Circadian Health Regulation and Optimization for Rejuvenation Outcomes

The purpose of this study is to assess if modifying lifestyle behaviors such as improving nutrition quality while consolidating caloric intake to a consistent 8-10 hour window, incorporating regular exercise and ensuring a consistent sleep window will help improve glucose (sugar) regulation, physical, cognitive and immune function and improve other markers of metabolic, cardiovascular health and aging (i.e. lipid levels, inflammation markers, etc.).

Circadian clocks ("circa" means approximately and "dia" means day) are daily rhythms in physiology and behavior (activity, sleep, eating pattern) that help the body anticipate and adapt to predictable events in the environment. These rhythms are generated and maintained by biological clocks that are present in the brain and almost every organ. Remarkably, even in the absence of any timing information from a device, the human body can keep track of time and thereby help us eat and sleep at optimum times. However, our lifestyle and work schedules can lead us to eat, exercise, and sleep at times that the clocks in our body are not prepared for. When these abnormal daily patterns continue for several weeks or years, it can affect our health in many ways including increased body weight, poor sleep, and elevated risk for various chronic diseases.

A growing body of preclinical research has shown that synchronizing behaviors, such as food intake, exercise, and light exposure, with the body's biological clock improves skeletal muscle function, cognitive performance, and inflammatory markers. Clinical studies have further validated these findings, showing that circadian-based interventions, such as time-restricted eating (TRE), which restricts all caloric intake to a personalized consistent daily eating window, daytime light exposure and exercise have been shown to improve mood, sleep quality and cardiometabolic health. Despite these promising individual findings, no study has comprehensively examined the combined effects of TRE, structured exercise and optimized sleep schedule as an integrated strategy to restore circadian alignment and reverse key physiological markers of aging in older adults.

In this study, the investigators are interested in evaluating the effects of modifying eating, activity and sleeping patterns on age related health outcomes in older adults with elevated blood sugar levels. All participants will be provided with a personalized circadian rhythm optimization (CRO) program centered on (1) consuming a Mediterranean diet within a personalized 8-10-hour daytime window, (2) increasing daytime light exposure and reducing bright light at night, (3) incorporating 150 minutes of moderate-intensity aerobic exercise each week (4) holding a consistent 7-9 hour sleep schedule (5) taking supplements based on individual needs.

The study is 90-days including a 2-week screening/baseline assessment followed by a 2-week period to developed their personalized plan based off their baseline assessments and finally a 8-week guided intervention period. Health assessments will be taken at screening/baseline, and at 90 days. Assessments will include cognitive function (cognitive assessment battery), physical function (VO2 Max, isometric strength, short physical performance battery), dietary recall (ASA24), blood tests (biomarkers of cardiometabolic health and immune parameters), glycemic regulation (Continuous Glucose Monitors), body composition ( bioelectrical impedance scan), dietary intake (logged on the myCircadianClock smartphone app), sleep and quality of life questionnaires, and activity, sleep, and wrist temperature (actigraphy watch) and subclavian and ankle surface temperature (non-invasive temperature sensor).

Inclusion criteria

• Age: 50-80 years
• Fasting glucose ≥ 100 mg/dL or HbA1c > 5.6%
• Own a smartphone (Apple iOS or Android OS)
• Proficient in reading and speaking in English
• An eating window ≥12 hour/day
• Willing to travel to sports facilities for exercise training sessions
• Participants on cardiovascular medications (HMG CoA reductase inhibitors (statins), metformin, SLGT2 inhibitors, GLP1 receptor agonists other lipid-modifying drugs (including over-the counter drugs such as red yeast rice and fish oil), anti-hypertensive, drugs), are allowed if on a stable dose for 6-months, but dose adjustments are not allowed during the study

Exclusion criteria

• Insufficient dietary logging on the mCC app during screening, defined as less than 7 of 14 days of baseline of dietary logging with a minimum of 2 items a day, at least 5 hours apart
• Type 1 Diabetes or Insulin-dependent Type 2 Diabetes
• HbA1C > 9.0%
• Use of sulfonylurea or insulin within the last 3 months (due to unknown safety with TRE)
• Change in medications that could impact study outcomes within the past 6 months
• Change in weight of >4kg in the past 3 months
• Systolic BP greater than 160 mmHg and/or diastolic BP greater than 110 mmHg at rest
• Fasting LDL cholesterol greater than 250 mg/dL
• Fasting triglycerides greater than 500g/dL
• Variable work hours, such as working night shifts
• Caregiver for a dependent requiring frequent nocturnal care/sleep interruptions
• Active tobacco use, illicit drug use, or history of treatment for alcohol abuse in the past 5 years.
• Travel involving a time zone change of more than 3 hours twice or more during the study period
• Active treatment for inflammatory and/or rheumatologic disease
• History of a major adverse cardiovascular event within the past year (acute coronary syndrome, percutaneous coronary intervention, coronary artery bypass graft surgery, hospitalization for congestive heart failure, stroke/transient ischemic attack)
• Uncontrolled arrhythmia (i.e. rate-controlled atrial fibrillation/atrial flutter are acceptable)
• Previously diagnosed with sever aortic stenosis
• Previously diagnosed with sever COPD (FEV1/FVC ratio <.7 & FEV1 (%predicted) <49
• Orthopedic impairments severely compromising exercise performance
• BMI <18.5 kg/m2
• History of thyroid disease requiring dose titration of thyroid replacement medication(s) within the past 6 months (i.e. hypothyroidism on a stable dose of thyroid replacement therapy is not an exclusion).
• History of adrenal disease in the past 5 years
• History of malignancy undergoing active treatment, except non-melanoma skin cancer, in the past 5 years
• History of an eating disorder in the past 5 years
• History of cirrhosis in the past 5 years
• History of stage 4 or 5 chronic kidney disease or dialysis in the past 5 years
• History of HIV/AIDs
• Currently enrolled in weight-loss or weight-management program
• Regularly engages in 100 minutes or more of structured exercise
• VO2 max threshold is above average for that individuals age group [78]
• Uncontrolled psychiatric disorder including prior hospitalization