From Our 2012 Archives
Have Diabetes? Lifestyle Changes May Help Mobility
Study Shows Modest Weight Loss and Exercise Can Cut Loss-of-Mobility Risk by About 50%
By Brenda Goodman, MA
Reviewed by Laura J. Martin, MD
The good news is that neither lifestyle change requires drastic measures.
The study, published in the New England Journal of Medicine, shows that losing just a little bit of weight and adding 25 minutes of physical activity a day can help prevent worsening of mobility-related disabilities among people with type 2 diabetes.
Experts who weren't involved in the research praised the study for showing, once again, how critical lifestyle changes can be.
"I think this is an important study which comes to state what's been said again and again: that you have to lose weight and be fit. The more fit you are, the fewer problems you're going to have," says Spyros Mezitis, MD, an endocrinologist at Lenox Hill Hospital in New York. He was not involved in the new study.
Mobility-Related Disability and Diabetes
Problems with mobility become more common with age. Studies have shown that about 30% of adults over age 50 face some kind of difficulty with everyday activities.
"When you look at people with diabetes, that basically doubles. Over 60% of people who have diabetes report some difficulty in their daily activities," says study researcher W. Jack Rejeski, PhD, a professor of health and exercise science at Wake Forest University in Winston-Salem, N.C.
Activity limitations include problems like struggling to climb stairs or push a vacuum cleaner, or having trouble bending over to pick up something off the floor.
"The loss of independence, the loss of being able to do valued activities, is what really is important to people as they age, so it's fairly catastrophic from a personal standpoint," Rejeski says.
Weight Loss and Exercise to Prevent Mobility Problems
For the study, researchers randomly assigned adults aged 45 to 74 with type 2 diabetes to a program of diet and exercise or to regular diabetes education and support classes.
The goal of the lifestyle intervention program was to help people lose at least 7% of their body weight by reducing calories and boosting physical activity by 175 minutes a week -- or 25 minutes a day -- of moderately paced exercise, like walking.
After four years, people in the diet and exercise group had lost, on average, about 6% of their body weight. For a person who weighs 250 pounds, that's about a 15-pound loss.
The scale hadn't moved much for the group that got diabetes education. They lost, on average, less than 1% of their total body weight, or just over 2 pounds for a person who weighs 250.
People in the lifestyle intervention group were also more active. They burned about 881 calories per week, compared to 99 calories a week in the education group.
The lifestyle group made modest changes, on average. But those changes were still enough, in many cases, to reap big health benefits.
People in the lifestyle group cut their risk of mobility-related disability by nearly 50% compared to people in the education group.
They were also less likely to report severe problems with their mobility. About 1 in 4 people in the education group reported severe mobility-related disability, meaning that they had difficulty with nearly all daily tasks, compared to 1 in 5 people in the lifestyle-change group.
When researchers looked more closely to see if it was weight loss or improved fitness that was responsible for the benefits, they found that both were important, though weight loss seemed to have a slightly larger impact.
For every 1% reduction in weight, researchers calculated that people cut their loss-of-mobility risk by 7.3%. For every 1% improvement in fitness, the mobility-related disability risk dropped by 1.4%.
"The message is clearly that both are important. To ignore one or the other if you're overweight or obese would be a big mistake," Rejeski says.
That's because previous studies have found that exercise helps maintain weight loss and can help prevent yo-yo dieting, where large amounts of weight are rapidly gained and lost over and over again. Yo-yo dieting can slow metabolism, ultimately leading to weight gain over the longer term, Rejeski says.
SOURCES: Rejeski, W.J. The New England Journal of Medicine, March 28, 2012. W. Jack Rejeski, PhD, professor, health and exercise science; director, behavioral physiology laboratory; Wake Forest University, Winston-Salem, N.C. Spyros Mezitis, MD, endocrinologist, Lenox Hill Hospital, New York, N.Y.
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