HIIT for Reducing Frailty in Older Veterans
(HIIT@Home Trial)
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: VA Office of Research and Development
Disqualifiers: Severe COPD, CKD, Severe HTN, others
No Placebo Group
Trial Summary
What is the purpose of this trial?This trial tests if short, intense exercises with rest periods can help older Veterans stay healthier and more active. The goal is to see if this method can reduce frailty and improve their ability to recover from stress.
Do I need to stop my current medications for the trial?
The trial protocol does not specify whether you need to stop taking your current medications.
What data supports the idea that HIIT for Reducing Frailty in Older Veterans is an effective treatment?
The available research shows that high-intensity walking training, a form of HIIT, significantly reduced frailty in older adults. Participants in a study experienced improvements in walking speed, distance, and balance without any negative side effects. They also rated the program highly and recommended it for others. Compared to other treatments like multicomponent training and resistance training, HIIT showed specific benefits in reducing frailty and improving physical abilities. However, multicomponent training also improved fitness but required ongoing exercise to maintain benefits, while resistance training showed improvements in strength and functional capacity.
12345What safety data exists for HIIT in older adults?
The safety of high-intensity interval training (HIIT) in older adults has been evaluated in several studies. A scoping review found that HIIT protocols are generally well-tolerated by older adults, with no significant adverse events reported. A study on high-intensity walking training in frail older adults reported no adverse events and high participant satisfaction. A meta-review of systematic reviews found no acute injuries associated with HIIT and high adherence rates. Additionally, HIIT has been recognized as a safe alternative to moderate-intensity training in cardiac rehabilitation for older patients with cardiovascular disease. Overall, HIIT appears to be safe for older adults, but larger studies are needed to further confirm these findings.
16789Is Center-based or Home-based HIIT a promising treatment for reducing frailty in older veterans?
Yes, Center-based and Home-based HIIT (High Intensity Interval Training) are promising treatments for reducing frailty in older veterans. HIIT can improve physical fitness, reduce the risk of falls, and enhance overall health in frail older adults. Home-based HIIT is particularly beneficial as it is more accessible and can reach a larger population at a lower cost.
12101112Eligibility Criteria
This trial is for older veterans, both male and female of any race, who are at least 60 years old. Participants should be non-frail or pre-frail with a frailty score less than 3 and must be medically cleared to exercise. Those with severe COPD, advanced kidney disease, extreme high blood pressure, or significant cognitive impairment cannot join.Inclusion Criteria
Medically cleared for exercise
I am not considered frail according to a frailty score.
I am 60 years old or older.
+1 more
Exclusion Criteria
VA-SLUMS score 20 (Cognition)
I have severe COPD, CKD stage 3, or very high blood pressure.
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants undergo 12 weeks of high intensity interval training (HIIT) to improve resilience and reduce frailty
12 weeks
Center-based and home-based sessions
Follow-up
Participants are monitored for safety and effectiveness after treatment
4 weeks
Participant Groups
The study is testing the effects of different types of High Intensity Interval Training (HIIT) on reducing frailty and enhancing resilience in older adults. It compares center-based HIIT, home-based HIIT against a control group receiving standard attention without intensive training.
3Treatment groups
Experimental Treatment
Group I: Home based HIITExperimental Treatment1 Intervention
Home based HIIT
Group II: Center based attention controlExperimental Treatment1 Intervention
Center based attention control
Group III: Center based HIITExperimental Treatment1 Intervention
Center based HIIT
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Kansas City VA Medical Center, Kansas City, MOKansas City, MO
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Who Is Running the Clinical Trial?
VA Office of Research and DevelopmentLead Sponsor
References
Feasibility and Impact of High-Intensity Walking Training in Frail Older Adults. [2018]To investigate the impact of high-intensity walking training (HIWT) on prefrail and frail older adults, five assisted living residents underwent a supervised 12-session intervention. The intervention consisted of 30 min of HIWT at 70-80% of heart rate reserve or ratings of 15 to 17 (hard to very hard) on the Borg Rating of Perceived Exertion scale. Training included walking at fast speeds, multi-directions, stairs, and outdoor surfaces with and without an assistive device. Training significantly reduced frailty using the SHARE-FI (p = .008), increased fast gait speed (p = .01), improved 6-min walk test distance (p = .03), and enhanced Berg Balance Scale scores (p = .03). There were no adverse events and all participants reached target training intensity in all 12 sessions. Participants viewed the walking intervention as highly satisfactory (9.6/10 on a Likert scale) and 100% recommended that the assisted living facility should offer HIWT as part of routine programming.
Effects of multicomponent training and detraining on the fitness of older adults with or at risk of frailty: results of a 10-month quasi-experimental study. [2023]The aims of this study were (1) to analyse the effects of a 6-month multicomponent training (MCT) on the physical fitness of older adults with or at risk of frailty; (2) to study the consequences of a 4-month detraining period; (3) to analyse the influence of frailty status on the training and detraining adaptations. A total of 102 robust, frail and prefrail older adults (80.1 ± 6.1 y) were divided into an intervention (TRAIN) and control group (CON). The TRAIN performed a 6-month MCT, while the CON continued with their usual lifestyle. Fitness assessment was mainly based on the Senior Fitness Test. Four evaluations were carried out; at baseline, and at 3, 6 and 10 months from baseline. Linear mixed models were performed to analyse group by time interactions and to compare differences in changes within groups between different time points. After 6-month MCT, TRAIN showed greater improvements for all fitness variables (group effects p < 0.05, except for flexibility) when compared to the CON. During the 4-month detraining period, TRAIN significantly decreased their balance, upper-limb flexibility and upper and lower-limb strength (all p < 0.05). CON only decreased upper-limb flexibility. When accounting for frailty status in the TRAIN, the frail-prefrail showed lower adaptations to the training and were more affected by detraining than the robust. The presented MCT is a good strategy to improve fitness in this population, but its positive effects are limited in time. It is, therefore, critical to avoid detraining periods.Trial registration: ClinicalTrials.gov identifier: NCT03831841.HighlightsOur 6-month MCT-program improves the physical fitness of robust, frail and prefrail older adultsA detraining period of four months partially deteriorates the physical fitness of robust, frail and prefrail older adults, so it is recommended to promote ongoing exercise programs or smaller break periodsIt seems that those older adults with a more advanced frailty status may not benefit from exercise to the same degree and will be more affected by detraining. Therefore, trainers may need to individualize training protocols to obtain the greatest exercise benefits.
The effectiveness of exercise interventions for the management of frailty: a systematic review. [2022]This systematic review examines the effectiveness of current exercise interventions for the management of frailty. Eight electronic databases were searched for randomized controlled trials that identified their participants as "frail" either in the title, abstract, and/or text and included exercise as an independent component of the intervention. Three of the 47 included studies utilized a validated definition of frailty to categorize participants. Emerging evidence suggests that exercise has a positive impact on some physical determinants and on all functional ability outcomes reported in this systematic review. Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults. There was a paucity of evidence to characterize the most beneficial exercise program for this population. However, multicomponent training interventions, of long duration (≥5 months), performed three times per week, for 30-45 minutes per session, generally had superior outcomes than other exercise programs. In conclusion, structured exercise training seems to have a positive impact on frail older adults and may be used for the management of frailty.
A Randomized Controlled Feasibility Trial Evaluating a Resistance Training Intervention With Frail Older Adults in Residential Care: The Keeping Active in Residential Elderly Trial. [2022]Frailty is associated with negative health outcomes, disability, and mortality. Physical activity is an effective intervention to improve functional health status. However, the effect of resistance training on multidimensional health in frail older adults remains unclear. This randomized controlled trial was conducted in a U.K. residential care home to assess feasibility with limited efficacy testing on health and functional outcomes and to inform a future definitive randomized controlled trial. Eleven frail older adults (>65 years) completed a 6-week machine-based resistance training protocol three times a week. Uptake and retention were greater than 80%. The measures and intervention were found to be acceptable and practicable. The analyses indicated large improvements in functional capacity, frailty, and strength in the intervention group compared with the controls. These findings support the feasibility of a definitive randomized controlled trial and reinforce the value of resistance training in this population. This trial was registered with ClinicalTrials.gov: NCT03141879.
Are dose-response relationships of resistance training reliable to improve functional performance in frail and pre-frail older adults? A systematic review with meta-analysis and meta-regression of randomized controlled trials. [2023]This systematic review with meta-analyses investigates the impact of resistance training (RT), using meta-regressions, on functional performance in frail and pre-frail adults aged ≥ 65 years to determine the key variables of RT. Ten randomized controlled trials involving 1303 participants were analyzed. Five studies assessed habitual walking speed (HWS), three studies evaluated performance in the timed-up-and-go test (TUG), three studies evaluated performance in the Short Physical Performance Battery (SPPB), and three studies assessed performance in the sit-to-stand test (STS). RT alone improved STS time and SPPB scores in frail and pre-frail older adults. RT improved STS performance (Effect Size (ES):- 0.536; 95% CI - 0.874 to - 0.199; p = .002) and led to a 2.261-point increase in SPPB performance (ES:1.682; 95% CI 0.579-2.786; p = .003). At least two weekly training sessions are required to increase SPPB scores, and three sessions seem to optimize the improvements. Higher training volume per exercise and volume per session reduce the gains in SPPB performance. We did not observe any association between different doses of RT and STS time improvements. RT alone positively influenced TUG performance only in community-dwelling older frail and pre-frail adults but not in institutionalized older individuals. RT alone did not improve the HWS compared to the non-active control group.
High-Intensity Interval Training in Older Adults: a Scoping Review. [2021]High-intensity interval training (HIIT) is an increasingly popular form of aerobic exercise which includes bouts of high-intensity exercise interspersed with periods of rest. The health benefits, risks, and optimal design of HIIT are still unclear. Further, most research on HIIT has been done in young and middle-aged adults, and as such, the tolerability and effects in senior populations are less well-known. The purpose of this scoping review was to characterize HIIT research that has been done in older adults including protocols, feasibility, and safety and to identify gaps in the current knowledge. Five databases were searched with variations of the terms, "high-intensity interval training" and "older adults" for experimental or quasi-experimental studies published in or after 2009. Studies were included if they had a treatment group with a mean age of 65 years or older who did HIIT, exclusively. Of 4644 papers identified, 69 met the inclusion criteria. The average duration of training was 7.9 (7.0) weeks (mean [SD]) and protocols ranged widely. The average sample size was 47.0 (65.2) subjects (mean [SD]). Healthy populations were the most studied group (n = 30), followed by subjects with cardiovascular (n = 12) or cardiac disease (n = 9), metabolic dysfunction (n = 8), and others (n = 10). The most common primary outcomes included changes in cardiorespiratory fitness (such as VO2peak) as well as feasibility and safety of the protocols as measured by the number of participant dropouts, adverse events, and compliance rate. HIIT protocols were diverse but were generally well-tolerated and may confer many health advantages to older adults. Larger studies and more research in clinical populations most representative of older adults are needed to further evaluate the clinical effects of HIIT in these groups.
Can high-intensity interval training improve physical and mental health outcomes? A meta-review of 33 systematic reviews across the lifespan. [2023]High-intensity-interval-training (HIIT) has been suggested to have beneficial effects in multiple populations across individual systematic reviews, although there is a lack of clarity in the totality of the evidence whether HIIT is effective and safe across different populations and outcomes. The aim of this meta-review was to establish the benefits, safety and adherence of HIIT interventions across all populations from systematic reviews and meta-analyses. Major databases were searched for systematic reviews (with/without meta-analyses) of randomised & non-randomised trials that compared HIIT to a control. Thirty-three systematic reviews (including 25 meta-analyses) were retrieved encompassing healthy subjects and people with physical health complications. Evidence suggested HIIT improved cardiorespiratory fitness, anthropometric measures, blood glucose and glycaemic control, arterial compliance and vascular function, cardiac function, heart rate, some inflammatory markers, exercise capacity and muscle mass, versus non-active controls. Compared to active controls, HIIT improved cardiorespiratory fitness, some inflammatory markers and muscle structure. Improvements in anxiety and depression were seen compared to pre-training. Additionally, no acute injuries were reported, and mean adherence rates surpassed 80% in most systematic reviews. Thus, HIIT is associated with multiple benefits. Further large-scale high-quality studies are needed to reaffirm and expand these findings.Abbreviations: ACSM: American College of Sports Medicine; BMI: Body Mass Index; BNP: Brain Natriuretic Peptide; BP: Blood Pressure; CAD: Coronary Artery Disease; CHD: Coronary Heart Disease; COPD: Chronic Obstructive Pulmonary Disease; CRP: c- reactive Protein; CVD: Cardiovascular Disease; DBP: Diastolic Blood Pressure; ES: Effect Size; FAS: Reduced Fatty Acid Synthase; FATP-1: Reduced Fatty Acid Transport Protein 1; FMD: Flow Mediated Dilation; Hs-CRP: High-sensitivity c- reactive Protein; HDL: High Density Lipoprotein; HIIT: High-Intensity Interval Training; HOMA: Homoeostatic Model Assessment; HR: Heart Rate; HTx: Heart Transplant Recipients; IL-6: Interleukin-6; LDL: Low Density Lipoprotein; LV: Left Ventricular; LVEF: Left Ventricular Ejection Fraction; MD: Mean Difference; MetS: Metabolic Syndrome; MPO: Myeloperoxidase; MICT: Moderate-Intensity Continuous Training; NO: Nitric Oxide; NRCT: Non-Randomised Controlled Trial; PA: Physical Activity; PAI-1: Plasminogen-activator-inhibitor-1; QoL: Quality of Life; RCT: Randomised Controlled Trial; RoB: Risk of Bias; RPP: Rate Pressure Product; RT: Resistance Training; SBP: Systolic Blood Pressure; SD: Standardised Difference; SMD: Standardised Mean Difference; TAU: Treatment-As-Usual; T2DM: Type 2 Diabetes Mellitus; TC: Total Cholesterol; TG: Triglycerides; TNF-alfa: Tumour Necrosis Factor alpha; UMD: Unstandardised Mean Difference; WC: Waist Circumference; WHR: Waist-to-Hip Ratio; WMD: Weighted Mean DifferenceKey points: HIIT may improve cardiorespiratory fitness, cardiovascular function, anthropometric variables, exercise capacity, muscular structure and function, and anxiety and depression severity in healthy individuals and those with physical health disorders.Additionally, HIIT appears to be safe and does not seem to be associated with acute injuries or serious cardiovascular events.
Impact of high-intensity interval training on cardiorespiratory fitness, body composition, physical fitness, and metabolic parameters in older adults: A meta-analysis of randomized controlled trials. [2021]High-intensity interval training (HIIT) can effectively increase peak oxygen consumption, body composition, physical fitness, and health-related characteristics of adults; however, its impact in the older population remains highly debated. This review and meta-analysis aimed to evaluate the effects of high-intensity interval training on cardiorespiratory fitness, body composition, physical fitness, and health-related outcomes in older adults. Four electronic databases (PubMed, Scopus, Medline, and Web of Science) were searched (until July 2020) for randomized trials comparing the effect of HIIT on physical fitness, metabolic parameters, and cardiorespiratory fitness in older adults. The Cochrane risk of bias assessment tool was used to evaluate the methodological quality of the included studies; Stata 14.0 software was used for statistical analysis. HIIT significantly improved the maximum rate of oxygen consumption (VO2peak) as compared to a moderate-intensity continuous training (MICT) protocol (HIIT vs. MICT: weighted mean difference = 1.74, 95% confidence interval: 0.80-2.69, p < 0.001). Additional subgroup analyses determined that training periods >12 weeks, training frequencies of 2 sessions/week, session lengths of 40 min, 6 sets and repetitions, training times per repetition of >60 s, and rest times of <90 s were more effective for VO2peak. This systematic review and meta-analysis showed that HIIT induces favorable adaptions in cardiorespiratory fitness, physical fitness, muscle power, cardiac contractile function, mitochondrial citrate synthase activity, and reduced blood triglyceride and glucose levels in older individuals, which may help to maintain aerobic fitness and slow down the process of sarcopenia.
High-Intensity Interval Training in Cardiac Rehabilitation. [2020]Recently, high-intensity interval training (HIIT) has been recognized as a safe and effective alternative to moderate-intensity continuous training for older patients with cardiovascular disease (CVD) in cardiac rehabilitation settings in an effort to improve health outcomes. This brief review considers general principles and suggestions for prescription of HIIT for older patients with CVD, specific challenges pertaining to older adults, the physiologic mechanisms by which HIIT contributes to improvements in peak Vo2, and the effects of HIIT on cardiovascular health in older patients with coronary artery disease and heart failure.
Effects of Low-Speed and High-Speed Resistance Training Programs on Frailty Status, Physical Performance, Cognitive Function, and Blood Pressure in Prefrail and Frail Older Adults. [2021]Aim: The current study investigated the effects of low-speed resistance training (LSRT) and high-speed resistance training (HSRT) on frailty status, physical performance, cognitive function and blood pressure in pre-frail and frail older people. Material and Methods: Sixty older adults, 32 prefrail and 28 frail, were randomly allocated into LSRT, HSRT, and control group (CG). Before and after intervention periods frailty status, blood pressure, heart rate, and a set of physical performance capabilities and cognitive domains were assessed. Exercise interventions occurred over 16 weeks and included four resistance exercises with 4-8 sets of 4-10 repetitions at moderate intensity. Results: The prevalence of frailty criteria in prefrail and frail older adults were reduced after both LSRT and HSRT. In prefrail, LSRT significantly improved lower-limb muscle strength, while mobility was only improved after HSRT. Muscle power and dual-task performance were significantly increased in both LSRT and HSRT. In frail, LSRT and HSRT similarly improved lower-limb muscle strength and power. However, exclusive improvements in dual-task were observed after LSRT. Memory was significantly increased in prefrail and frail, regardless of the type of resistance training. No significant changes were observed in blood pressure and heart rate. Conclusion: Findings of the present study indicated that both LSRT and HSRT reversed frailty status and improved physical performance in prefrail and frail older adults. Notably, different patterns of improvement were observed among RT protocols. Regarding frailty status, LSRT seemed to be more effective in reverse prefrailty and frailty when compared to HSRT. Greater improvements in muscle strength and power were also observed after LSRT, while HSRT produced superior increases in mobility and dual-task performance. One-leg stand performance was significantly reduced in LSRT, but not HSRT and CG, after 16 weeks. In contrast, RT programs similarly improved verbal memory in prefrail. Finally, no changes in blood pressure and heart rate were observed, regardless of the type of RT. Trial Registration: The protocol was approved by the University of Campinas Human Research Ethics Committee (Protocol No. 20021919.7.0000.5404) and retrospectively registered at ClinicalTrials.gov Protocol Registration and Results System: NCT04868071.
Home Exercise Interventions in Frail Older Adults. [2022]Frailty is characterized by decreased physiological reserve and increased risk of falls, disability, hospitalization, and mortality. Frail older adults may benefit from exercise interventions targeting their multiple problems and functional deficits; however, most research focuses on center-based interventions, which may present accessibility challenges for frail older adults. Therefore, the purpose of this review is to summarize the most recently published home-based exercise interventions for frail older adults living at home.
A home-based exercise program focused on proprioception to reduce falls in frail and pre-frail community-dwelling older adults. [2021]Frailty and falls are closely associated with each other as well as with disability, hospitalization, and death. Exercise can reduce these risks in both robust and frail older people. This before-after, non-randomized intervention study assessed a one-year proprioception training program with individual daily home exercises in 564 community-dwelling people aged 70 years and over, with different frailty phenotypes. After the exercise program, we observed a moderate reduction in the mean number of falls, fear of falls, body mass index and body fat percentage in frail and pre-frail participants. These results suggest that a home proprioception program may be a viable alternative to complex multicomponent exercise programs in settings where these are not feasible, since home proprioception can reach a larger population at a lower cost, and it affords clear benefits.