A Lifestyle Intervention Program for Successfully Addressing Major Cardiometabolic Risks in Persons with SCI: a Three-subject Case Series

Overview

Journal Spinal Cord Ser Cases

Specialty Neurology

Date 2017 Apr 7

PMID 28382218

Citations 11

Authors

Gregory E Bigford

Armando J Mendez

Luisa Betancourt

Patricia Burns-Drecq

Deborah Backus

Mark S Nash

Affiliations

Soon will be listed here.

Abstract

Introduction: This study is a prospective case series analyzing the effects of a comprehensive lifestyle intervention program in three patients with chronic paraplegia having major risks for the cardiometabolic syndrome (CMS).

Case Presentation: Individuals underwent an intense 6-month program of circuit resistance exercise, nutrition using a Mediterranean diet and behavioral support, followed by a 6-month extension (maintenance) phase involving minimal support. The primary goal was a 7% reduction of body mass. Other outcomes analyzed insulin resistance using the HOMA-IR model, and plasma levels of fasting triglycerides and high-density lipoprotein cholesterol. All participants achieved the goal for 7% reduction of body mass and maintained the loss after the MP. Improvements were observed in 2/3 subjects for HOMA-IR and high-density lipoprotein cholesterol. All participants improved their risk for plasma triglycerides.

Discussion: We conclude, in a three-person case series of persons with chronic paraplegia, a lifestyle intervention program involving circuit resistance training, a calorie-restrictive Mediterranean-style diet and behavioral support, results in clinically significant loss of body mass and effectively reduced component risks for CMS and diabetes. These results were for the most part maintained after a 6-month MP involving minimal supervision.

Citing Articles

Self-Reported Difficulty with and Assistance Needed by People with Spinal Cord Injury to Prepare Meals at Home.

Froehlich-Grobe K Int J Environ Res Public Health. 2024; 21(11).

PMID: 39595730 PMC: 11594136. DOI: 10.3390/ijerph21111463.

Modification of the Diabetes Prevention Program Lifestyle Intervention in Persons with Spinal Cord Injury: Efficacy for Reducing Major Cardiometabolic Risks, Increased Fitness, and Improved Health-Related Quality of Life.

Bigford G, Lehmann D, Betancourt L, Maher J, Mendez A, Nash M J Spine Res Surg. 2024; 6(1).

PMID: 39309246 PMC: 11414834. DOI: 10.26502/fjsrs0070.

The Impact of Caregiver/Care-Receiver Co-Treatment in a Therapeutic Lifestyle Intervention for Chronic Spinal Cord Injury: A Comparative Case Series.

Bigford G, Lehmann D, Mendez A, Nash M Ann Case Rep. 2024; 9(2).

PMID: 39308936 PMC: 11414831. DOI: 10.29011/2574-7754.101755.

Therapeutic Lifestyle Intervention Targeting Enhanced Cardiometabolic Health and Function for Persons with Chronic Spinal Cord Injury in Caregiver/Care-Receiver Co-Treatment: A Study Protocol of a Multisite Randomized Controlled Trial.

Bigford G, Betancourt L, Charlifue S, Nash M Int J Environ Res Public Health. 2023; 20(19).

PMID: 37835090 PMC: 10572441. DOI: 10.3390/ijerph20196819.

Systemic inflammation after spinal cord injury: A review of biological evidence, related health risks, and potential therapies.

Bigford G, Garshick E Curr Opin Pharmacol. 2022; 67:102303.

PMID: 36206621 PMC: 9929918. DOI: 10.1016/j.coph.2022.102303.

References

Grimby G, Broberg C, Krotkiewska I, Krotkiewski M . Muscle fiber composition in patients with traumatic cord lesion. Scand J Rehabil Med. 1976; 8(1):37-42. View

Bauman W, Spungen A . Coronary heart disease in individuals with spinal cord injury: assessment of risk factors. Spinal Cord. 2008; 46(7):466-76. DOI: 10.1038/sj.sc.3102161. View

Estruch R, Martinez-Gonzalez M, Corella D, Salas-Salvado J, Ruiz-Gutierrez V, Covas M . Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145(1):1-11. DOI: 10.7326/0003-4819-145-1-200607040-00004. View

Esposito K, Ciotola M, Giugliano D . Mediterranean diet and the metabolic syndrome. Mol Nutr Food Res. 2007; 51(10):1268-74. DOI: 10.1002/mnfr.200600297. View

Buchholz A, McGillivray C, Pencharz P . Differences in resting metabolic rate between paraplegic and able-bodied subjects are explained by differences in body composition. Am J Clin Nutr. 2003; 77(2):371-8. DOI: 10.1093/ajcn/77.2.371. View

Ratner R, Goldberg R, Haffner S, Marcovina S, Orchard T, Fowler S . Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program. Diabetes Care. 2005; 28(4):888-94. PMC: 1307521. DOI: 10.2337/diacare.28.4.888. View

Scelsi R, Marchetti C, Poggi P, Lotta S, Lommi G . Muscle fiber type morphology and distribution in paraplegic patients with traumatic cord lesion. Histochemical and ultrastructural aspects of rectus femoris muscle. Acta Neuropathol. 1982; 57(4):243-8. DOI: 10.1007/BF00692178. View

Simmons O, Kressler J, Nash M . Reference fitness values in the untrained spinal cord injury population. Arch Phys Med Rehabil. 2014; 95(12):2272-8. DOI: 10.1016/j.apmr.2014.06.015. View

Castro M, Apple Jr D, Hillegass E, Dudley G . Influence of complete spinal cord injury on skeletal muscle cross-sectional area within the first 6 months of injury. Eur J Appl Physiol Occup Physiol. 1999; 80(4):373-8. DOI: 10.1007/s004210050606. View

10.

Toth P . High-density lipoprotein and cardiovascular risk. Circulation. 2004; 109(15):1809-12. DOI: 10.1161/01.CIR.0000126889.97626.B8. View

11.

Ceriello A, Quagliaro L, Piconi L, Assaloni R, Da Ros R, Maier A . Effect of postprandial hypertriglyceridemia and hyperglycemia on circulating adhesion molecules and oxidative stress generation and the possible role of simvastatin treatment. Diabetes. 2004; 53(3):701-10. DOI: 10.2337/diabetes.53.3.701. View

12.

Jacobs P, Nash M . Exercise recommendations for individuals with spinal cord injury. Sports Med. 2004; 34(11):727-51. DOI: 10.2165/00007256-200434110-00003. View

13.

Sabour H, Javidan A, Vafa M, Shidfar F, Nazari M, Saberi H . Calorie and macronutrients intake in people with spinal cord injuries: an analysis by sex and injury-related variables. Nutrition. 2011; 28(2):143-7. DOI: 10.1016/j.nut.2011.04.007. View

14.

Spungen A, Adkins R, Stewart C, Wang J, Pierson Jr R, Waters R . Factors influencing body composition in persons with spinal cord injury: a cross-sectional study. J Appl Physiol (1985). 2003; 95(6):2398-407. DOI: 10.1152/japplphysiol.00729.2002. View

15.

Kressler J, Cowan R, Bigford G, Nash M . Reducing cardiometabolic disease in spinal cord injury. Phys Med Rehabil Clin N Am. 2014; 25(3):573-604, viii. DOI: 10.1016/j.pmr.2014.04.006. View

16.

Jeon J, Steadward R, Wheeler G, Bell G, McCargar L, Harber V . Intact sympathetic nervous system is required for leptin effects on resting metabolic rate in people with spinal cord injury. J Clin Endocrinol Metab. 2003; 88(1):402-7. DOI: 10.1210/jc.2002-020939. View

17.

Perret C, Stoffel-Kurt N . Comparison of nutritional intake between individuals with acute and chronic spinal cord injury. J Spinal Cord Med. 2012; 34(6):569-75. PMC: 3237283. DOI: 10.1179/2045772311Y.0000000026. View

18.

Gayoso-Diz P, Otero-Gonzalez A, Rodriguez-Alvarez M, Gude F, Garcia F, de Francisco A . Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study. BMC Endocr Disord. 2013; 13:47. PMC: 4016563. DOI: 10.1186/1472-6823-13-47. View

19.

Wallace T, Levy J, Matthews D . Use and abuse of HOMA modeling. Diabetes Care. 2004; 27(6):1487-95. DOI: 10.2337/diacare.27.6.1487. View

20.

Esposito K, Ciotola M, Giugliano D . Low-carbohydrate diet and coronary heart disease in women. N Engl J Med. 2007; 356(7):750. DOI: 10.1056/NEJMc063464. View