Piedmont Aging, Cognition & Exercise Study-2 (PACE-2)

Wake Forest University (WFU)

Status: Completed

Conditions: Prediabetes; Mild Cognitive Impairment

Treatments: Behavioral: Exercise/Aerobic; Behavioral: Exercise/Stretching

Study type: Interventional

Funder types: Other

Identifiers

NCT02312843

IRB00022598

Details and patient eligibility

About

The purpose of this research study is to examine the effects of high and low intensity exercise for those with mild memory loss and pre-diabetes. The investigators will also examine the effects of this exercise on certain proteins and hormones in body fluids, and on brain structure and function using magnetic resonance imaging (MRI). Recent studies indicate that exercise improves memory and thinking abilities for adults with mild memory loss OR pre-diabetes. This study examines the effects of exercise on people with mild memory loss AND pre-diabetes.

Enrollment: 33 patients

Sex: All

Ages: 50 to 89 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• 50 years or older
• Mild memory concerns
• In good health
• Not taking diabetes medications
• Not currently exercising

Exclusion criteria

• Significant neurologic disease that might affect cognition, such as AD, stroke, Parkinson's disease, multiple sclerosis, or severe head injury with loss of consciousness > 30 min or with permanent neurologic sequelae;
• Significant medical illness or organ failure, such as:
• Liver disease: history of hepatitis or hepatic failure
• Significant elevations in liver function tests: lab values more than 2.5 times the upper limit of normal
• Kidney disease known history of kidney failure.
• Uncontrolled hypertension
• Cardiovascular disease, defined as: any acute cardiovascular abnormality, such as new or unstable angina, uncontrolled irregular heart beat (treated a-fib and occasional PVC's are OK) or symptomatic heart failure, acute shortness of breath for any reason, or clinically significant edema, is an exclusion. History in the last year of myocardial infarction, angina, coronary artery angioplasty, bypass grafting, pacemaker insertion, STENT placement, postural hypotension, transient ischemic attack, or carotid artery surgery.
• Chronic lung disease, such as: COPD/emphysema
• Hemoglobin A1c levels that fall outside the range of 5.7-6.4%; If 2-h OGTT glucose values 220 mg/dL and hemoglobin A1c levels meet inclusion criteria (5.7-6.4%), then PCP written indication that no pharmacologic intervention for type 2 diabetes is needed at present will be required for continued study participation.
• Current use of anti-psychotic, anti-convulsant, anxiolytic, or sedative medication;
• Current use of any cognition-enhancing medication, including experimental medications within the past 60 days;
• Current or previous use of hypoglycemic agents or insulin (except during pregnacy); diabetics previously on oral agents but have been off of them for > 1 year are ok pending PI and study physician approval.
• Musculoskeletal impairment sufficient to interfere with study participation

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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33 participants in 2 patient groups, including a placebo group

High-Intensity Program-aerobic exercises

Active Comparator group

Description:

This exercise program will consist of walking or running on a treadmill or elliptical trainer, or spinning on a stationary bicycle. The goal of the program will be for participants to exercise at a moderate to high level of intensity, defined as 70-80% (American College of Sports Medicine guidelines) of heart rate reserve (HRR), for 45-60 minutes 4 days per week. At the start of each training session and following a 5-minute warm-up, subjects will exercise at 50% HRR (0.5\[HRmax-HRrest\] +HRrest) and intensity will gradually be increased to the individualized target heart rate training zone. Exercise facilitators will use a pre-specified computerized program. This program provides guidelines for the individualized progression of exercise based on age and resting heart rate. Subjects will wear a digital heart rate monitoring device for the duration of the training session to ensure they are exercising safely at the specified level of intensity.

Treatment:

Behavioral: Exercise/Aerobic

Low-intensity Program-Stretching

Placebo Comparator group

Description:

The low-intensity activity program will consist of an individualized and organized series of stretching and balance activities for the whole body, specifically designed for older adults. Consistent with the high-intensity protocol, subjects will complete the prescribed 45-60 minute stretching routine 4 days per week at the exercise facility. All stretching routines will include warm-up and cool-down activities, and will be within each subject's range of motion. Each stretch will be held for 20-30 s and repeated 5-10 times. Subjects will wear a digital heart rate monitoring device to ensure they are stretching safely and at an intensity below 35% HRR. The activity log completed during each stretching session will include HR, stretching duration, and mean HR during stretching. Subjects will also have the option to participate in structured pre-approved (by the exercise facilitator) stretching classes at the exercise facility when available.

Treatment:

Behavioral: Exercise/Stretching