The effect of exercise on systemic inflammation in veterans with COPD and OSA.

运动对患有慢性阻塞性肺病和阻塞性睡眠呼吸暂停的退伍军人全身炎症的影响。

• 批准号: 9290785
• 负责人: Madalina Macrea
• 金额: --
• 依托单位: SALEM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9290785
• 关键词: Accelerometer; Adult; Aerobic; Affect; Air; Antioxidants; Area; Award; Biological Markers; Book Chapters; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Chronic Obstructive Airway Disease; Clinical; Computers; Continuous Positive Airway Pressure; Control Groups; Cross-Sectional Studies; Data; Disease; Drowsiness; Dyspnea; Economics; Event; Exercise; Foundations; Future; General Population; Goals; Healthcare; Heart; High Prevalence; Home environment; Hour; Hypoxia; Impairment; Inflammation; Interleukin-6; Intervention; Leisures; Life Style; Measures; Medical; Mentors; Modification; Morbidity - disease rate; Obesity; Obstructive Sleep Apnea; Patients; Physical activity; Pilot Projects; Plasma; Population; Prevalence Study; Publishing; Quality of life; Randomized; Randomized Controlled Trials; Research; Rest; Scientist; Serum; Sleep; Sleep Apnea Syndromes; Superoxide Dismutase; Superoxides; Syndrome; Testing; Time; Training; Translating; Veterans; Walking; arm; base; cardiovascular disorder risk; cardiovascular risk factor; cost; design; disorder risk; endothelial dysfunction; exercise capacity; exercise intensity; exercise intervention; exercise program; exercise rehabilitation; exercise training; improved; inflammatory marker; meetings; meter; mortality; multidisciplinary; novel; programs; research study; response; sedentary; standard of care; symposium

The term "overlap syndrome" (OS) is used to describe the association of both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea disease (OSA) in a single Veteran. Given the high prevalence of both COPD and OSA, it is expected that a third of Veterans with OSA could be affected by OS. We demonstrated in 2 cross-sectional studies that the prevalence of OS in our Veteran population with COPD was above 44%. Importantly, Veterans with OS have a higher cardiovascular morbidity and mortality than either OSA or COPD-only Veterans, likely due to worse nocturnal hypoxia and subsequent inflammation and endothelial dysfunction. Our preliminary data shows that serum hs-CRP levels are higher in Veterans with OS than Veterans with COPD-only. Therefore, therapy for Veterans with OS that decreases cardiovascular disease (CVD) by targeting inflammation is a high priority. Home-based exercise interventions that translate to a lifestyle with increased physical activity (PA) are an ideal strategy as 150 minutes of leisure time PA a week is associated with reduction in risk of CVD-related events and death. Further, PA decreases biomarkers of systemic inflammation (IL-6 and CRP). However, no data is available on the effect of exercise on biomarkers of systemic inflammation in Veterans with OS. It is difficult to increase the leisure time PA in adults with COPD and OSA as this population is more sedentary due to a combination of increased obesity, daytime sleepiness and dyspnea. Therefore, home-based exercise would be ideal for these Veterans. In a pilot study of 19 Veterans with COPD we demonstrated that the use of the Wii Fit program for home-based exercise was feasible and safe. The mean six-minute walk distance increased by 23 meters (p=0.01) after 12 weeks of moderate intensity exercise with the Wii Fit. Thus, adapting this exercise strategy to Veterans with OS is a novel treatment approach whose goal is durable increases in leisure time PA. Randomized controlled trials have failed to demonstrate that the current standard therapy for OSA, i.e. continuous positive airway pressure (CPAP), alters inflammatory markers in OSA. The objective of this proposal is to conduct a single arm 12- week home-based exercise pilot intervention to determine the effect on biomarkers of systemic inflammation in 50 Veterans with OS on CPAP. We hypothesize that 1) Baseline PA intensity and duration will correlate inversely with the biomarkers of systemic inflammation independently of nocturnal hypoxia; and 2) Exercise training using a home-based computer exercise program will decrease biomarkers of systemic inflammation and increase exercise capacity in Veterans. To test these hypotheses, we will analyze measures of baseline PA intensity and duration (accelerometry) and biomarkers of systemic inflammation in Veterans with OS (AIM 1). Then the following parameters will be assessed at baseline and after 12 weeks of home exercise training: a) biomarkers of systemic inflammation; b) PA intensity and duration; c) exercise capacity (AIM 2). Findings will support a future randomized exercise trial that will impact strategies to reduce CVD risk and in Veterans with OS through increased physical activity. The long-term clinical goal is to successfully implement a home exercise intervention in the routine medical care of the large Veteran population with sleep disordered breathing (SDB) with the ultimate goal of reducing their risk of CVD-related events and death through increased physical activity. This research area is a high priority given the high prevalence of OS and impact on Veterans' and general population morbidity, mortality and health-care associated costs.

术语“重叠综合征”（OS）用于描述两种慢性阻塞性肺的关联 一名退伍军人中的疾病（COPD）和阻塞性睡眠呼吸暂停疾病（OSA）。考虑到很高的患病率 COPD和OSA都可以预期，有OSA的退伍军人中有三分之一可能受OS的影响。我们 在两项横断面研究中证明，我们的COPD退伍军人人口中的OS患病率是 超过44％。重要的是，具有OS的退伍军人的心血管发病率和死亡率高于任何一个 OSA或仅COPD的退伍军人，可能是由于夜间缺氧和随后的炎症而引起的 内皮功能障碍。我们的初步数据表明，OS的退伍军人中血清HS-CRP水平较高 比只有COPD的退伍军人。因此，对患有OS的退伍军人减少心血管的治疗 通过靶向炎症，疾病（CVD）是一个高优先级。基于家庭的运动干预措施，转化为 体育锻炼增加（PA）的生活方式是每周150分钟的休闲时间PA的理想策略 与CVD相关事件和死亡的风险降低有关。此外，PA减少了生物标志物 系统性炎症（IL-6和CRP）。但是，没有关于运动对生物标志物的影响的数据 OS退伍军人的系统性炎症。 COPD的成年人很难增加休闲时间PA OSA由于肥胖，白天嗜睡的结合，由于该人群的久坐不变 和呼吸困难。因此，以家庭为基础的运动是这些退伍军人的理想选择。在19个试点研究中 与COPD的退伍军人，我们证明了将Wii Fit计划用于家庭运动的使用是 可行和安全。 12周后，平均六分钟步行距离增加了23米（P = 0.01） Wii拟合度中等强度运动。因此，将这种锻炼策略适应与OS的退伍军人是 新型治疗方法的目标是持久的休闲时间PA。随机对照试验 未能证明当前的OSA标准疗法，即连续的正气道压力 （CPAP），改变OSA中的炎症标记。该提案的目的是进行单臂12- 基于周的家庭锻炼试点干预以确定对系统性生物标志物的影响 在CPAP上使用OS的50名退伍军人的炎症。我们假设1）基线PA强度和持续时间 将与夜间缺氧独立于全身炎症的生物标志物成反相关。和2） 使用家庭计算机锻炼计划进行锻炼训练将减少系统性的生物标志物 炎症并增加退伍军人的运动能力。为了检验这些假设，我们将分析 OS的退伍军人的基线PA强度和持续时间（加速度计）和全身炎症的生物标志物 （目标1）。然后，将在基线和家庭锻炼12周后评估以下参数 培训：a）系统性炎症的生物标志物； b）PA强度和持续时间； c）运动能力（目标2）。 调查结果将支持未来的随机运动试验，该试验将影响降低CVD风险的策略和 通过增加体育锻炼的退伍军人。长期临床目标是成功实施 家庭锻炼干预，对大量退伍军人人口的常规医疗保健 呼吸（SDB）的最终目标是降低与CVD相关事件的风险和死亡的风险 增加体育锻炼。鉴于OS的高流行和影响，该研究领域是优先事项 退伍军人和一般人口发病率，死亡率和医疗保健相关费用。