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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT06345937
Other study ID # REB #44724
Secondary ID
Status Recruiting
Phase N/A
First received
Last updated
Start date May 3, 2024
Est. completion date August 1, 2028

Study information

Verified date May 2024
Source University of Toronto
Contact Amy A. Kirkham, PhD
Phone 416-946-4069
Email amy.kirkham@utoronto.ca
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This study aims to produce new evidence, specific to women, on the efficacy and mechanisms of exercise and diet for cardiometabolic risk reduction in pre and postmenopausal women. Using a 3-arm randomized controlled trial (RCT) with equal recruitment and stratification by menopausal status to 6 months of: 1) exercise following Health Canada guidelines; 2) the same exercise plus counselling to follow Canada's Dietary Guidelines to improve diet quality; or 3) stretching group, this study will answer the following questions: - How does the impact of exercise compare among each of the causal links between physical inactivity and cardiometabolic disease in women? - What is the effect modification of adding a diet quality intervention to exercise? - What is the effect modification by menopausal status? The investigators hypothesize that exercise adaptations will be: 1) largest peripherally, including Matsuda index (primary outcome), Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), arteriovenous oxygen difference (avO2diff), and visceral fat, compared to centrally (stroke volume (SV), endothelial function, aortic stiffness), 2) blunted or absent in post vs premenopause; 3) enhanced by the addition of diet quality which will be essential or additive for Matsuda index, metabolic syndrome, Framingham cardiovascular disease (CVD) risk, cytokines and adipokines, thigh myosteatosis, muscle mass, peak oxygen uptake (VO2peak), 4) enhanced by adding diet quality in more outcomes postmenopause.


Recruitment information / eligibility

Status Recruiting
Enrollment 180
Est. completion date August 1, 2028
Est. primary completion date August 1, 2027
Accepts healthy volunteers No
Gender Female
Age group 30 Years and older
Eligibility Inclusion Criteria: - Biologically female - Aged 30+ - Pre- or postmenopausal: Premenopause: having regular menstrual cycles (21-35 days long without a persistent difference of =7 days between cycles). Post-menopause: =12 months of amenorrhea or history of double oophorectomy and do not have irregular or occasional menstrual cycle in last 12 months. - High CANRISK score (score of =33): The online CANRISK tool (www.healthycanadians.gc.ca/en/canrisk) assigns scores to risk factors for type 2 diabetes (that overlap with cardiovascular disease/cancer), including age, body mass index, moderate-vigorous physical activity (MVPA), fruit/vegetable intake, hypertension, pregnancy complications, ethnicity and education, and is validated for Canada's multiethnic population. - Able to commit to come to the University once per week for 24 weeks. Exclusion Criteria: - Perimenopausal or those whom the investigators cannot discern pre- vs perimenopausal status - Diagnosed cardiovascular diseases, type 2 diabetes, non-alcoholic fatty liver disease, cancer (except for non-melanoma skin cancer), or respiratory disease (e.g., Chronic obstructive pulmonary disease (COPD) or severe or uncontrolled asthma). - Major signs or symptoms of cardiovascular diseases, diabetes, or renal disease (taken from the American College of Sports Medicine's Guidelines for Exercise Testing and Prescription 11th edition Table 2.1: pain or discomfort in the chest, neck, jaw, arms with rest or exercise, shortness of breath at rest or with mild exertion, dizziness or syncope, loss of balance or passing out, ankle edema, palpitations or tachycardia, intermittent claudication, known heart murmur, unusual fatigue with usual activities.) - American Heart Association's absolute or relative contraindications for symptom-limited maximal exercise testing (myocardial infarction, aortic or coronary artery stenosis, heart failure, pulmonary embolism or deep vein thrombosis, inflammation of the heart (myocarditis, pericarditis, and/or endocarditis), uncontrolled cardiac arrythmia, advanced or complete electrical heart block, stroke or transient ischemia attack, blood pressure >200mmHg/100mmHg, a cancer diagnosis other than skin cancer) - Unable to provide informed consent or communicate in English - Pregnant or breast-feeding currently or in the past 3 months - Mobility limitations to aerobic exercise (i.e., wheelchair, walker use, limp impeding walking) - Smoking cigarettes or marijuana within the past 3 months - Taking exogenous hormones in any format currently or in the past 3 months - Contraindications to research MRI (e.g., pacemaker, magnetic implants) - BMI exceeding 40 kg/m2 - Extreme claustrophobia - Self-report >30 min/week of moderate-to-vigorous intensity aerobic physical activity - Following a diet that largely restricts entire food groups or time of eating (e.g., vegan, ketogenic, carnivore, one meal a day) in last 3 months - Students in classes or labs of the professors who are involved in the study - Experienced significant weight loss (i.e., >5 kg) in past 3 months - Currently taking weight loss medications - Diagnosed history of an eating disorder or self-report of potential undiagnosed eating disorder - Plans to be away/unavailable for a substantial period of the intervention overall (i.e., >4 weeks throughout the 6 months or >2 weeks within the first 12 weeks of the intervention). - Allergies to local anesthetics

Study Design


Related Conditions & MeSH terms


Intervention

Behavioral:
Behavioural Experimental: guidelines-based physical activity
Through a combination of exercise trainer-led in-person and virtual sessions, as well as counselling for independent aerobic exercise, participants will be guided to achieve 150 weekly minutes of moderate-intensity aerobic activity and twice weekly whole-body muscle strengthening.
Behavioural Experimental: guidelines-based physical activity and healthy eating
Behavioural Experimental: guidelines-based physical activity: Through a combination of exercise trainer-led in-person and virtual sessions, as well as counselling for independent aerobic exercise, participants will be guided to achieve 150 weekly minutes of moderate-intensity aerobic activity and twice weekly whole-body muscle strengthening. Behavioural Experimental: guidelines-based healthy eating: One-on-one phone/virtual counselling from a registered dietitian to change dietary habits to be in line with Canada's Food Guide.
Behavioural: Stretching exercise
Twice weekly virtual instructor-led whole-body stretching.

Locations

Country Name City State
Canada University of Toronto Toronto Ontario

Sponsors (2)

Lead Sponsor Collaborator
University of Toronto Canadian Institutes of Health Research (CIHR)

Country where clinical trial is conducted

Canada, 

Outcome

Type Measure Description Time frame Safety issue
Other Cardiorespiratory fitness Measured as peak volume of oxygen consumption via indirect calorimetry during a cardiopulmonary exercise test on a treadmill. 6 months
Other Heart Rate Recovery Measured as the difference between peak heart rate during the cardiorespiratory fitness test and heart rate 2-minutes after stopping the exercise test. 6 months
Other Exercise stroke volume & cardiac output Measured during submaximal and maximal periods of a cycling exercise test, using echocardiography. 6 months
Other Left ventricular ejection fraction Measured during rest, submaximal and maximal periods of cycling exercise test, using echocardiography 6 months
Other Left ventricular mass Measured via echocardiography at rest 6 months
Other Arteriovenous Oxygen Difference (avO2diff) Measured using two methods: (1) calculated as the volume of oxygen (VO2) from the corresponding workload from the day 1 treadmill test divided by cardiac output at rest, submaximal, and maximal periods of the cycling exercise test; and (2) direct assessment using near-infrared spectroscopy as a measure of tissue oxygenation in the legs at rest, submaximal, and maximal periods of the cycling exercise test. 6 months
Other Endothelial Function Measured using a brachial artery flow-mediated dilation test using ultrasound. 6 months
Other Carotid Intima Media Thickness Measured using a common carotid artery image using ultrasound. 6 months
Other Central & Peripheral Arterial stiffness Measured as the pulse wave velocity of the central (carotid-femoral) and peripheral leg (femoral-dorsalis pedis) and arm (carotid-radial) regions. 6 months
Other Blood Pressure Measured as the average of the last 5 of 6 blood pressure measurements using an automatic blood pressure device. 6 months
Other Resting Heart Rate & Heart Rate Variability Assessed using a 3-lead electrocardiogram in the supine position for 10 minutes after a 5-minute supine rest. 6 months
Other Thigh Myosteatosis Measured as thigh muscle fat fraction (percent of muscle compartment composed of fat pixels) determined from contiguous axial fat-water separation 3 Tesla (3T) magnetic resonance images of both thighs. 6 months
Other Knee flexion and extension (strength and endurance) Measured using an isokinetic dynamometer (Biodex) to assess peak torque and total work in 30 repetitions of knee flexion. 6 months
Other Thigh Muscle Volume Measured determined from contiguous axial fat-water separation 3T magnetic resonance images of both thighs 6 months
Other Biochemical markers of skeletal muscle protein content Measured via western blotting from a skeletal muscle biopsy of the vastus lateralis muscle. Proteins of interest include those found in mitochondria, contractile signaling pathways, insulin signaling pathways, and in glucose and fat metabolism. 6 months
Other Biochemical markers of skeletal muscle structure Measured via immunofluorescence from a skeletal muscle biopsy of the vastus lateralis muscle. Outcomes of interest include skeletal muscle capillarization, lipid content, and fiber type and cross sectional area. 6 months
Other Biochemical markers of skeletal muscle enzyme activity Measured via spectrophotometer to assess the maximal enzyme activity of enzymes involved in skeletal muscle oxidative capacity, from a biopsy of the vastus lateralis muscle. 6 months
Other Whole-body fat and fat-free mass Measured using a body composition device (BodPod) to estimate whole body fat (in kg and %) and fat free mass (in kg and %). 6 months
Other Visceral adipose tissue Volumes of adipose tissue in the visceral region measured using 3T fat-water separation magnetic resonance imaging 6 months
Other Liver fat fraction Measured as percent of liver volume composed of fat pixels determined from 3 slices through the middle of the liver using the PROFIT1 3T magnetic resonance images sequence. 6 months
Other Body circumferences Circumferences of the waist, hip and neck, measured using an inelastic tape 6 months
Other Concentration of inflammation biomarkers in blood Assessments from blood including leptin, adiponectin, Tumour Necrosis Factor alpha (TNF-a), Interleukin-6 (IL-6), C-reactive protein (CRP). These measures have been grouped together as the markers will be considered together when interpreted. 6 months
Other Lipid panel: high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, total Cholesterol, Triglycerides Analyzed from blood serum using a clinical assay at a core lab. 6 months
Other Hemoglobin A1c Analyzed from blood plasma using a clinical assay at a core lab. 6 months
Other Dietary intake Various components of dietary intake including macronutrients and micronutrients will be assessed through 3-day food records over 2 weekdays and 1 weekend collected using Automated Self-Administered 24hour (ASA-24) online system. 3 months, 6 months, 12 months
Other Liver enzymes: alanine transaminase (ALT), aspartate aminotransferase (AST), and albumin Assessment of ALT, AST, and albumin via a fasting blood serum draw, analyzed on a clinical assay at a core lab. 6 months
Other Liver fibrosis Liver T1 time evaluated using the PROFIT1 magnetic resonance sequence, validated marker of liver fibrosis. 6 months
Other Aerobic physical activity adherence Average adherence to prescribed aerobic physical activity weekly minutes measured via Garmin smart watch 6 months, 12 months
Other Resistance exercise adherence Average adherence to prescribed resistance exercise activity weekly sessions via an attendance log 6 months, 12 months
Other Diet quality An overall measure of alignment with the dietary guidelines measured via the Canadian healthy eating index calculated from 3-day diet records 3 months, 6 months, 12 months
Other Health-related quality of life Assessed by RAND-36, where an independent score is provided for 8 scales ranging from 0 to 100 and 2 component summary scales ranging from 0-50 with a higher score indicating better quality of life. 3 months, 6 months, 12 months
Other Menopausal symptom presence and severity Assessed by the Menopause-specific Quality of Life (MENQOL) questionnaire. Each of four domains is constrained between 1 to 8 where a higher score indicates more symptoms. 3 months, 6 months, 12 months
Other Psychosocial stress Assessed by the perceived stress scale (PSS-14) where individual scores can range from 0 to 56 with higher scores indicating higher perceived stress 3 months, 6 months, 12 months
Other Depression & Anxiety Measured by the Hospital Anxiety and Depression Scale (HADS); score ranges from 0-21 for each of depression and anxiety with a higher score indicating more severe depression or anxiety 3 months, 6 months, 12 months
Other Barriers and self-efficacy for physical activity Assessed by the barriers to self-efficacy scale (BARSE). For each item, participants indicate their confidence to execute the behavior on a 100-point percentage scale comprised of 10-point increments, ranging from 0% (not at all confident) to 100% (highly confident). Total strength for each measure of self-efficacy is then calculated by summing the confidence ratings and dividing by the total number of items in the scale, resulting in a maximum possible efficacy score of 100. 3 months, 6 months, 12 months
Other Physical activity motivation Assessed via the multi-process action control approach, which is a series of questionnaires developed to understand affective attitudes, instrumental attitudes, perceived capability over physical activity, perceived opportunity for physical activity, decisional intentions, behavioural regulation, physical activity habits, and identity around physical activity. Higher scores represent better physical activity motivations. (Reference: Rhodes, R.E. (2017). The evolving understanding of physical activity behavior: A multi-process action control approach. In A. J. Elliot (Ed), Advances in Motivation Science. (pp. 171-205).) 3 months, 6 months, 12 months
Other Sleep quality - subjective Subjectively assessed by the Pittsburgh Sleep Quality Index (PQSI), which measures components of sleep: sleep duration, disturbance, sleep latency, daytime dysfunction due to sleepiness, sleep efficiency, overall sleep quality, and sleep medication use, with higher scores reflecting poorer sleep quality. 3 months, 6 months, 12 months
Other Sleep quantity and quality - device measured Measured via Garmin smart watch for the total sleep duration and efficiency. 3 months, 6 months, 12 months
Other Self-reported physical activity Assessed by the Recent Physical Activity Questionnaire (RPAQ) that collects information about types and amounts of activity (sedentary and physical activities) over the last 3 months in the following domains: leisure time, occupation, commuting, domestic life, with greater scores indicating longer time engaging in forms of activity. 3 months, 6 months, 12 months
Other Serum Estradiol Assessed using fasting blood serum in a clinical assay. 6 months
Other Salivary Estradiol Assessed using a salivary sample in-house using a clinical assay. 6 months
Other Hemoglobin Assessed using a fasting blood plasma sample in a clinical assay at a core lab. 6 months
Other Free fatty acids Assessed using fasting blood serum in a clinical assay. 6 months
Other Body weight Assessed using a calibrated scale attached to the BodPod body composition device. 6 months
Other Body mass index (BMI) Calculated from a measurement of height using a stadiometer and body weight (detailed above). 6 months
Other Energy Balance Energy balance will be quantified as: 3-day avg calorie intake - [estimated resting metabolic rate + 3-day avg Garmin estimate of physical activity energy expenditure + 10% of calorie intake (thermic effect of food)]. 3 months, 6 months, 12 months
Primary Insulin resistance As assessed by the Matsuda Index calculated from an oral glucose tolerance test (OGTT). 6 months
Secondary Hepatic insulin resistance Indirectly measured via HOMA-IR using fasting glucose and insulin levels 6 months
Secondary Metabolic syndrome severity Calculated as a z-score to allow for tracking change in the interventions 6 months
Secondary Framingham 10-year risk (%) Calculated using a widely-used standardized scoring system 6 months
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