Physical Function Following a Long-Term Lifestyle Intervention Among Middle Aged and Older Adults With Type 2 Diabetes: The Look AHEAD Study

Denise K. Houston, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Rebecca H. Neiberg, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Michael E. Miller, Wake Forest School of Medicine, Winston-Salem, North Carolina.
James O. Hill, University of Colorado Denver School of Medicine, Aurora.
John M. Jakicic, University of Pittsburgh, Pennsylvania.Follow
Karen C. Johnson, University of Tennessee Health Science Center, Memphis.
Edward W. Gregg, Centers for Disease Control, Atlanta, Georgia.
Van S. Hubbard, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
Xavier Pi-Sunyer, Columbia University Medical Center, New York, New York.
W Jack Rejeski, Wake Forest University, Winston-Salem, North Carolina.
Rena R. Wing, Brown University and Miriam Hospital, Providence, Rhode Island.
John P. Bantle, University of Minnesota, Minneapolis.
Elizabeth Beale, Keck School of Medicine of University of Southern California, Los Angeles.
Robert I. Berkowitz, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Maria Cassidy-Begay, Southwestern American Indian Center, Phoenix, Arizona.
Jeanne M. Clark, Johns Hopkins School of Medicine, Baltimore, Maryland.
Mace Coday, University of Tennessee Health Science Center, Memphis.
Linda M. Delahanty, Massachusetts General Hospital, Boston.
Gareth Dutton, University of Alabama at Birmingham School of Medicine.
Caitlin Egan, Weight Control and Diabetes Research Center, Providence, Rhode Island.
John P. Foreyt, Baylor College of Medicine, Houston, Texas.Follow
Frank L. Greenway, Pennington Biomedical Research Center, Baton Rouge, Louisiana.
Helen P. Hazuda, University of Texas Health Science Center at San Antonio.
Andrea Hergenroeder, University of Pittsburgh, Pennsylvania.
Edward S. Horton, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts.
Robert W. Jeffery, University of Minnesota, Minneapolis.Follow
Steven E. Kahn, University of Washington, Seattle.Follow
Anne Kure, University of Washington, Seattle.
William C. Knowler, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona.
Cora E. Lewis, University of Alabama at Birmingham School of Medicine.
Corby K. Martin, Pennington Biomedical Research Center, Baton Rouge, Louisiana.
Sara Michaels, Indian Health Service, Shiprock, New Mexico.
Maria G. Montez, University of Texas Health Science Center at San Antonio.

Abstract

Background: Lifestyle interventions have been shown to improve physical function over the short term; however, whether these benefits are sustainable is unknown. The long-term effects of an intensive lifestyle intervention (ILI) on physical function were assessed using a randomized post-test design in the Look AHEAD trial. Methods: Overweight and obese (body mass index ≥ 25 kg/m2) middle-aged and older adults (aged 45-76 years at enrollment) with type 2 diabetes enrolled in Look AHEAD, a trial evaluating an ILI designed to achieve weight loss through caloric restriction and increased physical activity compared to diabetes support and education (DSE), underwent standardized assessments of performance-based physical function including a 4- and 400-m walk, lower extremity physical performance (expanded Short Physical Performance Battery, SPPBexp), and grip strength approximately 11 years postrandomization and 1.5 years after the intervention was stopped (n = 3,783). Results: Individuals randomized to ILI had lower odds of slow gait speed (<0.8 m/s) compared to those randomized to DSE (adjusted OR [95% CI]: 0.84 [0.71 to 0.99]). Individuals randomized to ILI also had faster gait speed over 4- and 400-m (adjusted mean difference [95% CI]: 0.019 [0.007 to 0.031] m/s, p = .002, and 0.023 [0.012 to 0.034] m/sec, p < .0001, respectively) and higher SPPBexp scores (0.037 [0.011 to 0.063], p = .005) compared to those randomized to DSE. The intervention effect was slightly larger for SPPBexp scores among older versus younger participants (0.081 [0.038 to 0.124] vs 0.013 [-0.021 to 0.047], p = .01). Conclusions: An intensive lifestyle intervention has modest but significant long-term benefits on physical function in overweight and obese middle-aged and older adults with type 2 diabetes. ClinicalTrials.gov Identifier: NCT00017953.

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The journals of gerontology. Series A, Biological sciences and medical sciences

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