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To the Editor: Dr Dunn and colleagues¹ compared the benefits of incorporating moderate-intensity physical activity into one's daily routine (lifestyle approach) with those of a structured, fitness center–based exercise program. After 6 months, the structured program increased in cardiorespiratory fitness nearly 3-fold more than the lifestyle program.² Between 6 and 24 months, participants in the structured program lost some of their initial fitness gain, leading the authors to conclude that "a lifestyle physical activity intervention is as effective as a structured exercise program in improving physical activity, cardiorespiratory fitness, and blood pressure." However, differences in the delivery of the intervention between groups could weaken this conclusion.

First, to maintain their intervention beyond 6 months, the structured exercise group was required to pay a $495 initiation fee and $80 monthly dues (totaling $1935), whereas the lifestyle group paid no fees (A. L. Dunn, written communication, October 15, 1998). This design could . . . [Full Text of this Article]

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