Myotonic Dystrophy Type 1 Aerobic Exercise Study (DM1ex)
Primary Purpose
Myotonic Dystrophy 1, Muscular Dystrophies
Status
Completed
Phase
Not Applicable
Locations
Canada
Study Type
Interventional
Intervention
Exercise training
Sponsored by
About this trial
This is an interventional supportive care trial for Myotonic Dystrophy 1 focused on measuring aerobic exercise
Eligibility Criteria
Inclusion Criteria:
DM1 participants:
- Male or female clinically diagnosed with DM1
- CTG repeats 100-1000
- Normal weight (BMI 18.5 - 24.9 kg/m2) or overweight (BMI 25 - 29.9 kg/m2)
Age matched controls:
- Healthy men and women
- Normal weight (BMI 18.5 - 24.9 kg/m2) or overweight (BMI 25 - 29.9 kg/m2)
- Physically inactive (< 1-2 hour of formal exercise/week)
Exclusion Criteria:
- Smoking
- Obese (BMI > 30.0 kg/m2)
- Use of narcotic analgesic or anti-inflammatory drugs
- Type 1 or 2 diabetes (more than one anti-diabetic drug)
- Cardiovascular disease (recent myocardial infarction (< 6 months))
- Uncontrolled hypertension requiring more than 2 medications
- Congestive heart failure requiring more than one medication for control-
- Known liver disease
- Cognitive impairments limiting ability to provide informed consent
- Active musculoskeletal injuries and/or severe osteoarthritis
Sites / Locations
- McMaster University Medical Center
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Exercise training group
Arm Description
All participants will be receiving same exercise training intervention
Outcomes
Primary Outcome Measures
Maximal aerobic capacity
VO2max in mL/min/kg-1
Secondary Outcome Measures
6 minute walk test
changes in number of meters walked during the 6 minute walk test
5x sit to stand
changes in the time (seconds) needed to complete 5x sit to stand from a chair
timed up and go
changes in the time (seconds) needed to complete a timed up and go test
Leg muscle strength
maximal isometric knee extension via Biodex in N*m
Grip strength
changes in grip strength (kg) using a hand dynamometer
Body composition
change in fat free mass and fat mass measured via DXA in kg
Muscle fibre cross sectional area
changes in fibre cross sectional area from muscle biopsy of vastus lateralis using immunoflourescence
Mitochondrial protein content
changes in mitochondrial proteins from muscle biopsy of vastus lateralis using western blotting
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04187482
Brief Title
Myotonic Dystrophy Type 1 Aerobic Exercise Study
Acronym
DM1ex
Official Title
Functional and Cellular Benefits of Aerobic Exercise in Myotonic Dystrophy Type 1 Patients
Study Type
Interventional
2. Study Status
Record Verification Date
March 2022
Overall Recruitment Status
Completed
Study Start Date
December 6, 2019 (Actual)
Primary Completion Date
March 29, 2020 (Actual)
Study Completion Date
November 1, 2021 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
McMaster University
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Myotonic dystrophy type 1 (DM1) is a genetic disease that primarily targets skeletal muscle resulting in severe weakness and muscle loss. As a result, individuals suffering from DM1 become very inactive and lose mobility resulting in a lower quality of life. This study will investigate the effect of a 12-week moderate intensity exercise protocol on skeletal muscle function and cellular benefits in DM1 patients.
Detailed Description
The present study is a repeated measures design, with sampling of the cohorts on two separate occasions. Upon obtaining informed consent, participants will be assigned into one of two groups:
Group 1: DM1 Exercise Group DM1 diagnosed, physically inactive males, n = 6 DM1 diagnosed, physically inactive females, n = 7
Group 2: Healthy controls (no exercise) Healthy, physically inactive males n = 6 Healthy, physically inactive females n = 7
Introduction - Day 1 (Visit 1); On the initial visit, the potential participant will come to McMaster Children's Hospital to meet with a study coordinator involved in the project. The coordinator will explain the study in detail, answer any questions, and review the consent form. Upon obtaining informed consent, eligible participants will complete a medical screening questionnaire to determine their readiness to perform exercise. Participant characteristics will then be measured. At this time, anthropometric measurements (i.e., height, weight, waist circumference) and a dual energy x-ray absorptiometry (DXA) measurement will be performed. This must be done in order to verify that the participant meets the inclusion criteria of being normal weight (BMI 18.5 - 24.9 kg/m2) or overweight (BMI 25 - 29.9 kg/m2). Following this screening, participants will undergo an ECG to measure any conductance blockage and perform a maximal cycling test to determine their aerobic capacity (V02max). Maximal aerobic testing will then be followed by another 12 lead ECG to detect any possible structural cardiac issues in our participants. Thereafter, participants will begin the following the study timeline, all of which will occur at the McMaster Children's Hospital, 2H Neurometabolic Clinic.
Baseline testing - Day 3 (Visit 2); Participants will arrive the following day to undergo functional testing which will include 6-minute walk test, 5x sit to stand, timed up and go, grip strength and maximal voluntary knee extension using the Biodex dynamometer. Participants will then complete the SF-36.
Follow up testing - Day 5 (Visit 3); Participants will arrive following an overnight fast (including no caffeine for 12 hours) and having abstained from any exercise for the prior 24 hours. Participants will undergo a muscle biopsy from the vastus lateralis.
DM1 participants only:
Exercise training - Visit 4 - 39; Participants will begin the exercise protocol consisting of 3 exercise sessions per week for a 12-week period. All exercise sessions will be done on a cycle ergometer (Lode, Groningen, Netherlands). Each exercise session will consist of 3 minutes of warm up, 30 minutes at 65% V02max and will end with 2 minutes of cool down. Exercise progression over the 12 weeks will go as follows:
Weeks 1 and 2: 3 min warm up, 65% VO2max for 30 min, 2 min cool down
Weeks 3 and 4: increase to 35 min (+ warm up/cool down)
Weeks 5 and 6: drop to 30 min and increase to 70% VO2max
Weeks 7 and 8: increase to 35 min (+ warm up/cool down)
Weeks 9 and 10: drop to 30 min and increase to 75%VO2 max
Weeks 11 and 12: increase to 35 min (+ warm up/cool down)
Endpoint testing - Visit 40; At this time, anthropometric re-measurements (i.e., height, weight, waist circumference) and a dual energy x-ray absorptiometry (DXA) measurement will be performed. Thereafter, participants will undergo an ECG to measure any conductance blockage and perform a maximal cycling test to determine their aerobic capacity (V02peak). Maximal aerobic testing will then be followed by another 12 lead ECG to detect any possible structural cardiac issues in our participants.
Endpoint testing - Visit 41; Participants will arrive the following day to undergo functional testing which will include 6-minute walk test, timed up and go, grip strength and maximal voluntary knee extension using the Biodex dynamometer. Participants will then complete the SF-36.
Endpoint testing - Visit 42; Participants will arrive following an overnight fast (including no caffeine for 12 hours) and having abstained from any exercise for the prior 24 hours. Participants will undergo a muscle biopsy from the vastus lateralis.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Myotonic Dystrophy 1, Muscular Dystrophies
Keywords
aerobic exercise
7. Study Design
Primary Purpose
Supportive Care
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
Participants are undergoing 12-weeks of aerobic exercise training
Masking
None (Open Label)
Allocation
N/A
Enrollment
13 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Exercise training group
Arm Type
Experimental
Arm Description
All participants will be receiving same exercise training intervention
Intervention Type
Other
Intervention Name(s)
Exercise training
Intervention Description
All participants with DM1 will undergo a 12-week aerobic exercise training intervention on a cycle ergometer
Primary Outcome Measure Information:
Title
Maximal aerobic capacity
Description
VO2max in mL/min/kg-1
Time Frame
3 months from enrolment
Secondary Outcome Measure Information:
Title
6 minute walk test
Description
changes in number of meters walked during the 6 minute walk test
Time Frame
3 months from enrolment
Title
5x sit to stand
Description
changes in the time (seconds) needed to complete 5x sit to stand from a chair
Time Frame
3 months from enrolment
Title
timed up and go
Description
changes in the time (seconds) needed to complete a timed up and go test
Time Frame
3 months from enrolment
Title
Leg muscle strength
Description
maximal isometric knee extension via Biodex in N*m
Time Frame
3 months from enrolment
Title
Grip strength
Description
changes in grip strength (kg) using a hand dynamometer
Time Frame
3 months from enrolment
Title
Body composition
Description
change in fat free mass and fat mass measured via DXA in kg
Time Frame
3 months from enrolment
Title
Muscle fibre cross sectional area
Description
changes in fibre cross sectional area from muscle biopsy of vastus lateralis using immunoflourescence
Time Frame
3 months after intervention is complete
Title
Mitochondrial protein content
Description
changes in mitochondrial proteins from muscle biopsy of vastus lateralis using western blotting
Time Frame
3 months after intervention is complete
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
DM1 participants:
Male or female clinically diagnosed with DM1
CTG repeats 100-1000
Normal weight (BMI 18.5 - 24.9 kg/m2) or overweight (BMI 25 - 29.9 kg/m2)
Age matched controls:
Healthy men and women
Normal weight (BMI 18.5 - 24.9 kg/m2) or overweight (BMI 25 - 29.9 kg/m2)
Physically inactive (< 1-2 hour of formal exercise/week)
Exclusion Criteria:
Smoking
Obese (BMI > 30.0 kg/m2)
Use of narcotic analgesic or anti-inflammatory drugs
Type 1 or 2 diabetes (more than one anti-diabetic drug)
Cardiovascular disease (recent myocardial infarction (< 6 months))
Uncontrolled hypertension requiring more than 2 medications
Congestive heart failure requiring more than one medication for control-
Known liver disease
Cognitive impairments limiting ability to provide informed consent
Active musculoskeletal injuries and/or severe osteoarthritis
Facility Information:
Facility Name
McMaster University Medical Center
City
Hamilton
State/Province
Ontario
ZIP/Postal Code
L8N 3Z5
Country
Canada
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
35316212
Citation
Mikhail AI, Nagy PL, Manta K, Rouse N, Manta A, Ng SY, Nagy MF, Smith P, Lu JQ, Nederveen JP, Ljubicic V, Tarnopolsky MA. Aerobic exercise elicits clinical adaptations in myotonic dystrophy type 1 patients independently of pathophysiological changes. J Clin Invest. 2022 May 16;132(10):e156125. doi: 10.1172/JCI156125.
Results Reference
derived
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Myotonic Dystrophy Type 1 Aerobic Exercise Study
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