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

用于管理艾滋病毒相关心血管疾病风险的家庭锻炼

• 批准号: 8149894
• 负责人: STEVEN N. BLAIR
• 金额: $ 17.82万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-24 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8149894
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Adherence; Anti-Retroviral Agents; Applications Grants; Cardiovascular Diseases; Cardiovascular Pathology; Cardiovascular system; Caring; Clinical; Communities; Comorbidity; Consensus; Controlled Clinical Trials; Data; Diabetes Mellitus; Disease; Effectiveness; Evaluation; Exercise; Fatty acid glycerol esters; Feasibility Studies; Future; General Population; Goals; HIV; High Density Lipoprotein Cholesterol; High Prevalence; Home environment; Hypertriglyceridemia; Individual; Interleukin-6; Intervention; Intervention Studies; Knowledge; Laboratories; Lead; Life; Life Expectancy; Life Style; Low income; Low-Density Lipoproteins; Maintenance; Measures; Metabolic; Metabolic Diseases; Minority; Morbidity - disease rate; Observational Study; Participant; Patients; Pharmaceutical Preparations; Physical activity; Population; Prevalence; Process; Psychological Factors; Public Health; Quality of life; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Recommendation; Recruitment Activity; Regimen; Research; Risk; Risk Factors; Rural; Serum; South Carolina; Telephone; Testing; Training; United States Dept. of Health and Human Services; Very low density lipoprotein cholesterol; Virus Diseases; Visceral; antiretroviral therapy; base; cardiovascular disorder risk; cardiovascular risk factor; design; disorder risk; fitness; group intervention; modifiable risk; mortality; muscle form; programs; public health relevance; randomized trial; treatment as usual; very low density lipoprotein triglyceride

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.

描述（由申请人提供）：本R21申请的目标是对旨在降低与HIV感染和抗逆转录病毒治疗（ART）相关的心血管疾病风险的家庭体力活动计划进行可行性研究。在过去15年中，抗逆转录病毒疗法使艾滋病毒感染者的预期寿命延长了10年以上。沿着预期寿命的增加的是心血管疾病和糖尿病的风险增加。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ART方案。观察性研究和随机试验证明了体力活动/锻炼在降低一系列临床人群中代谢和心血管疾病风险方面的疗效。我们的研究小组和其他人的基于实验室的严格对照临床试验表明，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，即使是相对温和的增加体力活动增加心肺功能，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，并增加血清HDL胆固醇。然而，没有研究表明有效性，无论是程序的遵守或风险因素的减少，以家庭为基础的体育活动计划时，规定为那些艾滋病毒感染者。由于艾滋病毒感染在穷人、农村和少数民族人口中的比例过高，他们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特别令人关切。我们将获得功率计算的数据，测试基于电话的干预的可行性，并进行过程评估，以改进突破性的全面研究。身体活动计划将围绕适合临床人群家庭使用的活动建议进行设计。具体目标将包括1）测试从社区艾滋病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身体活动的共识公共卫生建议的身体活动计划的高水平计划依从性; 2）获得关于CVD风险因素变化的功效计算数据，心理因素和生活质量; 3）提供对心血管疾病的新兴危险因素（如血清CRP和白细胞介素6（IL-6））的活动诱导的变化的探索性评估，以便为未来的研究进行功效计算;和4）使用过程评估来完善干预措施，并准备和提交大型随机对照试验的拨款申请，以测试物理治疗的有效性。活动方案。 公共卫生相关性：由于药物治疗的进步，艾滋病毒/艾滋病（PLWHA）感染者的寿命更长，但患心血管疾病（CVD）和糖尿病的风险也更大。运动和增加体力活动可以减少这些疾病的风险因素在PLWHA，但没有研究已经测试了一个在家里锻炼计划，将有利于低收入人群和其他人谁没有获得运动设施。这项研究将测试在家锻炼计划的可行性，并为全面干预研究做准备，这可能会降低艾滋病毒感染者的心血管疾病风险。

项目成果

Association of Markers of Inflammation with Sleep and Physical Activity Among People Living with HIV or AIDS.

• DOI: 10.1007/s10461-014-0949-y
• 发表时间: 2015-06
• 期刊: AIDS AND BEHAVIOR
• 影响因子: 4.4
• 作者: Wirth, Michael D.;Jaggers, Jason R.;Dudgeon, Wesley D.;Hebert, James R.;Youngstedt, Shawn D.;Blair, Steven N.;Hand, Gregory A.
• 通讯作者: Hand, Gregory A.

A home-based exercise intervention to increase physical activity among people living with HIV: study design of a randomized clinical trial.

• DOI: 10.1186/1471-2458-13-502
• 发表时间: 2013-05-24
• 期刊: BMC public health
• 影响因子: 4.5
• 作者: Jaggers JR;Dudgeon W;Blair SN;Sui X;Burgess S;Wilcox S;Hand GA
• 通讯作者: Hand GA