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, Rebecca H. Neiberg, Michael E. Miller, James O. Hill, John M. Jakicic, Karen C. Johnson, Edward W. Gregg, Van S. Hubbard, Xavier Pi-Sunyer, W. Jack Rejeski, Rena R. Wing, John P. Bantle, Elizabeth Beale, Robert I. Berkowitz, Maria Cassidy-Begay, Jeanne M. Clark, Mace Coday, Linda M. Delahanty, Gareth Dutton, Caitlin EganJohn P. Foreyt, Frank L. Greenway, Helen P. Hazuda, Andrea Hergenroeder, Edward S. Horton, Robert W. Jeffery, Steven E. Kahn, Anne Kure, William C. Knowler, Cora E. Lewis, Corby K. Martin, Sara Michaels, Maria G. Montez, David M. Nathan, Jennifer Patricio, Anne Peters, Henry Pownall, Judith Regensteiner, Helmut Steinburg, Thomas A. Wadden, Karen White, Susan Z. Yanovski, Ping Zhang, Stephen B. Kritchevsky

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


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/m 2) 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, SPPB exp), 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 SPPB exp scores (0.037 [0.011 to 0.063], p =.005) compared to those randomized to DSE. The intervention effect was slightly larger for SPPB exp 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. Identifier NCT00017953.

Original languageEnglish (US)
Pages (from-to)1552-1559
Number of pages8
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Issue number11
StatePublished - Oct 8 2018

Bibliographical note

Funding Information:
This work was supported by the National Institutes of Health through cooperative agreements with the National Institute of Diabetes and Digestive and Kidney Diseases: DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, and DK56992. Additional funding was provided by the National Heart, Lung, and Blood Institute; National Institute of Nursing Research; National Institute on Aging; National Center on Minority Health and Health Disparities; NIH Office of Research on Women’s Health; and the Centers for Disease Control and Prevention. This research was supported in part by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases. The Indian Health Service (I.H.S.) provided personnel, medical oversight, and use of facilities. The opinions expressed in this article are those of the authors and do not necessarily reflect the views of the I.H.S. or other funding sources. Additional support was received from The Johns Hopkins Medical Institutions Bayview General Clinical Research Center (M01RR02719); the Massachusetts General Hospital Mallinckrodt General Clinical Research Center and the Massachusetts Institute of Technology General Clinical Research Center (M01RR01066); the Harvard Clinical and Translational Science Center (RR025758-04); the University of Colorado Health Sciences Center General Clinical Research Center (M01RR00051) and Clinical Nutrition Research Unit (P30 DK48520); the University of Tennessee at Memphis General Clinical Research Center (M01RR0021140); the University of Pittsburgh General Clinical Research Center (GCRC) (M01RR000056), the Clinical Translational Research Center (CTRC) funded by the Clinical & Translational Science Award (UL1 RR 024153) and NIH grant (DK 046204); the VA Puget Sound Health Care System Medical Research Service, Department of Veterans Affairs; and the Frederic C. Bartter General Clinical Research Center (M01RR01346). The following organizations have committed to make major contributions to Look AHEAD: FedEx Corporation; Health Management Resources; LifeScan, Inc., a Johnson & Johnson Company; OPTIFAST® of Nestle HealthCare Nutrition, Inc.; Hoffmann-La Roche, Inc.; Abbott Nutrition; and Slim-Fast Brand of Unilever North America.

Publisher Copyright:
© The Author(s) 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.


  • Diabetes
  • Mobility
  • Physical function
  • Weight loss


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