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At the cellular level, B12 acts as a cofactor for two critical enzymatic reactions: Methionine synthase converts homocysteine to methionine, essential for DNA methylation and synthesis Methylmalonyl-CoA mutase involved in fatty acid metabolism and myelin production By restoring adequate B12 levels, injections enable normal red blood cell maturation in the bone marrow, correcting the megaloblastic anaemia

Those in the structured intervention attended 38 facilitated peer team meetings during the course of the study and had a prescribed activity program with measurable goals for aerobic, resistance and stretching exercise

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