Lifestyle change and mobility in obese adults with type 2 diabetes.

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.).

[1]  Michael E. Miller,et al.  Physical Activity, Functional Limitations, and Disability in Older Adults , 2000, Journal of the American Geriatrics Society.

[2]  Michael M. Engelgau,et al.  Prevalence of Diabetes and Impaired Fasting Glucose in Adults in the U.S. Population , 2006, Diabetes Care.

[3]  Lain L. MacDonald,et al.  Hidden Markov and Other Models for Discrete- valued Time Series , 1997 .

[4]  R. Rubin,et al.  Correlates of Health‐Related Quality of Life in Overweight and Obese Adults with Type 2 Diabetes , 2006, Obesity.

[5]  T. Wadden,et al.  The Look AHEAD Study: A Description of the Lifestyle Intervention and the Evidence Supporting It , 2006, Obesity.

[6]  Jonathan Krakoff,et al.  Four‐Year Weight Losses in the Look AHEAD Study: Factors Associated With Long‐Term Success , 2011, Obesity.

[7]  L. Ferrucci,et al.  A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. , 1994, Journal of gerontology.

[8]  Rena R Wing,et al.  Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. , 2010, Archives of internal medicine.

[9]  M. Engelgau,et al.  The Evolving Diabetes Burden in the United States , 2004, Annals of Internal Medicine.

[10]  D. Williamson,et al.  Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence , 2010, Population health metrics.

[11]  W. Ambrosius,et al.  Translating weight loss and physical activity programs into the community to preserve mobility in older, obese adults in poor cardiovascular health. , 2011, Archives of internal medicine.

[12]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[13]  George A. Bray,et al.  Baseline characteristics of the randomised cohort from the Look AHEAD (Action for Health in Diabetes) study , 2006, Diabetes & vascular disease research.

[14]  L S Geiss,et al.  Projection of diabetes burden through 2050: impact of changing demography and disease prevalence in the U.S. , 2001, Diabetes care.

[15]  P. Thompson,et al.  ACSM's Guidelines for Exercise Testing and Prescription , 1995 .

[16]  Qiang Zhang,et al.  Multivariate Discrete Hidden Markov Models for Domain-Based Measurements and Assessment of Risk Factors in Child Development , 2010, Journal of computational and graphical statistics : a joint publication of American Statistical Association, Institute of Mathematical Statistics, Interface Foundation of North America.

[17]  S. Wild,et al.  Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. , 2004, Diabetes care.

[18]  K Bandeen-Roche,et al.  Preclinical mobility disability predicts incident mobility disability in older women. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[19]  L. Kuller,et al.  Excessive Loss of Skeletal Muscle Mass in Older Adults With Type 2 Diabetes , 2009, Diabetes Care.

[20]  D. Melzer,et al.  Obesity, Physical Function, and Mortality in Older Adults , 2008, Journal of the American Geriatrics Society.

[21]  R. Ness-Abramof.  Weight Loss, Exercise, or Both and Physical Function in Obese Older Adults , 2011 .

[22]  R. Paffenbarger,et al.  Physical activity as an index of heart attack risk in college alumni. , 1978, American journal of epidemiology.

[23]  R B Wallace,et al.  Maintaining mobility in late life. II. Smoking, alcohol consumption, physical activity, and body mass index. , 1993, American journal of epidemiology.

[24]  B. Penninx,et al.  Obese, older adults with knee osteoarthritis: weight loss, exercise, and quality of life. , 2002, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[25]  George A Mensah,et al.  An overview of cardiovascular disease burden in the United States. , 2007, Health affairs.

[26]  D. Williamson,et al.  Impact of a weight management program on health-related quality of life in overweight adults with type 2 diabetes. , 2009, Archives of internal medicine.

[27]  M. Sevick,et al.  Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. , 2004, Arthritis and rheumatism.

[28]  Michael E. Miller,et al.  Obesity influences transitional states of disability in older adults with knee pain. , 2008, Archives of physical medicine and rehabilitation.

[29]  J. Fries,et al.  Better assessment of physical function: item improvement is neglected but essential , 2009, Arthritis research & therapy.

[30]  G. Schwarz.  Estimating the Dimension of a Model , 1978 .

[31]  Suzanne G. Leveille,et al.  Diabetes and physical disability among older U.S. adults. , 2000, Diabetes care.

[32]  D. Williamson,et al.  The Association of BMI With Functional Status and Self‐rated Health in US Adults , 2008, Obesity.

[33]  Carl J Caspersen,et al.  Relationship of walking to mortality among US adults with diabetes. , 2003, Archives of internal medicine.

[34]  Karen C Johnson,et al.  Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. , 2003, Controlled clinical trials.

[35]  S. P. Pederson,et al.  Hidden Markov and Other Models for Discrete-Valued Time Series , 1998 .

[36]  W. Rejeski,et al.  Obesity, intentional weight loss and physical disability in older adults , 2010, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[37]  S. Kritchevsky,et al.  Joint Effects of Adiposity and Physical Activity on Incident Mobility Limitation in Older Adults , 2008, Journal of the American Geriatrics Society.

[38]  Mark A Pereira,et al.  Effect of a Lifestyle Intervention on Change in Cardiorespiratory Fitness in Adults with Type 2 Diabetes: Results from the Look AHEAD Study , 2008, International Journal of Obesity.

[39]  D. Mackinnon.  Introduction to Statistical Mediation Analysis , 2008 .

[40]  Edward H. Ip,et al.  Latent Markov Model for Analyzing Temporal Configuration for Violence Profiles and Trajectories in a Sample of Batterers , 2010 .

[41]  J. Ware,et al.  The SF-36 Arthritis-Specific Health Index (ASHI): I. Development and cross-validation of scoring algorithms. , 1999, Medical care.