This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (374)  • Contact me when this article is cited  Related Content  • Related letter  • Related articles  • Similar articles in JAMA  Topic Collections  • Randomized Controlled Trial  • Alert me on articles by topic  Social Bookmarking   What's this?

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).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTER

Lifestyle and Structured Interventions to Increase Physical Activity
Paul T. Williams, Richard A. Winett, Ralph N. Carpinelli, George Davey Smith, Shah Ebrahim, Andrea L. Dunn, Steven N. Blair, James B. Kampert, Bess H. Marcus, Melissa E. Garcia, H. W. Kohl III, Ross Andersen, and Michael Pratt
JAMA. 1999;282(16):1515-1517.
EXTRACT | FULL TEXT  

RELATED ARTICLES

Effects of Lifestyle Activity vs Structured Aerobic Exercise in Obese Women: A Randomized Trial
Ross E. Andersen, Thomas A. Wadden, Susan J. Bartlett, Babette Zemel, Tony J. Verde, and Shawn C. Franckowiak
JAMA. 1999;281(4):335-340.
ABSTRACT | FULL TEXT  

Benefits of Lifestyle Activity vs Structured Exercise
Michael Pratt
JAMA. 1999;281(4):375-376.
EXTRACT | FULL TEXT  

January 27, 1999
JAMA. 1999;281(4):391-392.
EXTRACT | FULL TEXT  

Why you should exercise
JAMA. 1999;281(4):394.
PDF  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Do Sedentary Older Adults Benefit From Community-Based Exercise? Results From the Active Start Program
Yan et al.
The Gerontologist 2009;49:847-855.
ABSTRACT | FULL TEXT  

Physical Activity Behavior Change Interventions Based on the Transtheoretical Model: A Systematic Review
Hutchison et al.
Health Educ Behav 2009;36:829-845.
ABSTRACT  

Responses of Blood Lipids to Aerobic, Resistance, and Combined Aerobic With Resistance Exercise Training: A Systematic Review of Current Evidence
Tambalis et al.
ANGIOLOGY 2009;60:614-632.
ABSTRACT  

Recruiting Older Adults Into a Physical Activity Promotion Program: Active Living Every Day Offered in a Naturally Occurring Retirement Community
Hildebrand and Neufeld
The Gerontologist 2009;49:702-710.
ABSTRACT | FULL TEXT  

ACCF/AHA/ACP 2009 competence and training statement: a curriculum on prevention of cardiovascular disease.
American College of Cardiology Foundation et al.
J Am Coll Cardiol 2009;54:1336-1363.
FULL TEXT  

ACCF/AHA/ACP 2009 Competence and Training Statement: A Curriculum on Prevention of Cardiovascular Disease: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Competence and Training (Writing Committee to Develop a Competence and Training Statement on Prevention of Cardiovascular Disease): Developed in Collaboration With the American Academy of Neurology; American Association of Cardiovascular and Pulmonary Rehabilitation; American College of Preventive Medicine; American College of Sports Medicine; American Diabetes Association; American Society of Hypertension; Association of Black Cardiologists; Centers for Disease Control and Prevention; National Heart, Lung, and Blood Institute; National Lipid Association; and Preventive Cardiovascular Nurses Association
WRITING COMMITTEE MEMBERS et al.
Circulation 2009;120:e100-e126.
FULL TEXT  

Feasibility of an exercise counseling intervention for depressed women smokers
Vickers et al.
Nicotine Tob Res 2009;11:985-995.
ABSTRACT | FULL TEXT  

Promoting Lifestyle Physical Activity: Experiences With the First Step Program
Tudor-Locke
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2009;3:50S-54S.
ABSTRACT  

Effectiveness of Lifestyle Physical Activity Interventions to Reduce Cardiovascular Disease
Dunn
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2009;3:11S-18S.
ABSTRACT  

Physical Activity, Weight Control, and Breast Cancer Risk and Survival: Clinical Trial Rationale and Design Considerations
Ballard-Barbash et al.
JNCI J Natl Cancer Inst 2009;101:630-643.
ABSTRACT | FULL TEXT  

Results from the Active for Life process evaluation: program delivery fidelity and adaptations
Griffin et al.
Health Educ Res 2009;0:cyp017v1-cyp017.
ABSTRACT | FULL TEXT  

Exercise physiologist's role in clinical practice
Franklin et al.
Br. J. Sports. Med. 2009;43:93-98.
ABSTRACT | FULL TEXT  

Initiating and maintaining resistance training in older adults: a social cognitive theory-based approach
Winett et al.
Br. J. Sports. Med. 2009;43:114-119.
ABSTRACT | FULL TEXT  

Physical Activity as a Preventative Factor for Frailty: The Health, Aging, and Body Composition Study
Peterson et al.
J Gerontol A Biol Sci Med Sci 2009;0:gln001v2-gln001.
ABSTRACT | FULL TEXT  

Internet-delivered lifestyle physical activity intervention: limited inflammation and antioxidant capacity efficacy in overweight adults
Smith et al.
J. Appl. Physiol. 2009;106:49-56.
ABSTRACT | FULL TEXT  

Effects of Moderate-Intensity Exercise on Polysomnographic and Subjective Sleep Quality in Older Adults With Mild to Moderate Sleep Complaints
King et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2008;63:997-1004.
ABSTRACT | FULL TEXT  

Physical activity in the elderly--it is never too late!
Song
QJM 2008;101:743-744.
FULL TEXT  

Effect of Exercise on 24-Month Weight Loss Maintenance in Overweight Women
Jakicic et al.
Arch Intern Med 2008;168:1550-1559.
ABSTRACT | FULL TEXT  

Physical Activity during Adulthood and Adolescence in Relation to Renal Cell Cancer
Moore et al.
Am J Epidemiol 2008;168:149-157.
ABSTRACT | FULL TEXT  

Themed Review: Clinical Interventions to Promote Physical Activity in Youth
Meriwether et al.
AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2008;2:7-25.
ABSTRACT  

Diabetes and Exercise
The Diabetes Educator 2008;34:37-40.
FULL TEXT  

Physical Activity and Reduced Risk of Cardiovascular Events: Potential Mediating Mechanisms
Mora et al.
Circulation 2007;116:2110-2118.
ABSTRACT | FULL TEXT  

Guidelines Advise Exercise Management for At-Risk Patients
Hendry
DOC News 2007;4:5-5.
FULL TEXT  

Self-perceived weight status and exercise adequacy
Jackson-Elmoore
Health Educ Res 2007;22:588-598.
ABSTRACT | FULL TEXT  

An Investigation of Habitual and Incidental Physical Activity Among Costa Rican and Costa Rican American Teenage Girls
D'Alonzo and Cortese
J Transcult Nurs 2007;18:201-207.
ABSTRACT  

Invited Commentary: A Challenge for Physical Activity Epidemiology
Sesso
Am J Epidemiol 2007;165:1351-1353.
ABSTRACT | FULL TEXT  

The Health-e-AME Faith-Based Physical Activity Initiative: Description and Baseline Findings
Wilcox et al.
Health Promot Pract 2007;8:69-78.
ABSTRACT  

Relationship between walking levels and perceptions of the local neighbourhood environment
Alton et al.
Arch. Dis. Child. 2007;92:29-33.
ABSTRACT | FULL TEXT  

Physical Activity Intervention Studies: What We Know and What We Need to Know: A Scientific Statement From the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity); Council on Cardiovascular Disease in the Young; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research
Marcus et al.
Circulation 2006;114:2739-2752.
ABSTRACT | FULL TEXT  

Effects of a Life Skills Intervention for Increasing Physical Activity in Adolescent Girls
Young et al.
Arch Pediatr Adolesc Med 2006;160:1255-1261.
ABSTRACT | FULL TEXT  

Physical Activity Counseling for Older Women
Costanzo et al.
West J Nurs Res 2006;28:786-801.
ABSTRACT  

Commentary: Stairway to health
Andersen
Int J Epidemiol 2006;35:1291-1291.
FULL TEXT  

Validation of a New Brief Physical Activity Survey among Men and Women Aged 60-69 Years
Taylor-Piliae et al.
Am J Epidemiol 2006;164:598-606.
ABSTRACT | FULL TEXT  

Offering lifestyle advice is Good Clinical Practice
DOC News 2006;3:6-6.
FULL TEXT  

Tai Chi Chuan: Mind-Body Practice or Exercise Intervention? Studying the Benefit for Cancer Survivors
Mansky et al.
Integr Cancer Ther 2006;5:192-201.
ABSTRACT  

Physical activity, public health, and aging: critical issues and research priorities.
Prohaska et al.
Journals of Gerontology Series B: Psychological Sciences and Social Science 2006;61:S267-S273.
FULL TEXT  

Results of the First Year of Active for Life: Translation of 2 Evidence-Based Physical Activity Programs for Older Adults Into Community Settings
Wilcox et al.
AJPH 2006;96:1201-1209.
ABSTRACT | FULL TEXT  

Putting Promotion Into Practice: The African Americans Building a Legacy of Health Organizational Wellness Program
Yancey et al.
Health Promot Pract 2006;7:233S-246S.
ABSTRACT  

TREAD: TReatment with Exercise Augmentation for Depression: study rationale and design
Trivedi et al.
Clin Trials 2006;3:291-305.
ABSTRACT  

Active Transport to Work in Australia: Is it all downhill from here?
Bell et al.
Asia Pac J Public Health 2006;18:62-68.
 

Psychosocial work conditions, unemployment, and leisure-time physical activity: A population-based study
Mohammad Ali and Lindstrom
Scand J Public Health 2006;34:209-216.
ABSTRACT  

Prescribing Exercise at Varied Levels of Intensity and Frequency: A Randomized Trial
Duncan et al.
Arch Intern Med 2005;165:2362-2369.
ABSTRACT | FULL TEXT  

Postpartum Physical Activity and Related Psychosocial Factors Among Women With Recent Gestational Diabetes Mellitus
Smith et al.
Diabetes Care 2005;28:2650-2654.
ABSTRACT | FULL TEXT  

Physical activity and diabetes prevention
LaMonte et al.
J. Appl. Physiol. 2005;99:1205-1213.
ABSTRACT | FULL TEXT  

Promotion of Physical Activity Among High-School Girls: A Randomized Controlled Trial
Pate et al.
AJPH 2005;95:1582-1587.
ABSTRACT | FULL TEXT  

Physical activity considerations for the treatment and prevention of obesity
Jakicic and Otto
Am. J. Clin. Nutr. 2005;82:226S-229S.
ABSTRACT | FULL TEXT  

Weight Management Using Lifestyle Modification in the Prevention and Management of Type 2 Diabetes: Rationale and Strategies
The American Diabetes Association et al.
Clin. Diabetes 2005;23:130-136.
FULL TEXT  

Home-Based Physical Activity Intervention for Breast Cancer Patients
Pinto et al.
JCO 2005;23:3577-3587.
ABSTRACT | FULL TEXT  

A Cost-Benefit Analysis of Physical Activity Using Bike/Pedestrian Trails
Wang et al.
Health Promot Pract 2005;6:174-179.
ABSTRACT  

The Practice and the Theory: Lessons from the Application of a Theories of Change Approach
Mackenzie and Blamey
Evaluation 2005;11:151-168.
ABSTRACT  

Mediator Analysis of Moms on the Move
Fahrenwald et al.
West J Nurs Res 2005;27:271-291.
ABSTRACT  

Integrating Physical Activity Into Mental Health Services for Persons With Serious Mental Illness
Richardson et al.
Psychiatr. Serv. 2005;56:324-331.
ABSTRACT | FULL TEXT  

Fitness instructors: How does their knowledge on weight loss measure up?
Forsyth et al.
Health Education Journal 2005;64:154-167.
ABSTRACT  

Physical Activity in the Prevention of Type 2 Diabetes: The Finnish Diabetes Prevention Study
Laaksonen et al.
Diabetes 2005;54:158-165.
ABSTRACT | FULL TEXT  

Clinical Implications of Obesity With Specific Focus on Cardiovascular Disease: A Statement for Professionals From the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: Endorsed by the American College of Cardiology Foundation
Klein et al.
Circulation 2004;110:2952-2967.
ABSTRACT | FULL TEXT  

Body Mass Index, Physical Activity, and the Risk of Decline in Overall Health and Physical Functioning in Late Middle Age
He and Baker
AJPH 2004;94:1567-1573.
ABSTRACT | FULL TEXT  

Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies. A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition
Klein et al.
Am. J. Clin. Nutr. 2004;80:257-263.
ABSTRACT | FULL TEXT  

Weight Management Through Lifestyle Modification for the Prevention and Management of Type 2 Diabetes: Rationale and Strategies: A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition
Klein et al.
Diabetes Care 2004;27:2067-2073.
FULL TEXT  

Associations of Perceived Social and Physical Environmental Supports With Physical Activity and Walking Behavior
Addy et al.
AJPH 2004;94:440-443.
ABSTRACT | FULL TEXT  

Ready to be Physically Active? The Effects of a Course Preparing Low-Income Multiethnic Women to be more Physically Active
Collins et al.
Health Educ Behav 2004;31:47-64.
ABSTRACT  

Hypertension and Obesity
Aneja et al.
Recent Prog Horm Res 2004;59:169-205.
ABSTRACT | FULL TEXT  

Effects of physical activity on exercise tests and respiratory function
Cheng et al.
Br. J. Sports. Med. 2003;37:521-528.
ABSTRACT | FULL TEXT  

The Importance of Physical Activity and Cardiorespiratory Fitness for Patients With Type 2 Diabetes
Blair and Church
Diabetes Spectr. 2003;16:236-240.
ABSTRACT | FULL TEXT  

Outcomes of an Exercise Program for Older Women Recruited through Primary Care
Clark et al.
J Aging Health 2003;15:567-585.
ABSTRACT  

Physical Activity Beliefs, Behaviors, and Cardiovascular Fitness of Mexican Immigrant Women
Juarbe et al.
J Transcult Nurs 2003;14:108-116.
ABSTRACT  

Are activity promotion interventions based on the transtheoretical model effective? A critical review
Adams and White
Br. J. Sports. Med. 2003;37:106-114.
ABSTRACT | FULL TEXT  

Increasing Physical Activity in People With Type 2 Diabetes
Kirk et al.
Diabetes Care 2003;26:1186-1192.
ABSTRACT | FULL TEXT  

The Role of Physical Activity in Prevention and Treatment of Body Weight Gain in Adults
Jakicic
J. Nutr. 2002;132:3826S-3829.
ABSTRACT | FULL TEXT  

Advising people to take more exercise is ineffective: a randomized controlled trial of physical activity promotion in primary care
Hillsdon et al.
Int J Epidemiol 2002;31:808-815.
ABSTRACT | FULL TEXT  

Physical activity attenuates the effect of increased left ventricular mass on the risk of ischemic stroke: The Northern Manhattan Stroke Study
Rodriguez et al.
J Am Coll Cardiol 2002;39:1482-1488.
ABSTRACT | FULL TEXT  

Exercise Comes of Age: Rationale and Recommendations for a Geriatric Exercise Prescription
Singh
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2002;57:M262-282.
FULL TEXT  

The Public Health Problem of Increasing Prevalence Rates of Obesity and What Should Be Done About It
Blair and Nichaman
Mayo Clin Proc. 2002;77:109-113.
 

An Obligation for Primary Care Physicians to Prescribe Physical Activity to Sedentary Patients to Reduce the Risk of Chronic Health Conditions
Chakravarthy et al.
Mayo Clin Proc. 2002;77:165-173.
ABSTRACT  

A systematic approach to the development and evaluation of an intervention promoting stair use
Adams and White
Health Education Journal 2002;61:272-286.
ABSTRACT  

The Built Environment and Human Activity Patterns: Exploring the Impacts of Urban Form on Public Health
Frank and Engelke
Journal of Planning Literature 2001;16:202-218.
ABSTRACT  

An Evaluation of Choose to Move 1999: An American Heart Association Physical Activity Program for Women
Koffman et al.
Arch Intern Med 2001;161:2193-2199.
ABSTRACT | FULL TEXT  

Physical activity and health: current issues and research needs
Hardman
Int J Epidemiol 2001;30:1193-1197.
FULL TEXT  

How Much Activity Do Youth Get? A Quantitative Review of Heart-Rate Measured Activity
Epstein et al.
Pediatrics 2001;108:e44-44.
ABSTRACT | FULL TEXT  

Recent advances: Sports medicine
Bahr
BMJ 2001;323:328-331.
FULL TEXT  

Effects of Physical Activity Counseling in Primary Care: The Activity Counseling Trial: A Randomized Controlled Trial
The Writing Group for the Activity Counseling Tria
JAMA 2001;286:677-687.
ABSTRACT | FULL TEXT  

Physical Activity Counseling in Primary Care: The Challenge of Effecting Behavioral Change
Wee
JAMA 2001;286:717-719.
FULL TEXT  

Physical Activity Outcomes of CHAMPS II: A Physical Activity Promotion Program for Older Adults
Stewart et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2001;56:M465-470.
ABSTRACT | FULL TEXT  

Physical Activity and Television Watching in Relation to Risk for Type 2 Diabetes Mellitus in Men
Hu et al.
Arch Intern Med 2001;161:1542-1548.
ABSTRACT | FULL TEXT  

Intensity of Physical Activity and Risk of Coronary Heart Disease
Bates et al.
JAMA 2001;285:2973-2974.
FULL TEXT  

Sources of Variance in Daily Physical Activity Levels in the Seasonal Variation of Blood Cholesterol Study
Matthews et al.
Am J Epidemiol 2001;153:987-995.
ABSTRACT | FULL TEXT  

Physical Inactivity and Short-term All-Cause Mortality in Adults With Chronic Disease
Martinson et al.
Arch Intern Med 2001;161:1173-1180.
ABSTRACT | FULL TEXT  

Cardiovascular Fitness as a Predictor of Mortality in Men
Laukkanen et al.
Arch Intern Med 2001;161:825-831.
ABSTRACT | FULL TEXT  

Care of older people: Promoting health and function in an ageing population
Andrews
BMJ 2001;322:728-729.
FULL TEXT  

Physical Activity and Risk for Cardiovascular Events in Diabetic Women
Hu et al.
ANN INTERN MED 2001;134:96-105.
ABSTRACT | FULL TEXT  

Seasonal Variation in Household, Occupational, and Leisure Time Physical Activity: Longitudinal Analyses from the Seasonal Variation of Blood Cholesterol Study
Matthews et al.
Am J Epidemiol 2001;153:172-183.
ABSTRACT | FULL TEXT