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Health Promotion and Education

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Little is known about the most effective health promotion activities, including nutrition interventions, to meet the long-term wellness needs for persons after SCI. A holistic wellness program intervention was developed, conducted and assessed by Zemper et al. (2003). Improvement in healthy diet involves a number of factors. One important factor of health promotion and education is improving the ‘food environment’. This involves diet education, expanding current food choices, and providing better access to healthy foods (Hata, Inayama, & Yoshiike, 2017).

Table 8 Nutritional Intervention and Long-Term Wellness Needs for Individuals after SCI

Discussion

In the Zemper et al. (2003) study, 43 adults with SCI were randomly assigned to intervention or control groups. The intervention group attended 6 half-day wellness workshops over a 3-month period which included nutrition, physical activity, lifestyle management and prevention of secondary conditions. Among other measurements, total cholesterol and BMI were assessed. Health Promoting Lifestyle Profile-II (HPLP-II) was used to assess nutrition and other health promotion habits. There was improvement in the HPLP-II nutrition subscale mean score for the intervention group. Mean BMI values actually increased for both groups. Total cholesterol values rose for both groups; changes in HDL and LDL cholesterol values were not reported. There were significant improvements in reported eating and weight-related behaviours.

A study was conducted by Liusuwan et al. (2007) which investigated the effects of behavioural intervention, exercise and nutrition education to improve health and fitness in adolescents with spinal cord dysfunction as the result of myelomeningocele and SCI. Among twenty adolescent subjects, fourteen completed all testing sessions conducted prior to and after completing a 16-week intervention program. Testing included measurements of aerobic fitness, heart rate (HR), oxygen uptake, peak isokinetic arm and shoulder strength, body composition, BMI and blood work assessment which included total, HDL and LDL cholesterol and triglycerides. Participants were given a schedule of aerobic and strengthening exercises and attended nutrition education and behaviour modification sessions every other week accompanied by their parents. Results suggested that there was no significant overall change in weight, BMI or blood work. There was a significant increase in whole body lean tissue without a concomitant increase in whole body fat. Fitness measures revealed a significant increase in maximum power output, work efficiency and resting oxygen uptake. Shoulder extension strength increased. There were no significant changes in total, HDL or LDL cholesterol or triglycerides during the 16-week program.

In a cross-sectional study Hata et al. (2016) examined a Japanese chronic male SCI population about their perceptions of their social participation in the community and the social support they receive from relatives and friends, in relation to their health and dietary satisfaction. The authors reported that individuals with sufficient social participation and social support are more likely to have greater self-rated health and dietary satisfaction. Resultantly, health promotion programs should emphasize these two social determinants of health. In particular, the authors found an odds ratio of having high dietary satisfaction seven times greater for those with high social support when comparing between individuals with low social participation (OR=6.99 vs OR=1.00), and six times greater for those with high social support when comparing between individuals with high social participation (OR=8.64 vs OR=1.38).

Hata, Inayama, and Yoshiike (2017) conducted another cross-sectional study, this time investigating perceived food environment and its relationship with health-related quality of life (HRQOL) and diet satisfaction of community-dwelling SCI individuals. The perceived food environment was studied, looking at how readily available and accessible healthy food is (Hata, Inayama, & Yoshiike, 2017). HRQOL was divided into physical and mental scores, and the authors found they were differently associated with factors of food environment. Physical scores were related to: stores with safe and reliable food, dietary information in the community, and accurate diet information from the media (ORs= 1.61, 1.67, and 1.74, respectively). Mental scores were related to: balanced meals in the household, nutritious foods at reasonable prices, and acquired diet information from the community (ORs= 1.86, 1.62, and 2.30, respectively). Lastly, diet satisfaction was related to: balanced meals in the household, food information available from the family, and accurate diet information from the media (ORs= 6.50, 2.70, and 1.75, respectively). This study highlights the importance of the perceived food environment of SCI individuals and its role in HRQOL and diet satisfaction while living in the community (Hata, Inayama, & Yoshiike, 2017).

Conclusion

There is level 1b evidence (from one RCT; Zemper et al. 2003) that improved health-related behaviours are adopted following a holistic wellness program for individuals with SCI.

There is level 4 evidence (from one pre-post study; Liusuwan et al. 2007) that an education program combining nutrition, exercise and behaviour modification is effective in increasing whole body lean tissue, maximum power output, work efficiency, resting oxygen uptake and shoulder strength in persons with SCI.

There is level 5 evidence (from one observational study; Hata et al. 2016) that social participation and social support have beneficial effects on an individual with SCI’s self-rated health and dietary satisfaction.

There is level 5 evidence (from one observational study; Hata, Inayama, & Yoshiike, 2017) that the perceived food environment is associated with health related quality of life and diet satisfaction of community-dwelling SCI individuals.

  • Participation in a holistic wellness program is positively associated with improved eating and weight-related behaviours in persons with SCI.

    A combined nutrition, exercise and behaviour modification program can help persons with SCI increase metabolically active lean tissue, work efficiency, resting oxygen uptake and strength.

    Having a high social participation is positively associated with better self-rated health, and receiving sufficient social support is positively associated with a greater dietary satisfaction, in persons with SCI.

    Having a positive perceived food environment is associated with higher physical and mental scores of health-related quality of life, and higher diet satisfaction in persons with SCI.