Efficacy of the Diabetes Prevention Program Group Lifestyle Balance Program Modified for Individuals with TBI (GLB-TBI): Results from a 12-month Randomized Controlled Trial

Abstract

Background Obesity after traumatic brain injury (TBI) is a public health issue and no evidence-based weight loss interventions exist to meet the unique needs of individuals after TBI. Purpose To (a) examine the efficacy of the Diabetes Prevention Program Group Lifestyle Balance for TBI (GLB-TBI) weight-loss intervention compared to an attention control for primary (weight-loss) and secondary health outcomes; (b) determine participant compliance with the GLB-TBI; and (c) determine if compliance is associated with improved outcomes. Methods Individuals with moderate to severe TBI, age 18–64 years, ≥6 months postinjury, and body mass index of ≥25 kg/m2 were randomized to a 12-month, 22-session GLB-TBI intervention or attention control condition. Weight-loss (lbs.), anthropometric, biomarkers, and patient-reported outcomes were collected at baseline, 3, 6, and 12 months. Results The GLB-TBI group (n = 27) lost 17.8 ± 41.4lbs (7.9%) over the 12-month program and the attention control group (n = 27) lost 0 ± 55.4lbs (0%). The GLB-TBI group had significant improvements in diastolic blood pressure, triglycerides, and HDL cholesterol. GLB-TBI attendance was 89.6% and weekly self-monitoring of diet and activity was 68.8%. Relative to baseline, the GLB-TBI compliant group (≥80% attendance; ≥85% self-monitoring; n = 10) had a statistically significant decrease in weight at each assessment, the noncompliant group had a significant decrease between 6 and 12 months (n = 17), with no change in weight in the attention control group (n = 27). Conclusions Findings suggest for adults with TBI who are overweight or obese, participation in the GLB-TBI can significantly reduce weight and metabolic risk factors and increase self-reported habits for diet and exercise.

A randomized controlled trial protocol for people with traumatic brain injury enrolled in a telehealth delivered diabetes prevention program (tGLB-TBI)

“…We will need to enroll 88 participants (44 per group) to detect a 5% reduction in weight, with a power of 0.8 and assuming a 20% attrition rate. These estimates are based upon our published GLB-TBI RCT weight-loss data [ 5 ] summarized below: Weight at baseline (mean, SD) 221.4 ± 51lbs. Weight-loss after 12 months of GLB-TBI 17.8 ± 16.4lbs …”

“…We recently completed a randomized controlled trial (RCT) examining the efficacy of in-person participation in the GLB-TBI on weight-loss compared to an attention control group. Individuals in the GLB-TBI group (n = 27) lost −17.8 ± 16.4lbs (−7.9%) over the 12-month program and the attention control group (n = 28) lost 0 ± 55.4lbs (0%) [ 5 ]. The GLB-TBI group also had significant improvements (p < 0.05) in diastolic blood pressure (−16 mmHg), waist circumference (−3.4in), triglycerides (−53.1mg/DL), HDL cholesterol (+3.9mg/DL), metabolic syndrome risk (84% reduction), diabetes risk (37% reduction), 6-min walk test (+50 m), self-efficacy and self-report habits for diet and exercise when compared to the attention control.…”

Feasibility of a physiotherapist-supervised walking program with telephone coaching to increase physical activity following acquired brain injury

“…Walking as a regular form of physical activity has many known health benefits in free living adult populations and certain neurological populations (Halabchi et al 2017;Jones et al 2021). Prior studies have implemented physical activity programs with adults in the sub-acute and chronic phase post-ABI (Lund et al 2012;Bellon et al 2015;Driver et al 2023). There is a need to explore the feasibility of such programs for the inpatient rehabilitation setting, as patients in these settings are physically inactive (Kunkel et al 2015).…”