Progressive resistance and aerobic training in HIV Infections - Clinical Trials Registry

Study Overview

Status

Completed

Conditions

HIV Infections

Intervention / Treatment

Behavioral: Progressive resistance and aerobic training

Detailed Description

Baseline Testing: Eligible patients will be tested at the General Clinical Research Center (GCRC) of Massachusetts General Hospital or at the GCRC at Massachusetts Institute of Technology (MIT). For women with regular menses, the admission will correspond to the early follicular phase. Patients will receive a menstrual history calendar to submit at the baseline and 16 week visits. A complete history and physical exam will be performed, including a detailed history of all drugs being used in the treatment of the HIV disease or any associated conditions. Weight will be measured and expressed as a percentage of ideal body weight (IBW) and body mass index. Blood will be sampled to determine hormonal function (testosterone, free testosterone, SHBG, estradiol, LH, and FSH), nutritional status (albumin, prealbumin), lipid parameters (HDL, LDL, cholesterol, triglycerides), immune function (CD4, viral load, CBC), and thrombolytic markers (t-PA, PAI-1). An HIV test will be performed at the baseline visit only, in order to document patient status. Glucose homeostasis will be measured with the use of fasting glucose and insulin levels and an oral glucose tolerance test (OGTT). Heart rate will be monitored to test cardiovascular function. A spot urine will be collected for bone markers and beta-human chorionic gonadotropin (bHCG). Lean body mass and fat mass will be determined by a dual energy x-ray absorptiometry [DEXA] (to be performed at the MIT CRC); total body water will be determined by bioimpedance analysis; muscle cross-sectional area will be determined by anthropometric measurements. A quantitative computed tomography (CT) scan of the thigh and abdomen will be done to measure visceral and subcutaneous fat. A Magnetic Resonance Spectroscopy of calf muscles for determination of lipid concentrations in skeletal muscle will be done. (Subjects with contraindications to magnetic resonance imaging [MRI] will be able to remain in the protocol, but the MR-Spectroscopy will not be performed). A complete dietary assessment and resting energy expenditure will be performed. Quality of life will be assessed using the MOS HIV questionnaire and an activity questionnaire as well as the Karnofsky performance assessment.

A submaximal exercise bicycle test will be done to assess aerobic capability, and a 6 minute walk test, sit to stand and get up and go tests will be done to assess overall functional status by the physical therapy (PT) department. Those who are not randomized to exercise at the baseline visit, will have one repetition maximum (1 RM) testing. The 1 RM is defined as the maximal amount of weight that can be lifted throughout full range of motion. The 1 RM will be tested by performing exercises including calf raises, arm curls, lateral raises, knee flexors, bench press and half squats. The 1 RM testing will be repeated on those who are not randomized to exercise at the 8 and 16 week visits.

After the baseline investigation is over, subjects will be randomized into one of two groups (exercise or no exercise) for 16 weeks. Strength training will be performed using standard free weights under the supervision of a trained physical therapist or member of the study staff. Each session begins with a 5 minute warm-up and a standard flexibility routine. The strength training routine will follow and will focus on the following muscle groups: knee extensors and hip extensors, ankle plantar flexors, elbow flexors, pectoralis and shoulder abduction. The aerobic training program will follow the general guidelines established by the American College of Sports Medicine. Training will be performed using a standard stationery bicycle. Aerobic/endurance exercise will be performed with large muscle groups. The duration of the aerobic component of the training session will be 20 minutes during the first two weeks and 30 minutes thereafter. The intensity of the exercise will be 60% of maximal heart rate during the first two weeks and 75% thereafter. As the weeks progress, the repetitions and intensity of the exercise will be gradually increased. Subjects return to the GCRC at 8 weeks for a medical history, a physical exam, weight, and pregnancy test. Subjects return again at 16 weeks for a visit identical to that at baseline.

Study Type

Interventional

Enrollment

40

Phase

Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

United States
- Massachusetts
  - Boston, Massachusetts, United States, 02114
    - Mass General Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 60 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Description

Inclusion Criteria:

Subjects with documented HIV infection, by Western blot or ELISA
Ages 18-60
Self-report AND physical evidence, as assessed by the investigators, of at least one of the following:
- increased abdominal girth;
- relative loss of fat in the face;
- relative loss of fat in the extremities; *dorsocervical fat pad;
- relative increased breast size;
- a score greater than or equal to 1.5 on the Lipodystrophy Scale and a waist to hip ratio of greater than or equal to 0.85.

Exclusion Criteria:

Pregnant or actively seeking pregnancy
Breastfeeding
New opportunistic infection diagnosed within 4 weeks of the study
Pharmacologic glucocorticoid therapy (> 7.5 mg Prednisone or its equivalent/day)
Androgen, growth hormone or Megace within 3 months of study initiation
New anti-retroviral therapy within 1 month of the study
SGOT > 5x normal and/or clinically significant liver disease
Creatinine > 2.0 mg/dL and/or clinically significant renal disease
Hemoglobin (Hgb) < 8.0g/dL
Active substance abuse

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Interventional Model: Parallel Assignment
Masking: None (Open Label)

What is the study measuring?

Primary Outcome Measures

Outcome Measure
aerobic fitness

Secondary Outcome Measures

Outcome Measure
lipids
body composition
strength
glucose
cardiovascular disease (CVD) risk markers

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Massachusetts General Hospital

Collaborators

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Dolan SE, Frontera W, Librizzi J, Ljungquist K, Juan S, Dorman R, Cole ME, Kanter JR, Grinspoon S. Effects of a supervised home-based aerobic and progressive resistance training regimen in women infected with human immunodeficiency virus: a randomized trial. Arch Intern Med. 2006 Jun 12;166(11):1225-31. doi: 10.1001/archinte.166.11.1225.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

November 1, 2002

Study Completion (Actual)

July 1, 2005

Study Registration Dates

First Submitted

May 19, 2005

First Submitted That Met QC Criteria