Muscle Lipid and Insulin Resistance in the Elderly (MIRA)

This project will provide novel information concerning the ability of exercise to enhance the capacity for oxidative metabolism of fatty acids and improve insulin resistance in older adults who are at high risk for the development of type 2 diabetes. Ultimately this may help identify mechanisms and therapeutic targets implicated in skeletal muscle metabolic dysregulation. The proposed study is to conduct a randomized controlled exercise training intervention trial in older men and women. In addition, the response to exercise in these subjects will be compared to those of highly endurance-trained, age-matched athletes.

Study Overview

• Status: Completed
• Conditions: Obesity
• Intervention / Treatment: Behavioral: Exercise Group; Behavioral: Health Education Group

Detailed Description

Hypothesis and Specific Aims:

1. To determine whether aerobic exercise improves both skeletal muscle fat distribution and insulin sensitivity of older men and women. We will test two hypotheses.

   i. Physical exercise in older adults will decrease the amount of fat interspersed within muscle, specifically the fat between muscle groups (intermuscular adipose tissue) as well as decrease specific lipid metabolites within muscle cells, compared to controls.

   ii. Exercise-induced improvements in insulin sensitivity of older men and women will be related to the changes in muscle fat content independent of changes in total body fat or visceral abdominal adipose tissue.

2. To determine whether increased capacity for oxidative fatty acid metabolism within muscle results in improved insulin sensitivity in older adults. We will test two hypotheses.

   i. Exercise training will increase the capacity of muscle to oxidize fatty acids assessed both in vitro and in vivo.

   ii. Improved capacity for oxidative fatty acid metabolism will predict improvements in insulin sensitivity.

• Study Type: Interventional
• Enrollment (Actual): 92
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Pittsburgh, Pennsylvania, United States, 15213
      • University of Pittsburgh

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 60 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• 60 - 70 years of age
• No weight gain/loss of >10 lbs in 6 months
• Sedentary (No more than 1 continuous exercise/week) or Highly trained (>5 exercise sessions/week for a duration of one year or more)
• Non-Smoker
• BMI 18-38.0
• Resting blood pressure less than 150mmHg systolic/95 mmHg diastolic
• Normal glucose tolerance: Fasting glucose < 100 mg/dl or 2 hour glucose from OGTT < 140 mg/dl or impaired glucose tolerance (fasting glucose > 100 mg/dl < 126 mg/dl or 2 hour glucose from OGTT > 140 mg/dl but less than 200 mg/dl
• Note from PCP/Cardiologist for exercise clearance if positive stress test symptoms were observed from GXT

Exclusion Criteria:

• Clinically significant CVD including h/o MI
• Peripheral Vascular Disease
• Hepatic, renal, muscular/neuromuscular, or active hematologic/oncologic disease
• Clinically diminished pulse
• Presence of bruits in lower extremities
• Previous history of pulmonary emboli
• Peripheral Neuropathy
• Currently not engaged in a regular program and have a V)2 max pre-training value > 55 ml/kg-fat free mass-min., indicative of moderate fitness OR currently engaged in regular program and having a V)2 max value < 55 ml/kg-fat free mass-min.
• Anemia (Hematocrit < 34%)
• Any contraindications to moderate exercise
• Inability and/or willingness to comply with the protocol as written
• Active alcohol or substance abuse (Past 5 years)
• Total cholesterol > 300 mg/dL
• Triglyceride > 350 mg/dL
• ALT > 80, AST > 80, Alk Phos > 240
• Proteinuria (defined as > 1+ on routine dipstick) hypothyroidism (sTSH>8)
• Therapeutic Doses of Nicotinic Acid
• Type 2 Diabetes: Fasting Glucose > 126 mg/dl or 2 hour glucose > 200 mg/dl
• Oral Glucocorticoids
• Females currently on hormone replacement therapy (HRT) less than 6 months
• Claustrophobia
• Previous difficulty with lidocaine or other local anesthetic

• Stress test symptoms:

  • Positive ECG (>2mm ST segment depression) without PCP cardiologist permission to participate
  • Signs or symptoms of cardiovascular decomposition (hypotensive response to exercise
  • Onset of angina or angina like symptoms, shortness of breath, change in heart rhythm, signs of poor perfusion (light-headedness), tightness
  • Hypotension

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 1; Exercise Group	Behavioral: Exercise Group; Sixteen week intervention where subjects will be progressed to four days per week for 45 minutes per session, 180 minutes minimum per week, of moderate intensity supervised exercise.
Experimental: Health Education Group	Behavioral: Health Education Group; Sixteen week intervention. This group will not receive specific exercise education or prescription but will be asked to participate in biweekly health education sessions

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Insulin sensitivity and muscle fat content will be measured at the beginning and the end of the intervention to determine the effects of exercise on these measures.	16 weeks

Secondary Outcome Measures

Outcome Measure	Time Frame
Examine if exercise-induced improvements in insulin sensitivity are similar in normal weight and in obese older subjects.	16 weeks

Collaborators and Investigators

• Sponsor: University of Pittsburgh
• Collaborators: National Institute on Aging (NIA)
• Investigators: Principal Investigator: Bret H. Goodpaster, PhD, University of Pittsburgh

Study record dates

Study Major Dates

• Study Start: July 1, 2004
• Primary Completion (Actual): December 31, 2017
• Study Completion (Actual): December 31, 2017

Study Registration Dates

• First Submitted: October 2, 2008
• First Submitted That Met QC Criteria: October 2, 2008
• First Posted (Estimate): October 3, 2008

Study Record Updates

• Last Update Posted (Actual): February 6, 2018
• Last Update Submitted That Met QC Criteria: February 3, 2018
• Last Verified: February 1, 2018

More Information

Terms related to this study

• Keywords: Physical Activity; Obesity; Insulin Resistance; Exercise Training
• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Hyperinsulinism; Insulin Resistance
• Other Study ID Numbers: 0405764; 5R01AG021961 (U.S. NIH Grant/Contract)