Time Course Adaptations Using Deuterated Creatine (D3Cr) Method

Time Course Adaptations Using Deuterated Creatine (D3Cr) Method: A Pilot Study

The pilot study is to assess the feasibility of using a new method to measure muscle mass called Deuterated Creatine (D3Cr) method and thereby understand the role of muscle mass on functional outcomes in older adults.

Study Overview

• Status: Completed
• Conditions: Sarcopenia
• Intervention / Treatment: Behavioral: Resistance Training; Behavioral: Successful Aging

Detailed Description

Muscle loss with age is considered to be an important cause of disability in older adults. However, current tools frequently used and recommended to measure muscle mass in trials have limitations: For example, DEXA (Dual-energy X-ray absorptiometry) and BIA (Bioelectrical impedance analysis)- both widely used in clinical trials cannot distinguish muscle tissue from non-muscle elements such as subcutaneous and intramuscular fat, skin, water and connective tissue.

Deuterated creatine (D3Cr) dilution is a novel promising method that provides an accurate measure of the functional contractile tissue, without including the non-contractile elements, by measuring total body creatine. Our preliminary cross-sectional results in men aged >65 years show functional muscle mass (FMM) assessed by D3-Cr to be significantly associated with performance outcomes and long-term outcomes, while DEXA showed no associations. However, these are observational data and cannot determine a causative role of muscle per se on functional outcomes.

Hence, the objective of the pilot study is to assess the feasibility of our proposed future study to evaluate the role of muscle mass on functional outcomes. Specifically, the pilot study will randomize moderate to low-functioning older adults to a resistance training program or successful aging health education program to assess recruitment yields, participant adherence, retention, training program design aspects, sample size, and the cost of the main trial. Further, the impact of these changes in FMM on short-term performance outcomes, such as strength, walking speed, SPPB, self-reported measures, and balance will be examined.

• Study Type: Interventional
• Enrollment (Actual): 21
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Florida
    • Gainesville, Florida, United States, 32610
      • UF Health at the University of Florida
    • Gainesville, Florida, United States, 32611
      • UF Institute on Aging Clinical and Translational Research Building

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• men and women aged 70 or greater
• at high risk for mobility disability based on lower extremity functional limitations measured by Short Physical Performance battery (SPPB) with a score ≤ 8 out of 12
• could safely participate in the resistance training intervention as determined by medical history and physical examination.
• willing to give informed consent to be randomized to either the resistance training group or successful aging heath education comparison group and willing to follow the study protocol

Exclusion Criteria:

• Severe cardiac disease, including NYHA Class III or IV congestive heart failure, clinically significant aortic stenosis, history of cardiac arrest, use of a cardiac defibrillator, or uncontrolled angina
• Myocardial infarction, major heart surgery, stroke, deep vein thrombosis, or pulmonary embolus in the past 6 months
• Lung disease requiring either oral or injected steroids, or the use of supplemental oxygen
• Short, portable mental status questionnaire with 3 or more errors
• Severe arthritis (either osteoarthritis or rheumatoid arthritis) that severely limits mobility
• Severe lower back or shoulder pain that can worsen with weight lifting exercises.
• Cancer requiring treatment in the past 1 year (Melanomas excluded)
• Any present or recent history of severe psychiatric illness including depression that might preclude providing informed consent, safe participation, or compliance (self-report and investigator judgement
• Development of chest pain or severe shortness of breath on the 400 m self-paced walk test
• Parkinson's disease or other serious neurological disorders; renal disease requiring dialysis; other illness of such severity that life expectancy is considered to be less than 12 months
• Current diagnosis of schizophrenia, other psychotic disorders, or bipolar disorder
• Current consumption of more than 14 alcoholic drinks per week
• Uncontrolled hypertension (systolic blood pressure > 200 mm Hg and/or diastolic blood pressure >110 mm Hg)
• Currently on testosterone, Dehydroepiandrosterone (DHEA), or anabolic steroids.
• Undergoing physical therapy involving the lower extremities
• Currently enrolled in another randomized trial involving a pharmaceutical or lifestyle intervention. Observational studies are permitted
• Participation in progressive resistance exercise regimen ( ≥1 day/week) within the previous 6 months prior to screening.
• Weight change (intentional or not) over the last 6 months of > 5% of body or plan to lose or gain weight during the study
• Any other cardiovascular, pulmonary, orthopedic, neurologic, or other conditions that in the opinion of the local clinician would preclude participation and successful completion of the protocol

Temporary Exclusion Criteria:

• Recent bacterial/viral infection (e.g. pneumonia) (< 2 weeks);
• Acute febrile illness in past 2 months;
• Severe hypertension, e.g., SBP > 200 mm Hg, DBP > 110 mm Hg
• Major surgery or fracture or hip/knee replacement (< 6 months);
• Hospitalization within the last 6 months ( Not ER visits)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Successful Aging; The comparator group will meet for stretching and health education classes every 2-5 weeks up to 7 total visits.	Behavioral: Successful Aging; The successful aging will attend stretching and health lectures as a group . The topics might include, medication management, disease management (e.g. blood pressure, diabetes, arthritis, dementia, pain management, diet) and other health related matters.; Other Names: Health Education; HE
Experimental: Resistance Training group (RT); The resistance training intervention will include a full body, resistance training performed three days per week.The intensity, volume, tempo, and progression will be based on the Federal Physical Activity guidelines	Behavioral: Resistance Training; The intensity, volume, tempo, and progression will be based on the Federal Physical Activity guidelines. The resistance training exercises will include mainly multi-joint exercises using selectorized machines. Each session will include upper body exercises (Chest Press, Shoulder Press, Seated Rows, Bicep curls, and Tricep Extensions) and lower body exercises (Leg Press, Leg Extension and Leg Curls, and Calf raise) that will be tailored to the participant needs.; Other Names: RT; Strength Training; Weight Training

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Muscle Mass	Change in Muscle mass measured using D3Cr	Baseline and week 16

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Appendicular Lean Mass (ALM)	Change in ALM by dual-energy x-ray absorptiometry (DEXA)	Baseline and week 16
Lean Body Mass (LBM)	Change in LBM assessed using DXA	Baseline, and Week 16
Correlation Between Changes in Muscle Mass	Correlation between longitudinal changes in D3 Cr muscle mass (MM) and DXA appendicular lean mass (ALM)	Baseline and Week 15

Collaborators and Investigators

• Sponsor: University of Florida
• Collaborators: National Institute on Aging (NIA)
• Investigators: Principal Investigator: Todd Manini, PhD, University of Florida

Publications and helpful links

General Publications

• Balachandran AT, Evans WJ, Cawthon PM, Wang Y, Shankaran M, Hellerstein MK, Qiu P, Manini T. Comparing D3-Creatine Dilution and Dual-Energy X-ray Absorptiometry Muscle Mass Responses to Strength Training in Low-Functioning Older Adults. J Gerontol A Biol Sci Med Sci. 2023 Aug 27;78(9):1591-1596. doi: 10.1093/gerona/glad047.

Study record dates

Study Major Dates

• Study Start (Actual): February 1, 2019
• Primary Completion (Actual): August 1, 2020
• Study Completion (Actual): August 1, 2020

Study Registration Dates

• First Submitted: June 5, 2018
• First Submitted That Met QC Criteria: June 19, 2018
• First Posted (Actual): June 29, 2018

Study Record Updates

• Last Update Posted (Actual): July 3, 2024
• Last Update Submitted That Met QC Criteria: June 10, 2024
• Last Verified: June 1, 2024

More Information

Terms related to this study

• Keywords: older adults; muscle mass; physical function; resistance training; muscle loss; Deuterated creatine (D3Cr) dilution
• Additional Relevant MeSH Terms: Nervous System Diseases; Neurologic Manifestations; Neuromuscular Manifestations; Pathological Conditions, Anatomical; Muscular Atrophy; Atrophy; Sarcopenia
• Other Study ID Numbers: IRB201801249 - N; P30AG028740 (U.S. NIH Grant/Contract)

Drug and device information, study documents

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