Overview

This trial is active, not recruiting.

Condition ischemic preconditioning
Treatments remote ischemic preconditioning (ripc), exercise
Phase phase 2
Sponsor The Hospital for Sick Children
Start date May 2010
End date February 2013
Trial size 12 participants
Trial identifier NCT01164618, 1000015862

Summary

The purpose of this study is to assess the effects of repeated RIPC and exercise, on exercise performance, skeletal muscle responses and circulating cellular and humoral biology in humans

United States No locations recruiting
Other Countries No locations recruiting

Study Design

Allocation randomized
Endpoint classification efficacy study
Intervention model crossover assignment
Masking open label
Primary purpose basic science
Arm
(Experimental)
The subjects in this arm will begin on the daily remote ischemic preconditioning (RIPC) protocol for 10 days. After a 21 day washout period they will then crossover to 10 days of daily exercise.
remote ischemic preconditioning (ripc)
RIPC will be induced using a standard blood pressure cuff and hand anaeroid sphygmomanometer, on the right arm. The subject will be seated, the blood pressure cuff placed on the arm and inflated to a pressure of 200mmHg for 5 minutes (ischemia). The cuff will then be deflated for 5 minutes (reperfusion) completing one cycle of ischemia reperfusion. A total of 4 inflation and deflation cycles will be applied. This protocol of RIPC will be applied daily, for 10 consecutive days.
exercise
Subjects will then undergo exercise daily, for 10 consecutive days. A chronic high-intensity interval exercise training protocol standardized to subjects' aerobic power (VO¬2max) will be used. Each exercise session will consist of a 5 min warm-up period followed by 4 sets of 2 min high intensity intervals interspersed with 3 min recovery periods.
(Experimental)
The subjects in this arm will begin on the exercise protocol for 10 days. After a 21 day washout period they will then crossover to 10 days of daily remote ischemic preconditioning (RIPC).
remote ischemic preconditioning (ripc)
RIPC will be induced using a standard blood pressure cuff and hand anaeroid sphygmomanometer, on the right arm. The subject will be seated, the blood pressure cuff placed on the arm and inflated to a pressure of 200mmHg for 5 minutes (ischemia). The cuff will then be deflated for 5 minutes (reperfusion) completing one cycle of ischemia reperfusion. A total of 4 inflation and deflation cycles will be applied. This protocol of RIPC will be applied daily, for 10 consecutive days.
exercise
Subjects will then undergo exercise daily, for 10 consecutive days. A chronic high-intensity interval exercise training protocol standardized to subjects' aerobic power (VO¬2max) will be used. Each exercise session will consist of a 5 min warm-up period followed by 4 sets of 2 min high intensity intervals interspersed with 3 min recovery periods.

Primary Outcomes

Measure
Ischemia-reperfusion injury tolerance
time frame: Day 1 of the Excercise intervention
Ischemia-reperfusion injury tolerance
time frame: Day 1 of the RIPC intervention
Ischemia-reperfusion injury tolerance
time frame: Day 2 of the Excercise intervention
Ischemia-reperfusion injury tolerance
time frame: Day 2 of the RIPC intervention
Ischemia-reperfusion injury tolerance
time frame: Day 10 of the Excercise intervention
Ischemia-reperfusion injury tolerance
time frame: Day 10 of the RIPC intervention

Secondary Outcomes

Measure
Change in skeletal muscle metabolic parameters metabolism as measured by 31P-MRS and BOLD fMRI over time within groups and between groups
time frame: Days 1, 2 and 10 days of each intervention (RIPC and Excercise)
Neutrophil Function - adhesion, phagocytotic index, and superoxide production over time within groups and between groups
time frame: Days 1, 2 and 10 of each intervention (RIPC and Excercise)
Neutrophil Gene Expression over time within groups and between groups
time frame: Days 1, 2 and 10 of each intervention (RIPC and Excercise)
Ischemia-reperfusion injury tolerance
time frame: Days 1, 2 and 10 of each intervention (RIPC and Excercise)
Exercise Capacity (VO2max) over time within groups and between groups
time frame: Day 10 of each intervention (RIPC and Exercise)

Eligibility Criteria

Male or female participants at least 18 years old.

Inclusion Criteria: 1. Age ≥ 18 years, 2. Informed consent Exclusion Criteria: 1. Contraindication to exercise, 2. Vigorous aerobic/anaerobic exercise in duration of ≥15 minutes during the 21 days prior to commencement of the study, or either of the RIPC or exercise protocol arms, 3. Overt viral or bacterial infection in the 10 days prior to commencement of the study, or during either of the RIPC or exercise protocol arms, 4. Alcohol and/or caffeine consumption in the 10 days prior to, or at any time during the study period 5. Pregnancy

Additional Information

Official title The Biology of Chronic Preconditioning: Genomic and Physiologic Mechanisms of Response
Principal investigator Andrew Redington, MD
Description Remote ischemic preconditioning (RIPC) results in a powerful and widespread protective effect against subsequent prolonged ischemia-reperfusion (IR) injury of distant organs and systemic inflammatory responses, both of which are key elements in the evolution of local and multiorgan effects of many clinical IR syndromes. The signal transduction within the target organ to generate ischemia tolerance, and the effects of RIPC on systemic anti-inflammatory pathways, however, remain to be elucidated fully. Particularly, data regarding the mechanisms of 'second window' protection (a resurgence of protection 24-72 hrs after the initial RIPC stimulus) is scant; even less is known of the effects of repeated RIPC, and a potential 'third window' of protection. Our preliminary data and several recent publications have shown that the biology of RIPC and exercise show considerable overlap. This research has raised the possibility of a reciprocal effect between RIPC and exercise, with chronic exercise being a model of the potential effects of 'chronic preconditioning'. This is relevant, as repeated RIPC might be a strategy to improve exercise function in those with limited exercise tolerance e.g. heart failure.
Trial information was received from ClinicalTrials.gov and was last updated in August 2013.
Information provided to ClinicalTrials.gov by The Hospital for Sick Children.