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Dunn AL, Marcus BH, Kampert JB, Garcia ME, Kohl III HW, Blair SN. Comparison of Lifestyle and Structured Interventions
to Increase Physical Activity and Cardiorespiratory Fitness: A Randomized Trial. JAMA. 1999;281(4):327–334. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-4-joc80889
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).
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,
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 (VO2peak) 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
VO2peak 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,
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.
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