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Study Description

Physical inactivity is a major public health challenge underlying a broad range of health problems at all ages. While physical activity (PA) has shown to produce relevant health benefits, the underlying molecular mechanisms are poorly known. The coordinated effort of clinical and animal studies supported by bioinformatics and chemical analyses will achieve the Molecular Transducers of Physical Activity Consortium (MoTrPAC) goals of assessing the molecular changes that occur in response to PA. The Consortium Coordinating Center (CCC) for the MoTrPAC will provide support for the organization, administration, planning, standardization, documentation, monitoring and reporting activities relating to the MoTrPAC. The CCC will play a pivotal role in ensuring the cohesion of the MoTrPAC by enhancing communication and integration across all study components, including the Clinical Sites, the Preclinical Animal Study Sites, the Bioinformatics Center, the Chemical Analysis Sites, and the various study committees. The CCC will develop strategies and strategic planning processes by integrating activities of the MoTrPAC investigators and facilitate interactions and communications with junior and senior investigators outside the consortium to maximize the use of the MoTrPAC resources toward achieving the overall research goals. To accomplish these goals and maximize the progress and productivity of the MoTrPAC, the CCC will promote team science, team leadership, and innovative leadership approaches across all study components. Strategic planning that follows the principles of the dynamic theory of strategy will be fostered to evaluate alternative approaches, maintain the cutting-edge scientific focus, leverage state-of-the-art coordination technologies, anticipate challenges, and maximize future opportunities to ensure the success of the consortium.

 The CCC will comprise four integrated components led by four highly qualified PIs who have a long-lasting track record of successfully working in synergy. The four CCC components comprise the Administrative Coordinating Center, the Data Management, Analysis, and Quality Control Center, the Biospecimens Repository, and the Exercise Intervention Core. The CCC will employ innovative project management tools and web-based tracking of exercise adherence and diet, and will capitalize on the outstanding track record and expertise of its investigators in: (a) working together; (b) successfully coordinating, managing, and leading large long-term multicenter clinical trials involving PA and other interventions; (c) implementing rigor and transparency in research, (d) acquiring, managing, storing and analyzing biological samples; (e) conducting animal exercise studies; (f) sharing resources; (g) publishing results; and (h) leading multidisciplinary teams. The CCC will ensure and promote the continued success of the MoTrPAC in advancing knowledge about the molecular changes that occur in response to PA, and relating these changes to the health benefits of PA.

ELIGIBILITY CRITERIA:

Ages Eligible for Study:           18 Years and older   (Adult, Older Adult)

Sexes Eligible for Study:          All

Accepts Healthy Volunteers:  Yes

Inclusion Criteria:

ADULT PARTICIPANT INCLUSION CRITERIA - SEDENTARY PARTICIPANTS

• Willingness to provide informed consent to participate in the MoTrPAC Study
• Must be able to read and speak English well enough to provide informed consent and understand instructions
• Aged ≥18 y
• Body Mass Index (BMI) >19 to <35 kg/m2
• Sedentary defined as self-reporting no more than 1 day per week, lasting no more than 60 minutes, of regular (structured) EE [e.g., brisk walking, jogging, running, cycling, elliptical, or swimming activity that results in feelings of increased heart rate, rapid breathing, and/or sweating] or RE (resulting in muscular fatigue) in the past year
  • Persons bicycling as a mode of transportation to and from work >1 day/week etc. are not considered sedentary
  • Leisure walkers are included unless they meet the heart rate, breathing, and sweating criteria noted above

ADULT PARTICIPANT INCLUSION CRITERIA - HIGHLY ACTIVE PARTICIPANTS

• Willingness to provide informed consent to participate in the MoTrPAC Study
• Must be able to read and speak English well enough to provide informed consent and understand instructions
• Aged ≥18 y
• BMI >19 to <35 kg/m2
• Comparator Participants
  • HAEE: defined as >240 minutes/week of ET for >1 year; this can include running, walking (brisk, power), cycling, elliptical, etc. which (at a minimum) results in increased heart rate, rapid breathing and sweating
  • Must include cycling at least 2 days/week
  • HARE: defined as RT of ≥3 upper and ≥3 lower body muscle groups ≥2 times/week for >1 year; using a prescription sufficient to increase strength and muscle mass
  • Elite or Competitive Athletes: can be included, if they meet HAEE or HARE inclusion criteria
  • Potential participants are informed that use of performance enhancing drugs in the last 6 months is exclusionary
  • In addition to meeting HAEE or HARE inclusion criteria, all HA participants must meet all other exclusion criteria defined in this protocol
  • Individuals who meet inclusion criteria for both HAEE and HARE are exclude

Exclusion Criteria:

ADULT PARTICIPANT EXCLUSION CRITERIA Exclusion criteria are confirmed by either self-report (i.e., medical and medication histories reviewed by a clinician), screening tests performed by the MoTrPAC study team at each clinical site, and/or clinician judgement as specified for each criterion.

• Diabetes (self-report and screening tests)
  • Treatment with any hypoglycemic agents (self-report) or A1c >6.4 (screening test; may reassess once if 6.5-6.7)
  • Fasting glucose >125 (screening test; may reassess once)
  • Use of hypoglycemic drugs (e.g., metformin) for non-diabetic reasons (self-report)
• Abnormal bleeding or coagulopathy (self-report)
  • History of a bleeding disorder or clotting abnormality
• Thyroid disease (screening test)
  • Thyroid Stimulating Hormone (TSH) value outside of the normal range for the laboratory
  • Individuals with hypothyroidism may be referred to their primary care provider (PCP) for evaluation and retested; any medication change must be stable for ≥3 months prior to retesting
  • Individuals with hyperthyroidism are excluded, including those with normal TSH on pharmacologic treatment
• Pulmonary (self-report)
  • Clinical diagnosis of Chronic Obstructive Pulmonary Disease (COPD)
• Metabolic bone disease (self-report)
  • History of non-traumatic fracture from a standing height or less
  • Current pharmacologic treatment for low bone mass or osteoporosis, other than calcium, vitamin D, or estrogen
• Estrogens, progestins (self-report)
  • Supplemental, replacement or therapeutic use of estrogens or progestins within the last 6 months, other than birth control or to control menopausal symptoms
• Pregnancy (screening test) and pregnancy-related conditions (self-report)
  • Pregnant - pregnancy test performed on day of DXA scan in women of child-bearing potential
  • Post-partum during the last 12 months
  • Lactating during the last 12 months
  • Planning to become pregnant during the participation period
• Elevated blood pressure readings (screening test)
  • Aged <60 years: Resting Systolic Blood Pressure (SBP) ≥140 mmHg or Resting Diastolic Blood Pressure (DBP) ≥90 mmHg
  • Aged ≥60 years: Resting SBP ≥150 mmHg or Resting DBP ≥90 mmHg
  • Reassessment of BP during screening will be allowed to ensure rested values are obtained
• Cardiovascular (self-report, screening test, and clinician judgement)
  • Congestive heart failure, coronary artery disease, significant valvular disease, congenital heart disease, serious arrhythmia, stroke, or symptomatic peripheral artery disease (self-report, screening test)
  • Specific criteria used to determine whether a volunteer can undergo the screening CPET follow the American Heart Association (AHA) Criteria [54]
  • Inability to complete the CPET
• Abnormal blood lipid profile (screening test)
  • Fasting triglycerides >500 mg/dL
  • Low-density lipoprotein cholesterol (LDL-C) >190mg/dL
• Cancer (self-report)
  • History of cancer treatment (other than non-melanoma skin cancer) and not "cancer-free" for at least 2 years
  • Anti-hormonal therapy (e.g., for breast or prostate cancer) within the last 6 months
• Chronic infection (self-report)
  • Infections requiring chronic antibiotic or anti-viral treatment
  • Human Immunodeficiency Virus
  • Individuals successfully treated for hepatitis C and virologically negative for at least 6 months are not excluded
• Liver enzyme tests (Alanine transaminase, Aspartate transaminase) (screening test)
  • >2 times the laboratory upper limit of normal
  • Reassessment during screening may be allowed under some conditions (e.g., recent use of acetaminophen)
  • Individuals may be referred to their PCP for evaluation; any medication change must be stable for ≥3 months prior to retesting
• Chronic renal insufficiency (screening test)
  • Estimated glomerular filtration rate <60 mL/min/1.73 m2 from serum creatinine (mg/dL) by the Chronic Kidney Disease Epidemiology Collaboration equation
  • Reassessment may be allowed under some conditions (e.g., questionable hydration status or other acute renal insult)
• Hematocrit (screening test)
  • Hematocrit >3 points outside of the local normal laboratory ranges for women and men
  • Reassessment may be allowed under certain conditions
  • Individuals may be referred to their PCP for evaluation; any medication change must be stable for ≥3 months prior to retesting
  • Individuals with known thalassemia trait may be included (despite having >3 points outside of the local normal laboratory ranges), upon approval from their PCP or a hematologist
• Blood donation (self-report)
  • Whole blood donation in the last 3 months or plans for blood donation during the entire protocol period
  • Platelet or plasma donation in the last week or plans for platelet or plasma donation during the entire protocol period
• Autoimmune disorders (self-report)
  • Individuals receiving any active treatment (including monoclonal antibodies) within the last 6 months
• Alcohol consumption (self-report)
  • More than 7 drinks per week for women
  • More than 14 drinks per week for men
  • History of binge drinking (≥5 drinks for males or ≥4 drinks for females in a 2-hour period more than once per month)
• Tobacco (self-report)
  • Self-reported use ≥3 days/week of tobacco or e-cigarette/e-nicotine products
• Marijuana (self-report)
  • Self-reported use ≥3 days/week in any form
• Shift workers (self-report)
  • Night shift work in the last 6 months
  • Planning night shift work during the study period
• Cognitive status (screening)
  • Unable to give consent to participate in and safely complete the protocol, as based on the judgement of the local investigator
• Psychiatric illness (self-report and screening test)
  • Hospitalization for any psychiatric condition within one year (self-report)
  • Center for Epidemiological Studies-Depression Scale (CESD) score ≥16 [55] (screening test)
• Weight change (self-report)
  • Weight change (intentional or not) over the last 6 months of >5% of body weight
  • Plan to lose or gain weight during the study
• Lidocaine or other local anesthetic (self-report)
  • Known allergy to lidocaine or other local anesthetic
• Other (clinician judgement)
  • Any other cardiovascular, pulmonary, orthopedic, neurologic, psychiatric or other conditions that, in the opinion of the local clinician, would preclude participation and successful completion of the protocol
  • Any other illnesses that, in the opinion of the local clinician, would negatively impact or mitigate participation in and completion of the protocol

EXCLUSIONS FOR MEDICATION USE

• Use of any new drug in the last 3 months
• Dose change for any drug in the last within 3 months
• Cardiovascular
  • Beta blockers and centrally acting anti-hypertensive drugs (clonidine, guanfacine and alpha-methyl-dopa)
  • Anticoagulants (coumadin or Direct Oral Anticoagulants)
  • Antiarrhythmic drugs: amiodarone, dronaderone, profafenone, disopyrimide, quinidine
  • Antiplatelet drugs (other than aspirin ≥100 mg/day): dipyridamole, clopidogrel, ticagrelor
  • Lipid-lowering medications
  • Participants who volunteer to stop lipid-lowering medications for the duration of the study are allowed; inclusion requires lipid-lowering medication to be stopped for 3 months and participant re-evaluated for LDL-C eligibility
• Psychiatric drugs
  • Chronic use of medium or long-acting sedatives and hypnotics (short-acting non-benzodiazepine sedative-hypnotics are allowed)
  • All benzodiazepines
  • Tricyclic antidepressants at a dose ≥75 mg total dose per day
  • Two or more drugs for depression
  • Mood stabilizers
  • Antiepileptic drugs
  • Stimulants, Attention-Deficit/Hyperactivity Disorder (ADHD) drugs
• Muscle relaxants
  • Methacarbamol; cyclobenzaprine; tizanidine; baclofen
• Pulmonary, inflammation
  • Chronic oral steroids
  • Burst/taper oral steroids more than once in the last 12 months
  • B2-agonists
  • allowed if on stable dose at least 3 months
• Genitourinary
  • Finasteride or dutasteride
  • Daily phosphodiesterase type 5 inhibitor use
• Hormonal
  • Testosterone, dehydroepiandrosterone, anabolic steroids
  • Anti-estrogens, anti-androgens
  • Growth hormone, insulin like growth factor-I, growth hormone releasing hormone
  • Any drugs used to treat diabetes mellitus or to lower blood glucose
  • Metformin for any indication
  • Any drugs used specifically to induce weight loss
  • Any drugs used specifically to induce muscle growth/hypertrophy or augment exercise-induced muscle hypertrophy
• Pain/inflammation
  • Narcotics and narcotic receptor agonists
  • Regular use of non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen ≥3 days per week
• Other
  • Anti-malarials
  • Low-potency topical steroids if ≥10% of surface area using rule of 9s
• Any other medications that, in the opinion of local clinicians, would negatively impact or mitigate full participation and completion

Study Design:

Allocation: Randomized

Intervention Model: Parallel Assignment

Masking: None (Open Label)

Study Location(s):

University of Alabama at Birmingham, Birmingham, Alabama, United States, 35294

University of Colorado Denver, Denver, Colorado, United States, 80217

Florida Hospital / Advent Health, Orlando, Florida, United States, 32803

Ball State University, Muncie, Indiana, United States, 47306

Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States, 70808

Duke University, Durham, North Carolina, United States, 27708

East Carolina University, Greenville, North Carolina, United States, 27858

University of Pittsburgh, Pittsburgh, Pennsylvania, United States, 15260

University of Texas Medical Branch, Galveston, Texas, United States, 77555

University of Texas Health Science Center, San Antonio, San Antonio, Texas, United States, 78229

Study Website:

https://www.clinicaltrials.gov/ct2/show/NCT03960827?term=Marco+Pahor&rank=4