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In this proposal, the investigators challenge the assumption that following the physical activity guidelines implies benefit for ALL adults, and that if benefit is not achieved in response to first line therapy, it will be by simply exercising more. Thus, for improving cardiorespiratory fitness and cardiometabolic risk factors, unanswered questions include: 1) To what extent, regardless of increasing exercise intensity or amount, is exercise not associated with benefit? Demonstration of a resistance to benefit through exercise in a substantial number of adults would be a novel and important finding, would counter the assumptions of many if not most health care practitioners, and could have immediate and direct application in all health care settings. 2) To what extent will non-responders to first line therapy (150 min/wk) be required to increase exercise intensity or amount to achieve benefit? 3) To what extent will failure to improve CRF segregate (be associate with) with cardiometabolic risk factors? The investigators propose that adults who remain exercise resistant for improvement in CRF and cardiometabolic risk despite increasing amount or intensity are at high risk of metabolic disease and consequently, are candidates for alternative treatment strategies.
The trial has two objectives:
Primary objective: After 16 weeks of first line therapy (150 min/wk of MPA), does increasing exercise intensity or amount for 16 weeks improve cardiorespiratory fitness (CRF, VO2peak) deferentially depending on the CRF response at 16 weeks.
Secondary objective: Determine whether common cardiometabolic risk factors segregate/cluster with respect to variation in CRF to first line therapy in adults, and, whether clinically meaningful improvements in cardiometabolic risk factors segregate with improvement in CRF.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Low amount, low intensity exercise | Experimental | exercise dose (amount and intensity) will be controlled. |
|
| Low amount, high intensity exercise | Experimental | exercise dose (amount and intensity) will be controlled. |
|
| Control | No Intervention | no exercise intervention | |
| High amount, high intensity exercise | Experimental | exercise dose (amount and intensity) will be controlled. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Low amount, low intensity exercise | Behavioral | Participants will exercise under supervision. Exercise dose will vary by amount and intensity |
|
| Measure | Description | Time Frame |
|---|---|---|
| Cardiorespiratory Fitness | Cardiorespiratory fitness will be determined using direct (open circuit spirometry) measures of oxygen consumption (expressed in L/min) obtained during a maximal treadmill test. | Measured at baseline and every 4 weeks for 32 weeks. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in glucose | Fasting glucose (mmol/L) | Measured at baseline, 16 and 32 weeks. |
| Change in blood lipids | Fasting LDL- and HDL-cholesterol (mmol/L) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Robert Ross, PhD | Contact | 613-533-6583 | rossr@queensu.ca |
| Name | Affiliation | Role |
|---|---|---|
| Robert Ross, PhD | Queen's University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| School of Kinesiology and Health Studies, Queen's University | Recruiting | Kingston | Ontario | K7L 3N6 | Canada |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40688055 | Derived | Ross R, Day AG, Stotz PJ, Wade S, Cooke R, Miller E, Liberatore N, Lamarche B. Response variability to exercise (REVISE): Study rationale, design and methods. Contemp Clin Trials Commun. 2025 Jul 5;46:101519. doi: 10.1016/j.conctc.2025.101519. eCollection 2025 Aug. |
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All data will be made available upon request.
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Within 1 year of study completion.
Deidentified participant data collected during the trial will be available to external groups upon scientific review.
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| ID | Term |
|---|---|
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D001519 | Behavior |
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randomized trial
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| Low amount, high intensity exercise | Behavioral | Participants will exercise under supervision. Exercise dose will vary by amount and intensity |
|
| High amount, high intensity exercise | Behavioral | Participants will exercise under supervision. Exercise dose will vary by amount and intensity |
|
| Measured at baseline, 16 and 32 weeks.] |
| Change in insulin | fasting insulin (pmol/L) | Measured at baseline, 16 and 32 weeks.] |
| Change in triglycerides | fasting triglycerides (mmol/L) | Measured at baseline, 16 and 32 weeks. |
| Change in body fat | Total adiposity | Measured at baseline, 16 and 32 weeks |
| Change in abdominal fat | Visceral adiposity | Measured at baseline, 16 and 32 weeks. |
| Change in lean body mass | Lean mass | Measured at baseline 16 and 32 weeks. |
| Change in subcutaneous fat | Subcutaneous adiposity | Measured at baseline, 16 and 32 weeks. |
| Change in obesity phenotype | waist circumference | Measured at baseline 16 and 32 weeks. |
| Change on body weight | Body weight | Measured at baseline, 16 and 32 weeks. |