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Effect of a lifestyle intervention on change in cardiorespiratory fitness in adults with type 2 diabetes: results from the Look AHEAD Study

International Journal of Obesity volume 33, pages 305–316 (2009)Cite this article

Abstract

Objective:

To examine the effect of an intensive lifestyle weight loss intervention (ILI) compared to diabetes support and education (DSE) on changes in fitness and physical activity in the Look AHEAD trial.

Design:

Randomized clinical trial to compare a lifestyle intervention for weight loss with a DSE condition in individuals with type 2 diabetes.

Subjects:

Data from 4376 overweight or obese adults with type 2 diabetes (age=58.7±6.8 years, body mass index (BMI)=35.8±5.8 kg/m2) who completed 1 year of the Look AHEAD trial and had available fitness data were analyzed.

Intervention:

Subjects were randomly assigned to DSE or ILI. DSE received standard care plus three education sessions over the 1-year period. ILI included individual and group contact throughout the year, restriction in energy intake and 175 min per week of prescribed physical activity.

Measurements:

Fitness was assessed using a submaximal graded exercise test. Physical activity was assessed by questionnaire in a subset of 2221 subjects.

Results:

Change in fitness was statistically greater in ILI vs DSE after adjustment for baseline fitness (20.9 vs 5.7%; P<0.0001). Multivariate analysis showed that change in fitness was greater in overweight vs obese Class II and III (P<0.05). Physical activity increased by 892±1694 kcal per week in ILI vs 108±1254 kcal per week in DSE (P<0.01). Changes in fitness (r=0.41) and physical activity (r=0.42) were significantly correlated with weight loss (P<0.0001).

Conclusions:

The ILI was effective in increasing physical activity and improving cardiorespiratory fitness in overweight and obese individuals with type 2 diabetes. This effect may add to weight loss in improving metabolic control in patients in lifestyle intervention programs.

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Acknowledgements

This study was supported by the Department of Health and Human Services through the following cooperative agreements from the National Institutes of Health: DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135 and DK56992. The following federal agencies have contributed support: National Institute of Diabetes and Digestive and Kidney Diseases; National Heart, Lung, and Blood Institute; National Institute of Nursing Research; National Center on Minority Health and Health Disparities; 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.

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 (M01RR01066); 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 (M01RR000056 44) and NIH grant (DK 046204); and the University of Washington/VA Puget Sound Health Care System Medical Research Service, Department of Veterans Affairs; 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 and Johnson Company; Optifast of Nestle Healthcare Nutrition Inc.; Hoffmann-La Roche Inc.; Abbott Nutrition and Slim-Fast Brand of Unilever North America.

Author information

Authors and Affiliations

  1. Department of Health and Physical Activity, Physical Activity and Weight Management Research Center, University of Pittsburgh, Pittsburgh, PA, USA

    J M Jakicic, S A Jaramillo, A Balasubramanyam, B Bancroft, J M Curtis, A Mathews, M Pereira, J G Regensteiner & P M Ribisl

Authors
  1. J M Jakicic
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  2. S A Jaramillo
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  3. A Balasubramanyam
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  4. B Bancroft
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  5. J M Curtis
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  6. A Mathews
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  7. M Pereira
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  8. J G Regensteiner
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  9. P M Ribisl
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Consortia

Look AHEAD Study Group

Corresponding author

Correspondence to J M Jakicic.

Appendix

Appendix

Clinical sites

The Johns Hopkins Medical Institutions

Frederick L Brancati, MD, MHS (principal investigator); Jeff Honas, MS (program coordinator); Lawrence Cheskin, MD (co-investigator); Jeanne M Clark, MD, MPH (co-investigator); Kerry Stewart, EdD (co-investigator); Richard Rubin, PhD (co-investigator); Jeanne Charleston, RN; Kathy Horak, RD.

Pennington Biomedical Research Center: George A Bray, MD (principal investigator); Kristi Rau (program coordinator); Allison Strate, RN (program coordinator); Brandi Armand, LPN (program coordinator); Frank L Greenway, MD (co-investigator); Donna H Ryan, MD (co-investigator); Donald Williamson, PhD (co-investigator); Amy Bachand; Michelle Begnaud; Betsy Berhard; Elizabeth Caderette; Barbara Cerniauskas; David Creel; Diane Crow; Helen Guay; Nancy Kora; Kelly LaFleur; Kim Landry; Missy Lingle; Jennifer Perault; Mandy Shipp, RD; Marisa Smith; Elizabeth Tucker.

The University of Alabama at Birmingham: Cora E Lewis, MD, MSPH (principal investigator); Sheikilya Thomas, MPH (program coordinator); Monika Safford, MD (co-investigator); Vicki DiLillo, PhD; Charlotte Bragg, MS, RD, LD; Amy Dobelstein; Stacey Gilbert, MPH; Stephen Glasser, MD; Sara Hannum, MA; Anne Hubbell, MS; Jennifer Jones, MA; DeLavallade Lee; Ruth Luketic, MA, MBA, MPH; Karen Marshall; L Christie Oden; Janet Raines, MS; Cathy Roche, RN, BSN; Janet Truman; Nita Webb, MA; Audrey Wrenn, MAEd.

Harvard Center

Massachusetts General Hospital: David M Nathan, MD (principal investigator); Heather Turgeon, RN, BS, CDE (program coordinator); Kristina Schumann, BA (program coordinator); Enrico Cagliero, MD (co-investigator); Linda Delahanty, MS, RD (co-investigator); Kathryn Hayward, MD (co-investigator); Ellen Anderson, MS, RD (co-investigator); Laurie Bissett, MS, RD; Richard Ginsburg, PhD; Valerie Goldman, MS, RD; Virginia Harlan, MSW; Charles McKitrick, RN, BSN, CDE; Alan McNamara, BS; Theresa Michel, DPT, DSc CCS; Alexi Poulos, BA; Barbara Steiner, EdM; Joclyn Tosch, BA.

Joslin Diabetes Center: Edward S Horton, MD (principal investigator); Sharon D Jackson, MS, RD, CDE (program coordinator); Osama Hamdy, MD, PhD (co-investigator); A Enrique Caballero, MD (co-investigator); Sarah Bain, BS; Elizabeth Bovaird, BSN, RN; Ann Goebel-Fabbri, PhD; Lori Lambert, MS, RD; Sarah Ledbury, MEd, RD; Maureen Malloy, BS; Kerry Ovalle, MS, RCEP, CDE.

Beth Israel Deaconess Medical Center: George Blackburn, MD, PhD (principal investigator); Christos Mantzoros, MD, DSc (co-investigator); Kristinia Day, RD; Ann McNamara, RN.

University of Colorado Health Sciences Center: James O Hill, PhD (principal investigator); Marsha Miller, MS, RD (program coordinator); JoAnn Phillipp, MS (program coordinator); Robert Schwartz, MD (co-investigator); Brent Van Dorsten, PhD (co-investigator); Judith Regensteiner, PhD (co-investigator); Salma Benchekroun, MS; Ligia Coelho, BS; Paulette Cohrs, RN, BSN; Elizabeth Daeninck, MS, RD; Amy Fields, MPH; Susan Green; April Hamilton, BS, CCRC; Jere Hamilton, BA; Eugene Leshchinskiy; Michael McDermott, MD; Lindsey Munkwitz, BS; Loretta Rome, TRS; Kristin Wallace, MPH; Terra Worley, BA.

Baylor College of Medicine: John P Foreyt, PhD (principal investigator); Rebecca S Reeves, DrPH, RD (program coordinator); Henry Pownall, PhD (co-investigator); Ashok Balasubramanyam, MBBS (co-investigator); Peter Jones, MD (co-investigator); Michele Burrington, RD; Chu-Huang Chen, MD, PhD; Allyson Clark, RD; Molly Gee, MEd, RD; Sharon Griggs; Michelle Hamilton; Veronica Holley; Jayne Joseph, RD; Patricia Pace, RD; Julieta Palencia, RN; Olga Satterwhite, RD; Jennifer Schmidt; Devin Volding, LMSW; Carolyn White.

University of California at Los Angeles School of Medicine: Mohammed F Saad, MD (principal investigator); Siran Ghazarian Sengardi, MD (program coordinator); Ken C Chiu, MD (co-investigator); Medhat Botrous; Michelle Chan, BS; Kati Konersman, MA, RD, CDE; Magpuri Perpetua, RD.

The University of Tennessee Health Science Center

University of Tennessee East: Karen C Johnson, MD, MPH (principal investigator); Carolyn Gresham, RN (program coordinator); Stephanie Connelly, MD, MPH (co-investigator); Amy Brewer, RD, MS; Mace Coday, PhD; Lisa Jones, RN; Lynne Lichtermann, RN, BSN; Shirley Vosburg, RD, MPH; J Lee Taylor, MEd, MBA.

University of Tennessee Downtown: Abbas E Kitabchi, PhD, MD (principal investigator); Helen Lambeth, RN, BSN (program coordinator); Debra Clark, LPN; Andrea Crisler, MT; Gracie Cunningham; Donna Green, RN; Debra Force, MS, RD, LDN; Robert Kores, PhD; Renate Rosenthal, PhD; Elizabeth Smith, MS, RD, LDN; Maria Sun, MS, RD, LDN; Judith Soberman, MD (co-investigator).

University of Minnesota: Robert W Jeffery, PhD (principal investigator); Carolyn Thorson, CCRP (program coordinator); John P Bantle, MD (co-investigator); J Bruce Redmon, MD (co-investigator); Richard S Crow, MD (co-investigator); Scott Crow, MD (co-investigator); Susan K Raatz, PhD, RD (co-investigator); Kerrin Brelje, MPH, RD; Carolyne Campbell; Jeanne Carls, MEd; Tara Carmean-Mihm, BA; Emily Finch, MA; Anna Fox, MA; Elizabeth Hoelscher, MPH, RD, CHES; La Donna James; Vicki A Maddy, BS, RD; Therese Ockenden, RN; Birgitta I Rice, MS, RPh, CHES; Tricia Skarphol, BS; Ann D Tucker, BA; Mary Susan Voeller, BA; Cara Walcheck, BS, RD.

St Luke's Roosevelt Hospital Center: Xavier Pi-Sunyer, MD (principal investigator); Jennifer Patricio, MS (program coordinator); Stanley Heshka, PhD (co-investigator); Carmen Pal, MD (co-investigator); Lynn Allen, MD; Diane Hirsch, RNC, MS, CDE; Mary Anne Holowaty, MS, CN.

University of Pennsylvania: Thomas A Wadden, PhD (principal investigator); Barbara J Maschak-Carey, MSN, CDE (program coordinator); Stanley Schwartz, MD (co-investigator); Gary D Foster, PhD (co-investigator); Robert I Berkowitz, MD (co-investigator); Henry Glick, PhD (co-investigator); Shiriki K Kumanyika, PhD, RD, MPH (co-investigator); Johanna Brock; Helen Chomentowski; Vicki Clark; Canice Crerand, PhD; Renee Davenport; Andrea Diamond, MS, RD; Anthony Fabricatore, PhD; Louise Hesson, MSN; Stephanie Krauthamer-Ewing, MPH; Robert Kuehnel, PhD; Patricia Lipschutz, MSN; Monica Mullen, MS, RD; Leslie Womble, PhD, MS; Nayyar Iqbal, MD.

University of Pittsburgh: David E Kelley, MD (principal investigator); Jacqueline Wesche-Thobaben, RN, BSN, CDE (program coordinator); Lewis Kuller, MD, DrPH (co-investigator); Andrea Kriska, PhD (co-investigator); Janet Bonk, RN, MPH; Rebecca Danchenko, BS; Daniel Edmundowicz, MD (co-investigator); Mary L Klem, PhD, MLIS (co-investigator); Monica E Yamamoto, DrPH, RD, FADA (co-investigator); Barb Elnyczky, MA; George A Grove, MS; Pat Harper, MS, RD, LDN; Janet Krulia, RN, BSN, CDE; Juliet Mancino, MS, RD, CDE, LDN; Anne Mathews, MS, RD, LDN; Tracey Y Murray, BS; Joan R Ritchea; Jennifer Rush, MPH; Karen Vujevich, RN-BC, MSN, CRNP; Donna Wolf, MS.

The Miriam Hospital/Brown Medical School: Rena R Wing, PhD (principal investigator); Renee Bright, MS (program coordinator); Vincent Pera, MD (co-investigator); John Jakicic, PhD (co-investigator); Deborah Tate, PhD (co-investigator); Amy Gorin, PhD (co-investigator); Kara Gallagher, PhD (co-investigator); Amy Bach, PhD; Barbara Bancroft, RN, MS; Anna Bertorelli, MBA, RD; Richard Carey, BS; Tatum Charron, BS; Heather Chenot, MS; Kimberley Chula-Maguire, MS; Pamela Coward, MS, RD; Lisa Cronkite, BS; Julie Currin, MD; Maureen Daly, RN; Caitlin Egan, MS; Erica Ferguson, BS, RD; Linda Foss, MPH; Jennifer Gauvin, BS; Don Kieffer, PhD; Lauren Lessard, BS; Deborah Maier, MS; JP Massaro, BS; Tammy Monk, MS; Rob Nicholson, PhD; Erin Patterson, BS; Suzanne Phelan, PhD; Hollie Raynor, PhD, RD; Douglas Raynor, PhD; Natalie Robinson, MS, RD; Deborah Robles; Jane Tavares, BS.

The University of Texas Health Science Center at San Antonio: Steven M Haffner, MD (principal investigator); Maria G Montez, RN, MSHP, CDE (program coordinator); Carlos Lorenzo, MD (co-investigator).

University of Washington/VA Puget Sound Health Care System: Steven Kahn MB, ChB (principal investigator); Brenda Montgomery, RN, MS, CDE (program coordinator); Robert Knopp, MD (co-investigator); Edward Lipkin, MD (co-investigator); Matthew L Maciejewski, PhD (co-investigator); Dace Trence, MD (co-investigator); Terry Barrett, BS; Joli Bartell, BA; Diane Greenberg, PhD; Anne Murillo, BS; Betty Ann Richmond, MEd; April Thomas, MPH, RD.

Southwestern American Indian Center, Phoenix, Arizona and Shiprock, New Mexico: William C Knowler, MD, DrPH (principal investigator); Paula Bolin, RN, MC (program coordinator); Tina Killean, BS (program coordinator); Cathy Manus, LPN (co-investigator); Jonathan Krakoff, MD (co-investigator); Jeffrey M Curtis, MD, MPH (co-investigator); Justin Glass, MD (co-investigator); Sara Michaels, MD (co-investigator); Peter H Bennett, MB, FRCP (co-investigator); Tina Morgan (co-investigator); Shandiin Begay, MPH; Bernadita Fallis RN, RHIT, CCS; Jeanette Hermes, MS, RD; Diane F Hollowbreast; Ruby Johnson; Maria Meacham, BSN, RN, CDE; Julie Nelson, RD; Carol Percy, RN; Patricia Poorthunder; Sandra Sangster; Nancy Scurlock, MSN, ANP-C, CDE; Leigh A Shovestull, RD, CDE; Janelia Smiley; Katie Toledo, MS, LPC; Christina Tomchee, BA; Darryl Tonemah, PhD.

University of Southern California: Anne Peters, MD (principal investigator); Valerie Ruelas, MSW, LCSW (program coordinator); Siran Ghazarian Sengardi, MD (program coordinator); Kathryn Graves, MPH, RD, CDE; Kati Konersman, MA, RD, CDE; Sara Serafin-Dokhan.

Coordinating Center

Wake Forest University: Mark A Espeland, PhD (principal investigator); Judy L Bahnson, BA (program coordinator); Lynne Wagenknecht, DrPH (co-investigator); David Reboussin, PhD (co-investigator); W Jack Rejeski, PhD (co-investigator); Alain Bertoni, MD, MPH (co-investigator); Wei Lang, PhD (co-investigator); Gary Miller, PhD (co-investigator); David Lefkowitz, MD (co-investigator); Patrick S Reynolds, MD (co-investigator); Paul Ribisl, PhD (co-investigator); Mara Vitolins, DrPH (co-investigator); Michael Booth, MBA (program coordinator); Kathy M Dotson, BA (program coordinator); Amelia Hodges, BS (program coordinator); Carrie C Williams, BS (program coordinator); Jerry M Barnes, MA; Patricia A Feeney, MS; Jason Griffin, BS; Lea Harvin, BS; William Herman, MD, MPH; Patricia Hogan, MS; Sarah Jaramillo, MS; Mark King, BS; Kathy Lane, BS; Rebecca Neiberg, MS; Andrea Ruggiero, MS; Christian Speas, BS; Michael P Walkup, MS; Karen Wall, AAS; Michelle Ward; Delia S West, PhD; Terri Windham.

Central Resources Centers

DXA Reading Center, University of California at San Francisco: Michael Nevitt, PhD (principal investigator); Susan Ewing, MS; Cynthia Hayashi; Jason Maeda, MPH; Lisa Palermo, MS, MA; Michaela Rahorst; Ann Schwartz, PhD; John Shepherd, PhD.

Central Laboratory, Northwest Lipid Research Laboratories: Santica M Marcovina, PhD, ScD (principal investigator); Greg Strylewicz, MS.

ECG Reading Center, EPICARE, Wake Forest University School of Medicine: Ronald J Prineas, MD, PhD (principal investigator); Teresa Alexander; Lisa Billings; Charles Campbell, AAS, BS; Sharon Hall; Susan Hensley; Yabing Li, MD; Zhu-Ming Zhang, MD.

Diet Assessment Center, University of South Carolina, Arnold School of Public Health, Center for Research in Nutrition and Health Disparities: Elizabeth J Mayer-Davis, PhD (principal investigator); Robert Moran, PhD.

Hall-Foushee Communications Inc.: Richard Foushee, PhD; Nancy J Hall, MA.

Federal sponsors

National Institute of Diabetes and Digestive and Kidney Diseases: Barbara Harrison, MS; Van S Hubbard, MD, PhD; Susan Z Yanovski, MD.

National Heart, Lung, and Blood Institute: Lawton S Cooper, MD, MPH; Jeffrey Cutler, MD, MPH; Eva Obarzanek, PhD, MPH, RD.

Centers for Disease Control and Prevention: Edward W Gregg, PhD; David F Williamson, PhD; Ping Zhang, PhD.

All other Look AHEAD staffs are listed alphabetically by site.

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Jakicic, J., Jaramillo, S., Balasubramanyam, A. et al. Effect of a lifestyle intervention on change in cardiorespiratory fitness in adults with type 2 diabetes: results from the Look AHEAD Study. Int J Obes 33, 305–316 (2009). https://doi.org/10.1038/ijo.2008.280

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