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Molecular Mechanism of Exercise in Cirrhosis

Primary Purpose

Cirrhosis, Liver

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Endurance Training 3 times per week
Resistance Exercise
Standard of Care
Sponsored by
The Cleveland Clinic
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Cirrhosis, Liver

Eligibility Criteria

40 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Adult patients age 40-65 years of both genders Diagnosis of cirrhosis by either liver biopsy, clinical, biochemical or imaging criteria Child's score 5-10 Model for End Stage Liver Disease (MELD) score less than 21 Abstinence from alcohol and/or other recreational drugs for at least 6 months Absence of concurrent illnesses (renal, cardiac, pulmonary, cerebrovascular, malignancy) or medication (anabolic steroids, corticosteroids) intake that affect skeletal muscle mass, diabetes mellitus (avoid altered muscle protein metabolism), or use of anticoagulants. abdominal or liver CT scan within 1 year of enrollment for stratification Exclusion Active alcohol consumption within 6 weeks of enrollment Pedal edema (grade 2) above the ankle will be excluded to avoid complications of the muscle biopsy. Liver transplant Active Malignancy Recent GI bleed (4 weeks) Hepatic Encephalopathy within previous 6 months Grade 2 or greater active esophageal varices Active infection Large Ascites as defined by clinical imaging Advanced disease cardiac or pulmonary disease Use of medications affecting muscle protein turnover including corticosteroids or medications used to prevent clotting Clinical lab values that indicate potential poor clotting as determined by the PI Inability to obtain informed consent; judged likely to be unable to perform exercise or unlikely to complete the study in the opinion of the investigators End stage kidney disease as determined by glomerular filtration rate (eGFR) < 15 ml/min/1.73m2 or dialysis Patients who in the opinion of the PI are unsafe for exercise (failure to pass stress test)

Sites / Locations

  • Cleveland ClinicRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Active Comparator

Arm Label

Endurance Arm

Resistance

Standard of Care

Arm Description

Outcomes

Primary Outcome Measures

Change in muscle mass over time

Secondary Outcome Measures

Full Information

First Posted
August 1, 2023
Last Updated
August 8, 2023
Sponsor
The Cleveland Clinic
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1. Study Identification

Unique Protocol Identification Number
NCT05982769
Brief Title
Molecular Mechanism of Exercise in Cirrhosis
Official Title
Molecular Mechanism of Exercise in Cirrhosis
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
April 11, 2022 (Actual)
Primary Completion Date
August 10, 2027 (Anticipated)
Study Completion Date
August 10, 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
The Cleveland Clinic

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
This study aims to investigate the effects of 12 weeks of resistance or endurance exercise on patients with cirrhosis. Cirrhotic patients are prone to muscle loss (sarcopenia) and ammonia build up due to liver dysfunction. The liver which in healthy patients is able to process ammonia through ureagenesis is unable to do so in cirrhosis and ammonia is taken up either by the brain causing confusion or the skeletal muscle causing muscle loss or sarcopenia. Primary sarcopenia occurs in older individuals and can be mitigated by exercise. Secondary sarcopenia occurs in response to disease such as cancer, chronic kidney disease, multiple sclerosis, and cirrhosis of all etiologies. Resistance exercise is an excellent stimulator for muscle protein synthesis and is widely used to build muscle mass and strength but has little benefit to cardiovascular function. Endurance exercise has shown to be safe in cirrhosis however there is no set prescription for cirrhosis as there is for other disease. Endurance exercise is known to promote improved cardiovascular health, improve fatigue, and generates less ammonia build up than resistance exercise. In patients with low muscle mass it is possible that endurance exercise alone will be enough to improve muscle mass. There have been few studies on exercise and cirrhosis, those that exist have shown benefits with endurance exercise. However there are even more limited studies on resistance exercise and few to no studies on the molecular mechanisms behind exercise in cirrhosis. Study visits are described fully in the protocol and consent form. After passing a screening visit patients will undergo a maximal exercise/fitness test (pre-baseline test) and other body composition measurements. After the screening and pre-baseline visit randomization will occur (2:2:1 endurance, resistance, or SOC) arrangements will be made to have the appropriate exercise equipment given to patients. Once the exercise equipment has arrived a baseline study visit will occur. After the baseline visit the endurance exercise group will cycle 3 days per week for 60 minutes under the supervision of the study team. The resistance exercise group will perform a whole body resistance workout 2 days per week for approximately 60 minutes under the supervision of a study team member. Patients in all groups will have the fitness test repeated at weeks 4, 8 and 12. After the 12 weeks of exercise the baseline visits will be repeated and after 2 weeks patients will complete one final fitness test to examine the effects of de-training.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cirrhosis, Liver

7. Study Design

Primary Purpose
Other
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
40 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Endurance Arm
Arm Type
Experimental
Arm Title
Resistance
Arm Type
Experimental
Arm Title
Standard of Care
Arm Type
Active Comparator
Intervention Type
Behavioral
Intervention Name(s)
Endurance Training 3 times per week
Intervention Description
endurance training will be performed from home 3 times per week under the supervision of the research team.
Intervention Type
Behavioral
Intervention Name(s)
Resistance Exercise
Intervention Description
resistance training will be performed from home 2 times per week under the supervision of the research team.
Intervention Type
Behavioral
Intervention Name(s)
Standard of Care
Intervention Description
continue usual activity
Primary Outcome Measure Information:
Title
Change in muscle mass over time
Time Frame
day 0 and day 90

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Adult patients age 40-65 years of both genders Diagnosis of cirrhosis by either liver biopsy, clinical, biochemical or imaging criteria Child's score 5-10 Model for End Stage Liver Disease (MELD) score less than 21 Abstinence from alcohol and/or other recreational drugs for at least 6 months Absence of concurrent illnesses (renal, cardiac, pulmonary, cerebrovascular, malignancy) or medication (anabolic steroids, corticosteroids) intake that affect skeletal muscle mass, diabetes mellitus (avoid altered muscle protein metabolism), or use of anticoagulants. abdominal or liver CT scan within 1 year of enrollment for stratification Exclusion Active alcohol consumption within 6 weeks of enrollment Pedal edema (grade 2) above the ankle will be excluded to avoid complications of the muscle biopsy. Liver transplant Active Malignancy Recent GI bleed (4 weeks) Hepatic Encephalopathy within previous 6 months Grade 2 or greater active esophageal varices Active infection Large Ascites as defined by clinical imaging Advanced disease cardiac or pulmonary disease Use of medications affecting muscle protein turnover including corticosteroids or medications used to prevent clotting Clinical lab values that indicate potential poor clotting as determined by the PI Inability to obtain informed consent; judged likely to be unable to perform exercise or unlikely to complete the study in the opinion of the investigators End stage kidney disease as determined by glomerular filtration rate (eGFR) < 15 ml/min/1.73m2 or dialysis Patients who in the opinion of the PI are unsafe for exercise (failure to pass stress test)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Srinivasan Dasarathy, MD
Phone
216-318-7010
Email
dasaras@ccf.org
First Name & Middle Initial & Last Name or Official Title & Degree
Annette Bellar
Email
bellara@ccf.org
Facility Information:
Facility Name
Cleveland Clinic
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Annette Bellar

12. IPD Sharing Statement

Plan to Share IPD
No

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Molecular Mechanism of Exercise in Cirrhosis

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