Cardiovascular DiseaseCLIP-IINCT01547182
Cooperative Lifestyle Programs (CLIP-II)
A study testing Caloric restriction, Aerobic Training and Resistance Training in people with Cardiovascular Disease and Obesity, run by Wake Forest University Health Sciences at 3 sites in United States.
Trial summary
The aim is to study the effects of weight loss and weight loss combined with different types of physical activity on changes in physical functioning of older adults who are at-risk for cardiovascular disease. Read more about this study
- Who is it for?
- Ages 60 to 79 years
- Conditions the study is for
- Cardiovascular Disease, Obesity, Physical Disability
- What is being tested?
- Caloric restriction, Aerobic Training and Resistance Training
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 249 participants
- Where
- 3 sitesUnited States
- Study dates
- Mar 2012to Oct 2016
- 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 60 to 79 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Residence: community-dwelling men and women from the counties of interest (SR)
- Age: between 60-79 yrs (SR)
- Activity Status: sedentary (less than 60 minutes of moderate intensity structured physical activity each week and occurs in no less than 10 minute blocks; SR)
- Adiposity: obese as defined by a BMI ≥ 30 (OAC)
- Medical Criteria: documented evidence of an MI, PCTI, chronic stable angina, cardiovascular surgery (coronary artery or valvular heart disease) or an ATP III diagnosis of the metabolic syndrome (PCP)
- Mobility Disability: disability defined as self-reported difficulty with walking ¼ mile, climbing stairs, lifting and carrying groceries, or performing other household chores such as cleaning and yard work (SR)
Show all 9Show fewer
- Stability of Residence: does not plan to move out of the county of residence for the duration of the study (SR)
- Agreeableness: willing and able to participate in all aspects of the trial (SR)
- Consents: willing to give an informed consent and sign a HIPAA authorization form (SR)
Who cannot join
- Severe Symptomatic Heart Disease: evidence of unstable angina, symptomatic congestive heart failure, or exercise induced complex ventricular arrhythmias (PCP)
- MI or cardiovascular procedure within the last 3-months (PCP)
- Blood Pressure: a resting blood pressure > 160/100 mmHg (OAC)
- Severe Systemic Disease: diagnosis of Parkinson's disease, chronic liver disease (cirrhosis, chronic hepatitis, etc.), systemic rheumatic condition (rheumatoid arthritis, psoriatic arthritis, Reiter's disease, systemic lupus erythematosus, etc.), end stage renal disease or other systemic diseases or abnormal laboratory values which would preclude participants from safely participating in the protocol or impair their ability to complete the study (PCP)
- Cancer: active treatment for cancer other than non-melanotic skin cancer (PCP)
- Hearing or Sight Impairments: significant visual or hearing impairment that cannot be corrected and results in the inability to use the telephone or hear normal conversation (SR, OAC)
Show all 13Show fewer
- Psychiatric Illness: bipolar depression or schizophrenia (defined as self-reported treatment for these conditions), currently receiving lithium or neuroleptics (PCP)
- Cognitive Impairment: dementia, delirium or impaired cognitive function as defined by a score on the Folstein Mini-Mental Status Exam < 21 (OAC)
- Participation in Other Trials: currently participating in or planning to participate in another medical intervention study (SR)
- Alcohol Intake: consuming more than 21 alcoholic drinks per week or alcoholism (SR)
- Functional Limitations: unable to walk unassisted (SR, OAC)
- English Literacy: unable to speak or read English
- Clinical Center Staff Evaluation: judged to be unsuitable for the trial for any reason by the clinic staff. A participant can be excluded prior to randomization because of some unspecified health problem that has been identified that would put the patient at risk for adherence or retention. These cases are discussed with a recruitment team consisting of the person who has raised the concern, an MD, and the study PIs.
Trial locations and contacts
3 sites in 1 country.
United States3 sites
Kernersville YMCA.
Kernersville, North Carolina, 27284
William G. White YMCA
Winston-Salem, North Carolina, 27101
Fulton YMCA
Winston-Salem, North Carolina, 27105
About this study
The aim is to study the effects of weight loss and weight loss combined with different types of physical activity on changes in physical functioning of older adults who are at-risk for cardiovascular disease.
Read the detailed description
Although aerobic exercise training (AT) has been the cornerstone of rehabilitation for patients with CVD or MetS, experts agree that with the escalating problem of obesity, prevention programs in this area need to target weight loss (WL) as well. This is reinforced by recent research of our own showing that obesity is a major risk factor for physical disability among older adults. From a translational perspective, clinical researchers have recommended that effective community partnerships are needed to deliver such programs. In response to this call, the investigators have recently completed a translational study funded by NHLBI, the Cooperative Lifestyle Intervention Program (CLIP). In this investigation, 288 obese, older adults with CVD or MetS were randomized to a successful aging control treatment (SA), AT, or AT+WL for 18-months. The primary outcome was mobility disability, assessed by performance on the 400 m Walk Test (400MWT), and our staff co-delivered the interventions with agents from 3 counties within the community infrastructure of North Carolina Cooperative Extension Centers. Whereas mobility improved significantly in the AT group compared to SA, AT+WL was superior to either SA or AT.
Building on CLIP, the investigators now propose to increase the translational significance of our interventions by having them delivered exclusively by community partners with our staff as "trainers and advisers" for desired behavior change. In addition, this study will provide the first large scale randomized controlled clinical trial to evaluate the effects of diet-induced weight loss (WL) on mobility in obese, older adults with CVD or the MetS as compared to WL combined with physical activity. The dual primary outcomes will be the 400MWT and muscle strength. Because uncertainty exists about the best approach for promoting WL in older adults due to concerns with the loss of lean mass, the design also permits a contrast between AT+WL and resistance exercise training (RT)+WL on muscle strength. Consistent with CLIP, our WL intervention will target a protein intake of 0.8 g∙kg body mass-1∙d-1. Reasons to consider RT+WL for older adults include: 1) the central role of muscle loss and decline in strength in mobility disability; 2) the underappreciated role of RT in cardiovascular health; 3) the influence of muscle mass on both resting and total energy expenditure as well as fat mass and bone health; and 5) the potential value of RT for improving mobility on tasks that depend heavily on the vertical movement of the center of mass (e.g., stair climbing). Eves and Plotnikoff22 have emphasized the importance of RT in older diseased populations and stated that "the investigators need to discover practical, sustainable, and economically viable ways to safely implement RT at the population level." To accomplish our goals, the investigators have created a community partnership with the YMCA, using 4 sites in Forsyth County, NC. One of the sites serves a large African American population. The investigators are moving this project from Cooperative Extension Centers to the YMCA because the former have neither the equipment nor the personnel necessary to independently train and monitor RT or AT.
- Conditions
- Cardiovascular Disease, Obesity, Physical Disability
- Being tested
- Caloric restriction, Aerobic Training, Resistance Training
- Medical subject headings
- Cardiovascular Diseases, Obesity
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Caloric restrictionBehavioural
Caloric restriction
Aerobic TrainingBehavioural
Walking
Resistance TrainingBehavioural
Lifting weights
| Study group | Role | What they receive |
|---|---|---|
| Weight Loss | Active comparator | Caloric restriction Receives: Behavioral: Caloric restriction |
| Weight Loss and Aerobic Training | Experimental | Caloric restriction and walking Receives: Behavioral: Caloric restriction; Behavioral: Aerobic Training |
| Weight Loss and Resistance Training | Experimental | Caloric restriction and lifting weights Receives: Behavioral: Caloric restriction; Behavioral: Resistance Training |
What is being measured
The primary outcome is the main question the study is designed to answer.
400-M walk test and Lower Leg Strength
Measured: 18 months
Secondary outcomes (1)
CT Scan
This study will generate preliminary estimates of the independent effects of exercise modality during weight loss on changes in CT-derived parameters of bone density and quality (i.e. structure, strength) and serum biomarkers of bone turnover in a subset (n=60) of CLIP II participants.
Measured: November 2013-March 2017
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted7 Mar 2012 (estimated)
- Study startMar 2012
- Primary completionOct 2016
- Study completionOct 2016
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for Cardiovascular DiseaseStudies of the same condition, open and under way.
- More trials run by Wake Forest University Health SciencesThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 249 participants (actual)
Sponsor and investigators
- Lead sponsor
- Wake Forest University Health Sciences
- Sponsor type
- University, hospital or other
- Collaborators
- National Heart, Lung, and Blood Institute (NHLBI)
- Responsible party
- Sponsor
- Investigators
- W. Jack Rejeski, PhD, Principal investigator, Wake Forest UniversityAnthony Marsh, PhD, Principal investigator, Wake Forest University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01547182
- Sponsor's protocol ID
- IRB00018631
- Other IDs
- 2R18HL076441-06
- Acronym
- CLIP-II
- Status last verified
- Aug 2018
- First submitted
- 1 Mar 2012
- Last updated
- 15 Aug 2018
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Rejeski JJ, Fanning J, Nicklas BJ, Rejeski WJ. Six-month changes in ghrelin and glucagon-like peptide-1 with weight loss are unrelated to long-term weight regain in obese older adults. Int J Obes (Lond). 2021 Apr;45(4):888-894. doi: 10.1038/s41366-021-00754-0. Epub 2021 Feb 1.
PubMed 33526855Rejeski WJ, Marsh AP, Fanning J, Ambrosius WT, Walkup MP, Nicklas BJ. Dietary Weight Loss, Exercise, and Inflammation in Older Adults with Overweight or Obesity and Cardiometabolic Disease. Obesity (Silver Spring). 2019 Nov;27(11):1805-1811. doi: 10.1002/oby.22600.
PubMed 31689007Kammire DE, Walkup MP, Ambrosius WT, Lenchik L, Shapses SA, Nicklas BJ, Houston DK, Marsh AP, Rejeski WJ, Beavers KM. Effect of Weight Change Following Intentional Weight Loss on Bone Health in Older Adults with Obesity. Obesity (Silver Spring). 2019 Nov;27(11):1839-1845. doi: 10.1002/oby.22604. Epub 2019 Sep 4.
PubMed 31486297Beavers KM, Ambrosius WT, Rejeski WJ, Burdette JH, Walkup MP, Sheedy JL, Nesbit BA, Gaukstern JE, Nicklas BJ, Marsh AP. Effect of Exercise Type During Intentional Weight Loss on Body Composition in Older Adults with Obesity. Obesity (Silver Spring). 2017 Nov;25(11):1823-1829. doi: 10.1002/oby.21977.
PubMed 29086504Marsh AP, Janssen JA, Ambrosius WT, Burdette JH, Gaukstern JE, Morgan AR, Nesbit BA, Paolini JB, Sheedy JL, Rejeski WJ. The Cooperative Lifestyle Intervention Program-II (CLIP-II): design and methods. Contemp Clin Trials. 2013 Nov;36(2):382-93. doi: 10.1016/j.cct.2013.08.006. Epub 2013 Aug 23.
PubMed 23974035
Study at a glance
From the registry record, last updated by the sponsor on 15 Aug 2018. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Cooperative Lifestyle Programs (CLIP-II)
- ClinicalTrials.gov ID
- NCT01547182
- Acronym / sponsor ID
- CLIP-II / IRB00018631
- Conditions
- Cardiovascular Disease, Obesity, Physical Disability
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 249 participants (actual)
- Lead sponsor
- Wake Forest University Health SciencesUniversity, hospital or other
- Collaborators
- National Heart, Lung, and Blood Institute (NHLBI)
- Study start
- Mar 2012
- Primary completion
- Oct 2016 (actual)
- Study completion
- Oct 2016 (actual)
- First posted
- 7 Mar 2012 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The aim is to study the effects of weight loss and weight loss combined with different types of physical activity on changes in physical functioning of older adults who are at-risk for cardiovascular disease.
Detailed description
Although aerobic exercise training (AT) has been the cornerstone of rehabilitation for patients with CVD or MetS, experts agree that with the escalating problem of obesity, prevention programs in this area need to target weight loss (WL) as well. This is reinforced by recent research of our own showing that obesity is a major risk factor for physical disability among older adults. From a translational perspective, clinical researchers have recommended that effective community partnerships are needed to deliver such programs. In response to this call, the investigators have recently completed a translational study funded by NHLBI, the Cooperative Lifestyle Intervention Program (CLIP). In this investigation, 288 obese, older adults with CVD or MetS were randomized to a successful aging control treatment (SA), AT, or AT+WL for 18-months. The primary outcome was mobility disability, assessed by performance on the 400 m Walk Test (400MWT), and our staff co-delivered the interventions with agents from 3 counties within the community infrastructure of North Carolina Cooperative Extension Centers. Whereas mobility improved significantly in the AT group compared to SA, AT+WL was superior to either SA or AT.
Building on CLIP, the investigators now propose to increase the translational significance of our interventions by having them delivered exclusively by community partners with our staff as "trainers and advisers" for desired behavior change. In addition, this study will provide the first large scale randomized controlled clinical trial to evaluate the effects of diet-induced weight loss (WL) on mobility in obese, older adults with CVD or the MetS as compared to WL combined with physical activity. The dual primary outcomes will be the 400MWT and muscle strength. Because uncertainty exists about the best approach for promoting WL in older adults due to concerns with the loss of lean mass, the design also permits a contrast between AT+WL and resistance exercise training (RT)+WL on muscle strength. Consistent with CLIP, our WL intervention will target a protein intake of 0.8 g∙kg body mass-1∙d-1. Reasons to consider RT+WL for older adults include: 1) the central role of muscle loss and decline in strength in mobility disability; 2) the underappreciated role of RT in cardiovascular health; 3) the influence of muscle mass on both resting and total energy expenditure as well as fat mass and bone health; and 5) the potential value of RT for improving mobility on tasks that depend heavily on the vertical movement of the center of mass (e.g., stair climbing). Eves and Plotnikoff22 have emphasized the importance of RT in older diseased populations and stated that "the investigators need to discover practical, sustainable, and economically viable ways to safely implement RT at the population level." To accomplish our goals, the investigators have created a community partnership with the YMCA, using 4 sites in Forsyth County, NC. One of the sites serves a large African American population. The investigators are moving this project from Cooperative Extension Centers to the YMCA because the former have neither the equipment nor the personnel necessary to independently train and monitor RT or AT.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Weight Loss | Active comparator | Behavioral: Caloric restrictionCaloric restriction |
| Weight Loss and Aerobic Training | Experimental | Behavioral: Caloric restriction, Behavioral: Aerobic TrainingCaloric restriction and walking |
| Weight Loss and Resistance Training | Experimental | Behavioral: Caloric restriction, Behavioral: Resistance TrainingCaloric restriction and lifting weights |
Who may qualify
- Ages
- 60 to 79 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (9 listed)
- Residence: community-dwelling men and women from the counties of interest (SR)
- Age: between 60-79 yrs (SR)
- Activity Status: sedentary (less than 60 minutes of moderate intensity structured physical activity each week and occurs in no less than 10 minute blocks; SR)
- Adiposity: obese as defined by a BMI ≥ 30 (OAC)
- Medical Criteria: documented evidence of an MI, PCTI, chronic stable angina, cardiovascular surgery (coronary artery or valvular heart disease) or an ATP III diagnosis of the metabolic syndrome (PCP)
Key exclusion criteria (13 listed)
- Severe Symptomatic Heart Disease: evidence of unstable angina, symptomatic congestive heart failure, or exercise induced complex ventricular arrhythmias (PCP)
- MI or cardiovascular procedure within the last 3-months (PCP)
- Blood Pressure: a resting blood pressure > 160/100 mmHg (OAC)
- Severe Systemic Disease: diagnosis of Parkinson's disease, chronic liver disease (cirrhosis, chronic hepatitis, etc.), systemic rheumatic condition (rheumatoid arthritis, psoriatic arthritis, Reiter's disease, systemic lupus erythematosus, etc.), end stage renal disease or other systemic diseases or abnormal laboratory values which would preclude participants from safely participating in the protocol or impair their ability to complete the study (PCP)
- Cancer: active treatment for cancer other than non-melanotic skin cancer (PCP)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Caloric restrictionCaloric restriction | Behavioural | Weight Loss, Weight Loss and Aerobic Training, Weight Loss and Resistance Training |
| Aerobic TrainingWalking | Behavioural | Weight Loss and Aerobic Training |
| Resistance TrainingLifting weights | Behavioural | Weight Loss and Resistance Training |
Primary outcome
400-M walk test and Lower Leg Strength
Time frame: 18 months
1 secondary outcome
CT Scan
Time frame: November 2013-March 2017
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 15 Aug 2018.
- Derived from this study: PubMed 33526855Rejeski JJ, Fanning J, Nicklas BJ, Rejeski WJ. Six-month changes in ghrelin and glucagon-like peptide-1 with weight loss are unrelated to long-term weight regain in obese older adults. Int J Obes (Lond). 2021 Apr;45(4):888-894. doi: 10.1038/s41366-021-00754-0. Epub 2021 Feb 1.
- Derived from this study: PubMed 31689007Rejeski WJ, Marsh AP, Fanning J, Ambrosius WT, Walkup MP, Nicklas BJ. Dietary Weight Loss, Exercise, and Inflammation in Older Adults with Overweight or Obesity and Cardiometabolic Disease. Obesity (Silver Spring). 2019 Nov;27(11):1805-1811. doi: 10.1002/oby.22600.
- Derived from this study: PubMed 31486297Kammire DE, Walkup MP, Ambrosius WT, Lenchik L, Shapses SA, Nicklas BJ, Houston DK, Marsh AP, Rejeski WJ, Beavers KM. Effect of Weight Change Following Intentional Weight Loss on Bone Health in Older Adults with Obesity. Obesity (Silver Spring). 2019 Nov;27(11):1839-1845. doi: 10.1002/oby.22604. Epub 2019 Sep 4.
- Derived from this study: PubMed 29086504Beavers KM, Ambrosius WT, Rejeski WJ, Burdette JH, Walkup MP, Sheedy JL, Nesbit BA, Gaukstern JE, Nicklas BJ, Marsh AP. Effect of Exercise Type During Intentional Weight Loss on Body Composition in Older Adults with Obesity. Obesity (Silver Spring). 2017 Nov;25(11):1823-1829. doi: 10.1002/oby.21977.
- Derived from this study: PubMed 23974035Marsh AP, Janssen JA, Ambrosius WT, Burdette JH, Gaukstern JE, Morgan AR, Nesbit BA, Paolini JB, Sheedy JL, Rejeski WJ. The Cooperative Lifestyle Intervention Program-II (CLIP-II): design and methods. Contemp Clin Trials. 2013 Nov;36(2):382-93. doi: 10.1016/j.cct.2013.08.006. Epub 2013 Aug 23.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
W. Jack Rejeski, PhD principal investigator
Wake Forest University
Anthony Marsh, PhD principal investigator
Wake Forest University
3 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Caloric restriction, Aerobic Training and Resistance Training in people with Cardiovascular Disease and Obesity, run by Wake Forest University Health Sciences at 3 sites in United States.
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 9 inclusion and 13 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 15 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 United States. 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. 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?
400-M walk test and Lower Leg Strength (time frame: 18 months). 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 NCT01547182, which also lists 5 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 15 Aug 2018.