The PRESS ERA: Protein & Resistance Exercise Supplement Study for Elderly with RA

描述(申请人提供)：类风湿性关节炎(RA)是一种以滑膜炎和关节炎为特征的全身性炎症性疾病。RA的关节炎可能是侵蚀性和破坏性的，导致疼痛、残疾和畸形。60岁以上人群中类风湿性关节炎的患病率约为2%，70岁及以上人群中患病率最高。与年龄匹配的非类风湿性关节炎患者相比，由于慢性炎症性疾病和不活动的共同作用，老年类风湿性关节炎患者的肌肉无力更多，肌肉质量更少，脂肪更多。由于老年RA患者体力活动少和脂肪含量高的既定模式，不建议单独补充额外的热量，但运动和营养干预的结合已被认为是治疗类风湿性恶病质和老年虚弱个体的重要治疗方法。阻力训练是一种安全有效的干预措施，可以改善年轻RA患者的力量、肌肉质量和功能。然而，它还没有在老年RA患者中进行测试，他们有相当多的肌肉无力和残疾。由于RA损伤的联合限制，许多阻力运动方案不能应用于老年人群。蛋白质补充，特别是在运动后阶段，可能会显著影响阻力运动对老年人肌肉力量的影响。此外，由于炎症性疾病的高分解代谢状态，老年RA患者每天可能有更高的蛋白质需求量。抵抗运动和蛋白质补充这两种重要干预措施的结合，以对抗与RA相关的身体成分变化、虚弱和残疾，从未在老年患者中进行过评估。这项研究提出了一项随机对照交叉试验，以评估为老年(70岁)RA患者量身定做的16周阻力训练计划，并结合蛋白质补充。这项研究中的锻炼方案是独特的，因为它结合了在专门设备上进行的动态和等长(静态)阻力锻炼，可以适应老年RA人群中经常遇到的运动限制范围。这项研究还将开始评估每日补充蛋白质是否可以获得额外的好处。随着人口老龄化，我们可能会看到炎症性风湿病的患病率增加，以及它对老年人肌肉、力量和疲劳的不利影响。该项目建议测试一种重要的辅助治疗、抗阻运动和蛋白质补充的方法，它是安全、廉价和潜在的高度有益的。

DESCRIPTION (provided by applicant): Rheumatoid arthritis (RA) is a systemic inflammatory disease characterized by synovitis and arthritis. The arthritis in RA can be erosive and destructive leading to pain, disability, and deformity. The prevalence of RA among individuals over the age of 60 years is approximately 2% and highest among those 70 years of age and older. Older individuals with RA have more muscle weakness, less muscle mass, and more fat mass than age- matched individuals without RA due to a combination of chronic inflammatory disease and inactivity. With the established pattern of low physical activity and high fat mass among older RA patients, additional caloric supplementation is not routinely recommended alone, but the combination of exercise and nutritional interventions have been suggested as important treatments for rheumatoid cachexia and older frail individuals in general. Resistance exercise is a safe and effective intervention to improve strength, muscle mass, and function in younger individuals with RA. However, it has not been tested in older RA patients who have considerably more muscle weakness and disability. Many resistance exercise protocols cannot be applied to an older population because of joint limitations from RA damage. Protein supplementation, particularly in the post-exercise period, may significantly influence the impact of resistance exercise on muscle strength in the elderly. Further, older individuals with RA may have higher daily protein requirements due to the hypercatabolic state of their inflammatory disease. The combination of these two important interventions, resistance exercise and protein supplementation, to combat the body composition changes, weakness, and disability associated with RA has never been evaluated in older individuals. This study proposes a randomized controlled cross-over trial to evaluate a tailored 16-week resistance exercise program, in combination with protein supplementation, for older (¿70 years of age) individuals with RA. The exercise protocol in this study is distinctive because it combines dynamic and isometric (static) resistance exercise performed on specialized equipment that can accommodate the range of motion limitations frequently encountered in the older RA population. This study will also begin to evaluate if additional benefit can be achieved with daily protein supplementation. As the population ages, we are likely to see an increase in the prevalence of inflammatory rheumatic disease and its concomitant detrimental effects on muscle, strength, and fatigue in the elderly. This project proposes to test an important adjuvant approach to treatment, resistance exercise and protein supplementation, which is safe, inexpensive, and potentially highly beneficial.