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：
10663627
负责人：
KIM M. HUFFMAN
金额：
$ 14.73万
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 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10663627
关键词：
Accounting Adherence Adipose tissue Aerobic Age Arthralgia Blood Glucose Blood Pressure Body Composition Body Weight decreased Body mass index Cardiopulmonary Cardiovascular Diseases Cell physiology Cells Clinical Clinical Trials Counseling Dietitian Disease Educational Intervention Exercise Exercise Test Fasting Fatigue Fatty acid glycerol esters Future Glucose Goals Health High Density Lipoprotein Cholesterol Immune Inflammation Inflammatory Information Systems Insulin Intervention Investigation Lead Lipoproteins Measurement Measures Medication Management Metabolic syndrome Modeling Muscle function Obesity Outcome Overweight 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 intervention exercise training functional gain global health health disparity improved inflammatory marker insulin sensitivity macrophage monocyte mortality obese person physical inactivity post intervention primary outcome programs recruit seropositive standard of care strength training systemic inflammatory response 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, 26 older, overweight to 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育锻炼。减肥和体力活动可以通过减少脂肪量和改善传统的心脏代谢健康此外，骨骼肌质量和功能增强，与疾病相关的心血管风险也会改善。减少脂肪量和全身锻炼都可以减少炎症，以探索这一假设，26 岁，超重至肥胖的 RA 患者将被随机分配至基于传统临床的对照干预组咨询或监督减肥加运动训练计划（每周减肥3次）。通过营养师主导的干预措施进行，目标是在 16 周内减轻 7% 的体重，每周称重并进行分组支持课程包括每周三次的间歇性有氧运动。加上每周两次的阻力训练，减肥和运动训练都会受到监督，以最大限度地发挥作用。主要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、HDL 胆固醇、甘油三酯和 RA 相关的血糖计算。心血管风险将通过全身炎症、RA 疾病活动度和巨噬细胞功能——风湿病和心血管疾病干预的关键细胞。对自我报告结果的影响将通过患者报告的有效措施进行评估结果测量信息系统（PROMIS）。这项探索性临床试验将显示是否减肥和运动训练的监督干预可改善 RA 的客观评估报告健康状况整体改善的患者的心血管风险、疾病活动和结果。将建立可行性、可接受性、合规性、保真度，并产生对大型设计至关重要的效果尺寸 RA 干预措施，特别是那些比较体重减轻和体力活动量和类型的干预措施。证明通过体力活动减轻体重不仅可以改善与 RA 相关的心血管风险，疾病活动，以及患者报告的全球健康状况，这项工作应该提供即时和持久的信息对 RA 临床护理的影响。