criteria | Changes throughout the course of the training intervention (weeks 0, 8 and 20) | 
| Gut microbiome (feces, N3-supplementation-only) | Relative composition of the gut microbiome measured using quantitative polymerase chain reaction | Changes from before to after N3-supplementation-only (week 0 to 8) | 
| Gut microbiome (feces, training intervention) | Relative composition of the gut microbiome measured using quantitative polymerase chain reaction | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Fecal short-chained fatty acids (N3-supplementation-only) | Short chained fatty acids measured in feces | Changes from before to after N3-supplementation-only (week 0 to 8) | 
| Fecal short-chained fatty acids (training intervention) | Short chained fatty acids measured in feces | Changes from before to after the resistance training intervention (week 8 to 20) | 
| Arterial stiffness | Arterial stiffness measured using pulse-wave velocity | Throughout the course of the intervention (week 0, 8 and 20) | 
| Health-related quality of life (SF-36) | Health-related quality of life measured using the SF-36 questionnaire | Changes throughout the course of the intervention (week 0, 8 and 20) | 
| Health-related quality of life in overweight/obesity | Health-related quality of life in overweight/obesity individuals measured using The impact of weight on quality of life (IWQOL) questionnaire | Changes throughout the course of the intervention (week 0, 8 and 20) | 
| Health-related quality of life (PANAS) | Health-related quality of life measured using the Positive and Negative Affect Schedule (PANAS) questionnaire | Changes throughout the course of the intervention (week 0, 8 and 20) | 
| Activities of daily living | Activities of daily living (e.g. time spent in physical activity, intensities of activities) measured using questionnaire | Changes throughout the course of the intervention (week 0, 8 and 20) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Resistance exercise, Omega 3