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Molecular Mechanisms of Exercise Benefits to Insulin Resistant People

Molecular Mechanisms of Exercise Benefits to Insulin Resistant People

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT04158375
Enrollment
58
Registered
2019-11-08
Start date
2020-09-02
Completion date
2024-09-30
Last updated
2025-11-25

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Insulin Resistance, Obesity

Keywords

Resistance Exercise

Brief summary

This proposal will investigate the underlying mechanisms of enhanced insulin sensitivity and improvement of muscle loss and performance in insulin resistant people by resistance exercise training. Based on the investigator's preliminary data, they hypothesize that the key regulators of health benefits of resistance training are two genes: PGC-1a4 and PPARB;, and that the increased expression of these genes following resistance training facilitates storage of glucose in muscle and enhances its utilization for the energy need of muscle for contraction as well as enhancing muscle mass and performance. The investigators will also determine whether resistance training can reduce the higher oxidative stress in insulin resistant humans and improve their muscle protein quality.

Detailed description

Identification of the molecular regulatory points of exercise benefits is of high national priority because of the opportunity to develop targeted novel therapeutics benefiting populations suffering from inactivity-related health problems, including T2DM and pre-diabetes, characterized by insulin resistance (IR). IR is most prevalent in the older population associated with sarcopenia. The investigators propose a novel metabolic regulatory role of PGC-1α4 (α4), a hypertrophy gene, enhanced by resistance exercise (RE). Based on substantial preliminary data, the investigators hypothesize that α4, in cooperation with PPARβ (Rβ), promotes muscle glycolysis and insulin sensitivity (IS) as well as increasing muscle mass and performance. Based on their novel preliminary data, they will also investigate whether by deacetylation of glycolytic proteins, RE enhances muscle glycolytic capacity. Rβ also reduces oxidative stress that not only enhances IS but also contributes to other health benefits. New mRNA based data indicates that RE reduces protein degradation which will be investigated in the current proposal. The investigators will determine whether 3 months of RE training enhances insulin sensitivity and muscle performance and mass in IR people through pathways of enhanced glycolysis, deacetylation of glycolytic proteins reducing protein degradation and enhancing synthesis and ameliorating oxidative stress. They will study 48 IR people 50-75 yrs before and after 3 months of either 4-times/week resistance training or sedentary life and compare them with lean IS people. They will collect vastus lateralis muscle biopsy samples before and after an acute exercise bout and following a mixed meal to measure markers of glycolysis, energy metabolites, glycogen synthase, glycogen content, α4, Rβ, insulin signaling proteins and proteome analysis. They will also measure markers of oxidative stress including 8-OXO-dg (measure of DNA damage), oxidative damage to proteins and subsequent muscle protein degradation, which they hypothesize is reduced by increased anti-oxidant effect of Rβ with RE training. They also will use in vivo labeling of specific muscle proteins utilizing stable isotope labeled tracers to determine whether α4 induced muscle hypertrophy occurs not only by reducing degradation but also by enhancing contractile protein synthesis. These studies will render the necessary mechanistic explanation on how RE enhances IS, glycolysis, reduces oxidative stress and promote muscle performance and mass in IR people, thus substantially contributing to health and life span.

Interventions

BEHAVIORALResistance Exercise

Resistance (RE) training will be performed 4 days per week using a combination of upper and lower body exercises at 8-12 repetitions per set. Participants will complete 2 progressing to 4 sets of 8 to 12 repetitions per exercise, with 1 minute rest between sets. Participants will warmup for 5 minutes on a treadmill, cycle ergometer or elliptical at \ 50% VO2 peak then begin resistance training. Resistance will be performed 4 days per week with lower body exercise on Monday and Thursday, and upper body on Tuesday and Friday. Wednesdays are a rest day. Participants will begin at 2 sets per exercise on weeks 1 and 2, then 3 sets for week 3, and 4 sets for weeks 4 to 12.

Sponsors

National Institute on Aging (NIA)
CollaboratorNIH
Mayo Clinic
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
50 Years to 75 Years
Healthy volunteers
Yes

Inclusion criteria

* age 50-75yrs * BMI 30-38kg/m2 * hip to waist ratio of \>0.85 in women and 1.0 in men * fasting glucose ≥100-140mg/dl Lean Group * age 50-75 years * hip to waist ratio of \<0.76 in women and 0.90 in men * fasting glucose of \<100mg/dl.

Exclusion criteria

for the study are as follows: * Coronary artery disease or heart failure. * Participation in a structured exercise program \>2 days per week * A known medical condition that in the judgment of the investigator might interfere with the completion of the protocol such as the following examples: * Inpatient psychiatric treatment in the past 6 months * Presence of a known adrenal disorder * Abnormal liver function test results (Transaminase \>2 times the upper limit of normal); testing required for subjects taking medications known to affect liver function or with diseases known to affect liver function * Abnormal renal function test results (calculated GFR \<60 mL/min/1.73m2); testing required for subjects with diabetes duration of greater than 5 years post onset of puberty * Active gastroparesis * If on antihypertensive, thyroid, anti-depressant or lipid lowering medication, lack of stability on the medication for the past 2 months prior to enrollment in the study * Uncontrolled thyroid disease (TSH undetectable or \>10 mlU/L); testing required within three months prior to admission for subjects with a goiter, positive antibodies, or who are on thyroid hormone replacement, and within one year otherwise * Abuse of alcohol or recreational drugs * Infectious process not anticipated to resolve prior to study procedures (e.g. meningitis, pneumonia, osteomyelitis). * Uncontrolled arterial hypertension (Resting diastolic blood pressure \>90 mmHg and/or systolic blood pressure \>160 mmHg) at the time of screening. * Oral steroids * A recent injury to body or limb, muscular disorder, use of any medication, any carcinogenic disease, or other significant medical disorder if that injury, medication or disease in the judgment of the investigator will affect the completion of the protocol * Restrictions on Use of Other Drugs or Treatments: * Medications that may impact study end points such as mitochondrial biology eg. beta blockers * Anti-hyperglycemic drugs including metformin * Any other medication that the investigator believes is a contraindication to the subject's participation.

Design outcomes

Primary

MeasureTime frameDescription
Change in Muscle StrengthBaseline and 3 MonthsChange in 1RM normalized to lean mass
Change in Insulin SensitivityBaseline and 3 MonthsDifference from baseline and 3 months of the insulin area on under the curve - A measure of insulin sensitivity as measured during an oral meal tolerance test - Time points (-20, 0, 10, 20, 30, 60, 90, 150, 240 minutes)
Change in Lean MassBaseline and 3 monthsChange in body lean mass as measured by DEXA scan

Secondary

MeasureTime frameDescription
Change in Fat PercentageBaseline and 3 MonthsChange in body fat percentage as measured by DEXA scan

Countries

United States

Participant flow

Participants by arm

ArmCount
Insulin Resistant Exercise Group
Resistance (RE) training will be performed 4 days per week using a combination of upper and lower body exercises at 8-12 repetitions per set. Resistance training will be performed using a combination of upper and lower body exercises using machine and free weights. Upper body exercises are chest press, incline press, seated row, lat pull down, triceps extension, biceps curl and lateral raises. Major muscle groups for upper body exercises will include chest (pectoralis major and minor), arm (biceps and triceps), shoulder (deltoids) and back (latissimus dorsi and rhomboids). Lower body exercises are leg press, lunge (with body weight progressing to dumbbells), seated leg extension, seated leg curl, calf raises and abdominal crunches. Major muscle groups for the lower body exercises will be thighs (quadriceps and hamstrings), calves (gastrocnemius and soleus) and core (rectus abdominus and obliques). Participants will complete 2 progressing to 4 sets, with 1 minute rest between sets. Participants will warmup. Resistance will be performed 4 days per week with lower body exercise on Monday and Thursday, and upper body on Tuesday and Friday. Wednesdays are a rest day. Participants will begin at 2 sets per exercise on weeks 1 and 2, then 3 sets for week 3, and 4 sets for weeks 4 to 12.
33
Insulin Resistant Control Group
Participants in this group will perform no exercise for the 3 month study period.
13
Insulin Sensitive Lean Group
Participants in this group will have a baseline study for comparison to the insulin resistant groups.
9
Total55

Withdrawals & dropouts

PeriodReasonFG000FG001FG002
Overall StudyWithdrawal by Subject030

Baseline characteristics

CharacteristicInsulin Resistant Exercise GroupInsulin Resistant Control GroupInsulin Sensitive Lean GroupTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
10 Participants3 Participants5 Participants18 Participants
Age, Categorical
Between 18 and 65 years
23 Participants10 Participants4 Participants37 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
1 Participants1 Participants1 Participants3 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
32 Participants12 Participants8 Participants52 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Black or African American
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
33 Participants13 Participants9 Participants55 Participants
Region of Enrollment
United States
33 Participants13 Participants9 Participants55 Participants
Sex: Female, Male
Female
17 Participants7 Participants5 Participants29 Participants
Sex: Female, Male
Male
16 Participants6 Participants4 Participants26 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 320 / 15
other
Total, other adverse events
0 / 320 / 15
serious
Total, serious adverse events
0 / 320 / 15

Outcome results

Primary

Change in Insulin Sensitivity

Difference from baseline and 3 months of the insulin area on under the curve - A measure of insulin sensitivity as measured during an oral meal tolerance test - Time points (-20, 0, 10, 20, 30, 60, 90, 150, 240 minutes)

Time frame: Baseline and 3 Months

Population: Only longitudinal arms were analyzed since this is a measure of change between baseline and 3 months (Insulin Resistant Exercise Group vs Insulin Resistant Control Group). The Insulin Sensitive Lean Group was only for baseline comparisons.

ArmMeasureValue (MEAN)Dispersion
Insulin Resistant Exercise GroupChange in Insulin Sensitivity-743.7 μIU*min/mLStandard Deviation 2292
Insulin Resistant Control GroupChange in Insulin Sensitivity-105.7 μIU*min/mLStandard Deviation 2015
Primary

Change in Lean Mass

Change in body lean mass as measured by DEXA scan

Time frame: Baseline and 3 months

Population: Only longitudinal arms were analyzed since this is a measure of change between baseline and 3 months (Insulin Resistant Exercise Group vs Insulin Resistant Control Group). The Insulin Sensitive Lean Group was only for baseline comparisons.

ArmMeasureValue (MEAN)Dispersion
Insulin Resistant Exercise GroupChange in Lean Mass542 gramsStandard Deviation 1526
Insulin Resistant Control GroupChange in Lean Mass-377 gramsStandard Deviation 1348
Primary

Change in Muscle Strength

Change in 1RM normalized to lean mass

Time frame: Baseline and 3 Months

Population: Only longitudinal arms were analyzed since this is a measure of change between baseline and 3 months (Insulin Resistant Exercise Group vs Insulin Resistant Control Group). The Insulin Sensitive Lean Group was only for baseline comparisons.

ArmMeasureValue (MEAN)Dispersion
Insulin Resistant Exercise GroupChange in Muscle Strength0.37 RatioStandard Deviation 0.31
Insulin Resistant Control GroupChange in Muscle Strength-0.2 RatioStandard Deviation 0.32
Secondary

Change in Fat Percentage

Change in body fat percentage as measured by DEXA scan

Time frame: Baseline and 3 Months

Population: Only longitudinal arms were analyzed since this is a measure of change between baseline and 3 months (Insulin Resistant Exercise Group vs Insulin Resistant Control Group). The Insulin Sensitive Lean Group was only for baseline comparisons.

ArmMeasureValue (MEAN)Dispersion
Insulin Resistant Exercise GroupChange in Fat Percentage-0.89 PercentageStandard Deviation 1.01
Insulin Resistant Control GroupChange in Fat Percentage0.12 PercentageStandard Deviation 1.14

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026