Role of Fasted Exercise on Improving Cardiometabolic Health

Investigating the Role of Fasted Exercise on Improving Cardiometabolic Health; a Potential Mediatory Role of Sirtuins

The aim of this randomised control trial is to investigate the role of fasted exercise on cardiometabolic health. Participants will be assigned to one of three conditions, fasted exercise, fed exercise and control (no exercise). Participants in the exercise groups will complete four weeks of moderate intensity cycling exercise, three times per week, either in the fasted or fed state according to their group assignment. Experimental trials involving anthropometric and cardiometabolic disease risk factor measurements as well as metabolic responses to a subsequent meal ingestion following exercise will be compared pre-intervention and post intervention.

Study Overview

• Status: Recruiting
• Conditions: Cardiovascular Diseases; Obesity; Diabetes Mellitus, Type 2
• Intervention / Treatment: Other: Exercise training in the fasted state; Other: Exercise training in the fed state

Detailed Description

The aim of this study is to investigate the effect of fasted exercise on cardiometabolic health and the potential mediatory role of sirtuins.

The objectives are to investigate:

1. The effect of a single bout of fasted exercise on acute metabolic responses following a high fat meal.
2. The effect of four weeks of fasted exercise training on cardiovascular and metabolic disease risk factors.
3. The effect of four weeks of fasted exercise training on circulating levels and subcutaneous adipose tissue gene expression of SIRT1, SIRT3 and SIRT6.

A randomised control trial will be conducted with volunteers allocated under the conditions of a) no exercise (control), b) fasted exercise training (FASTEX) and c) fed exercise training (FEDEX). The pre- and post-intervention visits will consist of 50 minutes of cycling at a moderate exercise intensity for both the FASTEX and FEDEX groups. The control group would not perform any exercise. The FASTEX group will perform the exercise in the fasted state, whilst the FEDEX and control groups will be fed a standardised breakfast meal one hour in advance of the exercise period. Following the exercise period, the participants will be fed a high fat meal and metabolic responses to the meal will be measured for four hours. Multiple blood samples will be obtained as well as a sample of subcutaneous adipose (fat) tissue. The FASTEX and FEDEX groups will then complete four weeks of moderate intensity continuous exercise training, either fasted or fed according to their group, on three days per week whilst the control group will maintain their normal sedentary lifestyle. All participants will return to the laboratory for post-intervention testing at the end of the four weeks with the same protocols and measurements as the pre-intervention testing.

• Study Type: Interventional
• Enrollment (Estimated): 30
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Adora Yau, PhD; Phone Number: +44(0)1612475504; Email: a.yau@mmu.ac.uk
• Study Contact Backup: Name: Gethin Evans, PhD; Phone Number: +44(0)1612471208; Email: gethin.evans@mmu.ac.uk

Study Locations

• United Kingdom
  • Greater Manchester
    • Manchester, Greater Manchester, United Kingdom, M1 5GD
      • Recruiting
      • Manchester Metropolitan University
      • Contact: Adora Yau, PhD; Phone Number: +44(0)1612475504; Email: a.yau@mmu.ac.uk
      • Contact: Gethin Evans, PhD; Phone Number: +44(0)1612471208; Email: gethin.evans@mmu.ac.uk
      • Principal Investigator: Adora Yau, PhD
      • Sub-Investigator: Gethin Evans, PhD
      • Sub-Investigator: Ria Weston, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 40 years (Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Male or female
• Non-smokers
• Physically inactive (partake in no more than one exercise session per week on average)
• Body mass index >18.5 kg/m2
• Healthy as assessed by medical screening questionnaire
• Prior recipient of local anaesthetic with no known adverse effects, no known hypersensitivity or no other health issue that may constrain the administration of lidocaine hydrochloride
• Free from musculoskeletal injury and able to perform cycling exercise
• Capacity to give informed consent

Exclusion Criteria:

• Regular exerciser
• BMI < 18.5 kg/m2
• Pregnant
• Allergy or intolerances to test meal products/ingredients (such as wheat or dairy products).
• Recent major body weight change (+/- 3 kg in the past month)
• Known hypersensitivity to Lidocaine Hydrochloride
• Cardiovascular disease - complete heart block or hypovolaemia
• Adam's-Stokes Syndrome
• Wolff-Parkinson-White Syndrome
• Porphyria
• Epilepsy
• Myasthenia Gravis
• Other chronic medical condition or diagnosis including respiratory (eg asthma), endocrine, cardiovascular, neuromuscular disorders.
• Taking medications or receiving treatment that may constrain the administration of lidocaine or local anaesthesia.

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: Fasted exercise; Exercise training in the fasted state	Other: Exercise training in the fasted state; Four weeks of moderate intensity cycling exercise, three times a week without eating breakfast meal
Active Comparator: Fed exercise; Exercise training in the fed state	Other: Exercise training in the fed state; Four weeks of moderate intensity cycling exercise, three times a week, after eating breakfast meal
No Intervention: Control; No exercise training

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in circulating concentrations of key metabolic markers following a high fat lunch meal	Serum concentrations of clinical chemistry blood analytes (glucose, triglycerides, cholesterol)	9 blood samples collected at pre-meal ingestion then every 30 min after ingestion for four hours
Changes in circulating concentrations of key metabolic markers during the experimental trial day	Serum concentrations of clinical chemistry blood analytes (glucose, triglycerides, cholesterol)	12 blood samples collected at 0 (baseline), 75 (pre-exercise), 125 (immediately post-exercise), 155 min (pre-meal ingestion) then every 30 min after ingestion for four hours
Area under the circulating concentration versus time curve (AUC) of key metabolic markers following a high fat lunch meal	Total responses of clinical chemistry blood analytes (glucose, triglycerides, cholesterol)	4.5 hours
Changes in cardiovascular and metabolic disease biochemistry risk factors	Fasted serum concentrations of clinical chemistry blood analytes (glucose, blood lipids, inflammatory markers)	4 weeks (pre and post intervention)
Changes in cardiovascular disease physiological risk factors	Systolic and diastolic blood pressure and calculation of mean arterial pressure using systolic and diastolic values	4 weeks (pre and post intervention)
Changes in concentration of sirtuin molecules	Serum concentrations of sirtuins	4 weeks (pre and post intervention)
Changes in sirtuin molecule gene expression	Adipose tissue gene expression of sirtuins	4 weeks (pre and post intervention)
Changes in sirtuin molecule tissue expression	Adipose tissue expression and cellular localisation of sirtuins	4 weeks (pre and post intervention)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in cardiovascular and metabolic disease anthropometric risk factors	Waist circumference, hip circumference and waist:hip ratio	4 weeks (pre and post intervention)
Change in body composition	Body fat percentage measured using bioelectrical impedance analysis	4 weeks (pre and post intervention)
Change in body mass	Body mass in kilograms	4 weeks (pre and post intervention)
Change in substrate oxidation during the experimental trial day	Carbohydrate and fat oxidation through indirect calorimetry	17 measurements at 0 (baseline), 15 (post-breakfast meal period), 45 (30 min post-breakfast meal period), 75 (pre-exercise), every 10 min during exercise, 155 (pre-meal ingestion), then every 30 min for four hours.
Heart rate response to exercise	Heart rate during exercise in the experimental trial using telemetry	At rest before exercise then every 5 min during 50 min cycle exercise
Perceived exertion	Rating of perceived exertion of exercise in the experimental trial using Borg scale	Every 5 min during 50 min cycle exercise
Change in physical activity levels	Physical activity energy expenditure during the intervention period	Daily for 4 weeks
Change in physical activity duration	Amount of time spent performing physical activity at different intensities (low, moderate, high) during the intervention period	Daily for 4 weeks
Change in energy intake	Energy intake using weighed food diary record during the intervention period	Daily for 4 weeks
Change in dietary nutritional intake	Macronutrient (carbohydrate, fat, protein) composition of food intake using weighed food diary record during the intervention period	Daily for 4 weeks

Collaborators and Investigators

• Sponsor: Manchester Metropolitan University
• Collaborators: European Society for Clinical Nutrition and Metabolism
• Investigators: Principal Investigator: Adora Yau, PhD, Manchester Metropolitan University; Study Director: Gethin Evans, PhD, Manchester Metropolitan University

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2023
• Primary Completion (Estimated): April 1, 2025
• Study Completion (Estimated): May 1, 2025

Study Registration Dates

• First Submitted: January 27, 2023
• First Submitted That Met QC Criteria: February 23, 2023
• First Posted (Actual): February 24, 2023

Study Record Updates

• Last Update Posted (Actual): March 7, 2024
• Last Update Submitted That Met QC Criteria: March 6, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: Cardiovascular disease; Exercise; Obesity; Diabetes Mellitus; Sirtuins; Cardiometabolic health; Fasted
• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases; Cardiovascular Diseases; Diabetes Mellitus; Diabetes Mellitus, Type 2
• Other Study ID Numbers: FastExTrainESPEN2022

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Planned communication of group results at a scientific conference. Planned publication in a scientific peer reviewed journal. Participant level data is not expected to be available as this complies with the conditions of the ethical approval granted for this study.

Drug and device information, study documents

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