High Intensity Interval Training (HIIT) to Reduce Frailty and Enhance Resilience in Older Veterans (HIIT@Home)

Frailty is defined as a greater susceptibility to stressors resulting from age-related impairments in adaptive biological systems. Frailty leads to poorer physical performance and functional capacity and higher risk of adverse outcomes including falls, hospitalization, and mortality. Resilience, defined as the capacity to recover from disruptions to homeostasis, is critical to successful aging because it precedes frailty and enhances adults' ability to maintain optimal health and function well into older age. Evidence- based therapies to help older adults enhance resilience are limited and the biological underpinnings contributing to improved resilience have not yet been fully characterized. To address this important need, the investigators will conduct a clinical trial to examine the benefits of center- and home-based high intensity interval training (HIIT) on functional capacity, frailty, and resilience, and also to identify novel biomarkers of resilience in older Veterans.

Study Overview

• Status: Recruiting
• Conditions: Frailty
• Intervention / Treatment: Behavioral: Center based HIIT; Behavioral: Home based HIIT; Behavioral: Center based attention (stretching only) control

Detailed Description

Impact of Home-Based High Intensity Interval Training on Resilience in Older Veterans More than 30% of U.S. Veterans 65 years or older are frail, which is three-times higher than in non-Veterans in the same age group. Frailty is defined as an increased susceptibility to stressors resulting from age-related impairments in adaptive biological systems, leading to higher risk of adverse outcomes including falls, disability, hospitalization, and mortality. Further, frailty prevalence increases with age, affecting 50% of all adults 85 and over. Resilience, which is defined as the capacity to recover from stress-induced disruptions to homeostasis, is critical to successful aging because it precedes frailty and presents an opportunity to intervene on early health deficits, thus preventing aging-related decline in health, function, and quality of life. Evidence-based therapies that enhance resilience in older adults are limited and the complex biological and physiological mechanisms underlying resilience are not yet fully understood. Consequently, Veterans seeking to boost their ability to recover from late-life stressors and prevent frailty have few proven options. The investigators overarching aim is to characterize the complex factors contributing to resilience and develop novel strategies that enhance resilience to boost health span in older adults. Towards this end, the investigators previous VA RR&D SPiRE Award allowed us to demonstrate the feasibility of 12-weeks of high intensity interval training (HIIT) among older Veterans. The investigators successfully enrolled and retained older male and female Veterans and safely conducted individually tailored HIIT that improved cardiorespiratory fitness, lower-body endurance, cognition, and quality of life. The purpose of the proposed larger trial is to build upon the investigators previous successes and develop and implement practical HIIT regimens to reduce frailty and enhance resilience in older Veterans. The investigators will conduct a randomized controlled trial to ascertain the therapeutic benefits of 12-weeks of center- and home-based HIIT on recovery and resilience among Veterans 60 years or older. The investigators have identified a series of biomarkers of resilience and are also seeking to examine key biological drivers of recovery at the molecular level. The investigators proposed study will not only identify feasible methods to measure resilience in older Veterans but will also assess the benefits of home-based HIIT on physical and cognitive performance, frailty, resilience, and health span.

• Study Type: Interventional
• Enrollment (Estimated): 200
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Kenneth L Seldeen, PhD; Phone Number: (716) 888-4869; Email: Kenneth.Seldeen@va.gov
• Study Contact Backup: Name: Bruce R Troen, MD; Phone Number: (816) 922-2755; Email: Bruce.Troen@va.gov

Study Locations

• United States
  • Missouri
    • Kansas City, Missouri, United States, 64128
      • Not yet recruiting
      • Kansas City VA Medical Center, Kansas City, MO
      • Contact: Bruce R Troen, MD; Email: bruce.troen@va.gov
      • Contact: Kenneth L Seldeen, PhD; Email: Kenneth.seldeen@va.gov
    • Kansas City, Missouri, United States, 64128-2226
      • Recruiting
      • Kansas City VA Medical Center, Kansas City, MO
      • Contact: Ramratan R Sharma, PhD MHSA; Phone Number: (816) 922-2757; Email: ram.sharma2@va.gov
      • Principal Investigator: Bruce R. Troen, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 60 years to 85 years (Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Ages 65 years and older
• Male and female, any race
• Medically cleared for exercise
• Non-frail or pre-frail (frailty score < 3)
• Ability to use a recumbent exercise bike

Exclusion Criteria:

• Severe co-morbidity: COPD (GOLD stage IV), CKD ( stage 3)), severe HTN (180 mmHg/120 mmHg)
• VA-SLUMS score 20 or lower (Cognition)

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Center based attention control	Behavioral: Center based attention (stretching only) control; Center based attention (stretching only) control
Experimental: Center based HIIT	Behavioral: Center based HIIT; Center based HIIT
Experimental: Home based HIIT	Behavioral: Home based HIIT; Home based HIIT

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Sub-maximal oxygen uptake test (VO2max)	Participants are asked to exercise on an upright exercise bike as the resistance increases over time. During the exercise, participants are asked to breath through a mask that is connected to a oxygen and carbon dioxide measuring device. The assessment last for approximately 5-10 minutes and provides data the pertain to an individuals lung capacity, breathing rate, and endurance.	Change from baseline to endpoint at 12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Gait speed	Participants are asked to perform a timed walk of approximately 15 feet in length	Change from baseline to endpoint at 12 weeks
Quality of life assessment	Quality of life assessment is performed using the Quality of life, enjoyment, and satisfaction questionnaire - short form (Q-LES-Q-SF) survey instrument. The survey instrument scores from 0 to 70 with a greater score representing better quality of life.	Change from baseline to endpoint at 12 weeks
Body Composition (Lean and fat mass)	Body composition will be measured using bioelectric impedance (BIA) - a technique where participants are asked to stand on the measurement device and hold on to two metal handles. A light - and non-detectable - current is then transmitted allowing for collection of body fat and lean mass in the subject. The assessment takes roughly 2-3 minutes.	Change from baseline to endpoint at 12 weeks
Step counts	Objectively measure activity using FITBIT Charge 5 actigraphy devices. These devices are worn on the wrist and capture total steps.	Change from baseline to endpoint at 12 weeks
C-Reactive Protein	Chronic inflammation may be indicative of distress and lead to chronic diseases. The study will examine the change in C-reactive protein in picograms per milliliter in serum from baseline to endpoint at 12 weeks.	Change from baseline to endpoint at 12 weeks
Interleukin-6	Chronic inflammation may be indicative of distress and lead to chronic diseases. The study will examine the change in interleukin-6 in picograms per milliliter in serum from baseline to endpoint at 12 weeks.	Change from baseline to endpoint at 12 weeks
Interleukin-10	Chronic inflammation may be indicative of distress and lead to chronic diseases. The study will examine the change in interleukin-10 in picograms per milliliter in serum from baseline to endpoint at 12 weeks.	Change from baseline to endpoint at 12 weeks
Amyloid beta 42/40 ratio	Serum cognitive marker: change in amyloid beta 42/40 ratio (a unitless measure derived from the ratio of serum amyloid-beta 42 in picograms per milliliter divided by serum amyloid-beta 40 in picograms per milliliter) from baseline to endpoint after 12 weeks.	Change from baseline to endpoint at 12 weeks
Cognitive screen - Cognivue	Cognivue to assess cognition. This is a computer based combinatorial visual and reaction time test, which is scored 0 to 100.	Change from baseline to endpoint at 12 weeks
Phosphorylated tau (P-tau)	Serum cognitive marker: plasma levels of phosphorylated tau (P-tau) in picograms per milliliter from baseline to endpoint after 12 weeks.	Change from baseline to endpoint at 12 weeks
Brain Derived Neurotrophic Factor (BDNF)	Serum cognitive marker: change in Brain Derived Neurotrophic Factor (BDNF) in picograms per milliliter from baseline to endpoint after 12 weeks.	Change from baseline to endpoint at 12 weeks
Fatigue	Fatigue as assessed by the Brief Fatigue Inventory, which contains 9 self-rated questions with an aggregate score range of 0 to 90.	Change from baseline to endpoint at 12 weeks
Sleep quantity and stages	Objectively measure sleep quantity and stages using FITBIT Charge 5 actigraphy devices. These devices are worn on the wrist and sleep metrics, including total sleep time and time spent in light, deep, and REM sleep stages.	Change from baseline to endpoint at 12 weeks
Sleep quality	Sleep quality as assessed by Pittsburgh Sleep Quality Index (PSQI). The PSQI contains 19 self-rated questions that combined to form 7 component scores, each with a range of 0 to 3 points. These in turn are added to yield a global score with a range of 0 to 21 points.	Change from baseline to endpoint at 12 weeks
Sleep chronotype	Sleep chronotype as assessed by the Morningness/Eveningness survey, which contains 19 self-rated questions with an aggregate score range of 19 to 72.	Change from baseline to endpoint at 12 weeks
Sleepiness	Sleepiness as assessed by the Epworth Sleepiness Scale, which contains 8 self-rated questions with an aggregate score range of 0 to 24.	Change from baseline to endpoint at 12 weeks
Insomnia	Insomnia as assessed by the Insomnia Severity Index, which contains 7 self-rated questions with an aggregate score range of 0 to 28.	Change from baseline to endpoint at 12 weeks
Anxiety and depression	Anxiety and depression as assessed by the Hospital Anxiety and Depression Scale (HADS), which contains 14 self-rated questions with an aggregate score range of 0 to 21.	Change from baseline to endpoint at 12 weeks
Sleep disorders	Sleep disorders as assessed by the Holland Sleep Disorders Questionnaire, which contains 32 self-rated questions with an aggregate score range of 32 and 160.	Change from baseline to endpoint at 12 weeks
Cognitive screen - SLUMS	Cognitive status will be assessed using the VA - St. Louis University Mental Survey (VA-SLUMS) involving memory tests, shape recognition, and story recall. The survey scores range from 0-30, with a higher score representing greater cognitive capability. The investigators will also utilize the Cognivue to assess cognition. This is a combinatorial visual and reaction time test.	Change from baseline to endpoint at 12 weeks
30 second chair rise test	The investigators will measure endurance in participants by asking participants to sit and rise repeated from a chair as many times in a 30 second time frame.	Change from baseline to endpoint at 12 weeks
Frailty assessment	Frailty is a syndrome marked by greater susceptibility to adverse outcomes like falls and disability. The investigators will be using the Fried Frailty Phenotype that includes: 1) unexpected weight loss of 5% or more in the last year or BMI < 18.5; score 0 or 1 if positive, 2) grip strength with BMI dependent cut points for men and women; score 0 or 1 if positive, 3) gait speed with height and sex dependent cutoffs; score 0 or 1 if positive, 4) activity assessed by a survey of the frequency of mild/moderate/energetic physical activity; score of 0 or 1, the latter if positive for hardly ever or never engaging in moderate or energetic physical activity, and 5) endurance assessed by survey of bed rest during the day; score of 0 or 1, the latter if occurring every day or every week. The composite score is therefore 0 to 5.	Change from baseline to endpoint at 12 weeks
Arm curl endurance	Participants will receive a free weight (8lbs for men and 5lbs for women) and asked to perform total number of arm curls in 30 seconds while in a seated position.	Change from baseline to endpoint at 12 weeks
Eforto Grip endurance	participants will be ask to perform a grip endurance assessment using an Eforto device. The device has a squeezable ball that measures force through changes in air pressure in response to squeezing. Participants are asked to attempt three maximal force tests at 5 seconds each, and then asked to maintain maximal grip for as long as they are able to hold.	Change from baseline to endpoint at 12 weeks
Biosway balance assessment	Participants are measured for microsway (mm/s) while standing on a Biosway balance device. Participants will be asked to hold balance for 45 seconds while standing comfortably, standing with eyes close, standing with a narrow stance, and standing with a narrow stance with eyes closed.	Change from baseline to endpoint at 12 weeks
Resilience to Blood occlusion	Participants will be asked to wear a blood pressure cuff while a functional near infrared spectroscopy device measures flow flow in the lower arm. The cuff will be applied to restrict blood flow for 2 minutes, and then released to observe blood oxygenation recovery in the lower arm.	Change from baseline to endpoint at 12 weeks
Stroop Color and Word Test	Participants will be asked to perform the Stroop color and word test. This test features three sections in which the participant will first read words written in black, then part two name the color of blocks, then the final part name the color of the written words.	Change from baseline to endpoint at 12 weeks

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Investigators: Principal Investigator: Bruce R. Troen, MD, Kansas City VA Medical Center, Kansas City, MO

Study record dates

Study Major Dates

• Study Start (Actual): January 29, 2024
• Primary Completion (Estimated): July 1, 2027
• Study Completion (Estimated): September 30, 2027

Study Registration Dates

• First Submitted: November 14, 2022
• First Submitted That Met QC Criteria: November 14, 2022
• First Posted (Actual): November 22, 2022

Study Record Updates

• Last Update Posted (Actual): December 12, 2025
• Last Update Submitted That Met QC Criteria: December 4, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: sleep; frailty; cognition; aging; veteran; functional capacity; resilience
• Additional Relevant MeSH Terms: Pathologic Processes; Pathological Conditions, Signs and Symptoms; Frailty
• Other Study ID Numbers: E3813-R; RX003813-01A2 (Other Grant/Funding Number: Veterans Affairs)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Final data sets will be made available upon specific request and under an authorized Data Use Agreement. This, in addition to the publications being made available via PubMed Central, will enable validation of results by recipients.
• IPD Sharing Time Frame: After analysis and completion of study along with subsequent publication of results.
• IPD Sharing Access Criteria: After analysis and completion of study along with subsequent publication of results.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No