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Sedentary TimeSTARTNCT06023680

The Sedentary to Active Rising to Thrive (START) Trial

A study testing Continuous sedentary reduction intervention and Bouted sedentary reduction intervention in people with Sedentary Time and Frailty, run by Johns Hopkins Bloomberg School of Public Health at 2 sites in United States.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

The goal of this behavioral clinical trial is to compare two different ways of becoming less sedentary and more active in 60 older adults at elevated risk of becoming frail. The main question this project aims to answer are whether participants in each intervention are able to gradually replace 30 minutes of sedentary… Read more about this study

Who is it for?
Ages 65 years and olderHealthy volunteers can take part
Conditions the study is for
Sedentary Time, Frailty
What is being tested?
Continuous sedentary reduction intervention and Bouted sedentary reduction intervention
Could I receive a placebo?
No, everyone receives an active treatment
How many people
61 participants
Where
2 sitesUnited States
Study dates
28 Nov 2023to Jun 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

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 65 years and older
  • All sexes
  • Healthy volunteers accepted
  • Older adult

Who may be able to join

  • Adults aged ≥65 years
  • Pre-frail defined as having 1-2 of the following criteria:
  • Self-reported unintentional weight loss
  • Self-reported fatigue
  • Self-reported low activity
  • Slowness measured during a 4-m walking test
Show all 12Show fewer
  • Weakness measured with grip strength
  • Self-reported regular physical activity <20 minutes/day
  • Self-reported willingness to work up to walking for 30 minutes/day
  • Self-reported ability to find a place to walk for up to 30 minutes/day
  • Agree to all study procedures and assessments
  • Ability to provide informed consent

Who cannot join

  • Self-reported diabetes
  • Self-reported problems related to alcohol or drugs
  • Self-reported inability to walk across a room
  • Self-reported use of a walker
  • Self-reported requirement of medical supervision when engaging in physical activity
  • Fallen >2 times in the past month
Show all 12Show fewer
  • Participation in another clinical trial
  • Plan to move out of the area within 6 months
  • Inability to provide self-transportation to study assessment visits
  • Inability to complete a usual-paced 400m walking test within 15 minutes without sitting or the help of another
  • Uncontrolled resting hypertension (>160/90 mmHg)
  • Cognitive impairment determined using the Montreal Cognitive Assessment Test

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • Johns Hopkins ProHealth

    Baltimore, Maryland, 21207

  • Bayview Medical Center

    Baltimore, Maryland, 21224

Other trials in United States

About this study

Official title: The Sedentary to Active Rising to Thrive (START) Trial: A Proof-of-Concept Sedentary Behavior Reduction Program

The goal of this behavioral clinical trial is to compare two different ways of becoming less sedentary and more active in 60 older adults at elevated risk of becoming frail.

The main question this project aims to answer are whether participants in each intervention are able to gradually replace 30 minutes of sedentary (sitting-like) behavior with very light walking over 60 days.

Read more

There are other questions this project aims to answer that include:

  1. whether it is easier to replace sedentary behavior with one 30-minute walking bout or three 10-minute walking bouts
  2. whether becoming less sedentary and more active leads to feeling better, have less stress, pain, and fatigue and have more confidence in becoming more regularly active
  3. whether becoming less sedentary and more active leads to better regulation of inflammation and metabolism

Participants will be randomized into one of two sedentary reduction behavior programs; one program that gradually replaces sedentary time with one 30-minute walking bout and the other program that gradually replaces sedentary time with three 10-minute walking bouts in the morning, afternoon, and evening. Researchers will compare both programs to see which one is easier to achieve and maintain over 60 days.

Read the detailed description

Initiating and maintaining habitual physical activity is difficult for sedentary older adults, particularly those encumbered by health challenges. The 2018 US Physical Activity Guidelines recommends that all adults perform ≥150 minutes/week of physical activity and reduce sedentary behaviors. Yet, traditional approaches to increase physical activity do little to address sedentary behavior reduction, especially for older adults. Lower sedentary behavior is associated with improved biological and psychosocial health-independent of meeting physical activity guidelines. Thus, there remains a critical need to implement and evaluate a structured way to reduce sedentary behavior as a potential pathway for habitual physical activity engagement.

This project aims to test two prescribe-able and feasible strategies to initiate and incorporate sedentary behavior reduction into daily lifestyle with remote monitoring. The interventions are an inexpensive and low burden approach to reduce sedentary behavior and promote habitual physical activity. Moreover, accelerometer-based outcomes of sedentary behavior are novel in intervention settings, particularly when measured in free-living, real-world settings. Lastly, this project directly addresses a gap of successful remotely deployable interventions geared to initiate and build activity into daily life by replacing sedentary time among older adults.

Aim 1. Explore the effectiveness of 2 interventions to reduce sedentary time in pre-frail older adults over 2 months

Hypothesis 1a. Each intervention will reduce objectively measured daily sedentary time from baseline levels over 2 months.

Hypothesis 1b. The continuous intervention will result in more reduction of objectively measured sedentary time than the bouts intervention.

Aim 2. Explore the dose-response relationship between sedentary time changes and patient-reported outcomes that include fatigue, fatigability, anxiety, general and exercise-based self-efficacy, stress, pain, and mood over 2 months

Hypothesis 2: Decreased daily sedentary time over 2 months is associated with decreased fatigue, fatigability, anxiety, stress, and pain, and increased general and exercise-based self-efficacy and mood over 2 months.

Aim 3. Explore the dose-response relationship between sedentary time changes and biomarkers of frailty-related inflammation, including serum interleukin (IL-6) (pg/mL) and tumor necrosis factor (TNF) -alpha receptor 1 (pg/mL) over 2 months

Hypothesis 3. Decreased daily sedentary time is associated with decreased serum (IL-6) and TNF-alpha receptor 1 over 2 months.

Aim 4. Explore the dose-response relationship between changes in sedentary time with biomarkers of glucose and lipid metabolism (glucose, insulin, total cholesterol (TC), low-density lipoprotein cholesterol (LDLC), triglycerides, high-density lipoprotein cholesterol (HDLC)), a cytokine marker related to frailty (Growth/Differentiation Factor-15; (GDF-15), hemoglobin A1C (hbA1c), non-esterified free fatty acid, and untargeted metabolomics-based markers of energy regulation.

Hypothesis 4. Decreased daily sedentary time is associated with decreased levels of blood glucose, insulin, TC, LDLC, triglycerides and increased HDLC, decreased GDF-15, decreased hbA1c, decreased non-esterified free fatty acid, and lower circulating metabolites necessary for energy regulation over 2 months.

Aim 5. Explore the dose-response and diurnal relationships between changes in sedentary time and interstitial glucose continuously monitored over 24 hours for 14 consecutive days using a Libre Pro sensor at baseline and 2 months later

Hypothesis 5. Decreased sedentary time is associated with decreased overall glucose and different time-of-day glucose levels, coefficient of variation, % of time in glucose at various ranges (e.g., ≥200, ≥180, ≥140, 70-180, 70-140, <70, <54 mg/dL), mean daily difference, and mean amplitude of glycemic excursion) over 2 months.

Being tested
Continuous sedentary reduction intervention, Bouted sedentary reduction intervention
Keywords
Physical Activity, Walking, Older Adults
Medical subject headings
Sedentary Behavior, Frailty, Motor Activity

What participants receive

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

  • Continuous sedentary reduction interventionBehavioural

    During Phase 1, one minute of sedentary time will be replaced with very light to light intensity walking at three different times during the day, every day for 10 days, reaching three separate 10-minute walking intervals (or bouts).

    During Phase 2, the three 10-minute walking bouts will be gradually combined into one 30-minute bout over the course of 20 days.

  • Bouted sedentary reduction interventionBehavioural

    During Phase 1, one minute of sedentary time will be replaced with very light to light intensity walking at three different times during the day, every day for 10 days, reaching three separate 10-minute walking intervals (or bouts).

    During Phase 2, the three 10-minute walking bouts will be maintained over the course of 20 days.

Study groups in NCT06023680
Study groupRoleWhat they receive
Continuous sedentary reduction interventionActive comparatorStructured intervention to progressively replace sedentary time with one daily 30-minute light-intensity walking bout
Receives: Behavioral: Continuous sedentary reduction intervention
Bouted sedentary reduction interventionActive comparatorStructured intervention to progressively replace sedentary time with three daily 10-minute light-intensity walking bouts
Receives: Behavioral: Bouted sedentary reduction intervention

What is being measured

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

  1. Change in Sedentary Time

    Sedentary time measured with a wrist worn monitor containing an accelerometer sensor

    This measurement is collected under a 7-day/24-hour wear protocol at baseline and again 2 months afterwards to determine the change in sedentary time before and after either intervention.

    Measured: Baseline, 2 months

  2. Intervention Difference in the Change in Sedentary Time

    Comparing the 2-month change in sedentary time between the two interventions

    Measured: Baseline, 2 months

Secondary outcomes (23)
  1. Change in Physical Activity Accumulation

    Physical activity fragmentation (e.g., broken up activity accumulation) wrist worn monitor containing an accelerometer sensor

    Measured: Baseline, 2 months

  2. Change in Walking Ability

    Ability to walk measured at a usual walking pace for 400m at baseline and 2 months afterwards.

    Measured: Baseline, 2 months

  3. Change in Walking Speed

    Walking speed measured at a usual walking pace for 4m at baseline and 2 months afterwards.

    Measured: Baseline, 2 months

  4. Change in Fatigue

    Fatigue measured using a Fatigue Scale questionnaire measured at baseline and 2 months afterwards.

    On the questionnaire, a score can range from 0-13 where higher scores mean higher fatigue.

    Measured: Baseline, 2 months

  5. Change in Fatigability

    Fatigability measured using a Pittsburgh Fatigability questionnaire measured at baseline and 2 months afterwards.

    On the questionnaire, a score can range from 0-100 where higher scores mean higher fatigability.

    Measured: Baseline, 2 months

  6. Change in Anxiety

    Anxiety measured using an Anxiety Scale questionnaire measured at baseline and 2 months afterwards.

    On the questionnaire, a score can range from 0-20 where higher scores mean higher anxiety.

    Measured: Baseline, 2 months

  7. Change in General Self Efficacy

    General Self Efficacy measured using a General Self Efficacy questionnaire measured at baseline and 2 months afterwards

    On the questionnaire, a score can range from 0-50 where higher scores mean higher general self efficacy.

    Measured: Baseline, 2 months

  8. Change in Exercise-based Self Efficacy

    Exercise-based Self Efficacy measured using an Exercise-based Self Efficacy questionnaire measured at baseline and 2 months afterwards.

    On the questionnaire, a score can range from 0-90 where higher scores mean higher exercise-based self efficacy.

    Measured: Baseline, 2 months

  9. Change in Stress

    Stress measured using a Perceived Stress Scale questionnaire measured at baseline and 2 months afterwards.

    On the questionnaire, a score can range from 0-70 where higher scores mean higher stress.

    Measured: Baseline, 2 months

  10. Change in Pain

    Pain measured using a modified version of the McGill pain questionnaire measured at baseline and 2 months afterwards.

    On the questionnaire, a score can range from 0-5 where higher scores mean greater pain.

    Measured: Baseline, 2 months

  11. Change in Mood

    Mood measured using a Profile of Mood Status questionnaire measured at baseline and 2 months afterwards.

    On the questionnaire, a score can range from 0-20 where higher scores mean greater mood disturbance.

    Measured: Baseline, 2 months

  12. Change in Inflammation

    Inflammation measured from blood draws quantifying serum IL-6 (pg/mL) and TNF-alpha receptor 1 (pg/mL) at baseline and 2 months afterwards

    Measured: Baseline, 2 months

  13. Change in Blood Glucose

    Blood glucose measured from blood draws

    Measured: Baseline, 2 months

  14. Change in Insulin

    Insulin measured from blood draws

    Measured: Baseline, 2 months

  15. Change in Total Cholesterol

    Total cholesterol measured from blood draws

    Measured: Baseline, 2 months

  16. Change in Low-Density Lipoprotein Cholesterol

    Low-density lipoprotein cholesterol measured from blood draws

    Measured: Baseline, 2 months

  17. Change in High-Density Lipoprotein Cholesterol

    High-density lipoprotein cholesterol measured from blood draws

    Measured: Baseline, 2 months

  18. Change in Triglycerides

    Triglycerides measured from blood draws

    Measured: Baseline, 2 months

  19. Change in Growth/Differentiation Factor-15

    Growth/Differentiation Factor-15 measured from blood draws

    Measured: Baseline, 2 months

  20. Change in Metabolites

    Untargeted metabolomics-based markers of energy regulation measured from blood draws

    Measured: Baseline, 2 months

  21. Change in Hemoglobin A1c

    Hemoglobin A1c measured from blood draws

    Measured: Baseline, 2 months

  22. Change in Non-Esterified Free Fatty Acid

    Non-Esterified Free Fatty Acid measured from blood draws

    Measured: Baseline, 2 months

  23. Change in Interstitial Glucose

    Interstitial glucose measured using a continuous glucose monitor worn 24-hours each day for 14 consecutive days at baseline and 2 months afterwards. Specific measurements include overall glucose and different time-of-day glucose levels, coefficient of variation, % of time in glucose at various ranges (e.g., ≥200, ≥180, ≥140, 70-180, 70-140, <70, <54 mg/dL), mean daily difference, and mean amplitude of glycemic excursion).

    Measured: Baseline, 2 months

Timeline

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

  1. First posted5 Sep 2023
  2. Study start28 Nov 2023
  3. Primary completion15 Jul 2026
  4. Study completionJun 2027 (estimated)

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
Other
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Investigator
Enrolment
61 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06023680
Sponsor's protocol ID
IRB00023391
Other IDs
K01AG076967
Acronym
START
Status last verified
Oct 2026
First submitted
29 Aug 2023
Last updated
5 Oct 2026
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Continuous sedentary reduction intervention and Bouted sedentary reduction intervention in people with Sedentary Time and Frailty, run by Johns Hopkins Bloomberg School of Public Health at 2 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 12 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: under way, not looking for participants, as of the sponsor's last update on 5 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 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?

This study is still under way. Results are not available in the source record yet.

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 Sedentary Time (time frame: Baseline, 2 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 5 Oct 2026.

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