Weight loss and exercise to improve rheumatoid arthritis cardiovascular risk

减肥和运动可改善类风湿性关节炎心血管风险

• 批准号: 9884906
• 负责人: KIM M. HUFFMAN
• 金额: $ 28.34万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9884906
• 关键词: Accounting; Adherence; Adipose tissue; Aerobic; Aerobic Exercise; Age; Arthralgia; Blood Glucose; Blood Pressure; Body Composition; Body Weight decreased; Cardiopulmonary; Cardiovascular Diseases; Cells; Clinical; Clinical Trials; Counseling; Dietitian; Disease; Educational Intervention; Elderly; Exercise; Exercise Test; Fasting; Fatigue; Fatty acid glycerol esters; Future; Gap Junctions; Glucose; Health; High Density Lipoprotein Cholesterol; Inflammation; Inflammatory; Information Systems; Insulin; Intervention; Investigation; Lead; Lipoproteins; Measurement; Measures; Medication Management; Metabolic syndrome; Modeling; Obesity; Outcome; Pain; Participant; Patient Outcomes Assessments; Patient Self-Report; Patients; Persons; Pharmacological Treatment; Physical Function; Physical activity; Positioning Attribute; Randomized; Reporting; Resistance; Rheumatism; Rheumatoid Arthritis; Risk; Risk Factors; Safety; Side; Skeletal Muscle; Supervision; Support Groups; System; Time; Training; Training Programs; Triglycerides; Work; arm; base; cardiometabolic risk; cardiometabolism; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; clinical care; design; diet and exercise; exercise training; functional gain; global health; health disparity; immune function; improved; inflammatory marker; insulin sensitivity; macrophage; monocyte; mortality; physical inactivity; post intervention; primary outcome; programs; seropositive; standard of care; strength training; treatment program; waist circumference

Despite recent, revolutionary improvements in pharmacologic management, rheumatoid arthritis (RA) remains associated with increased rates of cardiovascular disease and mortality. RA cardiovascular risk results from a combination of traditional risk factors and RA-related systemic inflammation. Consequently, to improve overall RA cardiovascular risk, efforts should target both traditional risk factors and inflammation. One hypothetical means of improving overall RA cardiovascular risk is through weight loss and physical activity. Together, weight loss and physical activity can improve traditional cardiometabolic health through fat mass loss and skeletal muscle quality and functional gains. Additionally, disease-related cardiovascular risk will improve as both fat mass loss and exercise reduce systemic inflammation. To explore this hypothesis, 44 older, obese persons with RA will be randomized to a control intervention based on traditional clinical counselling or to a supervised weight loss plus exercise training program (3 times per week). Weight loss will occur via a dietitian-led intervention targeting 7% weight loss over 16 weeks, with weekly weigh-ins and group support sessions. Exercise training will consist of three times per week of an interval-based aerobic program plus twice-weekly resistance training. Both weight loss and exercise training will be supervised to maximize safety and adherence. The primary cardiometabolic outcome is a highly validated metabolic syndrome z-score, calculated from blood pressure, waist circumference, HDL-cholesterol, triglycerides, and glucose. RA-related cardiovascular risk will be assessed with measures of systemic inflammation, RA disease activity, and macrophage function – key cells at the nexus of rheumatic and cardiovascular disease activity. Intervention impacts on self-reported outcomes will be assessed with validated measures from the Patient Reported Outcomes Measurement Information System (PROMIS). This exploratory clinical trial will show whether a supervised intervention with weight loss and exercise training improves objective assessments of RA cardiovascular risk, disease activity and results in patients reporting overall improved health. This investigation will establish feasibility, acceptance, compliance, fidelity, and generate effects sizes critical for designing larger RA interventions, especially those comparing weight loss and physical activity amounts and types. Also, by demonstrating that weight loss with physical activity not only improves RA-associated cardiovascular risk and disease activity, but also patient-reported global health, this work should provide immediate and long-lasting impacts on RA clinical care.

尽管最近，药物管理的革命性改善，类风湿关节炎（RA）仍然 与心血管疾病和死亡率的增加有关。 RA心血管风险来自 传统危险因素和与RA相关的全身性炎症的结合。因此，要改善整体 RA心血管风险，努力应针对传统的风险因素和炎症。一个假设 意味着改善RA心血管总体风险是通过体重减轻和体育锻炼。在一起，体重 损失和体育锻炼可以通过脂肪质量损失和骨骼来改善传统心脏代谢健康 肌肉质量和功能增长。此外，与疾病相关的心血管风险将改善 群众损失和运动减少全身性炎症。为了探讨这一假设，有44名年龄较大的肥胖者 RA将根据传统临床咨询或监督体重随机分配到控制干预措施 损失加运动训练计划（每周3次）。减肥将通过营养师主导的干预发生 在16周内以7％的体重减轻为目标，每周举重和小组支持会议。运动训练 每周三次基于间隔的有氧计划以及每周两次抵抗训练。 减肥和运动训练都将受到监督，以最大程度地提高安全性和依从性。主要 心脏代谢结果是一种高度验证的代谢综合征Z评分，是根据血压，腰部计算的 周长，HDL-胆固醇，甘油三酸酯和葡萄糖。将评估与RA相关的心血管风险 全身炎症，RA病活动和巨噬细胞功能的测量 - 下一个的关键细胞 风湿性和心血管疾病活性。将评估对自我报告结果的干预影响 通过患者报告的结果测量信息系统（Promis）的验证措施。 这项探索性临床试验将显示负重减肥和运动训练的监督干预 改善RA心血管风险，疾病活动的客观评估，并在报告的患者中结果 总体上改善了健康。这项投资将确定可行性，接受，合规性，忠诚和 产生效果大小对于设计较大的RA干预措施至关重要，尤其是那些比较体重减轻和 体育锻炼量和类型。另外，通过证明体育锻炼的体重减轻不仅 改善了与RA相关的心血管风险和疾病活动，但也由患者报告的全球健康，这 工作应立即对RA临床护理产生直接和持久的影响。