Home-based Exercise Training in Patients With Pulmonary Arterial Hypertension: Effect on Skeletal Muscular Function and Metabolism
Primary Purpose
Pulmonary Arterial Hypertension, Exercise Training, Home-based Rehabilitation
Status
Unknown status
Phase
Not Applicable
Locations
Canada
Study Type
Interventional
Intervention
Home-based rehabilitation
Sponsored by
About this trial
This is an interventional treatment trial for Pulmonary Arterial Hypertension
Eligibility Criteria
Inclusion Criteria:
- Men or women > 18 years old
- Pulmonary Arterial Hypertension group 1: idiopathic, genetics, drug or toxin-induced, associated with connective tissue, HIV, portal hypertension, congenital heart disease.
- Diagnosis performed by right heart catheterization with Pulmonary Arterial Pressure⩾ 20 mmHg, pulmonary artery occlusion pressure <15 and pulmonary vascular resistance >3 Wood units
- New York Heart Association II or III and a 6-Minute Walk Test < 500m
- Patient stable without therapeutic modification within the last 3 months
- Patient having wireless internet at home
- Consciously informed and written by the patient
Exclusion Criteria:
- Syncope within the last 6 month
- Metabolic comorbidity (eg Diabetes)
- Musculoskeletal impairment that does not allow physical exercise
- Patient unable or with contraindications to perform a cardio pulmonary exercise testing
- Patient with pulmonary veno-occlusive disease
- Presence of a permanent pacemaker or other contraindication to MRI
- Pregnant or breastfeeding woman
- Age <18 years
Sites / Locations
- University Institute of Cardiology and Respirology of Quebec
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Patients with Pulmonary Arterial Hypertension
Arm Description
12 weeks home-based rehabilitation
Outcomes
Primary Outcome Measures
Epigenetic factors influencing muscle metabolism
Transcriptome analysis using RNA-seq
Secondary Outcome Measures
Intramyocellular lipid accumulation
H-magnetic resonance spectroscopy and Oil red O technique
Muscular mitochondrial phosphorylation (ATP synthesis)
phosphorus-31 Magnetic resonance spectroscopy saturation transfer
Proportion of muscle fiber types
Ethanol modified technique
HbA1c
Serum HbA1c
Insulin
Serum Insulin
Glucose
Serum glucose
Apolipoprotein A1
Serum Apolipoprotein A1
Adiponectin
Serum Adiponectin
Leptin
Serum leptin
Volitional strength quadriceps
Maximal Voluntary force using isometric force meter
Non-volitional strength of the quadriceps
Maximal non-Voluntary force using isometric force meter and magnetic stimulation of the femoral neve
Maximal exercise capacity
Cardio-pulmonary exercise testing on a cycloergometer
Functional Exercise capacity
6-MWD
Quality of life (QOL)
Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) questionnaire. The CAMPHOR questionnaire contains 65 items in total, 25 relating to symptoms, 15 relating to activities, and 25 relating to QoL. It is negatively weighted; a higher score indicates worse QoL and greater functional limitation. Symptom and QoL items are both scored out of 25: "yes/true" scores 1 and "no/not true" scores 0. Activity items have three possible responses (score 0-2), giving a score out of 30. Each CAMPHOR assessment takes an average of 10 min
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04241497
Brief Title
Home-based Exercise Training in Patients With Pulmonary Arterial Hypertension: Effect on Skeletal Muscular Function and Metabolism
Official Title
Home-based Exercise Training in Patients With Pulmonary Arterial Hypertension: Effect on Skeletal Muscular Function and Metabolism
Study Type
Interventional
2. Study Status
Record Verification Date
January 2020
Overall Recruitment Status
Unknown status
Study Start Date
March 2020 (Anticipated)
Primary Completion Date
March 2021 (Anticipated)
Study Completion Date
March 2021 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Laval University
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
Pulmonary Arterial Hypertension has gone from a disease that causes rapid death to a more chronic condition. Yet, improved survival is associated with major challenges for clinicians as most patients remain with poor quality of life and limited exercise capacity. The effects of exercise training on exercise capacity have been largely evaluated and showed an improvement in 6-minutes walking distance (6MWD), peak V'O2. It is also known that exercise program improves quality of life. Maximal volitional and nonvolitional strength of the quadriceps are reduced in patients with Pulmonary Arterial Hypertension and correlated to exercise capacity. Moreover, on the cellular level, alterations are observed in both the respiratory as well as the peripheral muscles. Muscle fiber size has been reported to be decreased in some studies or conversely unaltered in human and animal models. Reduction in type I fibers and a more anaerobic energy metabolism has also been reported, but not in all studies. Likewise, a loss in capillary density in quadriceps of patients with Pulmonary Arterial Hypertension and rats has been reported, but could not be confirmed in other studies. While the impact of exercise training on clinical outcomes such as exercise capacity or quality of life is well known, this data highlight the fact that the underlying causes of peripheral muscle weakness as well as the mechanisms underlying the clinical improvements observed with exercise programs are not completely understood. Improvement of muscle cell metabolism in part via the enhancement of oxidative cellular metabolism and decrease in intracellular lipid accumulation may play a role in improving muscle function and exercise capacity.
In this study, we intend to evaluate the impact of a 12 weeks home-based rehabilitation program on peripheral muscle function and metabolism, focusing on lipid infiltration, oxidative metabolism and epigenetic factors that can be involved in metabolic syndrome, in patients with Pulmonary Arterial Hypertension.
Detailed Description
The 12 weeks home-based rehabilitation program is detailed as follows:
1st sessions at the hospital, in the presence of a physiotherapist/kinesiologist
3 weeks of supervised home-based rehabilitation (using a telemonitoring system) 3 times a weeks
9 weeks of unsupervised home-based rehabilitation (one phone call a week)
Patients will be evaluated at baseline and at endpoint (12 weeks)
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pulmonary Arterial Hypertension, Exercise Training, Home-based Rehabilitation, Exercise Capacity, Muscle Metabolism, Muscle Function, Lipid Infiltration, Oxidative Metabolism
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
10 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Patients with Pulmonary Arterial Hypertension
Arm Type
Experimental
Arm Description
12 weeks home-based rehabilitation
Intervention Type
Behavioral
Intervention Name(s)
Home-based rehabilitation
Intervention Description
1 supervised exercise session at the hospital; 3 weeks of supervised home-based exercise training (3x/week); 9 weeks of unsupervised home-based exercise training (3x/week)
Primary Outcome Measure Information:
Title
Epigenetic factors influencing muscle metabolism
Description
Transcriptome analysis using RNA-seq
Time Frame
Changes between baseline and 12 weeks of exercise rehabilitation
Secondary Outcome Measure Information:
Title
Intramyocellular lipid accumulation
Description
H-magnetic resonance spectroscopy and Oil red O technique
Time Frame
Changes between baseline and 12 weeks of exercise rehabilitation
Title
Muscular mitochondrial phosphorylation (ATP synthesis)
Description
phosphorus-31 Magnetic resonance spectroscopy saturation transfer
Time Frame
Changes between baseline and 12 weeks of exercise rehabilitation
Title
Proportion of muscle fiber types
Description
Ethanol modified technique
Time Frame
Changes between baseline and 12 weeks of exercise rehabilitation
Title
HbA1c
Description
Serum HbA1c
Time Frame
Changes between baseline and 12 weeks of exercise rehabilitation
Title
Insulin
Description
Serum Insulin
Time Frame
Changes between baseline and 12 weeks of exercise rehabilitation
Title
Glucose
Description
Serum glucose
Time Frame
Changes between baseline and 12 weeks of exercise rehabilitation
Title
Apolipoprotein A1
Description
Serum Apolipoprotein A1
Time Frame
Changes between baseline and 12 weeks of exercise rehabilitation
Title
Adiponectin
Description
Serum Adiponectin
Time Frame
Changes between baseline and 12 weeks of exercise rehabilitation
Title
Leptin
Description
Serum leptin
Time Frame
Changes between baseline and 12 weeks of exercise rehabilitation
Title
Volitional strength quadriceps
Description
Maximal Voluntary force using isometric force meter
Time Frame
Changes between baseline and 12 weeks of exercise rehabilitation
Title
Non-volitional strength of the quadriceps
Description
Maximal non-Voluntary force using isometric force meter and magnetic stimulation of the femoral neve
Time Frame
Changes between baseline and 12 weeks of exercise rehabilitation
Title
Maximal exercise capacity
Description
Cardio-pulmonary exercise testing on a cycloergometer
Time Frame
Changes between baseline and 12 weeks of exercise rehabilitation
Title
Functional Exercise capacity
Description
6-MWD
Time Frame
Changes between baseline and 12 weeks of exercise rehabilitation
Title
Quality of life (QOL)
Description
Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) questionnaire. The CAMPHOR questionnaire contains 65 items in total, 25 relating to symptoms, 15 relating to activities, and 25 relating to QoL. It is negatively weighted; a higher score indicates worse QoL and greater functional limitation. Symptom and QoL items are both scored out of 25: "yes/true" scores 1 and "no/not true" scores 0. Activity items have three possible responses (score 0-2), giving a score out of 30. Each CAMPHOR assessment takes an average of 10 min
Time Frame
Changes between baseline and 12 weeks of exercise rehabilitation
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
100 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Men or women > 18 years old
Pulmonary Arterial Hypertension group 1: idiopathic, genetics, drug or toxin-induced, associated with connective tissue, HIV, portal hypertension, congenital heart disease.
Diagnosis performed by right heart catheterization with Pulmonary Arterial Pressure⩾ 20 mmHg, pulmonary artery occlusion pressure <15 and pulmonary vascular resistance >3 Wood units
New York Heart Association II or III and a 6-Minute Walk Test < 500m
Patient stable without therapeutic modification within the last 3 months
Patient having wireless internet at home
Consciously informed and written by the patient
Exclusion Criteria:
Syncope within the last 6 month
Metabolic comorbidity (eg Diabetes)
Musculoskeletal impairment that does not allow physical exercise
Patient unable or with contraindications to perform a cardio pulmonary exercise testing
Patient with pulmonary veno-occlusive disease
Presence of a permanent pacemaker or other contraindication to MRI
Pregnant or breastfeeding woman
Age <18 years
Facility Information:
Facility Name
University Institute of Cardiology and Respirology of Quebec
City
Québec
ZIP/Postal Code
QC G1V 4G5
Country
Canada
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Marius Lebret, PhD
Phone
418 656 8711
Ext
2560
Email
marius.lebret@criucpq.ulaval.ca
First Name & Middle Initial & Last Name & Degree
Steeve Provencher, MD
Phone
418 656 8711
Ext
5526
Email
steeve.provencher@criucpq.ulaval.ca
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
22323570
Citation
Grunig E, Lichtblau M, Ehlken N, Ghofrani HA, Reichenberger F, Staehler G, Halank M, Fischer C, Seyfarth HJ, Klose H, Meyer A, Sorichter S, Wilkens H, Rosenkranz S, Opitz C, Leuchte H, Karger G, Speich R, Nagel C. Safety and efficacy of exercise training in various forms of pulmonary hypertension. Eur Respir J. 2012 Jul;40(1):84-92. doi: 10.1183/09031936.00123711. Epub 2012 Feb 9.
Results Reference
result
PubMed Identifier
26231884
Citation
Ehlken N, Lichtblau M, Klose H, Weidenhammer J, Fischer C, Nechwatal R, Uiker S, Halank M, Olsson K, Seeger W, Gall H, Rosenkranz S, Wilkens H, Mertens D, Seyfarth HJ, Opitz C, Ulrich S, Egenlauf B, Grunig E. Exercise training improves peak oxygen consumption and haemodynamics in patients with severe pulmonary arterial hypertension and inoperable chronic thrombo-embolic pulmonary hypertension: a prospective, randomized, controlled trial. Eur Heart J. 2016 Jan 1;37(1):35-44. doi: 10.1093/eurheartj/ehv337. Epub 2015 Jul 31.
Results Reference
result
PubMed Identifier
30578391
Citation
Grunig E, Eichstaedt C, Barbera JA, Benjamin N, Blanco I, Bossone E, Cittadini A, Coghlan G, Corris P, D'Alto M, D'Andrea A, Delcroix M, de Man F, Gaine S, Ghio S, Gibbs S, Gumbiene L, Howard LS, Johnson M, Jureviciene E, Kiely DG, Kovacs G, MacKenzie A, Marra AM, McCaffrey N, McCaughey P, Naeije R, Olschewski H, Pepke-Zaba J, Reis A, Santos M, Saxer S, Tulloh RM, Ulrich S, Vonk Noordegraaf A, Peacock AJ. ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension. Eur Respir J. 2019 Feb 28;53(2):1800332. doi: 10.1183/13993003.00332-2018. Print 2019 Feb.
Results Reference
result
PubMed Identifier
24977625
Citation
Potus F, Malenfant S, Graydon C, Mainguy V, Tremblay E, Breuils-Bonnet S, Ribeiro F, Porlier A, Maltais F, Bonnet S, Provencher S. Impaired angiogenesis and peripheral muscle microcirculation loss contribute to exercise intolerance in pulmonary arterial hypertension. Am J Respir Crit Care Med. 2014 Aug 1;190(3):318-28. doi: 10.1164/rccm.201402-0383OC.
Results Reference
result
PubMed Identifier
29025748
Citation
Malenfant S, Brassard P, Paquette M, Le Blanc O, Chouinard A, Nadeau V, Allan PD, Tzeng YC, Simard S, Bonnet S, Provencher S. Compromised Cerebrovascular Regulation and Cerebral Oxygenation in Pulmonary Arterial Hypertension. J Am Heart Assoc. 2017 Oct 12;6(10):e006126. doi: 10.1161/JAHA.117.006126.
Results Reference
result
PubMed Identifier
25548805
Citation
Malenfant S, Potus F, Fournier F, Breuils-Bonnet S, Pflieger A, Bourassa S, Tremblay E, Nehme B, Droit A, Bonnet S, Provencher S. Skeletal muscle proteomic signature and metabolic impairment in pulmonary hypertension. J Mol Med (Berl). 2015 May;93(5):573-84. doi: 10.1007/s00109-014-1244-0. Epub 2014 Dec 30.
Results Reference
result
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Home-based Exercise Training in Patients With Pulmonary Arterial Hypertension: Effect on Skeletal Muscular Function and Metabolism
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