Effects of Exercise Intervention on Aging-related Motor Decline

Not Applicable

Completed

• Conditions: Aging; Exercise
• Interventions: Behavioral: Aerobic Exercise Intervention; Behavioral: Stretching Exercise Intervention; Behavioral: Self Monitoring

• Registration Number: NCT01787292
• Lead Sponsor: VA Office of Research and Development

Brief Summary

The purpose of this research study is to test whether differing levels of physical fitness affects patterns of motor dexterity and brain activity that have been shown to differ due to aging. Testing will take place at the Atlanta VA Medical Center and at Emory University.

Participants will be healthy adults within the target age range of 60-85 for the study. The study will require multiple visits over 15 months. There will be about 64 people volunteering for this study.

Detailed Description

The U.S. Census reports over 14 million U.S. Veterans (\>63%) are beyond mid-life (\>55 years). Declines in upper extremity motor performance respective of strength and dexterity are well documented within this age cohort). Recent cross-sectional research has discovered that aging related motor deficits may be influenced by a loss of interhemispheric inhibition (IHI) between primary motor cortices. However, this loss may not be an inevitable consequence of aging. Work from previous VA OAA Predoctoral and CDA-1 awards have shown that aerobic fitness may serve to mitigate losses in interhemispheric inhibition assessed by both functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS). That is, individuals who are aerobically fit show higher levels of IHI and improved dexterity and reaction times.

In light of new evidence from the investigators' lab's recent cross-sectional studies, physical activity over the long term (at least 2-5 years) may serve to alter levels of IHI and improve motor performance in the upper extremity. Aerobic exercise may provide a mechanism (reduced loss of interhemispheric inhibition) that could serve to improve motor function, but the neural mechanism responsible for such effects remains unclear. Previous investigations of interhemispheric communication and exercise have been limited by nature of inquiry, as cross-sectional research cannot measure changes over time in participants. As such, it is currently unknown how exercise may directly affect levels of interhemispheric communication and motor performance.

Behavioral interventions (motor strength and coordination) have been shown to be effective in improving upper extremity motor performance in older adults, however the duration of these gains appear to be short-lived. After as little as a few weeks of detraining, motor strength and coordination in the upper extremity rapidly begins to return to pre-intervention levels. Evidence from exercise interventions assessing gait and locomotion have shown that exercise programs over a longer term (\>6 months) are associated with improved proprioception, fewer falls and better balance. However, the comparison of outcomes of upper extremity function in elderly adults respective of exercise duration remains largely unexplored. In addition to comparing the effects of short-term exercise (3 months) versus behavioral training (3 months) on upper extremity function, the current proposal will evaluate if a longer-term (6 months) exercise program can maintain or enhance upper extremity function and associated levels of interhemispheric inhibition.

The current study proposes the next logical step in my line of research and directly investigates the effects of exercise in an intervention with sedentary older Veterans (50-80 years), a group most likely to exhibit aging-related motor deficits. The investigators propose to enroll 40 Veterans into an upper extremity dexterity improvement program involving behavioral and exercise components. The behavioral intervention is a muscle coordination training previously shown to improve unimanual motor performance in older adults. The exercise intervention is a supervised group cycling regimen. The figure below shows the study design. Interhemispheric communication will be assessed with fMRI, and TMS.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study Start: 2013-01-14
• Study First Submitted: 2013-02-05
• Study First Submitted QC: 2013-02-05
• Study First Posted: 2013-02-08
• Primary Completion: 2018-07-07
• Study Completion: 2019-08-01
• Results First Submitted: 2019-09-23
• Status Verified: 2020-02
• Results First Submitted QC: 2020-02-05
• Last Update Submitted: 2020-02-05
• Results First Posted: 2020-02-20
• Last Update Posted: 2020-02-20

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 33

Inclusion Criteria

• Living persons between 60 and 85 years of age

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Exclusion Criteria

• unmanaged diabetes
• participants completing vigorous exercise per week
• participants whose profession requires vigorous physical labor
• contraindication to magnetic resonance imaging

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
Aerobic Exercise Intervention	Aerobic Exercise Intervention	B. Interval aerobic cycling under supervised trainer. 3 times per week for 20-45 minutes. HR will be targeted between 50-85% of age-related maximum.
Stretching Exercise Intervention	Stretching Exercise Intervention	A. Light stretching and balance exercises under supervised trainer. 3 times per week for 20-45 minutes. HR will be targeted to be under 50% of age-related maximum.
Self Monitoring Intervention	Self Monitoring	C. 6 month self-monitored training phase during which time participants will exercise using a take home bike ergometer.

Primary Outcome Measures

Name	Time	Method
Comparison of Cardiovascular Efficiency for Balance Exercise First Group After Home-based Intervention	24 and 48 weeks	VO2peak estimation completed using the YMCA protocol investigating overall volume of oxygen consumption as a function of heart rate during work loads.
Silent Period Duration After Exercise Cycling Program	Baseline, 12 weeks, 24 weeks	Duration of ipsilateral silent period from Transcranial magnetic stimulation measured in milliseconds
Silent Period Duration for Balance Group	Baseline, 12 weeks, 24 weeks	Ipsilateral silent period duration as assessed by TMS
fMRI Interhemispheric Inhibition Improvement After Balance Training	Baseline, 12 weeks, 24 weeks	Area under the curve of fMRI measures of right motor cortex BOLD profile will remain similar to pre measurements. The BOLD profile is the z-normalized area under the curve value of the fMRI impulse response function. A higher number indicates less interhemispheric inhibition.
Comparison of Cardiovascular Efficiency for Aerobic Exercise First Group After Home-based Intervention	24 and 48 weeks	Comparison of home based aerobic exercise intervention to assessments made after completion of crossover intervention in Participants receiving aerobic condition first. VO2peak estimation completed using the YMCA protocol investigating overall volume of oxygen consumption as a function of heart rate during work loads. Estimated VO2 peak values are in ml/kg(min).
Comparison of Silent Period Duration After Aerobic Exercise	Baseline, 12 weeks, 24 weeks	Comparison of silent period duration at 24 weeks compared to baseline
Comparison of Silent Period Duration After Balance Exercise	24 and 48 weeks	Comparison of Home based training effects on TMS measures of silent period duration as compared to facility based exercise programs.
Estimate Cardiovascular Efficiency After Aerobic Exercise	Baseline, 12 weeks, 24 weeks	Estimate of Volume of oxygen consumption (VO2peak) using YMCA protocol for cardiovascular assessment.
fMRI Interhemispheric Inhibition Improvement After Aerobic Exercise	Baseline to 24 Weeks with cross-over	Participants who exercise will evidence larger increases in interhemispheric inhibition as assessed by functional magnetic resonance measured by a z-normalized area under curve of right primary motor cortex. The area under the curve is an estimate of the fMRI hemodynamic response impulse response function. A higher number of AUC indicates less interhemispheric inhibition. In contrast, a lower number in this analysis indicates higher interhemispheric inhibition.
Estimate of Cardiovascular Efficiency After Balance Training	Baseline, 12 weeks, 24 weeks	Estimated VO2peak using YMCA cycle test completed over nine to twelve minutes.

Secondary Outcome Measures

Name	Time	Method
Heart Rate Workload After Home Based Intervention	24 and 48 weeks	Measured heart rate after home based intervention; Technical implementation at the facility level prevented acquisition of these metrics until late in the project.
Target Heart Rate Zone After Aerobic Exercise First	24 and 48 weeks	Targeted Heart Rate Zone among participants compared among short term exercise groups
Target Heart Rate Zone for Balance First Participants	24 and 48 weeks	Heart rate in aerobic target zone is measured in percentage of time in at least 50% of participants heart rate reserve.

Trial Locations

Locations (1)

Atlanta VA Medical and Rehab Center, Decatur, GA; 🇺🇸 Decatur, Georgia, United States