Multiple Sclerosis, Rheumatoid Arthritis, Stroke
Conditions
Keywords
Self Care, Exercise, Weight management
Brief summary
The objective of this study is to conduct a randomized controlled pilot study to examine the efficacy, feasibility and safety of the SystemCHANGE™(SC) health promotion and wellness program in adults with disabling conditions. Particularly, the study will focus on developing a program of research on adapting and testing SC weight management interventions in overweight and obese stroke survivors and persons with chronic inflammatory autoimmune/immune-mediated diseases, specifically those with multiple sclerosis (MS) and rheumatoid arthritis (RA).
Detailed description
Individuals with disabling conditions, such as stroke, multiple sclerosis, or rheumatoid arthritis, face many barriers to engaging in physical activity, healthy nutritional habits, and good sleep hygiene. This leads to weight gain, de-conditioning, and declines in upper- and lower- extremity function, which makes it even more difficult to engage in healthy behaviors, thereby perpetuating a cycle of functional decline. Developing an effective weight management intervention may be a strategy for disrupting this disabling cycle and reducing the impact of the disease. Fostering a positive social environment may help adults with disabling conditions overcome barriers to engaging in healthy behaviors. SystemCHANGE (SC) is a new behavior change program that uses approaches consistent with social ecological theories and process improvement techniques (i.e. changing the dynamics of a system or group) to increase social support in lifestyle behaviors that promote energy balance. SC focuses on redesigning the social environment using a series of trial-and-error experiments, which is in contrast to cognitive-behavioral interventions that focus on changing a person's viewpoint of a situation and increasing motivation. In a SC intervention, individuals are taught a set of skills to assist them in incorporating habitual lifestyle behaviors into their daily systems so they succeed despite wavering motivation. The rationale for developing a weight management intervention for these patients is to slow disability progression and prevent secondary conditions.
Interventions
BEHAVIORALSystemCHANGE Group Lifestyle counseling
BEHAVIORALPhone Lifestyle Counseling
Sponsors
American Heart Association
National Institutes of Health (NIH)
Case Western Reserve University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
30 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
Stroke: * Physician-confirmed diagnosis of stroke (\> 6 weeks) * Body mass index between 23 to 45 kg/m2 * Age 30 to 75 years
Exclusion criteria
Stroke: * Pregnant or plans to become pregnant in the next 6 months * Current participation in a face-to-face weight management program * Uncontrolled diabetes (hospitalization within the prior 6 months) * Serious mental illness * Thyroid and adrenal gland diseases * Inability to walk 3 meters with or without a cane or walker * Severe cardiopulmonary disease that limits engagement in physical activity (e.g., myocardial infarction, congestive heart failure, coronary artery bypass grafting or valve replacement during the past three months, serious cardiac arrhythmias, hypertrophic cardiomyopathy, severe aortic stenosis, and pulmonary embolus) or abnormal blood pressure or heart rate response after the 6-Minute Walking Test (e.g., a drop in systolic blood pressure of \>10mmHg from baseline) * Severe cognitive deficits (Screening questioanire called the Short Orientation Memory-Concentration \< 12) * Currently taking oral corticosteroids, antipsychotic (except for depression medication), or medications specifically for weight loss * 3 or more falls in the past month * Bulimia * Unable to speak English over the phone * Able to eat independently and is not on a special diet because of difficulty in swallowing * Unstable weight (gained or lost \>10lbs in the last two months) Inclusion Criteria MS or RA: * Physician-confirmed diagnosis of multiple sclerosis or rheumatoid arthritis * Body mass index between 23 to 45 kg/m2
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Changes from baseline in body weight. | Each patient will be given the assessments at 2 points during the study, at baseline and at posttest (an average of 6 months from baseline). | A digital scale will be used to measure Body weight. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Changes from baseline in Walking Test. | Each patient will be given the assessments at 2 points during the study, at baseline and at posttest (an average of 6 months from baseline). | A Six Minute Walking Test will be administered using standardized instructions and verbal cues |
| Changes from baseline in 1-minute sit to stand test | Each patient will be given the assessments at 2 points during the study, at baseline and at posttest (an average of 6 months from baseline). | A 1-minute sit to stand test will be administered using standardized instructions and verbal cues |
| Changes from baseline Physical Activity | Each patient will be given the assessments at 2 points during the study, at baseline and at posttest (an average of 6 months from baseline). | Physical Activity and Disability Survey-Revised will be administered to assess physical function. Higher scores on the Physical Activity and Disability Survey-Revised indicates increased physical activity levels. Score range: Not applicable. |
| Changes from baseline in cardiovascular risk biomarkers. | Each patient will be given the assessments at 2 points during the study, at baseline and at posttest (an average of 6 months from baseline). | The Alere Cholestech LDX 1 Analyzer will be used to measure Triglycerides levels. |
| Changes from baseline social support for physical activity from family | Each patient will be given the assessments at 2 points during the study, at baseline and at posttest (an average of 6 months from baseline). | Social Support for Exercise Behavior scales will be administered. A higher score on social support scales indicates greater social support from family to engage in physical activity (possible score range is 1 to 5). |
| Changes from baseline in emotional well-being | Each patient will be given the assessments at 2 points during the study, at baseline and at posttest (an average of 6 months from baseline). | Quality of Life in Neurological Disorders (Neuro-Qol) positive affect & wellbeing questionnaires will be administered. Higher scores on Quality of Life in Neurological Disorders (Neuro-Qol) positive affect and well-being indicates a greater life satisfaction (possible score range 9 to 45). |
| Changes from baseline Self-efficacy for weight management | Each patient will be given the assessments at 2 points during the study, at baseline and at posttest (an average of 6 months from baseline). | Weight Efficacy Lifestyle Questionnaire-Short Form (WEL-SF) will be administered. A higher score on the weight efficacy lifestyle questionnaire indicates more confidence to engage in a healthy behavior (possible score range for self-efficacy weight is 1 to 10) |
Countries
United States
Outcome results
None listed