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Physical function following a long-term lifestyle intervention among middle aged and older adults with type 2 diabetes: the Look AHEAD study
Houston DK, Neiberg RH, Miller ME, Hill JO, Jakicic JM, Johnson KC, Gregg EW, Hubbard VS, Pi-Sunyer X, Rejeski WJ, Wing RR, Bantle JP, Beale E, Berkowitz RI, Cassidy-Begay M, Clark JM, Coday M, Delahanty LM, Dutton G, Egan C, Foreyt JP, Greenway FL, Hazuda HP, Hergenroeder A, Horton ES, Jeffery RW, Kahn SE, Kure A, Knowler WC, Lewis CE, Martin CK, Michaels S, Montez MG, Nathan DM, Patricio J, Peters A, Pownall H, Regensteiner J, Steinburg H, Wadden TA, White K, Yanovski SZ, Zhang P, Kritchevsky SB
The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2018 Nov;73(11):1552-1559
clinical trial
5/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

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 to 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 = 0.002, and 0.023 (0.012 to 0.034) m/sec, p < 0.0001, respectively) and higher SPPBexp scores (0.037 (0.011 to 0.063), p = 0.005) 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) versus 0.013 (-0.021 to 0.047), p = 0.01). 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.
Copyright the Gerontological Society of America. Reproduced by permission of the publisher.

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