Resistance Exercise Training in the Older Population With Obesity (RETOPO)

Effects of a Resistance Exercise Training Program on Skeletal Muscle Quality, Immune Response and Physical Performance in Normal Weight Versus Obesity Older Women

Background:

Aging leads to an alteration in the immune response, characterized by a chronic inflammatory state, and a progressive decrease in muscle quantity and quality, a situation that increases in women and in the presence of obesity. With respect to muscle quality, intramuscular infiltration of adipose tissue has been considered a relevant parameter, involved in the relationship between aging-obesity-inflammation. As a therapeutic strategy, physical training with resistance exercises (or also known as strength training) has been shown to be effective in increasing skeletal muscle mass in this age group. However, its role on muscle quality in normal-weight versus obese older women has not been fully addressed.

Hypothesis:

A 12-week resistance exercise training program is effective in improving muscle quality, immune response and physical performance in normal weight and obese older women. In addition to the above, the investigators hypothesize that women with obesity will present greater baseline alterations, so the percentage of change will be higher compared to older women with normal weight after the training program.

Goals:

The primary aim of this study is to evaluate the effects of a 12-week resistance exercise training on muscle quality (infiltration of intramuscular adipose tissue), immune response and physical performance in older women between 60 and 79 years of age with obesity compared to older women with normal weight of the same age range.

Methodology:

The present clinical trial will consider 2 groups of older women between 60 and 79 years old: normal weight (BMI=18.5 to 24.9 kg/m 2 and % fat <25.9) and obese (BMI =30 to 39.9 Kg/m 2 and fat % >32). Participants will perform 12 weeks of training with resistance exercises 3 times a week. Before and after training, intramuscular infiltration of adipose tissue (echogenicity) will be measured by ultrasound, followed by aspects of muscle architecture (muscle thickness, penile angle and fascicle length) and functional parameters of muscle quality (maximum strength determined by 1 repetition maximum-1RM, maximum voluntary isometric strength of knee extensors through a lower limb force and power transducer). Finally, fasting blood samples will be obtained (immune response) and physical performance, body composition, physical activity level, and quality of life will be evaluated.

Study Overview

• Status: Not yet recruiting
• Conditions: Obesity; Aging
• Intervention / Treatment: Other: Prolonged resistance exercise training

Detailed Description

Background:

Aging leads to an alteration in the immune response, characterized by a chronic inflammatory state, and a progressive decrease in muscle quantity and quality, a situation that increases in women and in the presence of obesity. With respect to muscle quality, intramuscular infiltration of adipose tissue has been considered a relevant parameter, involved in the relationship between aging-obesity-inflammation. As a therapeutic strategy, physical training with resistance exercises (or also known as strength training) has been shown to be effective in increasing skeletal muscle mass in this age group. However, its role on muscle quality in normal-weight versus obese older women has not been fully addressed.

Hypothesis:

A 12-week resistance exercise training program is effective in improving muscle quality, immune response and physical performance in normal weight and obese older women. In addition to the above, the investigators hypothesize that women with obesity will present greater baseline alterations, so the percentage of change will be higher compared to older women with normal weight after the training program.

Goals:

The primary aim of this study is evaluate the effects of a 12-week resistance exercise training on muscle quality (infiltration of intramuscular adipose tissue), immune response and physical performance in older women between 60 and 79 years of age with obesity compared to older women with normal weight of the same age range.

Specific goals:

To evaluate the effects of a 12-week resistance exercise training program in elderly women between 60 and 79 years of age with obesity, in comparison to older people with normal weight of the same age range on parameters of:

• Muscle architecture (muscle thickness, pennation angle and fascicle length) and muscle quality functionalities (power and strength).
• Immune response through inflammatory cytokines: Tumor necrosis factor a (TNFa) interleukin-1 (IL-1), IL-6, IL-8 and induction of neutrophil extracellular traps (NETosis).
• Physical performance (SPPB), Body composition (BIA) and quality of life (SF-36).

Methodology:

The present clinical trial will consider 2 study groups of older women between 60 and 79 years old: normal weight (BMI=18.5 to 24.9 kg/m 2 and % fat <25.9) and obese (BMI =30 to 39.9 Kg/m 2 and fat % >32). Participants will perform 12 weeks of training with resistance exercises 3 times a week. Before and after training, intramuscular infiltration of adipose tissue (echogenicity) will be measured by ultrasound, followed by aspects of muscle architecture (muscle thickness, penile angle and fascicle length) and functional parameters of muscle quality (maximum strength determined by 1 repetition maximum-1RM, maximum voluntary isometric strength of knee extensors through a lower limb force and power transducer). Finally, fasting blood samples will be obtained (immune response) and physical performance, body composition, physical activity level, and quality of life will be evaluated.

Study parameters/endpoints

• The main study endpoint is the decrease in echointensity as a marker of muscle quality, evaluated through ultrasonography in the quadriceps muscles of the lower limbs of participants subjected to 12 weeks of resistance training.
• Secondary endpoints include: Muscle architecture parameter (morphological aspects of muscle quality); muscle thickness, pennation angle and fascicle length; Functional parameters of muscle quality, maximum voluntary isometric strength of knee extensors and lower limb power; Immune response in blood (TNFa, IL-1, IL-6, IL-8 and NETosis); Physical performance (SPPB), evaluation of maximum strength (1RM) and handgrip strength; Body composition (fat mass and total muscle mass and for each lower limb) and anthropometry (waist - hip, thigh and calf circumference, leg length and knee height); And Level of physical activity (IPAQ) and Quality of Life (SF-36).
• Other study parameters include: Age, body weight, body height, body mass index (BMI), lipid profile, glucose, insulin, HOMA index, blood pressure, heart rate and perception of effort using the Borg scale.

Expected results:

The effect of resistance exercise training on muscle quality in normal-weight versus obese older women is still unclear. The present research project aims to demonstrate the effectiveness of this training modality in improving muscle quality parameters, as well as measures of immune response and physical performance in older women. However, the investigators believe that the impact will be greater in women with obesity, as they present greater baseline alterations compared to older normal weight women. The possible findings will define the scientific-practical foundations for the prescription of physical training in older women with obesity.

• Study Type: Interventional
• Enrollment (Estimated): 32
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: GABRIEL MARZUCA, MSc, PhD; Phone Number: 996343630; Email: gabriel.marzuca@ufrontera.cl
• Study Contact Backup: Name: Nicolás Vidal-Seguel, MSc; Phone Number: 998595445; Email: nicolasenrique.vidal@ufrontera.cl

Study Locations

• Chile
  • IX Región De La Araucanía
    • Temuco, IX Región De La Araucanía, Chile, 4780000
      • Universidad de La Frontera
      • Contact: GABRIEL MARZUCA, MSc, PhD; Phone Number: 996343630; Email: gabriel.marzuca@ufrontera.cl
      • Contact: Nicolás Vidal-Seguel, MSc; Phone Number: 998595445; Email: nicolasenrique.vidal@ufrontera.cl

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Older women between 60 and 79 years old who live in the community, that is, they do not live in nursing homes or similar.
• Older people with normal weight (BMI=18.5 to 24.9 kg/m2 and % fat <25.9) and those with obesity (BMI= 30 to 39.9 Kg/m2 and % fat > 32).
• Cognitive ability to follow verbal orders.

Exclusion Criteria:

• Neuromuscular or mobility disorders that do not allow resistance training to be carried out safely (debilitating arthritis, spasticity/rigidity, neurological disorders and paralysis).
• Use of nutritional supplementation that can regulate skeletal muscle (leucine, glutamine, casein, whey-protein, fatty acids and creatine).
• Untreated and/or uncontrolled chronic diseases.
• Have carried out a training program with resistance exercises in the last 6 months.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Screening
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Normal Weight; All volunteers Normal Weight: BMI=18.5 kg/m2 to 24.9 kg/m2 and % fat <25.9%, n=16	Other: Prolonged resistance exercise training; Training with resistance exercises for upper and lower limbs will be carried out 3 times a week (Monday, Wednesday and Friday) for 12 weeks for all participants. The training will follow the guidelines of the American College of Sports Medicine ("American College of Sports Medicine Position Stand. Progression Models in Resistance Training for Healthy Adults," 2009) and will consist of a 5-minute cardiovascular warm-up on a cycle ergometer, followed by weight training. Resistance training will be carried out with exercise machines: 5 sets of leg press, leg extension and leg flexion for lower limbs and 3 sets of chest press and triceps extension for upper limbs. Subsequently, the participants will perform global flexibility exercises for 5 minutes to return to calm.
Experimental: Obese; All volunteers Obesity: BMI= 30.0 kg/m2 to 39.9 kg/m2 m2 and % fat > 32%, n=16.	Other: Prolonged resistance exercise training; Training with resistance exercises for upper and lower limbs will be carried out 3 times a week (Monday, Wednesday and Friday) for 12 weeks for all participants. The training will follow the guidelines of the American College of Sports Medicine ("American College of Sports Medicine Position Stand. Progression Models in Resistance Training for Healthy Adults," 2009) and will consist of a 5-minute cardiovascular warm-up on a cycle ergometer, followed by weight training. Resistance training will be carried out with exercise machines: 5 sets of leg press, leg extension and leg flexion for lower limbs and 3 sets of chest press and triceps extension for upper limbs. Subsequently, the participants will perform global flexibility exercises for 5 minutes to return to calm.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in intermuscular adipose tissue (measured via ultrasonography) after prolonged resistance-type exercise training	Intramuscular adipose tissue infiltration evaluated by echointensity (Pixel Intensity 0 to 255) in the rectus femoris and vastus intermedius muscles of both lower limbs	Before, and after 12 weeks of training

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in muscle thickness (measured via ultrasonography) after prolonged resistance-type exercise training	Muscle thickness (centimeters) evaluated in the rectus femoris and vastus intermedius muscles of both lower limbs. The muscle thickness evaluated as the distance between the deep and superficial fascia.	Before, and after 12 weeks of training
Change in pennation angle (measured via ultrasonography) after prolonged resistance-type exercise training	Pennation angle (degree) evaluated in the rectus femoris and vastus intermedius muscles of both lower limbs. The pennation angle evaluated as the angle between the fascicle and the deep fascia. The average of three measurements will be calculated	Before, and after 12 weeks of training
Change in fascicle length (measured via ultrasonography) after prolonged resistance-type exercise training	Fascicle length (centimeters) evaluated in the rectus femoris and vastus intermedius muscles of both lower limbs. Fascicle length = sin(y +90º) × MT/ sin(180º-(y +180º- PA)), where "y" is the angle between the superficial and deep facia, while PA is the pennation angle, while MT is the Muscle thickness.	Before, and after 12 weeks of training
Change in physical performance (measured via Short physical performance battery (SPPB)) after prolonged resistance-type exercise training	Measurement of physical performance via SPPB	Before, and after 12 weeks of training
Change in arms and legs strength (measured via 1-Repetition Maximum (1RM) testing) after prolonged resistance-type exercise training	Maximal strength assessment via 1RM testing of leg press, leg extension, leg flexion, chest press and triceps extension	Before, and after 12 weeks of training
Change in hand grip strength (measured via JAMAR(R) handheld dynamometer) after prolonged resistance-type exercise training	Maximal strength assessment via 1RM testing of JAMAR(R) handheld dynamometer.	Before, and after 12 weeks of training
Change in maximum voluntary isometric strength (measured via Force transducer) after prolonged resistance-type exercise training.	The maximum voluntary isometric knee extension force (Newton) evaluated in both lower limbs (always maintaining randomness in the limbs).	Before, and after 12 weeks of training
Change in muscle power of the lower limbs (measured via Five Times Sit to Stand test) after prolonged resistance-type exercise training.	The muscle power of the lower limbs (Watt) evaluated by equation STS Men Power.	Before, and after 12 weeks of training
Change in Immune response in blood (measured via flow cytometry) after prolonged resistance-type exercise training.	The immune response evaluated by TNFa,IL-1, IL-6, IL-8 (pg/ml)	Before, and after 12 weeks of training
Change in NETosis in blood (measured via IncuCyte) after prolonged resistance-type exercise training.	The NETosis (%) evaluated with live cell imaging in donated neutrophils cultured with serum from the participants for 30 h.	Before, and after 12 weeks of training
Change in Whole body lean mass (measured via Bioimpedance) after prolonged resistance-type exercise training.	The Whole Body lean mass (Kg) through TANITA MC 980U PLUS	Before, and after 12 weeks of training
Change in Whole body fat mass (measured via Bioimpedance) after prolonged resistance-type exercise training.	The Whole Body fat mass (Kg) through TANITA MC 980U PLUS	Before, and after 12 weeks of training
Change in Physical activity level (measured via IPAQ short version) after prolonged resistance-type exercise training.	The physical activity level evaluated by International Physical Activity Questionnaire, short version. Classifying the level of physical activity as low, moderate or high.	Before, and after 12 weeks of training
Change in Quality of Life level (measured via SF-36) after prolonged resistance-type exercise training.	The Quality of Life level evaluated by SF-36 questionnaire. The score ranges from 0 to 100%, where a higher score High implies a better quality of life related to health.	Before, and after 12 weeks of training

Collaborators and Investigators

• Sponsor: Universidad de La Frontera
• Investigators: Study Director: GABRIEL MARZUCA, Msc, PhD, Universidad de La Frontera. Temuco, Chile

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2024
• Primary Completion (Estimated): January 28, 2025
• Study Completion (Estimated): June 1, 2025

Study Registration Dates

• First Submitted: April 2, 2024
• First Submitted That Met QC Criteria: April 11, 2024
• First Posted (Actual): April 16, 2024

Study Record Updates

• Last Update Posted (Actual): April 16, 2024
• Last Update Submitted That Met QC Criteria: April 11, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: Strength training; Biochemical markers; Malnutrition due to excess; Clinical anatomy
• Additional Relevant MeSH Terms: Overnutrition; Nutrition Disorders; Overweight; Body Weight; Obesity
• Other Study ID Numbers: RETOPO2024

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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