Nutrition and Exercise for Sarcopenia

Nutrition and Exercise to Improve Protein Metabolism and Prevent Sarcopenia in Aging

The investigators' general hypothesis is that nutritional factors, including protein/energy malnutrition and/or an impaired response of muscle to nutrition, and inactivity play significant roles in developing sarcopenia, the involuntary loss of muscle mass and function with age. Therefore, age-specific prolonged interventions including nutritional manipulations and/or exercise may help to reduce, stabilize, or even reverse sarcopenia.

Study Overview

• Status: Completed
• Conditions: Sarcopenia
• Intervention / Treatment: Dietary supplement: Amino acids; Drug: Exercise

Detailed Description

Our preliminary studies indicate that, in older adults, muscle protein anabolism is normally stimulated by amino acids alone, but impaired when nutritional stimuli contain carbohydrate due to a relative insulin resistance of muscle protein synthesis. We have also found that amino acids are the most efficient nutrients for the acute stimulation of muscle protein anabolism and our pilot data suggest that they can also increase muscle mass in healthy older adults.

Inactivity is another likely contributor to sarcopenia. Exercise increases not only muscle protein synthesis,mass and strength, but also energy expenditure. Hence, exercise may improve the response of muscle to nutritional interventions in older subjects via increased energy requirements and food consumption, thereby allowing for achievement of true supplementation.

We will test the following specific hypotheses in older, community indwelling, sedentary subjects:

Using a factorial design we will address in older, community-indwelling, sedentary subjects the following hypotheses:

1. Nutritional supplementation with amino acids will improve muscle mass, strength, function, quality, and protein synthesis.
2. Progressive exercise training for 24 weeks will improve muscle mass strength,function, quality, perfusion, and protein metabolism.
3. Combined treatment with nutritional supplementation and progressive exercise training for 24 weeks will improve muscle mass, strength, function, quality, perfusion, and protein metabolism more than either intervention alone.

Our goal is to establish if specific interventions that can acutely increase muscle protein synthesis can also effectively translate into increased muscle mass and/or performance in older sedentary people, thus preventing frailty and promoting physical independence. To this end we will use stable isotope methodologies to measure muscle protein metabolism and contrast enhanced ultrasound to measure muscle perfusion, in order to determine if the treatments' acute effects can predict their chronic impact on muscle mass and function. We will also determine if chronic treatment leads to metabolic and/or vascular adaptations that may explain the measured changes in muscle mass and function.

• Study Type: Interventional
• Enrollment (Actual): 108
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Texas
    • Galveston, Texas, United States, 77550
      • Sealy Center on Aging, University of Texas Medical Branch

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years to 85 years (Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. age 65-85 yrs
2. ability to sign consent form (score >25 on the 30 item Mini Mental State Examination, MMSE)
3. stable body weight for at least 1 year (verified via medical records).

Exclusion Criteria:

1. physical dependence or frailty (impairment in any of the Activities of Daily Living (ADL), history of falls (≥2/year) or significant weight loss in the past year)
2. exercise training (≥2 weekly sessions of moderate-to-high intensity aerobic or resistance exercise)
3. significant heart, liver, kidney, blood or respiratory disease
4. peripheral vascular disease
5. diabetes or other untreated endocrine disease
6. active cancer
7. recent (within 6 months) treatment with anabolic steroids, or corticosteroids
8. alcohol or drug abuse
9. tobacco use (smoking or chewing, verified via medical records)
10. depression (>5 on the 15-item Geriatric Depression Scale (GDS))
11. malnutrition (BMI <20 kg/m2; hypoalbuminemia or hypotransferrenemia; protein intake<0.66 g/kg/day at run-in)
12. obesity (BMI>30 kg/m2).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: Quadruple

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Placebo
Experimental: Nutritional supplement	Dietary supplement: Amino acids; mixed pure crystalline amino acids for human use (Ajinomoto), 15 g/d
Experimental: Placebo + Exercise	Drug: Exercise; progressive exercise training
Experimental: Nutritional Supplement + Exercise	Dietary supplement: Amino acids; mixed pure crystalline amino acids for human use (Ajinomoto), 15 g/d; Drug: Exercise; progressive exercise training

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Muscle mass	6 months

Secondary Outcome Measures

Outcome Measure	Time Frame
Muscle function	6 months
muscle protein turnover	6 months

Collaborators and Investigators

• Sponsor: The University of Texas Medical Branch, Galveston
• Collaborators: National Institute on Aging (NIA)
• Investigators: Principal Investigator: Elena Volpi, MD,PhD, The University of Texas Medical Branch, Galveston

Publications and helpful links

General Publications

• Randolph AC, Markofski MM, Rasmussen BB, Volpi E. Effect of essential amino acid supplementation and aerobic exercise on insulin sensitivity in healthy older adults: A randomized clinical trial. Clin Nutr. 2020 May;39(5):1371-1378. doi: 10.1016/j.clnu.2019.06.017. Epub 2019 Jun 28.
• Markofski MM, Jennings K, Timmerman KL, Dickinson JM, Fry CS, Borack MS, Reidy PT, Deer RR, Randolph A, Rasmussen BB, Volpi E. Effect of Aerobic Exercise Training and Essential Amino Acid Supplementation for 24 Weeks on Physical Function, Body Composition, and Muscle Metabolism in Healthy, Independent Older Adults: A Randomized Clinical Trial. J Gerontol A Biol Sci Med Sci. 2019 Sep 15;74(10):1598-1604. doi: 10.1093/gerona/gly109.

Study record dates

Study Major Dates

• Study Start: March 1, 2009
• Primary Completion (Actual): December 1, 2014
• Study Completion (Actual): August 1, 2016

Study Registration Dates

• First Submitted: March 27, 2009
• First Submitted That Met QC Criteria: March 27, 2009
• First Posted (Estimate): March 31, 2009

Study Record Updates

• Last Update Posted (Estimate): December 12, 2016
• Last Update Submitted That Met QC Criteria: December 8, 2016
• Last Verified: December 1, 2016

More Information

Terms related to this study

• Keywords: exercise; nutrition; aging; Sarcopenia; metabolism
• Additional Relevant MeSH Terms: Nervous System Diseases; Neurologic Manifestations; Neuromuscular Manifestations; Pathological Conditions, Anatomical; Muscular Atrophy; Atrophy; Sarcopenia
• Other Study ID Numbers: 08-085; 5R01AG030070 (U.S. NIH Grant/Contract)