Reducing Cardiometabolic Disease in Spinal Cord Injury - 25/07/14

Doi : 10.1016/j.pmr.2014.04.006

Jochen Kressler, PhD ^a,^b, Rachel E. Cowan, PhD ^a,^b, Gregory E. Bigford, PhD ^a,^b, Mark S. Nash, PhD ^a,^b,^c,^⁎
^a Department of Neurological Surgery, Miller School of Medicine, University of Miami, 1475 North West 12th Avenue, Miami, FL 33136, USA
^b The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, 1095 North West 14th Terrace, Lois Pope LIFE Center, Miami, FL 33136, USA
^c Department of Rehabilitation Medicine, Miller School of Medicine, University of Miami, 1500 North West 12th Avenue, Suite 1409, Miami, FL 33136, USA

^∗Corresponding author.

Résumé

Accelerated cardiometabolic disease is a serious health hazard after spinal cord injuries (SCI). Lifestyle intervention with diet and exercise remains the cornerstone of effective cardiometabolic syndrome treatment. Behavioral approaches enhance compliance and benefits derived from both diet and exercise interventions and are necessary to assure that persons with SCI profit from intervention. Multitherapy strategies will likely be needed to control challenging component risks, such as gain in body mass, which has far reaching implications for maintenance of daily function as well as health.

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Keywords : Diet, Exercise, Behavioral modification, Drug therapy, Cardiometabolic syndrome, Spinal cord injuries

Plan

Key points

Cardiometabolic risks in SCI

Special Concerns for Persons with SCI (Accelerated Risk and Specific Targets)

Therapeutic lifestyle intervention

Diet Considerations—Energy Balance, Body Composition, and Malnutrition

Exercise Considerations—Role in Health and Weight Management

Exercise and Caloric Balance

PA Requirements for Weight Loss, Health, and Wellness

Exercise Prescription

Specific Considerations for SCI

Referral to a Clinical Exercise Professional

Managing Shoulder Pain

Behavioral Modification

Pharmacotherapeutic approaches

Drug Approaches to Treat Obesity

Drug Approaches to Treat Hyperglycemia

Drug Approaches to Treat Dyslipidemia

Drug Approaches to Treat Hypertension

Summary

Supported by grants from the National Institute for Disability and Rehabilitation Research #H133G080150, the Craig H. Neilsen Foundation #124683, and the Congressionally Mandated Medical Research Program - United States Department of Defense #W81XWH-10-1-1044 (SC090095).