Role Medical

Losing weight and exercising may help people with type 2 diabetes hold on to their mobility as they age, a new study shows.

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.

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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.

Losing weight and improving fitness may ward off some of the mobility problems that older overweight people with type 2 diabetes often face, according to a new study.

The lifestyle changes helped mobile people stay that way and eased severe mobility problems in others, at least over the short term.

Lead author W. Jack Rejeski from Wake Forest University in Winston-Salem, North Carolina, said 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.

In the new study, published in the New England Journal of Medicine, the researchers calculated that a one-percent drop in weight cut the risk of mobility problems by more than seven percent, and the same increase in fitness level lowered mobility risks by between one and two percent.

"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.

"There has yet to be really a large study like this that says, `This really does make a difference,`" Rejeski said, adding that he hopes the results find a way into typical conversations between doctors and their diabetic patients.


The ADA estimates that nearly 26 million Americans have diabetes -- most of them with type 2, the form of the disease often associated with being overweight -- and 79 million more are at risk for developing the condition. Those numbers are expected to increase dramatically as the US population ages.

Diabetics are twice as likely to have mobility problems as other people their age.

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

Volunteers in a comparison group were asked to attend group meetings -- focusing on nutrition, physical activity and support -- three times a year.

The study involved more than 5,000 volunteers age 45 to 74, all overweight or obese. They reported their own mobility on health surveys given over four years and took fitness tests at different points during the study period.

After a year, participants in the intervention group had lost an average of six percent of their body weight, compared to less than one percent in the "control" group.

Fifteen percent of people in the no-intervention group had severe mobility problems at the start of the study. That rate increased to nineteen percent after a year, and continued to rise over the next three years.

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

"It`s difficult to drag yourself out of that hole," said Rejeski.

For example, some people may regain the weight they lost, "but they also get older, and other things catch up with them," Fonseca, who is also an endocrinologist at the Tulane University School of Medicine in New Orleans, said.

The researchers found that 33 percent of the control group started out with good mobility, a fraction that didn`t change much over the next few years.

On the other hand, 37 percent of volunteers in the intervention group started out with good mobility. With diet and exercise, that ratio rose to 41 percent at the one-year mark and, although it declined after that, never fell below the starting point.

Rejeski`s team calculated that all in all, the lifestyle changes led to a 48-percent drop in the chance of diabetic patients losing their mobility.

"You don`t need extreme amounts of weight loss or extreme lifestyle change to improve your outlook," said 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?"