- Obesity/Overweight in Persons with Early and Chronic SCI: A Randomized Multi-Center Controlled Lifestyle Intervention
- SCI Survey to Determine Pressure Ulcer Vulnerability in the Outpatient Population
Obesity/Overweight in Persons with Early and Chronic SCI: A Randomized Multi-Center Controlled Lifestyle Intervention
Posted December 1, 2011
Mark S. Nash, Ph.D., FACSM, Miller School of Medicine, University of Miami, Miami, Florida
Obesity is a serious, and worsening, health concern for both military personnel and civilians with spinal cord injuries (SCI). A series of reports from 1994-1995 estimate that the rate of obesity is up to 66% higher in persons with disabilities than in non-disabled individuals. In addition to increasing risk for cardiovascular and metabolic diseases, obesity in SCI patients can lead to diminished work capacity, musculoskeletal strain, increased pain, worsening of neurological status, and life dissatisfaction. Dr. Mark Nash, at the University of Miami Miller School of Medicine, has received a Fiscal Year 2009 Spinal Cord Injury Research Program Clinical Trial Award - Rehabilitation to perform a multi-center randomized clinical trial evaluating a lifestyle intervention aimed at decreasing obesity in persons with SCI. This study will be conducted at two SCI rehabilitation centers and two VA Medical Centers and is expected to enroll a total of 64 individuals with SCI who are overweight or obese and have fasting glucose and lipid levels that are outside the accepted healthy ranges. Participants will be monitored for 6 months by lifestyle coaches who will personalize either a structured lifestyle intervention (circuit resistance training, calorie-matched Mediterranean-style diet, and behavioral support) or an exercise plan with non-diet behavioral support. At the end of the 6-month lifestyle intervention or exercise program, participants will be followed for a year while treatments are performed at home or in community-based centers. The primary goal of this study is to demonstrate a sustained weight loss of 7% body weight, an amount that has been previously shown to decrease risk of diabetes. Additional outcomes that will be measured for all participants include body fat percentage, overall fitness, glucose and lipid profiles, and perceived quality of life. This study will provide the necessary evidence to initiate health reform and improve weight management strategies for persons with SCI in both military and civilian settings.
Pressure ulcers, one of the most common long-term complications of spinal cord injury (SCI), are areas of tissue damage that occur as a result of interrupted blood circulation. Healthy individuals are able to make unconscious accommodations when decreases in tissue blood flow due to pressure are detected, but this feedback does not work as well in persons with SCI, who often have reduced or absent sensation and limited mobility. Pressure ulcers (PrUs) can result in weeks or months of bed confinement, rehabilitation setbacks, loss of employment and income, loss of social interaction, and decreased quality of life. While the risk remains high, not all SCI patients have the same propensity for developing PrUs. Dr. Lisa Gould, of the James A. Haley Veterans' Hospital (JAHVH), received an Exploration - Hypothesis Development Award from the Department of Defense Fiscal Year 2009 Spinal Cord Injury Research Program to identify the demographic, biophysical, and psychosocial factors that increase risk of PrUs in persons with SCI. This study will begin with a retrospective medical chart review of 60 patients from the JAHVH Spinal Cord Injury System of Care to refine the list of potential risk and protective factors. Next, anthropometric measurements will be taken using musculoskeletal ultrasound in individuals without PrUs, those that have had recurring PrUs, and those that have had one or two PrUs but have healed and remain healthy. Finally, a prospective survey of 800 SCI patients coming to JAHVH for their annual exams will be conducted. Together these data will lead to the identification of factors that are protective against the development of PrUs, allowing for improved risk assessment and customized interventions for individuals with SCI.