Influence of a six-month home-based individualized physical activity intervention on carotid plaque instability
Mathilde Mura1, Emeraude Rivoire1,2, Leila Dehina-Khenniche1,2
1University Claude Bernard Lyon 1, LIBM UR 7424, Team Atherosclerosis, Thrombosis and Physical Activity, Lyon, France.
Insights
Physical activity interventions significantly reduced intraplaque hemorrhage in asymptomatic patients with carotid stenosis. This home-based program is feasible and may complement standard medical treatment for carotid atherosclerotic plaque.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Carotid atherosclerotic plaque management in asymptomatic patients remains debated.
- Intraplaque hemorrhage (IPH) on MRI indicates plaque instability and ischemic risk.
- Previous studies suggest physical activity is linked to lower IPH prevalence.
Purpose of the Study:
- To assess the impact of a physical activity intervention on carotid plaque instability.
- To determine if a home-based physical activity program can reduce IPH in asymptomatic carotid stenosis patients.
Main Methods:
- Randomized clinical trial involving 56 asymptomatic patients with ≥50% carotid stenosis.
- Intervention group: 6-month individualized home-based physical activity program.
- Control group: usual care. Main outcome: change in IPH score via high-resolution MRI.
Main Results:
- The physical activity group showed a significant reduction in the intraplaque hemorrhage score (p=0.04).
- Daily step counts increased significantly in the intervention arm compared to controls (p=0.02).
- The intervention was feasible for asymptomatic patients with carotid atherosclerotic plaque.
Conclusions:
- An individualized home-based physical activity intervention can decrease intraplaque hemorrhage severity.
- This moderate-intensity physical activity is feasible and may be a valuable addition to the best medical treatment for this population.
Background:
Management of asymptomatic patients with carotid atherosclerotic plaque is still debated. Intraplaque haemorrhage measured by magnetic resonance imaging is the best in-vivo indicator of plaque instability and ischaemic risk. A cross-sectional study reported that physical activity was associated with lower prevalence of carotid intraplaque haemorrhage. The aim of this trial was to determine the influence of a physical activity intervention on plaque instability in asymptomatic patients with carotid stenosis.
Methods:
Physical Activity and Carotid Atherosclerotic Plaque haemorrhage is a randomized clinical trial (ID-RCB:2019-A01543-54/SI:19.06.21.40640; registered on clinicaltrials.govNCT04053166). Patients were enrolled at University Hospital of Lyon, France, from December 2019 to March 2022. Fifty-six asymptomatic patients with carotid artery stenosis ≥50% NASCET were included and randomized 1:1 in an interventional physical activity arm or a control arm. The interventional arm underwent 6 months of an individualized home-based physical activity program, while the control arm followed usual care. The main outcome is the variation of the intraplaque haemorrhage score measured with high-resolution magnetic resonance imaging of the carotid plaque. All data were analysed with an intention to treat. Investigators were blinded from grouping.
Findings:
Out of 52 patients participating in the trial, 26 were allocated in each arm. The intraplaque haemorrhage score was significantly reduced over time in the physical activity arm (estimate difference: -0.32 ± 0.15, [95% CI -0.63 to -0.01], p = 0.04). The physical activity arm had increased daily step counts at the end of the 6-month intervention compared to the control arm (1843 ± 758, [CI95% 313-3373], p = 0.02).
Interpretation:
This trial demonstrates that an individualized home-based physical activity intervention could reduce the severity of intraplaque haemorrhage detected by magnetic resonance imaging and that it is feasible in asymptomatic patients with carotid atherosclerotic plaque. These results suggest that this type of moderate-intensity physical activity could be included in this population to the best medical treatment.
Funding:
This study was funded by the Fédération Française de Cardiologie and Nouvelle Société Francophone d'Athérosclérose.
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