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Heinze-Milne S, Banga S, Howlett SE. Low testosterone concentrations and risk of ischaemic cardiovascular disease in ageing: not just a problem for older men. Lancet Healthy Longev 2022; 3:e83-e84. [PMID: 36098326 DOI: 10.1016/s2666-7568(22)00008-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Stefan Heinze-Milne
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Shubham Banga
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada; Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada.
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Bisset ES, Heinze-Milne S, Grandy SA, Howlett SE. Aerobic Exercise Attenuates Frailty in Aging Male and Female C57Bl/6 Mice and Effects Systemic Cytokines Differentially by Sex. J Gerontol A Biol Sci Med Sci 2022; 77:41-46. [PMID: 34610102 PMCID: PMC8751786 DOI: 10.1093/gerona/glab297] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Indexed: 12/19/2022] Open
Abstract
Aerobic exercise is a promising intervention to attenuate frailty, but preclinical studies have used only male animals. We investigated the impact of voluntary aerobic exercise on frailty, biological age (FRailty Inferred Geriatric Health Timeline [FRIGHT] clock), predicted life expectancy (Analysis of FRAIlty and Death [AFRAID] clock), and mortality in both sexes and determined whether exercise was associated with changes in inflammation. Older (21-23 months) male (n = 12) and female (n = 22) C57Bl/6 mice matched for baseline frailty scores were randomized into exercise (running wheel) and sedentary (no wheel) groups. Frailty index scores were measured biweekly (13 weeks), and 23 serum cytokines were measured at midpoint and end point. Exercise levels varied between mice but not between the sexes. Exercise had no effect on mortality, but it attenuated the development of frailty in both sexes (female = 0.32 ± 0.04 vs 0.21 ± 0.01; p = .005; male = 0.30 ± 0.02 vs 0.22 ± 0.02; p = .042) and reduced frailty in older females after 10 weeks. FRIGHT scores were unaffected by exercise but increased with time in sedentary males indicating increased biological age. Exercise prevented the age-associated decline in AFRAID scores in older females such that exercised females had a longer life expectancy. We investigated whether aerobic exercise was associated with changes in systemic inflammation. Cytokine levels were not affected by exercise in males, but levels of pro-inflammatory cytokines were positively correlated with the frequency of exercise in females. Despite increases in systemic inflammation, exercise reduced frailty and increased life span in older females. Thus, voluntary aerobic exercise, even late in life, has beneficial effects on health in both sexes but may be especially helpful in older females.
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Affiliation(s)
- Elise S Bisset
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stefan Heinze-Milne
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Scott A Grandy
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia, Canada
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Bisset ES, Heinze-Milne S, Grandy SA, Howlett SE. Corrigendum to: Aerobic Exercise Attenuates Frailty in Aging Male and Female C57Bl/6 Mice and Affects Systemic Cytokines Differentially by Sex. J Gerontol A Biol Sci Med Sci 2021; 77:291. [PMID: 34897435 PMCID: PMC8824599 DOI: 10.1093/gerona/glab350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Elise S Bisset
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stefan Heinze-Milne
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Scott A Grandy
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.,School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia, Canada
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Kane AE, Bisset ES, Heinze-Milne S, Keller KM, Grandy SA, Howlett SE. Maladaptive Changes Associated With Cardiac Aging Are Sex-Specific and Graded by Frailty and Inflammation in C57BL/6 Mice. J Gerontol A Biol Sci Med Sci 2021; 76:233-243. [PMID: 32857156 PMCID: PMC7812442 DOI: 10.1093/gerona/glaa212] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Indexed: 12/23/2022] Open
Abstract
We investigated whether late-life changes in cardiac structure and function were related to high levels of frailty and inflammation in male and female mice. Frailty (frailty index), ventricular structure/function (echocardiography), and serum cytokines (multiplex immunoassay) were measured in 16- and 23-month-old mice. Left ventricular (LV) mass and septal wall thickness increased with age in both sexes. Ejection fraction increased with age in males (60.4 ± 1.4 vs 68.9 ± 1.8%; p < .05) but not females (58.8 ± 2.5 vs 62.6 ± 2.4%). E/A ratios declined with age in males (1.6 ± 0.1 vs 1.3 ± 0.1; p < .05) but not females (1.4 ± 0.1 vs 1.3 ± 0.1) and this was accompanied by increased ventricular collagen levels in males. These changes in ejection fraction (r = 0.52; p = .01), septal wall thickness (r = 0.59; p = .002), E/A ratios (r = -0.49; p = .04), and fibrosis (r = 0.82; p = .002) were closely graded by frailty scores in males. Only septal wall thickness and LV mass increased with frailty in females. Serum cytokines changed modestly with age in both sexes. Nonetheless, in males, E/A ratios, LV mass, LV posterior wall thickness, and septal wall thickness increased as serum cytokines increased (eg, IL-6, IL-3, IL-1α, IL-1β, tumor necrosis factor-α, eotaxin, and macrophage inflammatory protein-1α), while ejection fraction declined with increasing IL-3 and granulocyte-macrophage colony stimulating factor. Cardiac outcomes were not correlated with inflammatory cytokines in females. Thus, changes in cardiac structure and function in late life are closely graded by both frailty and markers of inflammation, but this occurs primarily in males. This suggests poor overall health and inflammation drive maladaptive changes in older male hearts, while older females may be resistant to these adverse effects of frailty.
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Affiliation(s)
- Alice E Kane
- Department of Genetics, Harvard Medical School, Boston, Massachusetts.,Charles Perkins Center, The University of Sydney, Australia
| | - Elise S Bisset
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stefan Heinze-Milne
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kaitlyn M Keller
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Scott A Grandy
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.,School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, Nova Scotia, Canada
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Keller K, Kane A, Heinze-Milne S, Grandy SA, Howlett SE. Chronic Treatment With the ACE Inhibitor Enalapril Attenuates the Development of Frailty and Differentially Modifies Pro- and Anti-inflammatory Cytokines in Aging Male and Female C57BL/6 Mice. J Gerontol A Biol Sci Med Sci 2020; 74:1149-1157. [PMID: 30256910 DOI: 10.1093/gerona/gly219] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Indexed: 11/13/2022] Open
Abstract
Studies on interventions that can delay or treat frailty in humans are limited. There is evidence of beneficial effects of angiotensin converting enzyme (ACE) inhibitors on aspects related to frailty, such as physical function, even in those without cardiovascular disease. This study aimed to longitudinally investigate the effect of an ACE inhibitor on frailty in aging male and female mice. Frailty was assessed with a clinical frailty index (FI) which quantifies health-related deficits in middle-aged (9-13 months) and older (16-25 months) mice. Chronic treatment with enalapril (30 mg/kg/day in feed) attenuated frailty in middle-aged and older female mice, and older male mice, without a long-term effect on blood pressure. Enalapril treatment resulted in a reduction in the proinflammatory cytokines interleukin (IL)-1α, monocyte chemoattractant protein-1 and macrophage inflammatory protein-1a in older female mice, and an increase in the anti-inflammatory cytokine IL-10 in older male mice compared with control animals. These sex-specific effects on inflammation may contribute to the protective effects of enalapril against frailty. This is the first study to examine the longitudinal effect of an intervention on the FI in mice, and provides preclinical evidence that enalapril may delay the onset of frailty, even when started later in life.
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Affiliation(s)
- Kaitlyn Keller
- Department of Pharmacology, Dalhousie University, Halifax, Canada
| | - Alice Kane
- Department of Pharmacology, Dalhousie University, Halifax, Canada
| | - Stefan Heinze-Milne
- School of Health and Human Performance, Dalhousie University, Halifax, Canada
| | - Scott A Grandy
- Department of Pharmacology, Dalhousie University, Halifax, Canada.,School of Health and Human Performance, Dalhousie University, Halifax, Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, Canada.,Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, Canada
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Kane AE, Keller KM, Heinze-Milne S, Grandy SA, Howlett SE. A Murine Frailty Index Based on Clinical and Laboratory Measurements: Links Between Frailty and Pro-inflammatory Cytokines Differ in a Sex-Specific Manner. J Gerontol A Biol Sci Med Sci 2019; 74:275-282. [PMID: 29788087 DOI: 10.1093/gerona/gly117] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Indexed: 12/12/2022] Open
Abstract
A frailty index (FI) based on clinical deficit accumulation (FI-Clinical) quantifies frailty in aging mice. We aimed to develop a laboratory test-based murine FI tool (FI-Lab) and to investigate the effects of age and sex on FI-Lab scores, FI-Clinical scores, and the combination (FI-Combined), as well as to explore links between frailty and inflammation. Studies used older (17 and 23 months) C57BL/6 mice of both sexes. We developed an FI-Lab (blood pressure, blood chemistry, echocardiography) based on deviation from reference values in younger adults (12 months), which showed similar characteristics to a human FI-Lab tool. Interestingly, while FI-Clinical scores were higher in females, the opposite was true for FI-Lab scores and there was no sex difference in FI-Combined scores. All three FI tools revealed a positive correlation between pro-inflammatory cytokine levels and frailty in aging mice that differed between the sexes. Elevated levels of the pro-inflammatory cytokines interleukin (IL)-6, IL-9, and interferon-γ were associated with higher FI scores in aging females, while levels of IL-12p40 rose as FI scores increased in older males. Thus, an FI tool based on common laboratory tests can quantify frailty in mice; the positive correlation between inflammation and frailty scores in naturally aging mice differs between the sexes.
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Affiliation(s)
- Alice E Kane
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Kaitlyn M Keller
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Stefan Heinze-Milne
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Scott A Grandy
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.,School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.,Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, NS, Canada
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Banga S, Heinze-Milne S, Howlett SE. Abstract 443: Long-Term Testosterone Deficiency Modifies Frailty and Cardiac Structure and Function in Aging Male Mice. Circ Res 2019. [DOI: 10.1161/res.125.suppl_1.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Low circulating testosterone levels are correlated with heart diseases in older adults. The belief that low testosterone contributes to poor health and promotes frailty has dramatically increased testosterone prescriptions in recent years. Still links between low testosterone, frailty and the heart are unclear in part because preclinical studies typically use young, healthy animals. Here we investigated effects of chronic testosterone deficiency on frailty, body composition and cardiac structure/function in aging mice.
Methods:
Male C57BL/6 mice (18-21 mos) underwent a gonadectomy (GDX) or sham surgery (4-wks of age) and then were aged naturally. Sham (n=10-13) and GDX mice (n=11) were tested for frailty (frailty index (FI) tool), echocardiography, electrocardiography (ECG), blood pressure, and serum testosterone (ELISA, facial vein). Body composition was measured with dual-energy X-ray absorptiometry. Mice were anaesthetized (isoflurane) during all procedures except FI scoring.
Results:
Serum testosterone levels were lower in GDX mice than in sham controls (0.89±0.13 vs. 0.29±0.06 ng/mL; p<0.05). Systolic and diastolic blood pressures were unchanged between groups. Interestingly, GDX mice had lower lean mass than sham mice (23.5±1.2 vs. 27.4±0.7 g; p<0.05) but they were actually less frail (FI scores=0.17±0.05 vs. 0.23±0.01; p<0.05). GDX also reduced heart mass (186±11 vs. 148±15 mg; p<0.05) and prolonged the QRS complex (8.5±0.3 vs. 10.0±0.4 ms; p<0.05) without altering heart rate. While end systolic volume was reduced by GDX (p<0.05), ejection fraction, fractional shortening, and cardiac output remained unchanged.
Conclusions:
Chronic exposure to low circulating testosterone prolonged ventricular conduction time, reduced heart mass and lowered lean mass in aging male mice. This suggests that testosterone deficiency may promote electrical and contractile dysfunction in the setting of aging. However, despite adverse effects on the heart and lean muscle mass, frailty scores were actually lower in mice with chronic testosterone deficiency. This suggests that the impact of low testosterone on overall health is complex and raises questions about the benefits of testosterone supplementation in frail older adults.
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Robinson SA, O'Brien MW, Grandy SA, Heinze-Milne S, Kimmerly DS. Short-term supplement of virgin coconut oil improves endothelial-dependent dilation but not exercise-mediated hyperemia in young adults. Nutr Res 2019; 67:17-26. [DOI: 10.1016/j.nutres.2019.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022]
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Ayaz O, Banga S, Heinze-Milne S, Rose RA, Pyle WG, Howlett SE. Long-term testosterone deficiency modifies myofilament and calcium-handling proteins and promotes diastolic dysfunction in the aging mouse heart. Am J Physiol Heart Circ Physiol 2019; 316:H768-H780. [PMID: 30657724 DOI: 10.1152/ajpheart.00471.2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The impact of long-term gonadectomy (GDX) on cardiac contractile function was explored in the setting of aging. Male mice were subjected to bilateral GDX or sham operation (4 wk) and investigated at 16-18 mo of age. Ventricular myocytes were field stimulated (2 Hz, 37°C). Peak Ca2+ transients (fura 2) and contractions were similar in GDX and sham-operated mice, although Ca2+ transients (50% decay time: 45.2 ± 2.3 vs. 55.6 ± 3.1 ms, P < 0.05) and contractions (time constant of relaxation: 39.1 ± 3.2 vs. 69.5 ± 9.3 ms, P < 0.05) were prolonged in GDX mice. Action potential duration was increased in myocytes from GDX mice, but this did not account for prolonged responses, as Ca2+ transient decay was slow even when cells from GDX mice were voltage clamped with simulated "sham" action potentials. Western blots of proteins involved in Ca2+ sequestration and efflux showed that Na+/Ca2+ exchanger and sarco(endo)plasmic reticulum Ca2+-ATPase type 2 protein levels were unaffected, whereas phospholamban was dramatically higher in ventricles from aging GDX mice (0.24 ± 0.02 vs. 0.86 ± 0.13, P < 0.05). Myofilament Ca2+ sensitivity at physiological Ca2+ was similar, but phosphorylation of essential myosin light chain 1 was reduced by ≈50% in ventricles from aging GDX mice. M-mode echocardiography showed no change in systolic function (e.g., ejection fraction). Critically, pulse-wave Doppler echocardiography showed that GDX slowed isovolumic relaxation time (12.9 ± 0.9 vs. 16.9 ± 1.0 ms, P < 0.05), indicative of diastolic dysfunction. Thus, dysregulation of intracellular Ca2+ and myofilament dysfunction contribute to deficits in contraction in hearts from testosterone-deficient aging mice. This suggests that low testosterone helps promote diastolic dysfunction in the aging heart. NEW & NOTEWORTHY The influence of long-term gonadectomy on contractile function was examined in aging male hearts. Gonadectomy slowed the decay of Ca2+ transients and contractions in ventricular myocytes and slowed isovolumic relaxation time, demonstrating diastolic dysfunction. Underlying mechanisms included Ca2+ dysregulation, elevated phospholamban protein levels, and hypophosphorylation of a myofilament protein, essential myosin light chain. Testosterone deficiency led to intracellular Ca2+ dysregulation and myofilament dysfunction, which may facilitate diastolic dysfunction in the setting of aging.
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Affiliation(s)
- Omar Ayaz
- Department of Pharmacology, Dalhousie University , Halifax, Nova Scotia , Canada
| | - Shubham Banga
- Department of Pharmacology, Dalhousie University , Halifax, Nova Scotia , Canada
| | - Stefan Heinze-Milne
- Department of Pharmacology, Dalhousie University , Halifax, Nova Scotia , Canada
| | - Robert A Rose
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary , Calgary, Alberta , Canada
| | - W Glen Pyle
- Department of Biomedical Sciences, University of Guelph , Guelph, Ontario , Canada
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University , Halifax, Nova Scotia , Canada.,Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary , Calgary, Alberta , Canada
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Heinze-Milne S, Gerges M, Grandy SA. Inflammaging does not contribute to age-related changes in cardiac electrical activity. J Mol Cell Cardiol 2018. [DOI: 10.1016/j.yjmcc.2018.07.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kane A, Keller K, Feridooni H, Heinze-Milne S, Grandy S, Howlett S. Chronic treatment with the ACE inhibitor enalapril attenuates the development of frailty, prevents cardiac hypertrophy and increases IL-10 levels in aging male C57BL/6 mice. J Mol Cell Cardiol 2018. [DOI: 10.1016/j.yjmcc.2018.07.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Heinze-Milne S, Bakowsky V, Giacomantonio N, Grandy SA. Effects of a 12-week cardiovascular rehabilitation programme on systemic inflammation and traditional coronary artery disease risk factors in patients with rheumatoid arthritis (CARDIA trial): a randomised controlled trial. BMJ Open 2017; 7:e018540. [PMID: 29275344 PMCID: PMC5770912 DOI: 10.1136/bmjopen-2017-018540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Patients with systemic inflammatory diseases such as rheumatoid arthritis (RA) have an increased risk of cardiovascular disease (CVD) above the baseline risk attributable to traditional CVD risk factors seen in the general population. Exercise in cardiac rehabilitation (CR) is designed specifically for high-risk primary prevention and those with established CVD. Even though the European League Against Rheumatism guidelines state that exercise is safe for individuals with RA and exercise can reduce CVD risk, patients with RA rarely participate in CR. Thus, little is known about CR's impact on inflammatory and CVD risk in the RA population. The purpose of this trial is to determine the feasibility of a 12-week CR programme for patients with RA and whether it decreases CVD risk without exacerbating RA. METHODS AND ANALYSIS This is a randomised controlled trial whereby 60 participants with RA will be recruited and randomly assigned to either standard of care (SOC) treatment or SOC plus a 12-week CR programme (60 min of education plus two 60 min aerobic exercise sessions/week). Exercise will be performed at 60%-80% of heart rate reserve. Outcome measures (Framingham Risk Score, resting heart rate, blood pressure, blood lipids, markers of systemic inflammation (ie, interleukin (IL) 6 and tumour necrosis factor-α (TNF-α), Clinical Disease Assessment Index, Disease Activity Score-28, physical activity levels and peak cardiorespiratory fitness) will be assessed preintervention (week-0), postintervention (week-13) and 6 months postintervention. ETHICS AND DISSEMINATION Ethical approval was obtained from the Nova Scotia Health Authority Research Ethics Board. Results will be submitted for publication in an appropriate peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT01534871; Pre-results.
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Affiliation(s)
- Stefan Heinze-Milne
- School of Health and Human Performance, Dalhousie University, Halifax, Canada
| | - Volodko Bakowsky
- Division of Rheumatology, Department of Medicine, Nova Scotia Health Authority, Halifax, Canada
| | | | - Scott A Grandy
- School of Health and Human Performance, Dalhousie University, Halifax, Canada
- Division of Cardiology, Nova Scotia Health Authority, Halifax, Canada
- Department of Pharmacology, Dalhousie University, Halifax, Canada
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