Description: Background: Hutchinson-Gilford progeria syndrome is an extremely rare, fatal, segmental premature aging syndrome caused by a mutation in LMNA yielding the farnesylated aberrant protein progerin. Without progerin-specific treatment, death occurs at an average age of 14.6 years from an accelerated atherosclerosis. A previous single-arm clinical trial demonstrated that the protein farnesyltransferase inhibitor lonafarnib ameliorates some aspects of cardiovascular and bone disease. This present trial sought to further improve disease by additionally inhibiting progerin prenylation. Methods: Thirty-seven participants with Hutchinson-Gilford progeria syndrome received pravastatin, zoledronic acid, and lonafarnib. This combination therapy was evaluated, in addition to descriptive comparisons with the prior lonafarnib monotherapy trial. Results: No participants withdrew because of side effects. Primary outcome success was predefined by improved per-patient rate of weight gain or carotid artery echodensity; 71.0% of participants succeeded ( P 〈0.0001). Key cardiovascular and skeletal secondary variables were predefined. Secondary improvements included increased areal ( P =0.001) and volumetric ( P 〈0.001–0.006) bone mineral density and 1.5- to 1.8-fold increases in radial bone structure ( P 〈0.001). Median carotid artery wall echodensity and carotid-femoral pulse wave velocity demonstrated no significant changes. Percentages of participants with carotid (5% to 50%; P =0.001) and femoral (0% to 12%; P =0.13) artery plaques and extraskeletal calcifications (34.4% to 65.6%; P =0.006) increased. Other than increased bone mineral density, no improvement rates exceeded those of the prior lonafarnib monotherapy treatment trial. Conclusions: Comparisons with lonafarnib monotherapy treatment reveal additional bone mineral density benefit but likely no added cardiovascular benefit with the addition of pravastatin and zoledronic acid. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifiers: NCT00879034 and NCT00916747.

Description: Background and Purpose— Little is known about the effects of community-based walking programs in persons with chronic stroke. The purpose of this study was to determine the effects of aerobic (walking) training on functional status and health-related quality of life in stroke survivors. Methods— A single-blind randomized controlled trial was conducted. The intervention group (n=64) walked overground for 30 minutes, 3 times per week for 12 weeks. The control group (n=64) received massage to the affected side. Medical Outcomes Short Form, 36-Item Short Form Health Survey (SF-36), was used to assess health-related quality of life; Barthel Index and Older Americans Resource and Services scale for functional status; 6-minute walk test for endurance; and Motricity Index for lower extremity strength. Results— There was a trend toward greater improvement over time for the Physical Health Component of the SF-36 ( P =0.077) and significantly greater improvement over time for distance walked in 6 minutes in favor of the walking group ( P 〈0.001). Conclusions— Aerobic walking improves the physical health component of quality of life and endurance in persons with chronic stroke. It should form part of a comprehensive health promotion strategy. Clinical Trial Registration— Trial was not registered as enrollment commenced before 2005.