Influence of an individualised home based physical activity intervention on carotid atherosclerotic plaque instability in non endarterectomized patients ; Effet d’une intervention en activité physique individualisée en condition écologique sur l’instabilité de la plaque d’athérome carotidienne chez des patients non opérés

Atherosclerosis is an inflammatory multifactorial disease characterized by the presence of atherosclerotic plaques at the bifurcation of large arteries. Carotid atherosclerotic plaques can remain silent until their rupture provoques an ischemic stroke. Intraplaque hemorrhage (IPH) and intercrrent inflammatory processes cause plaque instability. IPH is the instability factor that better predicts plaque rupture. Benefits of the endarterectomy surgery remaisn controversials in patients asymptomatic of ischemic stroke. In two previous cross-sectional prospective study, our team demonstrated that patients practicing moderate physical activity (PA) had lower rates of IPH and pro-inflammatory monocytes. In this thesis, we hypothesized that an individualized home-based PA intervention can reduce IPH and modulate inflammation, as well as monocyte phenotype in asymptomatic patients with a non-endarterectomized carotid atherosclerotic plaque.Fifty-seven patients had been included in the unit of vascular and endovascular surgery of the Louis Pradel hospital in Lyon. Patients should have been asymptomatic of ischemic events for more than 6 months and present a carotid stenosis >50%. At inclusion and after 6 months, IPH was measured with a high-resolution MRI, a blood sample was used to quantify the inflammation state and determine the circulation monocytes phenotype, moreover, PA was quantified with a 6minutes walking test, a test of isometric contraction of the quadriceps and finally, sedentary behavior and PA levels were assessed by questionnaire. Patients were randomly allocated to the control or to the PA intervention group. In the PA group, patients should reach daily goals of steps, measured by a connected watch. Dailly steps goal was reevaluated twice a month, in order to encourage patients to increase their walking habits. Patients in the control group receive their usual care during the protocol.Fifty-two patients finished the study, 26 where randomized in each group. At inclusion, blood test, frequency of ...