Clinical trial NCT01787292: Effects of Exercise Intervention on Aging-related Motor Decline
Official title: Effects of Exercise Intervention on Aging-related Motor Decline (AGING)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Aging
Exercise
Keywords: Exercise
Magnetic Resonance Imaging
Transcranial Magnetic Stimulation
Aging
Lead sponsor: VA Office of Research and Development
Sponsor class: FED
First posted: 2013-02-08
Enrollment: 33
Sex: ALL
Minimum age (years): 60
Maximum age (years): 85
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Intervention model description: A. Light stretching and balance exercises under supervised trainer. 3 times per week for 20-45 minutes. HR will be targeted to be under 50% of age-related maximum.

B. Interval aerobic cycling under supervised trainer. 3 times per week for 20-45 minutes. HR will be targeted between 50-85% of age-related maximum.

C. 6 month self-monitored training phase during which time participants will exercise using a take home bike ergometer
Primary purpose: BASIC_SCIENCE

Brief summary: The purpose of this research study is to test whether differing levels of physical fitness affects patterns of motor dexterity and brain activity that have been shown to differ due to aging. Testing will take place at the Atlanta VA Medical Center and at Emory University.

Participants will be healthy adults within the target age range of 60-85 for the study. The study will require multiple visits over 15 months. There will be about 64 people volunteering for this study.

Detailed description: The U.S. Census reports over 14 million U.S. Veterans (\>63%) are beyond mid-life (\>55 years). Declines in upper extremity motor performance respective of strength and dexterity are well documented within this age cohort). Recent cross-sectional research has discovered that aging related motor deficits may be influenced by a loss of interhemispheric inhibition (IHI) between primary motor cortices. However, this loss may not be an inevitable consequence of aging. Work from previous VA OAA Predoctoral and CDA-1 awards have shown that aerobic fitness may serve to mitigate losses in interhemispheric inhibition assessed by both functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS). That is, individuals who are aerobically fit show higher levels of IHI and improved dexterity and reaction times.

In light of new evidence from the investigators' lab's recent cross-sectional studies, physical activity over the long term (at least 2-5 years) may serve to alter levels of IHI and improve motor performance in the upper extremity. Aerobic exercise may provide a mechanism (reduced loss of interhemispheric inhibition) that could serve to improve motor function, but the neural mechanism responsible for such effects remains unclear. Previous investigations of interhemispheric communication and exercise have been limited by nature of inquiry, as cross-sectional research cannot measure changes over time in participants. As such, it is currently unknown how exercise may directly affect levels of interhemispheric communication and motor performance.

Behavioral interventions (motor strength and coordination) have been shown to be effective in improving upper extremity motor performance in older adults, however the duration of these gains appear to be short-lived. After as little as a few weeks of detraining, motor strength and coordination in the upper extremity rapidly begins to return to pre-intervention levels. Evidence from exercise interventions assessing gait and locomotion have shown that exercise programs over a longer term (\>6 months) are associated with improved proprioception, fewer falls and better balance. However, the comparison of outcomes of upper extremity function in elderly adults respective of exercise duration remains largely unexplored. In addition to comparing the effects of short-term exercise (3 months) versus behavioral training (3 months) on upper extremity function, the current proposal will evaluate if a longer-term (6 months) exercise program can maintain or enhance upper extremity function and associated levels of interhemispheric inhibition.

The current study proposes the next logical step in my line of research and directly investigates the effects of exercise in an intervention with sedentary older Veterans (50-80 years), a group most likely to exhibit aging-related motor deficits. The investigators propose to enroll 40 Veterans into an upper extremity dexterity improvement program involving behavioral and exercise components. The behavioral intervention is a muscle coordination training previously shown to improve unimanual motor performance in older adults. The exercise intervention is a supervised group cycling regimen. The figure below shows the study design. Interhemispheric communication will be assessed with fMRI, and TMS.

Eligibility criteria: Inclusion Criteria:

* Living persons between 60 and 85 years of age

Exclusion Criteria:

* unmanaged diabetes
* participants completing vigorous exercise per week
* participants whose profession requires vigorous physical labor
* contraindication to magnetic resonance imaging

Primary outcomes:
measure: Estimate Cardiovascular Efficiency After Aerobic Exercise
timeFrame: Baseline, 12 weeks, 24 weeks
measure: Estimate of Cardiovascular Efficiency After Balance Training
timeFrame: Baseline, 12 weeks, 24 weeks
measure: Silent Period Duration After Exercise Cycling Program
timeFrame: Baseline, 12 weeks, 24 weeks
measure: Silent Period Duration for Balance Group
timeFrame: Baseline, 12 weeks, 24 weeks
measure: fMRI Interhemispheric Inhibition Improvement After Aerobic Exercise
timeFrame: Baseline to 24 Weeks with cross-over
measure: fMRI Interhemispheric Inhibition Improvement After Balance Training
timeFrame: Baseline, 12 weeks, 24 weeks
measure: Comparison of Cardiovascular Efficiency for Aerobic Exercise First Group After Home-based Intervention
timeFrame: 24 and 48 weeks
measure: Comparison of Cardiovascular Efficiency for Balance Exercise First Group After Home-based Intervention
timeFrame: 24 and 48 weeks
measure: Comparison of Silent Period Duration After Aerobic Exercise
timeFrame: Baseline, 12 weeks, 24 weeks
measure: Comparison of Silent Period Duration After Balance Exercise
timeFrame: 24 and 48 weeks
Secondary outcomes:
measure: Target Heart Rate Zone for Balance First Participants
timeFrame: 24 and 48 weeks
measure: Target Heart Rate Zone After Aerobic Exercise First
timeFrame: 24 and 48 weeks
measure: Heart Rate Workload After Home Based Intervention
timeFrame: 24 and 48 weeks
Other outcomes:
Locations:
city: Decatur
country: United States
facility: Atlanta VA Medical and Rehab Center, Decatur, GA
state: Georgia
Study officials:
affiliation: Atlanta VA Medical and Rehab Center, Decatur, GA
name: Keith M. McGregor, PhD MS BA
role: PRINCIPAL_INVESTIGATOR
References:
citation: McGregor KM, Crosson B, Mammino K, Omar J, Garcia PS, Nocera JR. Influences of 12-Week Physical Activity Interventions on TMS Measures of Cortical Network Inhibition and Upper Extremity Motor Performance in Older Adults-A Feasibility Study. Front Aging Neurosci. 2018 Jan 4;9:422. doi: 10.3389/fnagi.2017.00422. eCollection 2017.
citation: Nocera J, Crosson B, Mammino K, McGregor KM. Changes in Cortical Activation Patterns in Language Areas following an Aerobic Exercise Intervention in Older Adults. Neural Plast. 2017;2017:6340302. doi: 10.1155/2017/6340302. Epub 2017 Mar 6.
citation: McGregor KM, Crosson B, Krishnamurthy LC, Krishnamurthy V, Hortman K, Gopinath K, Mammino KM, Omar J, Nocera JR. Effects of a 12-Week Aerobic Spin Intervention on Resting State Networks in Previously Sedentary Older Adults. Front Psychol. 2018 Nov 27;9:2376. doi: 10.3389/fpsyg.2018.02376. eCollection 2018.