Lifestyle change and mobility in obese adults with type 2 diabetes
Open accessAbstract
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.).
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Both aerobic and resistance exercise have beneficial effects in people with type 2 diabetes, and combining them has additive benefits.
“As is the case for persons with T2D, studies have demonstrated beneficial effects of both aerobic and resistance exercise and additive benefits when both forms of exercise are combined.727,847–852”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [727]
The Discussion (page not available) reports improved fitness and reduced mobility-related disability in adults with type 2 diabetes following a lifestyle intervention. It does not distinguish aerobic from resistance exercise or report additive benefits from combining them; the combination discussed there is weight loss plus exercise. (LLM, conf=0.78)
Experimental — accuracy not yet measuredPhysical activity is a key part of lifestyle treatment.
“Increased physical activity is an important component of lifestyle therapy.674,727”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [727]
Longer maintenance of weight loss might further reduce the risk of type 2 diabetes in at-risk people and preserve gains in sleep apnea, physical mobility, and other conditions improved by weight loss.
“Sustaining weight loss for longer periods may further improve the prevention of type 2 diabetes in at-risk individuals,34 as well as maintain improvements in sleep apnea,5 physical mobility,6 and other health conditions ameliorated by weight loss.7–9”
From Eight-year weight losses with an intensive lifestyle intervention: The look AHEAD study (2014) · cites this paper as [6]
Physical activity and aerobic exercise guidelines are similar in people with type 2 diabetes independent of lean versus overweight or obese BMI.
“Physical activity and aerobic exercise guidelines are similar in persons with T2D independent of lean vs overweight/obese BMI.431,674,727,728”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [727]
The Methods (Study participants; page not provided) include only overweight or obese adults with type 2 diabetes. The Methods (Study Design; page not provided) give this trial’s physical-activity goal, but do not compare exercise guidelines for lean and overweight or obese people. Searches for BMI-independent guidelines found no passage addressing that comparison. (LLM, conf=0.77)
Experimental — accuracy not yet measuredIn children, type 2 diabetes pathogenesis is critically driven by loss of β-cell function, and residual β-cell function determines glucose control in those recently diagnosed.
“The pathogenesis of the syndrome in children is also critically determined by β-cell function loss with the degree of residual β-cell function determining glucose control in recently diagnosed patients160.”
From Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future (2014) · cites this paper as [160]
Type 2 diabetes in youth seems to progress more aggressively than in adults, and the differing effects of interventions stem from a larger improvement in β-cell function.
“The disease’s course in youth appears to be more aggressive than in adults, with the differential impact of the interventions being the result of a greater improvement in β-cell function160.”
From Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future (2014) · cites this paper as [160]
Other benefits of exercise include slowing the decline in mobility among overweight people with diabetes.
“Other benefits include slowing the decline in mobility among overweight people with diabetes (251).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [251]
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Self-citationWing, R. R., & the Look AHEAD Research Group (2021) · Obesity · doi:10.1002/oby.23158 · Cited by 88 · see citing works
Management of Type 2 Diabetes Mellitus in Older Adults
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Synthetic therapeutic gene circuits in mammalian cells
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Impact of intensive lifestyle intervention on disability-free life expectancy: the Look AHEAD study
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Disability-Free Life-Years Lost Among Adults Aged ≥50 Years With and Without Diabetes
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Self-citationLook AHEAD Research Group, Wing, R. R., Bray, G. A., Cassidy-Begay, M., Clark, J. M., Coday, M., Egan, C., Evans, M., Foreyt, J. P., Glasser, S., et al. (2022) · Diabetes Care · doi:10.2337/dc21-1805 · Cited by 61 · see citing works
Self-citationSex Differences in the Effects of Type 2 Diabetes on Exercise Performance
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Aging and physical function in type 2 diabetes: 8 years of an intensive lifestyle intervention
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Self-citationDiabetes mellitus type 2 in adults
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Beyond the Obesity Paradox in Diabetes
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Self-citationType 2 diabetes and impaired physical function: a growing problem
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Long-term maintenance of weight loss after lifestyle intervention in frail, obese older adults
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Effectiveness of the MOVE! Multidisciplinary Weight Loss Program for Veterans in Los Angeles
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Longitudinal Examination of Symptom Profiles Among Breast Cancer Survivors
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Houston, D. K., Leng, X., Bray, G. A., Hergenroeder, A. L., Hill, J. O., Jakicic, J. M., Johnson, K., Neiberg, R. H., Marsh, A. P., Rejeski, W. J., et al. (2014) · Obesity · doi:10.1002/oby.20944 · Cited by 48 · see citing works
Self-citationWeight Loss Strategies in the Elderly: A Clinical Conundrum
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Physical Disability in the Elderly with Diabetes: Epidemiology and Mechanisms
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Pilates Method Training: Functional and Blood Glucose Responses of Older Women With Type 2 Diabetes
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Diabetes: An Update on the Pandemic and Potential Solutions
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Pharmacologic Treatment Options for Obesity: What Is Old Is New Again
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Hip strength: Ankle proprioceptive threshold ratio predicts falls and injury in diabetic neuropathy
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Partially Ordered Mixed Hidden Markov Model for the Disablement Process of Older Adults
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Self-citationWhy do we need drugs to treat the patient with obesity?
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Self-citationIntentional weight loss in older adults
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Metabolic surgery: shifting the focus from glycaemia and weight to end-organ health
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Relationship of Lifestyle with Academic Achievement in Nursing Students
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Diabetes, Nutrition, and Exercise
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Weight loss in the prevention and treatment of diabetes
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Is Physical Exercise a Core Therapeutical Element for Most Patients With Type 2 Diabetes?
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- Authors
- Rejeski, W. J., Ip, E. H., Bertoni, A. G., Bray, G. A., Evans, G., Gregg, E. W., & Zhang, Q.
- Affiliations
- Wake Forest University (US)
- Pennington Biomedical Research Center (US)
- Baylor College of Medicine (US)
- Centers for Disease Control and Prevention (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2012-03-29
- Volume
- 366
- Issue
- 13
- Pages
- 1209-1217
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC3339039
- OpenAlex
- W2143015497
- Cited by
- 301
- References
- 41
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 6 · 2023: 14 · 2022: 18 · 2021: 16 · 2020: 17 · 2019: 17 · 2018: 17 · 2017: 38 · 2016: 29 · 2015: 21 · 2014: 40 · 2013: 34 · 2012: 17
- FWCI
- 28.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- University Libraries (University of Maryland) (submittedVersion)
- Digital Repository at the University of Maryland (University of Maryland College Park)
- Funders
- National Institutes of Health (5p30dk046204-15)
- National Institute on Aging (R01-AG031827A, R01AG031827, P30AG021332)
- National Heart, Lung, and Blood Institute (U01HL101066, HL076441-01A1, R18HL076441, R01HL076441)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-57171, DK 57136, DK57149, DK 57002, DK57182, DK56990, (DK 046204, DK57008, DK57177, DK 57078, DK57219, U01DK057149, DK-57178, U01DK057151, U01DK057135, U01DK057131, U01DK056990, DK-57135, U01DK057136, DK-56992, DK57154, U01DK057178, U01DK057182, U01DK057078, U01DK057154, U01DK057008, U01DK057171, DK57131, U01DK057002, U01DK057219, U01DK056992, U01DK057177, P30DK017047, P30DK048520, DK 57151, P30-DK046204, P30-DK 48520)
- National Center for Research Resources (M01-RR-0021140, M01RR-00051, M01RR002719, M01RR-00211, M01RR000056, M01RR01346, M01RR000051, M01RR001066, M01RR001346, UL1RR024153, M0-1-RR-02719, M01RR000211, M01-RR01066)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- type 2 diabetes, obesity, mobility (physical function), functional decline, lifestyle intervention, weight loss, physical fitness, diabetes support and education, older adults, musculoskeletal symptoms
- MeSH terms
- Aged, Diabetes Mellitus, Type 2, Disability Evaluation, Female, Persons with Disabilities, Humans, Life Style, Male, Middle Aged, Motor Activity, Obesity, Patient Education as Topic, Physical Fitness, Risk, Weight Loss, Overweight, Mobility Limitation
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