Effects of customized risk reduction program on cardiovascular risk in males with spinal cord injury.

Persons with spinal cord injury (SCI) have heightened risk for cardiovascular disease (CVD). Multidisciplinary risk reduction programs using case management models have been effective in reducing CVD risk in nondisabled persons, but little is known regarding the effects of such programs in SCI. Twenty-six persons with SCI underwent a pilot 2 yr risk intervention program including frequent telephone contact by a case manager and in-person visits by a dietitian, physical therapist, and exercise physiologist. At 6 mo intervals, measurements were made of dietary intake, glucose and lipids, physical activity patterns, and exercise capacity. Of the 26 participants, 10 remained in the program for the full 2 yr; medical issues unrelated to the program were the major reasons for dropping out. Significant improvements were observed in weight, plasma insulin, homeostatic model assessment insulin resistance, and total cholesterol/high-density lipoprotein ratio, although these changes were not consistent across visits. No differences in estimates of physical activity patterns were demonstrated, nor were differences in dietary macronutrient intake observed. Thus, modest changes in some CVD risk markers can be achieved by a multidisciplinary risk reduction program in SCI. Such programs present more challenges than in ambulatory persons, and more intensive risk intervention may be required to appreciably reduce CVD risk in SCI.