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3.26.2018

Researchers Introduce a Lifestyle Intervention Diabetes Prevention Program for Spinal Cord Injury

Everyone knows that being overweight poses risks for heart disease and diabetes. However, anyone who has tried to lose weight knows it is no easy task. It is important that weight loss occurs in a healthy way, and that typically involves some combination of exercise, diet, will power, and perseverance.

When spinal cord injury (SCI) is added to the equation, the challenges of losing weight and the risk of developing heart disease and diabetes increase significantly. The muscle paralysis caused by SCI leads to two related problems: 1) fat is easily deposited in muscles that are not moving, which increases the amount of fat mass in the body, and 2) it’s hard to exercise paralyzed muscles, which makes it more difficult to lose weight by exercise alone. SCI also alters the way the body controls the metabolism of food, which can lead to unhealthy levels of sugars and lipids circulating in the blood. This can result in an even greater risk of developing heart disease and diabetes.

A few years ago, the National Institutes of Health funded a large multicenter trial comparing a diabetes prevention program to a standard-of-care medication therapy for non-disabled people at risk of developing type-2 diabetes. That trial was so effective it was stopped early so the treatment could be fast-tracked for widespread use. Mark Nash, Ph.D., FACSM, professor in the departments of neurological surgery, The Miami Project to Cure Paralysis, rehabilitation medicine, kinesiology and sports sciences and physical therapy, and colleagues recently received a Department of Defense grant to test a modified version of this diabetes prevention program in people living with SCI. The Nash lab calls it a Lifestyle Intervention Program for SCI.

Components of the first six months of the Lifestyle Intervention Program include supervised exercise intervention, an upper extremity circuit resistance training program performed three days a week, nutritional intervention, a calorie-restricted Mediterranean-style diet, behavioral intervention, and a 16-session protocol targeting behavioral changes through education, problem-solving skills, and cognitive restructuring. The second six months of the program include an unsupervised self-care extension phase maintenance program.

The team recently published results from three of the participants, all men with chronic paraplegia who were overweight. All three experienced a greater than 7 percent reduction in body mass, which was the primary study goal, and were able to maintain that loss in the maintenance phase of the program.

This benefit was associated with a reduction in fasting sugar and triglyceride levels in the blood. These are important factors to reduce the risk of developing diabetes. Furthermore, the exercise program was able to increase upper extremity strength and improve cardiorespiratory fitness – important for reducing fatigue and accomplishing activities of daily living.

More data on a larger population will be forthcoming, but these initial results are the first to show that people with SCI could substantially reduce their risk for diabetes.

Nash and Gregory E Bigford, Ph.D, assistant scientist, Armando J. Mendez, Ph.D., research associate professor, Luisa Betancourt, M.D., senior research associate, Patricia Burns-Drecq, senior research associate, and Deborah Backus published this work in Spinal Cord Series and Cases. The paper was titled “A lifestyle intervention program for successfully addressing major cardiometabolic risks in persons with SCI: a three-subject case series.”

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