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: 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
• 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

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，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。一起， 减肥和体育锻炼可以通过脂肪质量损失和 骨骼肌质量和功能增长。此外，与疾病相关的心血管风险将改善 脂肪质量损失和运动都可以减少全身注入。探索这个假设，年龄较大26个， 对患有RA的肥胖者的超重将根据传统临床进行控制干预 咨询或进行监督减肥加运动训练计划（每周3次）。减肥意志 通过营养师主导的干预措施，目标是在16周内减肥7％，每周体重和组 支持会议。运动训练将包括每周三次基于间隔的有氧计划 加上每周两次抵抗训练。减肥和运动训练都将受到监督以最大化 安全性和依从性。主要心脏代谢结果是高度验证的代谢综合征z评分， 根据血压，腰围，HDL-胆固醇，甘油三酸酯和葡萄糖计算得出。与RA有关的 心血管风险将通过全身感染，RA疾病活动和 巨噬细胞功能 - 风湿性和心血管疾病活动联系的关键细胞。干涉 对自我报告的结果的影响将通过报告的患者的验证措施评估 结果测量信息系统（Promis）。该探索性临床试验将显示 通过减肥和锻炼训练的监督干预改善了RA的客观评估 心血管风险，疾病活动和导致报告总体健康状况改善的患者。这项调查 将建立可行性，接受，合规性，保真度，并产生效果大小，对于设计更大 RA干预措施，尤其是那些比较体重减轻和体育锻炼量和类型的干预措施。另外，由 证明体育锻炼的体重减轻不仅可以改善与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，这项工作应立即提供持久 对RA临床护理的影响。