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Jiang R, Collins KA, Huffman KM, Hauser ER, Hubal MJ, Johnson JL, Williams RB, Siegler IC, Kraus WE. Genome-Wide Genetic Analysis of Dropout in a Controlled Exercise Intervention in Sedentary Adults With Overweight or Obesity and Cardiometabolic Disease. Ann Behav Med 2024; 58:363-374. [PMID: 38489667 PMCID: PMC11008589 DOI: 10.1093/abm/kaae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Despite the benefits of exercise, many individuals are unable or unwilling to adopt an exercise intervention. PURPOSE The purpose of this analysis was to identify putative genetic variants associated with dropout from exercise training interventions among individuals in the STRRIDE trials. METHODS We used a genome-wide association study approach to identify genetic variants in 603 participants initiating a supervised exercise intervention. Exercise intervention dropout occurred when a subject withdrew from further participation in the study or was otherwise lost to follow-up. RESULTS Exercise intervention dropout was associated with a cluster of single-nucleotide polymorphisms with the top candidate being rs722069 (T/C, risk allele = C) (unadjusted p = 2.2 × 10-7, odds ratio = 2.23) contained within a linkage disequilibrium block on chromosome 16. In Genotype-Tissue Expression, rs722069 is an expression quantitative trait locus of the EARS2, COG7, and DCTN5 genes in skeletal muscle tissue. In subsets of the STRRIDE genetic cohort with available muscle gene expression (n = 37) and metabolic data (n = 82), at baseline the C allele was associated with lesser muscle expression of EARS2 (p < .002) and COG7 (p = .074) as well as lesser muscle concentrations of C2- and C3-acylcarnitines (p = .026). CONCLUSIONS Our observations imply that exercise intervention dropout is genetically moderated through alterations in gene expression and metabolic pathways in skeletal muscle. Individual genetic traits may allow the development of a biomarker-based approach for identifying individuals who may benefit from more intensive counseling and other interventions to optimize exercise intervention adoption. CLINICAL TRIAL INFORMATION STRRIDE I = NCT00200993; STRRIDE AT/RT = NCT00275145; STRRIDE-PD = NCT00962962.
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Affiliation(s)
- Rong Jiang
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Katherine A Collins
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kim M Huffman
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth R Hauser
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Biostatistics, Duke University School of Medicine, Durham, NC, USA
| | - Monica J Hubal
- Department of Kinesiology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Johanna L Johnson
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Redford B Williams
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Ilene C Siegler
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Bareja A, Lee DE, Ho T, Waitt G, McKay LH, Hannou SA, Orenduff MC, McGreevy KM, Binder A, Ryan CP, Soderblom EJ, Belsky DW, Ferrucci L, Das JK, Banskota N, Kraus VB, Huebner JL, Kraus WE, Huffman KM, Baht GS, Horvath S, Parmer RJ, Miles LA, White JP. Liver-derived plasminogen mediates muscle stem cell expansion during caloric restriction through the plasminogen receptor Plg-R KT. Cell Rep 2024; 43:113881. [PMID: 38442019 DOI: 10.1016/j.celrep.2024.113881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 08/08/2023] [Accepted: 02/13/2024] [Indexed: 03/07/2024] Open
Abstract
An intriguing effect of short-term caloric restriction (CR) is the expansion of certain stem cell populations, including muscle stem cells (satellite cells), which facilitate an accelerated regenerative program after injury. Here, we utilized the MetRSL274G (MetRS) transgenic mouse to identify liver-secreted plasminogen as a candidate for regulating satellite cell expansion during short-term CR. Knockdown of circulating plasminogen prevents satellite cell expansion during short-term CR. Furthermore, loss of the plasminogen receptor KT (Plg-RKT) is also sufficient to prevent CR-related satellite cell expansion, consistent with direct signaling of plasminogen through the plasminogen receptor Plg-RKT/ERK kinase to promote proliferation of satellite cells. Importantly, we are able to replicate many of these findings in human participants from the CALERIE trial. Our results demonstrate that CR enhances liver protein secretion of plasminogen, which signals directly to the muscle satellite cell through Plg-RKT to promote proliferation and subsequent muscle resilience during CR.
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Affiliation(s)
- Akshay Bareja
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA; Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27701, USA
| | - David E Lee
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA; Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27701, USA
| | - Tricia Ho
- Proteomics and Metabolomics Core Facility, Duke University School of Medicine, Durham, NC, USA
| | - Greg Waitt
- Proteomics and Metabolomics Core Facility, Duke University School of Medicine, Durham, NC, USA
| | - Lauren H McKay
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27701, USA; Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of Chapel Hill, Chapel Hill, NC, USA
| | - Sarah A Hannou
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27701, USA
| | - Melissa C Orenduff
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27701, USA
| | - Kristen M McGreevy
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
| | - Alexandra Binder
- Population Sciences in the Pacific Program (Cancer Epidemiology), University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI 96813, USA; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
| | - Calen P Ryan
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Erik J Soderblom
- Proteomics and Metabolomics Core Facility, Duke University School of Medicine, Durham, NC, USA
| | - Daniel W Belsky
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Luigi Ferrucci
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Jayanta Kumar Das
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Nirad Banskota
- Longitudinal Studies Section, Translation Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Virginia B Kraus
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA; Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27701, USA; Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC 27701, USA
| | - Janet L Huebner
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27701, USA
| | - William E Kraus
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA; Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27701, USA; Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC 27701, USA
| | - Kim M Huffman
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA; Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27701, USA; Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC 27701, USA
| | - Gurpreet S Baht
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27701, USA; Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC 27701, USA; Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC 27701, USA
| | - Steve Horvath
- Computational Biology and Genomics Core, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA; Altos Labs, San Diego, CA, USA
| | - Robert J Parmer
- Department of Medicine, Veterans Administration San Diego Healthcare System, San Diego, CA, USA; Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Lindsey A Miles
- Department of Molecular Medicine, Scripps Research, La Jolla, CA 92037, USA
| | - James P White
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA; Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27701, USA; Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC 27701, USA.
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3
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Hastings WJ, Ye Q, Wolf SE, Ryan CP, Das SK, Huffman KM, Kobor MS, Kraus WE, MacIsaac JL, Martin CK, Racette SB, Redman LM, Belsky DW, Shalev I. Effect of long-term caloric restriction on telomere length in healthy adults: CALERIE™ 2 trial analysis. Aging Cell 2024:e14149. [PMID: 38504468 DOI: 10.1111/acel.14149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/21/2024] Open
Abstract
Caloric restriction (CR) modifies lifespan and aging biology in animal models. The Comprehensive Assessment of Long-Term Effects of Reducing Intake of Energy (CALERIE™) 2 trial tested translation of these findings to humans. CALERIE™ randomized healthy, nonobese men and premenopausal women (age 21-50y; BMI 22.0-27.9 kg/m2 ), to 25% CR or ad-libitum (AL) control (2:1) for 2 years. Prior analyses of CALERIE™ participants' blood chemistries, immunology, and epigenetic data suggest the 2-year CR intervention slowed biological aging. Here, we extend these analyses to test effects of CR on telomere length (TL) attrition. TL was quantified in blood samples collected at baseline, 12-, and 24-months by quantitative PCR (absolute TL; aTL) and a published DNA-methylation algorithm (DNAmTL). Intent-to-treat analysis found no significant differences in TL attrition across the first year, although there were trends toward increased attrition in the CR group for both aTL and DNAmTL measurements. When accounting for adherence heterogeneity with an Effect-of-Treatment-on-the-Treated analysis, greater CR dose was associated with increased DNAmTL attrition during the baseline to 12-month weight-loss period. By contrast, both CR group status and increased CR were associated with reduced aTL attrition over the month 12 to month 24 weight maintenance period. No differences were observed when considering TL change across the study duration from baseline to 24-months, leaving it unclear whether CR-related effects reflect long-term detriments to telomere fidelity, a hormesis-like adaptation to decreased energy availability, or measurement error and insufficient statistical power. Unraveling these trends will be a focus of future CALERIE™ analyses and trials.
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Affiliation(s)
- Waylon J Hastings
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Qiaofeng Ye
- Department of Biobehavioral Health, Pennsylvania State University, University Park, State College, Pennsylvania, USA
| | - Sarah E Wolf
- Department of Biobehavioral Health, Pennsylvania State University, University Park, State College, Pennsylvania, USA
- Institute for Ecology and Evolution, School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - Calen P Ryan
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Sai Krupa Das
- Jean Mayer, USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA
| | - Kim M Huffman
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael S Kobor
- Edwin S.H. Leong Centre for Healthy Aging, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - William E Kraus
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Julia L MacIsaac
- Edwin S.H. Leong Centre for Healthy Aging, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Susan B Racette
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Leanne M Redman
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Daniel W Belsky
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Idan Shalev
- Department of Biobehavioral Health, Pennsylvania State University, University Park, State College, Pennsylvania, USA
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4
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Andonian BJ, Ross LM, Sudnick AM, Johnson JL, Pieper CF, Belski KB, Counts JD, King AP, Wallis JT, Bennett WC, Gillespie JC, Moertl KM, Richard D, Huebner JL, Connelly MA, Siegler IC, Kraus WE, Bales CW, Porter Starr KN, Huffman KM. Effect of Remotely Supervised Weight Loss and Exercise Training Versus Lifestyle Counseling on Cardiovascular Risk and Clinical Outcomes in Older Adults With Rheumatoid Arthritis: A Randomized Controlled Trial. ACR Open Rheumatol 2024; 6:124-136. [PMID: 38126260 PMCID: PMC10933621 DOI: 10.1002/acr2.11639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE To compare a remotely supervised weight loss and exercise intervention to lifestyle counseling for effects on cardiovascular disease risk, disease activity, and patient-reported outcomes in older patients with rheumatoid arthritis (RA) and overweight/obesity. METHODS Twenty older (60-80 years), previously sedentary participants with seropositive RA and overweight/obesity were randomized to 16 weeks of either Supervised Weight loss and Exercise Training (SWET) or Counseling Health As Treatment (CHAT). The SWET group completed aerobic training (150 minutes/week moderate-to-vigorous intensity), resistance training (two days/week), and a hypocaloric diet (7% weight loss goal). The CHAT control group completed two lifestyle counseling sessions followed by monthly check-ins. The primary outcome was a composite metabolic syndrome z-score (MSSc) derived from fasting glucose, triglycerides, high density lipoprotein-cholesterol, minimal waist circumference, and mean arterial pressure. Secondary outcomes included RA disease activity and patient-reported outcomes. RESULTS Both groups improved MSSc (absolute change -1.67 ± 0.64 in SWET; -1.34 ± 1.30 in CHAT; P < 0.01 for both groups) with no between-group difference. Compared with CHAT, SWET significantly improved body weight, fat mass, Disease Activity Score-28 C-reactive protein, and patient-reported physical health, physical function, mental health, and fatigue (P < 0.04 for all between-group comparisons). Based on canonical correlations for fat mass, cardiorespiratory fitness, and leg strength, component-specific effects were strongest for (1) weight loss improving MSSc, physical health, and mental health; (2) aerobic training improving physical function and fatigue; and (3) resistance training improving Disease Activity Score-28 C-reactive protein. CONCLUSION In older patients with RA and overweight/obesity, 16 weeks of remotely supervised weight loss, aerobic training, and resistance training improve cardiometabolic health, patient-reported outcomes, and disease activity. Less intensive lifestyle counseling similarly improves cardiovascular disease risk profiles, suggesting an important role for integrative interventions in the routine clinical care of this at-risk RA population.
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Affiliation(s)
- Brian J. Andonian
- Duke University School of Medicine, Duke Molecular Physiology InstituteDurhamNorth Carolina
| | - Leanna M. Ross
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | - Alyssa M. Sudnick
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | - Johanna L. Johnson
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | - Carl F. Pieper
- Duke University School of Medicine, Duke Molecular Physiology InstituteDurhamNorth Carolina
| | - Kelsey B. Belski
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | - Julie D. Counts
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | | | | | - William C. Bennett
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | - Jillian C. Gillespie
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | - Kaileigh M. Moertl
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | - Dylan Richard
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | - Janet L. Huebner
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | | | - Ilene C. Siegler
- Duke University School of Medicine, Duke Molecular Physiology InstituteDurhamNorth Carolina
| | - William E. Kraus
- Duke University School of Medicine and Durham VA Medical CenterDurhamNorth Carolina
| | | | | | - Kim M. Huffman
- Duke University School of Medicine, Duke Molecular Physiology InstituteDurhamNorth Carolina
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5
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Aversa Z, White TA, Heeren AA, Hulshizer CA, Saul D, Zhang X, Molina AJA, Redman LM, Martin CK, Racette SB, Huffman KM, Bhapkar M, Khosla S, Das SK, Fielding RA, Atkinson EJ, LeBrasseur NK. Calorie restriction reduces biomarkers of cellular senescence in humans. Aging Cell 2024; 23:e14038. [PMID: 37961856 PMCID: PMC10861196 DOI: 10.1111/acel.14038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023] Open
Abstract
Calorie restriction (CR) with adequate nutrient intake is a potential geroprotective intervention. To advance this concept in humans, we tested the hypothesis that moderate CR in healthy young-to-middle-aged individuals would reduce circulating biomarkers of cellular senescence, a fundamental mechanism of aging and aging-related conditions. Using plasma specimens from the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE™) phase 2 study, we found that CR significantly reduced the concentrations of several senescence biomarkers at 12 and 24 months compared to an ad libitum diet. Using machine learning, changes in biomarker concentrations emerged as important predictors of the change in HOMA-IR and insulin sensitivity index at 12 and 24 months, and the change in resting metabolic rate residual at 12 months. Finally, using adipose tissue RNA-sequencing data from a subset of participants, we observed a significant reduction in a senescence-focused gene set in response to CR at both 12 and 24 months compared to baseline. Our results advance the understanding of the effects of CR in humans and further support a link between cellular senescence and metabolic health.
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Affiliation(s)
- Zaira Aversa
- Robert and Arlene Kogod Center on Aging, Mayo ClinicRochesterMinnesotaUSA
- Department of Physical Medicine and RehabilitationMayo ClinicRochesterMinnesotaUSA
| | - Thomas A. White
- Robert and Arlene Kogod Center on Aging, Mayo ClinicRochesterMinnesotaUSA
| | - Amanda A. Heeren
- Robert and Arlene Kogod Center on Aging, Mayo ClinicRochesterMinnesotaUSA
| | | | - Dominik Saul
- Robert and Arlene Kogod Center on Aging, Mayo ClinicRochesterMinnesotaUSA
- Department of Trauma and Reconstructive SurgeryEberhard Karls University Tübingen, BG Trauma Center TübingenTübingenGermany
| | - Xu Zhang
- Robert and Arlene Kogod Center on Aging, Mayo ClinicRochesterMinnesotaUSA
| | | | | | - Corby K. Martin
- Pennington Biomedical Research CenterBaton RougeLouisianaUSA
| | - Susan B. Racette
- College of Health SolutionsArizona State UniversityPhoenixArizonaUSA
- Program in Physical TherapyWashington University School of MedicineSt. LouisMissouriUSA
| | - Kim M. Huffman
- Duke Clinical Research Institute and Molecular Physiology Institute, School of MedicineDurhamNorth CarolinaUSA
| | - Manjushri Bhapkar
- Duke Clinical Research Institute and Molecular Physiology Institute, School of MedicineDurhamNorth CarolinaUSA
| | - Sundeep Khosla
- Robert and Arlene Kogod Center on Aging, Mayo ClinicRochesterMinnesotaUSA
- Division of EndocrinologyMayo Clinic College of MedicineRochesterMinnesotaUSA
| | - Sai Krupa Das
- Energy Metabolism Team, Jean Mayer USDA Human Nutrition Research Center on AgingTufts UniversityBostonMassachusettsUSA
| | - Roger A. Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on AgingTufts UniversityBostonMassachusettsUSA
| | | | - Nathan K. LeBrasseur
- Robert and Arlene Kogod Center on Aging, Mayo ClinicRochesterMinnesotaUSA
- Department of Physical Medicine and RehabilitationMayo ClinicRochesterMinnesotaUSA
- Paul F. Glenn Center for the Biology of Aging at Mayo ClinicRochesterMinnesotaUSA
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Roy R, Dang UJ, Huffman KM, Alayi T, Hathout Y, Nagaraju K, Visich PS, Hoffman EP. A population-based study of children suggests blunted morning cortisol rhythms are associated with alterations of the systemic inflammatory state. Psychoneuroendocrinology 2024; 159:106411. [PMID: 37820505 DOI: 10.1016/j.psyneuen.2023.106411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/18/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND In children, digital media, lifestyle, and the COVID pandemic have impacted sunlight exposure, exercise, and diet patterns - cues that entrain the circadian clock. We hypothesized that low morning cortisol reflects a weak circadian clock, impacting the pro-inflammatory state. The primary objective was to test relationships between diurnal cortisol fluctuations and the inflammatory state in children as a means of providing indirect support for this hypothesis. METHODS The Cardiovascular Health Intervention Program (CHIP) was a population-based cross-sectional and longitudinal study of circadian health in public elementary school children in Southern Maine, USA (recruitment period 2012-2017). Participants were 689 students in 4th grade (baseline; age=9.2 ± 0.4 years), and 647 students in 5th grade (age=10.5 ± 0.5 years). Nine salivary cortisol measures per child (2 awakening and 1 prior to bed for 3 sequential days) (n = 1336 child phenotype days; n = 7987 cortisol assays), 10 cytokines measured in morning and evening saliva samples (n = 202 child phenotype days), and lipids were measured. Clinical outcomes were blood pressure, weight and height (body mass index [BMI]; BMI = kg/m2), among others. FINDINGS Upon-waking cortisol levels were 0.28 ± 0.13 µg/dL, 30-minute post-waking 0.33 ± 0.15 µg/dL, and evening 0.08 ± 0.10 µg/dL. Salivary cytokine levels (n = 202) showed interleukins (IL) IL-1β and IL-8 were highest in early morning (upon awakening; AM), and IL-6 and tumor necrosis factor (TNF) TNF-α highest before bed (PM) (IL-1β AM > PM [-4.02 fold; p < 0.001]; IL-8 AM > PM [-1.36 fold; p < 0.001]; IL-6 AM < PM [+1.49 fold; p < 0.001]; TNF-α AM < PM [+1.73 fold; p = 0.03]. Regression modeling showed high morning cortisol was associated with high morning IL-1β (p = 3.82 ×10-6), but low evening IL-1β (p = 6.27 ×10-4). Regression modeling of BMI z-score as the response variable showed the expected significant relationships to high density lipoprotein (HDL) (negative; p < 0.001), mean arterial pressure (positive; p < 0.001), and morning cortisol (negative; p = 0.01) but only weak relationships to either evening cortisol (p = 0.1) or cytokine (positive; p = 0.02; from the model with smallest Rsquared) levels. INTERPRETATION We provide preliminary data on diurnal fluctuations of inflammatory cytokines in saliva in a population-based cohort of children. Correlation of morning and evening cortisol levels with inflammatory cytokines in the same saliva samples showed that high morning cortisol was associated with high morning IL-1β and low evening IL-1β. Future studies may test the hypothesis that strong diurnal cycling of IL-1β may serve as a homeostatic mechanism keeping the immune system in check, and that low morning cortisol (possible circadian misalignment) may lead to less stringent control of inflammatory networks.
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Affiliation(s)
- Runia Roy
- Department of Biomedical Engineering, Watson School of Engineering, Binghamton University - SUNY, Binghamton, NY, USA.
| | - Utkarsh J Dang
- Department of Health Outcomes and Administrative Sciences, School of Pharmacy and Pharmaceutical Sciences, Binghamton University - SUNY, Binghamton, NY, USA
| | - Kim M Huffman
- Duke Molecular Physiology Institute, Duke University, Durham, NC, USA
| | - Tchilabalo Alayi
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, Binghamton University - SUNY, Binghamton, NY, USA
| | - Yetrib Hathout
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, Binghamton University - SUNY, Binghamton, NY, USA
| | - Kanneboyina Nagaraju
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, Binghamton University - SUNY, Binghamton, NY, USA
| | - Paul S Visich
- Exercise and Sport Performance Department, University of New England, Biddeford, ME, USA
| | - Eric P Hoffman
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, Binghamton University - SUNY, Binghamton, NY, USA.
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7
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Parker DC, Whitson HE, Smith PJ, Kraus VB, Huebner JL, North R, Kraus WE, Cohen HJ, Huffman KM. Anti-CMV IgG Seropositivity is Associated with Plasma Biomarker Evidence of Amyloid-β Accumulation. J Alzheimers Dis 2024; 98:593-600. [PMID: 38393897 PMCID: PMC10960581 DOI: 10.3233/jad-230220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Background Some human studies have identified infection with cytomegalovirus (CMV), a member of the alpha herpesvirus family, as a risk factor for Alzheimer's disease and related dementias (ADRD). To our knowledge, no studies have evaluated associations of CMV seropositivity with plasma biomarkers of ADRD risk in middle-aged adults. Objective In participants recruited for an exercise study, we evaluated cross-sectional associations of CMV seropositivity with: Aβ42/Aβ40 ratio, a low ratio suggestive of central nervous system Aβ accumulation; glial fibrillary acidic protein (GFAP), a measure of neuroinflammation; and neurofilament light (NfL), a measure of neurodegeneration. Methods Anti-CMV IgG was quantified by ELISA. Plasma ADRD biomarkers were quantified using the ultrasensitive SIMOA assay. We used linear regression to evaluate associations of CMV seropositivity with the ADRD biomarkers, adjusting for age, sex, and race (n = 303; Age = 55.7±9.2 years). For ADRD biomarkers significantly associated with CMV seropositivity, we evaluated continuous associations of anti-CMV IgG levels with the ADRD biomarkers, excluding CMV seronegative participants. Results 53% of participants were CMV seropositive. CMV seropositivity was associated with a lesser Aβ42/Aβ40 ratio (β=-3.02e-03 95% CI [-5.97e-03, -7.18e-05]; p = 0.045). In CMV seropositive participants, greater anti-CMV IgG levels were associated with a lesser Aβ42/Aβ40 ratio (β=-4.85e-05 95% CI[-8.45e-05, -1.25e-05]; p = 0.009). CMV seropositivity was not associated with plasma GFAP or NfL in adjusted analyses. Conclusions CMV seropositivity was associated with a lesser plasma Aβ42/Aβ40 ratio. This association may be direct and causally related to CMV neuro-cytotoxicity or may be indirect and mediated by inflammatory factors resulting from CMV infection burden and/or the immune response.
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Affiliation(s)
- Daniel C. Parker
- Duke University School of Medicine, Division of Geriatrics, Durham, NC, USA
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
| | - Heather E. Whitson
- Duke University School of Medicine, Division of Geriatrics, Durham, NC, USA
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
- Durham VA Geriatrics Research Education and Clinical Center (GRECC), Durham, NC USA
| | - Patrick J. Smith
- University of North Carolina, Chapel Hill, Department of Psychiatry, Chapel Hill, NC, USA
| | - Virginia B. Kraus
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Medicine, Division of Rheumatology and Immunology, Durham, NC, USA
| | - Janet L. Huebner
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca North
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
| | - William E. Kraus
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Medicine, Division of Cardiology, Durham, NC, USA
| | - Harvey Jay Cohen
- Duke University School of Medicine, Division of Geriatrics, Durham, NC, USA
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC, USA
| | - Kim M. Huffman
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Medicine, Division of Rheumatology and Immunology, Durham, NC, USA
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8
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Bennett WC, Collins KA, Johnson JL, Slentz CA, Willis LH, Bales CW, Huffman KM, Kraus WE. Effects of exercise amount and intensity versus a combined exercise and lifestyle intervention on metabolic syndrome in adults with prediabetes: a STRRIDE-PD randomized trial. Front Physiol 2023; 14:1199763. [PMID: 37520827 PMCID: PMC10375017 DOI: 10.3389/fphys.2023.1199763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/16/2023] [Indexed: 08/01/2023] Open
Abstract
The purpose of this secondary analysis was to determine what portion of the effects of a Diabetes Prevention Program-like intervention on metabolic syndrome (MetS) could be achieved with exercise alone, as well as to determine the relative importance of exercise intensity and amount to the total exercise effect on MetS. Sedentary, overweight adults with prediabetes were randomly assigned to one of four 6-month interventions: 1) low-amount/moderate-intensity (10 kcal/kg/week at 50% peak V ˙ O 2 ); 2) high-amount/moderate-intensity (16 kcal/kg/week at 50% peak V ˙ O 2 ); 3) high-amount/vigorous-intensity (16 kcal/kg/week at 75% peak V ˙ O 2 ); or 4) diet (7% weight loss) plus low-amount/moderate-intensity (10 kcal/kg/week at 50% peak V ˙ O 2 ). The primary outcome of this secondary analysis was change in the MetS z-score. A total of 130 participants had complete data for all five Adult Treatment Panel (ATP) III MetS criteria. The diet-and-exercise group statistically outperformed the MetS z-score and the ATP III score compared to the exercise alone group. Aerobic exercise alone achieved 24%-50% of the total effect of the combined diet-and-exercise intervention on the MetS score. Low-amount moderate-intensity exercise quantitatively performed equal to or better than the interventions of high-amount moderate-intensity or high-amount vigorous-intensity exercise in improving the MetS score. The combined diet-and-exercise intervention remains more efficacious in improving the MetS z-score. However, all three exercise interventions alone showed improvements in the MetS z-score, suggesting that a modest amount of moderate-intensity exercise is all that is required to achieve approximately half the effect of a diet-and-exercise intervention on the MetS. Clinical Trial Registration: clinicaltrials.gov, identifier NCT00962962.
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Affiliation(s)
- William C. Bennett
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Katherine A. Collins
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Johanna L. Johnson
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Cris A. Slentz
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Leslie H. Willis
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Connie W. Bales
- Divison of Geriatrics, Department of Medicine, Durham VA Medical Center, Duke University School of Medicine, Durham, NC, United States
| | - Kim M. Huffman
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - William E. Kraus
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
- Division of Cardiology, Duke University School of Medicine, Durham, NC, United States
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9
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Collins KA, Huffman KM, Wolever RQ, Smith PJ, Siegler IC, Ross LM, Jakicic JM, Costa PT, Kraus WE. Race and sex differences in dropout from the STRRIDE trials. Front Sports Act Living 2023; 5:1215704. [PMID: 37492634 PMCID: PMC10364164 DOI: 10.3389/fspor.2023.1215704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Purpose To determine if race and sex differences exist in determinants and timing of dropout among individuals enrolled in an exercise and/or caloric restriction intervention. Methods A total of 947 adults with dyslipidemia (STRRIDE I, STRRIDE AT/RT) or prediabetes (STRRIDE-PD) were randomized to either inactive control or to 1 of 10 exercise interventions, ranging from doses of 8-23 kcal/kg/week, intensities of 50%-75% V ˙ O 2 peak, and durations of 6-8 months. Two groups included resistance training, and one included a dietary intervention (7% weight loss goal). Dropout was defined as an individual withdrawn from the study, with the reasons for dropout aggregated into determinant categories. Timing of dropout was defined as the last session attended and aggregated into phases (i.e., "ramp" period to allow gradual adaptation to exercise prescription). Utilizing descriptive statistics, percentages were generated according to categories of determinants and timing of dropout to describe the proportion of individuals who fell within each category. Results Black men and women were more likely to be lost to follow-up (Black men: 31.3% and Black women: 19.6%), or dropout due to work responsibilities (15.6% and 12.5%), "change of mind" (12.5% and 8.9%), transportation issues (6.3% and 3.6%), or reported lack of motivation (6.3% and 3.6%). Women in general noted lack of time more often than men as a reason for dropout (White women: 22.4% and Black women: 22.1%). Regardless of race and sex, most participants dropped out during the ramp period of the exercise intervention; with Black women (50%) and White men (37.1%) having the highest dropout rate during this period. Conclusion These findings emphasize the importance of targeted retention strategies when aiming to address race and sex differences that exist in determinants and timing of dropout among individuals enrolled in an exercise and/or caloric restriction intervention.
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Affiliation(s)
- Katherine A. Collins
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Kim M. Huffman
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
- Division of Rheumatology, Duke University School of Medicine, Durham, NC, United States
| | - Ruth Q. Wolever
- Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Patrick J. Smith
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Ilene C. Siegler
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Leanna M. Ross
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
- Division of Cardiology, Duke University School of Medicine, Durham, NC, United States
| | - John M. Jakicic
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Paul T. Costa
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, NC, United States
| | - William E. Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
- Division of Cardiology, Duke University School of Medicine, Durham, NC, United States
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10
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Collins KA, Huffman KM, Wolever RQ, Smith PJ, Ross LM, Siegler IC, Jakicic JM, Costa PT, Kraus WE. Demographic, Clinical, and Psychosocial Predictors of Exercise Adherence: The STRRIDE Trials. Transl J Am Coll Sports Med 2023; 8:e000229. [PMID: 37808468 PMCID: PMC10553264 DOI: 10.1249/tjx.0000000000000229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Purpose To identify baseline demographic, clinical, and psychosocial predictors of exercise intervention adherence in the Studies of a Targeted Risk Reduction Intervention through Defined Exercise (STRRIDE) trials. Methods A total of 947 adults with dyslipidemia or prediabetes were enrolled into an inactive control group or one of ten exercise interventions with doses of 10-23 kcal/kg/week, intensities of 40-80% of peak oxygen consumption, and training for 6-8-months. Two groups included resistance training. Mean percent aerobic and resistance adherence were calculated as the amount completed divided by the prescribed weekly minutes or total sets of exercise times 100, respectively. Thirty-eight clinical, demographic, and psychosocial measures were considered for three separate models: 1) clinical + demographic factors, 2) psychosocial factors, and 3) all measures. A backward bootstrapped variable selection algorithm and multiple regressions were performed for each model. Results In the clinical and demographic measures model (n=947), variables explained 16.7% of the variance in adherence (p<0.001); lesser fasting glucose explained the greatest amount of variance (partial R2 = 3.2%). In the psychosocial factors model (n=561), variables explained 19.3% of the variance in adherence (p<0.001); greater 36-Item Short Form Health Survey (SF-36) physical component score explained the greatest amount of variance (partial R2 = 8.7%). In the model with all clinical, demographic, and psychosocial measures (n=561), variables explained 22.1% of the variance (p<0.001); greater SF-36 physical component score explained the greatest amount of variance (partial R2 = 8.9%). SF-36 physical component score was the only variable to account for >5% of the variance in adherence in any of the models. Conclusions Baseline demographic, clinical, and psychosocial variables explain approximately 22% of the variance in exercise adherence. The limited variance explained suggests future research should investigate additional measures to better identify participants who are at risk for poor exercise intervention adherence.
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Affiliation(s)
- Katherine A. Collins
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC
| | - Kim M. Huffman
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC
- Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, NC
| | - Ruth Q. Wolever
- Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville, TN
| | - Patrick J. Smith
- Department of Psychiatry, the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Leanna M. Ross
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC
| | - Ilene C. Siegler
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - John M. Jakicic
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Paul T. Costa
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, NC
| | - William E. Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC
- Division of Cardiology, Duke University School of Medicine, Durham, NC
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11
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Waziry R, Ryan CP, Corcoran DL, Huffman KM, Kobor MS, Kothari M, Graf GH, Kraus VB, Kraus WE, Lin DTS, Pieper CF, Ramaker ME, Bhapkar M, Das SK, Ferrucci L, Hastings WJ, Kebbe M, Parker DC, Racette SB, Shalev I, Schilling B, Belsky DW. Author Correction: Effect of long-term caloric restriction on DNA methylation measures of biological aging in healthy adults from the CALERIE trial. Nat Aging 2023:10.1038/s43587-023-00432-y. [PMID: 37161091 DOI: 10.1038/s43587-023-00432-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- R Waziry
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - C P Ryan
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - D L Corcoran
- Department of Genetics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - K M Huffman
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - M S Kobor
- Department of Medical Genetics, Edwin S.H. Leong Healthy Aging Program, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - M Kothari
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - G H Graf
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - V B Kraus
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - W E Kraus
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - D T S Lin
- Department of Medical Genetics, Edwin S.H. Leong Healthy Aging Program, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - C F Pieper
- Center on Aging and Development, Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - M E Ramaker
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - M Bhapkar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - S K Das
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - L Ferrucci
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - W J Hastings
- Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA
| | - M Kebbe
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - D C Parker
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - S B Racette
- Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - I Shalev
- Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA
| | - B Schilling
- Buck Institute for Research on Aging, Novato, CA, USA
| | - D W Belsky
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA.
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
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12
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Andonian B, Ross LM, Zidek AM, Fos LB, Piner LW, Johnson JL, Belski KB, Counts JD, Pieper CF, Siegler IC, Bales CW, Porter Starr KN, Kraus WE, Huffman KM. Remotely Supervised Weight Loss and Exercise Training to Improve Rheumatoid Arthritis Cardiovascular Risk: Rationale and Design of the Supervised Weight Loss Plus Exercise Training-Rheumatoid Arthritis Trial. ACR Open Rheumatol 2023; 5:252-263. [PMID: 36992545 PMCID: PMC10184018 DOI: 10.1002/acr2.11536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 03/31/2023] Open
Abstract
Patients with rheumatoid arthritis (RA) remain at an increased risk for cardiovascular disease (CVD) and mortality. RA CVD results from a combination of traditional risk factors and RA-related systemic inflammation. One hypothetical means of improving overall RA CVD risk is through reduction of excess body weight and increased physical activity. Together, weight loss and physical activity can improve traditional cardiometabolic health through fat mass loss, while also improving skeletal muscle health. Additionally, disease-related CVD risk may improve as both fat mass loss and exercise reduce systemic inflammation. To explore this hypothesis, 26 older persons with RA and overweight/obesity will be randomized to 16 weeks of a usual care control arm or to a remotely Supervised Weight Loss Plus Exercise Training (SWET) program. A caloric restriction diet (targeting 7% weight loss) will occur via a dietitian-led intervention, with weekly weigh-ins and group support sessions. Exercise training will consist of both aerobic training (150 minutes/week moderate-to-vigorous exercise) and resistance training (twice weekly). The SWET remote program will be delivered via a combination of video conference, the study YouTube channel, and study mobile applications. The primary cardiometabolic outcome is the metabolic syndrome Z score, calculated from blood pressure, waist circumference, high-density lipoprotein cholesterol, triglycerides, and glucose. RA-specific CVD risk will be assessed with measures of systemic inflammation, disease activity, patient-reported outcomes, and immune cell function. The SWET-RA trial will be the first to assess whether a remotely supervised, combined lifestyle intervention improves cardiometabolic health in an at-risk population of older individuals with RA and overweight/obesity.
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Affiliation(s)
| | | | | | - Liezl B. Fos
- Duke University School of MedicineDurhamNorth Carolina
| | - Lucy W. Piner
- Duke University School of MedicineDurhamNorth Carolina
| | | | | | | | | | | | - Connie W. Bales
- Duke University School of Medicine and Geriatric Research, Education, and Clinical Center, Durham VA Medical CenterDurhamNorth Carolina
| | - Kathryn N. Porter Starr
- Duke University School of Medicine and Geriatric Research, Education, and Clinical Center, Durham VA Medical CenterDurhamNorth Carolina
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13
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Waziry R, Ryan CP, Corcoran DL, Huffman KM, Kobor MS, Kothari M, Graf GH, Kraus VB, Kraus WE, Lin DTS, Pieper CF, Ramaker ME, Bhapkar M, Das SK, Ferrucci L, Hastings WJ, Kebbe M, Parker DC, Racette SB, Shalev I, Schilling B, Belsky DW. Effect of long-term caloric restriction on DNA methylation measures of biological aging in healthy adults from the CALERIE trial. Nat Aging 2023; 3:248-257. [PMID: 37118425 PMCID: PMC10148951 DOI: 10.1038/s43587-022-00357-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/22/2022] [Indexed: 04/30/2023]
Abstract
The geroscience hypothesis proposes that therapy to slow or reverse molecular changes that occur with aging can delay or prevent multiple chronic diseases and extend healthy lifespan1-3. Caloric restriction (CR), defined as lessening caloric intake without depriving essential nutrients4, results in changes in molecular processes that have been associated with aging, including DNA methylation (DNAm)5-7, and is established to increase healthy lifespan in multiple species8,9. Here we report the results of a post hoc analysis of the influence of CR on DNAm measures of aging in blood samples from the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) trial, a randomized controlled trial in which n = 220 adults without obesity were randomized to 25% CR or ad libitum control diet for 2 yr (ref. 10). We found that CALERIE intervention slowed the pace of aging, as measured by the DunedinPACE DNAm algorithm, but did not lead to significant changes in biological age estimates measured by various DNAm clocks including PhenoAge and GrimAge. Treatment effect sizes were small. Nevertheless, modest slowing of the pace of aging can have profound effects on population health11-13. The finding that CR modified DunedinPACE in a randomized controlled trial supports the geroscience hypothesis, building on evidence from small and uncontrolled studies14-16 and contrasting with reports that biological aging may not be modifiable17. Ultimately, a conclusive test of the geroscience hypothesis will require trials with long-term follow-up to establish effects of intervention on primary healthy-aging endpoints, including incidence of chronic disease and mortality18-20.
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Affiliation(s)
- R Waziry
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - C P Ryan
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - D L Corcoran
- Department of Genetics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - K M Huffman
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - M S Kobor
- Department of Medical Genetics, Edwin S.H. Leong Healthy Aging Program, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - M Kothari
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
| | - G H Graf
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - V B Kraus
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - W E Kraus
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - D T S Lin
- Department of Medical Genetics, Edwin S.H. Leong Healthy Aging Program, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - C F Pieper
- Center on Aging and Development, Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - M E Ramaker
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - M Bhapkar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - S K Das
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - L Ferrucci
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - W J Hastings
- Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA
| | - M Kebbe
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - D C Parker
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - S B Racette
- Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - I Shalev
- Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA
| | - B Schilling
- Buck Institute for Research on Aging, Novato, CA, USA
| | - D W Belsky
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, NY, USA.
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
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14
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Ross LM, Zidek AM, Kraus WE, Bales CW, Porter Starr KN, Andonian BJ, Huffman KM. Abstract P442: An Innovative, Remotely Delivered Weight Loss and Exercise Intervention to Improve Rheumatoid Arthritis Cardiovascular Risk. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Introduction:
Despite improvements in pharmacologic management of rheumatoid arthritis (RA), patients with RA continue to have an increased risk for CVD - the leading cause of death in this population. RA CVD results from a combination of traditional risk factors - such as hypertension, dyslipidemia, physical inactivity, and obesity - and RA-related systemic inflammation. Although weight loss and physical activity are promising means for improving both traditional and inflammatory risk factors, evidence is lacking for lifestyle interventions targeting these health behaviors in RA.
Hypothesis:
In the SWET-RA trial, we hypothesized that, as compared to standard of care, a 16-week remotely delivered weight loss and exercise intervention would improve CVD risk factors in older persons with RA and obesity.
Methods:
Twenty-four patients (age 60-80 years; BMI 28-40 kg/m
2
) were randomized to one of two groups: 1) supervised weight loss and exercise training (SWET); or 2) counseling health as treatment (CHAT). The SWET intervention - delivered via video conference, the study YouTube channel, and mobile applications - consists of a) dietitian-led caloric restriction diet (7% weight loss goal) with weekly weigh-ins and group support sessions; and b) exercise physiologist-led aerobic (150 min moderate-to-vigorous exercise) and resistance training (twice weekly). CHAT provides initial clinical counseling on healthy diets and physical activity followed by monthly check-ins. Outcomes include body mass; body composition via Air Displacement Plethysmography; peak oxygen consumption [VO
2
(mL/kg/min)] via maximal cardiopulmonary exercise testing; and mean arterial blood pressure (MAP). Within-groups, paired t-tests assessed whether post- minus pre-intervention change scores (mean ± standard deviation) were significant (p<0.05).
Results:
To date, 13 patients (61.5% White; 84.6% female) have completed the study; 8 additional patients are expected to complete the study by February 2023. Following the intervention, the CHAT group (n=5) had mean changes in body mass, fat mass, and lean mass of -2.4 ± 4.0%, -3.3 ± 4.3 kg, and 1.0 ± 1.0 kg (all p>0.05). Those randomized to SWET (n=8) had significant improvements in body mass (-5.0 ± 2.9%; p=0.002) and fat mass (-4.3 ± 2.8 kg; p=0.004), and no change in lean mass (0.4 ± 1.2 kg; p=0.36). The CHAT group had a 1.1 ± 6.7% change in peak VO
2
(p=0.81), while the SWET group exhibited a 10.6 ± 16.7% change (p=0.13). There were minimal changes in MAP for both groups (CHAT: -1.0 ± 1.0 mmHg; SWET: -0.4 ± 1.2 mmHg).
Conclusions:
Preliminary findings indicate that, as compared to CHAT, the SWET intervention elicits beneficial changes in body mass, fat mass, and cardiorespiratory fitness. As the SWET-RA trial is pioneering a remotely delivered program, results from this study will help guide lifestyle intervention implementation to improve CVD risk in larger groups of patients with RA.
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15
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Collins KA, Huffman KM, Wolever RQ, Smith PJ, Siegler IC, Ross LM, Jakicic JM, Costa PT, Kraus WE. Abstract P358: Racial Differences in Determinants and Timing of Dropout From an Exercise Intervention: The STRRIDE Trials. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Introduction:
Most adults recognize the positive health benefits of being physically active and maintaining a healthy weight, yet inactivity and obesity rates continue to rise. This disconnect is even more pronounced among racial and ethnic minorities across the United States, with Black/African American women being the highest risk group for inactivity an obesity. To begin to close this growing racial disparity gap, racial differences in exercise intervention dropout must be assessed.
Hypothesis:
We hypothesized that compared to their White counterpart, Black participants would dropout earlier and more often due to environmental factors.
Methods:
A total of 947 adults with dyslipidemia (STRRIDE I, STRRIDE AT/RT) or prediabetes (STRRIDE-PD) were randomized to either inactive control or to 1 of 10 exercise interventions, ranging from doses of 8 to 23 kcal/kg/wk, intensities of 50% to 75%VO
2
peak, and durations of 6 to 8 months. Two groups included resistance training, and one included dietary intervention (7% weight loss goal). Dropout was defined as an individual who withdrew from the study. Timing of intervention dropout was defined as the last session attended and categorized into phases. Chi-square or
t
-tests assessed differences in baseline characteristics by race.
Results:
Black versus White participants were on average younger (50.7 ± 7.7 vs. 56.0 ± 8.9 years; p<0.01), however they had similar fitness levels (24.5 ± 6.0 vs. 24.7 ± 5.5 ml/kg/min; p=0.83) and body mass indexes (31.6 ± 3.1 vs. 30.8 ± 3.1 kg/m
2
; p=0.07). Black participants were particularly more likely to dropout during the ramp period (43.1% vs. 35.4%) of the exercise intervention compared to their White counterparts. Black participants were more likely to dropout because they lacked time (43.2% vs. 38.7%), work responsibilities (26.3 % vs. 14.3%), were lost to follow-up (23.9% vs. 14.6%), had transportation issues (4.6% vs 0.0%), changed their mind (10.2% vs. 8.5%), or lack of motivation (10.5% vs. 1.3%).
Conclusions:
Understanding racial differences among determinants and timing of exercise intervention dropout provides key insights for future interventions aiming to optimize exercise adoption and adherence. These insights will in turn improve cardiometabolic risk among this understudied minority group.
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Affiliation(s)
| | | | | | - Patrick J Smith
- Univ of North Carolina at Chapel Hill Sch of Medicine, Chapel Hill, NC
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Collins KA, Kraus WE, Rogers RJ, Hauser ER, Lang W, Jiang R, Schelbert EB, Huffman KM, Jakicic JM. Effect of behavioral weight-loss program on biomarkers of cardiometabolic disease risk: Heart Health Study randomized trial. Obesity (Silver Spring) 2023; 31:338-349. [PMID: 36621902 PMCID: PMC9877129 DOI: 10.1002/oby.23618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/11/2022] [Accepted: 09/27/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This study aimed to determine whether novel biomarkers of cardiometabolic health improve in response to a 12-month behavioral weight-loss intervention and to compare benefits of diet alone with diet plus physical activity for these biomarkers. METHODS Participants (N = 374) were randomized to either diet alone (DIET), diet plus 150 min/wk of prescribed moderate-intensity physical activity (DIET + PA150), or diet plus 250 min/wk of prescribed moderate-intensity physical activity (DIET + PA250). Biomarker concentrations were determined using nuclear magnetic resonance spectroscopy. Mixed models assessed for a time effect, group effect, or group by time interaction. RESULTS All groups significantly improved body weight (time: p < 0.0001), Lipoprotein Insulin Resistance Index score (time: p < 0.0001), Diabetes Risk Index score (time: p < 0.0001), branched-chain amino acid concentration (time: p < 0.0001), and GlycA concentration (time: p < 0.0001), with no group effect or group by time interactions. CONCLUSIONS All intervention groups prompted a notable beneficial change among biomarkers of insulin resistance and cardiometabolic health. However, the addition of at least moderate-intensity physical activity to a diet-only intervention did not provide any additional benefit. These findings highlight that an average weight loss of approximately 10% profoundly impacts biomarkers of insulin resistance and cardiometabolic disease in adults with overweight or obesity.
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Affiliation(s)
- Katherine A. Collins
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - William E. Kraus
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Elizabeth R. Hauser
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina USA
| | - Wei Lang
- Center on Aging and Mobility, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rong Jiang
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Erik B. Schelbert
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Minneapolis Heart Institute East, Saint Paul, Minnesota, USA
| | - Kim M. Huffman
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, North Carolina, USA
| | - John M. Jakicic
- University of Kansas Medical Center, Department of Internal Medicine, Division of Physical Activity and Weight Management, Kansas City, Kansas, USA
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17
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Parker DC, Kraus WE, Whitson HE, Kraus VB, Smith PJ, Cohen HJ, Pieper CF, Faldowski RA, Hall KS, Huebner JL, Ilkayeva OR, Bain JR, Newby LK, Huffman KM. Tryptophan Metabolism and Neurodegeneration: Longitudinal Associations of Kynurenine Pathway Metabolites with Cognitive Performance and Plasma Alzheimer's Disease and Related Dementias Biomarkers in the Duke Physical Performance Across the LifeSpan Study. J Alzheimers Dis 2023; 91:1141-1150. [PMID: 36565121 PMCID: PMC10074831 DOI: 10.3233/jad-220906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The kynurenine pathway (KP) comprises a family of tryptophan-derived metabolites that some studies have reported are associated with poorer cognitive performance and an increased risk of Alzheimer's disease and related dementias (ADRD). OBJECTIVE The objective of this study was to determine the associations of plasma KP metabolites (kynurenine [KYN], kynurenic acid [KA], and tryptophan [TRP]) with a panel of plasma ADRD biomarkers (Aβ42/ β40 ratio, pTau-181, glial fibrillary acidic protein [GFAP], and neurofilament light [NfL]) and cognitive performance in a subset of older adults drawn from the Duke Physical Performance Across the LifeSpan (PALS) study. METHODS The Montreal Cognitive Assessment (MoCA) was used to assess cognitive performance. We used multivariate multiple regression to evaluate associations of the KYN/TRP and KA/KYN ratios with MoCA score and plasma ADRD biomarkers at baseline and over two years (n = 301; Age = 74.8±8.7). RESULTS Over two years, an increasing KYN/TRP ratio was associated with increasing plasma concentrations of plasma p-Tau181 (β= 6.151; 95% CI [0.29, 12.01]; p = 0.040), GFAP (β= 11.12; 95% CI [1.73, 20.51]; p = 0.020), and NfL (β= 11.13; 95% CI [2.745, 19.52]; p = 0.009), but not MoCA score or the Aβ42/Aβ40 ratio. There were no significant associations of KA/KYN with MoCA score or plasma ADRD biomarkers. CONCLUSION Our findings provide evidence that greater concentrations of KP metabolites are associated longitudinally over two years with greater biomarker evidence of neurofibrillary tau pathology (pTau-181), neuroinflammation (GFAP), and neurodegeneration (NfL), suggesting that dysregulated KP metabolism may play a role in ADRD pathogenesis.
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Affiliation(s)
- Daniel C Parker
- Duke University School of Medicine, Division of Geriatrics, Durham, NC, USA
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
| | - William E Kraus
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
- Duke University School of Medicine, Division of Cardiology, Durham, NC, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC, USA
| | - Heather E Whitson
- Duke University School of Medicine, Division of Geriatrics, Durham, NC, USA
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
| | - Virginia B Kraus
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Medicine, Division of Rheumatology and Immunology, Durham, NC, USA
| | - Patrick J Smith
- Department of Psychiatry, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Harvey Jay Cohen
- Duke University School of Medicine, Division of Geriatrics, Durham, NC, USA
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC, USA
| | - Carl F Pieper
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Richard A Faldowski
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Katherine S Hall
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC, USA
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Durham, NC, USA
| | - Janet L Huebner
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC, USA
| | - Olga R Ilkayeva
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Durham, NC, USA
| | - James R Bain
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC, USA
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Durham, NC, USA
| | - L Kristin Newby
- Duke University School of Medicine, Division of Cardiology, Durham, NC, USA
- Duke University Clinical and Translational Science Institute, Durham, NC, USA
| | - Kim M Huffman
- Duke University Center for the Study of Aging and Human Development, Durham, NC, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Medicine, Division of Rheumatology and Immunology, Durham, NC, USA
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18
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Ramaker ME, Corcoran DL, Apsley AT, Kobor MS, Kraus VB, Kraus WE, Lin DTS, Orenduff MC, Pieper CF, Waziry R, Huffman KM, Belsky DW. Epigenome-wide Association Study Analysis of Calorie Restriction in Humans, CALERIETM Trial Analysis. J Gerontol A Biol Sci Med Sci 2022; 77:2395-2401. [PMID: 35965483 PMCID: PMC9799188 DOI: 10.1093/gerona/glac168] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Indexed: 01/20/2023] Open
Abstract
Calorie restriction (CR) increases healthy life span and is accompanied by slowing or reversal of aging-associated DNA methylation (DNAm) changes in animal models. In the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIETM) human trial, we evaluated associations of CR and changes in whole-blood DNAm. CALERIETM randomized 220 healthy, nonobese adults in a 2:1 allocation to 2 years of CR or ad libitum (AL) diet. The average CR in the treatment group through 24 months of follow-up was 12%. Whole blood (baseline, 12, and 24 months) DNAm profiles were measured. Epigenome-wide association study (EWAS) analysis tested CR-induced changes from baseline to 12 and 24 months in the n = 197 participants with available DNAm data. CR treatment was not associated with epigenome-wide significant (false discovery rate [FDR] < 0.05) DNAm changes at the individual-CpG-site level. Secondary analysis of sets of CpG sites identified in published EWAS revealed that CR induced DNAm changes opposite to those associated with higher body mass index and cigarette smoking (p < .003 at 12- and 24-month follow-ups). In contrast, CR altered DNAm at chronological-age-associated CpG sites in the direction of older age (p < .003 at 12- and 24-month follow-ups). Although individual CpG site DNAm changes in response to CR were not identified, analyses of sets CpGs identified in prior EWAS revealed CR-induced changes to blood DNAm. Altered CpG sets were enriched for insulin production, glucose tolerance, inflammation, and DNA-binding and DNA-regulation pathways, several of which are known to be modified by CR. DNAm changes may contribute to CR effects on aging.
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Affiliation(s)
- Megan E Ramaker
- Duke University Molecular Physiology Institute, Durham, North Carolina, USA
| | - David L Corcoran
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Abner T Apsley
- Behavioral Health Department, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Biobehavioral Health, Molecular, Cellular, and Integrative Biosciences Program, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Michael S Kobor
- BC Children’s Hopsital Research Institute (BCCHR), Vancouver, British Columbia, Canada
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
- Program in Child and Brain Development, CIFA, MaRS Centre, Vancouver, British Columbia, Canada
- The Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Virginia B Kraus
- Duke University Molecular Physiology Institute, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - William E Kraus
- Duke University Molecular Physiology Institute, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - David T S Lin
- BC Children’s Hopsital Research Institute (BCCHR), Vancouver, British Columbia, Canada
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melissa C Orenduff
- Duke University Molecular Physiology Institute, Durham, North Carolina, USA
| | - Carl F Pieper
- Center for Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Reem Waziry
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Kim M Huffman
- Duke University Molecular Physiology Institute, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel W Belsky
- Butler Columbia Aging Center, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
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19
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Collins KA, Ross LM, Slentz CA, Huffman KM, Kraus WE. Differential Effects of Amount, Intensity, and Mode of Exercise Training on Insulin Sensitivity and Glucose Homeostasis: A Narrative Review. Sports Med - Open 2022; 8:90. [PMID: 35834023 PMCID: PMC9283590 DOI: 10.1186/s40798-022-00480-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 06/18/2022] [Indexed: 11/29/2022]
Abstract
As type 2 diabetes remains a leading cause of morbidity and mortality, identifying the most appropriate preventive treatment early in the development of disease is an important public health matter. In general, lifestyle interventions incorporating exercise and weight loss via caloric restriction improve cardiometabolic risk by impacting several key markers of insulin sensitivity and glucose homeostasis. However, variations in the effects of specific types of exercise interventions on these markers have led to conflicting results surrounding the optimal amount, intensity, and mode of exercise for optimal effects. Moreover, the addition of weight loss via caloric restriction to exercise interventions appears to differentially impact changes in body composition, metabolism, and insulin sensitivity compared to exercise alone. Determining the optimal amount, intensity, and mode of exercise having the most beneficial impact on glycemic status is both: (1) clinically important to provide guidelines for appropriate exercise prescription; and (2) physiologically important to understand the pathways by which exercise—with and without weight loss—impacts glycemic status to enhance precision lifestyle medicine. Thus, the purposes of this narrative review are to: (1) summarize findings from the three Studies of a Targeted Risk Reduction Intervention through Defined Exercise (STRRIDE) randomized trials regarding the differential effects of exercise amount, intensity, and mode on insulin action and glucose homeostasis markers; and (2) compare the STRRIDE findings to other published dose–response exercise trials in order to piece together the various physiologic pathways by which specific exercise interventions—with or without weight loss—impact glycemic status.
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20
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Parker DC, Kraus WE, Huffman KM, Morey MC, Hall KS, Cohen HJ. Association of plasma inflammatory and metabolic biomarkers with plasma ADRD biomarkers in community‐dwelling older adults. Alzheimers Dement 2022. [DOI: 10.1002/alz.065521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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21
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Ross LM, Collins KA, AbouAssi HN, Bales CW, Huffman KM, Kraus WE. Effects Of Exercise Training With And Without Weight Loss On Oral Disposition Index In STRRIDE-PD. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000877500.07186.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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22
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Collins KA, Willis LH, Belski KB, Reaves MA, Huffman KM, Kraus WE. Evaluating Variation In Weight Change To An Exercise Intervention: The Strride Trials. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000879500.26969.ec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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23
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Andonian BJ, Fos L, Bennett W, Reaves M, Belski K, Huffman KM, Kraus WE. Forearm Muscle Oxidative Capacity And Biomechanical Property Testing As Clinical Tools For Rheumatoid Arthritis. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000882644.40650.8e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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24
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Orenduff MC, Coleman MF, Glenny EM, Huffman KM, Rezeli ET, Bareja A, Pieper CF, Kraus VB, Hursting SD. Differential effects of calorie restriction and rapamycin on age-related molecular and functional changes in skeletal muscle. Exp Gerontol 2022; 165:111841. [PMID: 35623538 PMCID: PMC9982835 DOI: 10.1016/j.exger.2022.111841] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/26/2022] [Accepted: 05/20/2022] [Indexed: 11/21/2022]
Abstract
Aging is a multifactorial process associated with progressive degradation of physiological integrity and function. One of the greatest factors contributing to the deleterious effects of aging is the decline of functional ability due to loss of muscle mass, strength, and function, a condition termed sarcopenia. Calorie restriction (CR) has consistently been shown to extend lifespan and delay the onset and progression of various age-related diseases, including sarcopenia. Additional anti-aging interventions that are receiving scientific attention are CR mimetics. Of these pharmacological compounds, rapamycin has shown similar CR-related longevity benefits without the need for diet restrictions. To investigate the potential role of rapamycin as an anti-sarcopenic alternative to CR, we conducted a study in male and female C57BL/6 J mice to assess the effects of rapamycin on age-related gene expression changes in skeletal muscle associated with loss of muscle mass, strength, and function, relative to control. We hypothesize that the effects of rapamycin will closely align with CR with respect to physical function and molecular indices associated with muscle quality. Our results indicate CR and rapamycin provide partial protection against age-related decline in muscle, while engaging uniquely different molecular pathways in skeletal muscle. Our preclinical findings of the therapeutic potential of rapamycin or a CR regimen on geroprotective benefits in muscle should be extended to translational studies towards the development of effective strategies for the prevention and management of sarcopenia.
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Affiliation(s)
- Melissa C Orenduff
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA; Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA.
| | - Michael F Coleman
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
| | - Elaine M Glenny
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
| | - Kim M Huffman
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA; Division of Rheumatology, Duke University School of Medicine, Durham, NC, USA
| | - Erika T Rezeli
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
| | - Akshay Bareja
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Virginia B Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA; Division of Rheumatology, Duke University School of Medicine, Durham, NC, USA
| | - Stephen D Hursting
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; University of North Carolina Nutrition Research Institute in Kannapolis, NC, USA
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25
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Andonian BJ, Koss A, Koves TR, Hauser ER, Hubal MJ, Pober DM, Lord JM, MacIver NJ, St Clair EW, Muoio DM, Kraus WE, Bartlett DB, Huffman KM. Rheumatoid arthritis T cell and muscle oxidative metabolism associate with exercise-induced changes in cardiorespiratory fitness. Sci Rep 2022; 12:7450. [PMID: 35523821 PMCID: PMC9076829 DOI: 10.1038/s41598-022-11458-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/18/2022] [Indexed: 11/09/2022] Open
Abstract
Rheumatoid arthritis (RA) T cells drive autoimmune features via metabolic reprogramming that reduces oxidative metabolism. Exercise training improves cardiorespiratory fitness (i.e., systemic oxidative metabolism) and thus may impact RA T cell oxidative metabolic function. In this pilot study of RA participants, we took advantage of heterogeneous responses to a high-intensity interval training (HIIT) exercise program to identify relationships between improvements in cardiorespiratory fitness with changes in peripheral T cell and skeletal muscle oxidative metabolism. In 12 previously sedentary persons with seropositive RA, maximal cardiopulmonary exercise tests, fasting blood, and vastus lateralis biopsies were obtained before and after 10 weeks of HIIT. Following HIIT, improvements in RA cardiorespiratory fitness were associated with changes in RA CD4 + T cell basal and maximal respiration and skeletal muscle carnitine acetyltransferase (CrAT) enzyme activity. Further, changes in CD4 + T cell respiration were associated with changes in naïve CD4 + CCR7 + CD45RA + T cells, muscle CrAT, and muscle medium-chain acylcarnitines and fat oxidation gene expression profiles. In summary, modulation of cardiorespiratory fitness and molecular markers of skeletal muscle oxidative metabolism during exercise training paralleled changes in T cell metabolism. Exercise training that improves RA cardiorespiratory fitness may therefore be valuable in managing pathologically related immune and muscle dysfunction.Trial registration: ClinicalTrials.gov, NCT02528344. Registered on 19 August 2015.
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Affiliation(s)
- Brian J Andonian
- Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, NC, 27701, USA.
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, 22701, USA.
| | - Alec Koss
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, 22701, USA
| | - Timothy R Koves
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, 22701, USA
| | - Elizabeth R Hauser
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, 22701, USA
| | - Monica J Hubal
- Department of Kinesiology, Indiana University-Purdue University Indianapolis School of Health & Human Sciences, Indianapolis, IN, 46202, USA
| | | | - Janet M Lord
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, UK
| | - Nancie J MacIver
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, 27514, USA
| | - E William St Clair
- Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, NC, 27701, USA
| | - Deborah M Muoio
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, 22701, USA
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, 22701, USA
| | - David B Bartlett
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, 22701, USA
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Kim M Huffman
- Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, NC, 27701, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, 22701, USA
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26
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Kaufman BG, Allen KD, Coffman CJ, Woolson S, Caves K, Hall K, Hoenig HM, Huffman KM, Morey MC, Hodges NJ, Ramasunder S, van Houtven CH. Cost and Quality of Life Outcomes of the STepped Exercise Program for Patients With Knee OsteoArthritis Trial. Value Health 2022; 25:614-621. [PMID: 35365305 DOI: 10.1016/j.jval.2021.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/31/2021] [Accepted: 09/30/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to evaluate the cost-effectiveness of the randomized clinical trial STEP-KOA (STepped Exercise Program for patients with Knee OsteoArthritis). METHODS The trial included 230 intervention and 115 control participants from 2 Veterans Affairs (VA) medical centers. A decision tree simulated outcomes for cohorts of patients receiving arthritis education (control) or STEP-KOA (intervention), which consisted of an internet-based exercise training program (step 1), phone counseling (step 2), and physical therapy (step 3) according to patient's response. Intervention costs were assessed from the VA perspective. Quality of life (QOL) was measured using 5-level EQ-5D US utility weights. Incremental cost-effectiveness ratios (ICERs) were calculated as the difference in costs divided by the difference in quality-adjusted life-years (QALYs) between arms at 9 months. A Monte Carlo probabilistic sensitivity analysis was used to generate a cost-effectiveness acceptability curve. RESULTS The adjusted model found differential improvement in QOL utility weights of 0.042 (95% confidence interval 0.003-0.080; P=.03) for STEP-KOA versus control at 9 months. In the base case, STEP-KOA resulted in an incremental gain of 0.028 QALYs and an incremental cost of $279 per patient for an ICER of $10 076. One-way sensitivity analyses found the largest sources of variation in the ICER were the impact on QOL and the need for a VA-owned tablet. The probabilistic sensitivity analysis found a 98% probability of cost-effectiveness at $50 000 willingness-to-pay per QALY. CONCLUSIONS STEP-KOA improves QOL and has a high probability of cost-effectiveness. Resources needed to implement the program will decline as ownership of mobile health devices increases.
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Affiliation(s)
- Brystana G Kaufman
- Duke University, Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA.
| | - Kelli D Allen
- Durham VA Medical Center, Durham, NC, USA; University of North Carolina, Chapel Hill, NC
| | - Cynthia J Coffman
- Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | | | - Kevin Caves
- Durham VA Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
| | - Katherine Hall
- Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
| | - Helen M Hoenig
- Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
| | - Kim M Huffman
- Duke University, Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
| | - Miriam C Morey
- Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
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Oliver CE, Patel H, Hong J, Carter J, Kraus WE, Huffman KM, Truskey GA. Tissue engineered skeletal muscle model of rheumatoid arthritis using human primary skeletal muscle cells. J Tissue Eng Regen Med 2022; 16:128-139. [PMID: 34781416 PMCID: PMC9487182 DOI: 10.1002/term.3266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/15/2021] [Accepted: 11/05/2021] [Indexed: 02/03/2023]
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease primarily targeting the joints. Autoreactive immune cells involved in RA affect other tissues, including skeletal muscle. Patients with RA experience diminished physical function, limited mobility, reduced muscle function, chronic pain, and increased mortality. To explore the impact of RA on skeletal muscle, we engineered electrically responsive, contractile human skeletal muscle constructs (myobundles) using primary skeletal muscle cells isolated from the vastus lateralis muscle of 11 RA patients (aged 57-74) and 10 aged healthy donors (aged 55-76), as well as from the hamstring muscle of six young healthy donors (less than 18 years of age) as a benchmark. Since all patients were receiving treatment for the disease, RA disease activity was mild. In 2D culture, RA myoblast purity, growth rate, and senescence were not statistically different than aged controls; however, RA myoblast purity showed greater variance compared to controls. Surprisingly, in 3D culture, contractile force production by RA myobundles was greater compared to aged controls. In support of this finding, assessment of RA myofiber maturation showed increased area of sarcomeric α-actinin (SAA) expression over time compared to aged controls. Furthermore, a linear regression test indicated a positive correlation between SAA protein levels and tetanus force production in RA and controls. Our findings suggest that medications prescribed to RA patients may maintain-or even enhance-muscle function, and this effect is retained and observed in in vitro culture. Future studies regarding the effects of RA therapeutics on RA skeletal muscle, in vivo and in vitro, are warranted.
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Affiliation(s)
| | - Hailee Patel
- Department of Biomedical Engineering, Duke University
| | - James Hong
- Department of Biomedical Engineering, Duke University
| | | | | | - Kim M. Huffman
- Department of Medicine, Duke University School of Medicine
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Collins KA, Huffman KM, Wolever RQ, Smith PJ, Siegler IC, Ross LM, Hauser ER, Jiang R, Jakicic JM, Costa PT, Kraus WE. Determinants of Dropout from and Variation in Adherence to an Exercise Intervention: The STRRIDE Randomized Trials. Transl J Am Coll Sports Med 2022; 7:e000190. [PMID: 35669034 PMCID: PMC9165469 DOI: 10.1249/tjx.0000000000000190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose This study aimed to characterize the timing and self-reported determinants of exercise dropout among sedentary adults with overweight or obesity. We also sought to explore variations in adherence among individuals who completed a 6- to 8-month structured exercise intervention. Methods A total of 947 adults with dyslipidemia [STRRIDE I, STRRIDE AT/RT] or prediabetes [STRRIDE-PD] were enrolled to either control or to one of 10 exercise interventions, ranging from doses of 8-23 kcal/kg/week; intensities of 50%-75% V̇O2 peak; and durations of 6-8 months. Two groups included resistance training and one included dietary intervention (7% weight loss goal). Dropout was defined as an individual who withdrew from the study due a variety of determinants. Timing of intervention dropout was defined as the last session attended and categorized into phases. Exercise training adherence was calculated by dividing weekly minutes or total sets of exercise completed by weekly minutes or total sets of exercise prescribed. General linear models were used to characterize the associations between timing of dropout and determinant category. Results Compared to exercise intervention completers (n=652), participants who dropped out (n=295) were on average non-white (98% vs. 80%, p<0.01), had higher body mass index (31.0 kg/m2 vs. 30.2 kg/m2; p<0.01), and were less fit at baseline (25.0 mg/kg/min vs. 26.7 ml/kg/min, p<0.01). Of those who dropped out, 67% did so prior to the start of or while ramping up to the prescribed exercise volume and intensity. The most commonly reported reason for dropout was lack of time (40%). Notably, among individuals who completed the ramp training period, subsequent exercise intervention adherence did not waiver over the ensuing 6-8 months of training. Conclusion These findings are some of the first to delineate associations between the timing of dropout and dropout determinants, providing guidance to future exercise interventions to better support individuals at-risk for dropout.
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Affiliation(s)
- Katherine A. Collins
- Duke University Medical Center, Duke Molecular Physiology Institute, Durham, NC, United States
| | - Kim M. Huffman
- Duke University Medical Center, Duke Molecular Physiology Institute, Durham, NC, United States
- Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, NC, United States
| | - Ruth Q. Wolever
- Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Ilene C. Siegler
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Leanna M. Ross
- Duke University Medical Center, Duke Molecular Physiology Institute, Durham, NC, United States
| | - Elizabeth R. Hauser
- Duke University Medical Center, Duke Molecular Physiology Institute, Durham, NC, United States
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, United States
| | - Rong Jiang
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - John M. Jakicic
- Translational Research Institute, Advent Health, Orlando, FL, United States
| | - Paul T. Costa
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - William E. Kraus
- Duke University Medical Center, Duke Molecular Physiology Institute, Durham, NC, United States
- Division of Cardiology, Duke University School of Medicine, Durham, NC, United States
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Smith ID, Ross LM, Gabaldon JR, Holdgate N, Pieper CF, Ning TC, Kraus WE, Huffman KM. The Relation of Accelerometer-Measured Physical Activity and Serum Uric Acid Using the National Health and Nutrition Survey (NHANES) 2003–2004. Front Sports Act Living 2022; 3:775398. [PMID: 35098119 PMCID: PMC8789886 DOI: 10.3389/fspor.2021.775398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Gout is a crystal-induced inflammatory arthritis caused by elevated uric acid. Physical activity has the potential to reduce serum uric acid (SUA), thus improving the disease burden of gout. In this study, we examined the association of objectively-measured physical activity and SUA. Methods: A cross-sectional study was conducted using survey, laboratory, and accelerometer data from the 2003–2004 National Health and Nutrition Examination Survey (NHANES). SUA concentrations (mg/dL) were obtained during an initial exam, and then physical activity (kCal/day) was measured with 7 days of ActiGraph accelerometry in participants (n = 3,475) representative of the ambulatory, non-institutionalized US civilian population. Regression, including restricted cubic splines, was used to assess the relation of physical activity and SUA in bivariate and adjusted models. Covariates included age, gender, race/ethnicity, alcohol use, body mass index, renal function, and urate-lowering therapy. Results: In the bivariate model, physical activity was correlated with SUA concentrations and included a non-linear component (p < 0.01). In the adjusted model, linear splines were employed with a node at the SUA nadir of 5.37mg/dL; this occurred at 703 kCal/day of physical activity. The association of physical activity and SUA was negative from 0 to 703 kCal/day (p = 0.07) and positive >703 kCal/day (p < 0.01 for the change in slope). Conclusion: Physical activity and SUA are associated in a non-linear fashion, with a minimum estimated SUA at 703 kCal/day of objectively-measured physical activity. These findings raise intriguing questions about the use of physical activity as a potential adjunctive therapy in patients with gout, and further interventional studies are needed to elucidate the effects of moderate intensity exercise on SUA concentrations.
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Affiliation(s)
- Isaac D. Smith
- Department of Medicine, Duke University School of Medicine, Duke University Hospital, Durham, NC, United States
- Division of Rheumatology and Immunology, Duke University School of Medicine, Duke University Hospital, Durham, NC, United States
- *Correspondence: Isaac D. Smith ; orcid.org/0000-0003-3313-4825
| | - Leanna M. Ross
- Department of Medicine, Duke University School of Medicine, Duke University Hospital, Durham, NC, United States
- Duke Molecular Physiology Institute, Duke University, Durham, NC, United States
| | - Josi R. Gabaldon
- Duke Molecular Physiology Institute, Duke University, Durham, NC, United States
- Oncology and Hematology Business Unit, Syneos Health Global Headquarters, Morrisville, NC, United States
| | | | - Carl F. Pieper
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States
| | - Tony C. Ning
- Triangle Orthopedic Associates, Durham, NC, United States
| | - William E. Kraus
- Department of Medicine, Duke University School of Medicine, Duke University Hospital, Durham, NC, United States
- Duke Molecular Physiology Institute, Duke University, Durham, NC, United States
- Division of Cardiology, Duke University School of Medicine, Durham, NC, United States
| | - Kim M. Huffman
- Department of Medicine, Duke University School of Medicine, Duke University Hospital, Durham, NC, United States
- Division of Rheumatology and Immunology, Duke University School of Medicine, Duke University Hospital, Durham, NC, United States
- Duke Molecular Physiology Institute, Duke University, Durham, NC, United States
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Somers TJ, Blumenthal JA, Dorfman CS, Huffman KM, Edmond SN, Miller SN, Wren AA, Caldwell D, Keefe FJ. Effects of a Weight and Pain Management Program in Patients With Rheumatoid Arthritis With Obesity: A Randomized Controlled Pilot Investigation. J Clin Rheumatol 2022; 28:7-13. [PMID: 34670994 DOI: 10.1097/rhu.0000000000001793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obesity is associated with poor outcomes for patients with rheumatoid arthritis (RA). Effective weight management is imperative. Although traditional lifestyle behavioral weight loss programs have demonstrated efficacy for reducing weight, these interventions do not meet the pain-related weight loss challenges of RA patients with obesity. OBJECTIVE A 12-session group program (90 minutes per session) was developed integrating pain coping skills training into a lifestyle behavioral weight loss intervention. In addition to the weekly group sessions, participants engaged in supervised exercise sessions 3 times per week. METHODS Through a small, pilot randomized trial, 50 participants were randomized to receive the intervention (n = 29) or standard care of RA (n = 21). Feasibility data (i.e., accrual, attrition, adherence) was examined using descriptive statistics (e.g., percent). We examined patterns of change in study outcomes from baseline to follow-up separately for the intervention and standard care arms using descriptive statistics and paired t tests. Effect sizes are also presented. RESULTS Of those randomized to the intervention group,79.3% initiated treatment, with participants attending 74.3% of group skills sessions and 64.2% of exercise sessions. Intervention participants evidenced reductions in weight (mean, -2.28 kg) and waist circumference (mean, -4.76 cm) and improvements in physical functioning, eating behaviors, pain, and self-efficacy for weight control. CONCLUSIONS Findings suggest that incorporating a combined pain coping skills training and behavioral weight loss intervention into medical management of RA may improve outcomes. Study accrual and attrition, as well as intervention adherence, will inform future, larger randomized efficacy trials of the intervention.Retrospectively registered: January 29, 2020, NCT04246827.
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Affiliation(s)
| | | | | | - Kim M Huffman
- Medicine, Duke University Medical Center, Durham, NC
| | | | | | - Anava A Wren
- Department of Pediatrics, Stanford Medical Center, Stanford, CA
| | - David Caldwell
- Division of Rheumatology, Duke University Medical Center, Durham, NC
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Huffman KM, Parker DC, Bhapkar M, Racette SB, Martin CK, Redman LM, Das SK, Connelly MA, Pieper CF, Orenduff M, Ross LM, Ramaker ME, Dorling JL, Rosen CJ, Shalaurova I, Otvos JD, Kraus VB, Kraus WE. Calorie restriction improves lipid-related emerging cardiometabolic risk factors in healthy adults without obesity: Distinct influences of BMI and sex from CALERIE™ a multicentre, phase 2, randomised controlled trial. EClinicalMedicine 2022; 43:101261. [PMID: 35028547 PMCID: PMC8741476 DOI: 10.1016/j.eclinm.2021.101261] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/06/2021] [Accepted: 12/17/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND For many cardiovascular risk factors there is no lower limit to which further reduction will result in decreased disease risk; this includes values within ranges considered normal for healthy adults. This seems to be true for new emerging metabolic risk factors identified by innovative technological advances. Further, there seems to be ever evolving evidence of differential responses to lifestyle interventions by sex and body compositions in the normal range. In this secondary analysis, we had the opportunity to test these principles for newly identified molecular biomarkers of cardiometabolic risk in a young (21-50 years), normal weight healthy population undergoing calorie restriction for two years. METHODS The Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE™) was a 24-month, multicenter, randomized controlled trial (May 2007-November 2012) in healthy, adults without obesity to evaluate the potential for calorie restriction (CR) to promote anti-aging adaptations, including those associated with disease risk. 218 participants (age 37.9 ± 7.2 years and body mass index (BMI) 25.1 ± 1.7 kg/m2, mean±SD) were randomized 2:1 to 24 months of CR (prescribed as 25% reduction from baseline calorie intake) versus ad libitum (AL). Fasting plasma from baseline, 12, and 24 months was used for assessments of lipoproteins, metabolites, and inflammatory markers using nuclear magnetic resonance spectroscopy. FINDINGS Averaging 11.9% CR, the CR group had reductions at 12 and 24 months in the cardiovascular disease risk markers, apolipoprotein B and GlycA, and risks for insulin resistance and type 2 diabetes-Lipoprotein Insulin Resistance Index and Diabetes Risk Index (all PCRvsAL ≤0.0009). Insulin resistance and diabetes risk improvements resulted from CR-induced alterations in lipoproteins, specifically reductions in triglyceride-rich lipoprotein particles and low-density lipoprotein particles, a shift to larger high-density lipoprotein particles (more effective cholesterol transporters), and reductions in branched chain amino acids (BCAAs) (all PCRvsAL ≤0.004). These CR responses were more pronounced in overweight than normal weight participants and greater in men than women. INTERPRETATION In normal to slightly overweight adults without overt risk factors or disease, 12 months of ∼12% CR improved newly identified risk markers for atherosclerotic cardiovascular disease, insulin resistance and type 2 diabetes. These markers suggest that CR improves risks by reducing inflammation and BCAAs and shifting lipoproteins from atherogenic to cholesterol transporting. Additionally, these improvements are greater for men and for those with greater BMIs indicating sex and BMI-influences merit attention in future investigations of lifestyle-mediated improvements in disease risk factors. FUNDING The CALERIE™ trial design and implementation were supported by a National Institutes of Health (NIH) U-grant provided to four institutions, the three intervention sites and a coordinating center (U01 AG022132, U01 AG020478, U01 AG020487 U01 AG020480). For this secondary analysis including sample acquisition and processing, data analysis and interpretation, additional funding was provided by the NIH to authors as follows: R01 AG054840 (MO, VBK); R33 AG070455 (KMH, DCP, MB, SBR, CKM, LMR, SKD, CFP, CJR, WEK); P30 DK072476 (CKM, LMR); and U54 GM104940 (CKM, LMR).
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Affiliation(s)
- Kim M. Huffman
- Divisions of Rheumatology and Immunology, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Corresponding author.
| | - Daniel C. Parker
- Geriatrics, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Manjushri Bhapkar
- Duke Clinical Research Institute, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Susan B. Racette
- Program in Physical Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Sai Krupa Das
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | | | - Carl F. Pieper
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Melissa Orenduff
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Leanna M. Ross
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Megan E. Ramaker
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - James L. Dorling
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Clifford J Rosen
- Maine Medical Center Research Institute 81 Research Drive Scarborough, Maine 04074 USA
| | - Irina Shalaurova
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, NC, USA
| | - James D. Otvos
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, NC, USA
| | - Virginia B. Kraus
- Divisions of Rheumatology and Immunology, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - William E. Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
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Collins KA, Ross LM, Piner LW, Fos LB, Slentz CA, Bateman LA, Willis LH, Bales CW, Siegler IC, Wolever RQ, Huffman KM, Kraus WE. Amount and intensity effects of exercise training alone versus a combined diet and exercise lifestyle intervention on health-related quality of life in the STRRIDE-PD randomized trial. BMJ Open Diabetes Res Care 2022; 10:10/1/e002584. [PMID: 35086944 PMCID: PMC8796224 DOI: 10.1136/bmjdrc-2021-002584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/23/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION To determine the relative contributions of various amounts and intensities of exercise alone to a combined lifestyle intervention on health-related quality of life (HrQoL) measures. RESEARCH DESIGN AND METHODS Participants (n=162) were sedentary, overweight/obese, with pre-diabetes, and randomized to one of four 6-month interventions: (1) high amount/moderate intensity exercise-energy expenditure of 16 kcal/kg of body weight/week (KKW) at 50% oxygen consumption (V̇O2) reserve; (2) high/vigorous-16 KKW at 75% V̇O2 reserve; (3) low/moderate-10 KKW at 50% V̇O2 reserve; (4) low/moderate plus diet-10 KKW at 50% V̇O2 reserve plus a calorically restricted diet. The 36-Item Short-Form Survey (SF-36) and Satisfaction with Physical Function and Appearance (SPF/SPA) survey were assessed at baseline and post-intervention. Analyses of covariance determined differences in change scores among groups (p<0.05). Paired t-tests determined significant pre-intervention versus post-intervention scores within groups (p<0.05). RESULTS Across the intervention, all groups (p<0.05) improved the physical component, SPF, and SPA scores. Only the low/moderate/diet group (p<0.001) significantly improved the mental component score. The high/vigorous group achieved 84.5% of the low/moderate/diet group effect for change in physical component score, and the low/moderate group achieved 83.7% of the low/moderate/diet group effect for change in mental component score. CONCLUSIONS In general, a low amount of moderate intensity exercise combined with diet was the most effective intervention for improving HrQoL. Of the exercise-only interventions, vigorous intensity exercise provided the greatest impact on changes in physical function. On the other hand, low amounts of moderate intensity exercise provided the greatest impact on mental well-being, potentially being a more attainable exercise dose for previously sedentary individuals with pre-diabetes to achieve.
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Affiliation(s)
- Katherine A Collins
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Leanna M Ross
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lucy W Piner
- Emeritis, Duke University School of Medicine, Durham, North Carolina, USA
| | - Liezl B Fos
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cris A Slentz
- Emeritis, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lori A Bateman
- Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Leslie H Willis
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Connie W Bales
- Department of Geriatrics, Duke University School of Medicine, Durham, North Carolina, USA
- Geriatric Research Education and Clinical Center, Durham VA Medical Center, Durham, North Carolina, USA
| | - Ilene C Siegler
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ruth Q Wolever
- Department of Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Kim M Huffman
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Rheumatology/Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Cardiology/Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Gumus Balikcioglu P, Ramaker ME, Mason KA, Huffman KM, Johnson JL, Ilkayeva O, Muehlbauer MJ, Freemark M, Kraus WE. Branched-Chain Amino Acid Catabolism and Cardiopulmonary Function Following Acute Maximal Exercise Testing in Adolescents. Front Cardiovasc Med 2021; 8:721354. [PMID: 34485418 PMCID: PMC8416443 DOI: 10.3389/fcvm.2021.721354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To provide energy for cardiopulmonary function and maintenance of blood glucose, acute aerobic exercise induces lipolysis, fatty acid oxidation (FAO), glycolysis, and glycogenolysis/gluconeogenesis. These adaptations are mediated by increases in cortisol, growth hormone (GH), and catecholamines and facilitated by a decline in insulin. Branched-chain amino acids (BCAA) also undergo catabolism during intense exercise. Here, we investigated the relationship between BCAA catabolism and metrics of cardiopulmonary function in healthy, well-developed, mature adolescent athletes undergoing an acute bout of maximal aerobic exercise. Hypothesis: We hypothesized: (a) acute maximal exercise in adolescents induces lipolysis, FAO, and BCAA catabolism associated with increases in GH and cortisol and a reduction in insulin; (b) increases in GH are associated with increases in ghrelin; and (c) metrics of cardiopulmonary function (aVO2, rVO2, aVO2/HRmax) following maximal exercise correlate with increases in GH secretion, FAO, and BCAA catabolism. Methods: Blood samples before and after maximal cardiopulmonary exercise in 11 adolescent athletes were analyzed by tandem-mass spectrometry. Paired, two-tailed student's t-tests identified significant changes following exercise. Linear regression determined if pre-exercise metabolite levels, or changes in metabolite levels, were associated with aVO2, rVO2, and aVO2/HRmax. Sex and school of origin were included as covariates in all regression analyses. Results: Following exercise there were increases in GH and cortisol, and decreases in ghrelin, but no changes in glucose or insulin concentrations. Suggesting increased lipolysis and FAO, the levels of glycerol, ketones, β-hydroxybutyrate, and acetylcarnitine concentrations increased. Pyruvate, lactate, alanine, and glutamate concentrations also increased. Plasma concentrations of valine (a BCAA) declined (p = 0.002) while valine degradation byproducts increased in association with decreases in urea cycle amino acids arginine and ornithine. Metrics of cardiopulmonary function were associated with increases in propionylcarnitine (C3, p = 0.013) and Ci4-DC/C4-DC (p < 0.01), byproducts of BCAA catabolism. Conclusions: Induction of lipolysis, FAO, gluconeogenesis, and glycogenolysis provides critical substrates for cardiopulmonary function during exercise. However, none of those pathways were significantly associated with metrics of cardiopulmonary function. The associations between rVO2, and aVO2/HRmax and C3 and Ci4-DC/C4-DC suggest that the cardiopulmonary response to maximal exercise in adolescents is linked to BCAA utilization and catabolism.
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Affiliation(s)
- Pinar Gumus Balikcioglu
- Division of Pediatric Endocrinology and Diabetes, Duke University School of Medicine, Durham, NC, United States.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Megan E Ramaker
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Kelly A Mason
- Division of Pediatric Endocrinology and Diabetes, Duke University School of Medicine, Durham, NC, United States
| | - Kim M Huffman
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Johanna L Johnson
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Olga Ilkayeva
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States.,Division of Endocrinology, Metabolism, and Nutrition, Duke University School of Medicine, Durham, NC, United States
| | - Michael J Muehlbauer
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Michael Freemark
- Division of Pediatric Endocrinology and Diabetes, Duke University School of Medicine, Durham, NC, United States.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States.,Division of Adult Cardiology, Duke University School of Medicine, Durham, NC, United States
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Andonian BJ, Johannemann A, Hubal MJ, Pober DM, Koss A, Kraus WE, Bartlett DB, Huffman KM. Altered skeletal muscle metabolic pathways, age, systemic inflammation, and low cardiorespiratory fitness associate with improvements in disease activity following high-intensity interval training in persons with rheumatoid arthritis. Arthritis Res Ther 2021; 23:187. [PMID: 34246305 PMCID: PMC8272378 DOI: 10.1186/s13075-021-02570-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/29/2021] [Indexed: 01/16/2023] Open
Abstract
Background Exercise training, including high-intensity interval training (HIIT), improves rheumatoid arthritis (RA) inflammatory disease activity via unclear mechanisms. Because exercise requires skeletal muscle, skeletal muscle molecular pathways may contribute. The purpose of this study was to identify connections between skeletal muscle molecular pathways, RA disease activity, and RA disease activity improvements following HIIT. Methods RA disease activity assessments and vastus lateralis skeletal muscle biopsies were performed in two separate cohorts of persons with established, seropositive, and/or erosive RA. Body composition and objective physical activity assessments were also performed in both the cross-sectional cohort and the longitudinal group before and after 10 weeks of HIIT. Baseline clinical assessments and muscle RNA gene expression were correlated with RA disease activity score in 28 joints (DAS-28) and DAS-28 improvements following HIIT. Skeletal muscle gene expression changes with HIIT were evaluated using analysis of covariance and biological pathway analysis. Results RA inflammatory disease activity was associated with greater amounts of intramuscular adiposity and less vigorous aerobic exercise (both p < 0.05). HIIT-induced disease activity improvements were greatest in those with an older age, elevated erythrocyte sedimentation rate, low cardiorespiratory fitness, and a skeletal muscle molecular profile indicative of altered metabolic pathways (p < 0.05 for all). Specifically, disease activity improvements were linked to baseline expression of RA skeletal muscle genes with cellular functions to (1) increase amino acid catabolism and interconversion (GLDC, BCKDHB, AASS, PYCR, RPL15), (2) increase glycolytic lactate production (AGL, PDK2, LDHB, HIF1A), and (3) reduce oxidative metabolism via altered beta-oxidation (PXMP2, ACSS2), TCA cycle flux (OGDH, SUCLA2, MDH1B), and electron transport chain complex I function (NDUFV3). The muscle mitochondrial glycine cleavage system (GCS) was identified as critically involved in RA disease activity improvements given upregulation of multiple GCS genes at baseline, while GLDC was significantly downregulated following HIIT. Conclusion In the absence of physical activity, RA inflammatory disease activity is associated with transcriptional remodeling of skeletal muscle metabolism. Following exercise training, the greatest improvements in disease activity occur in older, more inflamed, and less fit persons with RA. These exercise training-induced immunomodulatory changes may occur via reprogramming muscle bioenergetic and amino acid/protein homeostatic pathways. Trial registration ClinicalTrials.gov, NCT02528344. Registered on 19 August 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02570-3.
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Affiliation(s)
- Brian J Andonian
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA. .,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA.
| | - Andrew Johannemann
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Monica J Hubal
- Department of Kinesiology, Indiana University-Purdue University Indianapolis School of Health & Human Sciences, Indianapolis, IN, USA
| | | | - Alec Koss
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - David B Bartlett
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Kim M Huffman
- Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
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van Vliet S, Bain JR, Muehlbauer MJ, Provenza FD, Kronberg SL, Pieper CF, Huffman KM. A metabolomics comparison of plant-based meat and grass-fed meat indicates large nutritional differences despite comparable Nutrition Facts panels. Sci Rep 2021; 11:13828. [PMID: 34226581 PMCID: PMC8257669 DOI: 10.1038/s41598-021-93100-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/14/2021] [Indexed: 02/08/2023] Open
Abstract
A new generation of plant-based meat alternatives-formulated to mimic the taste and nutritional composition of red meat-have attracted considerable consumer interest, research attention, and media coverage. This has raised questions of whether plant-based meat alternatives represent proper nutritional replacements to animal meat. The goal of our study was to use untargeted metabolomics to provide an in-depth comparison of the metabolite profiles a popular plant-based meat alternative (n = 18) and grass-fed ground beef (n = 18) matched for serving size (113 g) and fat content (14 g). Despite apparent similarities based on Nutrition Facts panels, our metabolomics analysis found that metabolite abundances between the plant-based meat alternative and grass-fed ground beef differed by 90% (171 out of 190 profiled metabolites; false discovery rate adjusted p < 0.05). Several metabolites were found either exclusively (22 metabolites) or in greater quantities in beef (51 metabolites) (all, p < 0.05). Nutrients such as docosahexaenoic acid (ω-3), niacinamide (vitamin B3), glucosamine, hydroxyproline and the anti-oxidants allantoin, anserine, cysteamine, spermine, and squalene were amongst those only found in beef. Several other metabolites were found exclusively (31 metabolites) or in greater quantities (67 metabolites) in the plant-based meat alternative (all, p < 0.05). Ascorbate (vitamin C), phytosterols, and several phenolic anti-oxidants such as loganin, sulfurol, syringic acid, tyrosol, and vanillic acid were amongst those only found in the plant-based meat alternative. Large differences in metabolites within various nutrient classes (e.g., amino acids, dipeptides, vitamins, phenols, tocopherols, and fatty acids) with physiological, anti-inflammatory, and/or immunomodulatory roles indicate that these products should not be viewed as truly nutritionally interchangeable, but could be viewed as complementary in terms of provided nutrients. The new information we provide is important for making informed decisions by consumers and health professionals. It cannot be determined from our data if either source is healthier to consume.
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Affiliation(s)
- Stephan van Vliet
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA.
| | - James R Bain
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA
| | - Michael J Muehlbauer
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Scott L Kronberg
- Northern Great Plains Research Laboratory, USDA-Agricultural Research Service, Mandan, ND, USA
| | - Carl F Pieper
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA
| | - Kim M Huffman
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA
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Dvergsten JA, Reed AM, Landerman L, Pisetsky DS, Ilkayeva O, Huffman KM. Metabolomics Analysis Identifies a Lipidomic Profile in Treatment Naïve Juvenile Dermatomyositis Patients versus Healthy Control Subjects. Rheumatology (Oxford) 2021; 61:1699-1708. [PMID: 34185053 PMCID: PMC8996785 DOI: 10.1093/rheumatology/keab520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/16/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives To perform an exploratory study to identify a JDM serum metabolic profile that differs from healthy controls (HCs) and responds to immunosuppressive treatment. Methods Blood was collected from 9 HCs and 10 patients diagnosed with probable (n = 4) or definite (n = 6) JDM based on the criteria of Bohan and Peter for myositis, with 7 of the 10 providing longitudinal samples following initiation of treatment; these patients comprised the treatment-naïve cohort. Sera underwent mass spectroscopy–based measurements of targeted metabolic intermediates, including 15 amino acids, 45 acylcarnitines (ACs), 15 ceramides and 29 sphingomyelins. Principal components analysis reduced metabolites into smaller sets of factors each comprised of correlated metabolic intermediates. Factor scores and metabolite concentrations were compared with HCs using two-sample t-tests while treatment effects were evaluated using paired t-tests. Results Of eight principal components analysis–derived metabolite factors (one AC, two amino acids, three sphingosine and two ceramide), two were significantly associated with JDM: one AC factor containing mostly long-chain ACs (P = 0.049) and one ceramide factor (P < 0.01). For 12 individual ACs, mostly long chain, and three ceramides, concentrations were significantly greater for JDM than HCs. Factors based on these individual metabolites showed decreasing scores with treatment (P = 0.03 and P < 0.01, respectively). Conclusion While additional validation is needed, these lipids have potential as JDM serum diagnostic and/or treatment biomarkers. Additionally, the significant association of long-chain ACs and ceramides with JDM offers insights regarding pathogenesis, implicating dysregulation of mitochondrial fatty acid β-oxidation.
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Affiliation(s)
- Jeffrey A Dvergsten
- Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, NC, USA
| | - Ann M Reed
- Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, NC, USA
| | - Lawrence Landerman
- Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, NC, USA
| | - David S Pisetsky
- Department of Medicine and Immunology, Duke University Medical Center and Research Service, Durham VA Medical Center, Durham, NC, USA
| | - Olga Ilkayeva
- Department of Medicine, Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Kim M Huffman
- Department of Medicine, Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
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Schwartz AR, Bartlett DB, Johnson JL, Broadwater G, Channell M, Nolte KC, Wilkes PA, Huffman KM, Secord AA. A Pilot Study of Home-Based Exercise and Personalized Nutrition Counseling Intervention in Endometrial Cancer Survivors. Front Oncol 2021; 11:669961. [PMID: 34178654 PMCID: PMC8232933 DOI: 10.3389/fonc.2021.669961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/24/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction To assess the feasibility of a home-based aerobic exercise and nutrition counseling intervention and effect on cardiorespiratory fitness, cardiovascular disease risk profile, and immune response in obese endometrial cancer survivors. Methods A longitudinal pilot study assessed a 12-week home-based aerobic exercise and nutrition counseling intervention in obese endometrial cancer survivors. The primary outcome was feasibility defined as 80% adherence to weekly walking sessions calculated among individuals that completed the intervention. Secondary outcomes comprised pre- and post-intervention differences in cardiorespiratory fitness, cardiovascular risk factors, and T-cell function. Descriptive statistics summarized data. Wilcoxon sign tests identified differences between and pre and post-intervention variables. Results Nineteen women with stage 1 endometrial cancer consented; 9 withdrew and one was a screen failure. Median adherence to weekly walking sessions was 83.3%. Body composition was significantly altered with a reduction in median fat mass from 52.5 kg to 46.9 kg (p=0.04), and BMI from 37.5 kg/m2 to 36.2 kg/m2 (p = 0.004). There was no significant difference in cardiorespiratory fitness or cardiovascular parameters. The percentage of CD4+ and CD8+ T-cells producing IFNγ towards MAGE-A4 significantly increased from and 5.9% to 7.2% (p=0.043) and 13.9% to 14.8% (p=0.046), respectively. There were 3 related adverse events: hip pain, back sprain, and abdominal pain. Discussion Our home-based exercise and nutrition counseling program was feasible based on 80% adherence to walking sessions and favored altered body composition. However, the discontinuation rate was high and further research is needed to overcome barriers to implementation. Improvement in cardiovascular parameters will most likely require longer and more intensive programs.
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Affiliation(s)
- Amanda R Schwartz
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, NC, United States
| | - David B Bartlett
- Department of Medicine, Division of Medical Oncology, Duke University Hospital, Durham, NC, United States
| | - Johanna L Johnson
- Duke Molecular Physiology Institute, Duke Center for Living, Duke University, Durham, NC, United States
| | - Gloria Broadwater
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Meghan Channell
- Department of Clinical Research, Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Kimberly C Nolte
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke Cancer Institute, Duke University Health System, Durham, NC, United States
| | - Patricia A Wilkes
- Department of Nutrition Services, Duke University Hospital, Durham, NC, United States
| | - Kim M Huffman
- Duke Molecular Physiology Institute, Duke Center for Living, Duke University, Durham, NC, United States.,Department of Medicine, Division of Rheumatology, Duke University Hospital, Durham, NC, United States
| | - Angeles Alvarez Secord
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke Cancer Institute, Duke University Health System, Durham, NC, United States
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Dorling JL, van Vliet S, Huffman KM, Kraus WE, Bhapkar M, Pieper CF, Stewart T, Das SK, Racette SB, Roberts SB, Ravussin E, Redman LM, Martin CK. Effects of caloric restriction on human physiological, psychological, and behavioral outcomes: highlights from CALERIE phase 2. Nutr Rev 2021; 79:98-113. [PMID: 32940695 DOI: 10.1093/nutrit/nuaa085] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/01/2020] [Indexed: 02/04/2023] Open
Abstract
Caloric restriction (CR) is a strategy that attenuates aging in multiple nonhuman species. The Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) trials are part of a research program aiming to test the effects of CR on aging and longevity biomarkers in humans. Building on CALERIE phase 1, CALERIE phase 2 (CALERIE 2) was the largest study to date to assess sustained CR in healthy humans without obesity. In a 24-month randomized controlled trial comprising 218 participants at baseline, CALERIE 2 showed that moderate CR, 11.9% on average, induced improvements in aging-related biomarkers without adversely affecting psychological or behavioral outcomes. The objectives of this report are to summarize and review the highlights of CALERIE 2 and report previously unpublished results on eating disorder symptoms and cognitive function. This article specifically summarizes the physiological, psychological, aging, behavioral, and safety results of the trial. Also provided are research directions beyond CALERIE 2 that highlight important opportunities to investigate the role of CR in aging, longevity, and health span in humans.
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Affiliation(s)
- James L Dorling
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | - Kim M Huffman
- Duke University School of Medicine, Durham, North Carolina, USA
| | - William E Kraus
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Carl F Pieper
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Tiffany Stewart
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Sai Krupa Das
- US Department of Agriculture, Jean Mayer Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA
| | - Susan B Racette
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Susan B Roberts
- US Department of Agriculture, Jean Mayer Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Leanne M Redman
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Allen KD, Woolson S, Hoenig HM, Bongiorni D, Byrd J, Caves K, Hall KS, Heiderscheit B, Hodges NJ, Huffman KM, Morey MC, Ramasunder S, Severson H, Van Houtven C, Abbate LM, Coffman CJ. Stepped Exercise Program for Patients With Knee Osteoarthritis : A Randomized Controlled Trial. Ann Intern Med 2021; 174:298-307. [PMID: 33370174 PMCID: PMC10405203 DOI: 10.7326/m20-4447] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Evidence-based models are needed to deliver exercise-related services for knee osteoarthritis efficiently and according to patient needs. OBJECTIVE To examine a stepped exercise program for patients with knee osteoarthritis (STEP-KOA). DESIGN Randomized controlled trial. (ClinicalTrials.gov: NCT02653768). SETTING 2 U.S. Department of Veterans Affairs sites. PARTICIPANTS 345 patients (mean age, 60 years; 15% female; 67% people of color) with symptomatic knee osteoarthritis. INTERVENTION Participants were randomly assigned in a 2:1 ratio to STEP-KOA or an arthritis education (AE) control group, respectively. The STEP-KOA intervention began with 3 months of an internet-based exercise program (step 1). Participants who did not meet response criteria for improvement in pain and function after step 1 progressed to step 2, which involved 3 months of biweekly physical activity coaching calls. Participants who did not meet response criteria after step 2 went on to in-person physical therapy visits (step 3). The AE group received educational materials via mail every 2 weeks. MEASUREMENTS Primary outcome was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Scores for the STEP-KOA and AE groups at 9 months were compared by using linear mixed models. RESULTS In the STEP-KOA group, 65% of participants (150 of 230) progressed to step 2 and 35% (81 of 230) to step 3. The estimated baseline WOMAC score for the full sample was 47.5 (95% CI, 45.7 to 49.2). At 9-month follow-up, the estimated mean WOMAC score was 6.8 points (CI, -10.5 to -3.2 points) lower in the STEP-KOA than the AE group, indicating greater improvement. LIMITATION Participants were mostly male veterans, and follow-up was limited. CONCLUSION Veterans in STEP-KOA reported modest improvements in knee osteoarthritis symptoms compared with the control group. The STEP-KOA strategy may be efficient for delivering exercise therapies for knee osteoarthritis. PRIMARY FUNDING SOURCE Department of Veterans Affairs, Health Services Research and Development Service.
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Affiliation(s)
- Kelli D Allen
- Durham VA Health Care System, Durham, and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (K.D.A.)
| | - Sandra Woolson
- Durham VA Health Care System, Durham, North Carolina (S.W., D.B., N.J.H.)
| | - Helen M Hoenig
- Durham VA Health Care System and Duke University, Durham, North Carolina (H.M.H., K.S.H., K.M.H., M.C.M., S.R.)
| | - Dennis Bongiorni
- Durham VA Health Care System, Durham, North Carolina (S.W., D.B., N.J.H.)
| | - James Byrd
- Greenville VA Health Care Center, Greenville, North Carolina (J.B.)
| | - Kevin Caves
- Duke University, Durham, North Carolina (K.C.)
| | - Katherine S Hall
- Durham VA Health Care System and Duke University, Durham, North Carolina (H.M.H., K.S.H., K.M.H., M.C.M., S.R.)
| | | | - Nancy Jo Hodges
- Durham VA Health Care System, Durham, North Carolina (S.W., D.B., N.J.H.)
| | - Kim M Huffman
- Durham VA Health Care System and Duke University, Durham, North Carolina (H.M.H., K.S.H., K.M.H., M.C.M., S.R.)
| | - Miriam C Morey
- Durham VA Health Care System and Duke University, Durham, North Carolina (H.M.H., K.S.H., K.M.H., M.C.M., S.R.)
| | - Shalini Ramasunder
- Durham VA Health Care System and Duke University, Durham, North Carolina (H.M.H., K.S.H., K.M.H., M.C.M., S.R.)
| | | | - Courtney Van Houtven
- Durham VA Health Care System and Duke University School of Medicine, Durham, North Carolina (C.V.)
| | - Lauren M Abbate
- VA Eastern Colorado Health Care System and University of Colorado School of Medicine, Aurora, Colorado (L.M.A.)
| | - Cynthia J Coffman
- Durham VA Health Care System and Duke University Medical Center, Durham, North Carolina (C.J.C.)
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Ross LM, Slentz CA, Zidek AM, Huffman KM, Shalaurova I, Otvos JD, Connelly MA, Kraus VB, Bales CW, Houmard JA, Kraus WE. Effects of Amount, Intensity, and Mode of Exercise Training on Insulin Resistance and Type 2 Diabetes Risk in the STRRIDE Randomized Trials. Front Physiol 2021; 12:626142. [PMID: 33613319 PMCID: PMC7892901 DOI: 10.3389/fphys.2021.626142] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/14/2021] [Indexed: 12/19/2022] Open
Abstract
Background Lipoprotein Insulin Resistance Index (LP-IR) and Diabetes Risk Index are novel spectroscopic multimarkers of insulin resistance and type 2 diabetes risk. As the Studies of a Targeted Risk Reduction Intervention through Defined Exercise (STRRIDE) randomized trials have previously demonstrated the ability of exercise training to improve traditional markers of insulin action, the aim of this study was to examine the effects of exercise amount, intensity, and mode on LP-IR and the Diabetes Risk Index. Methods A total of 503 adults with dyslipidemia [STRRIDE I (n = 194), STRRIDE AT/RT (n = 139)] or prediabetes [STRRIDE-PD (n = 170)] were randomized to control or one of 10 exercise interventions, ranging from doses of 8–23 kcal/kg/week; intensities of 50–75% V̇O2peak; and durations of 6–8 months. Two groups included resistance training and one included dietary intervention (7% weight loss goal). Fasting plasma samples were obtained at baseline and 16–24 h after the final exercise bout. LP-IR, the Diabetes Risk Index, and concentrations of the branched chain amino acids valine and leucine were determined using nuclear magnetic resonance spectroscopy. LP-IR and the Diabetes Risk Index scores range from 0–100 and 1–100, respectively (greater scores indicate greater risk). Paired t-tests determined significance within groups (p < 0.05). Results After training, six exercise groups significantly improved LP-IR (ranging from −4.4 ± 8.2 to −12.4 ± 14.1), and four exercise groups significantly improved the Diabetes Risk Index (ranging from −2.8 ± 8.2 to −8.3 ± 10.4). The most beneficial interventions for both LP-IR and the Diabetes Risk Index were low amount/moderate intensity aerobic, aerobic plus resistance, and aerobic plus diet. Summary Multiple exercise interventions improved LP-IR and the Diabetes Risk Index. In those with dyslipidemia, adding resistance to aerobic training elicited a synergistic effect on insulin resistance and type 2 diabetes risk. In individuals with prediabetes, combining a dietary intervention and weight loss with aerobic training resulted in the most robust type 2 diabetes risk improvement.
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Affiliation(s)
- Leanna M Ross
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Cris A Slentz
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Alyssa M Zidek
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Kim M Huffman
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Irina Shalaurova
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC, United States
| | - James D Otvos
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC, United States
| | - Margery A Connelly
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC, United States
| | - Virginia B Kraus
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Connie W Bales
- Center for the Study of Aging, Department of Medicine, Duke University School of Medicine, Durham, NC, United States.,Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC, United States
| | - Joseph A Houmard
- Department of Kinesiology, East Carolina University, Greenville, NC, United States
| | - William E Kraus
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
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Coffman CJ, Arbeeva L, Schwartz TA, Callahan LF, Golightly YM, Goode AP, Huffman KM, Allen KD. Application of Heterogeneity of Treatment Effect Methods: Exploratory Analyses of a Trial of Exercise-Based Interventions for Knee OA. Arthritis Care Res (Hoboken) 2021; 74:1359-1368. [PMID: 33463020 PMCID: PMC8286274 DOI: 10.1002/acr.24564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/02/2020] [Accepted: 01/14/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate heterogeneity of treatment effects (HTE) in a trial of exercise-based interventions for knee osteoarthritis (OA). METHODS Participants (n=350) were randomized to standard physical therapy (PT; n=140), Internet-Based Exercise Training (IBET; n=142), or wait list control (WL; n=68). We applied QUalitative INteraction Trees (QUINT), a sequential partitioning method, and Generalized Unbiased Interaction Detection and Estimation (GUIDE), a regression tree approach, to identify subgroups with greater improvements in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score over 4-months. Predictors included 24 demographic, clinical and psychosocial characteristics. We conducted internal validation to estimate optimism (bias) in the range of mean outcome differences among arms. RESULTS Both QUINT and GUIDE indicated that for participants with lower body mass index (BMI), IBET was better than PT (improvements of WOMAC ranged from 6.3 to 9.1 points lower) and for those with higher BMI and longer duration of knee OA, PT was better than IBET (WOMAC improvement was 6.3 points). In GUIDE analyses comparing PT or IBET to WL, participants not employed had improvements in WOMAC ranging from 1.8 to 6.8 points lower with PT or IBT vs. WL. From internal validation, there were large corrections to the mean outcome differences among arms; however, after correction some differences remained in the clinically meaningful range. CONCLUSION Results suggest there may be subgroups who experience greater improvement in symptoms from PT or IBET, and this could guide referrals and future trials. However, uncertainty persists for specific treatment effect size estimates and how they apply beyond this study sample.
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Affiliation(s)
- Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, HSRD (152), 508 Fulton Street, Durham, NC, 27705, United States.,Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, United States
| | - Liubov Arbeeva
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Todd A Schwartz
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, United States.,School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Leigh F Callahan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Departments of Orthopaedics and Social Medicine, United States
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Adam P Goode
- Duke Clinical Research Institute, Duke University School of Medicine, United States.,Department of Orthopedic Surgery, Duke University Medical Center, Durham, United States.,Department of Population Health Sciences, Duke University Medical Center, Durham, United States
| | - Kim M Huffman
- Department of Medicine, Division of Rheumatology, Duke University Medical Center, Durham, United States
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, HSRD (152), 508 Fulton Street, Durham, NC, 27705, United States.,Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, United States
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Huffman KM, Andonian BJ, Abraham DM, Bareja A, Lee DE, Katz LH, Huebner JL, Kraus WE, White JP. Exercise protects against cardiac and skeletal muscle dysfunction in a mouse model of inflammatory arthritis. J Appl Physiol (1985) 2021; 130:853-864. [PMID: 33411638 DOI: 10.1152/japplphysiol.00576.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory arthritis impacting primarily joints and cardiac and skeletal muscle. RA's distinct impact on cardiac and skeletal muscle tissue is suggested by studies showing that new RA pharmacologic agents strongly improve joint inflammation, but have little impact on RA-associated mortality, cardiovascular disease, and sarcopenia. Thus, the objective is to understand the distinct effects of RA on cardiac and skeletal muscle, and to therapeutically target these tissues through endurance-based exercise as a way to improve RA mortality and morbidity. We utilize the well-characterized RA mouse model, the K/BxN mouse, to investigate cardiac and skeletal muscle pathologies, including the use of wheel-running exercise to mitigate these pathologies. Strikingly, we found that K/BxN mice, like patients with RA, also exhibit both cardiac and skeletal muscle myopathies that were correlated with circulating IL-6 levels. Three months of wheel-running exercise significantly improved K/BxN joint swelling and reduced systemic IL-6 concentrations. Importantly, there were morphological, gene expression, and functional improvements in both the skeletal muscle and cardiac myopathies with exercise. The K/BxN mouse model of RA recapitulated important RA clinical comorbidities, including altered joint, cardiac and skeletal muscle function. These morphological, molecular, and functional alterations were mitigated with regular exercise, thus suggesting exercise as a potential therapeutic intervention to lessen disease activity in the joint and the peripheral tissues, including the heart and skeletal muscle.NEW & NOTEWORTHY RA, even when controlled, is associated with skeletal muscle weakness and greater risk of cardiovascular disease (CVD). Using exercise as a therapeutic against, the progression of RA is often avoided due to fear of worsening RA pathology. We introduce the K/BxN mouse as an RA model to study both myocardial and skeletal muscle dysfunction. We show that endurance exercise can improve joint, cardiac, and skeletal muscle function in K/BxN mice, suggesting exercise may be beneficial for patients with RA.
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Affiliation(s)
- Kim M Huffman
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina.,Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina
| | - Brian J Andonian
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina
| | - Dennis M Abraham
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Akshay Bareja
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina
| | - David E Lee
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina
| | - Lauren H Katz
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina.,UNC Adams School of Dentistry, Chapel Hill, North Carolina
| | - Janet L Huebner
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina
| | - William E Kraus
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina.,Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina
| | - James P White
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina.,Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina
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Hirsch KR, Greenwalt CE, Saylor HE, Gould LM, Harrison CH, Brewer GJ, Blue MNM, Ferrando AA, Huffman KM, Mayer‐Davis EJ, Ryan ED, Smith‐Ryan AE. High-intensity interval training and essential amino acid supplementation: Effects on muscle characteristics and whole-body protein turnover. Physiol Rep 2021; 9:e14655. [PMID: 33369879 PMCID: PMC7769174 DOI: 10.14814/phy2.14655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/23/2020] [Accepted: 10/29/2020] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study was to compare the independent and combined effects of high-intensity interval training (HIIT) and essential amino acids (EAA) on lean mass, muscle characteristics of the quadriceps, and 24-hr whole-body protein turnover (WBPT) in overweight and obese adults. An exploratory aim was to evaluate potential modulatory effects of sex. Sixty-six adults (50% female; Age: 36.7 ± 6.0 yrs; %BF: 36.0 ± 7.8%) were assigned to 8 wks of: (a) HIIT, 2 days/wk; (b) EAA supplementation, 3.6 g twice daily; (c) HIIT + EAA; or (d) control. At baseline, 4 wks, and 8 wks, total body, thigh LM and muscle characteristics were measured via dual-energy x-ray absorptiometry and B-mode ultrasound, respectively. In a subsample, changes in WBPT was measured using [N15 ]alanine. Differences between groups were assessed using linear mixed models adjusted for baseline values, followed by 95% confidence intervals on adjusted mean change scores (Δ). HIIT and HIIT + EAA improved thigh LM (Δ: +0.17 ± 0.05 kg [0.08, 0.27]; +0.22 ± 0.05 kg [0.12,0.31]) and vastus lateralis cross-sectional area (Δ: +2.73 ± 0.52 cm2 [1.69,3.77]; +2.64 ± 0.53 cm2 [1.58,3.70]), volume (Δ: +54.50 ± 11.69 cm3 [31.07, 77.92]; +62.39 ± 12.05 cm3 [38.26, 86.52]), and quality (Δ: -5.46 ± 2.68a.u. [-10.84, -0.09]; -7.97 ± 2.76a.u.[-13.49, -2.45]). Protein synthesis, breakdown, and flux were greater with HIIT + EAA and EAA compared to HIIT (p < .05). Sex differences were minimal. Compared to women, men tended to respond more to HIIT, with or without EAA. For women, responses were greater with HIIT + EAA than HIIT. In overweight and obese adults, 8 weeks of HIIT, with or without EAA, improved thigh LM size and quality; EAA may enhance muscular adaptation via increases in protein turnover, supporting greater improvements in muscular size and quality.
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Affiliation(s)
- Katie R. Hirsch
- Applied Physiology LaboratoryDepartment of Exercise and Sport ScienceUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Human Movement Science CurriculumDepartment of Allied Health ScienceUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Department of GeriatricsDonald W. Reynolds Institute on AgingCenter for Translational Research in Aging & LongevityUniversity of Arkansas for Medical SciencesLittle RockARUSA
| | - Casey E. Greenwalt
- Applied Physiology LaboratoryDepartment of Exercise and Sport ScienceUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Hannah E. Saylor
- Applied Physiology LaboratoryDepartment of Exercise and Sport ScienceUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Human Movement Science CurriculumDepartment of Allied Health ScienceUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Lacey M. Gould
- Applied Physiology LaboratoryDepartment of Exercise and Sport ScienceUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Courtney H. Harrison
- Applied Physiology LaboratoryDepartment of Exercise and Sport ScienceUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Gabrielle J. Brewer
- Applied Physiology LaboratoryDepartment of Exercise and Sport ScienceUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Malia N. M. Blue
- Applied Physiology LaboratoryDepartment of Exercise and Sport ScienceUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Human Movement Science CurriculumDepartment of Allied Health ScienceUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Arny A. Ferrando
- Department of GeriatricsDonald W. Reynolds Institute on AgingCenter for Translational Research in Aging & LongevityUniversity of Arkansas for Medical SciencesLittle RockARUSA
| | - Kim M. Huffman
- Duke Molecular Physiology InstituteDuke UniversityDurhamNCUSA
- Department of MedicineDuke University School of MedicineDurhamNCUSA
| | - Elizabeth J. Mayer‐Davis
- Department of NutritionGillings School of Public HealthUniversity of North Carolina at Chapel Hill Chapel HillNCUSA
- Department of MedicineUniversity of North CarolinaChapel HillNCUSA
| | - Eric D. Ryan
- Human Movement Science CurriculumDepartment of Allied Health ScienceUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Neuromuscular Assessment LaboratoryDepartment of Exercise and Sport ScienceUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Abbie E. Smith‐Ryan
- Applied Physiology LaboratoryDepartment of Exercise and Sport ScienceUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Human Movement Science CurriculumDepartment of Allied Health ScienceUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Department of NutritionGillings School of Public HealthUniversity of North Carolina at Chapel Hill Chapel HillNCUSA
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Smith-Ryan AE, Blue MN, Anderson KC, Hirsch KR, Allen KD, Huebner JL, Muehlbauer MJ, Ilkayeva OR, Kraus VB, Kraus WE, Golightly YM, Huffman KM. Metabolic and physiological effects of high intensity interval training in patients with knee osteoarthritis: A pilot and feasibility study. Osteoarthritis and Cartilage Open 2020; 2:100083. [DOI: 10.1016/j.ocarto.2020.100083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/03/2020] [Indexed: 12/19/2022] Open
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Flowers PPE, Schwartz TA, Arbeeva L, Golightly YM, Pathak A, Cooke J, Gupta JJ, Callahan LF, Goode AP, Corsi M, Huffman KM, Allen KD. Racial Differences in Performance-Based Function and Potential Explanatory Factors Among Individuals With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2020; 72:1196-1204. [PMID: 31254451 PMCID: PMC6935430 DOI: 10.1002/acr.24018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 06/25/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE In individuals with knee osteoarthritis (OA), self-reported physical function is poorer in African Americans than in whites, but whether this difference holds true for objective assessments is unclear. The purpose of this study was to examine racial differences in performance-based physical function as well as potential underlying factors contributing to these racial differences. METHODS Participants with knee OA from a randomized controlled trial completed the 2-minute step test (2MST), timed-up-and-go (TUG), and 30-second chair stand (30s-CST) at baseline. Race differences in performance-based function were assessed by logistic regression. Separate models were adjusted for sets of demographic, socioeconomic, psychological health, and physical health variables. RESULTS In individuals with knee OA (n = 322; 72% women, 22% African American, mean ± SD age 66 ± 11 years, mean ± SD body mass index 31 ± 8 kg/m2 ), African Americans (versus whites) had greater unadjusted odds of poorer function (30s-CST odds ratio [OR] 2.79 [95% confidence interval (95% CI) 1.65-4.72], 2MST OR 2.37 [95% CI 1.40-4.03], and TUG OR 3.71 [95% CI 2.16-6.36]). Relationships were maintained when adjusted for demographic and psychological health covariates, but they were either partially attenuated or nonsignificant when adjusted for physical health and socioeconomic covariates. CONCLUSION African American adults with knee OA had poorer unadjusted performance-based function than whites. Physical health and socioeconomic characteristics diminished these differences, emphasizing the fact that these factors may be important to consider in mitigating racial disparities in function.
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Affiliation(s)
| | | | | | | | - Ami Pathak
- Comprehensive Physical Therapy Center, Chapel Hill, North Carolina
| | | | | | | | | | - Michela Corsi
- Northeastern Ohio Medical University, Rootstown, Ohio
| | | | - Kelli D Allen
- University of North Carolina at Chapel Hill and Durham VA Medical Center, Durham, North Carolina
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Duscha BD, Kraus WE, Jones WS, Robbins JL, Piner LW, Huffman KM, Allen JD, Annex BH. Skeletal muscle capillary density is related to anaerobic threshold and claudication in peripheral artery disease. Vasc Med 2020; 25:411-418. [PMID: 32841100 DOI: 10.1177/1358863x20945794] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Peripheral artery disease (PAD) is characterized by impaired blood flow to the lower extremities, causing claudication and exercise intolerance. Exercise intolerance may result from reduced skeletal muscle capillary density and impaired muscle oxygen delivery. This cross-sectional study tested the hypothesis that capillary density is related to claudication times and anaerobic threshold (AT) in patients with PAD. A total of 37 patients with PAD and 29 control subjects performed cardiopulmonary exercise testing on a treadmill for AT and gastrocnemius muscle biopsies. Skeletal muscle capillary density was measured using immunofluorescence staining. PAD had decreased capillary density (278 ± 87 vs 331 ± 86 endothelial cells/mm2, p = 0.05), peak VO2 (15.7 ± 3.9 vs 24.3 ± 5.2 mL/kg/min, p ⩽ 0.001), and VO2 at AT (11.5 ± 2.6 vs 16.1 ± 2.8 mL/kg/min, p ⩽ 0.001) compared to control subjects. In patients with PAD, but not control subjects, capillary density was related to VO2 at AT (r = 0.343; p = 0.038), time to AT (r = 0.381; p = 0.020), and time after AT to test termination (r = 0.610; p ⩽ 0.001). Capillary density was also related to time to claudication (r = 0.332; p = 0.038) and time after claudication to test termination (r = 0.584; p ⩽ 0.001). In conclusion, relationships between capillary density, AT, and claudication symptoms indicate that, in PAD, exercise limitations are likely partially dependent on limited skeletal muscle capillary density and oxidative metabolism.
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Affiliation(s)
- Brian D Duscha
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - William S Jones
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer L Robbins
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Lucy W Piner
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Kim M Huffman
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Jason D Allen
- Department of Kinesiology, Curry School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
- Division of Cardiovascular Medicine, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Brian H Annex
- Department of Medicine, Medical College of Georgia, Augusta, GA, USA
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47
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Dorling JL, Ravussin E, Redman LM, Bhapkar M, Huffman KM, Racette SB, Das SK, Apolzan JW, Kraus WE, Höchsmann C, Martin CK. Effect of 2 years of calorie restriction on liver biomarkers: results from the CALERIE phase 2 randomized controlled trial. Eur J Nutr 2020; 60:1633-1643. [PMID: 32803412 DOI: 10.1007/s00394-020-02361-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/05/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Calorie restriction (CR) is an effective treatment for obesity-related liver and metabolic disease. However, CR studies in individuals without obesity are needed to see if CR could delay disease onset. Liver biomarkers indicate hepatic health and are linked to cardiometabolic disease. Our aim was to examine the effects of a 2-year CR intervention on liver biomarkers in healthy individuals without obesity. METHODS The Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) study was a 2-year randomized controlled trial. Overall, 218 participants (body mass index: 25.1 ± 1.7 kg/m2) were enrolled into a control group (n = 75) that ate ad libitum (AL), or a CR group (n = 143) that aimed to decrease energy intake by 25%. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and bilirubin were measured during the trial. RESULTS At month 24, relative to the AL group, ALP (- 7 ± 1 IU/L; P < 0.01) and GGT (- 0.11 ± 0.04 log IU/L; P = 0.02) decreased and bilirubin increased (0.21 ± 0.06 log mg/dL; P < 0.01) in the CR group; no between-group differences in ALT (- 1 ± 1 IU/L; P > 0.99) or AST (2 ± 2 IU/L; P = 0.68) were revealed. However, sex-by-treatment-by-time interactions (P < 0.01) were observed, with CR (vs. control) inducing reduced ALT and GGT and increased AST in men only (P ≤ 0.02). CONCLUSIONS In metabolically healthy individuals without obesity, 2 years of CR improves several liver biomarkers, with potentially greater improvements in men. These data suggest that sustained CR may improve long-term liver and metabolic disease risk in healthy adults. TRIAL REGISTRATION Clinicaltrials.gov (NCT00427193). Registered January 2007.
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Affiliation(s)
- James L Dorling
- Pennington Biomedical Research Center, 6400 Perkins Rd., Baton Rouge, LA, 70808, USA.
| | - Eric Ravussin
- Pennington Biomedical Research Center, 6400 Perkins Rd., Baton Rouge, LA, 70808, USA
| | - Leanne M Redman
- Pennington Biomedical Research Center, 6400 Perkins Rd., Baton Rouge, LA, 70808, USA
| | | | | | | | - Sai K Das
- JM, USDA, Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - John W Apolzan
- Pennington Biomedical Research Center, 6400 Perkins Rd., Baton Rouge, LA, 70808, USA
| | | | - Christoph Höchsmann
- Pennington Biomedical Research Center, 6400 Perkins Rd., Baton Rouge, LA, 70808, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, 6400 Perkins Rd., Baton Rouge, LA, 70808, USA
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Bennett WC, Collins KA, Slentz CA, Bateman LA, Willis LH, Piner LW, Huffman KM, Houmard JA, Kraus WIE. The Effects Of Aerobic And/Or Resistance Training On The Sf-36 Health Survey From Strride-AT/RT. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000682680.43631.dc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ross LM, Tourani R, Ma S, Shen S, Parker DC, Huffman KM, Kraus VB, Aliferis CF, Kraus WE. Utilizing Causal Pathway Analysis To Predict Change In Cardiorespiratory Fitness In The STRRIDE Randomized Trials. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000679616.35014.8e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Huffman KM, Concoff A, Spitzer A, Richmond JC, Gomoll A, Kraus VB, Jones DG, Cinar A, Kelley S. Fitbit Analysis Shows Enhanced Mobility Of Knee Osteoarthritis Patients Treated With Triamcinolone Acetonide Extended Release. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000686588.47120.dc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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