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。 RA 心血管风险源自 传统危险因素和 RA 相关全身炎症的结合。因此，要提高整体 RA 心血管风险，应同时针对传统危险因素和炎症。一个假设 改善总体 RA 心血管风险的方法是减肥和体力活动。一起， 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 骨骼肌质量和功能增益。此外，与疾病相关的心血管风险将随着以下因素而改善： 脂肪量减少和运动都可以减少全身炎症。为了探索这个假设，26 岁的老人， 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 3 次）。减肥会 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 支持会议。运动训练将包括每周三次的间歇性有氧运动 再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 安全性和依从性。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、甘油三酯和葡萄糖计算。 RA相关 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活动的关键细胞。干涉 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表明是否 减肥和运动训练的监督干预可改善 RA 的客观评估 心血管风险、疾病活动以及患者报告健康状况总体改善的结果。此次调查 将建立可行性、可接受性、合规性、保真度，并产生对于设计更大的尺寸至关重要的效果尺寸 RA 干预措施，尤其是比较体重减轻和体力活动量和类型的干预措施。另外，通过 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 对 RA 临床护理的影响。