Feasibility and effectiveness of delivering an adapted weight loss intervention for people with spinal cord injury
1Driver S, 2Kramer K, 3Lee J, 1Froehlich-Grobe K
1Baylor Institute for Rehabilitation, Dallas, TX, USA; 2Innovative Wellness Solutions, Pittsburgh, PA, USA; 3Texas Tech University, Lubbock, TX, USA
Objective: Individuals living spinal cord injury (SCI) experience high rates of obesity1-3 and excessive body fat,4,5 which increases their risk for cardiovascular diseases. There is limited evidence regarding weight loss programs6 that address the unique issues facing this group and can effectively yield weight loss. Investigate the feasibility and effectiveness of the 12 month GLB AIM (Adapted for those with Impaired Mobility), a weight loss approach adapted from the Diabetes Prevention Program Group Lifestyle Balance (DPP GLB) for those with SCI.
Design: Randomized controlled trial, with a wait-list control who received the intervention 6 months later.
Setting: Testing occurred at hospital-based lab, with the intervention delivered via in-person (once a month) and phone meetings over 12 months.
Participants: Thirty-two people living with SCI, half men and half women, with an average age of
Intervention: Adapted to address issues facing people with mobility impairment, the 23 GLB AIM sessions were delivered by lifestyle coaches over 12 months. The intervention offers 13 weekly “core” meetings plus 10 “support” meetings staggered over eight months.
Main Outcome Measure(s): Feasibility was based on retention and engagement. Retention was defined as attending at least 4 sessions plus not withdrawing and engagement included (1) attending sessions and (2) self-monitoring daily food intake. Effectiveness analyses based on weight change, with outcomes presented from the groups combined.
Results: Over 12 months, 62.5% of the SCI sample remained in the study, 21.9% (n=7) formally withdrew and 15.6% (n=5) were lost to follow up or had health problems that prevented returning for the 12-month visit. Both groups had similar attendance, which averaged 74.6% during core sessions and 48.9% during support sessions. Self-monitoring was 33% among Group 1 and increased to 77% among Group 2, presumably due to electronic tracking. Those who remained in the study experienced a significant weight loss (p = 0.010), which averaged 5.0 +8.6 kg (4.7%).
Conclusion: Data from this 12 month trial suggest the GLB AIM is a feasible program to promote weight loss for people with SCI. Session attendance was high during the core weeks and encouraging and strongly encouraging supporting app use for self-monitoring doubled adherence among Group 2 participants. Program participants lost an average of about 5% of their starting weight, which is in line with GLB AIM weight loss goals and participants were engaged in the program.
Support: This research was supported by the Disability and Research Dissemination Center (DRDC) through its Grant Number 5U01DD001007, FAIN No. U01DD001007, subaward #16-3046 from the Centers for Disease Control and Prevention (CDC).
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