(23-04-12) Lifestyle change and mobility in obese adults with type 2 diabetes.

Rejeski WJ, Ip EH, Bertoni AG, Bray GA, Evans G, Gregg EW, Zhang Q; Look AHEAD
Research Group.
Collaborators (397)

Source
Reynolda Campus, Wake Forest University, Winston-Salem, NC 27109, USA.
[email protected]
Abstract
BACKGROUND:
Adults with type 2 diabetes mellitus often have limitations in mobility that
increase with age. An intensive lifestyle intervention that produces weight
loss and improves fitness could slow the loss of mobility in such patients.
METHODS:
We randomly assigned 5145 overweight or obese adults between the ages of 45
and 74 years with type 2 diabetes to either an intensive lifestyle intervention
or a diabetes support-and-education program; 5016 participants contributed
data. We used hidden Markov models to characterize disability states and mixed-
effects ordinal logistic regression to estimate the probability of functional
decline. The primary outcome was self-reported limitation in mobility, with
annual assessments for 4 years.
RESULTS:
At year 4, among 2514 adults in the lifestyle-intervention group, 517 (20.6%)
had severe disability and 969 (38.5%) had good mobility; the numbers among 2502
participants in the support group were 656 (26.2%) and 798 (31.9%),
respectively. The lifestyle-intervention group had a relative reduction of 48%
in the risk of loss of mobility, as compared with the support group (odds
ratio, 0.52; 95% confidence interval, 0.44 to 0.63; P<0.001). Both weight loss
and improved fitness (as assessed on treadmill testing) were significant
mediators of this effect (P<0.001 for both variables). Adverse events that were
related to the lifestyle intervention included a slightly higher frequency of
musculoskeletal symptoms at year 1.
CONCLUSIONS:
Weight loss and improved fitness slowed the decline in mobility in overweight
adults with type 2 diabetes. (Funded by the Department of Health and Human
Services and others; ClinicalTrials.gov number, NCT00017953.).

Source: N Engl J Med. 2012 Mar 29;366(13):1209-17

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