title: Lifestyle change and mobility in obese adults with type 2 diabetes.
abstract: 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.).
authors.affiliation: Reynolda Campus, Wake Forest University, Winston-Salem, NC 27109, USA. rejeski@wfu.edu
authors.forename: W Jack
authors.initials: WJ
authors.lastname: Rejeski
authors.forename: Edward H
authors.initials: EH
authors.lastname: Ip
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
authors.forename: George A
authors.initials: GA
authors.lastname: Bray
authors.forename: Gina
authors.initials: G
authors.lastname: Evans
authors.forename: Edward W
authors.initials: EW
authors.lastname: Gregg
authors.forename: Qiang
authors.initials: Q
authors.lastname: Zhang
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009043:Motor Activity; D009765:Obesity / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D050177:Overweight / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D010353:Patient Education as Topic; D010809:Physical Fitness; D012306:Risk; D015431:Weight Loss