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

基本信息

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
项目类别：
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

项目摘要

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.

尽管最近在药物管理方面取得了革命性的进步，但类风湿性关节炎 (RA) 仍然存在与心血管疾病发生率和死亡率增加有关。结合传统危险因素和 RA 相关全身炎症测试，以改善整体情况。 RA 心血管风险，应同时针对传统危险因素和炎症。改善总体 RA 心血管风险的方法是减肥和体力活动。损失和体力活动可以通过脂肪量减少和骨骼改善传统的心脏代谢健康此外，随着脂肪的增加，与疾病相关的心血管风险也会得到改善。体重减轻和运动可减少全身炎症为了探索这一假设，我们对 44 名老年肥胖者进行了研究。 RA 将被随机分配至基于传统临床咨询的对照干预组或监督体重组减肥加运动训练计划（每周 3 次）将通过营养师主导的干预措施实现减肥。目标是在 16 周内减轻 7% 的体重，并每周进行称重和团体支持运动训练。将包括每周三次间歇性有氧运动加上每周两次的阻力训练。减肥和运动训练都将受到监督，以最大限度地提高安全性和依从性。心脏代谢结果是经过高度验证的代谢综合征 z 评分，根据血压、腰围计算得出周长、高密度脂蛋白胆固醇、甘油三酯和血糖将通过 RA 相关心血管风险进行评估。全身炎症、RA 疾病活动和巨噬细胞功能的测量——巨噬细胞的连接处的关键细胞将评估干预措施对自我报告结果的影响。使用患者报告结果测量信息系统 (PROMIS) 中经过验证的测量值。这项探索性临床试验将表明减肥和运动训练的监督干预是否有效改善对 RA 心血管风险、疾病活动度和患者报告结果的客观评估这项调查将确定可行性、可接受性、合规性、保真度和健康状况。产生对于设计更大的 RA 干预措施至关重要的效应大小，尤其是那些比较减肥和此外，通过证明体力活动不仅可以减轻体重。改善与 RA 相关的心血管风险和疾病活动，同时也改善患者报告的全球健康状况，这工作应对 RA 临床护理产生直接和长期的影响。