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

描述（由申请人提供）：本R21申请的目的是进行一项以家庭为基础的体育活动计划的可行性研究，该计划旨在降低与HIV感染和抗逆转录病毒治疗（ART）相关的心血管疾病风险。在过去15年中，抗逆转录病毒治疗使艾滋病毒感染者的预期寿命延长了10年以上。随着预期寿命的延长，患心血管疾病和糖尿病的风险也在增加。这些合并症的风险至少部分来自病毒感染、生活方式选择和特定的抗逆转录病毒治疗方案。观察性研究和随机试验表明，在一系列临床人群中，体育活动/锻炼可以降低代谢和心血管疾病的风险。我们研究组和其他研究人员进行的实验室严格控制的临床试验表明，体育活动是减少PLWHA患者心血管发病率/死亡率的许多可改变危险因素的适当干预措施。这些研究表明，即使是相对适度的体力活动增加也能增加心肺健康，减少内脏脂肪和增加肌肉质量，降低血清总胆固醇和LDL/VLDL胆固醇，降低甘油三酯，增加血清高密度脂蛋白胆固醇。然而，目前还没有研究证明，对于艾滋病毒感染者来说，以家庭为基础的体育锻炼计划在坚持项目或减少风险因素方面是有效的。由于艾滋病毒感染在贫困、农村和少数民族人群中不成比例地流行，这些人群获得运动训练设施和专业支持的机会有限，因此，社区居住患者在家庭培训方面的知识差距尤其令人担忧。我们将获得功率计算数据，测试电话干预的可行性，并进行过程评估，以实现突破性的全面研究。身体活动计划将围绕适合临床人群家庭使用的活动建议来设计。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，并实现对体育活动计划的高水平依从性，该计划旨在帮助个人实现对体育活动的共识公共卫生建议；2)获取CVD危险因素、心理因素和生活质量变化的功率计算数据；3)对新出现的心血管疾病危险因素（如血清CRP和白细胞介素6 (IL-6)）的活动引起的变化进行探索性评估，以便为未来的研究进行功率计算；4)使用过程评估来完善干预措施，准备并提交一份大型随机对照试验的拨款申请，以测试体育活动计划的有效性。

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.