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| ID | Type | Description | Link |
|---|---|---|---|
| R21AT010847 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| University of Oklahoma | OTHER |
| National Center for Complementary and Integrative Health (NCCIH) | NIH |
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The purpose of this study is to determine whether massage can attenuate the loss of muscle mass in humans after a short period of disuse.
The loss of skeletal muscle mass is a common symptom associated with diseases such as cancer, AIDS, diabetes, and congestive heart failure, and with aging. Muscle atrophy is associated with poor disease prognosis and decreased quality of life and therefore, maintaining muscle size and reducing the loss of muscle during disuse atrophy is of vital significance. Mechanical stimulation of muscle, such as during resistance exercise, stimulates protein synthesis that increases muscle protein content, and muscle size. The investigators have shown that mechanical stimulation applied to skeletal muscle in the form of massage is an effective mechanotherapy in rats, since it leads to a shift in protein turnover favoring anabolism, attenuation of muscle loss and enhanced regrowth after disuse-induced atrophy. Whether the same positive effect of massage occurs in humans is currently unknown, but would be extremely beneficial for skeletal muscle and overall health in case where resistance exercise is contraindicated or not feasible. In addition to the direct anabolic effects on the massaged rat muscle, the investigators have shown an equally beneficial response on the homologous muscle in the contralateral non-massaged limb. This novel finding indicated the existence of indirect mechanisms that could have profound systemic effects beyond the massaged muscle. Extracellular vesicles (EVs) are lipid membrane-bound vesicles released from cells with the ability to modulate function of cells from which they are released, as well as in cells with which they fuse. As such EVs are likely mediators of the well-documented but poorly-understood effects of massage in humans on the brain and other organs, such as relief of pain, anxiety or depression or changes in immunity. Therefore, the goal of this proposal is to determine anabolic effects of massage in human muscle, and to identify whether EVs released with massage are candidates for beneficial effects of this mechanotherapy on muscle as well as other organs. In Aim 1 the investigators will address the following hypothesis: Massage acts as a mechanotherapy by attenuating muscle atrophy through a shift in protein biogenesis towards anabolism in humans. Using a novel massage device we will apply mechanical load to muscle undergoing atrophy through unilateral lower limb suspension and muscle size as well as protein synthesis and degradation will be determined. In Aim 2 the investigators will test the hypothesis that massage attenuates the loss of EVs during atrophy by enhancing EV biogenesis in muscle. The investigators will measure EVs and their miRNA cargo in the serum, and markers of EV biogenesis in muscle of human subjects from Aim 1. Results from this study will indicate not only whether mechanotherapy, such as massage, can attenuate atrophy and enhance anabolic processes during disuse, but also determine whether EVs are a candidate mechanism for the overall health benefits of massage.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Ambulatory Control | No Intervention | Following baseline assessments, participants will be randomized into the ambulatory group for the remainder of the study. Atrophy will not be induced and massage intervention will not be applied. Ambulatory groups will be recruited following the immobilized groups. | |
| Ambulatory Massage | Sham Comparator | Following baseline assessments, participants will be randomized into the ambulatory group for the remainder of the study. No atrophy induction. Four massage treatments will be applied every other day until the end of the study. Ambulatory groups will be recruited following the immobilized groups. |
|
| Immobilization Control | No Intervention | Following baseline assessments, participants will be randomized into the unilateral lower limb suspension group undergoing atrophy for the remainder of the study. Massage intervention will not be applied. | |
| Immobilization Massage | Experimental | Following baseline assessments, participants will be randomized into the unilateral lower limb suspension group undergoing atrophy for the remainder of the study. Four massage treatments will be applied every other day until the end of the study. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Massage | Other | A custom-made cyclic compressive loading (CCL) device will be used to apply a mechanical load to the left thigh of the participants. Massage application using a 35 Newton load will be applied for 15 minutes every other day over the course of 7 days for a total of four massages. |
| Measure | Description | Time Frame |
|---|---|---|
| Percent Change in Myofiber Cross Sectional Area (CSA). | The ability of massage to attenuate the atrophic response to disuse will be determined. Muscle biopsies of the vastus lateralis will be used to quantify myofiber cross-sectional area. The percent change in myofiber size between day 7 and day -2 was used. Calculation details: [(day 7 CSA) - (day -2 CSA)/(day -2 CSA)]*100 | 9 days |
| Myofibrillar Protein Synthesis Rate (MyoKsyn). | The ability of massage to attenuate the atrophic response to disuse due to protein synthesis will be determined. Muscle biopsies of the vastus lateralis will be used to quantify protein synthesis rates. | 9 days |
| Measure | Description | Time Frame |
|---|---|---|
| Percent Change in Serum Extracellular Vesicle Number (EV #). | The ability of massage to attenuate the loss in EV number will be determined. Serum will be used to quantify EV numbers. The percent change in EVs between day 7 and day -2 was used. | 9 days |
| Percent Change in the Expression of Muscle Rab27b mRNA. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Esther Dupont-Versteegden, Ph.D. | University of Kentucky | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Kentucky | Lexington | Kentucky | 40536 | United States |
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Consent, inclusion/exclusion criteria checklist, participant characteristics such as height and weight, and pregnancy testing were conducted prior to randomization.
Subjects were actively recruited from the University of Kentucky campus as well as from the surrounding Lexington community through local advertisement using IRB approved recruitment flyers or newspaper advertisement. Recruitment occurred between August of 2020 and May 2023.
The COVID pandemic shut down research activities at the University of Kentucky for some time impacting recruitment. Thus, the PI decided to focus on randomization of immobilized groups
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| ID | Title | Description |
|---|---|---|
| FG000 | Ambulatory Control | Following baseline assessments, participants will be randomized into the ambulatory group for the remainder of the study. Atrophy will not be induced and massage intervention will not be applied. Ambulatory groups will be recruited following the immobilized groups. |
| FG001 | Ambulatory Massage | Following baseline assessments, participants will be randomized into the ambulatory group for the remainder of the study. No atrophy induction. Four massage treatments will be applied every other day until the end of the study. Ambulatory groups will be recruited following the immobilized groups. Massage: A custom-made cyclic compressive loading (CCL) device will be used to apply a mechanical load to the left thigh of the participants. Massage application using a 35 Newton load will be applied for 15 minutes every other day over the course of 7 days for a total of four massages. |
| FG002 | Immobilization Control | Following baseline assessments, participants will be randomized into the unilateral lower limb suspension group undergoing atrophy for the remainder of the study. Massage intervention will not be applied. |
| FG003 | Immobilization Massage | Following baseline assessments, participants will be randomized into the unilateral lower limb suspension group undergoing atrophy for the remainder of the study. Four massage treatments will be applied every other day until the end of the study. Massage: A custom-made cyclic compressive loading (CCL) device will be used to apply a mechanical load to the left thigh of the participants. Massage application using a 35 Newton load will be applied for 15 minutes every other day over the course of 7 days for a total of four massages. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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More focus was placed on immobilization groups during COVID. The ambulatory massage group was not recruited as a result.
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| ID | Title | Description |
|---|---|---|
| BG000 | Ambulatory Control | Following baseline assessments, participants will be randomized into the ambulatory group for the remainder of the study. Atrophy will not be induced and massage intervention will not be applied. Ambulatory groups will be recruited following the immobilized groups. |
| BG001 |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Percent Change in Myofiber Cross Sectional Area (CSA). | The ability of massage to attenuate the atrophic response to disuse will be determined. Muscle biopsies of the vastus lateralis will be used to quantify myofiber cross-sectional area. The percent change in myofiber size between day 7 and day -2 was used. Calculation details: [(day 7 CSA) - (day -2 CSA)/(day -2 CSA)]*100 | Only one biopsy post 9 days was taken in the ambulatory groups only and thus % change could not be calculated. For the immobilization control group, one biopsy specimen could not be accurately analyzed due to tissue quality. | Posted | Mean | Standard Deviation | percent change from baseline | 9 days |
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Adverse events were monitored over the 9 day study period and for approximately 3 days post last biopsy.
AEs and SAEs were collected according to the standard definitions used by clinicaltrials.gov.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Ambulatory Control | Following baseline assessments, participants will be randomized into the ambulatory group for the remainder of the study. Atrophy will not be induced and massage intervention will not be applied. Ambulatory groups will be recruited following the immobilized groups. |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Nausea | Nervous system disorders | Non-systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Douglas Long | University of Kentucky | 859-323-5438 | delong2@uky.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Apr 13, 2023 | Apr 23, 2024 | Prot_002.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Oct 7, 2019 | May 15, 2024 | SAP_003.pdf |
| ICF | No | No | Yes | Informed Consent Form | Apr 13, 2023 | Jun 12, 2023 | ICF_001.pdf |
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| ID | Term |
|---|---|
| D009133 | Muscular Atrophy |
| D001284 | Atrophy |
| ID | Term |
|---|---|
| D020879 | Neuromuscular Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D020763 | Pathological Conditions, Anatomical |
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| ID | Term |
|---|---|
| D008405 | Massage |
| ID | Term |
|---|---|
| D064746 | Therapy, Soft Tissue |
| D026201 | Musculoskeletal Manipulations |
| D000529 | Complementary Therapies |
| D013812 | Therapeutics |
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Primary outcome assessors are blinded to treatment.
|
The ability of massage to attenuate the loss in Rab27b protein expression will be determined. Muscle biopsies of the vastus lateralis will be used to quantify muscle Rab27b expression. The percent change in muscle Rab27b expression between day 7 and day -2 was used. |
| 9 days |
| PI withdrawal, subject could not follow study schedule |
|
| Ambulatory Massage |
Following baseline assessments, participants will be randomized into the ambulatory group for the remainder of the study. No atrophy induction. Four massage treatments will be applied every other day until the end of the study. Ambulatory groups will be recruited following the immobilized groups. Massage: A custom-made cyclic compressive loading (CCL) device will be used to apply a mechanical load to the left thigh of the participants. Massage application using a 35 Newton load will be applied for 15 minutes every other day over the course of 7 days for a total of four massages. |
| BG002 | Immobilization Control | Following baseline assessments, participants will be randomized into the unilateral lower limb suspension group undergoing atrophy for the remainder of the study. Massage intervention will not be applied. |
| BG003 | Immobilization Massage | Following baseline assessments, participants will be randomized into the unilateral lower limb suspension group undergoing atrophy for the remainder of the study. Four massage treatments will be applied every other day until the end of the study. Massage: A custom-made cyclic compressive loading (CCL) device will be used to apply a mechanical load to the left thigh of the participants. Massage application using a 35 Newton load will be applied for 15 minutes every other day over the course of 7 days for a total of four massages. |
| BG004 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Standard Deviation | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
|
| OG001 | Ambulatory Massage | Following baseline assessments, participants will be randomized into the ambulatory group for the remainder of the study. No atrophy induction. Four massage treatments will be applied every other day until the end of the study. Ambulatory groups will be recruited following the immobilized groups. Massage: A custom-made cyclic compressive loading (CCL) device will be used to apply a mechanical load to the left thigh of the participants. Massage application using a 35 Newton load will be applied for 15 minutes every other day over the course of 7 days for a total of four massages. |
| OG002 | Immobilization Control | Following baseline assessments, participants will be randomized into the unilateral lower limb suspension group undergoing atrophy for the remainder of the study. Massage intervention will not be applied. |
| OG003 | Immobilization Massage | Following baseline assessments, participants will be randomized into the unilateral lower limb suspension group undergoing atrophy for the remainder of the study. Four massage treatments will be applied every other day until the end of the study. Massage: A custom-made cyclic compressive loading (CCL) device will be used to apply a mechanical load to the left thigh of the participants. Massage application using a 35 Newton load will be applied for 15 minutes every other day over the course of 7 days for a total of four massages. |
|
|
| Primary | Myofibrillar Protein Synthesis Rate (MyoKsyn). | The ability of massage to attenuate the atrophic response to disuse due to protein synthesis will be determined. Muscle biopsies of the vastus lateralis will be used to quantify protein synthesis rates. | Participants were not randomized to the ambulatory massage group. For the immobilization control group, one biopsy specimen could not be accurately analyzed due to tissue quality. | Posted | Mean | Standard Deviation | percentage of protein produced per day | 9 days |
|
|
|
| Secondary | Percent Change in Serum Extracellular Vesicle Number (EV #). | The ability of massage to attenuate the loss in EV number will be determined. Serum will be used to quantify EV numbers. The percent change in EVs between day 7 and day -2 was used. | Data was not generated. | Posted | 9 days |
|
|
| Secondary | Percent Change in the Expression of Muscle Rab27b mRNA. | The ability of massage to attenuate the loss in Rab27b protein expression will be determined. Muscle biopsies of the vastus lateralis will be used to quantify muscle Rab27b expression. The percent change in muscle Rab27b expression between day 7 and day -2 was used. | Data was not generated. | Posted | 9 days |
|
|
| 0 |
| 9 |
| 0 |
| 9 |
| 0 |
| 9 |
| EG001 | Ambulatory Massage | Following baseline assessments, participants will be randomized into the ambulatory group for the remainder of the study. No atrophy induction. Four massage treatments will be applied every other day until the end of the study. Ambulatory groups will be recruited following the immobilized groups. Massage: A custom-made cyclic compressive loading (CCL) device will be used to apply a mechanical load to the left thigh of the participants. Massage application using a 35 Newton load will be applied for 15 minutes every other day over the course of 7 days for a total of four massages. | 0 | 0 | 0 | 0 | 0 | 0 |
| EG002 | Immobilization Control | Following baseline assessments, participants will be randomized into the unilateral lower limb suspension group undergoing atrophy for the remainder of the study. Massage intervention will not be applied. | 0 | 16 | 0 | 16 | 4 | 16 |
| EG003 | Immobilization Massage | Following baseline assessments, participants will be randomized into the unilateral lower limb suspension group undergoing atrophy for the remainder of the study. Four massage treatments will be applied every other day until the end of the study. Massage: A custom-made cyclic compressive loading (CCL) device will be used to apply a mechanical load to the left thigh of the participants. Massage application using a 35 Newton load will be applied for 15 minutes every other day over the course of 7 days for a total of four massages. | 0 | 16 | 0 | 16 | 5 | 16 |
| Pain | Musculoskeletal and connective tissue disorders | Non-systematic Assessment | Persistent pain following biopsy |
|
| Blister | Skin and subcutaneous tissue disorders | Non-systematic Assessment | Blister forming underneath steri-strip applied following bioppsy. |
|
| Fatigue | General disorders | Non-systematic Assessment | Participant reported feeling more fatigue after ingesting heavy water |
|
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| D013568 | Pathological Conditions, Signs and Symptoms |
| D012816 | Signs and Symptoms |
| D026741 | Physical Therapy Modalities |
| D012046 | Rehabilitation |