Impact of a home-based activity and dietary intervention in people with slowly progressive neuromuscular diseases.

OBJECTIVE: To determine whether a home-based activity and dietary intervention can increase activity level, reduce caloric intake, and impact positively components of metabolic syndrome in a disabled population. DESIGN: Testing occurred at 3 points during the 6-month intervention period (baseline, 3mo, 6mo) and at 6 months postintervention. Each test point included laboratory testing of anthropometric and metabolic variables and 3 days of home-based activity and dietary monitoring. A personally tailored activity and dietary prescription based on baseline testing was implemented during the 6-month intervention period. SETTING: Human performance laboratory of a university and each subject's home. PARTICIPANTS: Twenty adult volunteer ambulatory subjects with several types of slowly progressive neuromuscular disease (NMD). INTERVENTION: Using a pedometer, subjects were instructed to increase number of steps by 25% over their baseline determined from home monitoring. An individualized dietary prescription was provided focusing on problematic issues identified from the baseline dietary profile. MAIN OUTCOME MEASURES: Body composition, physical activity, dietary intake, energy expenditure, gait efficiency, metabolic variables, and quality of life. RESULTS: At the end of the protocol, mean step count increased approximately 27% above baseline (P=.001) and caloric intake decreased over 300kcal/d (P=.002). Body fat percentage significantly decreased (from 33.3%+/-1.5% to 32.6%+/-1.6%, P=.032). Gait efficiency did not change, and metabolic variables did not show statistically significant improvement, although 2 of the 5 subjects originally meeting the criteria for metabolic syndrome at baseline no longer met the criteria at the end of the intervention period. Six months after completing the protocol, caloric intake remained significantly reduced (P=.02), but although mean step count remained elevated, it was not statistically significant. CONCLUSIONS: Using a home-based protocol, people with NMD can increase activity and reduce caloric intake. Although this 6-month program showed positive changes, it was insufficient to affect risk factors associated with metabolic syndrome. It remains to be seen if a program longer than 6 months or a more rigorous program could lead to a reduction in the risk factors associated with metabolic syndrome.

Metabolic syndrome in neuromuscular disease.

OBJECTIVES: To test the hypotheses that (1) people with neuromuscular disease (NMD) have multiple risk factors for cardiovascular disease and diabetes and (2) these risk factors worsen over time. DESIGN: Longitudinal testing with average 2.5-year follow-up. SETTING: Human performance laboratory of a university. PARTICIPANTS: Eleven ambulatory volunteers with slowly progressive NMD and 8 able-bodied controls, group-matched for age and body mass index (BMI) at baseline. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Percentage of body fat (%BF), physical activity, energy expenditure, blood lipids and glucose, and blood pressure. RESULTS: At baseline, NMD subjects were more obese (37%BF vs 34%BF, respectively) and more sedentary than the controls, spending less time in total activity (144 min/d vs 214 min/d) and in exercise (11 min/d vs 45 min/d). The NMD group also had numerous cardiovascular and metabolic risk factors, with low high-density lipoprotein cholesterol, high BMI, and high triglyceride being the most common. Additionally, 55% of the NMD group satisfied the criteria for metabolic syndrome, versus 0% in the control group. Most parameters did not significantly worsen during the average 2.5-year follow-up period in either group. CONCLUSIONS: People with NMD are at high risk for developing chronic diseases resulting from obesity and a sedentary lifestyle. Intervention studies aimed at reducing their risk for such chronic diseases are warranted.

A new air displacement plethysmograph for the measurement of body composition in infants.

ABSTRACT This article introduces and evaluates the PEA POD Infant Body Composition System, an air displacement plethysmograph designed for the assessment of body composition in infants between birth and 6 mo of age. The performance of the PEA POD was evaluated by repeated testing of National Institute of Standards and Technology-traceable weights and volumes. Mass was measured in a single session. Volume was measured in four sessions during a 2-d period (five times/session for both). The mean values for repeated mass measurements were almost identical to the masses of traceable weights. The SD and CV for repeated volume measurements were 1.1-4.5 mL and 0.02-0.09%, respectively. Both the mean SD and CV were within very narrow ranges (1.4-3.1 mL for SD and 0.03-0.08% for CV) across all volume levels. Furthermore, mean CV values using results from the four sessions indicated excellent within- and between-day reliability. Regression analyses (by session or with all sessions combined) of the measured volume against actual volume gave very low standard error of the estimate (SEE) (0.853-1.957 mL) and very high R(2) (1.000), with the intercept and slope not significantly different from 0 and 1, respectively. The mean percentage error in volume measurements was < or =0.05% at all volume levels. The study findings and the operational and physical characteristics of the system indicate that the PEA POD has the potential to provide clinicians and researchers with a diagnostic and research tool that is accurate, easily used by operators, and comfortable for subjects.