Exercise and Genes in Obese (EGO) (EGO)

The Effect of Exercise and Genes on Energy Expenditure, Appetite and Quality of Life in Morbidly Obese Patients

Regular exercise has several positive health effects including increased physical fitness and muscle mass. It is well known that increased muscle mass is associated with increased resting energy expenditure which may facilitate weight loss and maintenance. Previous studies have, however, failed to show any consistent association between the intensity of physical exercise and energy expenditure, or relate the variance in these adaptations to genetic variability. Whether high-intensity exercise (HIE) is associated with improved health related quality of life in severely obese patients remains unknown.

This PhD-project is based on a planned randomised controlled study including 50 or more treatment seeking morbidly obese patients who will be randomised to either a 24 week moderate-intensity exercise (MIE) programme or a 24 week high-intensity exercise (HIE) programme. The investigators main hypothesis is that patients randomised to the HIE-program will achieve higher energy expenditure during rest and physical activity after treatment than those allocated to the MIE-programme. In addition, the investigators hypothesise that the HIE-group will achieve a better health related quality of life than the MIE-group after treatment. The investigators also hypothesize that inter-individual variability in adaptation to the two training regimens may be due to genetic factors. If the investigators hypotheses are confirmed, this project might have beneficial clinical implications for future obesity treatment strategies.

Study Overview

• Status: Active, not recruiting
• Conditions: Obesity
• Intervention / Treatment: Other: Training intensity intervention

• Study Type: Interventional
• Enrollment (Anticipated): 50
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Norway
  • Bø, Norway, 3800
    • Telemark University College
  • Kristiansand, Norway, 4630
    • University in Agder
  • Trondheim, Norway, 7491
    • Norges Teknisk-naturvitenskapelig Universitet
  • Tønsberg, Norway, 3103
    • Vestfold Hospital trust
  • Raveien
    • Horten, Raveien, Norway, 3184
      • Vestfold University College
• United States
  • North Carolina
    • Durham, North Carolina, United States, 27708
      • Duke University School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Treatment seeking weight stable morbidly obese patients (BMI ≥ 40 kg/m2 or BMI 35 to 39.9 kg/m2 with ≥ 1 co morbidity) attending the outpatient Obesity Center, Vestfold Hospital Trust, will be informed about this RCT .

Exclusion Criteria:

• Uncompensated heart failure
• Recent myocardial infarction or stroke (<½ years)
• Severe arrhythmia or heart failure
• Unstable angina pectoris
• Renal failure
• Pregnancy
• Severe eating disorders
• Active substance abuse
• Being on a diet
• Taking medication known to affect appetite or metabolism (including thyroxin).

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: High intensity training group; HIE will consist of the following: 10 minute warm up at 70% of maximal heart rate.; 4 minute exercise intervals at 90-95% of maximal heart rate.; 4 minute interval bouts repeated 4 times.; Between each bouts there will be a 3 minute active recovery at 70% of maximal heart rate; After all four bouts are completed; 5 minute cool-down at 70% of maximal heart rate.	Other: Training intensity intervention; High intensity training group describes the group performing high intensity exercise intervention. Moderate intensity training group describes the the group performing moderate exercise intervention; Other Names: EGO-HIT
Experimental: Moderate intensity training group; MIE will consist of the following: 10 minute warm up at 50% of maximal heart rate.; 35 minutes exercise at 70% of maximal heart rate.; 4 minute cool-down at 50% of maximal heart rate.	Other: Training intensity intervention; High intensity training group describes the group performing high intensity exercise intervention. Moderate intensity training group describes the the group performing moderate exercise intervention; Other Names: EGO-HIT

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Energy expenditure during physical activity	Energy expenditure (EE) during volitional activity will be measured with ergo-spirometry tests one week before the exercise intervention period starts, and repeated after each exercise period. Increasing the aerobic work capacity is supposed to give the same proportional increase in energy expenditure at any given maximal intensity.	0, 8, 12 and 24 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Resting metabolic rate	Resting metabolic rate will be measured with ergo-spirometry test one week before the exercise intervention period starts, and repeated after each exercise period. Increasing the aerobic work capacity is supposed to give increased resting metabolic rate.	0, 8, 12 and 24 weeks
Cardiorespiratory fitness	Exercise may have a positive effect on cardiorespiratory fitness and will be measured with ergo-spirometry test	0, 8, 12 and 24 weeks
Body mass index	Exercise may have a positive effect on weight change and will be calculated as weight in kilograms divided by height in meters squared	0, 8, 12 and 24 weeks
Waist circumference	Exercise may have a positive effect on waist circumference and will be measured midway between the bottom edge of the lower rib and upper iliac crest in the horizontal plane.	0, 8, 12 and 24 weeks
Fat mass and fat free mass	Exercise may have a positive effect on body composition and will be measured with the bioelectrical impedance analyser Tanita BC-418	0, 8, 12 and 24 weeks
Appetite control	Patient self-appraisal of hunger and fullness will be assessed during fasting and after a standardised breakfast every 30 minutes (for a period of 3hours) using visual analogue scales.	0,12 and 24 weeks
Genetic susceptibility	We hypothesize that inter-individual variability in adaptation/response to the two training regimens may also be due to genetic factors. We have designed a gene panel consisting of recognized and previously reported risk genes/variants with flanking sequences relevant for exercise (VO2max), participation in physical activity, obesity, diabetes, asthma and obesity related sub-phenotypes. The panel covers 1.2 Mb and includes 299 genes (exons with exon-intron junctions) and 1468 intronic and intergenic SNPs. Next-generation sequencing will be performed using a gene panel of selected genes/genetic regions by Illumina Nextera technology. The method involves enzymatic fragmentation of DNA and probe-based enrichment. The samples will be sequenced (paired-end, 2x100 bp) on a HiScanSQ. All wet lab methods (with other gene panels) are ISO15189 certified and in routine use at Unit for Medical Genetics at Telemark Hospital.	0, 8, 12 and 24 weeks
Short form health survey (RAND-36)	RAND-36 is a 36-item measure of generic HRQOL consisting of eight additive subscales (Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health) and two summary scores each based on four subscales (Physical Component Summary and Mental Component Summary). Scores on all subscales range from 0 to 100. Summary-scores will be norm-based, with mean (SD) 50 (10). Higher scores on all scales represent better HRQOL.	0,12 and 24 weeks
Impact on Weight Questionnaire (IWQOL-Lite)	IWQOL-Lite is a 36-item measure of generic HRQOL consisting of eight additive subscales (Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health) and two summary scores each based on four subscales (Physical Component Summary and Mental Component Summary). Scores on all subscales range from 0 to 100. Summary-scores will be norm-based, with mean (SD) 50 (10). Higher scores on all scales represent better HRQOL.	0,12 and 24 weeks
Weight-Related Symptom Measure (WRSM)	WRSM is a 20-item measure for the presence and distress of 20 weight-related symptoms. The distress scores of the symptoms are reported on a six-point likert scale. Two summary scores are calculated; an additive score of presence of symptoms ranging from 1 to 20 and a symptom distress score for all symptoms. Symptom distress scores range from 0 to 100, with higher scores indicating a higher or worse total symptom distress.	0,12 and 24 weeks
Power of Food scale (PFS)	PFS assess both the psychological impact and respondent's responsiveness to a food-abundant environment. This is a 15-item scale whose items pertain to three situations: food being readily available in the environment but not physically present, food is physically present, but not tasted, and food is first tasted but not already consumed. The three subscales is scored 0-100 with higher scores indicating greater eating problems.	0,12 and 24 weeks
Binge Eating Scale (BES)	BES comprise 16 items assessing binge eating problems. Additive scores range between 0-46, with higher scores indicating greater problems. Cut-off scores have been established to determine binge severity, with "severe" represented by scores > 27, "moderate" by scores 18-26, and "mild-none" by scores < 17.	0,12 and 24 weeks
Three Factor Eating Questionnaire (TFEQ -R21)	TFEQ -R21 is a 21-item questionnaire covering eating behavior domains: the cognitive restraint scale (6 items) assesses control over food intake and influence over body weight and body shape; the emotional eating scale (6 items) measures the propensity to overeat in relation to negative mood states, e.g., when feeling lonely, anxious, or depressed; and, the uncontrolled eating scale (9 items) assesses the tendency to lose control over eating when feeling hungry or when exposed to external stimuli	0,12 and 24 weeks
Body weight change	Exercise may have a positive effect on weight change	0, 8, 12 and 24 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Substrate oxidation	Exercise may have a positive effect on substrate oxidation (for example fat oxidation) and will be measured with ergo-spirometry tests	0, 8, 12 and 24 weeks
Hip circumference	Exercise may have a positive effect on hip circumference and will be measured on the widest part of the hip in the horizontal plane.	0, 8, 12 and 24 weeks
Daily activity	Exercise can affect daily activity. Measurements of 24-hour activity during free living will be performed with accelerometer (ActiGraph wGT3x-BT, Pensacola, FL, USA). The 24-hour activity expressed as daily activity counts per minute (Vector magnitude, CPM). The registrations will last for 24 hours during 7 days including the weekend.	0, 17 and 24 weeks
Total energy intake	Exercise can affect total energy intake. A 180 items food frequency questionnaire developed in Norway and validated to assess habitual diet among men and women, was will be used. The dietary data will be entered by scanning, using the teleform program (10.0) (Datascan, Oslo, Norway). Daily intake of foods, energy and nutrients will be calculated using software (KBS version 7.3 2017; developed at the institute of Basic Medical Sciences, University of Oslo). The software is based on Norwegian food composition table (Norwegian Food Composition Database 2017. Norwegian Food Safety Authority)	0 and 24 weeks

Collaborators and Investigators

• Sponsor: Jarle Berge
• Collaborators: Norwegian University of Science and Technology; Duke University; University of Agder; University of South-Eastern Norway; Vestfold University College
• Investigators: Study Director: Jøran Hjelmesæth, professor, The Hospital of Vestfold

Publications and helpful links

General Publications

• Berge J, Hjelmesaeth J, Kolotkin RL, Storen O, Bratland-Sanda S, Hertel JK, Gjevestad E, Smastuen MC, Helgerud J, Bernklev T. Effect of aerobic exercise intensity on health-related quality of life in severe obesity: a randomized controlled trial. Health Qual Life Outcomes. 2022 Feb 24;20(1):34. doi: 10.1186/s12955-022-01940-y.
• Berge J, Hjelmesaeth J, Hertel JK, Gjevestad E, Smastuen MC, Johnson LK, Martins C, Andersen E, Helgerud J, Storen O. Effect of Aerobic Exercise Intensity on Energy Expenditure and Weight Loss in Severe Obesity-A Randomized Controlled Trial. Obesity (Silver Spring). 2021 Feb;29(2):359-369. doi: 10.1002/oby.23078.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2015
• Primary Completion (Anticipated): August 1, 2023
• Study Completion (Anticipated): August 1, 2023

Study Registration Dates

• First Submitted: June 26, 2014
• First Submitted That Met QC Criteria: December 5, 2014
• First Posted (Estimate): December 8, 2014

Study Record Updates

• Last Update Posted (Actual): September 23, 2021
• Last Update Submitted That Met QC Criteria: September 22, 2021
• Last Verified: September 1, 2021

More Information

Terms related to this study

• Keywords: Exercise and Genes in Obese (EGO)
• Other Study ID Numbers: EGO