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Exercise with Weight Loss Improves Mobility in Diabetes

Posted: Monday, April 09, 2012

People with diabetes are twice as likely to have mobility problems as other people their age, and losing weight and improving fitness may ward off some of the mobility problems that older overweight people with type 2 diabetes often face.
Lead author Dr. W. Jack Rejeski from Wake Forest University in Winston-Salem, North Carolina said that, "The lifestyle changes helped mobile people stay that way and eased severe mobility problems in others, at least over the short term and the trends show the importance of encouraging people to get their weight down and exercise sooner, rather than waiting until they develop problems getting around."

"There has yet to be really a large study like this that says, this really makes a difference,'" he said and added that he hopes the results find a way into typical conversations between doctors and their diabetic patients.

In the new study, the researchers calculated that a 1% drop in weight cut the risk of mobility problems by 7.3%, and a 1% increase in fitness level lowered mobility risks by 1.4%.

"If you can change people's lifestyles sufficiently, they're going to get more mobile and, over time, this will have a tremendous impact on their lives," said Dr. Vivian Fonseca, president of medicine and science for the American Diabetes Association, who wasn't involved in the research.

Dr. Rejeski and his colleagues tested a program in which obese or overweight diabetic volunteers were encouraged -- through diet plans, eat-smart strategies, meal replacements and other techniques -- to lose more than 7% of their body weight. They were also encouraged to exercise at least three hours per week, primarily by walking.

Volunteers in a control group were asked to attend group meetings -- focusing on nutrition, physical activity and support -- three times a year. Altogether the randomized trial involved more than 5,000 patients, ages 45 to 74. They reported their own mobility on health surveys given over four years and took fitness tests at different points during the study period.

Dr. Fonseca noted that those self-reports are a potential limitation of the study. After one year, the average weight loss was 6.15% in the intervention group and 0.88% in the control group (P<0.001). Fifteen percent of people in the no-intervention group had severe mobility problems at the start of the study. That rate increased to 19% after a year and continued to rise over the next three years.

In the diet and exercise group, 13% started off with severe mobility problems. After a year that fell slightly to 12% percent -- but after that, the likelihood of severe problems began to increase again.

"It's difficult to drag yourself out of that hole," said Dr. Rejeski. For example, some people may regain the weight they lost, "but they also get older, and other things catch up with them," said Dr. Fonseca, who is also an endocrinologist at the Tulane University School of Medicine in New Orleans.

In the control group, 33% of patients started out with good mobility, a fraction that didn't change much over the next few years. In the intervention group, 37% started out with good mobility. With diet and exercise, that ratio rose to 41% at the one-year mark. Although it declined after that, it never fell below the starting point.

Dr. Rejeski's team calculated that all in all, the lifestyle changes led to a 48% drop in the chance of diabetic patients losing their mobility (p<0.001).

"You don't need extreme amounts of weight loss or extreme lifestyle change to improve your outlook," said Dr. Fonseca. "It is achievable by many people who put their mind to it and who are given the right kind of tools to do that. The problem is how do we translate this to people outside the study?"

Source:, N Engl J Med 2012; 366:1209-1217March 29, 2012.

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