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A Randomized Trial

Andrea L. Dunn, PhD; Bess H. Marcus, PhD; James B. Kampert, PhD; Melissa E. Garcia, MPH; Harold W. Kohl III, PhD; Steven N. Blair, PED

JAMA. 1999;281:327-334.

Context  Even though the strong association between physical inactivity and ill health is well documented, 60% of the population is inadequately active or completely inactive. Traditional methods of prescribing exercise have not proven effective for increasing and maintaining a program of regular physical activity.

Objective  To compare the 24-month intervention effects of a lifestyle physical activity program with traditional structured exercise on improving physical activity, cardiorespiratory fitness, and cardiovascular disease risk factors.

Design  Randomized clinical trial conducted from August 1, 1993, through July 31, 1997.

Participants  Sedentary men (n = 116) and women (n = 119) with self-reported physical activity of less than 36 and 34 kcal/kg per day, respectively.

Interventions  Six months of intensive and 18 months of maintenance intervention on either a lifestyle physical activity or a traditional structured exercise program.

Main Outcome Measures  Primary outcomes were physical activity assessed by the 7-Day Physical Activity Recall and peak oxygen consumption (VO_2peak) by a maximal exercise treadmill test. Secondary outcomes were plasma lipid and lipoprotein cholesterol concentrations, blood pressure, and body composition. All measures were obtained at baseline and at 6 and 24 months.

Results  Both the lifestyle and structured activity groups had significant and comparable improvements in physical activity and cardiorespiratory fitness from baseline to 24 months. Adjusted mean changes (95% confidence intervals [CIs]) were 0.84 (95% CI, 0.42-1.25 kcal/kg per day; P<.001) and 0.69 (95% CI, 0.25-1.12 kcal/kg day; P = .002) for activity, and 0.77 (95% CI, 0.18-1.36 mL/kg per minute; P = .01) and 1.34 (95% CI, 0.72-1.96 mL/kg per minute; P<.001) for VO_2peak for the lifestyle and structured activity groups, respectively. There were significant and comparable reductions in systolic blood pressure (-3.63 [95% CI, -5.54 to -1.72 mm Hg; P<.001] and -3.26 [95% CI, -5.26 to -1.25 mm Hg; P = .002]) and diastolic blood pressure (-5.38 [95% CI, -6.90 to -3.86 mm Hg; P<.001] and -5.14 [95% CI, -6.73 to -3.54 mm Hg; P<.001) for the lifestyle and structured activity groups, respectively. Neither group significantly changed their weight (-0.05 [95% CI, -1.05 to 0.96 kg; P = .93] and 0.69 [95% CI, -0.37 to 1.74 kg; P = .20]), but each group significantly reduced their percentage of body fat (-2.39% [95% CI, -2.92% to -1.85%; P<.001] and -1.85% [95% CI, -2.41% to -1.28%; P<.001]) in the lifestyle and structured activity groups, respectively.

Conclusions  In previously sedentary healthy adults, a lifestyle physical activity intervention is as effective as a structured exercise program in improving physical activity, cardiorespiratory fitness, and blood pressure.

Author Affiliations: The Cooper Institute for Aerobics Research, Dallas, Tex (Drs Dunn, Kampert, and Blair); the Miriam Hospital and Brown University School of Medicine, Providence, RI (Dr Marcus); Baylor College of Medicine, Houston, Tex (Dr Kohl); and Vanderbilt University Medical Center, Nashville, Tenn (Ms Garcia).

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