The Effect of Long Duration Exercise on the Diastolic Function of the Heart (PEP)
|ClinicalTrials.gov Identifier: NCT02039154|
Recruitment Status : Completed
First Posted : January 17, 2014
Last Update Posted : November 21, 2017
|Condition or disease||Intervention/treatment|
|Aging||Behavioral: Aerobic and strength training group Behavioral: Balance and flexibility group|
Objectives: Chronic physical inactivity contributes to the deaths of nearly 1 in 10 Americans. In seniors, the single most common life-threatening disease is congestive heart failure and for these patients, abnormalities of diastolic function play a critical role in the pathophysiology of their disease. The primary investigator's previous research has demonstrated that: a) healthy but sedentary aging leads to atrophy and stiffening of the heart with reduced myocardial and chamber compliance; b) in contrast, highly competitive senior athletes had cardiac compliance that was indistinguishable from healthy young individuals suggesting that lifelong exercise training prevented this stiffening; c) even prolonged and intense exercise training started after age 65 failed to reverse age-related cardiac and vascular stiffening; d) cardiac stiffening begins in middle age (45-64) and can be substantially prevented by training 4-5 days/wk. The primary objective of this project, is therefore to identify sedentary individuals aged 45-64, and initiate an exercise program carefully designed to maximize effects on cardiovascular compliance and function. After this aim is accomplished, we will have established a novel, practical exercise training strategy designed to prevent the cardiovascular stiffening with aging, improve the functional capacity in our aging population, and ultimately to prevent Heart failure with preserved Ejection Fraction. Such a determination would have enormous public health significance since this condition is quite difficult to treat once established.
Hypothesis: The investigators hypothesize that exercise training implemented 4-5 times/week for 2 yrs in sedentary middle aged men and women (45-64yr) will improve cardiac and vascular compliance to a degree equivalent to life-long exercisers (and sedentary young). The investigators will perform invasive and non-invasive assessment of cardiovascular structure and function before and after an exercise program involving high intensity aerobic intervals, lower intensity endurance ("base training"), and strength training.
Specific Aim: To test our hypothesis, there will be two groups of previously sedentary subjects, ages 45-64 for 2 years, with the following interventions: 1) subjects undergoing prolonged endurance/interval/strength exercise training; and 2) yoga/balance control.
A comprehensive set of "Baseline Testing" (prior to the two year intervention) and "Follow-up Testing" (after the two year intervention) will take place to assess the effects of the intervention. This testing will include submaximal and maximal exercise testing as well as comprehensive invasive (right heart catheterization) and non-invasive (ultrasound) measures of cardiac mechanics, relaxation and morphology. From these data, the following indices of diastolic and systolic function will be generated: Starling and pressure/volume curves; calculations of left ventricle wall stress and strain; and measurements of flow propagation velocity, ejection fraction and relaxation velocity.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||61 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||None (Open Label)|
|Official Title:||The Effect of Long Duration Exercise on the Diastolic Function of the Heart|
|Actual Study Start Date :||July 2012|
|Primary Completion Date :||June 2016|
|Study Completion Date :||June 2016|
|Experimental: Aerobic and strength training group||
Behavioral: Aerobic and strength training group
A exercise training program will be developed individually for each subject with the goal of increasing duration and intensity consistent with modern training techniques. Workouts will vary with respect to mode (walk, cycle, swim), duration (30-60 minutes), and intensity (base, interval, recovery) to optimize the training response. Each subject will be assigned a personal trainer and a heart rate monitor so that every session is carefully tracked and recorded. For intervals, we will use the novel high intensity aerobic intervals (HAIT). Subjects will also perform strength training 1-2 days/week.
|Active Comparator: Balance and flexibility group||
Behavioral: Balance and flexibility group
For the balance and flexibility group, subjects will be encouraged to participate in yoga/tai chi/pilates classes that is approved by one of the exercise physiologists on the research team. The goal for this group is exercise classes that will be of benefit to them, but that will not include sustained aerobic, endurance exercise. In place of a group exercise class, subjects will have the option of purchasing videos for home use. The subjects will be encouraged to participate in some form of non-endurance training at least 3 days per week. Each subject will receive an exercise log in which they will be expected to record their training.
- Change in left ventricular stiffness (diastolic function/static) after training [ Time Frame: Two years ]
- Change in diastolic function/dynamic after training [ Time Frame: 2 years ]
- Change in systolic function after training [ Time Frame: 2 years ]
- Change in ventricular-vascular coupling after training [ Time Frame: 2 years ]
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02039154
|United States, Texas|
|The Institute for Exercise and Environmental Medicine|
|Dallas, Texas, United States, 75231|
|Principal Investigator:||Benjamin D Levine, MD||University of Texas Southwestern Medical Center|