Metabolic Syndrome and Fall Risk

Not Applicable

Completed

Brief Summary: Obesity and the metabolic syndrome (MetS) are rapidly growing problems. Individuals with the MetS are at risk for not only future chronic diseases, but they have a higher prevalence of neuropathy, including cardiac autonomic neuropathy, and have a higher incidence of falls. Currently there are no effective therapies to prevent or reverse the neuropathy seen in the MetS or to reduced the fall risk in this population. This research project will determine if a tailored balance exercise program will have functional benefits and result in a reduced fall risk in the growing population of patients with the MetS and neuropathy.

Detailed Description: Completed

55 participants with evidence of the MetS and autonomic neuropathy will be assessed for fall risk with the Four Square Step Test (FSST), which is a measure of dynamic standing balance. Additional endpoints include the dynamic gait index. Measures of height, weight, and waist circumference will be taken and an oral glucose tolerance test as well as lipids and blood pressure will also be measured. Autonomic function will be measured using cardiac autonomic testing, quantitative sudomotor axon reflex test and tilt table testing. Participants will be randomized into either a standard care group that will receive fall risk education or a targeted balance exercise intervention group. Both groups will meet once a week. The intervention group will receive a 12 week balance program with personalized incremental increases in the amount and difficulty of each maneuver.

Recruitment & Eligibility

Inclusion Criteria

MetS at the time of screening based on the International Diabetes Federation definition
No risk factors for other causes of neuropathy
Autonomic neuropathy as defined by the Toronto Diabetic Neuropathy Expert Group 2010/11 consensus criteria
Age 45-75 years inclusive at the time of screening
Medically stable at the time of enrollment
Able to participate in a standing balance exercise program without constant standby monitoring
Women of childbearing potential must be using an acceptable method of contraception for the duration of their participation in the study
Willing to accept assignment to either training group
Willing and able to participate in the assigned intervention program

Exclusion Criteria

Pregnant women, prisoners, institutionalized subjects and other at risk subjects
Etiology of neuropathy other than the MetS
History of severe medical conditions likely to shorten lifespan or alter ability to participate in the trial
Severe autonomic neuropathy that restricts daily function and the ability to participate in study interventions
An inability to understand or cooperate with the procedures of the trial or refusal to sign the informed consent

Arm && Interventions

Group	Intervention	Description
standard care	Standard care	Participants will meet in person on a weekly basis for a general education class regarding health and fall prevention but will not participate in an exercise class.
Balance exercise program	Balance exercise	Participants will attend weekly group training sessions and will keep an exercise log of home activity during a three month exercise program designed to improve balance. Balance exercises will be performed three times per week in a home-based training program.

Primary Outcome Measures

Name	Time	Method
Four Square Step Test (FSST)	12 weeks	A measure of proactive dynamic standing balance. A participant steps over four canes that are laid on the ground at 90 degree angles to each other. The participants stands in one of the squares formed by the canes and they are instructed to step as quickly as possible into each square in a specified sequence.

Secondary Outcome Measures

Name	Time	Method
Dynamic Gait Index (DGI)	12 weeks	An instrumented DGI will be performed on an instrumented gait mat. The DGI is a measure of functional balance during walking and it assesses an individual's ability to modify balance while walking in the presence of external demands (walking while changing speeds, head turns, stepping over and around obstacles, pivoting, and stair climbing). The short form DGI is scored 0-12, with higher number indicating better performance.

Locations (1): Baltimore VA Medical Center VA Maryland Health Care System, Baltimore, MD
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Baltimore, Maryland, United States

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