背景 2型糖尿病肥胖成人常随着年龄增长而活动受限。强调生活方式干预提出减轻体质量和提高适应性可减慢此类患者活动度减少的过程。方法本研究将患有2型糖尿病、年龄45～74岁、超重或肥胖的5 145例患者随机分组:生活方式干预组和支持组;5 016例参试者归入研究。用隐马可夫模式表现失能状态特征,用混合效应次序逻辑回归法评价功能减退的可能性。主要结果是自我报告活动受限,每年评估1次,共进行4年。结果 4年后生活方式干预组2 514例成人,严重失能517例(20.6%),活动度良好969例(38.5%);此数目在含2 502例参试者支持组中分别为656例(26.2%)和798例(31.9%)。与支持组相比,生活方式干预组活动度受损风险相对减少了48%〔OR=0.52,95%CI(0.44,0.63),P<0.001〕。减少体质量及提高适应性(用踏车试验做评估)为有意义的影响因素(P<0.001)。1年后与生活方式干预项相关的负性事件为肌肉骨骼症状发生频率略高。结论减少体质量及提高适应性减慢了2型糖尿病肥胖成人活动度减退过程。 Background Obese adults with type 2 diabetes often have limited mobility with age. Emphasis on life style interventions Reducing body mass and increasing fitness can slow the reduction in activity of these patients. METHODS: In this study, 5,145 patients with type 2 diabetes mellitus, aged 45-74 years, overweight or obese, were randomized into a lifestyle intervention group and a support group, and 5 016 participants included in the study. Hidden Markov model was used to show the characteristics of incapacitated condition, and the mixed effect sequence logistic regression method was used to evaluate the possibility of hypofunction. The main result is limited self-reporting activities, once a year for a total of four years. Results After 4 years, there were 2 514 adults in the lifestyle intervention group, 517 cases (20.6%) with severe disability, and 969 cases (38.5%) with good activity. This number was 656 cases in the support group with 2 502 participants (26.2%) and 798 cases (31.9%). Compared with the support group, the lifestyle intervention group had a 48% relative reduction in the risk of impaired mobility [OR = 0.52, 95% CI (0.44, 0.63), P <0.001). Reducing body mass and improving fitness (assessed by treadmill testing) were significant contributing factors (p <0.001). Negative events associated with lifestyle intervention after 1 year were slightly higher for musculoskeletal symptoms. Conclusion Reducing body mass and improving fitness slowed down the decline of activity of obese adults with type 2 diabetes.