New research has shown that weight loss and increased physical fitness reduce the risk of losing mobility in overweight or obese adults with type 2 diabetes. Older adults with type 2 diabetes are more likely to have reduced mobility than those without this disease, and obesity increases the risk for mobility-related health problems. As part of the Look AHEAD (Action for Health in Diabetes) clinical trial, researchers investigated whether a lifestyle intervention program could slow the reduction of mobility. Look AHEAD is determining whether a lifestyle intervention designed to promote weight loss can improve health outcomes in overweight or obese people with type 2 diabetes. Participants were randomly assigned to either an intensive lifestyle intervention group (ILI) or a diabetes support and education group (DSE). Among the tests done in the trial, the researchers measured participants’ weight, and they assessed the participants’ fitness with a treadmill test. When the Look AHEAD trial began, nearly two-thirds of participants reported mild, moderate, or severe restrictions in mobility. After 4 years of the study, participants in the ILI group did not lose as much mobility as those in the DSE group. The ILI intervention slowed decline in mobility by 48 percent compared to DSE. Moreover, 20.6 percent of ILI participants reported severe disability compared to 26.2 percent of participants in the DSE group. Similarly, 38.5 percent of those in the ILI group reported good mobility, whereas the rate was 31.9 percent in the DSE group. Weight loss was a slightly stronger predictor of better mobility than was improved fitness, but both contributed significantly to the observed reduction in risk. These results are consistent with previous analyses, which showed that participants in the ILI group lost significantly more weight than did those in the DSE group, and also had improved fitness, glucose control, blood pressure, and HDL cholesterol with less use of medication. These findings show that intensive lifestyle intervention programs can slow the decline of mobility in overweight or obese people with type 2 diabetes, and have significant implications for improving quality of life as people age.
In September 2012, the intervention was discontinued when it was found that intensive lifestyle intervention in overweight/obese adults with long standing type 2 diabetes did not reduce cardiovascular events such as heart attack and stroke. Although the intervention did not reduce cardiovascular events, Look AHEAD has previously shown other important health benefits of the lifestyle intervention, including decreasing sleep apnea, reducing the need for diabetes medications, improving quality of life, and helping to maintain physical mobility (as shown in this advance). Although the intervention was discontinued, follow up of all study participants will continue to evaluate their long-term health and effects of the weight loss intervention.
Rejeski WJ, Ip EH, Bertoni AG, et al. Lifestyle change and mobility in obese adults with type 2 diabetes. N Engl J Med
366: 1209-1217, 2012.