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SarcopeniaPEPOPNCT02717819

The Importance of Additional Protein to Benefit More From Training During and After Hospitalization

A study testing Protein, Resistance training and Vitamin D in people with Sarcopenia, run by Forskningsenheden at 3 sites in Denmark.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of the study is to investigate if an increased protein intake, in the form of a protein-enriched, milk-based supplement, can enhance the beneficial effect of resistance training, offered during hospitalization and 12 weeks post discharge, in older patients. Read more about this study

Who is it for?
Ages 70 years and olderHealthy volunteers can take part
Conditions the study is for
Sarcopenia
What is being tested?
Protein, Resistance training and Vitamin D
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
165 participants
Where
3 sitesDenmark
Study dates
15 Apr 2016to 20 Jun 2018
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 70 years and older
  • All sexes
  • Healthy volunteers accepted
  • Older adult

Who may be able to join

  • Men and women aged ≥ 70 years old
  • Able to speak and understand Danish
  • Expected length of stay > 3 days (evaluated by medical staff at department)
  • Ability to stand independently without walking aids
  • Admitted to the medical departments of Gentofte or Herlev Hospital or Rigshospitalet-Glostrup

Who cannot join

  • Active cancer
  • Renal insufficiency (eGFR < 30 mL/min/1.73m2)
  • Cognitive impairment (not able to comprehend the purpose of the study/give informed consent)
  • Terminal disease
  • Exclusively receiving enteral or parenteral nutrition
  • Milk/lactose allergy or intolerance
Show all 12Show fewer
  • Planning to lose weight/go on a special diet
  • Planned transfer to other hospitals/departments
  • Pacemaker/other implanted electrical stimulants (due to Bio-Impedance Analysis (BIA) measurements)
  • Not being able to lie still in seven minutes (only an exclusion criteria in the sub-study)
  • Withdrawal criteria: Death during admission (does not apply to subsequent admissions)
  • Withdrawal criteria: Discharge/transfer from the medical department before the intervention has started

Trial locations and contacts

3 sites in 1 country.

Denmark3 sites
  • Copenhagen University Hospital Gentofte

    Gentofte Municipality, 2820

  • Rigshospitalet-Glostrup

    Glostrup Municipality, 2600

  • Copenhagen University Hospital Herlev

    Herlev, 2730

Other trials in Denmark

About this study

Official title: A Protein-enriched, Milk-based Supplement to Counteract Sarcopenia in Acutely Ill Geriatric Patients Offered Resistance Exercise Training During and After Hospitalisation - a Double-blinded, Randomized Controlled Trial

The purpose of the study is to investigate if an increased protein intake, in the form of a protein-enriched, milk-based supplement, can enhance the beneficial effect of resistance training, offered during hospitalization and 12 weeks post discharge, in older patients. This will in part be evaluated from measures of muscle strength, muscle mass and physical functioning. Also, the study population's acceptance of the intervention product will be assessed along with measures related to 'cost-effectiveness'.

A sub-study will be performed in a sub-group (n=30) to investigate if bio-impedance analysis (BIA) correlates with Dual-Energy X-ray absorptiometry (DXA) at single time points, and to see if it is possible to track changes in lean body mass. In addition, the reliability of the bio-impedance analyzer will be evaluated.

Also, the prevalence and classification of sarcopenia will be assessed at baseline, and correlations to nutritional status will be investigated (n=120).

Read the detailed description

Main study:

The study design is a block randomised, double-blind, placebo-controlled, multicentre intervention study. A total of 120 hospitalized older adults, above 70 years, will be recruited consecutively from the medical departments of three Hospitals in the Capital Region of Denmark (n=40 each place).

Participants will be randomized into two groups - one group receives protein-enriched, milk-based supplements and the other group receives iso-energetic placebo products. Both groups participate in the same standardized resistance training program, and will be blinded to the supplement content. One training session consists of three exercises of the lower extremities (3 sets of 10 repetitions, pursuing an intensity of 8-12 repetition maximum (RM)). While admitted, supervised resistance training is offered daily. After discharge, the participants are encouraged to perform the same program as self-training four times per week.To ensure progression (or regression if necessary) the participants receive follow-up home visits by a physiotherapist, and thus after discharge the participants are closely monitored. All participants, irrespective of allocation, will get a daily vitamin D supplement.

The study duration for each participant starts while admitted to hospital and lasts until 12 weeks after discharge. Endpoint assessments will be performed at baseline (> 72-h after admission to hospital), after discharge (> 72-h) and 12 weeks (± 2 days) after discharge. A few endpoints will be collected during follow-up (6 months post intervention). Data will be collected by study investigators blinded to the allocation of the participants.

Sub-study: 'Validation of a portable bio-impedance analyzer in a population of older adults ≥ 70 years for the assessment of muscle mass and changes in muscle mass over time' A sub-study will be performed to investigate if the portable InBody-230 BIA correlate with DXA at single time points in 30 hospitalized older people ≥ 70 years, and to see if it is possible to track changes in LBM during the 12-week intervention. Total LBM, total fat mass, and percent LBM will be measured and compared as well as appendicular and trunk LBM. In addition, the reliability of the portable bio-impedance analyzer will be evaluated by assessing the degree of agreement between two subsequent measurements. In continuation of recruitment to the primary study, a subset of participants (n=30) will be asked if they want to participate in this sub-study, irrespective of their allocation in the main study. The measurements are going to be performed twice, while hospitalized and 12 weeks after discharge (± 5 days).

Sub-study: 'Prevalence of sarcopenia and investigation of the relationship between nutritional status and the EWGSOP conceptual stages for sarcopenia in hospitalized older patients > 70 years'.

The prevalence and classification of sarcopenia among Danish hospitalized older patients ≥ 70 years old (n=120) will be evaluated, according to the EWGSOP definition (Hand-grip-strength, 4-m gait speed, Bio-Impedance analysis). Also, examination of the relationship between measurements of nutritional status and the EWGSOP stages for sarcopenia (i.e. no sarcopenia, pre-sarcopenia, sarcopenia and severe sarcopenia) will be assessed at baseline. Nutritional status will be assessed according to BMI (< 18.5, 18.5-20.5, 20.5-25, > 25), Mini Nutritional Assessment (MNA) (no MN, risk of MN, MN), Malnutrition Universal Screening Tool (MUST) (low risk of MN, medium risk of MN, high risk of MN), and NRS-2002 (no MN, mild MN, moderate MN, severe MN)

Results will be communicated to the general population and published in peer-reviewed journals.

Conditions
Sarcopenia
Being tested
Protein, Placebo, Resistance training, Vitamin D
Keywords
Sarcopenia, Muscular atrophy, Frailty, Acute illness, Ageing, Protein supplementation, Whey protein, Resistance training, Strength training
Medical subject headings
Sarcopenia, Muscular Atrophy, Frailty

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ProteinDietary supplement

    Also called Protein-enriched, milk-based supplement (whey protein)

    Daily intake of supplement

  • PlaceboDietary supplement

    Also called Iso-energetic placebo-supplement (no protein)

    Daily intake of supplement

  • Resistance trainingOther

    Resistance training (offered daily while hospitalized, and encouragement of 4 x/week as self-training after discharge)

  • Vitamin DDietary supplement

    Aiming at a dose of 20 ug/day. 20 ug/day will be handed out to study participants who do not get vitamin D supplements from the hospital while admitted and to those who are not already taking vitamin D supplements themselfes e.g. as part of a combination tablet.

Study groups in NCT02717819
Study groupRoleWhat they receive
Resistance training and proteinExperimentalDaily supervised resistance training offered while hospitalized, and encouragement of self-training 4 times per week for duration of 12 weeks after discharge (standardized training program, which will be monitered). Daily intake of 2 x 125 ml protein-enriched, milk-based supplements (whey protein), in the same period (additional ~25 g protein and 1953 kJ per day). Daily vitamin D supplements.
Receives: Dietary Supplement: Protein; Other: Resistance training; Dietary Supplement: Vitamin D
Resistance training and placeboPlacebo comparatorDaily supervised resistance training offered while hospitalized, and encouragement of self-training 4 times per week for duration of 12 weeks after discharge (standardized training program, which will be monitered). Daily intake of 2 x125 ml iso-energetic placebo-supplements, in the same period. Daily vitamin D supplements.
Receives: Dietary Supplement: Placebo; Other: Resistance training; Dietary Supplement: Vitamin D

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in 30-s chair stand performance

    Number of stand-ups from a chair in 30 seconds (modified version, help from armrests are allowed).

    Measured: Baseline (admission to hospital), within 3 days of discharge, and 12 weeks after discharge

Secondary outcomes (18)
  1. Total lean body mass

    Lean body mass (kg and percent) evaluated by bio-impedance analysis (portable, dual-frequency, 8-Point Tactile Electrode System).

    Measured: Baseline (admission to hospital), within 3 days of discharge, and 12 weeks after discharge

  2. Appendicular lean body mass

    Appendicular lean body mass (kg and percent) evaluated by bio-impedance analysis (portable, dual-frequency, 8-Point Tactile Electrode System).

    Measured: Baseline (admission to hospital), within 3 days of discharge, and 12 weeks after discharge

  3. Trunk lean body mass

    Trunk lean body mass (kg and percent) evaluated by bio-impedance analysis (portable, dual-frequency, 8-Point Tactile Electrode System).

    Measured: Baseline (admission to hospital), within 3 days of discharge, and 12 weeks after discharge

  4. Change in hand grip strength

    Isometric hand grip strength (kg) (Saehan Medical digital dynamometer, 2012).

    Measured: Baseline (admission to hospital), within 3 days of discharge, and 12 weeks after discharge

  5. Change in 4 m gait speed

    The time used for walking 4 m (m/s and s )

    Measured: Baseline (admission to hospital), within 3 days of discharge, and 12 weeks after discharge

  6. Change in Activities of daily living (ADL)

    Use of Barthel-100

    Measured: Baseline (admission to hospital), within 3 days of discharge, and 12 weeks after discharge

  7. Change in mobility

    Use of De Morton Mobility Index (DEMMI)

    Measured: Baseline (admission to hospital), within 3 days of discharge, and 12 weeks after discharge

  8. Change in cognitive functioning

    Use of Mini Mental State Examination (MMSE)

    Measured: Baseline (admission to hospital), within 3 days of discharge, and 12 weeks after discharge

  9. Use of home care

    Interview: (yes/no)

    Measured: Baseline (admission to hospital), within 3 days of discharge, and 12 weeks after discharge

  10. Residence

    Interview: (own home, nursing home/assisted living facility, 24-hour rehabilitation facility)

    Measured: Baseline (admission to hospital), within 3 days of discharge, and 12 weeks after discharge

  11. Use of gait aid

    Interview: yes/no/cannot walk and registration of specific gait help

    Measured: Baseline (admission to hospital), within 3 days of discharge, and 12 weeks after discharge

  12. Length of hospital stay (LOS)

    The in-hospital intervention period (date of recruitment until date of discharge) (days)

    Measured: Day of discharge (from hospital)

  13. Readmission to hospital

    Frequency (number)

    Measured: From discharge until 12 weeks post discharge, and 6 months post discharge

  14. Length of total hospital stay for readmissions

    Total length (days).

    Measured: From discharge until 12 weeks post discharge, and 6 months post discharge

  15. Mortality

    Mortality (yes/no)

    Measured: From discharge until 12 weeks post discharge, and 6 months post discharge

  16. Change in health related Quality of life

    Questionnaire: Euroqol EQ-5D-3L

    Measured: Baseline (admission to hospital), within 3 days of discharge, and 12 weeks after discharge

  17. Change in Body weight

    Measured to the nearest 0.1 kg using a calibrated scale

    Measured: Baseline (admission to hospital), within 3 days of discharge, and 12 weeks after discharge

  18. Study population acceptance of product

    Self-administered evaluation-questionnaire

    Measured: 12 weeks post discharge

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Mar 2016 (estimated)
  2. Study start15 Apr 2016
  3. Primary completion20 Dec 2017
  4. Study completion20 Jun 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Outcomes assessor
Enrolment
165 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02717819
Sponsor's protocol ID
EFFECT.PEPOP.2016
Other IDs
H-16018240
Acronym
PEPOP
Status last verified
Aug 2018
First submitted
9 Mar 2016
Last updated
21 Aug 2018
Results posted
No
Data monitoring committee
No
Individual data sharing
No

Publications

  • Gade J, Beck AM, Andersen HE, Christensen B, Ronholt F, Klausen TW, Vinther A, Astrup A. Protein supplementation combined with low-intensity resistance training in geriatric medical patients during and after hospitalisation: a randomised, double-blind, multicentre trial. Br J Nutr. 2019 Nov 14;122(9):1006-1020. doi: 10.1017/S0007114519001831.

    PubMed 31337448
  • Gade J, Beck AM, Bitz C, Christensen B, Klausen TW, Vinther A, Astrup A. Protein-enriched, milk-based supplement to counteract sarcopenia in acutely ill geriatric patients offered resistance exercise training during and after hospitalisation: study protocol for a randomised, double-blind, multicentre trial. BMJ Open. 2018 Feb 1;8(2):e019210. doi: 10.1136/bmjopen-2017-019210.

    PubMed 29391380

Questions about this trial

What is this clinical trial studying?

A study testing Protein, Resistance training and Vitamin D in people with Sarcopenia, run by Forskningsenheden at 3 sites in Denmark.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 21 Aug 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Denmark. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in 30-s chair stand performance (time frame: Baseline (admission to hospital), within 3 days of discharge, and 12 weeks after discharge). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02717819, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Aug 2018.

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