DO-HEALTH / Vitamin D3 - Omega3 - Home Exercise - Healthy Ageing and Longevity Trial (DO-HEALTH)

Vitamin D3 - Omega3 - Home Exercise - Healthy Ageing and Longevity Trial (Acronym: DO-HEALTH)

The European population is aging rapidly which poses a challenge on the individual, the European societies, and health care systems. Among the most promising public health interventions that may extend healthy life expectancy at older age are vitamin D, marine omega-3 fatty acids and physical exercise. However, their individual and combined effects have yet to be confirmed in a clinical trial.

The broad aim of DO-HEALTH is to prolong healthy life expectancy in European seniors. The specific aim is to establish whether vitamin D, omega-3 fatty acids, and a simple home exercise program will prevent disease at older age.

To achieve these aims, DO-HEALTH will enroll 2152 community-dwelling men and women who are 70 years and older, an age when chronic diseases increase substantially. The DO-HEALTH seniors will be recruited from 7 European cities (Zurich, Basel, Geneva, Toulouse, Berlin, Innsbruck and Coimbra) and will be randomized in a 2x2x2 factorial design trial to a simple home exercise program and/or vitamin D, and/or omega-3 fatty acids, over a 3 year period. This will allow to test the individual and the combined benefit of the interventions in the prevention of 5 primary endpoints: incident non-vertebral fractures; functional decline; systolic and diastolic blood pressure change; cognitive decline; and the rate of any infection. Key secondary endpoints include incidence of hip fractures, rate of falls, severity of pain in symptomatic knee osteoarthritis, gastro-intestinal symptoms, mental and oral health, quality of life, and mortality.

All clinical endpoints will be supported by a large DO-HEALTH biomarker study to evaluate the effect of the interventions at the cellular level of multi-organ function. DO-HEALTH will further evaluate reasons why or why not seniors adhere to the 3 interventions, and will assess their cost-benefit in a health economic model based on documented health care utilization and observed incidence of chronic disease.

website DO-HEALTH: http://do-health.eu/wordpress/

Study Overview

• Status: Completed
• Conditions: Improve Healthy Ageing in Seniors; Prevent Disease at Older Age
• Intervention / Treatment: Drug: Vitamin D3; Drug: Omega 3 fatty acids; Procedure: Strength Home Exercise; Procedure: Flexibility Home Exercise

Detailed Description

The 3 primary treatment comparisons are:

1. 2000 IU vitamin D per day compared to placebo (controlling for the other treatment strategies)
2. 1 g of omega-3 fatty acids (EPA+DHA, ratio 1:2, from marine algae) compared to placebo (controlling for the other treatment strategies)
3. Home exercise program (muscle strength) of 30 minutes 3 times a week compared to a control exercise program (joint flexibility) 30 minutes 3 times a week

Follow-up: DO-HEALTH seniors will be followed for 3 years, in-person, and in 3-monthly intervals (4 clinical visits and 9 phone calls) at the 7 recruitment centers.

Study population: DO-HEALTH will enroll seniors age 70 years and older. To represent the largest part of the senior population, DO-HEALTH will recruit community-dwelling seniors. However, to represent also the pre-frail population at risk of institutionalization, at least 40% of seniors will be enrolled based on a fall with or without a fracture in the year before DO-HEALTH enrolment.

Study Design: This is a randomized, double-blind, placebo-controlled, 2×2×2 factorial design clinical trial.

Recruitment Centers: The trial will be performed at 7 recruitment centers located in 5 countries: Switzerland (University of Zurich, Basel University Hospital, Geneva University Hospital), France (University of Toulouse Hospital Centre), Germany (Charité Berlin), Portugal (University of Coimbra), and Austria (Innsbruck Medical University).

Randomization: Stratified block randomization. Labeling of study intervention will be performed by a central randomization centre in Switzerland.

Stratification variables: recruitment centre (7 centers), fall during previous 12 months (yes/no), gender, and age (70 - 84 and 85+). At least 40% of Seniors among those who fell or did not fall during the last year will be enforced at each of the 7 recruitment centers. Gender and age distribution will be monitored within each recruitment centre with the DO-HEALTH randomization software. If gross imbalance (less than 30% of fallers/non-fallers in a stratum) is detected within a centre, recruitment strategies for the centre will be adapted to boost recruitment of participants of underrepresented category.

website DO-HEALTH: http://do-health.eu/wordpress/

• Study Type: Interventional
• Enrollment (Actual): 2157
• Phase: Phase 3

Contacts and Locations

Study Locations

• Austria
  • Innsbruck, Austria
    • University of Innsbruck
• France
  • Toulouse, France
    • University of Toulouse - Centre de Recherche - Gérontopôle Hôpital La Grave
• Germany
  • Berlin, Germany
    • Charite Berlin
• Portugal
  • Coimbra, Portugal
    • University of Coimbra - Clínica Universitária de Reumatologia
• Switzerland
  • Basel, Switzerland
    • Basel University
  • Geneva, Switzerland
    • Hôpitaux universitaires de Genève
  • ZH
    • Zurich, ZH, Switzerland, 8091
      • Centre on Aging and Mobility, University of Zurich and City Hospital Waid

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 70 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion criteria:

• Age 70 years or older
• Mini Mental State Examination Score of at least 24
• Living in the community
• Sufficiently mobile to come to the study centre
• Able to walk 10 meters with or without a walking aid and able to get in and out of a chair without help
• Able to swallow study capsules
• Able and willing to participate, sign informed consent (including consent to analyze all samples until drop-out or withdrawal) and cooperate with study procedures

Exclusion criteria:

• Consumption of more than 1000 IU vitamin D/day in the 36 months prior to enrollment, or a bolus of 300'000 IU or more in the last 12 month prior to enrollment, and/ or unwillingness to limit vitamin D intake to the current standard of 800 IU/day of vitamin D during the course of the trial. Provision 1: an individual who consumed an average vitamin D dose between 1000 and 2000 IU vitamin D/day in the 3 months prior to enrollment, may be enrolled after a 3-month wash-out period where the maximum daily intake is limited to 800 IU vitamin D. Provision 2: an individual who consumed an average vitamin D dose higher than 2000 IU/day in the 3 months prior to enrollment, may be enrolled after a 6-month wash-out period where the maximum daily intake is limited to 800 IU vitamin D.
• Unwillingness to limit calcium supplement dose to 500 mg per day for the duration of the trial
• Taking omega-3 fat supplements in the 3 month prior to enrolment and unwilling to forgo their use for the duration of the trial
• Use of any active vitamin D metabolite (i.e. Rocaltrol, alphacalcidiol), PTH treatment (i.e. Teriparatide), or Calcitonin at baseline and unwillingness to forego these treatments during the course of the trial
• Current or recent (previous 4 months) participation in another clinical trial, or plans of such participation in the next 3 years (corresponding to DO-HEALTH length)
• Presence of the following diagnosed health conditions in the last 5 years: history of cancer (except non-melanoma skin cancer); myocardial infarction, stroke, transient ischemic attack, angina pectoris, or coronary artery intervention
• Severe renal impairment (creatinine clearance = 15 ml/min) or dialysis, hypercalcaemia (> 2.6 mmol/l)
• Hemiplegia or other severe gait impairment
• History of hypo- or primary hyperparathyroidism
• Severe liver disease
• History of granulomatous diseases (i.e. tuberculosis, sarcoidosis)
• Major visual or hearing impairment or other serious illness that would preclude participation
• Living with a partner who is enrolled in DO-HEALTH (i.e. only one person per household can be enrolled)
• Living in assisted living situations or a nursing home
• Temporary exclusion: acute fracture in the last 6 weeks
• Epilepsy and/or use of anti-epileptic drugs
• Individuals who fell more than 3 times in the last month
• Osteodystrophia deformans (M. Paget, Paget's disease)
• For study centers in Germany only: persons who are institutionalized / in prison by court order (§40, Abs. 1, Art. 4, "Gesetz über den Verkehr mit Arzneimitteln").

Study Plan

How is the study designed?

Design Details

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

Number of Arms

8

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: VitD-Omega3-StrengthExercise; Vitamin D3 (2000 IU/d); Omega-3 fatty acids (1 g/d); Strength Home Exercise (3*30 minutes/week)	Drug: Vitamin D3; 2000 IU/d; Other Names: Cholecalciferol; Drug: Omega 3 fatty acids; Ratio EPA:DHA = 1:2 1 g/d; Other Names: Eicosapentaenoic acid AND Docosahexaenoic acid; Procedure: Strength Home Exercise
Active Comparator: VitD-Omega3-FlexibilityExercise; Vitamin D3 (2000 IU/d); Omega-3 fatty acids (1 g/d); Flexibility Home Exercise (3*30 minutes/week)	Drug: Vitamin D3; 2000 IU/d; Other Names: Cholecalciferol; Drug: Omega 3 fatty acids; Ratio EPA:DHA = 1:2 1 g/d; Other Names: Eicosapentaenoic acid AND Docosahexaenoic acid; Procedure: Flexibility Home Exercise
Active Comparator: Placebo-Omega3-StrengthExercise; Placebo Vitamin D3; Omega-3 fatty acids (1 g/d); Strength Home Exercise (3*30 minutes/week)	Drug: Omega 3 fatty acids; Ratio EPA:DHA = 1:2 1 g/d; Other Names: Eicosapentaenoic acid AND Docosahexaenoic acid; Procedure: Strength Home Exercise
Active Comparator: Placebo-Omega3-FlexibilityExercise; Placebo Vitamin D3; Omega-3 fatty acids (1 g/d); Flexibility Home Exercise (3*30 minutes/week)	Drug: Omega 3 fatty acids; Ratio EPA:DHA = 1:2 1 g/d; Other Names: Eicosapentaenoic acid AND Docosahexaenoic acid; Procedure: Flexibility Home Exercise
Active Comparator: VitD-Placebo-StrengthExercise; Vitamin D3 (2000 IU/d); Placebo Omega-3 fatty acids; Strength Home Exercise (3*30 minutes/week)	Drug: Vitamin D3; 2000 IU/d; Other Names: Cholecalciferol; Procedure: Strength Home Exercise
Active Comparator: VitD-Placebo-FlexiblityExercise; Vitamin D3 (2000 IU/d); Placebo Omega-3 fatty acids; Flexibility Home Exercise (3*30 minutes/week)	Drug: Vitamin D3; 2000 IU/d; Other Names: Cholecalciferol; Procedure: Flexibility Home Exercise
Active Comparator: Placebo-Placebo-StrengthExercise; Placebo Vitamin D3; Placebo Omega-3 fatty acids; Strength Home Exercise (3*30 minutes/week)	Procedure: Strength Home Exercise
Sham Comparator: Placebo-Placebo-FlexibilityExercise; Placebo Vitamin D3; Placebo Omega-3 fatty acids; Flexibility Home Exercise (3*30 minutes/week)	Procedure: Flexibility Home Exercise

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Bone: Incident non-vertebral fractures over 36 months	Confirmed by medical and/or x-ray reports	over 36 months
Muscle: Functional decline (lower extremity function)	Measured with the SPPB (short physical performance test battery)	Baseline, 12, 24 and 36 months
Cardio-vascular: Systolic and diastolic blood pressure change	Standardized blood pressure assessment in sitting position	Baseline, 12, 24 and 36 months
Brain: Cognitive decline	Montreal Cognitive Assessment (MoCA)	Baseline, 12, 24 and 36 months
Immunity: Rate of any infections	3-monthly incident infection protocol	Baseline, and every 3 months up to 36 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Bone: Incident hip fractures	Based on medical records and/or x-ray reports	36 months
Bone: Incident total fractures	Combined non-vertebral and vertebral fractures among subgroup of 1502 participants with DXA vertebral morphometry assessment	36 months
Bone: Incident vertebral fractures	Based on DXA vertebral morphometry among subset of 1502 participants	36 months
Bone: Bone mineral density decrease at the lumbar spine and hip	Assessed in a subset of 1502 participants with DXA measurements	Baseline, 12, 24, and 36 months
Muscle: Rate of falls	Any low trauma fall, injurious fall	Assessed every 3 months over 36 months
Muscle: reaction time and grip strength	Reaction time will be assessed with the repeated sit-to-stand test; grip strength will be assessed with the Martin Vigorimeter	Baseline, 12,24,36 months
Muscle: Muscle mass decrease at upper and lower extremities	Subset of 1502 participants with DXA measurements	Baseline, 12,24,36 months
Muscle: Dual tasking 10-meter gait speed		Baseline, 12,24 and 36 months
Muscle/Bone: musculoskeletal pain	Assessed with the McGill questionnaire	Baseline, 12,24, and 36 months
Cardio-vascular: Incident Hypertension		36 months
Brain: mental health decline	Assessed with Geriatric Depression Scale	Baseline, 12,24, and 36 months
Brain: Incident Depression		36 months
Brain/Muscle: Dual tasking gait variability	Subset of 250 participants	Baseline, 12, 24 and 36 months
Immunity: Rate of upper respiratory infections / rate of flu-like illness	Assessed with infection protocol every 3 months	36 months
Immunity: Incident severe infections that lead to hospital admission		36 months
Cartilage/Bone: Severity of knee pain in participants with symptomatic knee osteoarthritis	Assessed with the KOOS questionnaire. Knee OA assessment with modified ACR criteria.	Baseline, 12, 24 and 36 months
Cartilage/Bone: Rate of knee buckling	Questionnaire-based.	Baseline, 12,24,36 months
Cartilage/Bone: NSAID use / number of joints with pain	Assessed by questionnaire and homunculus figure	Baseline, 12, 24, 36 months
Dental: Decline in oral health	Assessed with questionnaire.	Baseline, 12,24 and 36 months
Dental: Tooth loss	Assessed by tooth count at every clinical visit	36 months
Gastro-Intestinal: rate of GI symptoms	Assessed with ROME III questionnaire.	Baseline, 12, 24 and 36 months
Glucose-Metabolic: Change in fasting glucose, insulin levels (QUICKI, HOMA index)	Laboratory measures at the Central DO-HEALTH Laboratory (Institute of Clinical Chemistry at the University Hospital Zurich)	Baseline, 12,24,36 months
Glucose-Metabolic: Body composition	Subset of 1502 participants with DXA measurements	Baseline, 12, 24, 36 months
Kidney: Decline in kidney function	Blood creatinine levels and estimated glomerular filtration rate	Baseline, 12, 24, and 36 months
Global Health: Quality of life	Assessed with questionnaire (EuroQuol).	Every 6 months
Global Health: Incident disability regarding activities of daily living	Assessed with HAQ-PROMIS questionnaire	Baseline, 12, 24 and 36 months
Global Health: Incident nursing home admission		36 months
Global Health: Mortality		36 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Biomarker endpoints		Baseline, 12, 24, and 36 months
Bone: Incident repeat fractures	Any repeat non-vertebral fractures in all participants, vertebral fractures and total fractures among subset of 1502 seniors with yearly DXA measurements	36 months
BONE: Functional recovery after long bone fracture		36 months
Muscle: Incident sarcopenia / incident frailty / decline in physical function	Incident sarcopenia (among subset of 1502 seniors with yearly DXA measurements), incident frailty (questionnaire), decline in physical activity (questionnaire)	36 months
Cardio-vascular: Major cardio-vascular events	Major cardiovascular events as a composite endpoint (any event: myocardial infarction, stroke, revascularization procedures of CABG and PCI, incident congestive heart disease, cardiovascular mortality); individual endpoints: myocardial infarction, stroke, incident congestive heart disease, and cardiovascular mortality (assessed every 3 months over 36 months)	36 months
Brain: incident dementia		36 months
Immunity: Incident cancer / rate of implant infections / rate of gastro-intestinal infections	Incident cancer (any cancer, gastro-intestinal, breast cancer in women, prostate cancer in men); rate of implant infections after total hip or knee replacement (due to fracture or osteoarthritis); rate of gastro-intestinal infections	36 months
Cartilage/bone: Incident osteoarthritis	Incident symptomatic knee osteoarthritis; incident symptomatic hip osteoarthritis, incident symptomatic hand osteoarthritis; composite endpoint: incident symptomatic knee, hip or hand osteoarthritis; severity of hip pain in those with prevalent symptomatic hip osteoarthritis, severity of hand pain in those with prevalent symptomatic hand osteoarthritis	Baseline, 12, 24, and 36 months
Adherence laboratory	Serum 25(OH)D concentrations (measured both by an automated assay and HPLCMS/MS) and plasma PUFA concentrations (EPA, AA, DPA, DHA; measured by a sensitive and selective assay based on gas chromatography coupled to mass spectrometry detection (GC-MS)) in all participants	Baseline, 12, 24, and 36 months

Collaborators and Investigators

• Sponsor: University of Zurich
• Collaborators: Charite University, Berlin, Germany; University of Sheffield; University of Basel; Technische Universität Dresden; Medical University Innsbruck; University of Geneva, Switzerland; Roche Diagnostics; Recruitment Partners; University Hospital, Toulouse, France (Prof. Bruno Vellas, MD); University of Coimbra, Portugal (Prof. José daSilva, MD); Other University Partners; University of Manchester, UK (Prof. David Felson, MD MPH); Max Rubner University, Germany (Prof. Bernhard Watzl, PhD); Impact Partner; International Osteoporosis Foundation (IOF; Prof. John Kanis, MD); SME Partners; Ferrari Data Solution; Gut Pictures, Switzerland (Benno Gut; animated exercise video); NOVAMEN, France (Sandrine Rival; logistic management partner); Pharmalys, UK (Marieme Ba; monitoring partner); Industry Partners; DSM Nutritional Products (Dr. Elisabeth Stöcklin PhD, Dr. Manfred Eggersdorfer PhD); Nestlé (Michaela Höhne PhD, Irène Corthesy PhD); Funding within Framework 7 research program of the European Commission (project 278588); Further collaborators and advisors at website do-health.eu
• Investigators: Principal Investigator: Heike Bischoff Ferrari, Prof MD, "Centre on Aging and Mobility" University of Zurich, University Hospital Zurich and City Hospital Waid.

Publications and helpful links

General Publications

• Bischoff-Ferrari HA, Willett WC, Manson JE, Dawson-Hughes B, Manz MG, Theiler R, Braendle K, Vellas B, Rizzoli R, Kressig RW, Staehelin HB, Da Silva JAP, Armbrecht G, Egli A, Kanis JA, Orav EJ, Gaengler S. Combined Vitamin D, Omega-3 Fatty Acids, and a Simple Home Exercise Program May Reduce Cancer Risk Among Active Adults Aged 70 and Older: A Randomized Clinical Trial. Front Aging. 2022 Apr 25;3:852643. doi: 10.3389/fragi.2022.852643. eCollection 2022.
• de Godoi Rezende Costa Molino C, Chocano-Bedoya PO, Sadlon A, Theiler R, Orav JE, Vellas B, Rizzoli R, Kressig RW, Kanis JA, Guyonnet S, Lang W, Egli A, Bischoff-Ferrari HA; DO-HEALTH Research Group. Prevalence of polypharmacy in community-dwelling older adults from seven centres in five European countries: a cross-sectional study of DO-HEALTH. BMJ Open. 2022 Apr 29;12(4):e051881. doi: 10.1136/bmjopen-2021-051881.
• Schietzel S, Chocano-Bedoya PO, Sadlon A, Gagesch M, Willett WC, Orav EJ, Kressig RW, Vellas B, Rizzoli R, da Silva JAP, Blauth M, Kanis JA, Egli A, Bischoff-Ferrari HA. Prevalence of healthy aging among community dwelling adults age 70 and older from five European countries. BMC Geriatr. 2022 Mar 2;22(1):174. doi: 10.1186/s12877-022-02755-8.
• Bischoff-Ferrari HA, Vellas B, Rizzoli R, Kressig RW, da Silva JAP, Blauth M, Felson DT, McCloskey EV, Watzl B, Hofbauer LC, Felsenberg D, Willett WC, Dawson-Hughes B, Manson JE, Siebert U, Theiler R, Staehelin HB, de Godoi Rezende Costa Molino C, Chocano-Bedoya PO, Abderhalden LA, Egli A, Kanis JA, Orav EJ; DO-HEALTH Research Group. Effect of Vitamin D Supplementation, Omega-3 Fatty Acid Supplementation, or a Strength-Training Exercise Program on Clinical Outcomes in Older Adults: The DO-HEALTH Randomized Clinical Trial. JAMA. 2020 Nov 10;324(18):1855-1868. doi: 10.1001/jama.2020.16909.

Helpful Links

• European Commission project link for DO-HEALTH
• Website DO-HEALTH Consortium

Study record dates

Study Major Dates

• Study Start (Actual): December 20, 2012
• Primary Completion (Actual): November 17, 2017
• Study Completion (Actual): January 19, 2018

Study Registration Dates

• First Submitted: December 6, 2012
• First Submitted That Met QC Criteria: December 6, 2012
• First Posted (Estimate): December 10, 2012

Study Record Updates

• Last Update Posted (Actual): August 9, 2018
• Last Update Submitted That Met QC Criteria: August 8, 2018
• Last Verified: August 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Micronutrients; Vitamins; Bone Density Conservation Agents; Calcium-Regulating Hormones and Agents; Vitamin D; Cholecalciferol
• Other Study ID Numbers: KEK-ZH-2012-0249; DO-HEALTH (Other Grant/Funding Number: European Commission (project number 278588))

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No