Home-based Exercise for Management of HIV-associated Cardiovascular Disease Risk

描述(由申请人提供)：本R21申请的目标是对旨在降低与艾滋病毒感染和抗逆转录病毒治疗(ART)相关的心血管疾病风险的家庭体力活动计划进行可行性研究。在过去的15年里，抗逆转录病毒疗法使艾滋病毒感染者的预期寿命增加了10年以上。随着预期寿命的延长，心血管疾病和糖尿病的风险也会增加。这些合并症的风险，至少部分是由病毒感染、生活方式选择和特定的抗逆转录病毒疗法造成的。观察性研究和随机试验表明，在一系列临床人群中，体力活动/锻炼在降低代谢和心血管疾病风险方面具有有效性。我们研究小组和其他人进行的以实验室为基础的严格控制的临床试验表明，体力活动是减少PLWHA心血管发病率/死亡率的许多可改变的风险因素的适当干预措施。这些研究表明，即使是相对温和的体力活动增加也会增加心肺健康，减少内脏脂肪和增加肌肉质量，降低血清总胆固醇和低密度脂蛋白/极低密度脂蛋白胆固醇，降低甘油三酯，并增加血清高密度脂蛋白胆固醇。然而，还没有研究表明，无论是在遵守计划还是降低风险因素方面，为艾滋病毒携带者开出处方的家庭体力活动计划都是有效的。由于贫困人口、农村人口和少数族裔人口中艾滋病毒感染率不成比例，他们获得运动培训设施和专业支持的机会有限，因此在对社区患者进行居家培训方面的知识差距特别令人关切。我们将获得电力计算的数据，测试电话干预的可行性，并进行过程评估，以完善突破性的全面研究。体力活动计划将围绕适合临床人群家庭使用的活动建议进行设计。具体目标将包括：1)测试从社区艾滋病毒支持中心招募研究参与者的可行性，并实现对旨在帮助个人实现一致的公共健康体力活动推荐的体力活动计划的高水平遵守；2)获得用于计算心血管疾病风险因素、心理因素和生活质量变化的数据；3)提供活动诱导的心血管疾病新风险因素变化的探索性评估，如血清CRP和白细胞介素6(IL-6)，以便为未来的研究进行能量计算；以及4)使用过程评估来改进干预措施，并准备并提交大型随机对照试验的拨款申请，以测试体力活动计划的有效性。 公共卫生相关性：由于药物治疗的进步，艾滋病毒/艾滋病患者(PLWHA)的寿命更长，但患心血管疾病和糖尿病的风险也更大。锻炼和增加体力活动可以降低PLWHA中这些疾病的风险因素，但还没有研究测试一项家庭锻炼计划，该计划将使低收入者和其他无法获得锻炼设施的人受益。这项研究将测试PLWHA家庭锻炼计划的可行性，并为一项全面的干预研究做准备，这可能会降低PLWHA中的心血管疾病风险。

DESCRIPTION (provided by applicant): The goal of this R21 application is to conduct a feasibility study of a home-based physical activity program designed to reduce cardiovascular disease risk associated with HIV infection and anti- retroviral therapy (ART). In the last 15 years, ART has resulted in an increase of over 10 years in the life expectancy of HIV-infected individuals. Along with increased life expectancy is an increased risk of cardiovascular disease and diabetes. The risk of these comorbidities results, at least in part, from the viral infection, lifestyle choices, and specific ART regimens. Observational studies and randomized trials demonstrate the efficacy of physical activity/exercise in decreasing the risk of metabolic and cardiovascular pathologies in a range of clinical populations. Laboratory-based, tightly controlled clinical trials from our research group and others indicate that physical activity is an appropriate intervention for reducing many modifiable risk factors for cardiovascular morbidity/mortality in PLWHA. These studies indicate that even relatively modest increases in physical activity increase cardiorespiratory fitness, reduce visceral fat and increase muscle mass, reduce serum total and LDL/VLDL cholesterol, reduce triglycerides, and increase serum HDL cholesterol. However, no studies have demonstrated the effectiveness, in terms of either program adherence or risk factor reduction, of a home-based physical activity program when prescribed for those living with HIV. This gap in knowledge regarding home based training for community-dwelling patients is of special concern due to the disproportionate prevalence of HIV infection in poor, rural, and minority populations who have limited access to exercise training facilities and professional support. We will obtain data for power calculations, test the feasibility of a telephone-based intervention, and perform process evaluations to enable refining a breakthrough full-scale study. The physical activity program will be designed around activity recommendations that are appropriate for home use in a clinical population. SPECIFIC AIMS will include 1) Testing the feasibility of recruiting study participants from community-based HIV support centers, and achieving a high level of program adherence to a physical activity program designed to help individuals achieve the consensus public health recommendation for physical activity; 2) Obtaining data for power calculations on changes in risk factors for CVD, psychological factors, and quality of life; 3) Providing an exploratory assessment of activity-induced changes to emerging risk factors for cardiovascular disease, such as serum CRP and interleukin 6 (IL-6), in order to perform power calculations for future studies; and 4) Using process evaluations to refine interventions and to prepare and submit a grant application for a large randomized controlled trial to test the effectiveness of the physical activity program. PUBLIC HEALTH RELEVANCE: Because of advances in drug treatment, people living with HIV/AIDS (PLWHA) are living longer, but are also at greater risk for cardiovascular disease (CVD) and diabetes. Exercise and increased physical activity can reduce the risk factors for these diseases in PLWHA, but no studies have tested an at-home exercise program that would benefit low income people and others who do not have access to exercise facilities. This study will test the feasibility of an at-home exercise program for PLWHA and prepare for a full-scale intervention study, which may lead to a reduction in CVD risk among PLWHA.