Impact of Resistance Training-Protein Supplementation on Lean Muscle Mass in Childhood Cancer Survivors

Study Overview
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Brief Summary
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This study is being conducted because low lean muscle mass is prevalent among childhood cancer survivors. Lean muscle is the non-fatty muscle tissue that makes up part of the body's lean body mass. Low lean muscle mass is associated with loss of overall body strength, declining mobility and eventually, loss of independence. Among childhood cancer survivors, low lean muscle mass may contribute to reduced physical functioning and a sense of fatigue with exertion, limiting ability to participate in adequate physical activity. Loss of strength and a sense of fatigue with repeated movement make it difficult to participate in daily activities. Although there have not been exercise intervention studies among childhood cancer survivors specifically designed to evaluate the effects of resistance training on muscle mass, studies among individuals with chronic disease, including survivors of adult onset cancers, indicate that resistance exercise improves muscle mass, muscle strength, mobility, vitality and physical activity levels. Resistance training (weight lifting) is a form of physical activity that is designed to improve muscular fitness by exercising a muscle or a muscle group against external resistance. The purpose of the study is to evaluate the effects of resistance training combined with either a protein supplement or a sports drink on changes in lean muscle mass in young adults who were treated for childhood cancer. The sports drink, for this study, is considered a placebo.

Detailed Description
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This double-blind placebo controlled study will randomize adult survivors of childhood cancer who are 18 to 44 years of age, greater than ten years post first cancer diagnosis, and with low lean muscle mass to two groups: Resistance Training + Supplement (RT+S) or Resistance Training + Placebo (RT+P). Randomization will be stratified by sex and age (18-29 and 30-44 years) in a block size of 4. Three weekly resistance training sessions will occur over a 24 week period. The participants, investigator, trainer and individuals involved in testing will be blind to group assignment. Participants will receive information about physical activity and its health benefits. They will be randomly assigned to one of two groups to receive individually tailored resistance training three times per week for 24 weeks. One group will receive a protein supplement, while the other group will receive a sports drink (placebo). To assess outcomes, participants will have the following research tests: Blood will be drawn to assess heart health. Questionnaires will be completed to assess physical activity and health as well as food intake. Blood pressure measurement. Electrocardiogram to assess heart health. Height, weight, waist and hip measurements. Lean muscle mass will be measured by dual x-ray absorptiometry (DEXA scan). Muscle strength will be measured by handgrip, knee extension, and ankle dorsiflexion. Walking speed to determine usual walking speed. Six-minute walk test to determine endurance. Physical activity will be monitored by having the participant complete a survey and wear a small recording device (accelerometer) for seven days. Study Objectives: To evaluate the effects of 24-week supervised RT+S compared to RT+P on changes in lean muscle mass, muscle strength, walking speed, self-reported exhaustion and physical activity levels among childhood cancer survivors. To evaluate the effects of 24-week supervised RT+S compared to RT+P on changes in blood pressure, high density lipoprotein, triglycerides, abdominal obesity, fasting glucose, fasting insulin, and C-reactive protein among childhood cancer survivors.

Official Title
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Impact of Resistance Training-Protein Supplementation on Lean Muscle Mass in Childhood Cancer Survivors

Conditions
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Cancer

Intervention / Treatment
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* Other: Educational handouts
* Other: Resistance training
* Dietary Supplement: Supplementation
* Other: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants must be enrolled on the SJLIFE protocol at St. Jude Children's Research Hospital. 18.0-44.99 years of age >10 years post first cancer diagnosis. English speaking. Live within a 45-minute drive of a greater Memphis area ATC Fitness Center Low lean mass defined as either: Age- and sex-specific relative lean muscle mass standard deviation score ≤ -1.0. OR Body fat content greater than or equal to 25% in males or greater than or equal to 35% in females. Exclusion Criteria: Currently pregnant (assessed by serum pregnancy test). Contraindications to resistance training or protein supplementation (e.g. renal) verified by a physician.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 44 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Supplement Group<br>Participants will receive educational handouts and complete research testing to evaluate their physical condition prior to beginning the resistance training and dietary supplementation. Adherence will be assured as described below. | Other: Educational handouts<br>* Both groups of participants will receive educational handouts that explain the Physical Activity Guidelines for Americans at enrollment.<br>* Other names: guidelines;Other: Resistance training<br>* Individuals in both groups will participate in an individually tailored progressive resistance training program 3 times/week for 24 weeks. During weeks 1-4 participants will be supervised twice a week tapering to once a week in weeks 5-12, every other week in weeks 13-20 and then once a month in weeks 21-24 by an American College of Sports Medicine (ACSM) Certified Exercise Specialist (trainer). Adherence: To assure fidelity and safety of the resistance training component of the intervention, participants will initially be supervised more frequently They will complete an exercise log for each of their sessions. As the supervision level for exercise is tapered, participants may receive reminders to exercise and take their supplement/placebo via text, phone, or e-mail as needed.<br>* Other names: exercise;Dietary Supplement: Supplementation<br>* A medical quality protein supplement powder will be mixed with water or a sugar free drink mix to be taken daily within 60 minutes of training on exercise days or mid-morning on non-exercise days.<br>* Other names: protein dietary supplement;|
| Placebo Comparator: Placebo Group<br>Participants will receive educational handouts and complete research testing to evaluate their physical condition prior to beginning the resistance training and placebo. Adherence will be assured as described below. | Other: Educational handouts<br>* Both groups of participants will receive educational handouts that explain the Physical Activity Guidelines for Americans at enrollment.<br>* Other names: guidelines;Other: Resistance training<br>* Individuals in both groups will participate in an individually tailored progressive resistance training program 3 times/week for 24 weeks. During weeks 1-4 participants will be supervised twice a week tapering to once a week in weeks 5-12, every other week in weeks 13-20 and then once a month in weeks 21-24 by an American College of Sports Medicine (ACSM) Certified Exercise Specialist (trainer). Adherence: To assure fidelity and safety of the resistance training component of the intervention, participants will initially be supervised more frequently They will complete an exercise log for each of their sessions. As the supervision level for exercise is tapered, participants may receive reminders to exercise and take their supplement/placebo via text, phone, or e-mail as needed.<br>* Other names: exercise;Other: Placebo<br>* A placebo that appears to be identical to the medical quality protein supplement powder will be mixed with water or a sugar free drink mix to be taken daily within 60 minutes of training on exercise days or mid-morning on non-exercise days.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in lean muscle mass by arm | Dual x-ray absorptiometry (DEXA) will be used to determine lean muscle mass. Fat free mass will be measured in the total body scanning mode. | Baseline and at 24 weeks | 
| Change in handgrip by arm | Handgrip strength will be evaluated with a hand held dynamometer. | Baseline and at 24 weeks | 
| Change in knee extension by arm | Knee extension strength will be evaluated with the Biodex System IV dynamometer. | Baseline and at 24 weeks | 
| Change in ankle dorsiflexion by arm | Ankle dorsiflexion strength will be evaluated with the Biodex System IV dynamometer. | Baseline and at 24 weeks | 
| Change in walking speed by arm | Usual walking speed will be evaluated by having participants complete a timed 10 meter walk test. | Baseline and at 24 weeks | 
| Change in endurance by arm | Endurance will be evaluated by having participants complete the six minute walk test in a level of corridor as outlined by the American Thoracic Society. | Baseline and at 24 weeks | 
| Change in activity level by arm | Participants will complete the physical activity monitor (PAM) component of the most recent release of the National Health and Nutrition Examination Survey to measure activity levels. The PAM collects information on intensity and duration of common activities like walking and jogging for seven consecutive days. Participants will receive an accelerometer with written instructions, programmed to begin recording 12:01 a.m. on the day after the baseline assessment (the week before they begin training) and the day after their final training appointment. | Baseline and at 24 weeks | 
| Change in blood pressure by arm | Blood pressure will be evaluated with a sphygmomanometer. | Baseline and at 24 weeks | 
| Change in high density lipoprotein by arm | High density lipoprotein will be evaluated from fasting blood samples as part of a standard lipid panel. | Baseline and at 24 weeks | 
| Change in triglycerides by arm | Triglycerides will be evaluated from fasting blood samples as part of a standard lipid panel. | Baseline and at 24 weeks | 
| Change in abdominal obesity by arm | Abdominal obesity will be evaluated by measuring waist circumference with a Gulick tape measure to the nearest mm. | Baseline and at 24 weeks | 
| Change in fasting glucose by arm | Glucose level will be measured from fasting blood samples. | Baseline and at 24 weeks | 
| Change in fasting insulin by arm | Insulin level will be measure from fasting blood samples. | Baseline and at 24 weeks | 
| Change in C-reactive protein by arm | Highly sensitive C-reactive protein will be measured from fasting blood samples. | Baseline and at 24 weeks | 
| Change in self-reported exhaustion by arm | Measured using the vitality subscale of the Medical Outcomes Survey Short Form-36 (SF-36), version 2. | Baseline and at 24 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Adult cancer survivors, Exercise, Dietary supplementation