Changes in Body Composition Including Muscle With Anti-Obesity Medications, Both With and Without Exercise (M3-E)
The goal of this clinical trial is to learn whether adding either cardiovascular exercise or resistance exercise to pharmacotherapy treatment for obesity improves the retention of lean mass compared to pharmacotherapy alone in adults with overweight or obesity who are prescribed pharmacotherapy for obesity treatment by their personal physician. It will also provide information about whether either form of exercise added to pharmacotherapy for obesity treatment has additional benefits on other health and fitness measurements. The main questions it aims to answer are:
- Is there a difference in the change in total lean body mass between pharmacotherapy alone and either pharmacotherapy plus cardiovascular exercise or pharmacotherapy plus resistance exercise?
- Is there a difference in the change in muscle mass between the intervention conditions (pharmacotherapy alone, pharmacotherapy plus cardiovascular exercise, pharmacotherapy plus resistance exercise)?
- Is there a difference in the change in muscle quality between the intervention conditions (pharmacotherapy alone, pharmacotherapy plus cardiovascular exercise, pharmacotherapy plus resistance exercise)?
- Is there a difference in the change in body weight between the intervention conditions (pharmacotherapy alone, pharmacotherapy plus cardiovascular exercise, pharmacotherapy plus resistance exercise)?
- Is there a difference in the change in body composition (fat mass, fat mass distribution) between the intervention conditions (pharmacotherapy alone, pharmacotherapy plus cardiovascular exercise, pharmacotherapy plus resistance exercise)?
- Is there a difference in the change in cardiorespiratory fitness between the intervention conditions (pharmacotherapy alone, pharmacotherapy plus cardiovascular exercise, pharmacotherapy plus resistance exercise)?
- Is there a difference in the change in muscle strength between the intervention conditions (pharmacotherapy alone, pharmacotherapy plus cardiovascular exercise, pharmacotherapy plus resistance exercise)?
- Is there a difference in the change in physical function between the intervention conditions (pharmacotherapy alone, pharmacotherapy plus cardiovascular exercise, pharmacotherapy plus resistance exercise)?
- Is there a difference in the change in bone mineral density between the intervention conditions (pharmacotherapy alone, pharmacotherapy plus cardiovascular exercise, pharmacotherapy plus resistance exercise)?
- Is there a difference in the change in bone biomarkers between the intervention conditions (pharmacotherapy alone, pharmacotherapy plus cardiovascular exercise, pharmacotherapy plus resistance exercise)?
- Is there a difference in the change in resting blood pressure between the intervention conditions (pharmacotherapy alone, pharmacotherapy plus cardiovascular exercise, pharmacotherapy plus resistance exercise)?
- Is there a difference in the change in energy intake between the intervention conditions (pharmacotherapy alone, pharmacotherapy plus cardiovascular exercise, pharmacotherapy plus resistance exercise)?
- Is there a difference in the change in physical activity between the intervention conditions (pharmacotherapy alone, pharmacotherapy plus cardiovascular exercise, pharmacotherapy plus resistance exercise)?
- Is there an effect of sex, race/ethnicity, age, menopausal status, obesity management medication type, or other demographic characteristics on the outcomes that are being measured.
- What is the extent to which the retention of lean body mass or muscle mass mediates the effect of exercise on weight changes.
Participants will:
- Initiate and continue throughout the study period an eligible obesity management medication that is prescribed by their healthcare provider, and to report their adherence to this medication to the investigators.
- Participant in this study for a period of 6-8 months to complete outcome assessments that occur at baseline and at the conclusion of 6 months of the intervention period, and monitoring visits that occur at weeks 3, 6, 9, 12, 15, 18, and 21.
- If attend 3 supervised exercise sessions per week if assigned to either the cardiovascular exercise intervention or the resistance training intervention for a period of 24 weeks.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: John M. Jakicic, PhD
- Phone Number: 913-588-9078
- Email: jjakicic@kumc.edu
Study Contact Backup
- Name: Renee J. Rogers, PhD
- Phone Number: 913-588-8580
- Email: rrogers10@kumc.edu
Study Locations
-
-
Kansas
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Kansas City, Kansas, United States, 66160
- Recruiting
- University of Kansas Medical Center
-
Contact:
- John M. Jakicic, PhD
- Phone Number: 913-588-9078
- Email: jjakicic@kumc.edu
-
Principal Investigator:
- John M. Jakicic, PhD
-
Contact:
- Renee J. Rogers, PhD
- Phone Number: 913-588-8580
- Email: rrogers10@kumc.edu
-
Principal Investigator:
- Renee J. Rogers, PhD
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Both males and females of all race/ethnic groups are eligible for participation in this study.
- 18 to <65 years of age.
- Newly prescribed FDA-approved obesity manage medication that can include Tirzepatide, Semaglutide, or up to 4 additional next-generation obesity management medications (will receive DSMB approval prior to inclusion), approval for treatment (pharmacy, insurance, etc.), and the participant agreeing to start this treatment and continue treatment for at least 6 months (the participant will be recruited prior to this medication being initiated).
- Body mass index (BMI) of >=27.0 kg/m2 with at least one weight-related complication (hypertension, dyslipidemia, obstructive sleep apnea, or cardiovascular disease) provided it does not compromise the ability to safely complete the screening or outcome measures or to engage in the prescribed exercise interventions), or >=30 kg/m2 without weight-related complications. We will not limit enrollment based on an upper BMI level provided that the participant meets the other eligibility requirements. However, the participant will be excluded if they exceed the weight or size limits of the dual-energy x-ray absorptiometry (DXA) system that is used to assess body composition or the MRI that is used to assess muscle quality.
- Ability to provide informed consent prior to participation in this study.
- Clearance from the study physician for meeting all eligibility criteria for this study.
Exclusion Criteria:
- Type 2 diabetes.
- Report moderate-to-vigorous exercise for >60 min/week, and >1 day/week of structured cardiovascular or resistance exercise over the past 3 months.
- Report sustained weight loss of >=3% in the past 3 months.
- History of metabolic/bariatric surgery.
- Females who are pregnant or breastfeeding or reporting a planned pregnancy during the study period.
- Report a current medical condition or treatment for a medical condition that could affect body weight or contradict engagement in any aspect of the outcome measures or interventions.
- History of muscle conditions that may impact the quality of muscle or response to the study interventions (e.g., myopathy, muscular dystrophy, rhabdomyolysis, etc.).
- Contraindications to MRI (e.g., metal implants that are not MRI safe, etc.). NOTE: Participants who are otherwise eligible other than being contraindicated for the MRI scan will be eligible and the MRI scan will not be performed as a research procedure.
- Current congestive heart failure, angina, uncontrolled arrhythmia, symptoms indicative of an increased acute risk for a cardiovascular event, prior myocardial infarction or history of cardiomyopathy, coronary artery bypass grafting or angioplasty, conditions requiring chronic anticoagulation (i.e., recent or recurrent DVT).
- Resting systolic blood pressure of >=160 mmHg or resting diastolic blood pressure of >=100 mmHg. If medicated for blood pressure control, the medication dose needs to be stable for >=6 months.
- Eating disorders that would contraindicate weight loss or physical activity.
- Alcohol or substance abuse.
- Current psychological condition that is untreated, hospitalization for a psychological condition within the past 12 months, or not being on a stable dose of treatment for at least 6 months.
- Report plans to relocate to a location not accessible to the study site or having employment, personal, or travel commitments that prohibit attendance at scheduled intervention sessions or assessments.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Standard Care with an Obesity Management Medication
Participants will receive standard medical care from their personal physician related to their obesity management medication for a period of 6 months.
Progression of this medication will be monitored as part of the participation in this study.
Participants will undergo screening and baseline assessments prior to initiating the use of the medication and after a period of 6 months.
Upon randomization, participants will receive a "Nutrition 101" session where dietary considerations while taking this medication will be discussed.
We will also have a brief contact (weeks 3, 6, 9, 12, 15, 18, and 21) with the participant to monitor changes in weight, blood pressure, health status, and medication adherence and use (including the dose of the obesity management medication that they have been prescribed).
Participants will be instructed to maintain their current level of physical activity throughout the 6-month study period.
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Participant will receive standard medical care that includes the prescription and titration of a study eligible obesity management medication.
Participant will receive brief nutrition counseling specific to obesity managment medications after randomization for this study.
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Experimental: Standard Care with an Obesity Management Medication Plus Cardiovascular Exercise Training
Participants will receive the same standard of care as described for the "Standard Care with an Obesity Management Medication" condition; however, participants will also engage in supervised cardiovascular exercise training.
This will occur on 3 days per week and will progress to 50 minutes per session (150 minutes per week).
The intensity of the exercise will progress from 60%±5% to 70%±5% of age-predicted maximal heart rate (if taking beta-blocker medication intensity will progress from a Rating of Perceived Exertion of 11-13 to 12-14 based on the 6-20 Borg scale).
While walking will be the preferred mode of exercise, we will allow for alternative forms of cardiovascular exercise (upright or recumbent cycling, elliptical, etc.) to accommodate any physical limitations that may be present for a participant.
Heart rate will be monitored throughout these exercise sessions.
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Participant will receive standard medical care that includes the prescription and titration of a study eligible obesity management medication.
Participant will receive brief nutrition counseling specific to obesity managment medications after randomization for this study.
Participant will receive supervised cardiovascular exercise training on 3 days per week for a period of 6 months.
|
|
Experimental: Standard Care with an Obesity Management Medication Plus Resistance Exercise Training
Participants will receive the same standard of care as described for the "Standard Care with an Obesity Management Medication" condition; however, participants will also engage in supervised resistance exercise training.
This will occur 3 days per week and involve 9 different exercises.
Each exercise will progress to 3 sets with a rest period of 60 to 90 seconds between each set.
Warm-up sets will include 10 repetitions, and all remaining sets will perform repetitions until volitional fatigue.
Heart rate will be monitored throughout these exercise sessions.
|
Participant will receive standard medical care that includes the prescription and titration of a study eligible obesity management medication.
Participant will receive brief nutrition counseling specific to obesity managment medications after randomization for this study.
Participant will receive supervised resistance exercise training on 3 days per week for a period of 6 months.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Lean body mass
Time Frame: 0 and 6 months
|
Lean Body Mass (kg) will be assessed using a total body scan from dual-energy x-ray absorptiometry (DXA).
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0 and 6 months
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Percent body fat
Time Frame: 0 and 6 months
|
Percent body fat will be assessed using a total body scan from dual-energy x-ray absorptiometry (DXA).
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0 and 6 months
|
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Body Fat Mass
Time Frame: 0 and 6 months
|
Body fat mass (kg) will be assessed using a total body scan from dual-energy x-ray absorptiometry (DXA).
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0 and 6 months
|
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Muscle Mass
Time Frame: 0 and 6 months
|
Muscle Mass (kg) will be assessed using the deuterated creatine (D3Cr) dilution method.
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0 and 6 months
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Muscle Quality
Time Frame: 0 and 6 months
|
Muscle quality will be assessed using magnetic resonance imaging (MRI) of the mid-thigh.
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0 and 6 months
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Body Weight
Time Frame: 0 months, week 6, week 12, week 18, 6 months
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Body weight will be assessed in duplicate using a calibrated digital scale to the nearest 0.1 kg.
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0 months, week 6, week 12, week 18, 6 months
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Body Mass Index
Time Frame: 0 months, week 6, week 12, week 18, 6 months
|
Measurements of weight and height will be used to compute BMI (kg/m2).
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0 months, week 6, week 12, week 18, 6 months
|
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Bone mineral content
Time Frame: 0 and 6 months
|
Bone mineral content (grams) will be assessed using total body, femur, and spine scans from dual-energy x-ray absorptiometry (DXA).
|
0 and 6 months
|
|
Bone mineral density
Time Frame: 0 and 6 months
|
Bone mineral density (g/cm2) will be assessed using total body, femur, and spine scans from dual-energy x-ray absorptiometry (DXA).
|
0 and 6 months
|
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Bone Biomarkers
Time Frame: 0 and 6 months
|
Bone biomarkers will be assessed from blood samples collected using venipuncture.
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0 and 6 months
|
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Waist Circumference
Time Frame: 0 and 6 months
|
Circumference measures of the waist will be taken horizontally at both the iliac crest and the umbilicus.
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0 and 6 months
|
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Hip Circumference
Time Frame: 0 and 6 months
|
Circumference measures of the hip will be taken horizontally at the widest observed portion of the buttocks.
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0 and 6 months
|
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Cardiorespiratory Fitness
Time Frame: 0 and 6 months
|
Cardiorespiratory fitness will be represented as milliliters of oxygen consumed per kilogram of body weight per minute (ml/kg/min) measured with a metabolic cart during a submaximal graded exercise test that is terminated when the participant achieves 85% of age-predicted maximal heart rate or if taking a medication that will impact heart rate response to exercise, then achieving a Rating of Perceived Exertion (RPE) of 16 on the 6-20 scale.
|
0 and 6 months
|
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Cardiorespiratory Fitness
Time Frame: 0 and 6 months
|
Cardiorespiratory fitness will be represented as total liters of oxygen consumed per minute (L/min) measured with a metabolic cart during a submaximal graded exercise test that is terminated when the participant achieves 85% of age-predicted maximal heart rate or if taking a medication that will impact heart rate response to exercise, then achieving a Rating of Perceived Exertion (RPE) of 16 on the 6-20 scale.
|
0 and 6 months
|
|
Cardiorespiratory Fitness
Time Frame: 0 and 6 months
|
Cardiorespiratory fitness will be the duration measured in minutes to achieve 85% of age-predicted maximal heart rate during a submaximal graded exercise test performed on a treadmill or if taking a medication that will impact heart rate response to exercise, then achieving a Rating of Perceived Exertion (RPE) of 16 on the 6-20 scale.
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0 and 6 months
|
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Muscle Strength
Time Frame: 0 and 6 months
|
Muscular strength will be measured from an isometric leg extension performed on a dynamometer.
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0 and 6 months
|
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Physical Function
Time Frame: 0 and 6 months
|
Physical function will be measured using the Short Physical Performance Protocol (SPPB) that includes balance, gait speed, and chair stands).
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0 and 6 months
|
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Muscle Power
Time Frame: 0 and 6 months
|
Muscle Power is measured using the Margaria Power Stair Climb Task that requires the participant to walk up a standardized flight of stair, with the score being the time it takes to walk from the 3rd step to the 9th step.
A faster time at a given body mass indicates a greater level of muscle power.
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0 and 6 months
|
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Health-Related Quality of Life
Time Frame: 0 and 6 months
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Health-related quality of life is assessed with a standardized questionnaire.
This questionnaire consists of 8 scales (physical functioning, role limitations caused by health problems, role limitation caused by emotional problems, social functioning, emotional well-being, energy/fatigue, pain, general health perceptions) with each scale score between 0-100.
This also consists of 2 subscales (physical and mental health) with these being scored as the average of the scores from the scales that are factored into each measure.
This also provides an overall score, which is the average of the scores for each of the 8 scales.
A higher score on a scale or subscale indicates a higher health-related quality of life.
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0 and 6 months
|
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Energy Intake (Dietary Intake)
Time Frame: 0 months, week 6, week 12, week 18, 6 months
|
Energy Intake (Dietary Intake) expressed as kilocalories eaten per day (kcal/day) will be measured using the Diet History Questionnaire (DHQ) developed by NCI.
A higher score represents more calories eaten.
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0 months, week 6, week 12, week 18, 6 months
|
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Energy Intake (Dietary Intake)
Time Frame: 0 months, week 6, week 12, week 18, 6 months
|
Energy Intake (Dietary Intake) expressed as kilocalories eaten per day (kcal/day) will be measured using a 3-day dietary recall (2 weekdays and 1 weekend day).
A higher score represents more calories eaten.
|
0 months, week 6, week 12, week 18, 6 months
|
|
Physical Activity
Time Frame: 0 and 6 months
|
Physical activity will be measured using the Physical Activity and Exercise Questionnaire.
A higher score represents more physical activity expressed as minutes per week or calories of energy expenditure per week.
|
0 and 6 months
|
|
Physical Activity
Time Frame: 0 and 6 months
|
Physical activity will be measured using the Global Physical Activity Questionnaire (GPAQ).
A higher score represents more physical activity expressed as minutes per week or calories of energy expenditure per week.
|
0 and 6 months
|
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Physical Activity
Time Frame: 0 and 6 months
|
Physical activity will be measured Garmin wrist worn activity tracker that will be provided to each participant to wear throughout the entire 6 month intervention period.
A higher score represents more physical activity.
|
0 and 6 months
|
Other Outcome Measures
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Lifestyle and Health History
Time Frame: 0 months (prior to randomization)
|
A questionnaire developed specifically for this study that is conducted as an interview will be used to assess lifestyle and health factors to describe the sample for this study.
The score is either "yes" or "no" identifying the presences of a lifestyle or health factor.
|
0 months (prior to randomization)
|
|
Medication Reporting
Time Frame: 0 and 6 months, and weeks 3, 6, 9, 12, 15, 18, 21
|
A questionnaire developed specifically for this study will be used to assess medication history and use of prescribed obesity management medications.
The data collected include the type of medication, dose of medication, and frequency that the medication is taken, and what condition the medication is indicated to treat.
|
0 and 6 months, and weeks 3, 6, 9, 12, 15, 18, 21
|
|
Obesity Management Medication Adherence
Time Frame: 0 and 6 months, and weeks 3, 6, 9, 12, 15, 18, 21
|
A questionnaire developed specifically for this study will be used to assess adherence to the prescribed obesity management medications.
The data collected include the type of medication, dose of medication, and frequency that the medication is taken.
|
0 and 6 months, and weeks 3, 6, 9, 12, 15, 18, 21
|
|
Demographic Characteristics
Time Frame: 0 months
|
A questionnaire developed specifically for this study will be used to assessment demographic characteristics (age, sex, race, etc.).
|
0 months
|
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Adverse and Serious Adverse Events
Time Frame: 0 and 6 months, and weeks 3, 6, 9, 12, 15, 18, 21 and at other times when reported by the participant
|
Participants will be queried using a survey developed specifically for this study will be used to assess for adverse events and serious adverse events.
|
0 and 6 months, and weeks 3, 6, 9, 12, 15, 18, 21 and at other times when reported by the participant
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Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: John M. Jakicic, PhD, University of Kansas Medical Center
- Principal Investigator: Renee J. Rogers, PhD, University of Kansas Medical Center
Study record dates
Study Major Dates
Study Start (Estimated)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Nutrition Disorders
- Overnutrition
- Body Weight
- Pathological Conditions, Signs and Symptoms
- Behavior
- Nutritional and Metabolic Diseases
- Signs and Symptoms
- Overweight
- Obesity
- Motor Activity
- Motor Activity
- Movement
- Musculoskeletal Physiological Phenomena
- Musculoskeletal and Neural Physiological Phenomena
- Therapeutics
- Physical Therapy Modalities
- Patient Care
- Exercise Therapy
- Rehabilitation
- Aftercare
- Continuity of Patient Care
- Physical Conditioning, Human
- Exercise
- Resistance Training
Other Study ID Numbers
Other Study ID Numbers
- STUDY00161746
- R01DK141779-01A1 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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