Myogenic and Osteogenic Responses to eXercise and Ibuprofen (MOXI)

COX Inhibition & Musculoskeletal Responses to Exercise

The purpose of this study is to determine if the use of ibuprofen blocks the benefits of exercise to build bone and muscle mass.

Study Overview

• Status: Completed
• Conditions: Aging; Physical Fitness
• Intervention / Treatment: Drug: Placebo; Behavioral: musculoskeletal-loading exercise; Drug: Ibuprofen

Detailed Description

People are advised to engage in weight-bearing physical activity to help prevent the loss of bone and muscle mass that occurs with aging. There is evidence from studies of animals that non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, block some of the bone- and muscle-building effects of exercise. The aim of this study is to determine whether use of ibuprofen, either before or after exercise, blocks the benefits of exercise training on bone and skeletal muscle in older women and men. The hypothesis is that taking ibuprofen before exercise will block some of the effects of exercise training to increase bone density and muscle mass.

Women and men aged 60-75 years will complete a supervised, 9-month exercise training program designed to increase bone and muscle mass. The training will include weight lifting and weight-bearing exercises, such as jumping in place and treadmill walking, up to 5 days per week. Participants will be randomly assigned to take 1 of 3 study pill combinations before and after each exercise session. The combinations of study pills will be: placebo before/placebo after, placebo before/ibuprofen after, or ibuprofen before/placebo after. The dose of ibuprofen will be 400 mg. Bone density of the hip and spine, body composition (total body muscle and fat), and markers of bone turnover in the blood will be measured before and after 4.5 and 9 months of training. Muscle cross-sectional area of the thigh will be measured by CT before and after 9 months of training. A subset of participants will have biopsies of the thigh muscle before and after training to measure proteins and genes associated with muscle build-up and breakdown.

Volunteers who do not use ibuprofen, aspirin, or acetaminophen more than 3 days per month will be enrolled. People with intolerance to ibuprofen or related drugs, cardiovascular disease, or orthopedic problems that limit exercise will be excluded from the study.

• Study Type: Interventional
• Enrollment (Actual): 159
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Colorado
    • Aurora, Colorado, United States, 80045
      • University of Colorado Denver

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 60 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Aged 60 to 75 years
• Willing to participate in a 9-month supervised exercise program that will start at a moderate intensity and gradually progress to a vigorous intensity
• Not currently performing regular, moderate-to-vigorous weight-bearing or weight-lifting exercise
• Average use of NSAIDs (including low-dose aspirin) or acetaminophen less than 3 days per month

Exclusion Criteria:

• Relative or absolute contraindications to regular use of NSAIDs
• Known allergy or intolerance (heartburn, stomach pain, nausea, vomiting) to NSAIDs; controlled GERD(Gastroesophageal Reflux Disease), if not related to NSAID use, will not be an exclusion criterion
• Proton Pump Inhibitor (PPI) use if dose is unstable or if using for less than 6 months prior to study enrollment
• History of peptic ulcer or upper GI bleeding
• Anemia
• Asthma with bronchospasm induced by aspirin or other NSAIDs
• Moderate or severe renal impairment defined as a calculated creatinine clearance
• Chronic hepatobiliary disease, conservatively defined as liver function tests greater than 1.5 times the upper limit of normal (if such values are obtained on initial screening and thought to be transient in nature, repeated testing will be allowed)
• Hyperkalemia
• Osteoporosis
• Diabetes mellitus requiring pharmacologic therapy
• Congestive heart failure
• Uncontrolled hypertension; use of thiazide diuretics will be allowed if on a stable dose for at least 6 months
• Cardiovascular disease
• Thyroid dysfunction
• Orthopedic problems (e.g., chronic back pain, severe osteoarthritis, rheumatoid arthritis) that limit the ability to perform vigorous exercise and increase the likelihood that the volunteer will use pain medications other than the study pills

• Certain use of medications, including

  • Drugs that are known to alter bone metabolism (e.g., estrogen, SERMs(Selective estrogen-receptor modulators), testosterone, bisphosphonates, teriparatide, calcitonin, GnRH(Gonadotropin-releasing hormone) agonists)
  • Chronic use of oral corticosteroids or any use in the previous 6 months (use of inhaled steroids will not be an exclusion criterion based on a meta-analysis documenting that the effect on bone is not significant)
  • Average use of acetaminophen or NSAIDs, including low-dose aspirin, greater than 3 days per month; volunteers using aspirin for primary prevention may enroll in the study if they discontinue aspirin therapy for the 9-month intervention period
  • Anticoagulants (e.g., warfarin, clopidogrel)
  • Narcotics

Study Plan

How is the study designed?

Design Details

• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Placebo pre and post exercise; placebo before and after musculoskeletal-loading exercise	Drug: Placebo; with each exercise session (up to 5 days per week) for 9 months; Behavioral: musculoskeletal-loading exercise; Exercise training program designed to increase bone and muscle mass, including weight lifting and weight-bearing exercises such as jumping in place and treadmill walking up to 5 days per week for 9 months
Experimental: Placebo pre and ibuprofen post exercise; placebo before and ibuprofen after musculoskeletal-loading exercise	Drug: Placebo; with each exercise session (up to 5 days per week) for 9 months; Behavioral: musculoskeletal-loading exercise; Exercise training program designed to increase bone and muscle mass, including weight lifting and weight-bearing exercises such as jumping in place and treadmill walking up to 5 days per week for 9 months; Drug: Ibuprofen; 400 mg with each exercise session (up to 5 days per week) for 9 months; Other Names: Advil; Motrin
Experimental: Ibuprofen pre and placebo post exercise; ibuprofen before and placebo after musculoskeletal-loading exercise	Drug: Placebo; with each exercise session (up to 5 days per week) for 9 months; Behavioral: musculoskeletal-loading exercise; Exercise training program designed to increase bone and muscle mass, including weight lifting and weight-bearing exercises such as jumping in place and treadmill walking up to 5 days per week for 9 months; Drug: Ibuprofen; 400 mg with each exercise session (up to 5 days per week) for 9 months; Other Names: Advil; Motrin

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Percentage Change From Baseline in Lumbar Spine Bone Mineral Density (BMD) at 9 Months	Baseline and after 9 months of training
Percentage Change From Baseline in Total Hip Bone Mineral Density (BMD) at 9 Months	Baseline and after 9 months of training
Change From Baseline in Fat-free Mass at 9 Months	Baseline and after 9 months of training

Secondary Outcome Measures

Outcome Measure	Time Frame
Percentage Change From Baseline in Femoral Neck Bone Mineral Density (BMD) at 9 Months	Baseline and after 9 months of training
Percentage Change From Baseline in Trochanter Bone Mineral Density (BMD) at 9 Months	Baseline and after 9 months of training
Percentage Change From Baseline in Sub-trochanter Bone Mineral Density (BMD) at 9 Months	Baseline and after 9 months of training
Change in Thigh Cross-sectional Muscle Area	Baseline and after 9 months of training
Bone Turnover Markers	Baseline, and after 4.5 & 9 months of training
Expression of Selected Proteins and Genes Associated With Muscle Build-up and Breakdown	Baseline and after 9 months of training

Collaborators and Investigators

• Sponsor: University of Colorado, Denver
• Collaborators: National Institute on Aging (NIA)

Publications and helpful links

General Publications

• Chow JW, Chambers TJ. Indomethacin has distinct early and late actions on bone formation induced by mechanical stimulation. Am J Physiol. 1994 Aug;267(2 Pt 1):E287-92. doi: 10.1152/ajpendo.1994.267.2.E287.
• Li J, Burr DB, Turner CH. Suppression of prostaglandin synthesis with NS-398 has different effects on endocortical and periosteal bone formation induced by mechanical loading. Calcif Tissue Int. 2002 Apr;70(4):320-9. doi: 10.1007/s00223-001-1025-y. Epub 2002 Mar 26.
• Trappe TA, White F, Lambert CP, Cesar D, Hellerstein M, Evans WJ. Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis. Am J Physiol Endocrinol Metab. 2002 Mar;282(3):E551-6. doi: 10.1152/ajpendo.00352.2001.
• Wherry SJ, Wolfe P, Schwartz RS, Kohrt WM, Jankowski CM. Ibuprofen taken before exercise blunts the IL-6 response in older adults but does not alter bone alkaline phosphatase or c-telopeptide. Eur J Appl Physiol. 2021 Aug;121(8):2187-2192. doi: 10.1007/s00421-021-04691-8. Epub 2021 Apr 19.

Helpful Links

• Data analysis plan MOXI Study

Study record dates

Study Major Dates

• Study Start: July 1, 2007
• Primary Completion (Actual): December 1, 2011
• Study Completion (Actual): December 1, 2011

Study Registration Dates

• First Submitted: April 17, 2007
• First Submitted That Met QC Criteria: April 17, 2007
• First Posted (Estimate): April 19, 2007

Study Record Updates

• Last Update Posted (Estimate): November 1, 2015
• Last Update Submitted That Met QC Criteria: October 7, 2015
• Last Verified: October 1, 2015

More Information

Terms related to this study

• Keywords: muscle strength; bone density; body composition; bone metabolism; muscle function; cyclooxygenase inhibitor
• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Peripheral Nervous System Agents; Enzyme Inhibitors; Analgesics; Sensory System Agents; Anti-Inflammatory Agents, Non-Steroidal; Analgesics, Non-Narcotic; Anti-Inflammatory Agents; Antirheumatic Agents; Cyclooxygenase Inhibitors; Ibuprofen
• Other Study ID Numbers: 06-0769; R01AG018857 (U.S. NIH Grant/Contract)