Modifiable cardiovascular risk factors and safety of the combined exercise session in Takayasu\'s arteritis: multicenter, randomized study

Author(s)

Alexandre Moura dos Santos

• Document type: Master's Dissertation
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
• Defense date: 2021-01-26

Examining board members

Samuel Katsuyuki Shinjo; Gilda Aparecida Ferreira; Luiz Augusto Buoro Perandini; Rosa Maria Rodrigues Pereira

• Advisor: Samuel Katsuyuki Shinjo

Abstract

Introduction. Takayasu arteritis (TAK) is a primary systemic vasculitis with a high frequency of morbidity and mortality, cardiovascular disease and its risk factors. However, there are modifiable cardiovascular risk factors, still little studied in TAK, that could influence this morbidity and mortality, such as, for example, the lower aerobic capacity and aerobic power, the lower muscle strength, the lower level of physical activity and the worst composition body. Objectives. To evaluate the modifiable cardiovascular risk factors in female patients with TAK. Additionally, to evaluate the combined physical exercise for adverse effects, reactivation of the disease, its safety. Secondarily, assess the quality of life, functional capacity, ability to perform activities of daily living, and pre-existing comorbidities. Finally, to correlate modifiable cardiovascular risk factors, for example, aerobic power and strength with functional capacity, quality of life, and body composition. Methods This is a multicenter, randomized clinical study, carried out from 2019 to 2020, in two phases. In the first phase, a cross-sectional analysis was carried out in which 20 adult women with TAK (ACR 1990) were paired by sex, ethnicity, age, and body mass index with 16 controls without rheumatic diseases, to assess the modifiable cardiovascular risk factors, that is, aerobic capacity and power (VO2 relative and absolute peak, metabolic thresholds and heart rate, respiratory exchange ratio), strength, body composition (lean mass, fat mass, adipose tissue, body mass, body mass index and circumferences, and ratio waist-to-hip), physical activity, weekly metabolic equivalent (International Physical Activity Questionnaire - Short Form, IPAQ-SF) and functional capacity/activities of daily living (Health Assessment Questionnaire - HAQ and Short- Form Health Survey questionnaires - SF-36 ), disease status (Indian Takayasu Clinical Activity Score 2010, National Institute of Healthy, C-reactive protein - CRP and erythrocyte sedimentation rate - ESR). In the second phase (randomization), 14 of the 20 patients with TAK were randomized (1: 1) to undergo or not an acute session of combined physical exercise, to assess safety during the session, reactivation of the disease, and effects adverse effects (acutely and after a month of follow-up). Results. The 20 patients with TAK and 16 women in the control group had, respectively, age, ethnicity, and body mass index comparable to each other (P> 0.05). When compared to the control group, they also showed a reduction in peak VO2 (absolute and relative), reduced strength in lower limbs, increased visceral adipose tissue, reduced walking capacity, decreased weekly metabolic equivalent, walking ability, capacity functional (HAQ and SF-36) (P <0.05). However, there were no correlations between the reduction in aerobic power, strength, and the functional variables evaluated. After randomization, patients undergoing combined physical exercise did not experience adverse events, relapses, or acute worsening of the disease or after a month of follow-up. Regarding acute phase reagents, no significant differences were found before and after the session (0, 30, 60, 90, 120 minutes). In all phases, no adverse effects, complications (clinical and laboratory), or recurrences of the disease were observed. Conclusions. The patients in the TAK group have a significant worsening of the modifiable cardiovascular risk factors (aerobic power, lower limb strength, visceral adipose tissue, waist-to-hip ratio, and level of physical activity). In addition, it has worsened quality of life, functional capacity, and ability to perform activities of daily living. The increase in the presence of modifiable cardiovascular risk factors (aerobic power and muscle strength) was not correlated with lower quality of life, lower functional capacity, and worse body composition. The combined physical exercise was safe acutely and after one month of the session. (AU)

• FAPESP's process: 18/08735-3 - Aerobic capacity and strength exercise in Takayasu's arteritis: relationships and impacts on clinical, laboratory and vascular end points
• Grantee: Alexandre Moura dos Santos
• Support Opportunities: Scholarships in Brazil - Master