The PRESS ERA: Protein & Resistance Exercise Supplement Study for Elderly with RA

描述（由申请人提供）：类风湿关节炎（RA）是一种以滑膜炎和关节炎为特征的全身性炎症疾病。类风湿性关节炎具有侵蚀性和破坏性，可导致疼痛、残疾和畸形。RA在60岁以上人群中的患病率约为2%，在70岁及以上人群中患病率最高。由于慢性炎症性疾病和缺乏运动，老年RA患者比同龄无RA患者有更多的肌肉无力、更少的肌肉量和更多的脂肪量。随着老年RA患者低体力活动和高脂肪量的既定模式，额外的热量补充并不被常规推荐单独，但运动和营养干预的结合已被建议作为类风湿恶质和一般老年体弱个体的重要治疗方法。抗阻运动是一种安全有效的干预措施，可以改善年轻RA患者的力量、肌肉质量和功能。然而，它还没有在老年类风湿性关节炎患者中进行测试，这些患者有更多的肌肉无力和残疾。由于风湿性关节炎损伤造成的关节限制，许多阻力运动方案不能适用于老年人群。蛋白质补充，特别是在运动后时期，可能会显著影响老年人阻力运动对肌肉力量的影响。此外，患有类风湿性关节炎的老年人由于其炎症性疾病的高分解代谢状态可能有更高的每日蛋白质需求。抗阻运动和蛋白质补充这两种重要干预措施的结合，以对抗与类风湿性关节炎相关的身体成分变化、虚弱和残疾，从未在老年人中进行过评估。本研究提出了一项随机对照交叉试验，以评估针对老年（70岁）RA患者的量身定制的16周阻力运动计划，并结合蛋白质补充。本研究中的运动方案是独特的，因为它结合了在专门设备上进行的动态和等长（静态）阻力运动，可以适应老年类风湿关节炎患者经常遇到的运动范围限制。这项研究也将开始评估每日补充蛋白质是否能获得额外的好处。随着人口老龄化，我们很可能会看到炎症性风湿病的患病率增加，并伴随对老年人肌肉、力量和疲劳的有害影响。本项目提出测试一种重要的辅助治疗方法，抗阻运动和蛋白质补充，这是安全、廉价和潜在的高度有益的。

DESCRIPTION (provided by applicant): Rheumatoid arthritis (RA) is a systemic inflammatory disease characterized by synovitis and arthritis. The arthritis in RA can be erosive and destructive leading to pain, disability, and deformity. The prevalence of RA among individuals over the age of 60 years is approximately 2% and highest among those 70 years of age and older. Older individuals with RA have more muscle weakness, less muscle mass, and more fat mass than age- matched individuals without RA due to a combination of chronic inflammatory disease and inactivity. With the established pattern of low physical activity and high fat mass among older RA patients, additional caloric supplementation is not routinely recommended alone, but the combination of exercise and nutritional interventions have been suggested as important treatments for rheumatoid cachexia and older frail individuals in general. Resistance exercise is a safe and effective intervention to improve strength, muscle mass, and function in younger individuals with RA. However, it has not been tested in older RA patients who have considerably more muscle weakness and disability. Many resistance exercise protocols cannot be applied to an older population because of joint limitations from RA damage. Protein supplementation, particularly in the post-exercise period, may significantly influence the impact of resistance exercise on muscle strength in the elderly. Further, older individuals with RA may have higher daily protein requirements due to the hypercatabolic state of their inflammatory disease. The combination of these two important interventions, resistance exercise and protein supplementation, to combat the body composition changes, weakness, and disability associated with RA has never been evaluated in older individuals. This study proposes a randomized controlled cross-over trial to evaluate a tailored 16-week resistance exercise program, in combination with protein supplementation, for older (¿70 years of age) individuals with RA. The exercise protocol in this study is distinctive because it combines dynamic and isometric (static) resistance exercise performed on specialized equipment that can accommodate the range of motion limitations frequently encountered in the older RA population. This study will also begin to evaluate if additional benefit can be achieved with daily protein supplementation. As the population ages, we are likely to see an increase in the prevalence of inflammatory rheumatic disease and its concomitant detrimental effects on muscle, strength, and fatigue in the elderly. This project proposes to test an important adjuvant approach to treatment, resistance exercise and protein supplementation, which is safe, inexpensive, and potentially highly beneficial.