Lifestyle Change and Mobility in Obese Adults with Type 2 Diabetes

The aim  of the Look AHEAD (Action for Health in Diabetes) study was to asses the effect of an intensive lifestyle intervention on the body weight, fitness and mobility of overweight patients with type 2 diabetes (T2DM).

According to the Centers for Disease Control and Prevention more people may suffer from T2DM as they grow older. In the elderly, loss of mobility and physical disability are often unfortunate consequences of T2DM. Mobility is an important factor for the quality of life. Loss of mobility in the elderly, can lead to loss of independence, requiring institutionalization. Immobility is a risk factor for the onset and progression of most chronic diseases, including cardiovascular disease.

The study enrolled more than 5000 overweight or obese adults between the ages of 45 and 74 with T2DM. Participants were assigned to participate for 4 years in one of the following programs:

1. An intensive lifestyle intervention aimed at reaching an average of more than 7% weight loss and increasing the duration of physical activity to more than 175 minutes a week.
2. Diabetes support and education involved three group sessions a year focusing on nutrition, physical activity, and support.

The goal of both programs was to lower and maintain body weight and to improve fitness in order to slow the loss of mobility in aging patients with T2DM.

Weight was assessed at each annual visit and improved fitness was assessed according to the participants’ performance on a graded exercise treadmill test.

The participants’ mobility was assessed according to a self-report of the degree of limitation they experienced performing various activities. These included vigorous activities such as running and lifting heavy objects or more moderate activities such as pushing a vacuum cleaner, climbing one flight of stairs; bending, kneeling or walking more than one mile.

Mobility was then graded according to 4 states of disability which progressed from the healthiest state 1 – good mobility to the most severe state 4, with limitations and difficulty in performing nearly all tasks.

Results show that the average weight loss during this 4 year study was far greater in the lifestyle intervention group (6.15%) than in the diabetes support group (0.88%).

A larger proportion of participants in the lifestyle-intervention group were more mobile, and retained higher levels of healthy functioning during all 4 years, compared to the diabetes support group.

Throughout the 4 years of study, a greater rise in those rating themselves at the severest limited mobility state 4 (from 19% to 26%) was noted in the diabetes support group, compared to 12.3% to 20.6% in the lifestyle-intervention group.

In summary, the lifestyle intervention program has led to significant weight losses, improved fitness and state of mobility in patients with T2DM.