The Effect of Two Weeks of Voluntary Reduced Physical Activity in Chronic Obstructive Pulmonary Disease (COPD)

The Effect of Two Weeks of Voluntary Reduced Physical Activity in COPD - A Novel Methodology for Anabolic Drug Development

Chronic Obstructive Pulmonary Disease (COPD) is the most common pulmonary disease, responsible for considerable morbidity and mortality and is the third leading cause of death worldwide. As well as its consequences in the lungs, COPD is well recognized to be associated with a range of important systemic consequences and co-morbidities. Interestingly, skeletal muscle dysfunction is noted in both early and advanced disease, suggesting its origins may not be wholly pulmonary.

Treatment strategies targeting lung function are, unfortunately, of limited value. Given the burden of disease, it is becoming increasingly important that investigative and therapeutic work now focuses on other systemic characteristics and sequelae which define the disease phenotype.

This is a randomized controlled trial of the effect of 14 days of voluntary reduced activity on muscle mass, muscle strength, body composition, and atrophy signalling in patients with COPD and age-matched controls.

The primary hypothesis upon which this study is based is that a short reduction in ambulation will induce a transient reduction in quadriceps muscle mass, quadriceps strength and physical performance in patients with COPD compared to matched COPD patients whose mobility has not been restricted.

The secondary hypothesis is that the magnitude of the above changes will be greater in physically inactive COPD patients compared to physically inactive age-matched controls.

The overall aim of this research is to use an in vivo human model of 14 days of voluntary reduced physical activity to test the above hypotheses. If the model proves feasible, this will allow for earlier proof of concept studies of novel therapeutic agents.

Study Overview

• Status: Unknown
• Conditions: Muscle Atrophy; Chronic Obstructive Pulmonary Disease (COPD)
• Intervention / Treatment: Behavioral: 14 days of voluntary step count reduction to no more than 1500 steps/day.

Detailed Description

This is a non-commercial randomized controlled trial. 15 patients with COPD and 15 age-matched controls will voluntarily reduce their daily step-count to no more than 1500 steps/day, from a baseline of > 3500 steps/day.

Before and after 14 days of reduced daily step-count, these 30 participants will undergo measures of appendicular mass, quadriceps strength, exercise tolerance and blood and urinary biomarkers. Quadriceps muscle biopsies will also be taken before and after the 14-day intervention.

15 patients with COPD will be studied 14 days apart but will not undergo the intervention.

• Study Type: Interventional
• Enrollment (Anticipated): 45
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom, SW3 6NP
    • Recruiting
    • Royal Brompton & Harefield NHS Foundation Trust
    • Contact: Sara Kladidis, MB BS MRCP; Phone Number: 02073518029; Email: s.kladidis@rbht.nhs.uk
    • Principal Investigator: Michael Polkey, FRCP PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Non-smoking adult patients with COPD (GOLD stage II-IV)
• Non-smoking, healthy, age-matched controls
• Baseline step count > 3500 steps/day
• Baseline 6 minute walk distance > 140m

Exclusion Criteria:

• Inability to provide written, informed consent
• Significant co-morbidity limiting exercise tolerance
• Within 1 month of acute exacerbation of COPD
• Within 1 month of pulmonary rehabilitation
• History of venous thrombo-embolism or known increased risk of thrombotic disease

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: COPD - reduced activity levels; COPD patients who have voluntarily decreased their daily physical activity levels to no more than 1500 steps/day for 14 days.	Behavioral: 14 days of voluntary step count reduction to no more than 1500 steps/day.
Experimental: Healthy - reduced activity levels; Healthy age-matched controls who have voluntarily decreased their daily physical activity levels to no more than 1500 steps/day for 14 days.	Behavioral: 14 days of voluntary step count reduction to no more than 1500 steps/day.
No Intervention: COPD - unchanged activity levels

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quadriceps muscle mass as measured by dual-energy x-ray absorptiometry (DEXA) after two weeks of voluntary reduced physical activity.	Dual-energy X-ray absorptiometry (DEXA) scanning will be used to assess body composition. Two X-ray beams with different energy levels are used during this technique. It is a widely used scanning modality and is entirely painless. The radiation received by the patient during the scan is less than that of an airline flight from California to New York and back. Specifically, appendicular lean composition will be measured (g).	Change from baseline in quadriceps muscle mass at 14 days.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quadriceps strength determined as maximal voluntary contraction force (QMVC) and the force elicited by unpotentiated supramaximal stimulation of the femoral nerve (TwQ).	Subjects sit on a specially designed chair keeping the knee flexed at 90 degrees over the end. Force is measured via an inextensible strap placed around the ankle and connected to a strain gauge. Subjects are asked to extend their knee maximally against the strap with visual feedback and verbal encouragement from the investigator, until no further increased in QMVC occurs. QMVC is reported in kg and is the highest single value obtained. In addition, the strength and endurance of the quadriceps will be measured using magnetic femoral nerve stimulation (TwQ). This is used to determine muscle strength in a non-volitional manner. The nerve to be studied is depolarised by the application of a rapidly changing magnetic field produced by a coil positioned on the overlying skin surface. The magnetic field is relatively unimpeded by skin, fat and bone, and thus has the ability to stimulate deep nerves easily and with little discomfort.	Before and after the 14 day intervention
Rectus Femoris Cross Sectional Area determined by Quadriceps Ultrasound (RFCSA US)	An ultrasound (US) scan is a painless test that uses sound waves to create images of organs and structures. We will use it to assess the thickness of the thigh muscles. The patient rests in a reclined position for this test, and a lubricating jelly is applied to the thigh. The US probe is moved over the thigh area to produce a picture of the size of the thigh muscle. The leg to be scanned will be the same leg used for QMVC. The units of measure for the RFCSA are cm2.	Before and after the 14 day intervention
6 minute walk distance (6MWD)	The 6MWD is a practical and simple test that measures the distance that a subject can walk quickly on a flat, hard surface in a period of 6 minutes. This will be performed by appropriately trained study site personnel. The outcome of the 6MWD will the walking distance covered in meters. The test will be performed according to the ATS Guidelines, in a standardized manner.	Before and after the 14 day intervention
Short Physical Performance Battery (SPPB)	The SPPB is a brief performance test used to assess how well a subject can perform simple movements that represent the foundation of daily activities. The components that are assessed are 1) a Standing Balance Test, 2) a Four Meter Gait Speed and 3) a Sit to Stand Test. This collection of tests is routinely used in gerontology. It is scored out of a total of 12 points (4 for each of the 3 parameters aforementioned).	Before and after the 14 day intervention
Blood and urinary biomarkers	Serum and plasma aliquots will be prepared from the blood samples for mediator analysis. Analysis will include full blood count, urea and electrolytes, d-dimers, and markers of systemic inflammation (C-reactive protein & fibrinogen). Each donation of blood will not exceed 50mL per study visit. Urine samples will be collected and frozen. These will be available for testing potentially relevant biomarkers which may come under investigation within our group.	Before and after the 14 day intervention
Atrophy signalling determined from muscle biopsies	Muscle biopsies will be taken from the leg quadriceps muscle. These will be assessed for the presence of atrophy and hypertrophy signalling changes. The exact signalling panel will be determined from the most current literature review but is likely to include atrophic markers including myostatin, atrogin and MURF-1, hypertrophic markers including GSK3b, p70S6K and 4E-BP1, together with related microRNAs currently under investigation in our group.	Before and after the 14 day intervention

Collaborators and Investigators

• Sponsor: Royal Brompton & Harefield NHS Foundation Trust
• Investigators: Principal Investigator: Michael Polkey, FRCP PhD, Royal Brompton & Harefield NHS Foundation Trust

Study record dates

Study Major Dates

• Study Start: May 1, 2014
• Primary Completion (Anticipated): April 1, 2016
• Study Completion (Anticipated): May 1, 2016

Study Registration Dates

• First Submitted: August 18, 2014
• First Submitted That Met QC Criteria: August 19, 2014
• First Posted (Estimate): August 20, 2014

Study Record Updates

• Last Update Posted (Estimate): August 22, 2014
• Last Update Submitted That Met QC Criteria: August 21, 2014
• Last Verified: August 1, 2014

More Information

Terms related to this study

• Keywords: Cachexia; Skeletal Muscle; Physical Inactivity
• Additional Relevant MeSH Terms: Nervous System Diseases; Respiratory Tract Diseases; Neurologic Manifestations; Neuromuscular Manifestations; Pathological Conditions, Anatomical; Atrophy; Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive; Muscular Atrophy
• Other Study ID Numbers: 2014LF002B