Train High Eat Low for Osteoarthritis (THE LO Study)
Two-thirds of older Australians are affected by osteoarthritis (OA) of the knee, a condition in which there is progressive degeneration and loss of the articular cartilage meant to protect bony surfaces and absorb impact across joints. Knee osteoarthritis may reduce physical activity due to associated pain, depression, impaired gait and balance and lower-extremity muscle weakness and is the most common cause of disability in older adults.
It is known that a combination of genetic, lifestyle and mechanical factors contribute to the development and the clinical expression of OA. For example, abnormal joint loading (in particular increased knee adduction moment or KAM due to varus malalignment in medial knee OA), obesity, muscle weakness, sarcopenia, systemic and local inflammation, sedentariness, and dietary intake of fat, antioxidants and other micronutrients alter the risk and progression of OA.
Elevated KAM has been shown to increase the risk of radiographic medial knee OA progression by 6.5-fold, more than any other characteristic. Lifestyle programs have great potential to target these underlying factors, thus acting as disease-modifying interventions rather than simply providing pain relief.
THE LO Study is a randomised controlled clinical trial which aims to show for the first time that gait training, progressive resistance training, a low glycaemic index diet or a combination of these 3 targeted interventions will additively decrease the risk of disease progression, by reducing abnormal joint loading (KAM) through complementary, yet independent pathways.
This study is currently recruiting participants. If you are over 40 and have osteoarthritis of the knee, you may qualify for this research study. Please contact Kylie Anderberg on 9351-9826 for more information.
(Funded by the NHMRC)
Regular Exercise for Peripheral Arterial Ischaemia: A Randomised controlled Intervention Trial (REPAIR IT)
Peripheral vascular disease occurs in 17-24% of persons over the age of 70. Its primary symptom is pain when walking, called "intermittent claudication". Current first line treatment guidelines for patients with Peripheral Vascular Disease (PVD) are to "walk to maximum claudication pain, rest, repeat as often as possible". However, there are a group of patients with this disease who are unable to complete these walking guidelines due to the severity of claudication pain and/or co-morbidities such as osteoarthritis, obesity, diabetic foot complications. These patients are consequently prescribed pharmaceutical therapy, as they generally are unable to tolerate surgery.
In comparison to pharmacotherapy, meta-analysis of exercise has been shown to significantly improve symptoms of PVD with mean improvements in overall walking ability of 150%-179%. Meta-analysis of specific pharmacotherapy has been shown to improve walking distance by only 30-54%. In addition, the current obesity/type 2 diabetes epidemic is likely to markedly increase PVD prevalence thereby creating an urgent and compelling need for new evidence-based exercise guidelines for those with PVD and related co-morbidities who are unable to undertake the current walking treatment.
Weight lifting or progressive resistance training (PRT) may be a suitable alternative, as it has been shown to improve walking ability with benefits comparable to those seen in aerobic exercise programs. PRT also offers therapeutic benefit for the associated co-morbidities in this cohort, including coronary artery disease obesity, type 2 diabetes, hypertension and mobility impairment. With almost no data on PRT in PVD, there is convincing need for definitive, robust trials.
REPAIR IT will be the first randomised controlled trial in the world to evaluate the effect of regular exercise compared to current walking guidelines for PVD, whilst simultaneously examining possible mechanisms of benefit.
This study is currently recruiting participants. If you are aged 50 years or older and experience pain in your legs when you walk due to peripheral arterial disease or if you would like more information, please contact Belinda Parmenter on 9351-9528.
Study of Mental and Regular Training (The SMART Study)
Over 200,000 individuals are affected by dementia in Australia. The personal, social and economic burden of this illness is enormous, and is only projected to increase due to the ageing of the population. Even relatively modest goals, such as delaying the onset of dementia by a few years could have a large impact on quality of life for those afflicted and their families.
New strategies aimed at preventing cognitive decline are therefore an urgent priority with mounting evidence that involvement in a variety of mentally and physically stimulating activities throughout life may be important for optimal brain function and a reduced occurrence of memory problems in older adults. Even when started in later life, mental and physical exercises can maintain or improve brain function compared to those who do not engage in such activities. However, the best type or combination of activities to achieve such benefits is far from clear.
We have designed a robust clinical trial in which individuals who have early changes in memory or thinking ability without an identified cause will be randomly assigned to mental exercises, weight lifting exercise, both interventions together, or a control condition.
SMART Study participants receive a free comprehensive health assessment by a geriatrician and are instructed in a combination of mental and physical exercises 2 days per week, for 6 months. All training will be supervised by highly qualified health care professionals at the Lidcombe campus.
The University of Sydney and the University of New South Wales are currently investigating the effect of mental and physical training on memory and thinking abilities of older adults. Participants can be men or women aged 55 and older who currently may have early changes in memory. If you think you may be eligible, please contact Nidhi Jain on 9351-9138.
(Funded by the NHMRC)
ed Resistance Exercise and Type 2 Diabetes in Older Adults (The GREAT2DO Study)
Currently, there nearly 200 million adults with diabetes in the world, with this number estimated to rise to 333 million by the year 2025. Approximately 20% of older Australians have type 2 diabetes, 50% of it undiagnosed. Older adults comprise the largest group of adults with diabetes in Australia and internationally, and the excess morbidity, mortality and health care expenditures (government and personal) associated with this condition are rising rapidly, highlighting the urgent need to address strategies for this global epidemic.
We will use high velocity progressive resistance training (PRT), as it is the most specific way to target the most abundant and most insulin-resistant fast twitch muscle fibres in diabetes, and it has been shown to help prevent diabetes in high-risk adults. PRT has been shown to reduce blood pressure and improve dyslipidaemia and systemic inflammation, the risk factor profile linked to cardiovascular disease in this cohort.
The GREAT2DO Study aims to define the mechanisms of adaptation, feasibility, safety, and long-term adherence to Power Training to improve health outcomes for this fast growing population. Translation into clinical practice and generalisability is enhanced by the community setting we have chosen for implementation, the 12 month intervention and 5 year follow-up, and the typical older diabetic patients with metabolic syndrome and multiple co-morbidities we will recruit.
This randomised controlled clinical trial aims to show for the first time that high velocity PRT added to usual medical care of older adults with type 2 diabetes and metabolic syndrome is an extremely novel, strongly evidence-based, and potentially powerful adjunctive treatment for the epidemic of type 2 diabetes and its associated cardiovascular risk profile in older adults.
(Funded by the NHMRC; Recruitment has closed for this study)
Knowledge and Awareness of Anti-Doping in the Sporting Community
Despite the implementation of the World Anti-Doping Agency (WADA) code, some athletes continue to engage in doping behaviour and their knowledge and understanding of these substances may be of concern. This study proposes to anonymously survey a diverse and representative sample of about 3000 athletes at elite/sub-elite athletes from a range of sports and their coaches in order to:
- determine their awareness and knowledge of the Anti-Doping Policy & testing procedures;
- investigate their level of knowledge about prohibited substances; and
- examine their attitudes and behaviours towards doping in sport.
The results will also provide an understanding of the psychological reasons for doping and thus enable the future development of educational and anti-doping strategies in athletes based on preventative measures.
(Funded by Dept Health and Ageing, Anti-Doping Research program)
The Good Vibrations Study: Optimal Standing Posture in Whole Body Vibration for Muscle and Bone Improvements in Older Adults
This six-month randomised controlled trial aims to investigate the optimal standing posture (knees locked vs. flexed) to produce improvements in muscle and bone characteristics.
A comprehensive profile of bone and muscle function, mass, architecture and strength will be made by state of the art quantitative computed tomography (pQCT), X-ray absorptiometry (DEXA), blood markers and functional testing.
Whole body vibration (WBV) is a novel exercise modality with recent reported benefits to muscle and bone in humans. WBV uses high-frequency mechanical stimuli which are generated by a vibrating platform and transmitted through the body where they load the bone and stimulate muscle sensory receptors. Vibration application to the whole body has now been reported to improve muscle strength, bone mineral density balance and mobility.
Many studies have used various protocols for testing mechanical loading on the human skeleton through vibration. There is a need for further research to establish WBV as a safe and efficient way of improving strength and preventing muscle deterioration and fracture in humans.