Remotely Supervised Weight Loss and Exercise Training to Improve Rheumatoid Arthritis Cardiovascular Risk: Rationale and Design of the Supervised Weight Loss Plus Exercise Training-Rheumatoid Arthritis Trial.
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2023-05
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Patients with rheumatoid arthritis (RA) remain at an increased risk for cardiovascular disease (CVD) and mortality. RA CVD results from a combination of traditional risk factors and RA-related systemic inflammation. One hypothetical means of improving overall RA CVD risk is through reduction of excess body weight and increased physical activity. Together, weight loss and physical activity can improve traditional cardiometabolic health through fat mass loss, while also improving skeletal muscle health. Additionally, disease-related CVD risk may improve as both fat mass loss and exercise reduce systemic inflammation. To explore this hypothesis, 26 older persons with RA and overweight/obesity will be randomized to 16 weeks of a usual care control arm or to a remotely Supervised Weight Loss Plus Exercise Training (SWET) program. A caloric restriction diet (targeting 7% weight loss) will occur via a dietitian-led intervention, with weekly weigh-ins and group support sessions. Exercise training will consist of both aerobic training (150 minutes/week moderate-to-vigorous exercise) and resistance training (twice weekly). The SWET remote program will be delivered via a combination of video conference, the study YouTube channel, and study mobile applications. The primary cardiometabolic outcome is the metabolic syndrome Z score, calculated from blood pressure, waist circumference, high-density lipoprotein cholesterol, triglycerides, and glucose. RA-specific CVD risk will be assessed with measures of systemic inflammation, disease activity, patient-reported outcomes, and immune cell function. The SWET-RA trial will be the first to assess whether a remotely supervised, combined lifestyle intervention improves cardiometabolic health in an at-risk population of older individuals with RA and overweight/obesity.
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Andonian, BrianJ, Leanna M Ross, Alyssa M Zidek, Liezl B Fos, Lucy W Piner, Johanna L Johnson, Kelsey B Belski, Julie D Counts, et al. (2023). Remotely Supervised Weight Loss and Exercise Training to Improve Rheumatoid Arthritis Cardiovascular Risk: Rationale and Design of the Supervised Weight Loss Plus Exercise Training-Rheumatoid Arthritis Trial. ACR open rheumatology, 5(5). pp. 252–263. 10.1002/acr2.11536 Retrieved from https://hdl.handle.net/10161/30452.
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Scholars@Duke
Brian Andonian
Leanna Ross
Dr. Ross's research focuses on understanding the mechanisms by which exercise interventions elicit short- and long-term cardiometabolic health benefits. As cardiometabolic disease remains the leading cause of morbidity and mortality in the United States, the goal of her translational research is to enhance the development of evidence-based, precision exercise interventions that optimally prevent and treat disease.
Areas of Research Interest
Exercise dose-response and cardiometabolic health
Insulin action and glucose homeostasis
Legacy health benefits of exercise
Heterogeneity of response to exercise intervention
Precision lifestyle medicine
Epidemiology of physical activity and cardiorespiratory fitness
Carl F. Pieper
Analytic Interests.
1) Issues in the Design of Medical Experiments: I explore the use of reliability/generalizability models in experimental design. In addition to incorporation of reliability, I study powering longitudinal trials with multiple outcomes and substantial missing data using Mixed models.
2) Issues in the Analysis of Repeated Measures Designs & Longitudinal Data: Use of Hierarchical Linear Models (HLM) or Mixed Models in modeling trajectories of multiple variables over time (e.g., physical and cognitive functioning and Blood Pressure). My current work involves methodologies in simultaneous estimation of trajectories for multiple variables within and between domains, modeling co-occuring change.
Areas of Substantive interest: (1) Experimental design and analysis in gerontology and geriatrics, and psychiatry,
(2) Multivariate repeated measures designs,
Ilene C. Siegler
My research efforts are in the area of developmental health psychology and organized around understanding the role of personality in health and disease in middle and later life.
My primary research activity is as Principal Investigator of the UNC Alumni Heart Study (UNCAHS) a prospective epidemiologic study of 5000 middle aged men and women and 1200 of their spouses that evaluates the role of personality on coronary heart disease and coronary heart disease risk, cancer, and normal aging.
As head of Cancer Prevention Research Unit , I study the role of psychological factors related to mammography behavior and estrogen replacement therapy is being studied in UNCAHS women.
REPRESENTATIVE PUBLICATIONS
Siegler, I.C., Zonderman, A.B., Barefoot, J.C., Williams, R.B., Jr., Costa, P.T., Jr., & McCrae, R. R. (1990). Predicting personality from college MMPI scores: Implications for follow-up studies in psychosomatic medicine. Psychosomatic Medicine, 52, 644-652.
Siegler, I.C., Peterson, B.L., Barefoot, J.C., & Williams, R.B. (1992). Hostility during late adolescence predicts coronary risk factors at midlife. American Journal of Epidemiology, 138(2), 146-154.
Siegler, I.C., Peterson, B.L., Barefoot, J.C., Harvin, S.H. Dahlstrom, W.G., Kaplan, B.H., Costa, P.T. Jr., & Williams, R.B. (1992). Using college alumni populations in epidemiologic research: The UNC Alumni Heart Study. Journal of Clinical Epidemiology, 45(11), 1243-1250.
Siegler, I.C., Dawson, D.V., & Welsh, K.A. (1994). Caregiver ratings of personality change in Alzheimer's disease patients: A replication. Psychology and Aging, 9, 464-466.
Siegler, I.C., Feaganes, J.R., & Rimer, B.K. (1995). Predictors of adoption of mammography in women under age 50. Health Psychology, 14, 274-278.
1/13/99
Connie Watkins Bales
Research in our laboratory focuses on the role of nutrition (particularly vitamins and minerals) in the prevention and management of chronic diseases in older adults. Previous studies have concerned trace elements and cardiovascular disease, calcium and osteoporosis, and renal synthesis of vitamin D as it relates to bone health. Some of our newest work emphasizes the role of micronutrients as antioxidants and their interaction with the aging process. We are also working on various aspects of energy balance in older adults, ranging from failure to thrive in stroke patients with dysphagia to exercise and nutrition effects in overweight subjects who begin physical training. Thus we have a number of clinical and epidemiological projects on-going, many of which include a strong emphasis on nutrition assessment techniques in middle-aged and elderly subjects.
William Erle Kraus
My training, expertise and research interests range from human integrative physiology and genetics to animal exercise models to cell culture models of skeletal muscle adaptation to mechanical stretch. I am trained clinically as an internist and preventive cardiologist, with particular expertise in preventive cardiology and cardiac rehabilitation. My research training spans molecular biology and cell culture, molecular genetics, and integrative human exercise physiology and metabolism. I practice as a preventive cardiologist with a focus on cardiometabolic risk and exercise physiology for older athletes. My research space has both a basic wet laboratory component and a human integrative physiology one.
One focus of our work is an integrative physiologic examination of exercise effects in human subjects in clinical studies of exercise training in normal individuals, in individuals at risk of disease (such as pre-diabetes and metabolic syndrome; STRRIDE), and in individuals with disease (such as coronary heart disease, congestive heart failure and cancer).
A second focus of my research group is exploration of genetic determinates of disease risk in human subjects. We conduct studies of early onset cardiovascular disease (GENECARD; CATHGEN), congestive heart failure (HF-ACTION), peripheral arterial disease (AMNESTI), and metabolic syndrome. We are exploring analytic models of predicting disease risk using established and innovative statistical methodology.
A third focus of my group’s work is to understand the cellular signaling mechanisms underlying the normal adaptive responses of skeletal muscle to physiologic stimuli, such as occur in exercise conditioning, and to understand the abnormal maladaptive responses that occur in response to pathophysiologic stimuli, such as occur in congestive heart failure, aging and prolonged exposure to microgravity.
Recently we have begun to investigate interactions of genes and lifestyle interventions on cardiometabolic outcomes. We have experience with clinical lifestyle intervention studies, particularly the contributions of genetic variants to interventions responses. We call this Lifestyle Medicopharmacogenetics.
KEY WORDS:
exercise, skeletal muscle, energy metabolism, cell signaling, gene expression, cell stretch, heart failure, aging, spaceflight, human genetics, early onset cardiovascular disease, lifestyle medicine
Kim Marie Huffman
Determining the role of physical activity in modulating health outcomes (cardiovascular disease risk) in persons with rheumatologic diseases (rheumatoid arthritis, gout, osteoarthritis)
Integrating clinical rheumatology, basic immunology, metabolism, and exercise science in order to reduce morbidity in individuals with arthritis
Evaluating relationships between circulating and intra-muscular metabolic intermediates and insulin resistance in sedentary as well as individuals engaging in regular exercise
Addressing the role of physical activity in modulating inflammation, metabolism, and functional health in aging populations
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