Effect of Exercise in OI - Full Text View

Sponsor:	Vanderbilt University
Information provided by:	Vanderbilt University
ClinicalTrials.gov Identifier:	NCT00770484

Purpose

The main limitation patients with orthostatic intolerance (OI, or postural tachycardia syndrome, POTS) have to exercise is related to their increase in heart rate when standing. Main pharmacological treatment today is aimed at reducing heart rate with the use of betablockers (propanolol), this theoretically could also improve their exercise capacity; if their heart rate do not increase as much with the medication, they could exercise more. In addition, it has been suggested that in healthy volunteers subjected to head down tilt for 2 weeks (situation that produces a "simulated" transient POTS-like state) a single bout of intense exercise can improve orthostatic tolerance the day after exercising. The mechanisms involved in such response are not that clear but could be an increase in plasma volume already diminished in POTS patients. It seems likely that the same could be true for POTS patients.

The purpose of the present study are to pharmacologically improve the amount of exercise POTS patients can perform by reducing their baseline heart rate (specific aim 1) and to evaluate next day heart responses to an acute bout of intense exercise.

Therefore, the specific aims of this study are:

To test the hypothesis that lowering heart rate response with propanolol will result in an increase in exercise capacity.
To test the hypothesis that a single bout of exercise will result in an improvement in orthostatic tolerance the day after exercising.

Condition	Intervention
Orthostatic Intolerance Postural Tachycardia Syndrome	Drug: Propanolol Drug: Placebo

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Crossover Assignment Masking: Double Blind (Subject, Investigator) Primary Purpose: Treatment
Official Title:	Effects of Exercise in Orthostatic Intolerance

Resource links provided by NLM:

Genetics Home Reference related topics: Brugada syndrome short QT syndrome

MedlinePlus related topics: Exercise and Physical Fitness Marijuana Mitral Valve Prolapse

Drug Information available for: Propranolol hydrochloride Propranolol Dexpropranolol

U.S. FDA Resources

Further study details as provided by Vanderbilt University:

Primary Outcome Measures:

Maximal Oxygen Consumption Capacity (VO2 max) [ Time Frame: At the time of the actual intervention ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Heart rate in response to the intervention [ Time Frame: Day after intervention ] [ Designated as safety issue: No ]

Estimated Enrollment:	20
Study Start Date:	November 2008
Estimated Study Completion Date:	November 2012
Estimated Primary Completion Date:	November 2012 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Propanolol	Drug: Propanolol Propanolol 20 mg, given orally within 1 hour prior to exercising
Placebo Comparator: Placebo	Drug: Placebo Placebo, matching pill given orally within 1 hour prior to exercising

Detailed Description:

Subjects will be studied twice, once after receiving placebo and in a second occasion after receiving propanolol.
An exercise capacity test with estimation of maximal oxygen consumption (VO2 max) will be done within 1 hour of receiving a pill containing placebo and that will be in appearance identical to the one for propanolol. This test will be conducted on a stationary bicycle and the effort will be gradually increased while expired air is measured during exhaustive physical work. The test will last approximately 30 minutes and be conducted in Vanderbilt's Clinical Trial Center.
The day before and the day after the exercise test subjects will be asked to collect urine for 12 hours each time and to keep a record of how much liquid they ingest.
Posture study tests (measurements of heart rate and blood pressure taken while lying down and at intervals for up to 30 minutes while standing) will be done the day before and the day after the exercise test.

Eligibility

Ages Eligible for Study:	18 Years to 65 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Meet diagnostic criteria of POTS (Raj, et al., 2005)
Age between 18-65 years
Male and female are eligible (although the majority of patients POTS are female).
Able and willing to provide informed consent

Exclusion Criteria:

Presence of medical conditions that can explain postural tachycardia (e.g., dehydration, medications)
Pregnancy
Other factors which in the investigator's opinion would prevent the subject from completing the protocol.
Patients who are bedridden or chair-ridden.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00770484

Locations

United States, Tennessee
Vanderbilt University Medical Center	Recruiting
Nashville, Tennessee, United States, 37232
Contact: Alfredo Gamboa, MD adcresearch@vanderbilt.edu
Sub-Investigator: Alfredo Gamboa, MD
Sub-Investigator: Luis Okamoto, MD
Sub-Investigator: Andre Diedrich, M.D. Ph.D.
Sub-Investigator: Ginnie Farley
Principal Investigator: Italo Biaggioni, MD

Sponsors and Collaborators

Vanderbilt University

More Information

No publications provided

Responsible Party:	Italo Biaggioni, M.D. Professor of Medicine and Pharmacology., Vanderbilt University
ClinicalTrials.gov Identifier:	NCT00770484 History of Changes
Other Study ID Numbers:	080722
Study First Received:	October 9, 2008
Last Updated:	March 30, 2011
Health Authority:	United States: Institutional Review Board

Keywords provided by Vanderbilt University:

Exercise
Propanolol
Beta blockers

Additional relevant MeSH terms:

Orthostatic Intolerance
Mitral Valve Prolapse
Neurocirculatory Asthenia
Tachycardia
Postural Orthostatic Tachycardia Syndrome
Primary Dysautonomias
Autonomic Nervous System Diseases
Nervous System Diseases
Neurologic Manifestations
Signs and Symptoms
Heart Valve Prolapse
Heart Valve Diseases
Heart Diseases
Cardiovascular Diseases
Anxiety Disorders

Mental Disorders
Arrhythmias, Cardiac
Pathologic Processes
Propranolol
Anti-Arrhythmia Agents
Cardiovascular Agents
Therapeutic Uses
Pharmacologic Actions
Antihypertensive Agents
Adrenergic beta-Antagonists
Adrenergic Antagonists
Adrenergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs

ClinicalTrials.gov processed this record on February 09, 2012