title: Impact of a home-based activity and dietary intervention in people with slowly progressive neuromuscular diseases.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  Human performance laboratory of a university and each subject's home.
  
  
  METHODS
  Twenty adult volunteer ambulatory subjects with several types of slowly progressive neuromuscular disease (NMD).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, CA 95817, USA. ddkilmer@ucdavis.edu
authors.forename: David D
authors.initials: DD
authors.lastname: Kilmer
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Wright
authors.forename: Susan
authors.initials: S
authors.lastname: Aitkens
mesh_terms: D000328:Adult; D004032:Diet; D037001:Directive Counseling; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D010349:Patient Compliance; D012307:Risk Factors