Prospective Aerobic Reconditioning Intervention Study

NCT ID: NCT01113840

Last Updated: 2019-02-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

201 participants

Study Classification

INTERVENTIONAL

Study Start Date

1993-07-31

Study Completion Date

2009-12-31

Brief Summary

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The purpose of this study is :

* To determine if aerobic exercise conditioning can improve symptoms, cardiovascular function and quality of life in elderly patients with congestive heart failure.
* To describe the baseline clinical characteristics, cardiovascular function and neurohumoral function in elderly patients with congestive heart failure.
* To determine the specific cardiovascular and noncardiovascular mechanisms by which symptoms and quality of life may improve following exercise conditioning in elderly patients with congestive heart failure.

Detailed Description

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In patients over age 65, cardiovascular disease accounts for the largest percentage of deaths, hospital days, doctor visits, and overall health care expenditures. In addition, heart failure is the most common discharge diagnosis in the elderly. Heart failure can be defined as a state in which cardiac output is insufficient to meet metabolic demands. This is most frequently manifested by symptoms of fatigue and dyspnea. Inherent in this definition is that symptoms may be increased or only occur during times when metabolic demand is increased, such as during exercise. As such, exercise intolerance is a hallmark of the heart failure syndrome. Exercise intolerance correlates not only with disease severity and also with subsequent mortality. Exercise tolerance can be objectively quantified during maximal symptom limited standardized exercise protocols by analysis of exercise time, workload, METS (metabolic equivalents), and oxygen consumption (V02)' These measures have appropriately become accepted as standards for functional assessment in this disorder as well as outcome measures following therapeutic interventions in HF. P.A.R.I.S. is a randomized, attention-controlled, single-blind trial of supervised aerobic exercise training in older patients with heart failure. The primary outcome is exercise capacity and the main secondary outcome is quality of life. Mechanistic outcomes were also examined. In PARIS, which focused on cardiac mechanisms, there were HFPEF and HFREF patients studied in parallel. In PARIS-II, there were only HFPEF patients which focused on vascular mechanisms.

Main outcomes have been reported (see citations below).

Conditions

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Heart Failure

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Control

Control group continues with their daily activity as they were prior to randomization. Receive bi-weekly follow-up phone calls to assess health status and encourage adherence with protocol.

Group Type PLACEBO_COMPARATOR

Control

Intervention Type BEHAVIORAL

Control group continues daily life as prior to randomization.

Exercise

Exercise classes three times per week in a controlled, supervised environment.

Group Type ACTIVE_COMPARATOR

Exercise

Intervention Type BEHAVIORAL

Exercise classes three times per week in a controlled, supervised environment.

Interventions

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Exercise

Exercise classes three times per week in a controlled, supervised environment.

Intervention Type BEHAVIORAL

Control

Control group continues daily life as prior to randomization.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Age greater than or equal to 60 years of age
* Symptoms of congestive heart failure
* Able to understand and give informed consent

Exclusion Criteria

* Age \<60 years
* Does not have CHF
* Significant change in cardiac medication \<3 weeks
* Myocardial infarction \<3 weeks
* CABG surgery \<3 months
* Angina pectoris not controlled during daily activity by pharmacological therapy or at \<4 METS activity
* Sustained hypertension with systolic\> 190 and diastolic\> 110 on medications
* Valvular heart disease as the primary etiology of CHF
* Significant aortic stenosis
* Stroke of \<3 months or with any physical restriction impairment that would prevent participation in exercise programs
* Chronic obstructive pulmonary disease on therapy that limits exercise duration
* Uncontrolled diabetes mellitus
* Active treatment for cancer or other noncardiovascular conditions with life expectancy less than three years
* Anemia "10 gms Hb)
* Renal insufficiency (cr \>2.5 mg/dl)
* Psychiatric disease - uncontrolled major psychoses, depressions, dementia, or personality disorder
* Dementia - MMSE \~24 "22 for \~8th grade education)
* Lack of an acoustic window sufficient to allow definition of endocardial borders on the screening echocardiogram.
* Plans to leave area or be admitted to a nursing home within 2 years.
* Inability to walk at least 420 feet in 6 minutes without a cane or other assistive device.
* Inability to exercise at or near home.
* At the discretion of the clinical staff, it is believed that the participant cannot or will not complete the protocol because of frailty, illness, or other reason.
* Participation in a regular exercise regimen more than one time per week for at least twenty minutes per session; including but not limited to walking, swimming, weight lifting, golfing, or taking an exercise class.
* Inability to ambulate without cane or other assistive device during biomechanics testing or treadmill.
* Inability to attend at least fourteen weeks of the facility-based intervention
Minimum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institutes of Health (NIH)

NIH

Sponsor Role collaborator

National Institute on Aging (NIA)

NIH

Sponsor Role collaborator

Wake Forest University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Dalane W Kitzman, MD

Role: PRINCIPAL_INVESTIGATOR

Wake Forest University Health Sciences

Locations

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Wake Forest Baptist Health

Winston-Salem, North Carolina, United States

Site Status

Countries

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United States

References

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Kitzman DW, Little WC, Brubaker PH, Anderson RT, Hundley WG, Marburger CT, Brosnihan B, Morgan TM, Stewart KP. Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure. JAMA. 2002 Nov 6;288(17):2144-50. doi: 10.1001/jama.288.17.2144.

Reference Type RESULT
PMID: 12413374 (View on PubMed)

Kitzman DW, Brubaker PH, Morgan TM, Stewart KP, Little WC. Exercise training in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. Circ Heart Fail. 2010 Nov;3(6):659-67. doi: 10.1161/CIRCHEARTFAILURE.110.958785. Epub 2010 Sep 17.

Reference Type RESULT
PMID: 20852060 (View on PubMed)

Brubaker PH, Moore JB, Stewart KP, Wesley DJ, Kitzman DW. Endurance exercise training in older patients with heart failure: results from a randomized, controlled, single-blind trial. J Am Geriatr Soc. 2009 Nov;57(11):1982-9. doi: 10.1111/j.1532-5415.2009.02499.x.

Reference Type RESULT
PMID: 20121952 (View on PubMed)

John JM, Haykowsky M, Brubaker P, Stewart K, Kitzman DW. Decreased left ventricular distensibility in response to postural change in older patients with heart failure and preserved ejection fraction. Am J Physiol Heart Circ Physiol. 2010 Sep;299(3):H883-9. doi: 10.1152/ajpheart.00332.2010. Epub 2010 Jun 18.

Reference Type RESULT
PMID: 20562334 (View on PubMed)

Haykowsky MJ, Brubaker PH, John JM, Stewart KP, Morgan TM, Kitzman DW. Determinants of exercise intolerance in elderly heart failure patients with preserved ejection fraction. J Am Coll Cardiol. 2011 Jul 12;58(3):265-74. doi: 10.1016/j.jacc.2011.02.055.

Reference Type RESULT
PMID: 21737017 (View on PubMed)

Haykowsky MJ, Brubaker PH, Stewart KP, Morgan TM, Eggebeen J, Kitzman DW. Effect of endurance training on the determinants of peak exercise oxygen consumption in elderly patients with stable compensated heart failure and preserved ejection fraction. J Am Coll Cardiol. 2012 Jul 10;60(2):120-8. doi: 10.1016/j.jacc.2012.02.055.

Reference Type RESULT
PMID: 22766338 (View on PubMed)

Moore B, Brubaker PH, Stewart KP, Kitzman DW. VE/VCO2 slope in older heart failure patients with normal versus reduced ejection fraction compared with age-matched healthy controls. J Card Fail. 2007 May;13(4):259-62. doi: 10.1016/j.cardfail.2006.12.005.

Reference Type RESULT
PMID: 17517344 (View on PubMed)

Maldonado-Martin S, Brubaker PH, Kaminsky LA, Moore JB, Stewart KP, Kitzman DW. The relationship of a 6-min walk to VO(2 peak) and VT in older heart failure patients. Med Sci Sports Exerc. 2006 Jun;38(6):1047-53. doi: 10.1249/01.mss.0000222830.41735.14.

Reference Type RESULT
PMID: 16775543 (View on PubMed)

Brubaker PH, Joo KC, Stewart KP, Fray B, Moore B, Kitzman DW. Chronotropic incompetence and its contribution to exercise intolerance in older heart failure patients. J Cardiopulm Rehabil. 2006 Mar-Apr;26(2):86-9. doi: 10.1097/00008483-200603000-00007. No abstract available.

Reference Type RESULT
PMID: 16569976 (View on PubMed)

Brubaker PH, Marburger CT, Morgan TM, Fray B, Kitzman DW. Exercise responses of elderly patients with diastolic versus systolic heart failure. Med Sci Sports Exerc. 2003 Sep;35(9):1477-85. doi: 10.1249/01.MSS.0000084416.71232.EA.

Reference Type RESULT
PMID: 12972865 (View on PubMed)

Marburger CT, Brubaker PH, Pollock WE, Morgan TM, Kitzman DW. Reproducibility of cardiopulmonary exercise testing in elderly patients with congestive heart failure. Am J Cardiol. 1998 Oct 1;82(7):905-9. doi: 10.1016/s0002-9149(98)00502-5.

Reference Type RESULT
PMID: 9781977 (View on PubMed)

Kitzman DW, Brubaker PH, Herrington DM, Morgan TM, Stewart KP, Hundley WG, Abdelhamed A, Haykowsky MJ. Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. J Am Coll Cardiol. 2013 Aug 13;62(7):584-92. doi: 10.1016/j.jacc.2013.04.033. Epub 2013 May 9.

Reference Type RESULT
PMID: 23665370 (View on PubMed)

Haykowsky MJ, Herrington DM, Brubaker PH, Morgan TM, Hundley WG, Kitzman DW. Relationship of flow-mediated arterial dilation and exercise capacity in older patients with heart failure and preserved ejection fraction. J Gerontol A Biol Sci Med Sci. 2013 Feb;68(2):161-7. doi: 10.1093/gerona/gls099. Epub 2012 Apr 20.

Reference Type RESULT
PMID: 22522508 (View on PubMed)

Kitzman DW, Herrington DM, Brubaker PH, Moore JB, Eggebeen J, Haykowsky MJ. Carotid arterial stiffness and its relationship to exercise intolerance in older patients with heart failure and preserved ejection fraction. Hypertension. 2013 Jan;61(1):112-9. doi: 10.1161/HYPERTENSIONAHA.111.00163. Epub 2012 Nov 12.

Reference Type RESULT
PMID: 23150511 (View on PubMed)

Haykowsky MJ, Kouba EJ, Brubaker PH, Nicklas BJ, Eggebeen J, Kitzman DW. Skeletal muscle composition and its relation to exercise intolerance in older patients with heart failure and preserved ejection fraction. Am J Cardiol. 2014 Apr 1;113(7):1211-6. doi: 10.1016/j.amjcard.2013.12.031. Epub 2014 Jan 15.

Reference Type RESULT
PMID: 24507172 (View on PubMed)

Other Identifiers

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R01AG012257

Identifier Type: NIH

Identifier Source: secondary_id

View Link

R01AG018915

Identifier Type: NIH

Identifier Source: secondary_id

View Link

P.A.R.I.S. I and II

Identifier Type: -

Identifier Source: org_study_id

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