Yoga and Indices of Cardiovascular Risk in Older Women

描述（由申请人提供）：心血管疾病（CVD）仍然是妇女死亡的主要原因。心血管疾病的风险随着更年期急剧上升，可能是由于胰岛素抵抗和相关的动脉粥样硬化变化同时上升，这些变化共同构成了胰岛素抵抗综合征（IRS），这是一组代谢和血流动力学异常，与心血管疾病的发病和进展密切相关。越来越多的证据表明，练习瑜伽可能是一种安全且经济有效的策略，可以减少与irs相关的心血管疾病风险因素。然而，在西方人群中进行的严格研究很少，瑜伽对健康绝经后妇女心血管疾病风险的影响也没有研究。这项gcrc批准的随机对照试验将研究8周强化莱格尔瑜伽项目对该人群心血管疾病风险irs相关指标的影响。参与者将是60名健康的、久坐不动的绝经后妇女，年龄在50-75岁之间，超重和/或有第一级亲属患有2型糖尿病或原发性高血压。非裔美国女性将被过度抽样。我们的主要目的是评估利engar瑜伽对胰岛素敏感性变化的影响，QUICKI是一种结合了极好的信度和效度以及最小受试者负担的测量方法。我们的次要目的是：1)评估瑜伽对胰岛素抵抗的其他指标（空腹血糖、胰岛素、糖化血红蛋白）和心血管疾病风险的相关指标的影响，包括交感神经激活、血脂异常、内皮功能、炎症、凝血功能障碍、内脏肥胖、胰岛素样生长因子生物利用度、心率变异性、心理疾病和睡眠障碍；2)评估和优化整体方案设计，包括少数民族和非少数民族参与者的招募率、保留率、方案依从性和工具负担。干预将包括8周的结构化莱格尔瑜伽训练，包括每周两次90分钟的课程，以及每天在家指导瑜伽练习。对照组将完成一项为期8周的标准化教育电影计划，该计划旨在易于复制，并确保时间、员工注意力和社会互动的可比性。两组都将收到美国心脏协会关于女性更年期、衰老和心脏病的标准材料。8周治疗前后采集空腹血样，测量胰岛素抵抗特异性标志物及相关CVD风险生理、人体测量和心理指标。这项初步研究将提供瑜伽在降低绝经后妇女心血管疾病风险方面的潜在效用的重要信息，绝经后妇女心血管疾病和相关慢性疾病的风险增加。这项研究的结果也将提供关键的初步和可行性数据，以支持一项更大的、三组、多民族的随机对照试验，调查瑜伽练习对绝经后妇女心血管疾病风险的irs相关指标的影响。

DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) remains the leading cause of death in women. CVD risk rises sharply with menopause, likely due to the coincident rise in insulin resistance and related atherogenic changes that together comprise the insulin resistance syndrome (IRS), a cluster of metabolic and hemodynamic abnormalities strongly implicated in the pathogenesis and progression of CVD. There is growing evidence that the practice of yoga may offer a safe and cost-effective strategy for reducing IRS-related risk factors for CVD. However, rigorous studies in Western populations are few and the effects of yoga on CVD risk profiles in healthy postmenopausal women have not been studied. This GCRC-approved randomized controlled trial will investigate the effects of an 8 week intensive lyengar yoga program on IRS-related indices of CVD risk in this population. Participants will be 60 healthy, sedentary postmenopausal women aged 50-75 years who are overweight and/or have a first degree relative with type 2 diabetes mellitus or essential hypertension. African American women will be oversampled. Our primary aim is to evaluate the effects of lyengar yoga on change in insulin sensitivity as estimated by the QUICKI, a measure that combines excellent reliability and validity with minimal subject burden. Our secondary aims are: 1) to assess the effects of yoga on other markers of insulin resistance (fasting glucose, insulin, glycated hemoglobin), and related indices of CVD risk, including measures of sympathetic activation, dyslipidemia, endothelial function, inflammation, coagulopathy, visceral adiposity, insulin-like growth factor bioavailability, heart rate variability, psychological morbidity, and sleep disturbance; and 2) to evaluate and optimize the overall protocol design, including recruitment, and retention rates, protocol adherence, and instrument burden in both minority and non-minority participants. The intervention will comprise 8 weeks of structured lyengar yoga training, including two 90 minute classes/week in addition to daily directed yoga practice at home. The control group will complete an 8 week standardized educational film program designed to be easily replicable and to assure comparability of time, staff attention, and social interaction. Both groups will also receive standard American Heart Association materials regarding menopause, aging, and heart disease in women. Before and after the 8 week treatment period, fasting blood samples will be collected, and specific markers of insulin resistance and related physiological, anthropometric, and psychological indices of CVD risk will be measured. This pilot study will yield important information on the potential utility of yoga in reducing CVD risk in postmenopausal women, a population at increased risk for CVD and related chronic disorders. Findings of this study will also provide critical preliminary and feasibility data to support a larger, 3-arm, multi-ethnic RCT investigating the influence of yoga practice on IRS-related indices of CVD risk in women post-menopause.