Exercise for Healthy Aging: The Impact of HIV and Aging on Physical Function and the Somatopause

Study Overview
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Brief Summary
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The primary objective of this proposal is to compare a moderate or high intensity exercise intervention to improve physical function in persons aging with Human Immunodeficiency Virus (HIV).

Detailed Description
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The primary objective of this proposal is to compare a moderate or high intensity exercise intervention to improve physical function in persons aging with HIV. Both HIV-infected and HIV-uninfected older adults will be assigned to a moderate intensity cardiovascular and resistance training intervention for 12 weeks, and then randomized to either continue moderate intensity exercise, or increase to high intensity exercise for an additional 12 weeks. The primary outcome is the impact of exercise on physical function, as measured by the overall score of a modified Short Physical Performance Battery (mSPPB) and the chair rise time from the mSPPB. The secondary outcomes include changes in insulin-like growth factor-1 (systemic and local) and inflammation (interleukin-6 (IL-6), soluble tumor necrosis factor receptors 1 and 2 (sTNFR-1 and sTNFR-2)).

Official Title
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Exercise for Healthy Aging: The Impact of HIV and Aging on Physical Function and the Somatopause

Conditions
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HIV, Inflammation, Obesity, Aging, Biological

Intervention / Treatment
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* Other: High-intensity cardiovascular and resistance exercise
* Other: Moderate-intensity cardiovascular and resistance exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Ages 50-75 HIV+ must be on ART for a minimum of 2 years with viral load <200 copies/mL Sedentary cluster of differentiation 4 (CD4) T-cell count >200 cells/microliter BMI >19 and <41 Among females, must be post-menopausal Able to perform activities of daily living with out assistance Exclusion Criteria: Diabetes, poorly controlled with HgbA1c >7.5; on insulin On growth hormone (or growth hormone axis) therapy, intramuscular testosterone, corticosteroids. Known active hepatitis B or C (viremia). Severe liver disease Uncontrolled hypertension (SPB >180 or diastolic >100). Underlying cardiac conditions that would make exercise or exercise testing potentially unsafe (unstable ischemic heart disease, Class III or IV heart failure clinically significant aortic stenosis, uncontrolled angina, or uncontrolled arrhythmia) pulmonary disease requiring the use of supplemental oxygen ≥ 4 liters with physical exertion current diagnosis of malignancy (excluding non-melanoma skin cancers) within 48 weeks prior to enrollment surgery/trauma/injury/fracture within 24 weeks prior to enrollment that may impact a subject's ability to exercise history of stroke with residual deficits that may impact ability to exercise; orthopedic problems (e.g., severe osteoarthritis, rheumatoid arthritis) that greatly limit the ability to perform moderate-intensity resistance exercise (e.g., unable to be properly positioned in exercise equipment or to have severely restricted range of motion even after modifications have been made) weight over 300 pounds Montreal Cognitive Assessment (MOCA) score < 18 (will be evaluated at screening visit after consent obtained) AIDS-defining opportunistic infection within the 24 weeks prior to enrollment Person who appear to have unstable health, are incapable of safely participating in the exercise intervention, or are felt to have a life expectancy of < 1 year. Participants on anticoagulants (clopidogrel, Coumadin, etc) will be excluded from the muscle biopsy. Aspirin and Non-steroidal anti-inflammatory agents are not exclusions but should be stopped 1 week prior to muscle biopsy (subset of subjects).

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 75 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: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: HIV-uninfected<br>HIV-uninfected men and women, age 50-70 years. All participants will exercise at a moderate intensity (cardiovascular + resistance training) for 12 weeks, then will be randomized to continue moderate intensity or advance to high intensity exercise for an additional 12 weeks. | Other: High-intensity cardiovascular and resistance exercise<br> <br> Other: Moderate-intensity cardiovascular and resistance exercise<br> <br> |
| Experimental: HIV-infected<br>HIV-infected men and women, age 50-70 years. All participants will exercise at a moderate intensity (cardiovascular + resistance training) for 12 weeks, then will be randomized to continue moderate intensity or advance to high intensity exercise for an additional 12 weeks. | Other: High-intensity cardiovascular and resistance exercise<br> <br> Other: Moderate-intensity cardiovascular and resistance exercise<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to Rise From a Chair 10 Times (Modified From the Original Short Physical Performance Battery) | Chair rise time is measured as a continuous variable of time to stand up from a sitting position 10 times. Lower number = faster; larger number = slower | 24 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in Insulin-like Growth Factor (IGF)-1 | Measures at baseline and following 24 weeks of exercise | 24 weeks | 
| Changes in Inflammation (Interleukin-6 [IL-6], Soluble Tumor Necrosis Factor Receptors 1 and TNF-alpha. | The primary outcome is change from 0 to 24 weeks. These changes in inflammation are measured at baseline (pre-exercise) and at 24 weeks (post exercise). | Baseline and 24 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Frail Elderly, IGF-1