We are delighted to announce that the STRONG study has been funded!
We expect recruitment to start around June 2025. Once we are officially enrolling participants, we will put the info you need to enrol in the study right here.
If you have any questions, you can contact us at STRONG@nshealth.ca.
Reason for this study: Prior research has shown that blueberries, protein, and exercise programs alone are each good for lowering risks of frailty and heart disease. The STRONG study is the first study to test whether having regular blueberries, protein, and workouts together for a year can reduce frailty and risk of heart disease compared to usual diet and exercise plans that people may follow.
Our team’s goal is to find evidence-based ways to keep Nova Scotians feeling strong and healthy as they age!
Study plan: Half of the people in the study (the treatment group) will be given blueberries and protein powder to eat every day and asked to follow three personalized workout sessions per week for a year. The other half (the control group) will follow their usual diet and exercise routines for a year. Everyone will undergo a health assessment every 3 months during this year. One year after this year ends, everyone will have one last health assessment.
STRONG Scientific Summary
Introduction: As frailty and cardiovascular disease (CVD) are closely linked, lifestyle interventions to reduce frailty may improve cardiovascular health in at-risk individuals; however, interventions designed to reduce frailty to date are limited by testing individual lifestyle modifications rather than a prescribed package combining treatments, and none have investigated effects on cardiovascular health.
Objective: To determine whether a year-long STudy on bluebeRries, prOteiN, and exercise for improvinG frailty and CVD (STRONG) intervention reduces frailty and improves cardiovascular health in older Nova Scotians of both sexes.
Methods: STRONG is a pragmatic randomized controlled trial one year in length with an additional year of follow-up. We will recruit 240 older Nova Scotians aged ≥65 years (120 females and 120 males) using stratified sampling. Participants will be randomly assigned to one of two groups for 12 months: the control group (usual care) or the treatment group (the STRONG intervention of 1 cup of blueberries/day, 30g of protein/day, and three 60-minute multimodal exercise sessions with an exercise physiologist/week). Measured outcomes will include changes in CVD risk factors (e.g. blood pressure, lipid profile, glucose levels, Framingham risk scores), cardiovascular health (e.g. six-minute walk test, cardiac function measures), inflammatory markers, frailty (e.g. frailty index scores, balance, falls, changes in life-space, social engagement), physical fitness, and health-related quality of life.
Implications: CVD and frailty share pathophysiological mechanisms and pose a significant burden in Nova Scotia, straining the healthcare system and the well-being of its residents. Interventions that modify lifestyle may reduce both frailty and the burden of CVD on individual health outcomes and the broader healthcare system. This project will yield insights into the combined effects of protein, blueberries, and physical activity on cardiovascular health and frailty, potentially offering an evidence-based lifestyle treatment recommendation for older adults of both sexes.
STRONG TEAM
Dr. Susan Howlett is Professor of Pharmacology and Geriatric Medicine at Dalhousie University in Halifax where she has taught for more than 30 years. Her laboratory has discovered profound differences in male and female heart cell function, how these change with age and how sex hormones regulate these processes. Her lab has pioneered the measurement of frailty in naturally aging animals with a novel "frailty index" (FI) tool based on deficit accumulation. Her work shows that maladaptive, age-dependent changes in heart structure and function are better graded by the level of frailty than by age itself. A translational scientist, she has used results from animal studies to develop a new tool based on lab results (the FI-Lab) to measure frailty in people and has started STRONG to investigate how diet and exercise mitigate frailty and improve cardiovascular health in older adults.
Dr. Kenneth Rockwood is a geriatrician with a career-long interest in frailty. At Dalhousie University, he is a Professor of Geriatric Medicine & Neurology and holds a Chair in Frailty and Aging. With Nova Scotia Health, he is a staff physician, and Senior Medical Director of the Frailty and Elder Care Network. In 2024 he was made an Officer of the Order of Canada for his work on frailty and dementia.
Dr. Leah Cahill (she/her) is the Nutrition Lead for STRONG, as well as the Biostatistical Lead, and she oversees the patient/public partner engagement for STRONG. Dr. Cahill is Principal Investigator of the nourish research team at Nova Scotia Health and Dalhousie University where she holds the Howard Webster Research Chair in the Department of Medicine. A licensed and registered dietitian, Dr. Cahill completed her PhD at the University of Toronto before working as a post-doctoral scientist at Harvard University for five years before moving to Nova Scotia to establish her research program. Her research studies healthy aging and the prevention and treatment of cardiometabolic diseases using interventional, epidemiological, and clinical patient-oriented research methods that incorporate biomarkers, environmental factors (especially nutrition), and social determinants of health.
Dr. Scott Grandy is the Physical Activity Lead for STRONG. Dr. Grandy is an Associate Professor in the School of Health and Human Performance (Kinesiology) and Pharmacology, Dalhousie University. He is a senior scientist with the Beatrice Hunter Cancer Research Institute and an affiliate scientist in the Divisions of Cardiology and Medical Oncology, Nova Scotia Health, Central Zone. Dr. Grandy’s primary research focuses on how exercise can be used to prevent and treat chronic disease. Currently, he is investigating whether exercise can mitigate the cardiotoxic effects of cancer treatments and the increased risk of cardiovascular disease (CVD). More recently Dr. Grandy has begun to examine frailty in chronic disease populations to better understand how the relationship between exercise and frailty and how this relationship impacts treatment outcomes. To help address his research questions, Dr. Grandy co-established and co-leads the Physical Activity and Cancer Lab.
Olivia Mercer is the Study Coordinator extraordinaire for STRONG. In the years prior to graduating from St Francis Xavier University in May 2024 with a Bachelor of Arts and Science in Health, she worked for Nova Scotia Health Authority Research Ethics Board in the Archival Department, assisting with development of policy and utilizing information management systems and data collection. Since completing her undergraduate degree, she has been working as a Research Assistant to Drs Melanie Keats and Scott Grandy in the Physical Activity and Cancer Lab at Nova Scotia Health Authority. As a passionate swimmer, competing for many years, the importance of physical activity and health are close to her heart.
Chiara is a Research Associate with the Nourish Research Group. Her role with STRONG will include managing the data and conducting data analysis. She completed her undergraduate degree in Life Science at Queen's University (2020) and her Master's in Community Health & Epidemiology at Dalhousie University (2024). She is passionate about lots of areas of health research, particularly implementation studies that aim to turn research findings into real-life interventions that improve the healthcare system and patients' quality of life. Chiara enjoys getting exercise through cycling and dance and is excited to be a part of a physical activity study!
Tom Christensen is the Clinical Physiologist (CEP) for STRONG. Tom recently completed his masters degree a Dalhousie University, researching in the Physical Activity and Cancer (PAC) lab. Tom loves helping people maintain, improve, and enjoy their health and fitness. He develops the personalized exercise program for STRONG participants and leads them through the workouts.
Debbie Wright is a professional Registered Nurse with over 36 years’ experience in Critical Care, Cardiology and Emergency Care areas in various hospital settings as well as Emergency Flight Nursing. After many years in acute clinical care, she moved towards management and administration within Nova Scotia Health Authority. In 2012 as NSHA’s Cardiology Research Manager, she led the development of the research enterprise and in this capacity managed large-scale projects. It is in this role that she met and began working with Dr Scott Grandy on physical activity research. She expertly provides management and administrative support for STRONG.
STRONG has a panel of 5 public/patient partners who are older adults with diverse lived experience on our research team. They participate in every stage of our research, from designing research questions to planning studies, interpreting results, and sharing findings. They have all had patient-oriented research training from the Canadian Institutes of Health Research (CIHR).
Chris Consmueller is a first-year graduate student (Master’s of Science, Kinesiology) at Dalhousie University. In the spring of 2024, Chris graduated with a Bachelor of Science, Kinesiology (first-class honors) and Certificate in Human Physiology. He carries a strong passion for optimizing health through lifestyle factors (i.e. diet and exercise). Chris has built a diverse research background, participating in multiple research internships related to cardiovascular health. For example, during the summer of 2024, he took part in a three-month volunteer research internship focusing on cardiovascular immunometabolism at LMU Klinikum in Munich, Germany. Chris has started to work on his current Master’s study (the STRONG project) and is filled with excitement to use the results of this study to produce evidence-based lifestyle treatment plans for Nova Scotians with or at-risk of heart disease and/or frailty.
Basma Hagmusa is a first-year medical student at Dalhousie University. She completed her undergrad at the university of Toronto earning a Bachelor of Science degree for a double major in Biology and Chemistry. She has participated in research published about nano technology and its antimicrobial activities. As a medical student, she is working on STRONG to study ways to optimize the participation and retention of older adult participants in research studies.
Isabel Jeon (she/her) is a 3rd year undergraduate student studying medical sciences at Dalhousie University. She is from New Brunswick. Isabel has always had a passion for exercise and physical activity, and currently plays for the Dalhousie women's field hockey team. The STRONG study is Isabel's first involvement in research; she is excited to be part of the team!
STRONG in the News!
You can read more about STRONG in this announcement article here.