Resistance Exercise and Low-Intensity Physical Activity Breaks in Sedentary Time to Improve Muscle and Cardiometabolic Health

Study Overview
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Brief Summary
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What are the effects of resistance exercise (RE) alone or RE plus low intensity physical activity (LPA) breaks in sedentary time (ST) on skeletal muscle health in older adults? What are the effects of resistance exercise (RE) alone or RE plus low intensity physical activity (LPA) breaks in sedentary time (ST) on skeletal cardiometabolic health in older adults?

Detailed Description
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Although awareness of the detrimental impact that sedentary behavior has on skeletal muscle and cardiometabolic health has increased over the last 20 years, more than 60% of older adults remain sedentary for greater than 8 hours per day. Moreover, 80% to 90% of adults 60 years of age or older do not meet the current public health guidelines for aerobic exercise (AE) or resistance exercise (RE) based physical activity (PA). Collectively, these adverse health behaviors contribute to the development of multiple chronic medical conditions commonly afflicting older adults, including type 2 diabetes, cardiovascular disease, sarco/dynapenia, frailty, and premature mortality. Emerging evidence suggests that breaking up sedentary time with light intensity PA (LPA) improves muscle and cardiometabolic health. Recent data also suggest that RE combined with moderate intensity AE effectively improves muscle and cardiometabolic health in older adults. However, the impact that RE combined with LPA breaks in sedentary time has on muscle and cardiometabolic health in older adults remains unknown. The overall objective of this pilot study is to determine the effect of 16 weeks of RE alone or RE combined with LPA breaks in sedentary time on muscle and cardiometabolic health.

Official Title
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Resistance Exercise and Low-Intensity Physical Activity Breaks in Sedentary Time to Improve Skeletal Muscle and Cardiometabolic Health in Older Adults-REALPA Breaks in Sedentary Time Pilot Study

Conditions
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Aging, Sarcopenia, Disability Physical, Cardiovascular Diseases, Insulin Resistance, Diabetes Mellitus

Intervention / Treatment
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* Behavioral: Exercise Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Are capable and willing to give written informed consent, and understand exclusion criteria 65-80 years of age inclusive Body Mass Index (BMI) between 18.5-34.9 kg/m2, inclusive Physically inactive determined by self-report Stable medical therapy for allowable medications for 30 days defined as: No addition or removal of a medication No change in dosage of a medication Having no life-threatening conditions or diseases Willing to allow researchers to use data, bio-specimens (blood and muscle tissue), and images (e.g., magnetic resonance imaging) for research purposes after study participation is completed At least 2 weeks post-completion of the COVID19 vaccine regimen. a. Acceptable proof of vaccine includes a completed vaccine card and/or letter from a healthcare provider indicating the date that the COVID19 vaccine was completed. Exclusion Criteria: Nursing home resident Physically Active: a. > 100 min/wk of moderate OR > 50 min/wk vigorous intensity PA Saint Louis University Mental State (SLUMS) score < 21 Evidence or self-report history of deep vein thrombosis, pulmonary embolism, cardiovascular, peripheral vascular, cerebral vascular, pulmonary, or renal disease Evidence or self-report history of type 1 or 2 diabetes mellitus Evidence or self-report history of a bleeding disorder Evidence or self-report history of recurrent vasovagal episodes Evidence or self-report history of severe depression, Schizophrenia, bipolar disease Evidence or self-report history of mobility disability requiring a walker, wheel chair, or inability to walk across a small room. Evidence or self-report history of orthopedic limitations that would preclude them from participation in a dynamic exercise program Evidence or self-report history of severe arthritis (either osteoarthritis or rheumatoid arthritis) that would preclude them from participation in a dynamic exercise program Evidence or self-report of history untreated thyroid dysfunction. Weight loss of > 10% in the last 3 months prior to screening History of weight loss surgery. Use of medications known to influence study outcomes, such as: Insulin Oral antidiabetic medications (e.g., metformin) Corticosteroids Beta-blockers c. Anticoagulants Allergy to lidocaine Active smoking Current consumption of > 14 alcoholic drinks per week based on self-report Regular participation in resistance or aerobic exercise training within 3 months of initial screening Absolute Contraindication to Exercise as Defined by the American College of Sports Medicine,16 including: Resting diastolic blood pressure > 100 mm Hg Resting systolic blood pressure > 180 mm Hg Resting heart rate > 100 beats per min Having a body weight greater than 440 pounds Having medical implants such as a pacemaker or metal joint replacements Having tattoos or permanent makeup completed <30 days prior to the visit Recent (past 3 months) cancer diagnosis, undergoing immunotherapy, taking immune suppressants Presence of allergies or infections requiring antibiotics within the past 14 days Recent (past 3 months) major surgery on the abdomen, pelvis, or lower extremities Any other condition that in the judgement of the Principal Investigator and/or the Medical Director of this protocol may interfere with study participation and adherence to the protocol. Evidence or self-report history of severe depression in the last 5 years.

Ages Eligible for Study
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Minimum Age: 65 Years
Maximum Age: 80 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: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Resistance Exercise<br>Exercise Intervention: Participants will be asked to complete supervised resistance exercise 2 days per week. | Behavioral: Exercise Intervention<br>* The use of exercise to improve muscle and cardiometabolic health in older adults.<br>|
| Experimental: RE plus Low Intensity Physical Activity<br>Exercise Intervention: Participants will be asked to complete supervised resistance exercise 2 days per week and regular unsupervised low intensity physical activity breaks in sedentary time 5 days per week [6x10 min breaks/d at 2 metabolic equivalents (METS) or  30-40% peak oxygen consumption (VO2 peak),  500 kcal/wk above resting metabolism]. | Behavioral: Exercise Intervention<br>* The use of exercise to improve muscle and cardiometabolic health in older adults.<br>|
| Active Comparator: RE plus Moderate IntensityExercise<br>Exercise Intervention: Participants will be asked to complete supervised RE 2 days per week and supervised calorically matched moderate intensity physical activity 3 days per week (50 min/session at 4 METS ( 60-75% VO2 peak),  500 kcal/week above resting metabolism). | Behavioral: Exercise Intervention<br>* The use of exercise to improve muscle and cardiometabolic health in older adults.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Skeletal Muscle Strength | The investigators will determine the change from baseline in skeletal muscle strength. These measurements will be performed at baseline and following 16 weeks of exercise training using isokinetic dynamometry and 1 repetition maximum testing. | Measured at week 0 (baseline) and week 16 | 
| Skeletal Muscle Mass | The investigators will determine the change from baseline in skeletal muscle mass. These measurements will be performed at baseline and following 16 weeks of exercise training using Dual X-Ray Absorptiometry and Magnetic Resonance Imaging. | Measured at week 0 (baseline) and week 16 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mitochondrial Function | The investigators will determine the change from baseline in mitochondrial function. These measurements will be performed at baseline and following 16 weeks of exercise training. | Measured at week 0 (baseline) and week 16 |