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04-04-2012 | Physical rehabilitation | Article

Lifestyle intervention reduces mobility loss in diabetes

Abstract

Free abstract

MedWire News: Intensive lifestyle intervention leads to a significant reduction in the severity of mobility-related disability compared with diabetes support and education, show findings from a US study.

This effect was mediated by both weight loss and improvement in fitness, report Jack Rejeski (Wake Forest University, Winston-Salem, North Carolina) and colleagues.

"An insidious consequence of aging in persons with Type 2 diabetes is physical disability, particularly the loss of mobility," say the researchers. "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 team assigned 5016 overweight and obese adults with diabetes to participate in either an intensive lifestyle intervention (n=2514) or a diabetes support and education program (n=2502) as part of the Look AHEAD (Action for Health in Diabetes) study.

The two primary goals of the intervention program were to induce a mean weight loss from baseline of more than 7% and to increase the duration of physical activity to more than 175 minutes a week to improve fitness. The diabetes support-and-education program comprised three group sessions per year focusing on nutrition, physical activity, and support.

The primary study outcome was limitation in mobility, with assessment at annual visits over a 4-year period. Weight was assessed at each visit, and peak metabolic equivalent (MET) capacity was estimated from performance on a graded exercise treadmill test. Mobility was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) Physical Functioning subscale.

As reported in TheNew England Journal of Medicine, a significantly higher proportion of participants in the lifestyle intervention group than in the support group had good mobility during all 4 years.

At year 4, compared with participants in the support group, those in the intervention group had a significantly higher prevalence of good mobility, at 35.8% versus 31.9%. The intervention group also achieved a significant 48% reduction in risk for mobility-related disability compared with the support group.

Loss of weight and improved fitness were highly significant mediators for the intervention's effect on slowing loss of mobility, with every relative reduction of 1% in weight, and relative improvement of 1% in fitness reducing the risk for loss of mobility by 7.3% and 1.4%, respectively, reports the team.

"These are the first data from Look AHEAD to show that the intensive lifestyle intervention also reduced the risk of loss of mobility," say the researchers.

"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," they remark.

By Sally Robertson

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