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The
University of Michigan Health System (UMHS), Ann Arbor, Michigan
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INFORMED
CONSENT OF A SUBJECT
PARTICIPATING IN A RESEARCH STUDY
(Version April 1998)
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1.
GENERAL INFORMATION
The Institutional Review Board for Human Subject Research at the
University of Michigan Medical School (IRBMED) reviewed this research
project from the standpoint of the protection of human research
subjects. The IRBMED found the project to be in compliance with
the regulations of the United States Government and of the University
of Michigan.
| 1.1 |
This version
of the consent document was prepared on: 2001/05/29
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| 1.2 |
This version
of the consent document was approved by the IRBMED on: 2001/07/26
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| 1.3 |
This project's
approval by the IRBMED will expire on: 2002/07/26
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| 1.4 |
The archive number
assigned by the IRBMED to this project is: 1998-316
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| 1.5 |
Names of the
investigators responsible for this project: Katarina T.
BORER, Ph.D., Josephine Z. KASA-VUBU, M.D., Maryfran SOWERS,
Ph.D., and Mark SUPIANO, M.D.
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| 1.6 |
The title of
this research project is: Endocrine effects of training
exercise intensity in postmenopausal women.
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| 1.7 |
The protocol
number assigned to this study is: 1563 (GCRC)
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| 1.8 |
This research
is funded by: N/A |
2. INFORMATION ON THE RESEARCH STUDY
2.1 What is the purpose of this research study?
The purpose of this research project is to see whether exercise training
at different intensities affects body fat loss and the risks of developing
diabetes, coronary heart disease, and hypertension in postmenopausal
women. At the present time the effects of exercise intensity on these
factors are not well understood. This study will add to the basic
understanding of these issues and allow us to recommend to postmenopausal
women optimal exercise intensities to lose body fat, increase GH secretion
and increase insulin sensitivity.
2.2 Who can take part in this study?
You can participate in this study if you are a woman between the ages
of 50 and 65 years who is postmenopausal and on hormone replacement
therapy, in good general health, have a body mass index (BMI, weight
in kg/height in m2) of between 25 and 35, and exercise less than 20
min/day two days a week. However, if you have one or more of the following
conditions, you may not be eligible: an endocrine or metabolic disease,
hypertension or other condition requiring medication that would interfere
with the physiologic response to exercise; if you are smoking and
have respiratory disease (asthma), if you are dieting, or have musculo-skeletal
conditions that would preclude walking. The study group will be composed
of fifteen women. In case more subjects may wish to participate than
the study can accommodate, we will accept participants in the order
in which they apply except for two Afro-American and one Oriental
woman who will be given priority in order to meet the required ethnic
composition of the group.
2.3 Why should I consider
joining this study as a research subject?
Direct benefits to you include expected fat loss, lean mass increase,
improved cardiovascular fitness, probable decrease in health risks
for cardiovascular morbidity and mortality and for development of
diabetes and cancer. You also will receive useful information about
your body fat and bone mineral level, food intake, and risk of developing
diabetes. You will receive a $150 remuneration for blood collection
at the completion of the study.
2.4 Do I have to become
a subject in this study? If I joined the study, can I change my
mind and drop out before it ends?
Your becoming a subject in this study is entirely by your own free
choice. You may also drop out of the study by your own free will,
after having agreed to become a subject. You may refuse to enroll
in the study, or drop out of the study at any time without any penalty;
by doing so, you will not lose any benefits that you may be entitled
to.
In case you withdraw from the study, you will not be harmed in any
way but you will not receive the expected health benefits from walking
exercise: fat loss, lean mass increase, improved cardiovascular
fitness, probable decrease in health risks for cardiovascular morbidity
and mortality and for development of diabetes and cancer. You also
will not be eligible to receive monetary remuneration.
The investigators of this study may have to end your taking part
in this study as a subject, if any of the following conditions came
up:
| 1. |
you do not comply
with the agreed-upon walking routine; |
| 2. |
you do not cooperate
in agreed-upon measurements and blood collections; |
| 3. |
you stop hormone-replacement
therapy or start taking medication that could interefere with
physiologic reponses to exercise; and |
| 4. |
you start smoking
or dieting. |
2.5 What exactly will
be done to me, and what kinds of treatments or procedures will I
receive, if I agree to be a research subject in this study?
This study will involve a walking program at different walking speeds
for a period of 30 weeks. We will first determine your body fat
and aerobic fitness. Body fat will be assessed by measuring skinfold
thickness and circumference of different parts of your body . This
will be done in the CCRB and take approximately 30 minutes. Body
fat will be also measured through a whole body with a very low-radiation
dose X-ray scan called DEXA. This will be done at the School of
Public Health and take about 45 minutes. We will also measure total
body fat by bioimpedance in the General Clinical Research Center
(GCRC). This is done by measuring your body water with a very weak
electric current. These procedures will allow us to accurately determine
how much fat there is in your body, where it is distributed, and
how it changes with exercise training. Your aerobic fitness will
be assessed by having you breathe through a mouth piece as you walk
on a treadmill at different speeds. We will be measuring your aerobic
capacity from the breathing rate and the amount of oxygen you consume
as the effort increases. On the basis of the body fat and aerobic
fitness, we will match you with two other women of similar body
composition and aerobic capacity and assign you to a slow or fast-walking
group. Walking will be carried out five days a week. You will start
with one mile per day, and increase distance by one half mile each
week until you attain 3/miles per day. You will keep walking 3 miles/day
five days a week until the end of week 30. The same measurements
(aerobic capacity and body composition) will be repeated after 15
and 30 weeks of training.
The study also involves blood collection on three occasions, at
the start of the study and after 15 and 30 weeks of training. The
first and second time, you will be admitted to the General Clinical
Research Center (GCRC) for a total of 17 hours, and the third time
for a total of 14 hours. Upon admission by 5 pm, an intravenous
cannula will be placed in an arm vein or removal of blood samples
and for injection of hormone insulin and sugar glucose. A blood
sample (2 ml) will be collected at 10-minute intervals between 6
pm and 8 am the next morning. Dinner will be served at 6 pm, and
a snack at 9 pm. On two occasions only (at the start and after 15
weeks), you will be given no food by mouth from when you wake up
in the morning until 12:00 noon. At 08:00 in the morning a second
catheter will be inserted into a hand vein and you will receive
some glucose through the other catheter. On those two occasions,
between 8 am and 12:00 h, hormone insulin and glucose will be given
through one catheter and blood samples will be taken at frequent
(1 minute to 10 minute) intervals through the other to see how rapidly
your body takes up glucose from the blood. This tells us how sensitive
your body is to hormone insulin and indicates the risk of your becoming
diabetic. About one half of a pint of blood will be removed during
two tests which is about one half of the amount that can be safely
removed at any one time.
We will also ask that you fill out three-day dietary recalls and
7-day activity questionnaires on three occasions, at the start of
the study, after week 15 and week 30 of walking. This will take
about 10 minutes for each form each time. From this we will determine
how many calories you eat and from which food groups and how much
energy you expend in sleep and different physical activities.
We will share with you all the health information we obtain through
measurements. All of your records will be kept confidential.
2.6 What kinds of
harm can I experience in this study, and what will the investigators
do to reduce the chances of harm?
Vein puncture for the placement of an indwelling catheter may cause
pain, bruising, or inflammation. Standard sterile techniques for
vein puncture will be used and regular examination of i.v. catheter
sites will be done. Pain associated with vein puncture is usually
mild and short-lived. Blood collected each of three times will be
less than one half of the amount that can be safely removed at one
time and less than the amount normally removed in a simple blood
donation. There is a small chance that the injection of insulin
could lead to low blood sugar level (hypoglycemia.) A whole-body
x-ray scan (DEXA) involves exposure to a low level of x-ray radiation
which is less than 1% of radiation to which humans can safely be
exposed. A small chance of muscle soreness is possible upon initiation
of walking program.
As in everyday locomotion, injuries of the ankle, and knee could
occur.
There is a small chance that some subjects will experience mild
cardiorespiratory distress upon initiation of this program.
2.6 (b) Indicate the
measures to be taken to minimize each risk.
Vein puncture for the placement of an indwelling catheter will be
performed with standard sterile techniques. The sites will be regularly
examined to detect early signs of inflammation.
Anemia will be screened during the initial history and a blood count.
The blood count will be repeated at any point of the study if anemia
is clinically suspected. Infusion of variable amounts of blood sugar
during the insulin sensitivity test serves to prevent development
of hypoglycemia. Plasma glucose concentrations will be measured
with an automatic glucose analyzer at 5 minute intervals during
insulin infusion. Any deviations from normal blood sugar level will
be rapidly corrected by changing the rate of glucose infusion. The
dose of x-ray radiation is less than 1% of permissible annual radiation
exposure and should not pose any health hazard to participants.
Risks of joint injuries will be prevented or minimized by inclusion
of a warm up and cool down, recommendations to wear appropriate
walking shoes and by walking on a level surface. You should be given
clearance from your personal physician attesting that no conditions
exist that would make exercise potentially hazardous to your health.
Healthy people should experience no cardiac distress with any level
of walking in this study. Your answers in Physical Activity Readiness
Questionnaire also will help us identify conditions that would make
exercise potentially hazardous. If at any time any subject develops
chest pains or shortness of breath, exercise will be discontinued
and a physician consulted.
As an additional risk management measure, at least one person at
each walking session will have minimal training in American Red
Cross Adult CPR and Standard First Aid.
Taking part in more than one research study may be harmful to you.
If you are already taking part in another study, please let us know.
You should not take part in more than one study at the same time,
unless you and the investigators agree that you are not likely to
be harmed, and the outcome of the study will not be disturbed. This
is particularly important if you are receiving in another research
study any investigational or non-investigational drugs, or any kind
of radiation. If taken at the same time, some drugs may change each
other's effects on the body, so that one drug may become harmful
because of another drug. Risk of harm from radiation builds up with
each exposure, particularly if you get exposed to it shortly after
another radiation exposure.
2.7 What will the
investigators do to make sure that the information they will collect
on me will not get in wrong hands?
We shall put the information collected about you during the study
into a research record. This research record will not show your
name, but will have codes entered in it, that will allow the information
to be linked to you. However, we shall keep your research record
confidential, to the extent provided by federal, state and local
law. We shall not allow anyone to see your record, other than people
who have a right to see it . You will not be identified in any reports
on this study.
Should you get physically injured as a result of research-related
treatments or procedures, the University of Michigan will provide
first-aid medical treatment. Additional medical treatment will be
provided, if the University determines that it is responsible to
provide such treatment. However, the University does not provide
compensation to a person injured while taking part as a subject
in research.
2.11 Will I get paid
for taking part in this study?
For participation in this study, within three weeks upon its completion,
you will be paid $150 in the form of a check.
2.12 Will I or my
health insurance company be charged for any of the costs of this
study?
No.
2.13 Once I start
in this study as a subject, what do I do if I want to find out more
about the study, or to complain about the way I get treated?
If new information is obtained during the course of this research,
which may indicate that the risks of harm to subjects have increased
significantly, the investigators will let you know, so that you
may reconsider your willingness to stay as a subject in the study.
To find out more about any aspect of this study, including your
rights as a subject, you may contact the persons whose names, addresses
and telephone numbers appear below. If you have any questions or
concerns about your rights as a research subject, or any grievance,
you may also contact the Institutional Review Board for Human Subject
Research (IRBMED), University of Michigan, 4558 Kresge Medical Research
Building I, 200 Zina Pitcher Street, Ann Arbor, MI 48109-0570; telephone
734 763 4768.
2.14 If I decide not to become a subject in this study, what
may happen to me, or what other choices do I have if I need treatment?
Participation in this study is voluntary. You are free to participate
in, or withdraw from the study at any time. The investigators may
terminate your participation under the following circumstances:
failure to (1) follow agreed-upon walking routine, (2) participate
in agreed-upon measurements, or (3) discontinue hormone replacement
therapy or start taking medications that will affect physiological
responses to exercise.
3.
DOCUMENTATION OF CONSENT
3.1 Who gets to keep this document, once I sign it?
One copy of this document will be kept together with the investigators'
research records on this study. A second copy will be given to you
to keep. A third copy will be placed in your University of Michigan
Health System Medical Record.
3.2 Research subject's statement of consent to participate in
this study
I have read the information given above. The investigators personally
discussed with me and told me more about the study, and answered
my questions. I understand the meaning of this information. I am
aware that, like in any research, the investigators cannot always
predict what may happen or possibly go wrong. I have been given
sufficient time to consider if I should join this study. I hereby
consent by my own free choice to take part in the study as a research
subject.
3.3 Research subject's identity, and the identity and dated signatures
of the subject and/or legal representative of the subject, affirming
that consent was given
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Subject's
Name:
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______________________________________ |
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Subject's
Birth Date:
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______________________________________ |
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Subject's
UMHS Case Number:
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______________________________________ |
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Adult
subject personally giving consent:
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______________________________________ |
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Consenting
Signature of the Subject:
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______________________________________ |
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Date:
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______________________________________ |
3.4 Investigators'
confirming statement
I have given this research subject information on the study, which
in my opinion is accurate and sufficient for the subject to understand
fully the nature, risks and benefits of the study, and the rights
of a research subject. There has been no coercion or undue influence.
I have witnessed the signing of this document by the subject.
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Investigator's
Name:
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Katarina T. Borer
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Investigator's
Signature:
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______________________________________ |
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Date:
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______________________________________ |
You can reach the
investigators of this study as follows:
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Name
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Telephone
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E-mail
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Pager
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936-6266
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| Katarina
T. Borer, Ph.D. |
(734)
647-2703
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NA
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| Josephine
Kasa-Vubu, M.D. |
(734)
764-5175
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3383
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| Maryfran
Sowers, Ph.D. |
(734)
936-3892
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NA
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| Mark
Supiano, M.D. |
(734)
761-5564
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2647
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Saved as Consendiabetrev601.rtf in H:\Grantpro\IRB\.
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