Houston Denise K, Leng Xiaoyan, Bray George A, Hergenroeder Andrea L, Hill James O, Jakicic John M, Johnson Karen C, Neiberg Rebecca H, Marsh Anthony P, Rejeski W Jack, Kritchevsky Stephen B
Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Obesity (Silver Spring). 2015 Jan;23(1):77-84. doi: 10.1002/oby.20944. Epub 2014 Nov 29.
To assess the long-term effects of an intensive lifestyle intervention on physical function using a randomized post-test design in the Look AHEAD trial.
Overweight and obese (BMI ≥ 25 kg m(-2)) middle-aged and older adults (aged 45-76 years at enrollment) with type 2 diabetes (n = 964) at four clinics in Look AHEAD, a trial evaluating an intensive lifestyle intervention (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 an expanded short physical performance battery (SPPBexp ), 20-m and 400-m walk, and grip and knee extensor strength 8 years post-randomization, during the trial's weight maintenance phase.
Eight years post-randomization, individuals randomized to ILI had better SPPBexp scores [adjusted mean (SE) difference: 0.055 (0.022), P = 0.01] and faster 20-m and 400-m walk speeds [0.032 (0.012) m s(-1) , P = 0.01, and 0.025 (0.011) m s(-1) , P = 0.02, respectively] compared to those randomized to DSE. Achieved weight loss greatly attenuated the group differences in physical function, and the intervention effect was no longer significant.
An intensive lifestyle intervention has long-term benefits for mobility function in overweight and obese middle-aged and older individuals with type 2 diabetes.
在“展望未来”（Look AHEAD）试验中，采用随机后测设计评估强化生活方式干预对身体功能的长期影响。
“展望未来”试验在四个诊所开展，该试验评估了一种强化生活方式干预（ILI），即通过热量限制和增加身体活动来实现体重减轻，与糖尿病支持与教育（DSE）相比。该试验纳入了超重和肥胖（体重指数≥25 kg/m²）的中年及老年2型糖尿病患者（入组时年龄为45 - 76岁，n = 964）。在随机分组8年后，即试验的体重维持阶段，对基于表现的身体功能进行标准化评估，包括扩展简短身体表现量表（SPPBexp）、20米和400米步行测试以及握力和膝伸肌力量测试。
随机分组8年后，与随机分配至DSE组的个体相比，随机分配至ILI组的个体具有更好的SPPBexp评分[调整后均值（标准误）差异：0.055（0.022），P = 0.01]以及更快的20米和400米步行速度[分别为0.032（0.012）m/s，P = 0.01，和0.025（0.011）m/s，P = 0.02]。实现的体重减轻极大地减弱了身体功能方面的组间差异，干预效果不再显著。
强化生活方式干预对超重和肥胖的中年及老年2型糖尿病患者的运动功能具有长期益处。
