Six Months of Intensive Lifestyle Intervention Lessens Cardiometabolic Component Risks in Persons with SCI and their Caregivers: A Two Dyad Case Study
Nash M, Betancourt L, Bigford G, Maher J, Anthony M, Mendez A
University of Miami Miller School of Medicine, Miami, Florida, USA
Objective: Cardiometabolic (CM) risks of obesity, insulin resistance (IR), and dyslipidemia are highly prevalent after SCI, and impose disproportionate hazards for declining health and function throughout the lifespan. These risks similarly impose physical and emotional stresses on their caregivers, who must also maintain health and function as they ‘age with disability’.
This project tested the impact of a SCI lifestyle intervention (LI) program on CM component risks that compromise healthy aging in persons with SCI living in caregiver/care-receiver relationships. These goals are part of a larger data collection that will also examine impact of LI on the caregiver/care-receiver dyadic relationship, and test whether co-intervention with the caregiver improves health/function outcomes for their partner.
Design/Methods: To date, this randomized, parallel group, controlled study has co-enrolled two dyads comprised of a participant with chronic (> 1 year) SCI and their caregiver, the latter defined as a family member, significant other or friend living with a person with SCI who provides social and/or physical support including personal assistance, routine emotional encouragement and/or social interaction.
Participants with SCI (C5♂-AIS A and T4♀-AIS C, ages 40 and 46 years, respectively) who were obese by population-specific BMI (both > 35 kg/m2) and IR by Homeostatic Model v.2 (HOMA2- IR) criteria, underwent a 6-month LI program incorporating circuit resistance training, Mediterranean-style diet, and a customized 16-session behavioral support program. The LI programs were developed and tested in earlier NIDILRR and DoD-supported studies. Caregivers (ages 71 and 37 years, one overweight, one obese and insulin resistant) underwent a parallel LI program at a different training location. Outcomes were tested at baseline and 6 months for body mass and waist circumference (WC), strength, cardiorespiratory fitness (VO2PEAK [SCI] or predicted VO2PRED-MAX [Caregiver]), HOMA2-IR, and fasting lipids (high-density lipoprotein cholesterol [HDL-C] and Triglycerides [TG]).
Results: For participants with SCI upper body strength (as the sum of 6 strength maneuvers) and VO2PEAK improved 48% and 10.3%, respectively. Body mass was reduced from an average of 107.6 to 102.7 kg (-4.5%), and waist circumference was lowered by 2.4%. No trends for desired changes in fasting lipids were observed, although HOMA-2 IR was reduced from an average of 5.35 to 2.42 (-32.5%). For caregiver participants, strength and VO2PRED-MAX improved by 25.7% and 14.9%, respectively. Body mass was reduced by 3.9%, and WC reduced 9.1%. Lipids showed no pattern of change, although HOMA-2 IR values were lowered from 6.0 to 5.3 (11.5%).
Conclusion: In these early findings a LI program of exercise, nutrition, and behavioral support effectively reduced CM risks of overweight and insulin resistance for both persons with SCI and their caregivers. Maximal strength was improved to a greater degree than cardiorespiratory fitness. The durability of these findings in a 6-month period of distant supervision will now be tested. The impact of these benefits on function and dyadic interactions requires additional study and a larger sampling.
Support: U.S. DHHS/NIDILRR # 668455.
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