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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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“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]
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“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]
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“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]
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“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]
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“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]
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“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]
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“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:Standards of Care in Diabetes—2023 (2023) · cites this paper as [251]
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“Engaging in these health behaviors has established benefits, from preventing morbidity among healthy individuals (Akesson, Larsson, Discacciati, & Wolk, 2014) to reducing additional morbidity and functional limitations among those with chronic diseases (Rejeski et al., 2012).”
BackgroundHouston, 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 50
“Both weight loss and improvements in cardiorespiratory fitness were previously reported to mediate the intervention effect on self-reported limitations in mobility over the first 4 years in the Look AHEAD trial (10).”
BackgroundSelf-citationWeight Loss Strategies in the Elderly: A Clinical Conundrum
Coker, R. H., & Wolfe, R. R. (2018) · Obesity · doi:10.1002/oby.21961 · Cited by 47
“The potential synergism between caloric restriction and exercise may offer a promising alternative with respect to significant weight loss, muscle preservation and improved mobility (58,59).”
BackgroundMethodPhysical Disability in the Elderly with Diabetes: Epidemiology and Mechanisms
Bianchi, L., Zuliani, G., & Volpato, S. (2013) · Current Diabetes Reports · doi:10.1007/s11892-013-0424-6 · Cited by 47
Pilates Method Training: Functional and Blood Glucose Responses of Older Women With Type 2 Diabetes
Melo, K. C. B., Araújo, F. D. S., Júnior, C. C. M. C., de Andrade, K. T. P., & Moreira, S. R. (2018) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000002704 · Cited by 47
“The deterioration of the functional capacity (FC) in older patients with T2D is accompanied by accentuated loss of muscle mass and increased risk of falls, which makes them even more dependent with reduced life expectancy (31).”
BackgroundDiabetes: An Update on the Pandemic and Potential Solutions
Ali, M. K., Siegel, K. R., Chandrasekar, E. K., Tandon, N., Montoya, P. A., Mbanya, J. C., Chan, J. C. N., Zhang, P., & Narayan, K. M. V. (2017) · World Bank, Washington, DC eBooks · doi:10.1596/978-1-4648-0518-9_ch12 · Cited by 45
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“variety of health benefits and improvements in obesity-related comorbidities such as diabetes and hypertension [4], as well as in quality of life and physical mobility [14,15].”
BackgroundWertli, M. M., Held, U., Campello, M. A., & Weiner, S. S. (2016) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-016-0992-0 · Cited by 46
“It has been shown that improved fitness slowed the decline in mobility in overweight adults with type 2 diabetes [48].”
BackgroundPharmacologic Treatment Options for Obesity: What Is Old Is New Again
Ryan, D. H., & Bray, G. A. (2013) · Current Hypertension Reports · doi:10.1007/s11906-013-0343-6 · Cited by 42
“That weight loss had benefits regarding risk factors [1, 2], sleep apnea [3], urinary incontinence [4], mobility [5] and symptoms of depression [6].”
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Hip strength: Ankle proprioceptive threshold ratio predicts falls and injury in diabetic neuropathy
Richardson, J. K., DeMott, T. K., Allet, L., Kim, H., & Ashton‐Miller, J. A. (2013) · Muscle & Nerve · doi:10.1002/mus.24134 · Cited by 41
“decreased total mortality in those already with the disease.(10,11) However, walking for exercise often leads to falls and curtailment of activity,(15) with”
Partially Ordered Mixed Hidden Markov Model for the Disablement Process of Older Adults
Ip, E. H., Zhang, Q., Rejeski, W. J., Harris, T., & Kritchevsky, S. B. (2013) · Journal of the American Statistical Association · doi:10.1080/01621459.2013.770307 · Cited by 40
“For example, the POM-HMM can be used to evaluate the effects of an exercise intervention program on transition between disability states (Rejeski et al. 2012).”
MethodSelf-citationWhy do we need drugs to treat the patient with obesity?
Bray, G. A. (2013) · Obesity · doi:10.1002/oby.20394 · Cited by 40
“Both impaired mobility (40) and sleep apnea benefit from weight loss (41).”
BackgroundSelf-citationIntentional weight loss in older adults
Darmon, P. (2013) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0b013e32835f503f · Cited by 41
Espeland, M. A., Carmichael, O. T., Hayden, K. M., Neiberg, R. H., Newman, A. B., Keller, J. N., Wadden, T. A., Rapp, S. R., Hill, J. O., Horton, E. S., et al. (2017) · The Journals of Gerontology Series A · doi:10.1093/gerona/glx165 · Cited by 38
Metabolic surgery: shifting the focus from glycaemia and weight to end-organ health
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“However, individuals with established diabetes should be treated with antidiabetic drugs [26, 27].”
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Cashin, A. G., Lee, H., Lamb, S. E., Hopewell, S., Mansell, G., Williams, C. M., Kamper, S. J., Henschke, N., & McAuley, J. H. (2019) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2019.03.005 · Cited by 36
“(2012) used mediation analysis to understand how a complex lifestyle programme (intervention) improved mobility (outcome) through its effect on weight loss (mediator) [6].”
BackgroundMethodRelationship 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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Metadata
- 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 › Public Health, Environmental and Occupational Health › 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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