Weight Loss and Fitness May Enhance Mobility in Diabetes
Weight Loss and Fitness May Enhance Mobility in Diabetes
April 2, 2012 — An intensive lifestyle intervention to lower weight and improve fitness appeared to improve mobility among overweight patients with type 2 diabetes, according to the findings of a multicenter, randomized, controlled trial.
W. Jack Rejeski, PhD, from Wake Forest University in Winston-Salem, North Carolina, and colleagues published their findings in the March 29 issue of the New England Journal of Medicine.
The authors note the importance of maintaining mobility among patients with type 2 diabetes, particularly as they age: "An insidious consequence of aging in persons with type 2 diabetes is physical disability, particularly the loss of mobility," the authors write. "Reduced mobility puts patients at risk for loss of independence, leads to muscle loss (which compromises glucose storage and clearance), and compromises the quality of life."
The authors enrolled overweight and obese patients aged 45 to 74 years who had type 2 diabetes and randomly assigned them to an intensive lifestyle intervention or a diabetes support-and-education program. Among the 5016 patients with data for at least 1 follow-up visit, the intervention group had a 48% reduction in the risk for loss of mobility (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.44 - 0.63; P < .001).
The authors excluded patients with glycated hemoglobin levels exceeding 11%, blood pressure exceeding 160/100 mm Hg, triglyceride levels exceeding 6.8 mmol/L, inadequate control of coexisting conditions, underlying diseases that could limit the lifespan or affect safety, and the inability to pass a baseline exercise stress test.
No differences were observed between the baseline characteristics of the 2 groups, including age, sex, ethnicity, weight, and cardiovascular fitness.
After year 4 of the study, 38.5% of patients in the lifestyle intervention group exhibited good mobility compared with 31.9% in the support group. The lifestyle intervention group also exhibited higher odds of weight loss (OR, 5.4; 95% CI, 5.0 - 5.8; P < .001) and improved fitness (OR, 11.9; 95% CI, 10.6 - 13.1; P < .001). Both weight loss (OR, 0.93, 95% CI, 0.92 - 0.94; P < .001) and improved fitness (OR, 0.99; 95% CI, 0.98 - 0.99; P < .001) were associated with a lower risk for loss of mobility.
The authors indicate that their findings confirm the long-term efficacy of the intensive lifestyle intervention on weight loss, fitness, and the risk for cardiovascular disease: "Although the current findings may seem limited in light of this previous work and related reports that are based on 1-year data, these are the first data from [the Look AHEAD (Action for Health in Diabetes) Study] to show that the intensive lifestyle intervention also reduced the risk of loss of mobility," the authors write. "This is an important finding for clinical medicine, given the importance of disability in patients with type 2 diabetes and the fact that the prevalence of type 2 diabetes will increase as the population ages."
Gretchen A. Piatt, PhD, MPH, from the University of Michigan in Ann Arbor, agreed that maintaining mobility is an important goal among patients with type 2 diabetes. "It is important for healthcare providers to continue to encourage their patients, especially those with diabetes, to strive for weight loss if they are overweight or obese, and to maintain active lifestyles," Dr. Piatt told Medscape Medical News. "Making these types of behavior changes may lessen the likelihood of developing more serious health problems and, thus, increasing healthcare costs."
The study was supported by the Department of Human Health Services via grants from the National Institutes of Health, including the National Institute of Diabetes and Digestive and Kidney Diseases, the National Heart, Lung, and Blood Institute, the National institute on Aging, the National Institute of Nursing Research, and the National Center on Minority Health and Health Disparities; the Office of Research on Women’s Health; the Centers for Disease Control and Prevention; the Department of Veterans Affairs; and the Indian Health Service. Several authors received grants from additional institutions including the Johns Hopkins Medical Institutions Bayview General Clinical Research Center, the Massachusetts General Hospital Mallinckrodt General Clinical Research Center and the Massachusetts Institute of Technology General Clinical Research Center, the University of Colorado Health Sciences Center General Clinical Research Center and Clinical Nutrition Research Unit, the University of Tennessee at Memphis General Clinical Research Center, the University of Pittsburgh General Clinical Research Center, the Clinical Translational Research Center, and the Frederic C. Bartter General Clinical Research Center. Funding also came from FedEx, Health Management Resources, LifeScan, Nestle Health-Care Nutrition, Hoffmann–La Roche, Abbott Nutrition, and Unilever North America. One coauthor received honoraria from Takeda Pharmaceuticals, Vivus Pharmaceuticals, and Herbalife Nutritionals. The other authors and Dr. Piatt have disclosed no relevant financial relationships.
N Engl J Med. 2012;366:1209-1217. Abstract
April 2, 2012 — An intensive lifestyle intervention to lower weight and improve fitness appeared to improve mobility among overweight patients with type 2 diabetes, according to the findings of a multicenter, randomized, controlled trial.
W. Jack Rejeski, PhD, from Wake Forest University in Winston-Salem, North Carolina, and colleagues published their findings in the March 29 issue of the New England Journal of Medicine.
The authors note the importance of maintaining mobility among patients with type 2 diabetes, particularly as they age: "An insidious consequence of aging in persons with type 2 diabetes is physical disability, particularly the loss of mobility," the authors write. "Reduced mobility puts patients at risk for loss of independence, leads to muscle loss (which compromises glucose storage and clearance), and compromises the quality of life."
The authors enrolled overweight and obese patients aged 45 to 74 years who had type 2 diabetes and randomly assigned them to an intensive lifestyle intervention or a diabetes support-and-education program. Among the 5016 patients with data for at least 1 follow-up visit, the intervention group had a 48% reduction in the risk for loss of mobility (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.44 - 0.63; P < .001).
The authors excluded patients with glycated hemoglobin levels exceeding 11%, blood pressure exceeding 160/100 mm Hg, triglyceride levels exceeding 6.8 mmol/L, inadequate control of coexisting conditions, underlying diseases that could limit the lifespan or affect safety, and the inability to pass a baseline exercise stress test.
No differences were observed between the baseline characteristics of the 2 groups, including age, sex, ethnicity, weight, and cardiovascular fitness.
After year 4 of the study, 38.5% of patients in the lifestyle intervention group exhibited good mobility compared with 31.9% in the support group. The lifestyle intervention group also exhibited higher odds of weight loss (OR, 5.4; 95% CI, 5.0 - 5.8; P < .001) and improved fitness (OR, 11.9; 95% CI, 10.6 - 13.1; P < .001). Both weight loss (OR, 0.93, 95% CI, 0.92 - 0.94; P < .001) and improved fitness (OR, 0.99; 95% CI, 0.98 - 0.99; P < .001) were associated with a lower risk for loss of mobility.
The authors indicate that their findings confirm the long-term efficacy of the intensive lifestyle intervention on weight loss, fitness, and the risk for cardiovascular disease: "Although the current findings may seem limited in light of this previous work and related reports that are based on 1-year data, these are the first data from [the Look AHEAD (Action for Health in Diabetes) Study] to show that the intensive lifestyle intervention also reduced the risk of loss of mobility," the authors write. "This is an important finding for clinical medicine, given the importance of disability in patients with type 2 diabetes and the fact that the prevalence of type 2 diabetes will increase as the population ages."
Gretchen A. Piatt, PhD, MPH, from the University of Michigan in Ann Arbor, agreed that maintaining mobility is an important goal among patients with type 2 diabetes. "It is important for healthcare providers to continue to encourage their patients, especially those with diabetes, to strive for weight loss if they are overweight or obese, and to maintain active lifestyles," Dr. Piatt told Medscape Medical News. "Making these types of behavior changes may lessen the likelihood of developing more serious health problems and, thus, increasing healthcare costs."
The study was supported by the Department of Human Health Services via grants from the National Institutes of Health, including the National Institute of Diabetes and Digestive and Kidney Diseases, the National Heart, Lung, and Blood Institute, the National institute on Aging, the National Institute of Nursing Research, and the National Center on Minority Health and Health Disparities; the Office of Research on Women’s Health; the Centers for Disease Control and Prevention; the Department of Veterans Affairs; and the Indian Health Service. Several authors received grants from additional institutions including the Johns Hopkins Medical Institutions Bayview General Clinical Research Center, the Massachusetts General Hospital Mallinckrodt General Clinical Research Center and the Massachusetts Institute of Technology General Clinical Research Center, the University of Colorado Health Sciences Center General Clinical Research Center and Clinical Nutrition Research Unit, the University of Tennessee at Memphis General Clinical Research Center, the University of Pittsburgh General Clinical Research Center, the Clinical Translational Research Center, and the Frederic C. Bartter General Clinical Research Center. Funding also came from FedEx, Health Management Resources, LifeScan, Nestle Health-Care Nutrition, Hoffmann–La Roche, Abbott Nutrition, and Unilever North America. One coauthor received honoraria from Takeda Pharmaceuticals, Vivus Pharmaceuticals, and Herbalife Nutritionals. The other authors and Dr. Piatt have disclosed no relevant financial relationships.
N Engl J Med. 2012;366:1209-1217. Abstract
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