Effects of exercise training on systemic and arterial wall inflammation in childhood-onset Takayasu arteritis: a randomized, multicenter, controlled trial study

Author(s)

Camilla Astley Amaral Pedroso

• Document type: Master's Dissertation
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
• Defense date: 2020-05-15

Examining board members

Bruno Gualano; Gabriel Grizzo Cucato; Raphael Mendes Ritti Dias; Rosa Maria Rodrigues Pereira

• Advisor: Bruno Gualano

Abstract

Background: Childhood-onset Takayasu arteritis (c-TA) is an inflammatory vasculitis predisposing to a high risk of morbidity and mortality. No randomized controlled trial has been conducted in c-TA, precluding evidence-based treatment recommendations. Exercise has the potential to improve inflammation and cardiovascular health, but evidence remains scant in c-TA. The main objective of this study was to investigate the potential therapeutic effects of exercise in c-TA. Methods: This is a two-part study involving a cross-sectional comparison between c-TA and healthy controls, followed by a 12-week, multicenter, randomized controlled trial conducted in Sao Paulo (Brazil), between November 2017 and March 2019, to test the effects of a home-based, exercise intervention vs. standard of care in patients with c-TA (n = 17). The primary outcomes were arterial inflammation, assessed by [18F] fluoro- deoxy-D-glucose positron emission tomography/magnetic resonance imaging [FDG-PET/MRI]) and systemic inflammatory markers. Secondary outcomes included body composition, physical activity levels, physical capacity, cardiometabolic risk factors, disease-related parameters, and quality of life. This trial was registered at ClinicalTrials,gov number NCT03494062. Findings: In the cross-sectional comparison, c-TA patients showed worse physical capacity, physical activity levels, autonomic function, fat, lean and bone mass, insulin sensitivity, and quality of life vs. controls (P <= 0,05). Findings from randomized clinical trial showed that exercised patients experienced a reduction in the frequency of vessel segments with severe inflammation, whereas the non-exercised patients had an opposite response (P = 0,007). Decreased inflammation in aortic arch (P = 0,002) and left subclavian artery (P = 0,029) were more pronounced in the exercised vs. non-exercised patients. Greater improvements in visceral fat, steps per day, muscle function, strength, and vitality were also observed in the exercised vs. no exercised patients (all P <= 0,05). Interpretation: c-TA patients showed worse overall health-related factors, but exercise improved arterial inflammation, visceral fat, physical activity levels, functionality, and vitality. Exercise arises as a valuable, evidence-based intervention to treat c-TA patients (AU)

• FAPESP's process: 17/07358-9 - Physical activity in patients with Juvenile Takayasu Arteritis: Clinical effects and mechanisms of action.
• Grantee: Camilla Astley Amaral Pedroso
• Support Opportunities: Scholarships in Brazil - Master