Spinal Cord Injuries: Diabetes and Exercise Study

New Study Explores How Lifestyle Interventions Can Help Curb Diabetes Risk After Spinal Cord Injury

People with spinal cord injury (SCI) are at greater risk of developing diabetes and other problems because of limited activity levels, slower metabolism related to the injury and associated weight gain. Researchers leading a new study at Shepherd Center hope to change this. The study, titled “Obesity/Overweight in Persons with Early and Chronic SCI: A Randomized Multi-Center Lifestyle Intervention,” aims to determine whether exercise alone, or in combination with nutritional counseling and specific dietary changes, can help participants lose weight, thereby, lowering their risk for diabetes and heart disease. “We are trying to prevent diabetes, and though we are early in the study, some of our participants are already losing weight,” said Elizabeth Gonzalez, study coordinator. “You can see the happiness they feel as a result. It’s very fulfilling.” Laura Hawkins, an exercise therapist at Shepherd Center, added that protecting against diabetes is just one benefit. “Participants can also more easily propel themselves, move around and do wheelchair transfers. They report a better quality of life overall,” she said. Lamont McLeod, 35, of Sugar Hill, Ga., has already noticed a big difference. He sustained a C-5 to -6 SCI in a car accident in 2010 on his way to see the last ultrasound of his expected youngest child. Now, he is in month four of the yearlong exercise program. “I’m gaining much more strength and range of motion,” he said. “My arms used to get so tired and sore so quickly, but I can now hold my utensils and even playfully wrestle a bit with my 3-year-old.” Study participants are randomly assigned to one of two groups – the exercise program or the exercise program plus diet changes, which involves meeting with a dietitian, learning about portions and calories, and keeping a food log. During the initial three-month assessment period, participants maintain their usual eating and exercise habits. Over the next six months, all study participants will undergo exercise conditioning with a trainer, and half will also attend 16 education sessions about how to control body weight and adopt what is known as the Mediterranean diet – a diet that focuses on fresh fruits and vegetables, whole grains, lean meats and fish, and olive oil. This diet has been shown to lower the risk of diabetes and heart disease in other populations. In the final six months, participants will keep up with the same routine on their own either at Shepherd Center or at home. Researchers assess participants’ strength monthly and periodically conduct fitness testing. They also collect dietary and clinical information, including cholesterol, blood sugar and blood pressure levels. So far, Hawkins said Lamont has improved dramatically. He was only able to lift a single pound weight with his right (more impaired) hand at the start, and now he is already up to seven pounds. She, Gonzalez and the research team hope participants will continue to use the skills and healthful behaviors they are learning well beyond the study period. “Just like the rest of us, it’s hard to find the time,” Hawkins said. “But when they can see the tangible benefits, it’s a real motivator. For example, being able to go up the ramp of the parking deck without getting out of breath and being in better shape generally makes life easier.” “A lot of people in my situation get diabetes, high cholesterol or blood pressure because we aren’t as active as we used to be, and it’s important to try to prevent these heath issues,” explained Lamont, who recently returned to work as a real estate broker. “I’m learning there are a lot of activities I can do from the wheelchair.” The 15-month study is funded by the United States Department of Defense, a grant awarded to principal investigator Mark Nash, Ph.D., at the University of Miami. Shepherd Center is collaborating with Nash and will enroll 12 participants. Deborah Backus, P.T., Ph.D. is principal investigator at Shepherd. For more information or to learn about eligibility for this study, contact Elizabeth Gonzalez at elizabeth_gonzalez@shepherd.org(link sends e-mail) or 404-350-3116. The 45-minute program – done three times a week – includes hand cycling and a complete circuit of exercises including: Military/overhead press Horizontal rows Chest flies Bicep curls Lateral pull downs Tricep dips By Amanda Crowe, MA, MPH To access the CDR Library: http://uscm.med.sc.edu/CDR/index.asp