Modifying Diet and Exercise to Reduce Risk Factors for Diabetes Mellitus and Cardiovascular Disease in People with Spinal Cord Injury

By Weiss, Christina B.; Jeon, Justin Y. et al. | Palaestra, Winter 1998 | Go to article overview

Modifying Diet and Exercise to Reduce Risk Factors for Diabetes Mellitus and Cardiovascular Disease in People with Spinal Cord Injury


Weiss, Christina B., Jeon, Justin Y., Suh, Miyoung, Steadward, Robert D., Palaestra


"People with SCI have an increased risk of DM and CVD due primarily to a sedentary lifestyle and a large mass of paralyzed muscle."

Diabetes Mellitus (DM) is a chronic systemic syndrome characterized by high blood glucose. The human pancreas secretes a hormone called insulin, which facilitates the entry of glucose into all tissues of the body (Lewis & Collier, 1992). In a person with DM, the entry of glucose into tissue cells is impaired due to a deficiency of insulin produced or altered tissue cell receptors (American Diabetes Association, 1996). There are two variations of DM: Type I and Type II (Campaigne & Lampman, 1994). In Type I DM, the human pancreas produces very little insulin or none at all. In Type II DM, the human pancreas often makes an excessive amount of insulin, but tissue cells are resistant to insulin and therefore cannot use glucose as energy (Campaigne & Lampman, 1994).

Cardiovascular Disease (CVD) as described by the Heart and Stroke Foundation (1993) is a broad group of conditions, of which the major components are ischemic heart disease and stroke. Other conditions include arrhythmias (disturbance to heart rhythm); hypertension (high blood pressure); valvular heart disease (conditions of heart valves); peripheral vascular disease (that affecting the arteries and veins), and myocardial disease (conditions affecting the heart). It costs the Canadian Health Care System an estimated $17 billion annually to support those who survive and live with CVD (MacLean, 1994).

DM Mellitus in People with Spinal Cord Injury (SCI)

Type II DM is a more serious problem in people with SCI than in people without a disability. Recent research reported that 22% of people with SCI had Type II DM compared to 6% in a non-disabled sample, and that 56% of people with SCI had an abnormal glucose metabolism compared to 20% in a non-disabled sample (Bauman & Spungen, 1994). In fact, people with SCI have approximately four times higher risk of developing DM than the general population. This high incidence of impaired carbohydrate metabolisms is due to physical inactivity (Bauman & Spungen, 1994), a large amount of paralyzed muscle tissue (Burnham et al., 1996; Andersen, Mohr, Biering-Sorensen, Galbo, & Kjar, 1995), and changes in body composition after SCI (Bauman & Spungen, 1994; Bjorntorp, 1990; Despres, Sital, Lupien, Andre, & Claude, 1990). Therefore, it is very important to prevent DM in people with SCI.

Cardiovascular Disease in People with Spinal Cord Injury

Cardiovascular Disease (CVD) is a major cause of death and occurs at a younger age in people with SCI compared to people without a disability (Bauman et al., 1992a, 1992b). Risk factors for CVD are divided into those that are changeable (modifiable) and those that are unchangeable (nonmodifiable). Those that are modifiable are: cigarette smoking; abnormal blood pressure; high blood cholesterol levels; improper diets; reduced high density lipoprotein cholesterol; DM; abdominal obesity and sedentary lifestyle (Consultants Olympic Inc., 1995; Genest & Cohn, 1995; MacLean, 1994; Nair, Nargundkar, Johnasen, & Strachan, 1990). Those that are nonmodifiable are age, gender, and hereditary factors (Genest & Cohn., 1995). Research has demonstrated that reduced high density lipoprotein levels particularly raise the risk of CVD in people with SCI (Bauman et al., 1992b; Ragnarsson, Pollaack, & Twist, 1991). These reduced high density lipoprotein levels are attributed to physical inactivity (Ragnarsson et al., 1991).

Nutritional Intervention of DM and CVD

The ultimate goals of nutritional management of DM and CVD are to normalize blood glucose and achieve desirable blood lipid levels. Nutrients of most concern in these diseases are carbohydrates, protein, and fat.

Carbohydrates are found in starchy foods such as potatoes, rice, pasta, breads, and cereals. …

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Modifying Diet and Exercise to Reduce Risk Factors for Diabetes Mellitus and Cardiovascular Disease in People with Spinal Cord Injury
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