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Title: The role of physical activity on cardiovascular disease risk in patients with psoriasis
Author: Auker, Lisa
ISNI:       0000 0005 0289 3911
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2017
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Background: Patients with psoriasis have an increased risk of cardiovascular disease (CVD) and traditional CVD risk factors, including the metabolic syndrome, are highly prevalent in the psoriasis population. We postulated that individuals with psoriasis may avoid physical activity, which may contribute to their elevated CVD risk. Aims: The aims of this PhD were to: i) identify the barriers to cardiorespiratory fitness; ii) determine whether physical activity influences arterial stiffness and cardiorespiratory fitness and iii) identify biomarkers of physical activity and arterial stiffness in patients with psoriasis. Methods: 404 patients with psoriasis were recruited from primary and secondary care sources in the North West of England. Patients were asked to complete the International Physical Activity Questionnaire and the Dermatology Life Quality Index (DLQI). Analysis of venous blood was performed, and biomarkers, including soluble E-selectin metabolic markers, adipokines, circulatory lipids and inflammatory markers were measured. Participants also had an arterial function assessment using the TensioMed Arteriograph (The Arteriograph Company, Budapest, Hungary). Results: Over 50% of patients with psoriasis failed to meet the recommended guidelines for exercise, as provided by the American Heart Association. Psoriasis severity impacted on exercise behaviour and the DLQI identified six key psoriasis- specific barriers to physical activity, including: skin sensitivity, embarrassment, clothing choices, social/leisure activities, engagement in sport and treatment of psoriasis. Lipid and glycaemic control was found to have a significant impact on arterial stiffness (PWV), which is a preclinical indicator of future CVD risk. Importantly, we found that regulation of these biochemical parameters could be modulated by physical activity, thus providing a means to diminish the CVD risk of patients with psoriasis. Through arterial function assessment we identified that measurement of the diastolic reflection area (DRA) had utility as a bed-side measure of exercise profile which could provide a means to measure adherence to exercise in the psoriasis population. Conclusions: This is the first time exercise engagement, in a psoriasis population, has been investigated in relation to arterial stiffness, cardiorespiratory fitness and biochemical profile. Given the CVD risk in patients with psoriasis, these findings strengthen the need for intervention. PWV and DRA could provide means to monitor future CVD risk and exercise engagement, respectively, in a way that is objective, non-invasive and efficient.
Supervisor: Griffiths, Christopher ; Cordingley, Mary ; Young, Helen Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Physical Activity ; Psoriasis ; Cardiovascular disease ; Exercise ; Arterial Stiffness