Health promotion and cardiovascular risk reduction in people with spinal cord injury: physical activity, healthy diet and maintenance after discharge— protocol for a prospective national cohort study and a preintervention- postintervention study

Abstract

IntroductionSpinal cord injury (SCI) predisposes those who suffer from it to physical inactivity and weight gain; consequently, death due to cardiovascular diseases is more frequent among people with SCI than in the general population. The literature documents a consensus about an interdisciplinary multimodal approach for the prevention and treatment of cardiovascular risk factors including overweight and obesity in people with SCI, focusing on diet, physical activity (PA) and behavioural interventions. This study will investigate implementation of recommendations from a recent clinical practice guideline for identification and management of cardiometabolic risk after SCI through multimodal patient education in a subacute clinical setting.Methods and analysisAll patients who are aged 18 years or older with an SCI within the previous 12 months and admitted to highly specialised rehabilitation are included, regardless of SCI aetiology or neurological level. A primary study designed as a controlled, pragmatic, preintervention- postintervention study with 6-month follow-up evaluates the effect of the clinical intervention; a prospective national cohort study on body mass index (BMI) serves as a historical control. The intervention consists of a standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet that begins at the outset of primary SCI rehabilitation and is integrated into existing settings and workflows. Outcome measures are collected at admission, discharge and 6 months after discharge and include peak oxygen uptake (VO2peak) (primary outcome), BMI, body composition, metabolic profile, neurological status, level of functioning, depression, quality of life, objective PA (accelerometry), self-reported PA, self-assessed PA ability, shared decision making, and dietary habits. Test–retest reliability of four VO2peak test protocols are investigated, as is test–retest reliability of a multisensor accelerometer in a rehabilitation setting.Ethics and disseminationThe project is approved by the Committees on Health Research Ethics in the Capital Region of Denmark on 10 July 2018 (Journal-nr.: H-18018325). The principal investigator obtains informed consent from all participants. The interventions in the project are closely related to existing rehabilitation care, and the risk of pain and discomfort is considered modest. Any unintended events related to the elements of the intervention are reported, according to existing regional procedures. Data are stored in a secure web-based database (Redcap). The primary study and prospective cohort study are registered at Clinicaltrials.gov. Positive and negative results will be submitted to relevant scientific journals related to SCI for publication. Important protocol modifications are reported to the Committees on Health Research Ethics in the Capital Region of Denmark.Trial registration numbersNCT03689023 and NCT03369080.

Mechanical stimulations can inhibit local and remote tumor progression by downregulating WISP1

“…32 These devices are used for rehabilitation to enhance joint mobility. Besides loading to the skeletal system, weight-bearing physical activity induces varying responses in the cardiovascular system, immune system, and neurological systems, 33,34 and other systems may also be involved in the observed dynamic shift in cholesterol and calcitriol in the urine. In human urine analysis, potential bias may include the age and health conditions of individual participants and it is possible that the alterations in the selected biomarkers in the urine may not completely represent those in the primary and metastasized tumors.…”

Exploring the contextual transition from spinal cord injury rehabilitation to the home environment: a qualitative study

“…The underlying principles behind sufficient “information power” [ 19 ] guided the researchers to an adequate sample size of 12–14 participants recruited from the Department of Spinal Cord Injuries in Eastern Denmark. The primary researchers (LW and NHV) collaborated with a clinical specialist (NJH) from the SCI unit to identify potential participants from an existing cohort of individuals with SCI [ 11 ]. Inclusion criteria were as follows: injured with SCI within the last 12 months at admission to rehabilitation, regardless of SCI etiology, neurological level, or completeness of the lesion; >18 years of age; Danish speaking; discharged to home within 2–10 months at the time of the interview.…”

“…Funding This study, completed as part of a Master of Science in Health Science, University of Copenhagen, Denmark, was part of an ongoing research project [11] and conducted in collaboration with UCSF, which means that no external funding was required.…”

“…Recently, clinical practice guidelines were established for identifying and managing cardiac metabolic risk following SCI [ 9 ]. Some SCI units now offer a teaching program to facilitate an active, healthy lifestyle post-discharge to prevent long-term lifestyle complications [ 10 , 11 ]. In Denmark, ~95% of individuals with SCI are discharged to their home environment [ 12 ].…”

Analysis of the Experience of Individuals With Disability With Selected Aspects Related to Mono-Skiing

“…One of the significant causes limiting an individual's ability to move is lower limb amputation. Current technological advances providing modern compensatory aids contribute significantly to the realization of a full life for wheelchair users and offer compensatory fulfillment of various aspects of the importance of physical education and sports [13,40,11]. Not only some summer but also winter physical activities such as sledge hockey or skiing are suitable for the mentioned mobility limitations [22,20].…”