Randomized controlled pilot study of a SystemCHANGE™ weight management intervention in stroke survivors: rationale and protocol

Matthew Plow, Shirley M Moore, John P Kirwan, Fredrick Frost, Irene Katzan, Sue Jaeger, Jay Alberts, Matthew Plow, Shirley M Moore, John P Kirwan, Fredrick Frost, Irene Katzan, Sue Jaeger, Jay Alberts

Abstract

Background: Over 65% of stroke survivors are either overweight or obese and have multiple cardiovascular risk factors. However, few studies have examined the effects of comprehensive lifestyle behavior interventions to promote weight loss and control cardiovascular risk factors in stroke survivors. Thus, the purpose of this study is to examine a novel behavior change approach--SystemCHANGE™--to promote weight loss and improve health and function in stroke survivors. SystemCHANGE™ focuses on redesigning the social environment to achieve a specific goal.

Methods: We will conduct a randomized controlled pilot study to examine the efficacy, feasibility, and safety of the SystemCHANGE™ weight management program in overweight and obese stroke survivors. The central hypothesis of the study is that the SystemCHANGE™ intervention will help overweight and obese stroke survivors lose 5% of their body weight, thereby improving health and function. Thirty-five stroke survivors will be randomized into either the 6-month SystemCHANGE™ intervention or a contact-control intervention. Outcome measures will be assessed at baseline and again at 3 and 6 months after the interventions. Body composition will be assessed using a Bod Pod. Patient-reported outcomes will be the Stroke Impact Scale and Reintegration to Normal Living Index. Objective outcomes will include the 6-Minute Walking Test and Rivermead Motor Assessment.

Discussion: This study will be the first randomized controlled trial to evaluate the efficacy and safety of a weight management intervention in stroke survivors using the SystemCHANGE™ approach. Furthermore, it will be the first empirically-examined comprehensive lifestyle intervention designed to target physical activity, nutrition, and sleep to promote weight loss in stroke survivors.

Trial registration: ClinicalTrials.gov Identifier: NCT01776034.

References

    1. Kesarwani M, Perez A, Lopez VA, Wong ND, Franklin SS. Cardiovascular comorbidities and blood pressure control in stroke survivors. J Hypertens. 2009;27:1056–1063. doi: 10.1097/HJH.0b013e32832935ce.
    1. Ivey FM, Macko RF, Ryan AS, Hafer-Macko CE. Cardiovascular health and fitness after stroke. Top Stroke Rehabil. 2005;12:1–16.
    1. Beamer NB, Coull BM, Clark WM, Briley DP, Wynn M, Sexton G. Persistent inflammatory response in stroke survivors. Neurology. 1998;50:1722–1728. doi: 10.1212/WNL.50.6.1722.
    1. Ivey FM, Ryan AS, Hafer-Macko CE, Garrity BM, Sorkin JD, Goldberg AP, Macko RF. High prevalence of abnormal glucose metabolism and poor sensitivity of fasting plasma glucose in the chronic phase of stroke. Cerebrovasc Dis. 2006;22:368–371. doi: 10.1159/000094853.
    1. Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC, Halperin JL, Johnston SC, Katzan I, Kernan WN, Mitchell PH, Ovbiagele B, Palesch YY, Sacco RL, Schwamm LH, Wassertheil-Smoller S, Turan TN, Wentworth D. on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Clinical Cardiology, and Interdisciplinary Council on Quality of Care and Outcomes Research. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American heart Association/American stroke association. Stroke. 2011;42:227–276. doi: 10.1161/STR.0b013e3181f7d043.
    1. Kopunek SP, Michael KM, Shaughnessy M, Resnick B, Nahm ES, Whitall J, Goldberg A, Macko RF. Cardiovascular risk in survivors of stroke. Am J Prev Med. 2007;32:408–412. doi: 10.1016/j.amepre.2007.01.021.
    1. Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, Carnethon MR, Dai S, de Simone G, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Greenlund KJ, Hailpern SM, Heit JA, Ho PM, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marellia A, Matchar DB, McDermott MM, Meigs JB, Moy CS. Heart disease and stroke statistics–2011 update: a report from the American heart association. Circulation. 2011;123:e18–e209. doi: 10.1161/CIR.0b013e3182009701.
    1. Rimmer JH, Wang E, Smith D. Barriers associated with exercise and community access for individuals with stroke. J Rehabil Res Dev. 2008;45:315–322. doi: 10.1682/JRRD.2007.02.0042.
    1. Rimmer JH. Exercise and physical activity in persons aging with a physical disability. Phys Med Rehabil Clin N Am. 2005;16:41–56. doi: 10.1016/j.pmr.2004.06.013.
    1. Redfern J, McKevitt C, Wolfe CD. Development of complex interventions in stroke care: a systematic review. Stroke. 2006;37:2410–2419. doi: 10.1161/01.STR.0000237097.00342.a9.
    1. Seagle HM, Strain GW, Makris A, Reeves RS. Position of the American Dietetic Association: weight management. J Am Diet Assoc. 2009;109:330–346.
    1. Taheri S. The link between short sleep duration and obesity: we should recommend more sleep to prevent obesity. Arch Dis Child. 2006;91:881–884. doi: 10.1136/adc.2005.093013.
    1. Stuifbergen AK. Building health promotion interventions for persons with chronic disabling conditions. Fam Community Health. 2006;29:28S–34S. doi: 10.1097/00003727-200601001-00006.
    1. Webel AR, Moore SM, Hanson JE, Patel SR, Schmotzer B, Salata RA. Improving sleep hygiene behavior in adults living with HIV/AIDS: a randomized control pilot study of the SystemCHANGE™–HIV intervention. Appl Nurs Res. 2012;pii:S0897–1897. (12)00074-2.
    1. Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J. An ecological approach to creating active living communities. Annu Rev Public Health. 2006;27:297–322. doi: 10.1146/annurev.publhealth.27.021405.102100.
    1. Gregson J, Foerster SB, Orr R, Jones L, Benedict J, Clarke B, Hersey J, Lewis J, Zotz AK. System, environmental, and policy changes: using the social-ecological model as a framework for evaluating nutrition education and social marketing programs with low-income audiences. J Nutr Educ. 2001;Suppl 1:S4–S15.
    1. Baranowski T, Cullen KW, Nicklas T, Thompson D, Baranowski J. Are current health behavioral change models helpful in guiding prevention of weight gain efforts? Obes Res. 2003;Suppl 1:23S–43S.
    1. Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM. Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J (Clin Res Ed) 1982;284:1607–1608. doi: 10.1136/bmj.284.6329.1607.
    1. Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H. Validation of a short orientation-memory-concentration test of cognitive impairment. A J Psychiatry. 1983;140:734–739.
    1. United States. Dept. of Health and Human Services, United States. Dept. of Agriculture, United States. Dietary Guidelines Advisory Committee. Dietary guidelines for Americans, 2010. 7. Washington, D.C: G.P.O; 2010.
    1. Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26:1–7.
    1. Minderico CS, Silva AM, Teixeira PJ, Sardinha LB, Hull HR, Fields DA. Validity of air-displacement plethysmography in the assessment of body composition changes in a 16-month weight loss program. Nutr Metab (Lond) 2006;3:32. doi: 10.1186/1743-7075-3-32.
    1. Duncan PW, Bode RK, Min Lai S, Perera S. Rasch analysis of a new stroke-specific outcome scale: the stroke impact scale. Arch Phys Med Rehabil. 2003;84:950–963. doi: 10.1016/S0003-9993(03)00035-2.
    1. Wood-Dauphinee S, Williams JI. Reintegration to normal living as a proxy to quality of life. J Chronic Dis. 1987;40:491–502. doi: 10.1016/0021-9681(87)90005-1.
    1. Lincoln N, Leadbitter D. Assessment of motor function in stroke patients. Physiotherapy. 1979;65:48–51.
    1. Rimmer JH, Riley BB, Rubin SS. A new measure for assessing the physical activity behaviors of persons with disabilities and chronic health conditions: the physical activity and disability survey. Am J Health Promot. 2001;16:34–42. doi: 10.4278/0890-1171-16.1.34.
    1. Gershon RC, Lai JS, Bode R, Choi S, Moy C, Bleck T, Miller D, Peterman A, Cella D. Neuro-QOL: quality of life item banks for adults with neurological disorders: item development and calibrations based upon clinical and general population testing. Qual Life Res. 2012;21:475–486. doi: 10.1007/s11136-011-9958-8.
    1. Sallis J, Pinski R, Grossman T, Nader PR. The development of self-efficacy scales for health related diet and exercise behaviors. Health Educ Res. 1988;3:283–292. doi: 10.1093/her/3.3.283.
    1. Marcus BH, Selby VC, Niaura RS, Rossi JS. Self-efficacy and the stages of exercise behavior change. Res Q Exerc Sport. 1992;63:60–66. doi: 10.1080/02701367.1992.10607557.
    1. Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M. Effect of a self-management program on patients with chronic disease. Eff Clin Pract. 2001;4:256–262.
    1. Sallis JF, Grossman RM, Pinski RB, Patterson TL, Nader PR. The development of scales to measure social support for diet and exercise behaviors. Prev Med. 1987;16:825–836. doi: 10.1016/0091-7435(87)90022-3.
    1. Hertzog MA. Considerations in determining sample size for pilot studies. Res Nurs Health. 2008;31:180–191. doi: 10.1002/nur.20247.
    1. Dobkin BH. Progressive staging of pilot studies to improve phase III trials for motor interventions. Neurorehab Neural Repair. 2009;23:197–206.
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–381. doi: 10.1016/j.jbi.2008.08.010.
    1. Little RJ, D’Agostino R, Cohen ML, Dickersin K, Emerson SS, Farrar JT, Frangakis C, Hogan JW, Molenberghs G, Murphy SA, Neaton JD, Rotnitzky A, Scharfstein D, Shih WJ, Siegel JP, Stern H. The prevention and treatment of missing data in clinical trials. N Engl J Med. 2012;367:1355–1360. doi: 10.1056/NEJMsr1203730.
    1. Rimmer J, Wang E, Yamaki K, Davis B. Documenting Disparities in Obesity and Disability. Focus: A Publication of the National Center for the Dissemination of Disability Research (NCDDR) 2010;24:1–16.
    1. Liou TH, Pi-Sunyer FX, Laferrere B. Physical disability and obesity. Nutr Rev. 2005;63:321–331. doi: 10.1111/j.1753-4887.2005.tb00110.x.
    1. Vemmos K, Ntaios G, Spengos K, Savvari P, Vemmou A, Pappa T, Manios E, Georgiopoulos G, Alevizaki M. Association between obesity and mortality after acute first-ever stroke: the obesity-stroke paradox. Stroke. 2011;42:30–36. doi: 10.1161/STROKEAHA.110.593434.
    1. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009;53:1925–1932. doi: 10.1016/j.jacc.2008.12.068.
    1. David RT. Loss of skeletal muscle mass in aging: examining the relationship of starvation, sarcopenia and cachexia. Clin Nutr. 2007;26:389–399. doi: 10.1016/j.clnu.2007.03.008.
    1. Rimmer JH, Wang E. Obesity prevalence among a group of Chicago residents with disabilities. Arch Phys Med Rehabil. 2005;86:1461–1464. doi: 10.1016/j.apmr.2004.10.038.
    1. Weil E, Wachterman M, McCarthy EP, Davis RB, O’Day B, Iezzoni LI, Wee CC. Obesity among adults with disabling conditions. JAMA. 2002;288:1265–1268. doi: 10.1001/jama.288.10.1265.
    1. Plow M, Finlayson M. A qualitative study of nutritional behaviors in adults with multiple sclerosis. J Neurosci Nurs. 2012;44:337–350. doi: 10.1097/JNN.0b013e3182682f9b.

Source: PubMed

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