My overarching goal is to become an independent investigator in the area of lifestyle interventions for prevention and reduction of cardiometabolic risk factors (CMRF) in adults with spinal cord injury (SCI). The purpose of this application is to augment my previous training in obesity, behavioral science and research design with additional tools necessary to make this transition. As a behavioral scientist, my research and clinical practice focus on lifestyle interventions for obesity. After completion of my doctorate in Health Education and Promotion, I completed a competitive T-32 fellowship in Comparative Effectiveness Research at the University of Alabama at Birmingham (UAB), with special focus on tailoring lifestyle interventions for specific populations. This training furthered my understanding of adapting interventions for specific needs of special populations and measuring the effectiveness of these interventions using randomized controlled trials and real world clinical trials. Throughout my doctoral and post-doctoral training, I also received clinical training in the UAB Department of Nutrition Sciences. In this clinical role, I learned nutritional and physical activity considerations for treating obesity in a variety of chronic diseases, as well as how to incorporate behavior change strategies to improve adherence to dietary and exercise recommendations. I also had the opportunity to work with individuals with a variety of physical disabilities including SCI. It was during this clinical training that I began to understand the barriers individuals with physical disabilities face in developing healthy dietary and activity routines, and the lack of evidenced-based recommendations for reducing obesity and other CMRF in this population. To further my training, this career development award (CDA) will focus on three goals. First, I will increase my understanding of the unique disease processes associated with SCI that influence cardiometabolic risk factors after injury. Second, I will augment my current knowledge of psychosocial determinants of obesity with an increased understanding of the unique determinants of behavior change in adults with SCI. Third, I aim to increase my understanding of how to leverage emerging technology to develop novel interventions that can directly address barriers to adherence among adults with SCI. Completion of these training goals, along with the proposed study will put me in a position to apply for R01 level funding by the end of the CDA period. Despite significant evidence on CMRF and obesity among adults with SCI, there is little evidence on the best methods for addressing these significant health issues. Lifestyle interventions consisting of diet and exercise recommendations along with behavioral strategies to increase adherence to these recommendations, are considered the first line of treatment for weight loss and reduction of CMRF, but little research has explored how to adapt these interventions for adults with SCI. Specifically, dietary adherence continues to be an obstacle to long term weight maintenance, and this may be compounded in adults with SCI given the metabolic, psychosocial and environmental barriers associated with this disability. Reduced carbohydrate (CHO) diets have been found to improve CMRF in non-SCI groups. They have also been associated with decreased hunger and cravings, and improved mood and energy levels, all of which may lead to improved dietary adherence. The purpose of the proposed study is to assess differences in dietary adherence, body composition and insulin, glucose, lipids and hs-CRP between a reduced CHO and standard diet in obese adults with SCI. This study will employ a novel home-based telehealth intervention utilizing an Information and Communication Technology (ICT) platform designed specifically for individuals with SCI. I have developed an excellent mentoring team to guide this CDA. James Rimmer, PhD, will serve as primary mentor. Dr. Rimmer is internationally known for his work in exercise, health promotion and physical disabilities and currently serves as the inaugural UAB/Lakeshore Foundation Endowed Chair in Health Promotion and Rehabilitation Science. Barbara Gower, PhD will serve as co-mentor and will oversee my training in CMRF including trainings in measuring and interpreting body composition, insulin sensitivity and glucose tolerance. These mentors, along with consultants Kathleen Martin Ginis, PhD, Leslie McClure, PhD, and Yu-ying Chen, MD, PhD, will guide me through the proposed training program and ensure completion of the proposed study. The resources afforded to me by my mentoring team and UAB are excellent. I will be involved in research and training in the UAB Departments of Occupational Therapy and Physical Therapy, as well as the PhD program in Rehabilitation Science. Additionally, I will work closely with the UAB/Lakeshore Research Collaborative, which serves as a partnership between leading UAB researchers and state-of-the-art fitness and health promotion programs for people with physical disabilities. In conclusion, my research and clinical experience make me an excellent candidate for the K01 Mentored Career Development Award in Medical Rehabilitation Research. I believe that the completion of the proposed training plan and study, in conjunction with guidance from an outstanding mentor team and the resources afforded to me by UAB offer an excellent opportunity to complete my transition to independent investigator.

Public Health Relevance

Cardiometabolic diseases including cardiovascular disease and diabetes are among the leading causes of illness and death in adults living with spinal cord injury. These diseases can be reduced by following a healthy diet, but many people have trouble adhering to a healthy diet long term. Research in non-injured adults has shown that reduced carbohydrate diets may reduce these diseases and lead to increased dietary adherence over low fat diets; however no research has examined this in individuals with SCI. The purpose of this study is to assess the impact of a restricted carbohydrate diet on dietary adherence and cardiometabolic risk factors among adults with spinal cord injury.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Scientist Development Award - Research & Training (K01)
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National Institute of Child Health and Human Development Initial Review Group (CHHD)
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Marden, Susan F
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University of Alabama Birmingham
Other Health Professions
Sch Allied Health Professions
United States
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Wingo, Brooks C; Barry, Valene Garr; Ellis, Amy C et al. (2018) Comparison of segmental body composition estimated by bioelectrical impedance analysis and dual-energy X-ray absorptiometry. Clin Nutr ESPEN 28:141-147
Sineath, Ashley; Lambert, Lauren; Verga, Catherine et al. (2017) Monitoring intervention fidelity of a lifestyle behavioral intervention delivered through telehealth. Mhealth 3:35