title: The Newcastle exercise project: a randomised controlled trial of methods to promote physical activity in primary care The impact of physical fitness and health-age appraisal upon exercise intentions and behavior Telephone versus mail interventions for maintenance of physical activity in older adults. A randomized walking trial in postmenopausal women: effects on physical activity and health 10 years later. Cost-effectiveness of lifestyle and structured exercise interventions in sedentary adults: results of project ACTIVE. Use of the stages of change model in improving nutrition and exercise habits in enlisted Air Force men. Effectiveness of multidisciplinary lifestyle intervention for hypertension: a randomised controlled trial Project GRAD: two-year outcomes of a randomized controlled physical activity intervention among young adults. Graduate Ready for Activity Daily. A brief intervention to increase physical activity in sedentary working women. Effectiveness of physician-based assessment and counseling for exercise in a staff model HMO. Reaching Out to Promote Physical Activity in Australia: A Statewide Randomized Controlled Trial of a Stage-Targeted Intervention Physician-based activity counseling: Intervention effects on mediators of motivational readiness for physical activity Physician-based physical activity counseling for middle-aged and older adults: A randomized trial An evaluation of the effects of Tai Chi exercise on physical function among older persons: A randomized controlled trial Group-mediated activity counseling and traditional exercise therapy programs: Effects on health-related quality of life among older adults in cardiac rehabilitation Population-based randomized controlled trial of a stage-targeted physical activity intervention Efficacy of an individualized, motivationally-tailored physical activity intervention Evaluation of an internet-based physical activity intervention: A preliminary investigation An evaluation of Choose to Move 1999: an American Heart Association physical activity program for women. Randomized controlled trial of exercise training for older people (Sendai Silver Center Trial; SSCT): study design and primary outcome. Reducing cardiovascular risk factors in postmenopausal women through a lifestyle change intervention. Strategies for increasing early adherence to and long-term maintenance of home-based exercise training in healthy middle-aged men and women. Effects of physical activity counseling in primary care: the Activity Counseling Trial: a randomized controlled trial. “Walk in to Work Out”: a randomised controlled trial of a self help intervention to promote active commuting A systematic review of physical activity promotion in primary care office settings. RCT of a theory-based intervention promoting healthy eating and physical activity amongst out-patients older than 65 years. Can primary care doctors prescribe exercise to improve fitness? The Step Test Exercise Prescription (STEP) project. Long-term exercise and its effect on balance in older, osteoarthritic adults: results from the Fitness, Arthritis, and Seniors Trial (FAST). A randomized, controlled trial to study the effect of exercise consultation on the promotion of physical activity in people with Type 2 diabetes: a pilot study. Effect of individual counseling on physical activity fitness and health: a randomized controlled trial in a workplace setting. Effects of worksite physical exercise intervention on physical fitness, perceived health status, and work ability among home care workers: five-year follow-up. Promoting and maintaining physical activity in people with type 2 diabetes. An implementation study of two evidence-based exercise and health education programmes for older adults with osteoarthritis of the knee and hip. Can lay-led walking programmes increase physical activity in middle aged adults? A randomised controlled trial A randomized controlled trial of a home exercise programme for elderly people with poor mobility. Exercise and the transtheoretical model: a longitudinal test of a population sample. Effects of exercise training on physical activity in older people: a randomized controlled trial. Outcomes of an Exercise Program for Older Women Recruited through Primary Care Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. Mediators of physical activity behavior change among women with young children. Combining motivational and volitional interventions to promote exercise participation: protection motivation theory and implementation intentions. Promotion of health and physical activity improves the mental health of elderly immigrants: results of a group randomised controlled trial among Turkish immigrants in the Netherlands aged 45 and over Physical activity and nutrition programs for couples: a randomized controlled trial. Psychosocial predictors of changes in physical activity in overweight sedentary adults following counseling in primary care. Effectiveness of telephone support in increasing physical activity levels in primary care patients. Promoting physical activity among women with mobility impairments: a randomized controlled trial to assess a home- and community-based intervention. Effects of nurse counseling on walking for exercise in elderly primary care patients. The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial Harnessing motivational forces in the promotion of physical activity: the Community Health Advice by Telephone (CHAT) project. Physical activity intervention: a transtheoretical model-based intervention designed to help sedentary young adults become active. Health Opportunities with Physical Exercise (HOPE): social contextual interventions to reduce sedentary behavior in urban settings. Physical activity outcomes of CHAMPS II: a physical activity promotion program for older adults. Promoting physical activity in general practice: a controlled trial of written advice and information materials Effectiveness of a worksite exercise program with respect to perceived work ability and sick leaves among women with physical work. Randomized placebo-controlled trial of brisk walking in the prevention of postmenopausal osteoporosis. Preliminary evaluation of a multicomponent program for nutrition and physical activity change in primary care: PACE+ for adults. Minimal-contact physical activity interventions in women: a pilot study. Effects of walking training on health-related fitness in healthy middle-aged adults--a randomized controlled study. ACTIVE: a cognitive intervention trial to promote independence in older adults. Trial of print and telephone delivered interventions to influence walking. Effects on glucose tolerance, insulin secretion, insulin-like growth factor 1 and its binding protein, IGFBP-1, in a randomized controlled diet and exercise study in healthy, middle-aged men. Effects of a computer-based, telephone-counseling system on physical activity. The Fun, Food, and Fitness Project (FFFP): the Baylor GEMS pilot study. Advice on exercise from a family physician can help sedentary patients to become active. Promoting physical activity in low-income African-American communities: the PARR project. Randomised, controlled walking trials in postmenopausal women: the minimum dose to improve aerobic fitness? A nutrition and exercise intervention program for controlling weight in Samoan communities in New Zealand Exercise counselling by family physicians in Canada. An effective exercise-based intervention for improving mental health and quality of life measures: a randomized controlled trial. Will older sedentary people with non-insulin-dependent diabetes mellitus start exercising? A health promotion model. Project Joy: Faith Based Cardiovascular Health Promotion for African American Women The effects of self-monitoring and reinforcement on exercise adherence. Recruitment of older adults for a randomized, controlled trial of exercise advice in a general practice setting. Supervised versus Recommended Physical Exercise in Hypertensive Women. Is its Recommendation Enough? An Occupation Based Physical Activity Intervention Program Effects of low- and high-intensity home-based exercise training on functional capacity in healthy middle-aged men. Randomized trial of physical exercise alone or combined with bright light on mood and health-related quality of life. A self-paced step test to predict aerobic fitness in older adults in the primary care clinic. Evaluation of Individually Tailored Interventions on Exercise Adherence A randomized controlled trial of progressive resistance training in depressed elders. Ready to be Physically Active? The Effects of a Course Preparing Low-Income Multiethnic Women to be more Physically Active Effectiveness of counselling over 1 year on changes in lifestyle and coronary heart disease risk factors. A Center-Based Program for Exercise Change among Black-American Families The effect of life events and exercise program format on the adoption and maintenance of exercise behavior. Effects of a 5-year exercise-centered health-promoting programme on mortality and ADL impairment in the elderly. Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults. Primary care-based physical activity programs: effectiveness in sedentary older patients with osteoarthritis symptoms. Using Self-Efficacy and a Transtheoretical Model to Develop a Physical Activity Intervention for Obese Women A Randomized Control Trial of New Tailored Walking Campaigns in an Employee Sample The effect of exercise and diet on mental health and quality of life in middle-aged individuals with elevated risk factors for cardiovascular disease. A randomised controlled trial of three pragmatic approaches to initiate increased physical activity in sedentary patients with risk factors for cardiovascular disease. Cost-effectiveness of a primary care based physical activity intervention in 45-74 year old men and women: a randomised controlled trial. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. Walking with its training effects on the fitness and activity patterns of 79-91 year old females. Advising people to take more exercise is ineffective: a randomized controlled trial of physical activity promotion in primary care. Once a week is not enough: effects of a widely implemented group based exercise programme for older adults; a randomised controlled trial Increased exercise level and plasma lipoprotein concentrations: a one-year, randomized, controlled study in sedentary, middle-aged men. The Knowledge and Practices of Registered Nurse, Certified Diabetes Educators: Teaching Elderly Clients About Exercise Print versus website physical activity programs: a randomized trial. Six-month physical activity and fitness changes in Project Active, a randomized trial. User attitudes toward a physical activity promotion website. Enhancing exercise adherence in middle-aged males and females. A fall prevention program for elderly individuals. Exercise in long-term care settings. Randomised controlled trial to examine the effects of a GP exercise referral programme in Hailsham, East Sussex, on modifiable coronary heart disease risk factors. Evaluation of the results of a randomized controlled trial: how to define changes between baseline and follow-up. An office-based instrument for exercise counseling and prescription in primary care. The Step Test Exercise Prescription (STEP). Evaluation of relapse prevention and reinforcement interventions to promote exercise adherence in sedentary females. Randomized consent designs for clinical trials: an update. The impact of behavioral counseling on stage of change in fat intake, physical activity, and cigarette smoking in adults at increased risk of coronary heart disease. Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. Good maintenance of high-impact activity-induced bone gain by voluntary, unsupervised exercises: An 8-month follow-up of a randomized controlled trial. A randomized exercise trial in older women: increased activity over two years and the factors associated with compliance. Behavioural counselling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: randomised trial. Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women: a randomized trial. Psychologic Effects of Cardiovascular Conditioning: A Controlled Experiment Effects of 2,000 kcal per week of walking and stair climbing on physical fitness and risk factors for coronary heart disease. Prescribing exercise in multiple short bouts versus one continuous bout: effects on adherence, cardiorespiratory fitness, and weight loss in overweight women. Improving subjective health at the worksite: a randomized controlled trial of stress management training, physical exercise and an integrated health programme. An intervention to promote walking in sedentary women in the community. Impact of an Australian mass media campaign targeting physical activity in 1998. The Working Healthy Project: a worksite health-promotion trial targeting physical activity, diet, and smoking. Walking trials in postmenopausal women: effect of low doses of exercise and exercise fractionization on coronary risk factors. Physical activity and risk of developing colorectal cancer among college alumni. A home-based exercise program for nondisabled older adults. Groningen Active Living Model (GALM): stimulating physical activity in sedentary older adults; validation of the behavioral change model. Reduction in cardiovascular disease risk factors: 6-month results from Project Active. The effects of aerobic exercise and T'ai Chi on blood pressure in older people: results of a randomized trial. Promoting physical activity in a socially and economically deprived community: a 12 month randomized control trial of fitness assessment and exercise consultation Evaluation of a culturally appropriate intervention to increase physical activity. Evaluation of a lifestyle change programme for the treatment of obesity in general practice. Providing sedentary adults with choices for meeting their walking goals. Randomized trial of 2 interventions to increase older women's exercise. Effects of mail-mediated, stage-matched exercise behavior change strategies on female adults' leisure-time exercise behavior. The PHLAME firefighters' study: feasibility and findings. Long-term effects of varying intensities and formats of physical activity on participation rates, fitness, and lipoproteins in men and women aged 50 to 65 years. Exercise enhances the maintenance of smoking cessation in women. Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomized trial. Group- vs home-based exercise training in healthy older men and women. A community-based clinical trial. Testing the effect of the WALC intervention on exercise adherence in older adults. The effect of office-based physician's advice on adolescent exercise behavior. Former exercisers of an 18-month intervention display residual aBMD benefits compared with control women 3.5 years post-intervention: a follow-up of a randomized controlled high-impact trial A Green Prescription Study Exercise training and nutritional supplementation for physical frailty in very elderly people. Exercise training of men at retirement: a clinical trial. [One-year effect of health counseling on life style and risk factors of heart disease]. Exercise prescription: a clinical trial. Work Ability, Physical Activity, and Cardiorespiratory Fitness: 2-year Results From Project Active Physical activity and cardiovascular risk factors: effect of advice from an exercise specialist in Australian general practice. Improving Exercise Behavior: An Application of the Stages of Change Model in a Worksite Setting Evaluation of Motivationally Tailored vs. Standard Self-Help Physical Activity Interventions at the Workplace Randomised controlled trial of exercise in the elderly.
abstract: Abstract Objective : To evaluate the effectiveness of combinations of three methods to promote physical activity . Design : R and omised controlled trial . Baseline assessment with post-intervention follow up at 12 weeks and 1 year . Setting : One urban general practice , 1995 - 7 . Participants : 523 adults aged 40 to 64 years , r and omised to four intervention groups and a control group . Interventions : Brief ( one interview ) or intensive ( six interviews over 12 weeks ) motivational interviewing based on the stages of change model of behaviour change , with or without financial incentive ( 30 vouchers entitling free access to leisure facilities ) . Main outcome measures : Physical activity score ; sessions of moderate and vigorous activity in the preceding four weeks . Results : Response rate was 81 % at 12 weeks and 85 % at one year . More participants in the intervention group reported increased physical activity scores at 12 weeks than controls ( 38 % v 16 % , difference 22 % , 95 % confidence interval for difference 13 % to 32 % ) , with a 55 % increase observed in those offered six interviews plus vouchers . Vigorous activity increased in 29 % of intervention participants and 11 % of controls ( difference 18 % , 10 % to 26 % ) , but differences between the intervention groups were not significant . Short term increases in activity were not sustained , regardless of intensity of intervention . Conclusions : The most effective intervention for promoting adoption of exercise was the most intensive . Even this did not promote long term adherence to exercise . Brief interventions promoting physical activity that are used by many schemes in the United Kingdom are of question able effectiveness . Key messages Schemes promoting physical activity are currently popular in general practice in Britain , but few have been rigorously evaluated and their effectiveness is unknown . In this study , the most effective intervention for promoting adoption of physical activity was the most intensive , involving six motivational interviews and a financial incentive A comparatively brief intervention ( one interview ) was only effective in the short term in around a third of participants Short term increases in physical activity were not maintained at one year follow up and even the most intensive intervention was ineffective in promoting long term adherence to increased physical activity . National and local government , health authorities , and primary healthcare teams should be cautious about current and future expenditure on , and implementation of , exercise prescription or referral This study investigated the relative and combined effectiveness of the Canadian Home Fitness Test ( CHFT ) and Health Hazard Appraisal ( HHA ) to modify ( 1 ) intention to exercise with and without knowledge of the results and ( 2 ) intention and behavior to exercise over 3 months . The 200 subjects were r and omly attributed to groups , either ( 1 ) physical-fitness evaluation ( PF ) , ( 2 ) appraised health age ( HA ) , ( 3 ) physical-fitness evaluation and health-hazard appraisal ( PF-HA ) , or ( 4 ) control ( C ) , The immediate impact on the intention to exercise of passing one and /or the other tests , without knowledge of the results , was not significant . With knowledge of the results , the intentions of the PF and PF-HA groups differed from those of the C group . This effect disappeared after 3 months . There was no significant impact on exercise behavior over 3 months . The results indicated a short-term motivational effect from being informed of CHFT results . Maintaining this effect might require intervention on a long-term basis Although telephone and mail are often used to promote physical activity adoption , their ability to produce long-term maintenance is unclear . In this study , 140 men and women aged 50 - 65 years received 1 year of telephone counseling  to adopt higher ( i.e. , more vigorous ) versus lower intensity ( i.e. , moderate ) exercise . After 1 year , participants were rer and omized to a 2nd year of contact via ( a ) telephone and mail or ( b ) predominantly mail . Participants who were prescribed higher intensity exercise and received predominantly mail had better exercise adherence during the maintenance year than those who received telephone and mail . Both strategies were similarly effective in promoting maintenance in the lower intensity condition . Results suggest that after successful adoption of physical activity with the help of telephone counseling , less intensive interventions are successful for physical activity maintenance in older adults BACKGROUND It is important to determine if permanent lifestyle changes may result from physical activity interventions and whether health may be affected by these changes . OBJECTIVE To conduct a 10-year follow-up of physical activity and self-reported health status in participants of a r and omized clinical trial of walking intervention .  METHODS Of the original 229 volunteer postmenopausal women who participated in the original clinical trial , 196 ( N = 96 intervention and 100 controls ) completed the 10-year follow-up telephone interview . The interview protocol included questions on  self-reported walking for exercise  and purpose s other than exercise , the Paffenbarger sport and exercise index , functional status , and various chronic diseases and conditions . RESULTS The median values for both usual walking for exercise and total walking  were significantly higher for walkers compared with controls ( for both , P = .01 ) , with median differences of 706 and 420 kcal/wk , respectively . After excluding women who reported heart disease during the original trial , 2 women in the walking group ( 2 % ) and 11 women in the control group ( 12 % ) reported physician-diagnosed heart disease over the last 10 years ( P = .07 ) . There were also fewer hospitalizations , surgeries , and falls among women in the walking group , although these differences were not statistically significant ( P>.05 ) . CONCLUSIONS Although limited by self-report , this study may be the first to demonstrate long-term exercise compliance to a r and omized control trial in older women and to suggest that health benefits may have ensued as a result of these increased activity levels BACKGROUND Project ACTIVE was a r and omized clinical trial comparing two physical activity interventions , lifestyle and traditional structured exercise . The two interventions were evaluated and compared in terms of cost effectiveness and ability to enhance physical activity among sedentary adults . DESIGN This was a r and omized clinical trial . SETTING / PARTICIPANTS The study included 235 sedentary but healthy community-dwelling adults . INTERVENTION A center-based lifestyle intervention that consisted of behavioral skills training was compared to a structured exercise intervention that included supervised , center-based exercise . MAIN OUTCOME MEASURES The main outcome measures of interest included cost , cardiorespiratory fitness , and physical activity . RESULTS Both interventions were effective in increasing physical activity and fitness . At 6 months , the costs of the lifestyle and structured interventions were , respectively , $ 46.53 and $ 190.24 per participant per month . At 24 months these costs were $ 17.15 and $ 49.31 per participant per month . At both 6 months and 24 months , the lifestyle intervention was more cost-effective than the structured intervention for most outcomes measures . CONCLUSIONS A behaviorally-based lifestyle intervention approach in which participants are taught behavioral skills to increase their physical activity by integrating moderate-intensity physical activity into their daily lives is more cost-effective than a structured exercise program in improving physical activity and cardiorespiratory health . This study represents one of the first attempts to compare the efficiency of intervention alternatives for improving physical activity among healthy , sedentary adults Thirty-nine U.S. Air Force enlisted men participated in a r and omized controlled study that evaluated an experimental program design ed to enhance fitness . Subjects were assigned to either a treatment ( access to the program ) or control ( no access to program ) group for 6 months . To improve treatment group fitness ( as measured by VO2 , subjects received individually tailored information ( based on a behavior change model ) via the Internet to encourage adoption of positive diet and exercise behaviors . Results showed no significant effect in improving fitness in treatment . However , significant effects were observed for secondary outcomes such as weight ( controls , + 1.0 kg vs. treatment , -2.2 kg , p < 0.05 ) , body mass index ( + 0.3 kg/m2 vs. -0.7 kg/m2 , p < 0.05 ) , and percent body fat ( + 0.6 % vs. -1.5 % , p < 0.001 ) . The data suggest that the individually tailored exercise information was not effective in encouraging sufficient exercise intensity to impact fitness . However , the dietary tailored information appears to have encouraged the adoption of more positive nutritional practice s as demonstrated by the beneficial effects reflected in secondary outcomes Lifestyle factors like weight , alcohol consumption , salt intake and physical activity have shown to be important in treating hypertension . There have been made some r and omised trials about the effects of lifestyle interventions , but the numbers of patients have been relatively small and the duration s of follow-ups have been short . No controlled trials assessing the effects of lifestyle intervention in a rehabilitation setting have been reported . In this study , the effects of multidisciplinary lifestyle intervention in rehabilitation centres among middle-aged hypertensive employees were described . A total of 731 hypertensives from 45 worksites were r and omised to lifestyle intervention in a rehabilitation centre or to usual care in an occupational or primary health-care centre for 12 months . St and ard measurements were conducted before the intervention and 1-year later . Blood pressure ( BP ) levels were clearly reduced in the intervention group , while only minor changes were observed in the control group . The net changes between the two groups both for systolic and diastolic BPs were −2.1 mmHg ( 95 % confidence intervals ( CI ) −4.0 to −0.1 ) and −1.5 mmHg ( 95 % CI −2.6 to −0.4 ) , respectively . The net changes were greater among men than women . The multidisciplinary lifestyle intervention in a rehabilitation centre setting produced significant reductions in BP among middle-aged employees with hypertension INTRODUCTION Project Graduate Ready for Activity Daily evaluated a program to promote physical activity through the transition of university graduation in a r and omized controlled trial . METHODS Three hundred thirty-eight university seniors participated in either a cognitive-behavioral intervention course or a knowledge-oriented general health course during the semester before graduation .  Behaviorally oriented phone and mail follow-up was delivered to the intervention group for 18 months . Physical activity outcomes and mediating variables were assessed at baseline , 1 and 2 years ( 93 % retention rate ) . RESULTS There were no significant intervention effects on physical activity outcomes at 2 years for either men or women . Experiential and behavioral processes of change were significantly improved for intervention women over 2 years . CONCLUSIONS Despite excellent participation in a theoretically based , well-attended intervention , few long-term effects on physical activity or its mediators were found . Additional research is needed to determine optimal interventions for physical activity and to vali date or alter current behavior change theory The purpose of this study was to determine whether a brief , tailored counselling intervention is effective for increasing physical activity in sedentary women when delivered in the workplace . This prospect i ve r and omized trial used a brief intervention based on the Transtheoretical Model . The intervention group received health screening , a brief intervention , and , 2 weeks later , a booster telephone call from a nurse practitioner . The intervention was tailored to each woman 's reported exercise behaviour . The 134 women r and omized to the intervention were compared with 153 women in a control group who received health counselling not tailored to their exercise behaviour and no telephone call . Six weeks later , the intervention group , when compared to baseline , had significantly improved their physical activity , increasing their amount of weekend physical activity as well as minutes walked for exercise , on err and s , total walking , and total daily blocks walked . When compared to controls , they showed significantly greater gains . This test of a brief , tailored strategy provides a critical contribution to the search for efficient , effective ways for nurses to deliver workplace health promotion interventions BACKGROUND Few primary care physicians routinely counsel for exercise , despite the benefits of physical activity and the high prevalence of inactivity . The objective of this study is to assess the effectiveness of Physician-Based Assessment and Counseling for Exercise ( PACE ) , a brief , behavior-based tool for primary care providers counseling healthy adults . METHODS This study is a r and omized controlled trial of 812 patients age 30 years or older registered for well visits at 32 primary care physician offices at a staff model health maintenance organization . Intervention physicians were trained to deliver PACE exercise counseling protocol s at the index visit , and one reminder telephone call occurred at 1 month . An enhanced intervention group received additional activity reminders . RESULTS At the 6-month follow-up , the control group did not differ significantly from the intervention group for energy expended ( 2,048 kcal/week versus 2,108 kcal/ week , P = 0.77 ) , time spent in walking or other moderate to vigorous activities ( 202 min/week versus 187 min/ week , P = 0.99 ) , mental health , physical function , or behaviors previously shown to predict activity change . Among the intervention patients , the stages-of-change score for Contemplators increased significantly compared with controls ( P = 0.03 ) , but without a significant change in energy expended . Baseline levels of physical activity counseling were high ( 50 % ) , as were baseline patient physical activity levels ( 61 % exercised at least three times a week ) . CONCLUSIONS These results suggest that a one-time PACE counseling session with minimal reinforcement , in a setting with high baseline levels of activity , does not further increase activity . The finding that Contemplators advanced in stage of behavior change suggests that further studies are needed to examine long-term , repeated counseling interventions Purpose . This study examined the broader use of a print-media intervention , which was previously shown to be effective at promoting physical activity to participants recruited from a regional Australian community , as a strategy suitable for a more diverse statewide population sample . Methods . Participants were r and omly selected adults who responded to a telephone interview conducted by the New South Wales Health Department and consented to participate in a r and omized controlled trial . Consenters were allocated to either  intervention ( n = 361 ) or control ( n = 358 ) conditions . The intervention , a personalized letter plus stage-targeted booklets , was sent 1 week postbaseline . Data were collected via telephone interview at baseline and 2 and 8 months and were analyzed using repeated measures analysis of variance ( ANOVA ) and χ2 statistics . Results . The groups were similar at baseline ( mean age 43 ± 3 years ; 64 % women ) . Process evaluation showed high intervention recall ( 76 % at 2 months ) and high follow-up response rates ( > 85 % at 8 months ) were achieved . Nonsignificant increases in physical activity were observed ( F 1,719 = 2.18 , p = .14 ) . Discussion . A single mailing of stage-targeted print material s was not effective in promoting increases in physical activity among participants selected from the statewide population . Future research could examine how the effectiveness of print media might be enhanced , possibly by using supplementary media , community-based prompts , or other incentives In theory-based interventions for behavior change , there is a need to examine the effects of interventions on the underlying theoretical constructs and the mediating role of such constructs . These two questions are addressed in the Physically Active for Life study , a r and omized trial of physician-based exercise counseling for older adults . Three hundred fifty-five patients participated ( intervention n = 181 , control n = 174 ; mean age = 65.6 years ) . The underlying theories used were the Transtheoretical Model , Social Cognitive Theory and the constructs of decisional balance ( benefits and barriers ) , self-efficacy , and behavioral and cognitive processes of change . Motivational readiness for physical activity and related constructs were assessed at baseline , 6 weeks , and 8 months . Linear or logistic mixed effects models were used to examine intervention effects on the constructs , and logistic mixed effects models were used for mediator analyses . At 6 weeks , the intervention had significant effects on decisional balance , self-efficacy , and behavioral processes , but these effects were not maintained at 8 months . At 6 weeks , only decisional balance and behavioral processes were identified as mediators of motivational readiness outcomes . Results suggest that interventions of greater intensity and duration may be needed for sustained changes in mediators and motivational readiness for physical activity among older adults Sedentary behavior among older adults increases risk for chronic diseases . Physicians in a primary care setting can play an important role in promoting physical activity adoption among their older patients . The Physically Active for Life ( PAL ) project was a r and omized , controlled trial comparing the efficacy of brief physician-delivered physical activity counseling to usual care on self-reported physical activity levels . The physical activity counseling was based on the Transtheoretical Model of Change and social learning theory . Twenty-four community-based primary care medical practice s were recruited into the study ; 12 were r and omized to the Intervention condition and 12 to the Control condition . Physicians in the Intervention practice s received training in the delivery of brief physical activity counseling . Subjects in the Intervention practice s ( n=181 ) received brief activity counseling matched to their stage of motivational readiness for physical activity , a patient manual , a follow-up appointment with their physician to discuss activity counseling , and newsletter mailings . Subjects in the Control practice s ( n=174 ) received st and ard care .  Measures of motivational readiness for physical activity and the Physical Activity Scale for the Elderly ( PASE ) were administered to subjects in both conditions at baseline , 6 weeks following their initial appointment , and at 8 months . Results showed that at the 6-week follow-up , subjects in the Intervention condition were more likely to be in more advanced stages of motivational readiness for physical activity than subjects in the Control condition . This effect was not maintained at the 8 month follow-up and the intervention did not produce significant changes in PASE scores . Results suggest that more intensive , sustained interventions may be necessary to promote the adoption of physical activity among sedentary , middle-aged , and older adults in primary care medical practice This study was design ed to determine whether a 6-month Tai Chi exercise program can improve self-reported physical functioning limitations among healthy , physically inactive older individuals . Ninety-four community residents ages 65 to 96 ( M age = 72.8 years , SD = 5.1 ) volunteered to participate in the study . Participants were r and omly assigned to either a 6-month experimental ( Tai Chi ) group ( n = 49 ) , which exercised twice per week for 60 min , or a wait-list control group ( n = 45 ) . A 6-item self-report physical functioning scale , assessing the extent of behavioral dysfunction caused by health problems , was used to evaluate change in physical functioning limitations as a result of Tai Chi intervention . Results indicated that compared to the control group , participants in the Tai Chi group experienced significant improvements in all aspects of physical functioning over the course of the 6-month intervention . Overall , the experimental group had 65 % improvement across all 6 functional status measures ranging from daily activities such as walking and lifting to moderate-vigorous activities such as running . It was concluded that the 6-month Tai Chi exercise program was effective for improving functional status in healthy , physically inactive older adults . A self-paced and self-controlled activity such as Tai Chi has the potential to be an effective , low-cost means of improving functional status in older persons Background : Regular physical activity has been consistently related to improvements in health- related quality of life ( HRQL ) in older adults . Nevertheless , systematic investigations of the influence of exercise therapy on older men and women enrolled in cardiac rehabilitation remain sparse . Purpose : The primary purpose of this investigation was to compare the effects of a group-mediated cognitive behavioral physical activity intervention program ( GMCB ) to a traditional cardiac rehabilitation program ( CRP ) with regard to changes in HRQL in a community-dwelling sample of older adults . Methods : This r and omized clinical trial assigned 147 participants who were eligible for inclusion in cardiac rehabilitation to the GMCB or traditional CRP arms . Changes in HRQL at 3 and 12 months were assessed using the Short Form-36 ( SF-36 ) from the Medical Outcomes Study . Results : Mixed-model analyses yielded significant Baseline × Gender × Treatment interactions for the self-reported mental health component and the Vitality subscale of the SF-36 . Decomposition of these interactions revealed that men in both exercise therapy groups and women in the GMCB treatment with low baseline values demonstrated more favorable improvements in the HRQL perceived mental health measures than women in the CRP treatment . Conclusions : Improvements in HRQL among older adults enrolled in cardiac rehabilitation differ as a function of treatment , gender , and initial mental health status . Results are discussed in terms of the implication s for the design of future physical activity interventions among older adults with cardiovascular disease and the measurement of their HRQL Background : Intervention trials with self-selected participants have shown that mailed stage-targeted print material s can increase participation in physical activity in the short term . We examined the effects of a mailed stage-targeted print intervention design ed to promote physical activity , in a r and om sample of adults living in a regional city . Method : Participants ( n = 462 , 40–60 years of age ) were r and omly allocated to an intervention in - 227 ) or control group ( n - 235 ) . Measures included vali date d 2-week physical activity recall and stage of motivational readiness for physical activity . The intervention consisted of a single mailing of a letter and full-color stage-targeted booklets ( specific to precontemplation , contemplation , preparation , and action/maintenance ) 1 week postbaseline . Follow-up interviews were conducted at 2 and 6 months postbaseline . Results : After 2 months , participants in the intervention group were significantly More likely to meet the current American College of Sports Medicine/Centers for Disease Control and Prevention recommendation for sufficient physical activity than those in the control group ( adjusted odds ratio [ OR ] - 2.40 ; 95 % confidence interval [ CI ] = 1.44–3.99 ) . After 6 months , intervention participants who reported receiving and reading the intervention material s were significantly more likely to be meeting the sufficient physical activity criterion compared with the control group ( adjusted OR = 2.03 ; 95 % Cl = 1.16–3.56 ) . Conclusions : The stage-targeted print intervention was effective in promoting short-term increases in physical activity and was most effective for participants who recognized and used the material s. This low-cost , generalizable intervention has demonstrated potential as a practical population -based physical activity promotion strategy . Further research is required before widespread dissemination would be justified , as additional strategies may be required to ensure sustained change This study compared the efficacy of two low-cost interventions for physical activity adoption . Sedentary ( N=194 ) adults recruited through newspaper advertisements were r and omized to receive either a motivationally-matched , individually-tailored intervention ( IT ) or a st and ard self-help intervention ( ST ) . Assessment s and interventions were delivered by repeated mailings at baseline , one , three , and six months . Participants were assessed regarding current physical activity behavior , motivational readiness to adopt regular physical activity , and psychological constructs associated with physical activity participation ( e.g. self-efficacy , decisional balance ) . Repeated measures analyses of variance ( ANOVAs ) revealed significant increases in physical activity participation between baseline and six months for both groups with a significantly greater increase among IT participants . The IT group outperformed the ST group on all primary outcome measures : ( a ) minutes of physical activity per week , ( b ) reaching Centers for Disease Control and American College of Sports Medicine ( CDC/ACSM ) recommended minimum physical activity criteria , and ( c ) achieving the Action stage of motivational readiness for physical activity adoption . Both groups showed significant improvement between baseline and six months on the psychological constructs associated with physical activity adoption ( e.g. self-efficacy ) , with no significant differences observed between the treatment groups . Utilizing computer expert systems and self-help manuals to provide individually-tailored , motivationally-matched interventions appears to be an effective , low-cost approach for enhancing physical activity participation in the community The Internet has the potential for delivering innovative , interactive physical activity ( PA ) interventions to large numbers of people . This study was design ed to test the efficacy of an Internet intervention that consisted of a Web site plus 12 weekly e-mail tip sheets , compared with a waiting list control group . The Internet intervention was theory based and emphasized clear , graphical presentation of PA information . Sixty-five ( 30 intervention and 35 control ) sedentary adult employees of several large hospitals ( 9 men and 56 women ) were r and omly assigned to 1 of the 2 study arms . Of the 65 participants , 57 completed the 1-month follow-up , and 52 completed the 3-month follow-up . At both 1 and 3 months , those in the intervention group were significantly more likely to have progressed in stage of motivational readiness for PA than participants in the control group : 1 month , χ2(1 , N=52 ) = 4.05 , p > .05 ; 3 months , χ2(1 , N = 52 ) = 6.45 , p > .01 . We hypothesized that at 1 and 3 months , the intervention group would exhibit significant increases relative to the control group on the number of minutes of moderate activity . At the 1-month assessment , the intervention group did exhibit significant increases , relative to the control group in moderate minutes , F(1 , 54 ) = 5.79 , p > .05 ; however , at the 3-month assessment this difference was no longer significant . In addition , secondary analyses were conducted to examine total number of minutes of walking reported . At 1 month , the intervention group did exhibit significant increases , relative to the control group , in walking minutes , F(1 , 54 ) = 12.1 , p > .001 . At the 3-month assessment , amount of time spent in walking activity continued to be significantly higher for the intervention group compared with the control group , F(1 , 48 ) = 5.2 , p > .05 . These findings show that a theoretically based PA Web site and weekly e-mail tip sheets can have a short-term impact on PA motivation and behavior both at 1 and 3 months . As Internet access increases , and as b and with and other technical attributes of this medium improve , Web site delivered health behavior interventions will become increasingly useful in public health promotion BACKGROUND Rates of physical inactivity and poor nutrition , which are 2 of the most important modifiable risk factors for cardiovascular disease in women , are substantial . Even so , studies of interventions design ed to improve lifestyle behaviors in women have been limited and often confined to particular geographical areas . OBJECTIVE To evaluate the effect of Choose to Move on increasing women 's physical activity , improving their knowledge of heart disease and stroke , and improving their nutrition . PARTICIPANTS AND METHODS A prospect i ve , nonr and omized , 12-week educational intervention design ed by the American Heart Association for women across the United States . Participants received a welcome kit and manual with weekly information about how to manage cardiovascular disease risk factors and how to build a support system for lifestyle change . Women ( N = 23 171 ) aged 25 years or older were recruited by direct mail , the media , health care providers , and other means . Follow-up evaluations were returned from 6389 women at 2 weeks , 5338 at 4 weeks , 4209 at 8 weeks , 3916 at 10 weeks , and 3775 at 12 weeks . Participants self-reported their physical activity , diet , and knowledge about heart disease , stroke , and related symptoms . RESULTS Ninety percent of the participants were white and 56 % were aged between 35 and 54 years . Among the participants who completed the week 12 follow-up evaluation , the percentage who reported being active ( at least moderate exercise > or = 5 times per week or > 2(1/2 ) hours per week for the past 1 to 6 months ) increased from 32 % at baseline to 67 % at the program 's end ( P = .001 ) . Participants currently limiting excess calories or fat increased from 72 % to 91 % at week 10 follow-up evaluation ( P = .001 ) . The proportion correctly identifying heart disease as the leading cause of death increased from 84 % to 91 % at week 10 follow-up evaluation ( P<.001 ) . CONCLUSIONS Women who completed the Choose to Move program evaluation reported that they significantly increased their levels of physical activity , reduced their consumption of high-fat foods , and increased their knowledge and awareness of cardiovascular disease risk and its symptoms . This program provides an important model for public health , voluntary , and other health organizations of population -based , targeted low-cost self-help programs that support the Healthy People 2010 objectives for physical activity , nutrition , and cardiovascular health Physical exercise is expected to improve and maintain physical function in older people , thus promoting health and preventing or postponing the onset of disability in later life . The Sendai Silver Center Trial ( SSCT ) was a r and omized controlled trial design ed to evaluate the efficacy of exercise training among healthy free-living older people . Sixty-five eligible participants , aged from 60 to 81 years , were r and omly allocated to an exercise group or a control group . The subjects in the exercise group were asked to attend training classes at the Sendai Silver Center , a municipal health and welfare facility in the center of Sendai City , at least twice a week for 25 weeks . Each training class , lasting two hours , started with a warm-up session , followed by an endurance session with a bicycle ergometer , and a resistance exercise training session using rubber films , and ended with a cool-down session . The subjects in the control group were asked to attend recreational classes at the Center twice a month . There were no drop-outs or accidents during the intervention . Comparison of maximum oxygen consumption ( VO2max ) before and after the 25-week intervention revealed a significant increase in the exercise group ( 2.1 ml/kg/min ) but no significant change in the control group . Our result is equivalent to the participants becoming younger in aerobic capacity by five years after six months of exercise training BACKGROUND The impact of a 6-month lifestyle change intervention on cardiovascular risk factors in obese , sedentary , postmenopausal women was examined . A secondary aim of this investigation was to determine whether the addition of self-control skills training to an empirically supported lifestyle change intervention would result in greater cardiovascular risk reduction . METHODS Forty-four women were r and omly assigned to receive either a lifestyle change or a lifestyle change with self-control skills intervention . Pretreatment and posttreatment weight loss , body composition , physical activity , cardiorespiratory fitness , diet , blood pressure ( BP ) , blood lipids , and psychosocial functioning were assessed . Also , at 1-year posttreatment , weight loss , body composition , self-reported physical activity , and psychosocial functioning were assessed . RESULTS The women significantly increased their physical activity ( + 39.6 % ) and cardiorespiratory fitness ( + 13.5 % ) and reduced their body weight ( -6.5 % ) , fat mass ( -7.4 % ) , body fat ( -2.4 % ) , BP ( SBP -6.2 % , DBP -9.2 % ) , total cholesterol ( -7.4 % ) , triglycerides ( -16.5 % ) , and low-density lipoprotein ( LDL ) cholesterol ( 9.1 % ) and improved their diet ( p < 0.05 ) . At the 1-year follow-up , women had regained approximately 63 % of their posttreatment weight loss ( p < 0.05 ) , but had maintained their previous increases in physical activity . Additionally , there were no significant changes in fat free mass , body fat , anxiety , or depression between the end of treatment and 1-year posttreatment . The addition of self-control skills training did not significantly improve cardiovascular risk reduction . CONCLUSIONS Lifestyle change interventions may be an effective means for reducing cardiovascular risk in obese , sedentary , postmenopausal women . However , greater attention should be devoted to the maintenance of these positive lifestyle changes Two studies were undertaken to compare strategies for the adoption and maintenance of moderate-intensity , home-based exercise training . In the study of adoption , 52 men and women who had served for 6 months as controls for a study of moderate-intensity , home-based exercise training  received 30 minutes of baseline instruction . They were then r and omized to receive continuing instruction and support through 10 staff-initiated telephone contacts of 5 minutes each every 2 weeks , or to receive no telephone contacts . In subjects receiving telephone contacts , peak oxygen uptake increased significantly after 6 months , whereas no increase was observed in subjects receiving no staff support ( p less than 0.05 ) . In the maintenance study , 51 men and women who had significantly increased their peak oxygen uptake by 6 months of moderate-intensity , home-based exercise training  were r and omized to undergo daily self-monitoring and receive adherence instructions , or undergo weekly self-monitoring only , during a second 6-month period of training . Subjects performing daily self-monitoring reported completing significantly more exercise training sessions during the 6 months of training than subjects performing weekly self-monitoring ; functional capacity in both groups remained higher than before training ( p less than 0.05 ) . Taken together , these studies suggest that brief baseline instruction followed by continuing telephone contact with staff can be used to help people adopt a moderate-intensity ,  home-based exercise training program  that can be maintained by simple self-monitoring strategies CONTEXT Physical activity is important for health , yet few studies have examined the effectiveness of physical activity patient counseling in primary care . OBJECTIVE To compare the effects of 2 physical activity counseling interventions with current recommended care and with each other in a primary care setting . DESIGN The Activity Counseling Trial , a r and omized controlled trial with recruitment in 1995 - 1997 , with 24 months of follow-up . SETTING Eleven primary care facilities affiliated with 3 US clinical research centers . PARTICIPANTS Volunteer sample of 395 female and 479 male inactive primary care patients aged 35 to 75 years without clinical cardiovascular disease . INTERVENTIONS Participants were r and omly assigned to 1 of 3 groups : advice ( n = 292 ) , which included physician advice and written educational material s ( recommended care ) ; assistance ( n = 293 ) , which included all the components received by the advice group plus interactive mail and behavioral counseling at physician visits ; or counseling ( n = 289 ) , which included the assistance and advice group components plus regular telephone counseling and behavioral classes . MAIN OUTCOME MEASURES Cardiorespiratory fitness , measured by maximal oxygen uptake ( VO(2)max ) , and self-reported total physical activity , measured by a 7-day Physical Activity Recall , compared among the 3 groups and analyzed separately for men and women at 24 months . RESULTS At 24 months , 91.4 % of the sample had completed physical activity and 77.6 % had completed cardiorespiratory fitness measurements . For women at 24 months , VO(2)max was significantly higher in the assistance group than in the advice group ( mean difference , 80.7 mL/min ; 99.2 % confidence interval [ CI ] , 8.1 - 153.2 mL/min ) and in the counseling group than in the advice group ( mean difference , 73.9 mL/min ; 99.2 % CI , 0.9 - 147.0 mL/min ) , with no difference between the counseling and assistance groups and no significant differences in reported total physical activity . For men , there were no significant between-group differences in cardiorespiratory fitness or total physical activity . CONCLUSIONS Two patient counseling interventions differing in type and number of contacts were equally effective in women in improving cardiorespiratory fitness over 2 years compared with recommended care . In men , neither of the 2 counseling interventions was more effective than recommended care Study objective : To determine if a self help intervention , delivered via written interactive material s ( the “ Walk in to Work Out ” pack ) , could increase  active commuting behaviour ( walking and cycling ) . Design : R and omised controlled trial . The intervention group received the “ Walk in to Work Out ” pack , which contained written interactive material s based on the transtheoretical model of behaviour change , local information about distances and routes , and safety information . The control group received the pack six months later . Focus groups were also conducted after six months . Setting : Three workplaces in the city of Glasgow , Scotl and , UK . Participants : 295 employees who had been identified as thinking about , or doing some irregular , walking or cycling to work . Main results : The intervention group was almost twice as likely to increase walking to work as the control group at six months ( odds ratio of 1.93 , 95 % confidence intervals 1.06 to 3.52 ) . The intervention was not successful at increasing cycling . There were no distance travelled to work , gender , or age influences on the results . Twenty five per cent ( 95 % confidence intervals 17 % to 32 % ) of the intervention group , who received the pack at baseline , were regularly actively commuting at the 12 month follow up . Conclusion : The “ Walk in to Work Out ” pack was successful in increasing walking but not cycling . The environment for cycling must be improved before cycling will become a popular option OBJECTIVE To assess the efficacy of physical activity promotion in primary care office setting s. DESIGN Systematic review of clinical trials in which the efficacy of physical activity promotion was investigated in a primary care office setting with at least one month of follow up . SUBJECTS A total of 13,981 adults , aged 17 - 85 + , were included from 203 practice s in eight trials assessing physical activity promotion in primary care office setting s. MAIN OUTCOME MEASURES Odds ratios and 95 % confidence intervals were calculated comparing the number of participants who increased their physical activity or were active at follow up in the intervention group with a control group for each study . RESULTS Five of eight trials where positive with statistically significant results ( range 0.91 - 6.56 ) , but significant biases or limited clinical relevance of the outcomes were found in all trials . Short term trials of less than one year ( four of four were positive ) , single-risk-factor trials ( three of three were positive ) , r and omised clinical trials ( two of three were positive ) , and those assessing moderate levels of physical activity ( three of four were positive ) were most likely to find benefit . Only one of four trials lasting longer than a year were positive . CONCLUSION There is limited evidence from well design ed trials that office based physical activity promotion in primary care setting s is efficacious in promoting changes in physical activity that could conceivably have lasting clinical benefits A r and omised controlled trial was used to evaluate a theory-based health promotion intervention . The intervention , a healthy living booklet , was design ed to promote healthy eating and physical activity amongst people aged over 65 years attending hospital out-patient clinics . The booklet employed persuasive arguments targeting the most proximal cognitive antecedents of behaviour specified by the theory of planned behaviour , as well as goal setting prompts . Participants ( N = 252 , average age=82 ) were r and omly allocated to a control ( patient satisfaction question naire ) or intervention ( healthy living booklet ) group .  Cognitions and behaviour were measured pre-intervention and at a two week follow up . The intervention group made significantly higher gains in perceived behavioural control , intention and behaviour for both target behaviours , suggesting that the intervention was successful . Sixty three of those invited to set goals to eat more healthily ( e.g. , " to eat five portions of fruit and vegetables a day " ) did so , and 67 % of those who set such goals reported 100 % success in acting on them . By contrast , only 34 % of intervention participants set an activity goal ( e.g. , " a five minute walk everyday " ) , and only 51 % reported 100 % success in enacting these goals . Results suggest that the observed behavioural effects of the healthy eating booklet could be attributed to goal setting as well as changes in perceived behavioural control and intention BACKGROUND Sedentary lifestyle is associated with adverse health outcomes . Available evidence suggests that , despite positive attitudes toward regular exercise in promoting a healthy lifestyle , few physicians actually prescribe exercise for their patients . Barriers include lack of skills and st and ard office instruments . Because primary care physicians have regular contact with a large proportion of the population , the impact of preventive health interventions may be great . OBJECTIVES To determine the effect of an exercise prescription instrument ( i.e. , Step Test Exercise Prescription [ STEP ] ) , compared to usual-care exercise counseling delivered by primary care doctors on fitness and exercise self-efficacy among elderly community-dwelling patients . DESIGN R and omized controlled trial ; baseline assessment and intervention delivery with postintervention follow-up at 3 , 6 , and 12 months . SETTING Four large ( > 5000 active patient files ) academic , primary care practice s : three in urban setting s and one in a rural setting , each with four primary care physicians ; two clinics provided the STEP intervention and two provided usual care control . PARTICIPANTS A total of 284 healthy community-dwelling patients ( 72 per clinic ) aged > 65 years were recruited in 1998 - 1999 . INTERVENTION STEP included exercise counseling and prescription of an exercise training heart rate . MAIN OUTCOME MEASURES The primary outcome measure was aerobic fitness ( VO(2max ) ) . Secondary outcomes included predicted VO(2max ) from the STEP test , exercise self-efficacy ( ESE ) , and clinical anthropometric parameters . RESULTS A total of 241 subjects ( 131 intervention , 110 control ) completed the trial .  VO(2max ) was significantly increased in the STEP intervention group ( 11 % ; 21.3 to 24ml/kg/min ) compared to the control group ( 4 % ; 22 to 23ml/kg/min ) over 6 months ( p < 0.001 ) , and 14 % ( 21.3 to 24.9ml/kg/min ) and 3 % ( 22.1 to 22.8ml/kg/min ) , respectively , at 12 months ( p < 0.001 ) . A similar significant increase in ESE ( 32 % ; 4.6 vs 6.8 ) was observed for the STEP group compared to the control group ( 22 % ; 4.2 vs 5.4 ) at 12 months ( p < 0.001 ) . Systolic blood pressure decreased 7.3 % and body mass index decreased 7.4 % in the STEP group , with no significant change in the control group ( p < 0.05 ) . Exercise counseling time was significantly ( p < 0.02 ) longer in the STEP ( 11.7+/-3.0 min ) compared to the control group ( 7.1+/-7.0 min ) , but more ( p < 0.05 ) subjects completed > or = 80 % of available exercise opportunities in the STEP group . CONCLUSIONS Primary care physicians can improve fitness and exercise confidence of their elderly patients using a tailored exercise prescription ( e.g. , STEP ) . Further , STEP appears to maintain benefits to 12 months and may improve exercise adherence . Future study should determine the impact of combining cognitive/behavior change strategies with STEP OBJECTIVES To examine the effects of 18-month aerobic walking and strength training programs on static postural stability among older adults with knee osteoarthritis . DESIGN R and omized , single-blind , clinical trial of therapeutic exercise . SETTING Both center-based ( university ) and home-based . PARTICIPANTS A cohort of 103 older adults ( age = 60 years ) with knee osteoarthritis who were participants in a large ( n = 439 ) clinical trial and who were r and omly assigned to undergo biomechanical testing . INTERVENTION An 18-month center- ( 3 months ) and home-based ( 15 months ) therapeutic exercise program . The subjects were r and omized to one of three treatment arms : ( 1 ) aerobic walking ; ( 2 ) health education control ; or ( 3 ) weight training . MEASUREMENTS Force platform static balance measures of average length ( Rm ) of the center of pressure ( COP ) , average velocity ( Vel ) of the COP , elliptical area ( Ae ) of the COP , and balance time ( T ) . Measures were made under four conditions : eyes open , double- and single-leg stances and eyes closed , double- and single-leg stances . RESULTS In the eyes closed , double-leg stance condition , both the aerobic and weight training groups demonstrated significantly better sway measures relative to the health education group . The aerobic group also demonstrated better balance in the eyes open , single-leg stance condition . CONCLUSIONS Our results suggest that long-term weight training and aerobic walking programs significantly improve postural sway in older , osteoarthritic adults , thereby decreasing the likelihood of larger postural sway disturbances relative to a control group AIM To evaluate the effect of exercise consultation on promotion of physical activity in people with Type 2 diabetes . METHODS Twenty-six sedentary people with Type 2 diabetes were r and omly assigned to receive an exercise consultation and st and ard exercise information ( experimental ) or st and ard exercise information alone ( control ) . Exercise consultation is a one-to-one discussion , based on the transtheoretical model , design ed to educate , strengthen motivation and develop realistic strategies to promote physical activity . Changes from baseline at five weeks were assessed in ( a ) stage of exercise behaviour ( b ) physical activity levels ( 7-day recall question naire and an accelerometer ) ( c ) quality of life ( SF-36 Health Survey and 22-Item Well-Being Question naire ) . RESULTS 82 % ( 9/11 ) of participants receiving a consultation increased their stage of exercise behaviour compared to 33 % ( 4/12 ) of controls ( chi2 = 5.4 , P = 0.02 ) . Physical activity counts/week increased by 4 % ( 1636 067/1696 191 ) in the experimental group and decreased by 9 % ( 1560 960/1725 510 ) in controls . A significant difference was recorded for the change in activity counts per week from baseline to follow-up between the experimental and control group ( 98 % CI = 60 673 - 710 827 ) . The number of participants taking part in sport or leisure activity increased by 55 % ( 6/11 ) in the experimental group and decreased by 6 % ( 1/12 ) in controls . Positive changes were evident in the experimental group , compared to controls , in both quality of life question naires . CONCLUSION Exercise consultation is more effective in stimulating exercise behaviour change in the short term than a st and ard exercise leaflet BACKGROUND Physical inactivity and obesity are major public health problems . Our objective was to investigate the effectiveness of an individual counseling intervention at the workplace on physical activity fitness and health . Counseling content derived from the Patient-centered Assessment and Counseling for Exercise and Nutrition ( PACE ) program . METHODS A total of 299 employees of three municipal services in the Dutch town of Enschede were r and omly allocated into intervention ( n = 131 ) and control group ( n = 168 ) . Over a 9-month period , intervention group subjects were offered seven counseling sessions . Counseling was based on the individual 's stage of behavioral change using PACE physical activity and nutrition protocol s. Subjects in both the intervention and control group received written information about several lifestyle factors . Primary outcome measures were physical activity ( total energy expenditure , during sports activities , during physical activity leisure time other than sports , and meeting the moderate-intensity public health recommendations ) ; cardiorespiratory fitness ; and prevalence of musculoskeletal symptoms . Secondary outcome measures were body composition ( body mass index [ BMI ] , and percentage of body fat measured via skinfold thicknesses ) ; blood pressure ; and blood cholesterol . RESULTS There were significant positive effects on total energy expenditure , physical activity during sports , cardiorespiratory fitness , percentage of body fat , and blood cholesterol . No effects were found for the proportion of subjects meeting the public health recommendation of moderate-intensity physical activity , physical activity during leisure time other than sports , prevalence of musculoskeletal symptoms , body mass index , and blood pressure . CONCLUSIONS Individual face-to-face counseling at the workplace based on PACE protocol s positively influenced physical activity levels and some components of physical fitness . The implementation of workplace counseling programs for individuals should therefore be promoted OBJECTIVE The effects and constancy of a worksite physical exercise intervention were examined in relation to the physical fitness , perceived health status , and work ability of female service workers during periods of 1 and 5 years . METHODS The subjects comprised female home care workers divided into an intervention group ( n = 50 , mean age 41.8 ( SD 10.4 ) years ) and a control group ( n = 37 , mean age 43.3 ( SD 8.8 ) years ) . The intervention group participated in 9 months of supervised exercise intervention twice a week during the workday . Functional capacity , perceived health , and work ability were assessed at the beginning of the study and after a 1- and a 5-year period of follow-up . RESULTS In the 1-year follow-up measurements , body fat had decreased ( 4 % ) and dynamic muscle performance and maximal oxygen consumption in relation to body mass ( 30 - 38 and 7 % , respectively ) had increased in the intervention group . The differences in outcome variables between the intervention and the control groups were significant ( from P = 0.014 to P < 0.001 ) . These positive effects of worksite exercise were observed despite the age of the subjects , and the changes were consistent during a 5-year period . In the control group the decline of the work ability index ( L smean ) was about three times faster than in the intervention group during the 5-year period . CONCLUSIONS Physical exercise executed in work units can be used to improve the physical capacity of female home care aides and prevent the early decline of their work ability . In jobs that are physically dem and ing , such as home care work , early prevention must start before the age-related deterioration of health and physical capacity BACKGROUND Limited research has investigated how to promote physical activity in people with type 2 diabetes . This study evaluated physical activity counseling over 12 months in people with type 2 diabetes . DESIGN Participants were given st and ard exercise information and r and omly assigned to receive physical activity counseling or not . Data were collected from September 2000 through to September 2002 and analyzed from October 2002 to February 2003 . SETTING / PARTICIPANTS Diabetes outpatient clinic . Seventy inactive people with type 2 diabetes . INTERVENTION Physical activity counseling , based on the transtheoretical model , combined motivational theory and cognitive behavioral strategies into an individualized intervention to promote physical activity . Consultations were delivered at baseline and 6 months , with phone calls at 1 and 3 months post-consultation . MAIN OUTCOME MEASURES Changes from baseline at 12 months in physical activity ( 7-day recall and accelerometer ) , stages and processes of exercise behavior change . RESULTS Between-group differences were recorded in physical activity ( recall and accelerometer ) at 12 months ( p < 0.01 ) . Experimental participants significantly increased total activity ( median difference , 115 minutes ; 95 % confidence interval [CI]=73 - 150 minutes ) . Control participants recorded no significant change ( median difference , -15 minutes ; 95 % CI=-53 - 13 minutes ) . The accelerometer experimental participants recorded no significant change ( mean difference , 416,632 counts ; 95 % CI=-27,743 , 1,051,007 counts/week ) , while control participants recorded a significant decrease ( mean difference , -669,061 counts ; 95 % CI=-1,292,285 , -45,837 counts/week ) . At 12 months , more experimental participants compared to controls were in active stages of behavior(6-month chi(2)=26.4 , p < 0.01 ; 12-month chi(2)=19.9 , p < 0.01 , respectively ) . Between-group differences were recorded at 12 months for the frequency of using all processes ( p < 0.01 ) , except dramatic relief and stimulus control . CONCLUSIONS Physical activity counseling was effective for promoting physical activity over 12 months in people with type 2 diabetes Implementation studies are recommended to assess the feasibility and effectiveness in real-life of programmes which have been tested in r and omized controlled trials ( RCTs ) . We report on an implementation study of two evidence -based exercise and health education programmes for older adults with osteoarthritis ( OA ) of the knee or hip . Three types of primary health-care providers ( n = 18 ) delivered the OA Knee programme ( n = 20 ) and the OA Hip programme ( n = 20 ) , supported by programme manuals and implementation guidelines , in four regions . The outcome measures were pain and mobility . The Knee programme had OA knowledge and self-efficacy as additional outcome measures . Differences in outcome measures and background variables of participants were assessed between the RCTs and the implementation study . Positive effects ( P < 0.05 ) were found for OA knowledge , pain and self-efficacy in the Knee programme ( n = 157 ) , and for pain in the Hip programme ( n = 132 ) . No effect was found for mobility . Effect sizes of the RCTs and the present study were comparable . Background variables did not explain the variance in the outcome measures . The outcomes of the previous RCTs and the implementation study were comparable , and indicated the ecological validity of the two programmes . The implication s for nationwide dissemination and implementation in The Netherl and s are discussed Study objective : To compare health walks , a community based lay-led walking scheme versus advice only on physical activity  and cardiovascular health status in middle aged adults . Design : R and omised controlled trial with one year follow up . Physical activity was measured by question naire . Other measures included attitudes to exercise , body mass index , cholesterol , aerobic capacity , and blood pressure . Setting : Primary care and community . Participants : 260 men and women aged 40–70 years , taking less than 120 minutes of moderate intensity activity per week . Main results : Seventy three per cent of people completed the trial . Of these , the proportion increasing their activity above 120 minutes of moderate intensity activity per week was 22.6 % in the advice only and 35.7 % in the health walks group at 12 months ( between group difference = 13 % ( 95 % CI 0.003 % to 25.9 % ) p=0.05 ) . Intention to treat analysis , using the last known value for missing cases , demonstrated smaller differences between the groups ( between group difference = 6 % ( 95 % CI −5 % to 16.4 % ) ) with the trend in favour of health walks . There were improvements in the total time spent and number of occasions of moderate intensity activity , and aerobic capacity , but no statistically significant differences between the groups . Other cardiovascular risk factors remained unchanged . Conclusions : There were no significant between group differences in self reported physical activity at 12 month follow up when the analysis was by intention to treat . In people who completed the trial , health walks was more effective than giving advice only in increasing moderate intensity activity above 120 minutes per week Eighty-six elderly people with limited mobility and dependence in at least one activity of daily living were recruited to a home exercise study . The subjects ( mean age 82 years ) were allocated at r and om to either a strength exercise group , a mobility exercise group or a health education group . Subjects were visited for 30 minutes every 3 - 4 weeks by a physiotherapist who gave both verbal and written instruction . Sixty-nine of the original 86 completed the 6-month study , with five drop-outs from the strength group , ten drop-outs from the mobility group , and two drop-outs from the health education group . By the end of the study , there were no significant differences between the groups with regard to changes in outcome variables . The results showed a trend towards improvement in both the exercise groups in both Sit to St and and Timed Get Up and Go tests , but this failed to attain statistical significance . Further work is required to identify the optimal exercise intervention for this subgroup of the elderly population BACKGROUND The purpose of this study was to test the ability of the Transtheoretical Model ( TTM ) to predict exercise stage transition of individuals in a large , untreated- population -based , r and om sample of Canadian adults ( 18 - 65 years of age ) over two consecutive time periods . METHODS Assessment s of TTM 's  stage of exercise behavior change , self-efficacy , pros , cons , experiential processes , and behavioral processes were made at baseline ( time 1 ) , 6 months ( time 2 ) , and 1 year ( time 3 ) . Six hundred eighty-three men and women , identified through r and om-digit telephone dialing , completed all measures across the three time points . Within each time period ( time 1 - 2 ; time 2 - 3 ) participants were categorized as having regressed ( moved back at least on stage ) , remained ( no stage change ) , or progressed ( moved forward at least one stage ) . Baseline TTM constructs were analyzed for their ability to predict change transition across the two time periods . RESULTS Of 40 possible predictions ( 20 for each time period ) 18 ( 45 % ) were supported . CONCLUSIONS Overall , the findings demonstrate partial support for the internal validation of TTM in the exercise domain . Implication s of the findings are discussed and future directions for research ers , practitioners , and program planners are provided BACKGROUND Recent r and omized controlled trials indicated that exercise training for elderly significantly increased their physical fitness . However , very few studies have examined changes in physical activity after exercise training . The purpose of this study was to investigate whether six-month exercise training for older adults can increase and maintain their physical activity in daily life . METHODS Sixty-two men and women aged 60 to 81 years ( mean age 67.1 years ) , living in communities , were r and omly allocated into an exercise group ( n = 32 ) or a control group ( n = 33 ) . The intervention started in April 1998 and lasted for 25 weeks . The exercise regimen consisted of endurance training and resistance exercises in a two-hour class conducted at least twice a week . The subjects completed a physical activity diary at each pre-intervention ( March 1998 ) , post-intervention ( September 1998 ) and follow-up ( April 1999 ) measurement of physical activity . Physical activity , expressed as total daily energy expenditure , was calculated by multiplying the amount of time spent in each activity and the corresponding METs . RESULTS Total daily energy expenditure significantly increased from 40.8 kcal/kg/day to 43.5 kcal/kg/day in the exercise group ( p = 0.03 ) , but did not change in the control group . At the follow-up measurement , the mean total daily energy expenditure in the exercise group remained significantly higher , by 1.7 kcal/kg/day , than that at the pre-intervention ( p = 0.05 ) . CONCLUSIONS This r and omized controlled trial indicated that exercise training for elderly was effective in increasing physical activity in daily life Objectives : This study reports the social cognitive , health status , and health service use outcomes of an exercise intervention among women over 50 years of age . Methods : A r and om sample of patients was drawn from two primary care centers that serve a predominantly low-income and African American population . After provider screen , 412 women were eligible and invited to participate in the study . Of these , 123 participated and 1-year follow-up data are available for 72 participants . Results : Participants were more likely to be African American and had a higher average body weight than non participants . Perceived health was the only variable that differed by adherence group at baseline . At 1 year , differences were apparent for body weight , body mass index , hip and waist circumference , triceps skinfold , and exercise self-esteem . The no-adherence group got worse , whereas the moderate adherence group improved . Discussion : These data suggest that even suboptimal adherence to moderate-intensity exercise can yield health benefits BACKGROUND recent studies have found that moderate intensity exercise is an effective intervention strategy for preventing falls  in older people . However , research is required to determine whether supervised group exercise programmes , conducted in community setting s with at-risk older people referred by their health care practitioner are also effective in improving physical functioning and preventing falls in this group . OBJECTIVES to determine whether participation in a weekly group exercise programme with ancillary home exercises over one year improves balance , muscle strength , reaction time , physical functioning , health status and prevents falls in at-risk community-dwelling older people . METHODS the sample comprised 163 people aged over 65 years identified as at risk of falling using a st and ardised assessment screen by their general practitioner or hospital-based physiotherapist , residing in South Western Sydney , Australia . Subjects were r and omised into either an exercise intervention group or a control group .  Physical performance and general health measures were assessed at baseline and repeated 6-months into the trial . Falls were measured over a 12-month follow-up period using monthly postal surveys . RESULTS at baseline both groups were well matched in their physical performance , health and activity levels . The intervention subjects attended a median of 23 exercise classes over the year , and most undertook the home exercise sessions at least weekly . At retest , the exercise group performed significantly better than the controls in three of six balance measures ; postural sway on the floor with eyes open and eyes closed and coordinated stability . The groups did not differ at retest in measures of strength , reaction time and walking speed or on Short-Form 36 , Physical Activity Scale for the Elderly or fear of falling scales . Within the 12-month trial period , the rate of falls in the intervention group was 40 % lower than that of the control group ( IRR=0.60 , 95 % CI 0.36 - 0.99 ) . CONCLUSIONS these findings indicate that participation in a weekly group exercise programme with ancillary home exercises can improve balance and reduce the rate of falling in at-risk community dwelling older people BACKGROUND Women with children are less likely to engage in  adequate physical activity ( PA )  than women without children . This study aim ed to evaluate the efficacy of two strategies for promoting increased  PA  among mothers of preschool-aged children , and to explore the mediators of any result ing change in PA behavior . DESIGN Controlled intervention trial incorporating repeated data collection from 554 women , r and omized to one of three experimental conditions . Intervention Group 1 served as a control , while women in Groups 2 and 3 were given print information about overcoming PA barriers . Women in Group 3 were also invited to discuss the development of local strategies for the promotion of PA among mothers of young children . The primary strategies included increasing partner support , social advocacy , and capacity building , and were implemented through collaboration among participants , research ers , and community organizations . MAIN OUTCOME MEASURES Adequate physical activity ( PA ) , self-efficacy ( SE ) and partner support ( PS ) . RESULTS Following the intervention , women in Group 3 were significantly more likely to meet guidelines for PA than controls ( odds ratio [OR]=1.71 , confidence interval [CI]=1.05 - 2.77 ) ] after controlling for age and PA at baseline . After controlling for baseline PA , residualized change in SE ( OR=1.86 , CI=1.17 - 2.94 ) and PS ( OR=2.29 , CI=1.46 - 3.58 ) significantly predicted meeting guidelines . After controlling for residual change in PS and SE , the significant intervention effect was attenuated ( Group 3 OR=1.40 , CI=0.76 - 2.36 ) , indicating that partner support and self-efficacy may be mediators of physical activity behavior change . CONCLUSIONS The findings indicate that community participation approaches that facilitate increased self-efficacy and partner support can be effective in increasing PA  among mothers of young children OBJECTIVE This study compared a motivational intervention based on protection motivation theory ( PMT , Rogers , 1975 , 1983 ) with the same motivational intervention augmented by a volitional intervention based on implementation intentions ( Gollwitzer , 1993 ) . DESIGN The study had a longitudinal design , involving three waves of data collection over a 2-week period , incorporating an experimental manipulation of PMT variables at Time 1 and a volitional , implementation intention intervention at Time 2 . METHOD Participants ( N=248 ) were r and omly allocated to a control group or one of two intervention groups .  Cognitions and exercise behaviour were measured at three time-points over a 2-week period . RESULTS The motivational intervention significantly increased threat and coping appraisal and intentions to engage in exercise but did not bring about a significant increase in subsequent exercise behaviour . In contrast , the combined protection motivation theory/implementation intention intervention had a dramatic effect on subsequent exercise behaviour . This volitional intervention did not influence behavioural intention or any other motivational variables . CONCLUSIONS It is concluded that supplementing PMT with implementation intentions strengthens the ability of the model to explain behaviour . This has implication s for health education programmes , which should aim to increase both participants ' motivation and their volition Objectives : Older immigrants from non-industrialised countries are a growing group , they have comparatively many health problems and are often hard to reach through health promotion and other preventive services . The aim of this study was to assess the effect of a short health education and physical exercise programme on the health and the physical activity of Turkish first generation elderly immigrants . Design : R and omised controlled trial . Setting : Welfare services in six Dutch cities . Participants : 126 people born in Turkey and aged 45 years and over , of whom 92 completed the trial . Intervention : Eight , two hour sessions consisting of health education and exercises . Topics in health education focused on means to maintain a good health . Education was adapted to the culture and knowledge of older Turks and offered by a Turkish peer educator , in Turkish . Main outcome measures : Physical and mental wellbeing , and mental health based on the SF-12/36 ; knowledge on health and disease ; physical activity . Results : Participants were highly disadvantaged ; 52 % had not completed primary school and 49 % had considerable problems in speaking Dutch . Participants in the intervention group showed an improvement in mental health ( effect size : 0.38 SD ( 95 % confidence intervals 0.03 to 0.73 ) , p=0.03 ) ; the oldest subgroup also in mental wellbeing ( effect size 0.75 SD ( 0.22 to 1.28 ) , p=0.01 ) . No improvements were seen in physical wellbeing and activity , nor in knowledge . Conclusions : Health education and physical exercise improve the mental state of deprived immigrants . Painstaking cultural adaptations to contents and method of delivery are essential to reach this effect Diet and physical activity habits may deteriorate after cohabitation , leading to weight gain and increased risk of lifestyle diseases . We carried out a 4-month , r and omized controlled trial of a diet and physical activity program for couples with a 1-year follow-up , comparing two methods of delivery . The program used six modules , which , after an initial group session , were mailed to the low-level intervention group .  In the high-level intervention group , half of the modules were mailed , and the others were delivered at interactive group sessions . A control group received no intervention . Postintervention and at follow-up , physical fitness improved in the high-level group , saturated fat intake decreased in both intervention groups , and low-density lipoprotein cholesterol fell in the high-level group . Fewer participants in the high-level group became overweight or obese . Health promotion for couples can improve health behaviors and potentially lower the risk of lifestyle diseases in participants and their future families BACKGROUND Increasing regular physical activity in adults at elevated risk of cardiovascular disease is an important target for preventive medicine . This study evaluated demographic , social and cognitive predictors of self-reported changes in physical activity after 4 and 12 months in a r and omized trial of behavioral counseling in primary care . METHOD Data were analyzed from 234 male and 271 female sedentary patients with a body mass index of 25 - 35 ( age 49.1 years , SD 11.2 years ) , who had been counseled by nurses in general practice using stage-matched behavioral methods or st and ard health promotion and who were reassessed after 4 months . A total of 187 men and 231 women were reassessed after 12 months . RESULTS Physical activity at baseline was associated with educational status , having a partner who exercised , perceived barriers , and self-efficacy . Changes over 4 months were greater with behavioral counseling , in non-smokers and in patients with higher ratings of motivation to change and self-efficacy at baseline . Changes over 12 months were greater with behavioral counseling and were predicted in the behavioral group by social support variables , perceived benefits , and barriers . Stage of readiness to change predicted increased activity at 4 but not 12 months . CONCLUSIONS Social support and cognitive variables predict increased physical activity following counseling in primary care of sedentary overweight adults . Different factors are relevant to short- and long-term modifications in behavior BACKGROUND Physician counseling of patients  to increase physical activity has had limited success in changing behavior . Providing organizational support to primary care providers and their patients may increase effectiveness . OBJECTIVE This study evaluates the effectiveness of a telephone-based intervention to increase physical activity  among patients who exercised < 15 minutes daily and wanted to increase their physical activity over a 6-month period . DESIGN This was a r and omized controlled trial , conducted from 1997 to 1998 , of 316 patients aged 18 to 65 who were recruited from a mailed health risk assessment . Baseline and 6-month post-intervention telephone assessment s were conducted by telephone . SETTING One family physician 's patients in a suburban community . INTERVENTION Three sessions of telephone-delivered motivational counseling . MAIN OUTCOME MEASURES Physical activity score ( 11-item Physician-Based Assessment and Counseling for Exercise [ PACE ] ) 6 months after the intervention . RESULTS After adjusting for baseline exercise , there was a significantly higher level of self-reported exercise among individuals r and omized to the intervention at the 6-month follow-up . The mean level of activity at follow-up for the intervention group was a PACE score of 5.37 , compared to 4.98 in the control group ( p<0.05 ) . In the secondary analysis , which was limited to individuals who received the intervention , the effect was stronger ( PACE score of 5.58 compared to 4.94 , p<0.013 ) . CONCLUSIONS Patients can be recruited using a health-screening question naire to receive a telephone-delivered behavioral intervention to successfully increase their physical activity levels OBJECTIVE To assess the effectiveness of an intervention to promote physical activity and fitness in physically disabled women . DESIGN R and omized controlled trial . SETTING Home or community . PARTICIPANTS Seventy-five adult women with mobility limitations .  INTERVENTION Incorporated behavioral techniques , social support , and education to promote exercise . MAIN OUTCOME MEASURES Fitness measures included weight , body mass index , resting blood pressure and heart rate , time to complete a mobility course , and heart rate during and blood pressure after navigating the course . Also collected self-reported experience of secondary conditions and weekly self-reports of physical activity . RESULTS We found no significant fitness differences between groups , except for peak heart rate . However , paired t tests of the physical activity data revealed the experimental group significantly increased its total weekly physical activity minutes ( P=.04 ) , and the increase in weekly cardiovascular activity approached significance ( P=.06 ) . CONCLUSIONS The experimental group did not experience better fitness or fewer secondary conditions than the controls . However , the experimental group 's physical activity data indicate that this group significantly increased its activity over 6 months . Thus , although this study did not detect health changes , it showed that mobility-impaired women can adopt and maintain a physical activity program Background . Counseling sedentary primary care patients can increase physical activity , but whether this approach will increase exercise and fitness in elderly adults with chronic diseases remains to be determined . Methods . After receiving individualized nurse counseling to begin a program of walking for health , 60- to 80-year-old primary care patients were r and omized to one of three levels of telephone contacts over 10 months : ( i ) 20 nurse-initiated calls , ( ii ) 10 nurse-initiated calls plus 10 motivational calls programmed through an automated phone calling system , or ( iii ) no program-initiated phone contacts .  Self-reported ( diary ) walking adherence was the primary outcome ; other activity , social support , health quality of life , and measured walking performance , mobility , and body mass index and girths were also assessed during the initiation ( months 1 - 6 ) and maintenance ( months 7 - 10 ) phases of the trial . Results . Average adherence for the 181 participants to the goal of walking at least 20 minutes on 3 or more days per week was 44 % for initiation and 42 % for maintenance . Participants receiving the combination of nurse-initiated personal and automated phone calls  walked significantly more frequently than those with no phone contacts . Fitness improved in all three groups ; changes were generally correlated with self-reported walking . Having a companion was associated with more frequent walking . Perceived quality of physical and mental health did not change . Conclusions . Simple and relatively inexpensive nurse contacts can motivate elderly primary care patients to walk for exercise , and this activity is associated with measurable health benefits OBJECTIVE To describe the 1 ) lifestyle intervention used in the Finnish Diabetes Prevention Study , 2 ) short- and long-term changes in diet and exercise behavior , and 3 ) effect of the intervention on glucose and lipid metabolism . RESEARCH DESIGN AND METHODS There were 522 middle-aged , overweight subjects with impaired glucose tolerance who were r and omized to either a usual care control group or an intensive lifestyle intervention group .  The control group received general dietary and exercise advice at baseline and had an annual physician 's examination . The subjects in the intervention group received additional individualized dietary counseling from a nutritionist . They were also offered circuit-type resistance training sessions and advised to increase overall physical activity .  The intervention was the most intensive during the first year , followed by a maintenance period . The intervention goals were to reduce body weight , reduce dietary and saturated fat , and increase physical activity and dietary fiber . RESULTS The intervention group showed significantly greater improvement in each intervention goal . After 1 and 3 years , weight reductions were 4.5 and 3.5 kg in the intervention group and 1.0 and 0.9 kg in the control group , respectively . Measures of glycemia and lipemia improved more in the intervention group . CONCLUSIONS The intensive lifestyle intervention produced long-term beneficial changes in diet , physical activity , and clinical and biochemical parameters and reduced diabetes risk . This type of intervention is a feasible option to prevent type 2 diabetes and should be implemented in the primary health care system Abstract Objective : To assess the long term effectiveness of the “ green prescription ” programme , a clinician based initiative in general practice that provides counselling on physical activity . Design : Cluster r and omised controlled trial . Practice s were r and omised before systematic screening and recruitment of patients . Setting : 42 rural and urban general practice s in one region of New Zeal and . Subjects : All sedentary 40–79 year old patients visiting their general practitioner during the study 's recruitment period . Intervention : General practitioners were prompted by the patient to give oral and written advice on physical activity during usual consultations . Exercise specialists continued support by telephone and post . Control patients received usual care . Main outcome measures : Change in physical activity , quality of life ( as measured by the “ short form 36 ” ( SF-36 ) question naire ) , cardiovascular risk ( Framingham and D'Agostino equations ) , and blood pressure over a 12 month period . Results : 74 % ( 117/159 ) of general practitioners and 66 % ( 878/1322 ) of screened eligible patients participated in the study . The follow up rate was 85 % ( 750/878 ) . Mean total energy expenditure increased by 9.4 kcal/kg/week ( P=0.001 ) and leisure exercise by 2.7 kcal/kg/week ( P=0.02 ) or 34 minutes/week more in the intervention group than in the control group ( P=0.04 ) . The proportion of the intervention group undertaking 2.5 hours/week of leisure exercise  increased by 9.72 % ( P=0.003 ) more than in the control group ( number needed to treat=10.3 ) . SF-36 measures of self rated “ general health , ” “ role physical , ” “ vitality , ” and “ bodily pain ” improved significantly more in the intervention group ( P<0.05 ) . A trend towards decreasing blood pressure became apparent but no significant difference in four year risk of coronary heart disease . Conclusion : Counselling patients in general practice on exercise is effective in increasing physical activity and improving quality of life over 12 months . What is already known on this topic Counselling patients in general practice on exercise has result ed in gains in physical fitness and activity , but no health benefits have been found What this study adds Counselling patients in general practice on exercise is effective in increasing physical activity and improving quality of life over 12 months without evidence of adverse effects The intervention may reduce blood pressure by an average of 1–2 mm Hg over 12 months No changes in the risk of coronary heart disease were observed The intervention is sustainable in usual general practice Prompting practice staff to deliver the intervention may have increased its Physical inactivity among middle- and older-aged adults is pervasive , and is linked with numerous chronic conditions that diminish health and functioning . Counselor-directed physical activity programs may enhance extrinsic motivation ( reflected in social influence theories , such as self-presentation theory ) and , in turn , physical activity adherence , while the counselor is in charge of program delivery . However , external influences can undermine intrinsic motivation , making it more difficult to maintain physical activity once counselor-initiated contact ends . In contrast , programs that diminish the socially evaluative and controlling aspects of the counseling interchange may promote intrinsic motivation ( described in cognitive evaluation theory ) , and , thus , physical activity maintenance , even when counselor-initiated contact ceases . The objective of the Community Health Advice by Telephone ( CHAT ) project is to compare these two theories by conducting a r and omized controlled trial evaluating the effects of a telephone-administered counseling program delivered by a person ( social influence enhancement ) or computer ( cognitive evaluation enhancement ) on physical activity adoption and maintenance over 18 months . Healthy , sedentary adults ( n = 225 ) aged 55 years and older are r and omized to one of these programs or to a control arm . This study will contribute to advancing motivational theory as well as provide information on the sustained effectiveness of interventions with substantial public health applicability Physical activity levels in young adults are low . Research supports the use of the Transtheoretical Model of behaviour change ( TM ) in design ing physical activity interventions . This study used a pre-post r and omized control design to investigate the effectiveness of a self-instructional intervention for helping sedentary young adults to initiate physical activity . Post-intervention , significantly more of the experimental group ( 80 % ) , in comparison to the control group ( 68 % ) , improved their exercise stage of change ( SOC ) from baseline ( P < 0.05 ) . Discriminant analyses revealed that discrimination between stage improvement/non-improvement was possible using the processes of change data . Stage improvers scored significantly higher on all of the behavioral and four out of five of the cognitive processes of change . For stage improvers , the processes of self-re-evaluation and self-liberation were most frequently used , whilst social liberation was used significantly more by the experimental than the control group . This inexpensive , self-instructional intervention , based on the TM and the ' active living message ' , is an effective method of assisting sedentary young adults to progress through the exercise SOC Physical activity interventions targeting social and physical environments of the urban poor hold promise in improving health outcomes in underserved communities . This study r and omly assigned overweight , sedentary , economically disadvantaged adults to one of three intervention conditions at The Hope and Healing Center , a large inner-city health facility providing numerous options for exercise . Within the tenets of Social Action Theory , the Health Opportunities with Physical Exercise ( HOPE ) trial will test the efficacy of two behavior change models , social support and patient-provider interaction , to increase physical activity . In addition to a st and ard care condition , in which patients have open access to Hope and Healing physical activity programming , patients were assigned to one of two behavior change interventions . Those assigned to patient-peer receive face-to-face , systematic and scheduled encouragement from study -trained ' peer ' interventionists at the facility . Patients assigned to patient-provider receive face-to-face , systematic and scheduled encouragement provided by study -trained ' provider ' interventionists also at the facility . The primary outcomes of change in exercise behavior will be documented by self-reported physical activity and confirmed by fitness testing at baseline , 6 , 12 and 24 months during the 1 year of active intervention and 1 year of relapse prevention follow-up . Intervention conditions will be compared on psychosocial mediators including motivational appraisal s , ratings of social support , rapport , problem solving and self-efficacy for overcoming barriers to increased physical activity . Novel aspects of this intervention include : ( 1 ) delivery of socially based physical activity interventions to an economically disadvantaged urban population , ( 2 ) reduction of environmental barriers to be physically active and ( 3 ) emphasis on social interactions influencing health habit change . Results of this study have the potential to identify mechanisms of behavior change that could be adopted by physical activity interventions aim ed at reducing sedentary behavior and health disparities in high-risk , underserved population BACKGROUND Despite well-known benefits of physical activity for older adults , about two thirds are underactive . Community-based programs are needed to facilitate increased physical activity . We examine the effectiveness of CHAMPS II , an inclusive , choice-based physical activity promotion program to increase lifetime physical activity levels of seniors . CHAMPS guided participants to choose activities that took into account their health , preferences , and abilities . It offered information on ways for them to exercise safely , motivate themselves , overcome barriers , and develop a balanced exercise regimen . METHODS A 1-year r and omized controlled trial was conducted with physically underactive seniors in a multispecialty group practice . Changes in self-reported physical activity by group were evaluated using ANCOVA , controlling for age and sex . RESULTS Of 173 r and omized subjects , 164 ( 95 % ) completed the trial . Subjects were aged 65 to 90 years ( M = 74 , SD = 6 ) ; 66 % were female . The intervention group increased estimated caloric expenditure by 487 calories/week in moderate ( or greater ) intensity activities ( MET > /= 3.0 ; p < .001 ) and by 687 calories/week in physical activities of any intensity ( p < .001 ) . Control group changes were negligible . Between-group analyses found that the changes were significantly different in both measures ( p values < .05 ) . Overweight persons especially benefited from this program . The program was as effective for women , older adults ( 75 + ) , and those who did not set aside time to exercise at baseline . CONCLUSIONS The program led to meaningful physical activity increases . Individually tailored programs to encourage lifestyle changes in seniors may be effective and applicable to health care and community setting Objective —To investigate the impact of a simple written prescription for physical activity given by a general practitioner and the effect of supplementing this with mailed information material s about physical activity . Methods —A controlled trial was conducted in 27 general practice s in New South Wales , Australia . Subjects were sequential routine care patients between 25 and 65 years old . Controls ( n = 386 ) were recruited first , and intervention subjects two weeks later . Intervention subjects were r and omised to receive a prescription only ( n = 380 ) or a prescription plus a mailed booklet ( n = 376 ) . Self reported physical activity levels were measured by interview at baseline , 6–10 weeks , and seven to eight months . Results —By intention to treat , the average changes in minutes of total physical activity did not differ significantly between the groups . Inactive people in the prescription plus supplementary booklet group were significantly more likely than controls to report an increase in their physical activity by at least 60 min/week after 6–10 weeks ( odds ratio 1.58 , 95 % confidence interval 1.06 to 2.35 ) . No significant short term improvements in self reported activity were shown in the prescription only group . In the supplemented group , the proportion reporting an increase in physical activity to 3344 kJ/week at 6–10 weeks was not significant , and neither intervention group showed significant increases in any of the outcome measures at seven to eight months by intention to treat . Treatment received analysis showed greater improvements in intervention groups , especially the prescription plus booklet group , in which the odds of inactive people in this group reporting increased activity became significant at seven to eight months . Conclusions —A prescription for physical activity from a general practitioner , supplemented by additional written material s , can lead to modest short term improvements in self reported physical activity levels among inactive patients . A prescription alone was found not to be effective OBJECTIVES This multicentered r and omized controlled trial evaluated the effect of worksite exercise intervention on perceived work ability and sick leaves . METHODS Women ( N = 260 , mean age 40 years ) engaged in physically dem and ing laundry work were individually r and omized into an intervention ( N = 133 ) or control ( N = 127 ) group . Perceived work ability was assessed with question naires at 3 , 8 , 12 , and 15 months . Sick leave information was obtained from the personnel administration . Follow-up attendance was 100 % at 3 months but declined gradually to 90 % by 15 months . Both the intervention and control subjects received a 30-minute feedback on their physical capacity from a physiotherapist and individual exercise prescription and counseling . The intervention subjects also participated in worksite exercise training guided by a physiotherapist . Sixty-minute sessions ( N = 26 ) were held once a week for 8 months . About 50 % of the intervention group participated in at least two-thirds of the sessions . RESULTS According to a dichotomized work ability index , at 12 months , workers with " good " or " excellent " work ability increased more in the intervention group than in the control group ( 11.0 % , 95 % CI 0.2 - 21.9 ) , as did the health-related prognosis of work ability at 8 months ( 8.1 % , 95 % CI 0.5 - 16.3 ) . There were no statistically significant differences between the two groups as regards job satisfaction , work ability index ( including series of questions on 7 items ) , or sick leaves . CONCLUSIONS Physical activity once a week at worksites improves the perceived work ability of women with physically dem and ing work only slightly . Perceived work ability and sick leaves can not be affected very positively using single-component exercise intervention . Work ability promotion may need a more multiprofessional approach OBJECTIVE to evaluate the effects of brisk walking on bone mineral density in women who had suffered an upper limb fracture . DESIGN r and omized placebo-controlled trial . Assessment s of bone mineral density were made before and at 1 and 2 years after intervention . St and ardized and vali date d measures of physical capacity , self-rated health status and falls were used . SETTING district general hospital outpatient department . SUBJECTS 165 women drawn from local accident and emergency departments with a history of fracture of an upper limb in the previous 2 years . Women were r and omly allocated to intervention ( self-paced brisk walking ) or placebo ( upper limb exercises ) groups . INTERVENTION both groups were seen at 3-monthly intervals to assess progress , measure physical capacity and maintain enthusiasm . The brisk-walking group were instructed to progressively increase the amount and speed of walking in a manner that suited them . The upper limb exercise placebo group were asked to carry out a series of exercises design ed to improve flexibility and fine h and movements , appropriate for a past history of upper limb fracture . RESULTS drop-outs from both intervention and placebo groups were substantial ( 41 % ) , although there were no significant differences in bone mineral density , physical capacity or health status between drop-outs and participants . At 2 years , among those completing the trial , bone mineral density at the femoral neck had fallen in the placebo group to a greater extent than in the brisk-walking group [ mean net difference between intervention and placebo groups 0.019 g/cm2 , 95 % confidence interval ( CI ) -0.0026 to + 0.041 g/cm2 , P = 0.056 ] . Lumbar spine bone mineral density had increased to a similar extent ( + 0.017 g/cm2 ) in both groups . The cumulative risk of falls was higher in the brisk-walking group ( excess risk of 15 per 100 person-years , 95 % CI 1.4 - 29 per 100 person-years , P < 0.05 ) . There were no significant differences in clinical or spinal x-ray fracture risk or self-rated health status between intervention and placebo groups . CONCLUSION the promotion of exercise through brisk-walking advice given by nursing staff may have a small , but clinical ly important , impact on bone mineral density but is associated with an increased risk of falls . Self-paced brisk walking is difficult to evaluate in r and omized controlled trials because of drop-outs , placebo group exercise , limited compliance and lack of st and ardization of the duration and intensity of walking . Further work is needed to evaluate the best means of safely achieving increased activity levels in different groups , such as older women and those at high risk of fractures BACKGROUND Patient-centered Assessment and Counseling on Exercise plus nutrition ( PACE+ ) is an intervention based in primary care setting s to help patients change physical activity and dietary behaviors . METHODS One hundred seventy-three adults were assessed before and after a 4-month intervention . All patients completed a computerized assessment and created tailored " action plans " to change one physical activity and one nutrition behavior that they then discussed with their provider . After the visit , subjects were r and omized to one of four extended intervention conditions : control , mail only , infrequent phone and mail , and frequent phone and mail . Self-report of five target behaviors ( moderate and vigorous physical activity stage of change , dietary fat , fruit/vegetable intake , and overeating behaviors ) was collected at baseline and 4 months . Acceptability measures were also taken . RESULTS Participants in all conditions improved on all behaviors over time , supporting the utility of the computer and provider counseling components . The extended intervention did not produce differential results with respect to mode ( phone or mail ) or intensity ( frequent or infrequent ) . However , for each behavior , participants who targeted the behavior to change improved significantly more than those who did not target the behavior . Acceptability of the intervention was high . CONCLUSIONS Primary care-based , interactive health communication to improve physical activity and dietary behavior is feasible and has promising initial results OBJECTIVE To examine the impact of 3 minimal-contact lifestyle interventions on physical activity in women . METHODS Fifty female volunteers were r and omly assigned to one of 3 lifestyle physical activity interventions for 8 weeks . Subjects wore an accelerometer for a week at baseline and postintervention to objective ly monitor their physical activity . RESULTS Participants significantly increased their physical activity from baseline to postintervention ; however , there was no significant difference in physical activity among the 3 intervention groups . CONCLUSIONS Results of this pilot study support the use of minimal-contact lifestyle interventions to promote physical activity in women The effects of walking training on VO2max , serum lipoproteins and plasma fibrinogen were studied in 119 healthy middle-aged persons . Training prescription was 65 - 75 % of VO2max , 50 min/session , four times a week for 15 weeks . The net difference ( between pre-posttraining changes in the walking and control group ) was statistically significant for VO2max ( 0.14 l .min-1 , 95 % CI 0.04 , 0.23 ) , total cholesterol ( -0.20 mmol.l-1 , CI -0.34 , -0.06 ) , LDL cholesterol ( -0.17 mmol.l-1 , CI -0.29 , -0.05 ) , ratio of HDL cholesterol to total cholesterol ( 0.014 , CI 0.005 , 0.023 ) , and triglycerides ( -0.15 mmol.l-1 , CI -0.26 , -0.04 ) . No statistically significant changes occurred in fibrinogen . The findings indicate that walking training of moderate intensity result ed in a modest increase in VO2max and minor but consistently favorable changes in serum lipoproteins The Advanced Cognitive Training for Independent and Vital Elderly ( ACTIVE ) trial is a r and omized , controlled , single-masked trial design ed to determine whether cognitive training interventions ( memory , reasoning , and speed of information processing ) , which have previously been found to be successful at improving mental abilities under laboratory or small-scale field conditions , can affect cognitively based measures of daily functioning . Enrollment began during 1998 ; 2-year follow-up will be completed by January 2002 . Primary outcomes focus on measures of cognitively dem and ing everyday functioning , including financial management , food preparation , medication use , and driving . Secondary outcomes include health-related quality of life , mobility , and health-service utilization .  Trial participants ( n = 2832 ) are aged 65 and over , and at entry into the trial , did not have significant cognitive , physical , or functional decline .  Because of its size and the carefully developed rigor , ACTIVE may serve as a guide for future behavioral medicine trials of this nature BACKGROUND Both self-help print material s and telephone-assisted counseling have generally proved useful strategies to increase physical activity . This study examined their effectiveness in an intervention aim ed specifically at promoting walking for specific purpose s. METHODS Participants ( n = 399 ) were r and omly allocated to one of two 3-week intervention programs . The Print program comprised multiple mailing of brochures that emphasized walking within the local community environments . The Print plus Telephone program received the same brochures plus three telephone calls . Data collected via mailed self-completed surveys were analyzed by exploring outcomes related to walking for specific purpose s. RESULTS There were no significant differences between the two programs in any of the walking measures . Both groups significantly increased time reported walking for exercise per week [ Print : t(1,277 ) = -3.50 , P < 0.001 ; Print plus telephone : t(1,106 ) = -2.44 , P < 0.016 ] . Significantly , more participants in the Print plus Telephone group reported receiving and reading the material s ( chi2 = 20.11 , P < 0.0001 ) . CONCLUSIONS The intervention programs were more successful at increasing walking for exercise than for any other purpose . The addition of brief telephone support was successful in focusing participants ' attention on the print material s , but did not result in any additional increase in walking OBJECTIVES To study the effects of advice on diet , exercise and their combination on oral glucose tolerance ( OGTT ) , insulin secretion , insulin-like growth factor-1 ( IGF-1 ) and its binding protein , IGFBP-1 . DESIGN A 6-month , r and omized , controlled intervention study . SETTING Primary health care centres in Sollentuna , Stockholm and the Department of Medicine , Karolinska Hospital , Stockholm , Sweden . SUBJECTS One hundred and fifty-seven normoglycaemic healthy men , mean age 46 years , range 35 - 60 years , with slightly to moderately raised cardiovascular risk factors . INTERVENTIONS Advice on diet ( D , n = 40 ) , exercise ( E , n = 39 ) a combination of both ( DE , n = 39 ) and a control group ( C , n = 39 ) . MAIN OUTCOME MEASURES An OGTT , insulin secretion , IGF-1 and its binding protein , IGFBP-1 . RESULTS The number of pathological OGTTs in the intervention groups decreased from 42/118 to 33/118 whilst the number in the control group did not change . Fasting insulin levels decreased in groups E and DE from 8.8 - 7.4 mU L-1 ( P < 0.01 ) and from 8.3 - 6.7 mU L-1 ( P < 0.01 ) , respectively . Accordingly , the insulin area under the curve decreased from 5278 to 4828 ( P < 0.05 ) in group E , and from 5482 to 4809 ( P < 0.01 ) in group DE . IGF-1 only increased in group D. The most prominent changes were noted for IGFBP-1 , which increased in all three intervention groups and to the highest degree in group DE ( from 33.7 - 42.6 micrograms L-1 , P < 0.001 ) . CONCLUSIONS A combination of increased exercise and improved diet , as well as increased exercise alone , favourably affect glucose and insulin homeostasis in middle-aged men with moderately elevated cardiovascular risk factors . The most marked changes were noted for IGFBP-1 , possibly suggesting a decreased insulin secretion and an enhanced insulin sensitivity BACKGROUND There is increasing interest in developing interventions to promote physical activity ( PA ) that do not involve face-to-face contact with health professionals . We developed a fully automated PA counseling system ( telephone-linked communication , TLC-PA ) that was delivered via telephone . DESIGN A r and omized , controlled trial with 298 adult , sedentary members ( mean age , 45.9 years ; 72 % women ; 45 % white ; and 45 % African American ) of a multi-site medical practice . The comparison group ( TLC-Eat ) received an automated intervention promoting healthy eating , which was also delivered via telephone . INTERVENTION The TLC-PA promoted moderate-intensity PA ( MI-PA ) based on the transtheoretical model of behavior change and social cognitive theory . The system was available to participants for 6 months . MAIN OUTCOMES Energy expenditure in MI-PA , proportion of participants who met recommendations for MI-PA , and motivational readiness for PA . MEASURES Self-reports of PA behavior and motivational readiness at baseline , 3 months , and 6 months . RESULTS At 3 months , intention-to-treat analyses showed that the TLC-PA group was more likely to meet recommendations for MI- or vigorous-intensity PA ( VI-PA ) compared to the TLC-Eat group ( TLC-PA=26 % vs TLC-Eat=19.6 % , p=0.04 ) . Among study completers , TLC-PA subjects reported significantly higher daily kilocalorie energy expenditure in MI-PA ( 2.3 kcal/kg/d vs 2.0 kcal/kg/d , p=0.02 ) ; a larger proportion met recommendations for MI- or VI-PA ( 31.2 % vs 21.3 % , p=0.02 ) and were in more advanced stages of motivational readiness than TLC-Eat subjects ( TLC-PA=52.5 % vs TLC-Eat=42.2 % , p=0.04 ) . Results were not maintained at 6 months . The proportion of TLC-PA users decreased significantly over the intervention period . CONCLUSIONS A fully automated counseling system had positive short-term effects on PA among sedentary adults . Lack of maintenance of effects may be due to a decrease in the number of participants who continued to use the system OBJECTIVE The Girls health Enrichment Multisite Studies ( GEMS ) Fun , Food , and Fitness Project ( FFFP ) was design ed to prevent obesity among 8-year-old African-American girls . DESIGN Twelve-week , two-arm parallel group r and omized controlled pilot study . SETTING Summer day camp and homes in Houston , Texas . PARTICIPANTS Thirty-five girls and their parents or caregivers were r and omly assigned to treatment ( N=19 ) or control groups ( N=16 ) . INTERVENTION Girls in the intervention group attended a special 4-week summer day camp , followed by a special 8-week home Internet intervention for the girls and their parents . Control group girls attended a different 4-week summer day camp , followed by a monthly home Internet intervention , neither of which components included the GEMS-FFFP enhancements . MAIN OUTCOME MEASURES Body mass index ( BMI ) , consumption of fruit , 100 % fruit juice , and vegetables ( FJV ) , physical activity . RESULTS After adjusting for baseline BMI , there were no significant differences in BMI between treatment and control group girls , either at the end of the 4-week summer day camp , or after the full 12-week intervention . By the end of the summer camp , the subgroup of treatment group girls heavier at baseline exhibited a trend ( P<.08 ) toward lower BMI , compared to their heavier counterparts in the control group . Overall results at the end of the 12-week program demonstrated substantial , although not significant , differences between treatment and control groups in the hypothesized directions . On average , less than half the treatment sample logged onto the Website , which limited intervention dose . CONCLUSIONS Summer day camp appears to offer promise for initiating health behavior change . Effective methods must be developed and tested to enhance log-on rates among healthy children and their parents before Internet programs can achieve their potential OBJECTIVES To test the effectiveness , in the setting of primary health care , of verbal advice on exercise from a family physician ( FP ) combined with supporting written information . DESIGN A controlled trial with subjects allocated to a control group or one of two intervention groups using a balanced design based on day of the week . SETTING Ten general practice s in Perth , Western Australia . SUBJECTS All sedentary patients consulting an FP . INTERVENTION Verbal advice on exercise from the FP and a pamphlet on exercise mailed to the patient 's home address within 2 days of his/her visit to the doctor . MAIN OUTCOME MEASURE Level of physical activity at follow-up . RESULTS 6,351 adult patients attending an FP practice completed a screening question naire , and 763 sedentary adults were recruited to the project . The response to follow-up , via a postal survey at 1 , 6 , and 12 months after the index consultation was 70 % , 60 % , and 57 % , respectively . At 1 month a sub sample of the control and intervention subjects were contacted for a telephone interview to verify self-reported levels of activity ( n = 136 ) . Treating all nonresponders as sedentary , at 1 month significantly more subjects in the combined intervention groups reported doing some physical activity ( 40 % ) compared with the control group ( 31 % ) . Similarly , at 6 months , 30 % of the control group and 38 % of the combined intervention groups were " now active . " There was very little change at follow-up at 12 months ( 31 % control and 36 % intervention groups , respectively ) . CONCLUSION A simple intervention aim ed at the promotion of physical activity to sedentary patients in general practice can help reduce inactivity Data suggest that low-income and minority individuals are less physically active than the general population . We conducted a constituency-based physical activity promotion program , the Physical Activity for Risk Reduction ( PARR ) project , from 1988 to 1991 , with residents of rental communities administered by the Housing Authority of the Birmingham District in Birmingham , Alabama . Data collected through focus groups and by survey of r and omly selected residents ' exercise practice s , beliefs , barriers to and facilitators of physical activity were used to develop specific intervention programs that were implemented and evaluated in six intervention and two control communities through surveys and process evaluations . Trained community residents conducted data collection and interventions . Ninety-nine percent of respondents in the baseline survey were African Americans . Thirty-one percent reported no participation in any of 13 physical activities in the previous year . Significant differences ( P < .05 ) in average attendance by community at group exercise sessions indicated substantial variability in effectiveness of the intervention , due at least in part to factors related to both the communities and the leaders . This variability appeared to explain patterns of change in preintervention and postintervention physical activity scores in intervention communities . Data and experiences from PARR will be applicable to the delivery of similar types of health-related programs in undeserved communities Background : The American College of Sports Medicine recommends 20–60 minutes of aerobic exercise three to five days a week at an intensity of 40/50–85 % of maximal aerobic power ( Vo2max ) reserve , expending a total of 700–2000 kcal ( 2.93–8.36 MJ ) a week to improve aerobic power and body composition . Objective : To ascertain the minimum effective dose of exercise . Methods : Voluntary , healthy , non-obese , sedentary , postmenopausal women ( n = 121 ) , 48–63 years of age , were r and omised to four low dose walking groups or a control group ; 116 subjects completed the study . The exercise groups walked five days a week for 24 weeks with the following intensity ( % of Vo2max ) and energy expenditure ( kcal/week ) : group W1 , 55%/1500 kcal ; group W2 , 45%/1500 kcal ; group W3 , 55%/1000 kcal ; group W4 , 45%/1000 kcal .  Vo2max  was measured in a direct maximal treadmill test .  Submaximal aerobic fitness was estimated as heart rates at submaximal work levels corresponding to 65 % and 75 % of the baseline Vo2max . The body mass index ( BMI ) was calculated and percentage of body fat ( F% ) estimated from skinfolds . Results : The net change ( the differences between changes in each exercise group and the control group ) in Vo2max was 2.9 ml/min/kg ( 95 % confidence interval ( CI ) 1.5 to 4.2 ) in group W1 , 2.6 ml/min/kg ( 95 % CI 1.3 to 4.0 ) in group W2 , 2.4 ml/min/kg ( 95 % CI 0.9 to 3.8 ) in group W3 , and 2.2 ml/min/kg ( 95 % CI 0.8 to 3.5 ) in group W4 . The heart rates in st and ard submaximal work decreased 4 to 8 beats/min in all the groups . There was no change in BMI , but the F% decreased by about 1 % unit in all the groups . Conclusions : Walking ( for 24 weeks ) at moderate intensity 45 % to 55 % of Vo2max , with a total weekly energy expenditure of 1000–1500 kcal , improves Vo2max and body composition of previously sedentary , non-obese , postmenopausal women . This dose of exercise apparently approaches the minimum effective dose OBJECTIVE : To promote weight loss in Samoan church communities through an exercise program and nutrition education . METHODS : A quasi-experimental design was used to assess weight change , over 1 y , in cohorts of people aged 20–77 y from three non-r and omised Samoan church communities ( two intervention , n=365 and one control , n=106 ) in Auckl and , New Zeal and . The intervention churches received aerobics sessions and nutrition education about dietary fat . RESULTS : Baseline body mass index for the intervention and control churches was ( mean±s.e . ) 34.8±0.4 and 34.3±0.9 kg/m2 , respectively . The intervention churches lost an average of 0.4±0.3 kg compared to a 1.3±0.6 kg weight gain in the control church ( P=0.039 , adjusted for confounders ) . The number of people who were vigorously active increased by 10 % in the intervention churches compared to a 5 % decline in the control church ( P=0.007 ) . Nutrition education had little apparent impact on knowledge or behaviour . CONCLUSION : Samoan communities in New Zeal and are very obese and have high rates of annual weight gain . A community-based intervention program arrested this weight gain in the short term BACKGROUND Exercise counselling is not frequently conducted by family physicians in several countries . Little is known about the exercise counselling practice s of family physicians in Canada . The objective of this study was to assess physician confidence , current versus desired practice , and barriers related to the counselling of exercise by family physicians in Canada . METHODS The study was a cross-sectional survey that included a r and om selection of family physicians in six provinces . A total of 330 family physicians completed the question naire , result ing in a response rate of 61.1 % . A family physician was defined as a physician who practice s family medicine at least 75 % of their practice time . RESULTS A total of 58.2 % believed only 0 - 25 % of their patients would respond to their counselling and 42.4 % felt " moderately knowledgeable " to exercise counsel . Only 11.8 % counselled 76 - 100 % of their patients about exercise , but 43.3 % thought they should be counselling 76 - 100 % of their patients . Barriers to exercise counselling that rated most important included lack of time ( 65.7 % ) and lack of exercise education in medical school ( 64.8 % ) . CONCLUSIONS Family physicians indicated their current level of exercise counselling is suboptimal and confidence levels in exercise counselling were not high . Future educational opportunities for physicians may assist in improving exercise counselling OBJECTIVES This study investigates the effectiveness of 24-week aerobic and weight-training exercise plus behavior modification for mental health and quality of life ( QOL ) outcomes . METHODS Mental health and QOL data was collected using the Depression Anxiety and Stress Scales and SF-36 Health Status Survey , respectively . Employees from a single work-site were r and omized into either treatment or wait-list control groups . RESULTS Mental Health ( P = 0.005 ) , Vitality ( P < 0.001 ) , General Health ( P = 0.009 ) , Bodily Pain ( P = 0.005 ) , Physical Functioning ( P = 0.004 ) , Depression ( P = 0.048 ) , and Stress ( P = 0.036 ) scales significantly improved for the treatment group compared to wait-list controls after 24 weeks . CONCLUSIONS Multimodal exercise is as effective as other single-modality exercise treatments for depressive symptoms and , in contrast to other studies , does improve stress symptoms and QOL outcomes Exercise and diet are the cornerstones of management of non-insulin-dependent diabetes mellitus ( NIDDM ) . Many older people have difficulty in exercising , missing benefits on glycaemic control , weight , cardiac disease and mood . We report the outcomes of a 6 month structured exercise and support programme based on a health promotion model , on physical activity , glycaemic control and parameters of cardiovascular risk in non-exercisers , compared with st and ard outpatient clinic education . A total of 26 non-exercising patients were r and omised to an intervention or control group ( ten men , 16 women ; mean age ( + /- S.D. ) 60 + /- 8 years ) . Programme participation was not associated with any significant increase in activity . Glycated hemoglobin ( HbAtc ) levels tended to stabilise in the intervention group during the 6 month programme and to deteriorate in the control group ( P = 0.03 ) ; by 12 months HbA1C levels deteriorated to a similar level in both . Programme participation did not cause significant change in anthropometric or metabolic parameters . Examining the cohort as a whole , increased activity over 6 months was associated with improvements in weight , body mass index ( BMI ) , body fat and fasting insulin . Activity increases over 12 months were associated with improvements in weight and BMI . These changes could not be attributed to changes in energy intake or dietary composition . We conclude that while exercise can benefit older people with NIDDM , a programme based on a model of health promotion was not effective in increasing physical activity Objective . The authors tested the impact on cardiovascular risk profiles of African American women ages 40 years and older after one year of participation in one of three church-based nutrition and physical activity strategies : a st and ard behavioral group intervention , the st and ard intervention supplemented with spiritual strategies , or self-help strategies . Methods . Women were screened at baseline and after one year of participation . The authors analyzed intention-to-treat within group and between groups using a generalized estimating equations adjustment for intra-church clustering . Because spiritual strategies were added to the st and ard intervention by participants themselves , the results from both active groups were similar and , thus , combined for comparisons with the self-help group . Results . A total of 529 women from 16 churches enrolled . Intervention participants exhibited significant improvements in body weight ( −1.1 lbs ) , waist circumference ( −0.66 inches ) , systolic blood pressure ( −1.6 mmHg ) , dietary energy ( −117 kcal ) , dietary total fat ( −8 g ) , and sodium intake ( −145 mg ) . The self-help group did not . In the active intervention group , women in the top decile for weight loss at one year had even larger , clinical ly meaningful changes in risk outcomes ( −19.8 lbs ) . Conclusions . Intervention participants achieved clinical ly important improvements in cardiovascular disease risk profiles one year after program initiation , which did not occur in the self-help group . Church-based interventions can significantly benefit the cardiovascular health of African American women Two behavioral techniques were assessed to determine their effects on subjects ' adherence to unsupervised exercise . The subjects were 35 moderately fit persons who had just completed an adult fitness program ( AF group ) and 42 sedentary individuals who were recruited through the campus newspaper ( NEWS group ) . Participants were r and omly assigned to one of three conditions : ( a ) self-monitoring , ( b ) reinforcement supplied by another person , or ( c ) control . All subjects were given instructions on how to exercise and asked to exercise on their own for 18 weeks . Self-monitoring subjects kept written records of their exercise behavior , while reinforcement subjects verbally reported their exercise behavior to another person who periodically administered rewards . Pre- and posttreatment tests on the NEWS group revealed no significant treatment or interaction effects . However , the reinforcement group had an 11 % improvement in predicted max VO2 and a 9 bpm improvement in exercise heart rate compared to 7.8 % , 5 bpm for the self-monitoring ( SM ) group and 5.3 % , 6 bpm for the control group . T-tests indicated that reward and SM groups improved significantly on these variables , whereas the control group did not . SM ( M = 2.07 ) and reinforcement ( M = 2.29 ) groups reported a significantly higher frequency of exercise per week than the control ( M = 1.36 ) group . The AF subjects were able to maintain their fitness level ( with the exception of a small increase in body fat ) over the 18-week period . The behavioral interventions had little differential effect on adherence by AF subjects who were already regular exercisers OBJECTIVES The success of any clinical trial depends strongly on recruiting enough participants in a reasonable time period . This paper aims to identify the obstacles , as well as the successful aspects , of recruiting of older participants into an exercise study . DESIGN This describes the recruitment of 299 older adults into a r and omized , controlled trial of exercise advice in a general practice setting . Letters of invitation were sent from two general practice s inviting the patients to attend a 15-minute screening appointment . Patients considered eligible for enrollment were then scheduled for a baseline appointment and r and omized into the trial . SETTING Two general practice s in Adelaide , South Australia . PARTICIPANTS Healthy , sedentary , community-dwelling patients aged 60 years or older . RESULTS A total of 2878 letters of invitation were sent , and 913 patients attended a screening appointment . Of these , 351 ( 38.4 % ) were initially eligible , with one-third excluded because they were already too physically active . Two hundred ninety-nine participants , approximately 1 of every 10 patients sent letters , were enrolled in the project at the end of a 15-week period . DISCUSSION A general practice approach was effective in recruiting 299 older adults  to an  exercise project  within an acceptable time frame . Factors promoting the success of recruitment through general practice included choosing large , well established practice s , computerized age-sex registers , and placing minimal dem and s on the general practitioners and practice staff . A continuing problem with recruiting participants for a project involving exercise is that the volunteer population tends to be healthy and interested in physical activity Objective : The aim of this study is to evaluate , in women with grade 1 essential hypertension , the response of cardio-respiratory and blood pressure ( BP ) after 6 weeks of supervised physical exercise ( PE ) vs only recommended exercise . Methods : Eighteen consecutive hypertensive women whose BP control was stable were assigned r and omly into two exercise groups . Group A including nine patients in an aerobic PE programme supervised by a physiotherapist , aged ( mean ± SD ) 35.5 ± 5.5 years old . Group B , nine patients aged 37.7 ± 7.2 years old , received only oral and written instructions about the benefits of aerobic PE for controlling BP . We used a treadmill for walking to observe the cardio-respiratory and BP response at the beginning and at the end of the period of exercise training , and the response in all the patients , and to test whether there were any differences between the two groups . Results : There were significant differences in cardio-respiratory parameters in group A , in basal VO2/kg post- vs pre-rehabilitation 27.6 ± 5.1 vs 23.1 ± 4.6 , change 4.4 ± 2 ; O2 pulse 10.9 ± 0.9 vs 10.4 ± 1.6 , varied 0.5 ± 0.1 ; furthermore we observed heart rate 73.3 ± 12.37 vs 86.6 ± 12.8 , change −13.4 ± 12.1 and metabolic equivalents of oxygen 9 ± 1.2 vs 6.6 ± 2.7 , change 2.5 ± 1.6 , while in BP in group A , the differences were 153.1 ± 7.1 vs 148.8 ± 13.6 , change −6.3 ± 0.7 mm/g , p < 0.01 between pre- and post-rehabilitation . There were also significant differences between pre- and post-rehabilitation in group A in systolic BP 153 ± 7.3 vs 135.1 ± 16 , change −18.1 ± 4.1 , p < 0.001 and diastolic BP 92.6 ± 10.1 vs 83.5 ± 9.1 , change −9 ± 4 , p < 0.05 ; no change in group B. Finally , an improvement was observed in pulse pressure post-rehabilitation in group A 61.4 ± 15.2 vs 51.6 ± 11.4 , change −9.8 ± 3.9 vs group B 59.4 ± 11.2 vs 59.3 ± 10.6 , only −0.1 ± 0.8 , p < 0.001 . Conclusions : These results suggest that supervised PE  in hypertensive women  significantly improves cardio-respiratory and BP values , as well as vascular adaptability The purpose of this quasi-experimental study was to determine the effectiveness of an occupation based health and fitness program .  Subjects were 1,504 police trainees ( 85 % male , 15 % female ) with an ethnic distribution of 82 % white , 16 % African American , and 2 % other . Data were collected at 25 sites across the state of North Carolina . The sites were r and omly assigned to either the experimental group ( implemented the intervention ) or the control group ( continued usual training ) . As compared with controls , subjects at the experimental sites improved significantly in cardiovascular fitness ( aerobic power ) , general muscular strength ( number of sit ups per minute ) , and flexibility , and lowered their body fat . The intervention required minimal equipment and was taught primarily by peers who received a 1 week training program . This occupational approach to improving health could be particularly useful in occupations with many workers who seldom engage in leisure time physical activity The effects of 12 weeks of home-based exercise training on peak oxygen consumption ( VO2 max ) in healthy sedentary middle-aged men , mean age 49 + /- 6 years , were evaluated . Twenty-one men trained at low intensity , 23 trained at high intensity and 20 were control subjects .  Individually prescribed low- and high-intensity training was performed 5 times per week within a range of 42 to 60 % and 63 to 81 % of baseline VO2 max , corresponding to average heart rates of 102 to 122 and 128 to 148 beats/min , respectively . Caloric expenditure per training session approximated 350 kcal in both groups ; adherence was at least 90 % in both groups . VO2 max increased 8 % in patients who trained at low intensity , 17 % in those who trained at high intensity ( both p less than 0.001 ) , and not at all in control subjects . Low-intensity exercise training at home significantly augments functional capacity in healthy sedentary middle-aged men BACKGROUND So-called atypical depressive symptoms ( carbohydrate craving , prolonged sleep , weight gain , increased appetite ) frequently emerge in association with low illumination to which people are ordinarily exposed indoors , or even outdoors at extreme latitudes in wintertime . Our objective was to analyse the effect of physical exercise alone or combined with bright light on mood and the health-related quality of life during winter . METHODS We carried out a r and omized controlled trial on 120 indoor employees in southern Finl and between November and January . The subjects were allocated to supervised fitness training under bright ( 2500 - 4000 lx ) or ordinary ( 400 - 600 lx ) light conditions in a gym 2 - 3 times weekly for 8 weeks , or supervised relaxation training once a week over the same period as active placebo . We collected question naire data on the changes in mood and health-related quality of life after 4 and 8 weeks of training , and after 4 months follow-up . RESULTS Fitness training in bright light result ed in greater relief from atypical depressive symptoms and more vitality than in ordinary room light . Compared with relaxation alone , the former regime improved general mental health and social functioning in addition to the improvement in depressive symptoms and vitality , whereas the latter only increased vitality . CONCLUSIONS Supervised physical exercise combined with exposure to bright light appears to be an effective intervention for improving mood and certain aspects of the health-related quality of life in wintertime . This effect appears unrelated to the history of season-dependent symptoms , being noticeable among healthy individuals OBJECTIVES To study the potential usefulness of a submaximal self-paced step test as a prediction of maximal aerobic capacity ( VO2max ) in older adults in the primary care setting . DESIGN Data were collected during a prospect i ve r and omized study of an exercise program . SETTING Four university family medical clinics in London , Ontario , Canada . PARTICIPANTS A r and om sample of 240 healthy older ( > or = 65 ) men ( n = 118 ) and women ( n = 122 ) from four family medical clinics underwent  self-paced step testing in the clinic with a family physician ( n = 16 ) , and step testing and a maximal exercise treadmill test with measurement of respired gases in an exercise laboratory . Testing was done in r and om order ( clinic/laboratory ) separated by 2 weeks and then repeated at 52 weeks , following introduction of an exercise program . Relationships between outcome variables were examined by Pearson correlation coefficients while prediction of VO2max was examined using multivariate regression analysis . Cross-validation with 30 age-matched hypertensive and 40 age-matched post-hip arthroplasty patients was used to test the accuracy of the predictive models . MEASUREMENTS Measured VO2max , predicted VO2max , step test time , step test heart rate , body mass index ( BMI ) , and O2 pulse . RESULTS Two hundred women ( n = 108 ) and men ( n = 92 ) completed both the initial and 52-week assessment s. Stepping time , heart rate , age , BMI , and O2 pulse were strongly associated with VO2max for both a normal and a fast step pace and were chosen to develop the predictive model . Normal step-pace correlation with VO2max ( ml/kg/min ) was no different ( female 0.93 : male 0.91 ) from fast pace ( 0.95:0.90 ) with no difference between clinic and laboratory measurement at baseline or 52 weeks . Cross-validation showed no significant difference from the main group using the predictive model . CONCLUSIONS The self-paced step test is a safe and simple clinical instrument that strongly and reliably predicts VO2max , is sensitive to change , and is generalizable in the family practice setting among community-dwelling older adults differing in fitness and health status This study 's purpose was to test the effects of a reversal theory-driven individualized exercise prescription on exercise consistency , weight , percentage body fat , and exercise motivation for a group of faculty , students , and staff at a southwestern university . Participants were r and omly assigned to 5-week education plus monitoring or monitoring-only treatment groups . The hypothesis was that participants in the education plus monitoring group would have more consistent exercisers , higher exercise motivation scores , and greater overall weight loss and decrease in percentage of body fat than would those in the monitoring-only group . Consistent exercisers will score higher than inconsistent exercisers on exercise motivation scores . More participants were exercising at recommended levels in the education plus monitoring group than in the monitoring-only group after the study intervention . Consistent exercisers had significantly higher motivation scores than did inconsistent exercisers . Thus , individualized exercise prescriptions using reversal theory can be beneficial in promoting a consistent exercise program BACKGROUND Depression in elderly people may be contributed to by the multiple losses of aging . Exercise has the potential to positively impact many of these losses simultaneously . We tested the hypothesis that progressive resistance training ( PRT ) would reduce depression while improving physiologic capacity , quality of life , morale , function and self-efficacy without adverse events in an older , significantly depressed population . METHODS We conducted a 10-week r and omized controlled trial of volunteers aged 60 and above with major or minor depression or dysthymia . Subjects were r and omized for 10 weeks to either a supervised PRT program three times a week or an attention-control group . RESULTS A total of 32 subjects aged 60 - 84 , mean age 71.3 + /- 1.2 yr , were r and omized and completed the study . No significant adverse events occurred . Median compliance was 95 % . PRT significantly reduced all depression measures ( Beck Depression Inventory in exercisers 21.3 + /- 1.8 to 9.8 + /- 2.4 versus controls 18.4 + /- 1.7 to 13.8 + /- 2 , p = .002 ; Hamilton Rating Scale of Depression in exercisers 12.3 + /- 0.9 to 5.3 + /- 1.3 versus controls 11.4 + /- 1.0 to 8.9 + /- 1.3 , p = .008 ) . Quality of life subscales of bodily pain ( p = .001 ) , vitality ( p = .002 ) , social functioning ( p = .008 ) , and role emotional ( p = .02 ) were all significantly improved by exercise compared to controls . Strength increased a mean of 33 % + /- 4 % in exercisers and decreased 2 % + /- 2 % in controls ( p < .0001 ) . In a multiple stepwise regression model , intensity of training was a significant independent predictor of decrease in depression scores ( r2 = .617 , p = .0002 ) . CONCLUSIONS PRT is an effective antidepressant in depressed elders , while also improving strength , morale , and quality of life The purpose of this study is to evaluate the effect of a preintervention physical activity preparatory course on physical activity , and social , cognitive , and transtheoretical constructs . The sample included 82 low-income , multiethnic women ( 75 % Latina ) who completed an 8-week course design ed to prepare them to become more active prior to r and omization into a 10-month physical activity intervention .  Participants completed precourse and postcourse measures . Paired-comparison t tests showed increases in knowledge , perceived social support for exercise , minutes of walking per week , and total cognitive and behavioral processes following the preparatory course . Perceived barriers and self-efficacy for exercise did not change from precourse to postcourse . Preintervention preparatory courses may be an effective way to increase social and cognitive constructs associated with physical activity behavior , potentially yielding a greater effect from subsequent interventions Many have studied the effects of different lifestyles on disease , mortality or risk factors for a disease , but little is known about how behaviour is changed in the population . We studied the need for counselling and its effect on willingness and ability to change lifestyle , and subsequent changes in CHD risk factors .  All 152 male employees in a computer company , 25 - 45 years of age , were invited to participate . Subjects were r and omized into an intervention group ( I-group ) and a control group . The I-group was divided into subgroups based on baseline behaviour and risk factor status . Changes were evaluated after 1 year . After an initial health examination , participants from the I-group were counselled at baseline and after 5 months . Eighty-five ( 56 % ) males participated . Twenty-nine were assigned to a control group and 56 to an intervention group ( I-group ) ( dropout = 8) . An exercise group ( E-group ) was advised to exercise aerobically three times/week , a diet group to reduce the intake of saturated fat and increase fish products , and smokers to quit smoking . Forty subjects were recommended one or more behavioural changes and eight had no need . Thirty-four were willing to make behavioural changes . Compared to the control group , the fitness level increased ( P < 0.01 ) and body weight decreased in the I-group ( P < 0.05 ) . It may be concluded that individual counselling promotes regular exercise with subsequent improvements in CHD risk factors . The diet- and smoking counselling models were less successful in terms of adherence A center-based program was design ed and implemented to promote aerobic physical activity among healthy Black-American families with children in the fifth through seventh grade s. Ninety-four Black-American families were actively recruited and r and omly as signed to an experimental or control group . Families in the experimental group were encouraged to participate in a program with the following features : one education and two fitness sessions per week for 14 weeks ; educational sessions that included individual counseling , small group education , aerobic activity , and snack components ; located in a convenient building cherished by the community ; aerobic activity sessions in a fitness center outfitted and staffed according to modern characteristics ; a variety of incentives including free transportation and babysitting and reminders to promote attendance . Per cent participation was low , with about 20 % participating in the desired fitness center sessions by the end of the program . As a result of low participation , no differences were detected beween experimental and control groups on indicators of cardiovascular fitness . In postprogram interviews , conflicts with work and school events were the most commonly reported reasons for nonattendance . We concluded that because of difficulties in at tendance , center-based programs appear to have limited value as the sole modality for intervention in public health programs for promoting physical activity among healthy This study prospect ively investigated the effects of major life events on subsequent  exercise adherence rates of individuals ( N = 173 ) participating in a 2-year , r and omized , controlled clinical trial of 3 different exercise conditions ( higher-intensity home-based ; lower-intensity home-based ; and higher-intensity class-based ) . For 3 of 4 6-month exercise-adherence periods , an analysis of variance indicated a significant main effect ( p < .05 ) for major life events . Compared with participants reporting 0 or 1 major life event ,  exercise adherence in the maintenance phase was significantly lower for those reporting 3 or 4 major life events regardless of the exercise condition . No significant life-event-exercise-adherence relationship was found in the adoption phase of exercise participation ( i.e. , Months 1 to 6 ) . The deleterious effect of life events emphasizes the importance of instruction regarding how to prepare for high-risk situations that can lead to missed exercise sessions or to program attrition OBJECTIVE the effects of regular exercise over 5 years on mortality and ADL impairment were evaluated in elderly people . DESIGN intervention study . SETTING Tsuru City , Yamanashi Prefecture , Japan . METHODS the subjects of this study were 245 elderly people living at home . Of these individuals , 155 ( 56 males aged 76.5+/-4.2 years at the baseline level ; 99 females aged 76.2+/-4.8 years ) who voluntarily participated in our original health-promoting programme were regarded as an intervention group . The remaining 90 ( 29 males aged 77.6+/-5.2 years at the baseline level ; 61 females aged 77.3+/-5.1 years ) were regarded as a control group . The programme was a 5-year intervention consisting of collective sessions given six times a year every 2 months . The intervention was a combination of an exercise programme based on theories of exercise physiology and a support programme based on health education theories . The relative risks of death and ADL impairment adjusted for age , presence or absence of cardiovascular or musculo-skeletal disorders , and functional fitness level at the baseline were calculated using logistic regression analysis . RESULTS the rates of participant compliance per year were 67.7 % in the first year of the intervention period and gradually decreased thereafter to 43.9 % in the last year . Amongst female subjects the percentage of those who exercised habitually at the end of the study period was the same as that in the baseline in the intervention group but was significantly lower at the end of the study in the control group ( chi2 = 10.576 , P < 0.01 ) . The relative risk of death in the intervention group was 1.0 ( 95 % CI 0.22 - 4.51 ) amongst the males and 0.16 ( 95 % CI 0.03 - 0.81 ) amongst the females . Relative risk of ADL impairment was 0.22 ( 95 % CI 0.03 - 1.42 ) amongst the males and 0.36 ( 95 % CI 0.13 - 1.02 ) amongst the females . CONCLUSION These findings suggest that the improved mortality and state of independence in the female portion of the intervention group occurred as a result of increased physical exercise levels in daily life . However , validation of our results must await research that employs a r and omized control trial to avoid various biases and confounding factors between the intervention and the control groups BACKGROUND Although inactivity is an important contributor to impaired functioning and disability with age , little is known concerning how improvements in physical functioning and well-being in older adults vary with the type of physical activity undertaken . METHODS One hundred three adults age 65 years and older , recruited via population -based methods , were r and omized to 12 months of community-based , moderate-intensity endurance and strengthening exercises ( Fit & Firm ) or stretching and flexibility exercises ( Stretch & Flex ) . A combination of class- and home-based exercise formats was used . Measured and self-rated physical performance along with perceived functioning and well-being were assessed pre- and postintervention . RESULTS Fit & Firm subjects showed greater 12-month improvements in both measured and self-rated endurance and strength compared to Stretch & Flex subjects . Stretch & Flex subjects reported greater improvements in bodily pain , and Stretch & Flex men evidence d greater improvements in flexibility relative to Fit & Firm subjects . Although overall exercise adherence was high in both exercise conditions ( approximately 80 % ) , subjects in both conditions showed better adherence to the home- versus class-based portions of their exercise prescriptions . CONCLUSIONS Community-based programs focusing on moderate-intensity endurance and strengthening exercises or flexibility exercises can be delivered through a combination of formats that result in improvement in important functional and well-being outcomes . This represents one of the first studies to report significant improvements in an important quality of life outcome -bodily pain-with a regular regimen of stretching and flexibility exercises in a community-based sample of older adults OBJECTIVE This study examined , in a group of older patients , ( a ) the effectiveness of an invitation to participate in a program providing individualized physical activity advice in a primary care setting and ( b ) the changes in self-reported physical activity and symptoms in patients with osteoarthritis ( OA ) . METHODS Healthy , sedentary community-dwelling men and women aged 60 years or more were invited to participate . Following r and om allocation , the intervention group received individualized physical activity advice at baseline and at 3 , 6 , and 12 months followup . RESULTS Of the 299 people who satisfied the study 's inclusion criteria , a subgroup of 69 people reported pain and stiffness of the hip or knee at baseline . These patients reported increases in frequency and time of walking and vigorous exercise ( all P < 0.001 ) , with no change to OA symptom scores ( pain and stiffness ) , and a small decline in physical functioning was reported at 12 months followup in the control group only ( P = 0.027 ) . At the 12-month followup more intervention participants than control participants ( P = 0.013 ) reported a greater intention to exercise . CONCLUSIONS An offer of primary care-based physical activity advice , with an emphasis on the benefits for general health ( rather than " treatment " for OA ) , will attract individuals with OA symptoms . Although the present study was unable to demonstrate intervention-control group differences for the majority of outcomes , intention to exercise did appear to be positively influenced Purpose . To assess the effectiveness of applying behavior change theory to a physical activity intervention for obese , sedentary women . Design . A 48-week r and omized controlled trial . Subjects were r and omized to one of two intervention groups . Setting . A university classroom and a local health club . Subjects . Fifty-eight sedentary , obese women . Interventions . A 24-week theory-based physical activity program that aims to change the way subjects think and behave in relation to physical activity ( treatment group , n = 29 ) and a traditionally structured exercise program ( control group , n = 29 ) . Measures . Question naires on physical activity , stage of change , processes of change , and self-efficacy were completed at baseline , 24 weeks , and 48 weeks . Results . Twenty-seven of the 29 participants in the treatment group and 17 participants in the control group completed the study . Analysis of variance revealed significant and positive changes in measures of eight processes of change , self-efficacy , physical activity , and cardiorespiratory fitness in the treatment group at 24 weeks . All but one of these changes were maintained at 48 weeks . In the control group , significant changes occurred in only two processes of change , and no change occurred in self-efficacy , physical activity , or cardiorespiratory fitness at 24 or 48 weeks . Conclusion . A theory-based intervention is more likely to change the way obese women think and behave in relation to physical activity than a traditional exercise program that does not incorporate behavior change theory Public health groups use mass media communications to address the problem of sedentary behaviour . However , these campaigns are poorly evaluated and lack tailoring . Campaigns and question naires were developed based on existing theoreti cal , cross - sectional , and qualitative data regarding how to promote walking with people who are not regularly active . Subjects were volunteer white - collar employees ( n = 181 ) r and omly allocated by quota to the campaigns , or control , for one week . One - hundred - thirty - eight subjects ( 76 . 2 % ) completed pre - and postcampaign ques tionnaires . T his study successfully ( 1 ) developed four new tailored campaigns to promote walking according to a formalized process that health promoters can adapt and refine , ( 2 ) developed a complimentary measure of outcomes , and ( 3 ) compared the new campaigns with the English Health Education Authority ( HEA ) '' Active for L ife '' campaign ( control ) Mental health and quality of life were assessed before and after a one-year exercise and diet intervention among 219 healthy individuals , aged 41 - 50 years , with elevated risk factors for cardiovascular disease . The participants were r and omized to four groups : diet ( n = 55 ) , diet and exercise ( n = 67 ) , exercise ( n = 54 ) and no active intervention ( n = 43 ) . Quality of life was measured with one eight-item scale and two one-item scales . Mental health was measured by the General Health Question naire ( 30-item version ) . Depression , anxiety , feelings of competence and self-esteem , coping and social dysfunction were measured using subscales of the General Health Question naire . Somatic anxiety was measured by the anxiety subscale of the Symptom Check List-90 . Exercise improved the total GHQ scores , perceived competence/self-esteem , and coping as measured by the GHQ subscales . There were no significant effects of diet or exercise on quality of life , depression or anxiety . A high rate of participation in the exercise programme ( > 70 % ) was associated with greater improvements in total GHQ scores , anxiety , perceived competence/self-esteem and coping BACKGROUND Physical activity is a major modifiable risk factor for cardiovascular disease , but it is unclear what combination of feasible approaches , using existing re sources in primary care , work best to initiate increased physical activity . AIM To assess three approaches to initiate increased physical activity . DESIGN OF STUDY R and omised controlled ( 2 X 2 X 2 ) factorial trial . SETTING Four general practice s. METHOD One hundred and fifty-one sedentary patients with computer documented risk factors for cardiovascular disease were r and omised to eight groups defined by three factors :  prescription by general practitioners ( GPs ) for brisk exercise not requiring a leisure facility ( for example , walking ) 30 minutes per day , 5 days per week ; counselling by practice nurses , based on psychological theory to modify intentions and perceived control of behaviour , and using behavioural implementation techniques ( for example , contracting , ' rehearsal ' ) ; use of the Health Education Authority booklet ' Getting active , feeling fit ' . RESULTS Single interventions had modest effects . There was a trend from the least intensive interventions ( control + /- booklet ) to the more intensive interventions ( prescription and counselling combined + /- booklet ) for both increased physical activity and fitness ( test for trend , P = 0.02 and P = 0.05 , respectively ) . Only with the most intense intervention ( prescription and counselling combined ) were there significant increases in both physical activity and fitness from baseline ( Godin score = 14.4 , 95 % confidence interval [ CI ] = 7.8 to 21 , which was equivalent to three 15-minute sessions of brisk exercise and a 6-minute walking distance = 28.5 m , respectively , 95 % CI = 11.1 to 45.8 ) . Counselling only made a difference among those individuals with lower intention at baseline . CONCLUSION Feasible interventions using available staff , which combine exercise prescription and counselling explicitly based on psychological theory , can probably initiate important increases in physical activity OBJECTIVE To assess the cost-effectiveness of a primary care based intervention aim ed at increasing levels of physical activity in inactive people aged 45 - 74 . METHODS A total of 714 inactive people aged 45 - 74 , taken from two west London general practice s , were r and omised into two groups . Intervention subjects were invited to a consultation with an exercise development officer , and offered a personalised 10 week programme to increase their level of regular physical activity , combining leisure centre and home based activities . Control subjects were sent information on local leisure centres . All subjects were followed up at eight months . RESULTS There was a net 10.6 % ( 95 % confidence interval 4.5 to 16.9 % ) reduction in the proportion of people classified as sedentary in the intervention group compared with the control group , eight months after the intervention . The intervention group also reported an increase in the mean number of episodes of physical activity per week , as compared with the control group ( an additional 1.52 episodes ( 95 % confidence interval 1.14 to 1.95 ) ) . The cost of moving a person out of the sedentary group was shown to be less than 650 Pounds . The cost of moving someone to the now commonly recommended level was estimated at almost 2500 Pounds . CONCLUSIONS Moderate physical activity can be successfully encouraged in previously sedentary men and women aged 45 - 74 through a primary care based intervention . The process of recruitment was the most important variable cost . A high uptake rate would maximise cost-effectiveness , and sensitivity analysis suggests that unit costs could be halved with a more effective recruitment strategy BACKGROUND The role of walking , as compared with vigorous exercise , in the prevention of coronary heart disease remains controversial , and data for women on this topic are sparse . METHODS We prospect ively examined the associations between the score for total physical activity , walking , and vigorous exercise and the incidence of coronary events among 72,488 female nurses who were 40 to 65 years old in 1986 . Participants were free of diagnosed cardiovascular disease or cancer at the time of entry and completed serial detailed question naires about physical activity . During eight years of follow-up , we documented 645 incident coronary events ( nonfatal myocardial infa rct ion or death from coronary disease ) . RESULTS There was a strong , grade d inverse association between physical activity and the risk of coronary events . As compared with women in the lowest quintile group for energy expenditure ( expressed as the metabolic-equivalent [ MET ] score ) , women in increasing quintile groups had age-adjusted relative risks of 0.77 , 0.65 , 0.54 , and 0.46 for coronary events ( P for trend < 0.001 ) . In multivariate analyses , the inverse gradient remained strong ( relative risks , 0.88 , 0.81 , 0.74 , and 0.66 for women in increasing quintile groups as compared with those in the lowest quintile group ; P for trend=0.002 ) . Walking was inversely associated with the risk of coronary events ; women in the highest quintile group for walking , who walked the equivalent of three or more hours per week at a brisk pace , had a multivariate relative risk of 0.65 ( 95 percent confidence interval , 0.47 to 0.91 ) as compared with women who walked infrequently . Regular vigorous exercise ( > or = 6 MET ) was associated with similar risk reductions ( 30 to 40 percent ) . Sedentary women who became active in middle adulthood or later had a lower risk of coronary events than their counterparts who remained sedentary . CONCLUSIONS These prospect i ve data indicate that brisk walking and vigorous exercise are associated with substantial and similar reductions in the incidence of coronary events among women BACKGROUND Information is lacking about the physiological and psychosocial effects of exercise among very old persons . AIM To investigate the effect of a twice-weekly , six-month progressive walking programme on 38 healthy women in their ninth decade , for evidence of the benefits of exercise . METHODS Aerobic fitness , blood pressure , skinfold thickness and habitual activity patterns were studied in a r and omised controlled trial . Women were chosen , as this is a group of increasing demographic importance for which studies are lacking . RESULTS The training group and control group were not significantly different at baseline . However , after six months of progressive exercise the training group showed lower resting ( p < 0.05 ) and working ( p < 0.005 ) heart rates compared with non-exercising controls . ANCOVA analyses indicated higher scores for the training group compared with the control group for Maximum Current Activity and Normative Impairment Index ( both p < 0.001 ) , which are both components of the Habitual Activity Profile . Morale also significantly improved within the training group ( p < 0.01 ) . CONCLUSIONS These data show the trainability of very old women and the positive impact a low frequency , progressive exercise programme can have on cardiorespiratory fitness and daily living activity patterns . Such improvements are likely to be indicative of an enhanced outlook for independence BACKGROUND Over the last 10 years ' exercise referral schemes ' have been popular even though the evidence for effectiveness of any one-to-one intervention in primary care is deficient . We report the results of a primary care based one-to-one intervention that compared the effect of two communication styles with a no-intervention control group on self-reported physical activity at 12 months . METHODS In all , 1658 middle-aged men and women were r and omly assigned to 30 minutes of brief negotiation or direct advice in primary care or a no-intervention control group . The main outcome was self-reported physical activity at 12 months . Secondary outcome measures included change in blood pressure and body mass index . RESULTS Intention-to-treat analysis revealed no significant differences in physical activity between groups . Brief negotiation group participants who completed the study increased their physical activity significantly more than controls . There was no change in body mass index in any group . The brief negotiation group produced a greater reduction in diastolic blood pressure than direct advice . CONCLUSION If patients whose health may benefit from increased physical activity seek advice in primary care , 20 - 30 minutes of brief negotiation to increase physical activity is probably more effective than similar attempts to persuade or coerce . However , blanket physical activity promotion in primary care is not effective . The most effective way of increasing physical activity in primary care has yet to be determined Objectives : To determine the effects of gymnastics on the health related quality of life ( HRQoL ) and functional status of independently living people , aged 65 to 80 years .  Gymnastics formed part of the More Exercise for Seniors ( MBvO in Dutch ) programme , a group based exercise programme for older adults in the Netherl and s. It has been widely implemented since 1980 . Design : R and omised controlled trial with pretest and post-test measurements . Intervention : The exercise programme given by experienced instructors lasted 10 weeks and was given weekly ( MBvO1 ; n = 125 , six groups ) or twice weekly ( MBvO2 ; n = 68 , six groups ) . The control group ( n = 193 ) was offered a health education programme . Setting : Community dwelling of older people , with a comparatively low level of fitness as assessed with the Groningen Fitness test for the Elderly . Results : No significant effects were found on the HRQoL ( Vitality Plus Scale , TAAQoL , and R AND -36 ) and the functional status ( Physical Performance Test and the Groningen Activity Restriction Scale ) . The MBvO2 group , with a low level of physical activity at baseline , showed the only improvement found on the Vitality Plus Scale ( F = 4.53 ; p = 0.01 ) . Conclusions : MBvO gymnastics once a week did not provide benefits in HRQoL and functional status after 10 weeks . However , participants with a low level of physical activity may benefit from MBvO gymnastics if they participate twice a week . To improve the health of the general public , sedentary older adults should be recruited and encouraged to combine MBvO with the health enhancing physical activity guidelines Eighty-one sedentary but healthy men aged 30 - 55 participated in a 1 yr r and omized study of the effects of exercise on  plasma lipoprotein concentrations . Forty-eight were assigned to a running program , while 33 remained as sedentary controls ( an approximately 3:2 ratio ) . After 1 yr the running group had become significantly fitter and leaner than the control group . Lipoprotein concentration changes in the runners ( vs. controls ) uniformly favored reduced risk of coronary heart disease , but were not significant when all 46 participants with complete data were included . However , the 25 men who averaged at least eight miles ( 12.9 kilometers ) per wk of running increased their plasma high-density-lipoprotein ( HDL ) cholesterol level by 4.4 mg/dl ( p = 0.045 ) and their HDL2 mass level by 33 mg/dl ( p = 0.059 ) , vs. controls . Significant correlations were found for distance run per wk vs. change in plasma HDL-cholesterol ( r = 0.48 ) , HDL2 ( r = 0.41 ) , and low-density-lipoprotein cholesterol ( r = -0.31 ) . Changes in percent body fat and in HDL-cholesterol were correlated ( r = -0.47 ) in runners . There appears to be a threshold at about 8 miles per wk above which a 1-yr running program leads to beneficial lipoprotein changes This study identified the knowledge base and practice s of Registered Nurse , . Certified Diabetes Educators ( RN , CDEs ) regarding their exercise teaching programs for elderly clients who have non-insulin-dependent diabetes mellitus ( NIDDM ) . The r and om sample of 197 AADE members surveyed by question naire was a highly educated and experienced group . RN , CDEs who worked 30 or more hours per week in diabetes education or attended four or more continuing education ( CE ) programs per year had significantly more comprehensive exercise teaching program design s and instructional techniques to enhance elderly NIDDM clients ' learning ( P<.05 ) . However ; many CDEs do not teach their elderly clients about exercise due to lack of re sources , lack of specific knowledge to prescribe exercise , and negative stereotypes of elderly clients ' ability to exercise . Greater availability of educational programs for CDEs to explore curriculum development , program planning , evaluation , and exercise prescription for elderly clients with multisystem disease is recommended BACKGROUND Mediated physical activity interventions can reach large numbers of people at low cost . Programs delivered through the mail that target the stage of motivational readiness have been shown to increase activity . Communication technology ( websites and e-mail ) might provide a means for delivering similar programs . METHODS R and omized trial conducted between August and October 2001 . Participants included staff at an Australian university ( n=655 ; mean age=43 , st and ard deviation , 10 years ) . Participants were r and omized to either an 8-week , stage-targeted print program ( Print ) or 8-week , stage-targeted website ( Web ) program . The main outcome was change in self-reported physical activity . RESULTS There was no significant increase in total reported physical activity within or between groups when analyzed by intention to treat ( F [1,653]=0.41 , p=0.52 ) . There was a significant increase in total physical activity reported by the Print participants who were inactive at baseline ( t [1,173]=-2.21 , p=0.04 ) , and a significant decrease in the average time spent sitting on a weekday in the Web group ( t [1,326]=2.2 , p=0.03 ) . CONCLUSIONS There were no differences between the Print and Web program effects on reported physical activity . The Print group demonstrated slightly larger effects and a higher level of recognition of program material PURPOSE Project Active is a r and omized clinical trial ( N = 235 ) comparing a lifestyle physical activity program with a structured exercise program in changing physical activity ( total energy expenditure [ kcal.kg-1.d-1 ] ) and cardiorespiratory fitness ( VO2peak in mL.kg-1.min-1 ) . METHODS Sedentary but healthy adults ( N = 235 ) aged 35 - 60 years received 6 months of intensive intervention . RESULTS Analysis of covariance ( ANCOVA ) , adjusting for baseline measure , age , gender , body mass index ( BMI ) , cohort , and ethnicity , showed that at 6 months both lifestyle and structured groups significantly increased energy expenditure over baseline ( P < 0.001 ) . The mean increases + /- SE , 1.53 + /- 0.19 kcal.kg-1.d-1 for the lifestyle group and 1.34 + /- 0.20 kcal.kg-1 d-1 for the structured group , were not significantly different between groups ( P = 0.49 ) . For cardiorespiratory fitness , both groups had significant increases from baseline ( P < 0.001 ) . Mean increases + /- SE were 1.58 + /- 0.33 mL.kg-1.min-1 and 3.64 + /- 0.33 mL.kg-1.min-1 for the lifestyle and structured groups , respectively . This was significantly greater in the structured group ( P < 0.001 ) . We also studied changes in intensity of physical activity . Both groups significantly increased moderate intensity activity from baseline , but the increase was significantly greater in the lifestyle group than the structured group ( P = 0.02 ) . In contrast , the structured group increased its hard activity more than the lifestyle group , but the difference was not significantly different ( P = 0.02 ) . In contrast , the structured group increased its hard increased ( P < 0.01 ) for both groups by 0.25 kcal.kg-1.d-1 . CONCLUSION Both intervention approaches are effective for increasing physical activity and fitness over a 6-month period in initially sedentary men and women BACKGROUND The goal of the present study was to examine participants ' perceptions of a theory-driven , physical activity promotion website . METHODS Participants in the present study were individuals in the website condition of a r and omized trial design ed to test the efficacy of the website .  At 1 month , participants were surveyed regarding their self-report of barriers , frequency of use , and helpfulness of the website . RESULTS Overall , 30 worksite participants were r and omized to the website condition and 24 ( 80 % ) completed the survey at 1 month . The main barrier to using the website was a " lack of time " ( 63 % ) . No participants endorsed trouble using the website , a lack of interest in using the internet , or a lack of interest in changing their activity level as barriers to using the website . Furthermore , most sections of the website were found to be " helpful . " Patterns of use and perceived utility differed by readiness to become active . For example , more respondents in the " preparation " stage at baseline reported using the overall website , in addition to the " becoming active " and " physical activity and health " sections , than those in the " contemplation " stage at baseline . Perceived utility and frequency of use of specific sections were often divergent , where some sections were rated more helpful and used less frequently ( the " Overcoming Barriers " section , for example ) , while the reverse was true for other sections ( the " Walking Fitness Test " section , for example ) . CONCLUSION In conclusion , the website was well accepted and few barriers were noted . Areas of the website that were used less frequently or found to be less helpful will become areas of focus for future iterations of the site BACKGROUND Perceptions of personal efficacy have been consistently identified as being determinants of exercise adherence in asymptomatic , rehabilitative , younger , and older population s. The present study incorporated a r and omized control design in an effort to examine the effects of an efficacy-based intervention in enhancing exercise adherence in a large sample ( N = 114 ) of formerly sedentary middle-aged males and females . METHODS Subjects r and omly assigned to an exercise plus intervention group or an exercise plus attentional control group participated in a 5-month long walking program led by trained personnel . Exercise behavior ( frequency , miles walked , duration ) were assessed on a continuous basis and self-efficacy was measured at 1 , 2 , and 4 months . RESULTS Repeated measures multivariate analyses revealed a significant treatment effect with subjects in the intervention group exercising more frequently , for longer duration , and walking greater distances over the course of the program . Path analysis indicated that the effect of the treatment on adherence was direct rather than through self-efficacy as hypothesized . Self-efficacy was , however , a significant predictor of exercise behavior in the early and middle stages of the exercise program but not during the last month . CONCLUSIONS An intervention program design ed to maximize information pertaining to participants ' capabilities appears to have had a reasonable effect on reducing attrition in middle-aged males and females and self-efficacy was a significant predictor of exercise frequency over time . Further research efforts are required to tease out those cognitive factors that might underlie any effects of interventions in exercise adherence The purpose of this research was to explore the role of exercise in preventing falls , specifically assessing the effectiveness of an ankle strengthening and walking program to improve balance , ankle strength , walking speed , and falls efficacy and to decrease falls and subjects ' fear of falling .  Sixteen individuals participated in the study which was conducted at two nursing homes . Subjects were assigned r and omly to an intervention or control group . The participants in the intervention group completed a 3-month supervised program of ankle strengthening exercises and walking . Descriptive statistics were used to characterize the sample , and differences in the least square means were used to assess the outcome variables ( i.e. , balance , ankle strength , walking speed , falls , fear of falling , falls efficacy ) before the exercise program , and again at 3 months and 6 months after the program for the intervention and control subjects . Findings for the intervention group from pretest to 3-month posttest were , for the most part , maintained or in the predicted direction , suggesting that regular exercise shows promise for preventing deterioration and improving fall-related outcomes for elderly nursing home residents OBJECTIVE : To examine the effects of a GP exercise referral programme on modifiable  coronary heart disease risk factors . DESIGN : R and omised controlled trial . A battery of vali date d measures were carried out at 0 , 8 , 16 , 26 , and 37 weeks . SETTING : Two community health centres and a leisure centre in Hailsham , East Sussex . SUBJECTS : 389 patients ( smokers , hypertensive or overweight ) were selected from medical records , screened for contraindications to exercise and 345 were invited into the study . Of 142 patients r and omly allocated , 40 ( 41 % ) completed the study in the exercise group and 31 ( 69 % ) in the control group .  Sixty ( 35 % ) invited smokers ( 48 % of non-smokers ) , 71 ( 38 % ) invited hypertensive patients ( 45 % of non-hypertensive patients ) , and 107 ( 45 % ) overweight patients ( 33 % of non-overweight patients ) were r and omised . Of those r and omised , 27 ( 45 % ) smokers , 52 ( 48 % ) overweight , and 43 ( 61 % ) hypertensive patients completed the study . INTERVENTION : The exercise group was offered 20 , half price sessions over 10 weeks at a leisure centre . Patients engaged in moderate and vigorous aerobic type activity on various exercise machines , in a semi-supervised , informal environment . RESULTS : 87 % of those referred used the prescription and 28 % ( high adherers)(45 % of obese patients ) did at least 15 sessions . The exercise group reduced sum of skinfolds by 8.1 % ( 2.9 to 13.3 , 95 % confidence intervals ) more than the control group , up to 16 weeks after baseline . High adherers reduced sum of skinfolds by 9.2 % ( 0.9 to 17.5 ) more than the control group , up to 26 weeks . High adherers reduced systolic blood pressure by 7.2 % ( -0.7 to 14.9 ) ( that is , 9 mm Hg ) more than low adherers , up to 37 weeks . Non-smokers and obese patients attended more prescribed sessions than smokers and non-overweight patients . CONCLUSIONS : Reduction in sum of skinfolds was maintained up to 26 weeks , among high adherers compared with controls . Reduction in systolic blood pressure was evident up to 37 weeks among high adherers , but only in comparison with low adherers . Selection of appropriate referees and use of other strategies to improve exercise adherence will help to maximise the benefits from GP exercise prescription schemes OBJECTIVE The most common way to evaluate the effect of an intervention is to compare the  intervention and nonintervention groups regarding the change in the outcome variable between baseline and follow-up ; however , there are many different ways to define " changes . " The purpose of this article is to demonstrate how different definitions of " change " used in the analysis can influence the results of a study . STUDY DESIGN AND SETTING Two different r and omized controlled trials were used as examples . RESULTS The results of the analyses showed that for continuous outcome variables , analysis of covariance seems to be the most appropriate because it corrects for the phenomenon of regression to the mean . For dichotomous outcome variables , multinomial logistic regression analysis with all possible changes over time as outcome seems to be the most appropriate , especially because of its straightforward interpretation . CONCLUSION A different definition of " change " can lead to different results in the evaluation of the effect of an intervention BACKGROUND Available evidence suggests that despite physicians ' positive attitudes toward exercise as an important part of promoting a healthy lifestyle , few physicians actually prescribe exercise for their patients . One barrier may be lack of a st and ard office instrument . OBJECTIVES To determine the ( 1 ) exercise counseling habits among a large group of Canadian family physicians and ( 2 ) acceptance and utilization of an exercise counseling instrument geared to primary care practice . DESIGN R and omized control trial . SETTING Primary care practice . PARTICIPANTS Family physicians ( N = 400 ) from 3 regions of Canada , representing both rural and urban practice ( ratio of 1:3 ) . Patients ( 10 per practice ) were healthy community dwellers older than 65 years obtained as a convenience sample in their family practice . INTERVENTIONS In phase 1 , 400 physicians listed as being in general or family practice by their provincial registries were r and omly selected from a larger group listed by these registries and contacted by telephone . A total of 362 completed a 10-minute question naire that detailed practice demographics , preventive practice , and exercise counseling habits . In phase 2 , 293 agreed to further participate in the administration of an exercise prescription r and omly assigned to them by the study team . Two methods of exercise prescription were compared : counseling using the American College of Sports Medicine guidelines ( control ) and counseling using guidelines and an office-based step test ( Step Test Exercise Prescription [ STEP ] ) to determine fitness level and prescribe an exercise training heart rate . Physicians were asked to deliver their assigned exercise prescription to a convenience sample of the next 10 healthy patients older than 65 years who presented to the office . MAIN OUTCOME MEASURES Primary outcome measures were physician exercise counseling confidence and knowledge before and after the study . Secondary outcomes included details of the exercise counseling sessions ( e.g. , time required ) . RESULTS In phase 1 , more than 90 % of the 362 physicians cl aim ed to practice preventive health counseling , and 70 % cl aim ed to include exercise counseling . Only 67.4 % felt confident regarding their exercise prescribing , and most ( 93.8 % ) were interested in improving their exercise prescribing skills . The leading barriers to exercise prescription were described in order as inadequate time , lack of necessary skills and tools , and lack of reimbursement . In phase 2 , no difference in physician profile , patient profile , or indications for exercise counseling were observed between control ( n = 145 ) and STEP ( n = 148 ) groups . STEP was significantly longer ( 16.4 vs 12.9 min ; P = .001 ) to administer ; however , improvement in physician confidence ( P = .01 ) and knowledge ( P = .009 ) were significantly greater compared with controls . CONCLUSIONS Most family physicians practice d preventive exercise counseling but reported lack of time and skills as barriers to this practice . Physicians r and omized to the STEP group took longer to deliver exercise advice but felt more confident and knowledgeable compared with controls An experimental design was employed to assess the effectiveness of a relapse prevention program , a reinforcement program , and an exercise-only control group in increasing  exercise program adherence and short-term maintenance in 120 previously sedentary female university employees . The subjects participated in an 18-week exercise program composed of stretching , calisthenics , and aerobic dance .  Attendance during the first half of the program was significantly higher for subjects in the relapse prevention group than for those in the control group . A nonsignificant trend in this direction emerged during the second half of the program and at 2-month follow-up . For all treatment groups , attrition ( attendance at less than two thirds of the exercise sessions ) was substantial , averaging 72 % at the end of the 18-week program . These findings indicate that relapse prevention and reinforcement programs may not assist previously sedentary females in long-term adherence to an exercise program R and omized consent design s were introduced to make it easier for physicians to enter patients in r and omized clinical trials . Physician reluctance to participate in r and omized clinical trials is often a reflection that the physician-patient relationship could be compromised if the physician makes known to the patient his/her inability to select a preferred therapy . Clinical trials having a no-treatment control or placebo amplify this concern . This paper review s the main ideas of r and omized consent design s ( single and double ) and the statistical model underlying the analysis , and presents some recent experiences OBJECTIVES This study assessed stages of change in fat intake , physical activity , and cigarette smoking during a r and omized controlled trial of behavioral counseling . METHODS Twenty general practice s ( primary health care centers ) were r and omized to lifestyle counseling by behavioral methods or to usual health promotion . A total of 883 patients were selected for the presence of 1 or more of the following risk factors : cigarette smoking , high cholesterol , or a combination of a high body mass index and low physical activity . Stage of change ( precontemplation , contemplation , preparation , and action/maintenance ) was assessed at baseline and after 4 and 12 months . RESULTS The odds of moving to action/maintenance for behavioral intervention vs control patients at 4 months were 2.15 ( 95 % confidence interval [ CI ] = 1.30 , 3.56 ) for fat reduction , 1.89 ( 95 % CI = 1.07 , 3.36 ) for increased physical activity , and 1.77 ( 95 % CI = 0.76 , 4.14 ) for smoking cessation . The likelihood of achieving action/maintenance was related to baseline stage for all 3 behaviors . CONCLUSIONS Brief behavioral counseling based on advice matched to stage of readiness for change may be valuable in encouraging healthy lifestyles among patients in primary care at raised risk of cardiovascular disease OBJECTIVE To determine the effects of moderate-intensity exercise training on self-rated ( subjective ) sleep quality among healthy , sedentary older adults reporting moderate sleep complaints . DESIGN R and omized controlled trial of 16 weeks ' duration . SETTING General community . PARTICIPANTS Volunteer sample of 29 women and 14 men ( of 67 eligible subjects ) aged 50 to 76 years who were sedentary , free of cardiovascular disease , and reported moderate sleep complaints . No participant was withdrawn for adverse effects . INTERVENTION R and omized to 16 weeks of community-based , moderate-intensity exercise training or to a wait-listed control condition . Exercise consisted primarily of four 30- to 40-minute endurance training sessions ( low-impact aerobics ; brisk walking ) prescribed per week at 60 % to 75 % of heart rate reserve based on peak treadmill exercise heart rate . MAIN OUTCOME MEASURE Pittsburgh Sleep Quality Index ( PSQI ) . RESULTS Compared with controls ( C ) , subjects in the exercise training condition ( E ) showed significant improvement in the PSQI global sleep score at 16 weeks ( baseline and posttest values in mean [ SD ] for C=8.93 [ 3.1 ] and 8.8 [ 2.6 ] ; baseline and posttest values for E=8.7 [ 3.0 ] and 5.4 [ 2.8 ] ; mean posttest difference between conditions=3.4 ; P<.001 ; 95 % confidence interval , 1.9 - 5.4 ) , as well as in the sleep parameters of rated sleep quality , sleep-onset latency ( baseline and posttest values for C=26.1 [ 20.0 ] and 23.8 [ 15.3 ] ; for E=28.4 [ 20.2 ] and 14.6 [ 13.0 ] ; net improvement=11.5 minutes ) , and sleep duration baseline and posttest scores for C=5.8 [ 1.1 ] and 6.0 [ 1.0 ] ; for E=6.0 [ 1.1 ] and 6.8 [ 1.2 ] ; net improvement=42 minutes ) assessed via PSQI and sleep diaries ( P=.05 ) . CONCLUSIONS Older adults with moderate sleep complaints can improve self-rated sleep quality by initiating a regular moderate-intensity exercise program The purpose of this study was to evaluate whether premenopausal women 's voluntary unsupervised aerobic and step training could maintain the skeletal benefits obtained by an 18-month supervised high-impact training , and if so , to what extent . Thirty women of the original 39 study subjects ( i. e. , persons who completed the preceding 18-month r and omized training intervention and who volunteered to continue the training on their own for a further 8 months ) and 19 women of the 45 original control subjects ( i.e. , persons who volunteered to continue as controls ) were included . The study group trained an average of twice per week and the training consisted of regular aerobic and step classes provided by local fitness centers .  Areal bone mineral density ( BMD , g/cm2 ) was measured from the lumbar spine , femoral neck , trochanter area of the femur , distal femur , patella , proximal tibia , calcaneus , and dominant distal radius at baseline and after 18 and 26 months . During the extended 8-month follow-up , the BMD of the study group increased more at the femoral neck ( the intergroup change was + 0.9 % at 18 months and + 2.8 % at 26 months , p = 0.004 for the change between 18 and 26 months ) and remained at the 18-month level at the distal femur , patella , proximal tibia , and calcaneus . In these sites , the statistically significant changes during the entire 26 months of training were 1.7 - 4.0 % in the training group as compared with the changes of -0.9 - 1.5 % in the control group . In the lumbar spine , BMD decreased from the 18-month level in both groups . In conclusion , the significant BMD increases that were obtained by supervised 18-month high-impact training were effectively maintained with subsequent unsupervised regular aerobic and step classes ( twice per week ) . The finding emphasizes the effectiveness and feasibility of self-controlled aerobic and step exercises in the primary prevention of osteoporosis among healthy premenopausal women The health effects of increased physical activity in the prevention or treatment of any disease can only be meaningfully assessed if compliance to the exercise regimen is maintained . The current research examined compliance in a clinical trial investigating the effect of walking on bone loss in 229 postmenopausal women , r and omized into either a walking or a control group . Although at baseline there was no difference in physical activity between the two groups , after a period of 2 yr , the walking group reported significantly greater physical activity as measured by reported mean blocks walked daily and objective activity monitor day readings . Closer examination of the walking group revealed that compliers ( average 7 + miles walked/wk over the 2 yr ) , when compared to non-compliers , tended at baseline to be more active , lighter weight , and non-smokers . However , the variable that best differentiated between the two compliance groups was the frequency of reported illness over the 2-yr period , with compliers cl aim ing significantly less illness Abstract Objective : To measure the effect of behaviourally oriented counselling in general practice on healthy behaviour and biological risk factors in patients at increased risk of coronary heart disease . Design : Cluster r and omised controlled trial . Participants : 883 men and women selected for the presence of one or more modifiable risk factors : regular cigarette smoking , high serum cholesterol concentration ( 6.5 - 9.0 mmol/l ) , and high body mass index ( 25 - 35 ) combined with low physical activity . Intervention : Brief behavioural counselling , on the basis of the stage of change model , carried out by practice nurses to reduce smoking and dietary fat intake and to increase regular physical activity . Main outcome measures : Question naire measures of diet , exercise , and smoking habits , and blood pressure , serum total cholesterol concentration , weight , body mass index , and smoking cessation ( with biochemical validation ) at 4 and 12 months . Results : Favourable differences were recorded in the intervention group for dietary fat intake , regular exercise , and cigarettes smoked per day at 4 and 12 months . Systolic blood pressure was reduced to a greater extent in the intervention group at 4 but not at 12 months No differences were found between groups in changes in total serum cholesterol concentration , weight , body mass index , diastolic pressure , or smoking cessation . Conclusions : Brief behavioural counselling by practice nurses led to improvements in healthy behaviour . More extended counselling to help patients sustain and build on behaviour changes may be required before differences in biological risk factors emerge CONTEXT Enhancing participation in long-term exercise may translate into improved long-term weight loss  in overweight adults . OBJECTIVES To compare the effects of intermittent with traditional continuous exercise on weight loss , adherence , and fitness , and to examine the effect of combining intermittent exercise with that using home exercise equipment . DESIGN R and omized trial from September 1996 through September 1998 . SETTING AND PARTICIPANTS A total of 148 sedentary , overweight ( mean [ SD ] body mass index , 32.8 [ 4.0 ] kg/m2 ) women ( mean [ SD ] age , 36.7 [ 5.6 ] years ) in a university-based weight control program . INTERVENTIONS Eighteen-month behavioral weight control program with 3 groups : long-bout exercise ( LB ) , multiple short-bout exercise ( SB ) , or multiple short-bout exercise with home exercise equipment ( SBEQ ) using a treadmill . MAIN OUTCOME MEASURES Body weight , body composition , cardiorespiratory fitness , and exercise adherence . RESULTS Of 148 subjects , 115 ( 78 % ) completed the 18-month program . At 18 months , mean ( SD ) weight loss was significantly greater in subjects in the SBEQ group compared with subjects in the SB group ( -7.4 [ 7.8 ] kg vs -3.7 [ 6.6 ] kg ; P<.05 ) . Mean ( SD ) weight loss for subjects in the LB group ( -5.8 [ 7.1 ] kg ) was not significantly different than for subjects in the SB or SBEQ groups . Subjects in the SBEQ group maintained a higher level of exercise than subjects in both the SB and LB groups ( P<.05 ) at 13 to 18 months of treatment . All groups showed an increase in cardiorespiratory fitness from baseline to 18 months , with no difference between groups . Mean ( SD ) weight loss at 18 months was significantly greater in individuals exercising more than 200 min/wk throughout the intervention ( -13.1 [ 8.0 ] kg ) compared with individuals exercising 150 to 200 min/wk ( -8.5 [ 5.8 ] kg ) or less than 150 min/wk ( -3.5 [ 6.5 ] kg ) ( P<.05 ) . CONCLUSIONS Compared with the LB group , subjects in the SB group did not experience improved long-term weight loss , exercise participation , or cardiorespiratory fitness . Access to home exercise equipment facilitated the maintenance of SB , which may improve long-term weight loss . A dose-response relationship exists between amount of exercise and long-term  weight loss  in overweight adult women & NA ; Although there have been numerous studies documenting a relationship between physical fitness and psychologic functioning , few have employed the type of experimental design that would allow conclusions to be drawn regarding cause and effect . In the present study , college students were r and omly assigned to a cardiovascular conditioning program or to a control program design ed to give the appearance of physical training while minimizing cardiovascular benefits . Both groups were tested for cardiovascular fitness as well as on a number of self‐rating scales before and after the 6‐week program . The cardiovascular group demonstrated a significantly greater improvement in cardiovascular fitness than the control group and also tended to show a greater reduction in anxiety and greater increase in measures of general psychologic well‐being BACKGROUND Epidemiologic evidence suggests that 8,368 kJ or 2000 kcal per week of moderate physical activity , including walking and stair climbing , can reduce risk of coronary heart disease ( CHD ) . The goal of this study was to assess the effects of this amount of these two activities on physical fitness and risk factors for CHD . METHODS Twenty-two healthy , slightly overweight , sedentary , normotensive , normolipemic men , age 22 to 44 years , were r and omly assigned to an exercise or control group for 12 weeks followed by a 4-week washout period . The subjects then were crossed-over to the alternate group for an additional 12-week period . Exercise consisted of 5 days per week of supervised treadmill exercise plus stair climbing . Treadmill exercise consisted of walking for 45 minutes at 5.15 km per hour at 2 % grade for a total of 19.3 km per week . Subjects also climbed 10 floors of stairs at a time at their own pace without prescribed target heart rates for a total of 50 floors per week . The estimated total weekly energy cost of the treadmill walking plus stair climbing was 8,368 kJ or 2,000 kcal . Mean observed heart rates were 55 % and 82 % of maximal heart rate during treadmill walking and stair climbing , respectively . Data from the two exercise periods and two control periods were pooled and compared by analysis of variance . RESULTS Sixteen subjects completed all phases of the study .  Maximal oxygen uptake ( VO2max ) by the Bruce treadmill exercise protocol with metabolic gas measurements was below average for age at baseline , and was not significantly affected by 12 weeks of training . No significant changes were noted between groups in body weight or percent body fat ( hydrostatic weighing ) , although there was a trend for loss of weight and fat with exercise training . Mean systolic blood pressure ( 119 mm Hg ) was unchanged in both groups . However , diastolic blood pressure ( 72 mm Hg and 78 mm Hg for the treatment and control groups , respectively ) showed an unexpected 6 mm Hg increase during the exercise period and a 5 mm Hg decline during the control period . Mean plasma lipid and lipoprotein levels were unaffected by training , except for a 16 % reduction in triglycerides ( P < .05 ) . However , a 28 % increase in plasma high density lipoprotein (HDL)-cholesterol ( P < .01 ) was noted during the initial 12-week training period , which regressed during the washout period , and was not replicated during the second 12-week exercise period . CONCLUSIONS Twelve weeks of walking and stair climbing at a moderate pace and intensity at an energy cost of about 2,000 kcal per week failed to improve physical fitness or risk factors for CHD . A reduction in physical activities other than the prescribed exercise program , as reported by a physical activity recall question naire , probably contributed to an absence of an exercise response . A longer and /or a more intense activity program is apparently required to improve these modalities OBJECTIVE To investigate whether prescribing exercise in several short-bouts versus one long-bout per day would enhance exercise adherence , cardiorespiratory fitness , and weight loss in overweight adult females in a behavioral weight control program . DESIGN R and omized controlled trial with subjects r and omized to either a short-bout exercise group ( SB , n = 28 , age = 40.4 + /- 5.9 yrs ) or a long-bout exercise group ( LB , n = 28 , age = 40.9 + /- 7.3 yrs ) , with subjects followed for a period of 20 weeks . Both groups were instructed to exercise 5 days per week with exercise duration progressing from 20 to 40 min per day . The LB group performed one exercise bout per day , whereas the SB group performed multiple 10 min bouts of exercise per day . The recommended caloric intake for all subjects was 5022 - 6277 kJ/day ( 1200 - 1500 kcal/day ) , with fat reduced to 20 % of caloric intake . SUBJECTS Fifty-six obese , sedentary females ( BMI = 33.9 + /- 4.1 kg/m2 ) . MEASUREMENTS Exercise participation was assessed from self-reported diaries and Tri-Trac Accelerometers . Cardiorespiratory fitness was assessed using a submaximal cycle ergometer test . RESULTS Exercising in multiple short-bouts per day improved adherence to exercise : the SB group reported  exercising on a greater number of days ( mean + /- s.d . = 87.3 + /- 29.5 days vs 69.1 + /- 28.9 days ; P < 0.05 ) and for a greater total duration ( 223.8 + /- 69.5 min/week vs 188.2 + /- 58.4 min/week ; P = 0.08 ) than the LB group . Predicted VO2Peak increased by 5.6 % and 5.0 % for the LB and SB groups , respectively ( P < 0.05 ) . There was a trend for the weight loss to be greater in the SB group ( -8.9 + /- 5.3 kg ) compared to the LB group ( -6.4 + /- 4.5 kg ; P < 0.07 ) . CONCLUSION These results suggest that short-bouts of exercise may enhance exercise adherence .  Short-bouts of exercise may also enhance weight loss and produce similar changes in cardiorespiratory fitness when compared to long-bouts of exercise . Thus , short-bouts of exercise may be preferred when prescribing exercise to obese adults Our objective was to evaluate the effect of 12 weeks of stress management training ( SMT ) , physical exercise ( PE ) and an integrated health programme ( IHP ) in a worksite setting on subjective health complaints . To do this , we r and omly split 860 employees into the following groups : control ( n = 344 ) , PE ( n = 189 ) , IHP ( comprising physical exercise and health information ) ( n = 165 ) and SMT ( n = 162 ) . There were no significant effects on subjective health complaints , sick leave or job stress . However , strong and specific positive effects were experienced for the particular goal areas defined for each intervention . The PE group showed improved general health , physical fitness and muscle pain , while the SMT group showed improved stress management . The IHP group showed the strongest effects , affecting most goals set for treatment OBJECTIVE To evaluate a telephone counseling intervention that was design ed to help sedentary women begin and maintain a walking program . METHODS Females ( N = 197 ) were r and omly assigned to either an intervention , attention control , or no-attention control group . Assessment s were made at baseline and 6 months . RESULTS Women in the intervention group reported more time walked each day than did control women ( P < .05 ) . The intervention worked equally for African American and European American women as well as for different income groups . CONCLUSION Overall , a counseling intervention via telephone appears to be a good way to help women begin a walking program BACKGROUND Physical activity is now a public health priority , but there is only limited evidence on the effectiveness of mass-reach campaigns . INTERVENTION Paid and unpaid television and print-media advertising , physician mail-outs , and community-level support programs and strategies . SETTING / PARTICIPANTS A mass-media statewide campaign to promote regular moderate-intensity activity was conducted during February 1998 . The target group was adults aged 25 to 60 who were motivated but insufficiently active . DESIGN Cohort and independent- sample , cross-sectional representative population surveys , before and after the campaign . The intervention was conducted in the state of New South Wales , with the other states of Australia as the comparison region . MEASURES Telephone survey items on physical activity , media message awareness , physical activity knowledge , self-efficacy , and intentions . RESULTS Unprompted recall of the activity messages in the campaign state increased substantially from 2.1 % to 20.9 % ( p<0.01 ) , with small changes elsewhere in Australia ( 1.2 % to 2.6 % ) . There were large changes in prompted awareness from 12.9 % to 50.7 % ( p<0.0001 ) , much larger than changes elsewhere ( 14.1 % to 16 % , p=0.06 ) . Knowledge of appropriate moderate-intensity activity and physical activity self-efficacy increased significantly and only in the campaign state . Compared to all others , those in the target group who recalled the media message were 2.08 times more likely to increase their activity by at least an hour per week ( 95 % confidence interval = 1.51 - 2.86 ) . CONCLUSIONS This integrated campaign positively influenced short-term physical activity message recall , knowledge , and behavior of the target population , compared to the population in the region who were not exposed Worksites are a key channel for delivery of interventions design ed to reduce chronic disease among adult population s. Although some evaluations of worksite physical-activity interventions have been conducted , to date very few r and omized trials of worksite health promotion have included the goal of increasing physical-activity levels as part of a comprehensive multiple risk factor approach to worksite health promotion . This article presents the results regarding behavior change found among the cohort of 2055 individuals who completed three health-behavior assessment s as part of their worksites ' participation in The Working Healthy Project ( WHP ) , a multiple risk factor intervention implemented in 26 manufacturing worksites . In this study , a r and omized matched-pair design was used . Fifty-one percent ( n = 2,761 ) of the employees who completed the baseline assessment also completed the interim survey . Eighty-three percent of those who completed the interim assessment also completed the final survey . The WHP intervention targeted smoking , nutrition , and physical activity . At baseline , 38 % of the sample reported engaging in regular exercise , and subjects reported consuming an average of 2.7 servings of fruits and vegetables per day , 7.9 grams of fiber per 1000 kilocalories , and 35.4 % calories from fat per day ; 28 % of the sample were smokers . By the time of both the interim ( intervention midpoint ) and final ( end of intervention ) assessment s , participants in the intervention condition had significantly increased their exercise behavior , compared with the control condition . There was also increased consumption of fruits and vegetables and fiber in the intervention condition by the time of the final assessment , compared with the control condition . No differences by condition were found with regard to percentage of calories from fat consumed or smoking cessation . These results suggest that among a cohort of participants in a worksite health promotion study , there were significant health behavior changes across two risk factors over time . These data suggest that further investigation of multiple risk factor worksite health promotion is warranted , particularly with a focus on ways to increase participation in these programs and to diffuse intervention effects throughout the entire workforce We studied the fractionization of walking training and search ed for the minimum dose to affect coronary risk factors in two r and omized controlled trials . Altogether 134 ( Study I ) and 121 ( Study II ) healthy , sedentary postmenopausal women started the trials , and 130 ( Study I ) and 116 ( Study II ) completed them . In Study I the exercise intensity was 65 % of the maximal aerobic power ( VO2max ) and a total of 300 kcal was expended in one ( Group W1 ) or two ( Group W2 ) daily walking bouts . In Study II the exercise was continuous , and the exercise intensity ( % of VO2max ) and energy expenditure ( kcal session(-1 ) ) were 55 % and 300 kcal ( Group W3 ) , 45 % and 300 kcal ( Group W4 ) , 55 % and 200 kcal ( Group W5 ) and 45 % and 200 kcal ( Group W6 ) . All the subjects walked 5 days a week . The outcome measures were blood pressure , serum lipoproteins and blood glucose and plasma insulin in fasting state and also during 2-h oral glucose tolerance test in Study I. There was no change in diastolic pressure in the original study groups , but in the combined exercise group ( W1+W2 ) in Study I , the mean diastolic pressure declined by -3.0 mmHg ( 95 % con-fidence interval ( CI ) -5.5 to -0.4 ) ( P=0.025 ) in comparison with that of the controls . The mean blood glucose declined by -0.21 mmol L(-1 ) ( CI -0.33 to -0.09 ) in Group W1 and -0.13 mmol L(-1 ) ( CI -0.25 to -0.01 ) in Group W2 compared to controls ( P=0.03 ) . Also the 2-h glucose concentration decreased in Groups W1 and W2 compared to controls . Systolic blood pressure , serum lipoproteins and insulin levels did not change in Study I or Study II . We conclude that our training program with the greatest exercise dose , exercise intensity 65 % of VO2max and weekly expenditure of 1500 kcal had a minimal , positive effect on diastolic pressure and blood glucose , and the effect was similar in one or two daily exercise session groups . This exercise dose is probably close to the minimum to affect coronary risk factors in healthy postmenopausal women . To get a more pronounced and clinical ly relevant effect , a greater exercise dose is needed The assessment of physical activity at a single time to evaluate its association with cancer may be limited , since such a measure may not adequately reflect activity over the long term . To overcome this limitation , we studied 17,148 Harvard alumni aged 30 - 79 years who were followed prospect ively for the occurrence of colon cancer ( n = 225 ) and rectal cancer ( n = 44 ) from 1965 through 1988 .  Physical activity , based on self-reported stair climbing , walking , and sports play , was assessed in either 1962 or 1966 ( 1962/1966 ) and again in 1977 . The increased activity evaluated using either assessment ( 1962/1966 or 1977 ) taken alone was not associated with risk of colon cancer . However , alumni who were highly active ( energy expenditure of greater than 2500 kilocalories/wk ) at both assessment s had half the risk of developing colon cancer relative to those who were inactive ( less than 1000 kilocalories/wk ) at both assessment s ( age-adjusted rate ratio = 0.50 ; 90 % confidence interval = 0.27 - 0.93 ) , whereas those who were moderately active ( 1000 - 2500 kilocalories/wk ) at both assessment s had an age-adjusted rate ratio of 0.52 ( 90 % confidence interval = 0.28 - 0.94 ) . We conclude that either consistently higher levels of activity are necessary to protect against colon cancer or combining two assessment s increased the precision of physical activity measurement . We found no evidence that increased physical activity protected against rectal cancer OBJECTIVES This paper describes a videotaped , home-based , strength training program , titled Strong-for-Life and reports on its effectiveness in improving muscle strength , psychological well-being , and health status in a sample of older persons . DESIGN AND SETTING We enrolled 102 nondisabled , community-dwelling older people aged 66 to 87 , identified from the Medicare beneficiary list , into a r and omized , controlled trial . MEASUREMENTS Effectiveness was based on change in isokinetic upper and lower extremity muscle strength , psychologic well-being , and health status . RESULTS Results revealed several statistically significant short-term benefits after 12 to 15 weeks of exercise , especially for men . Younger older adults demonstrated a 10 % improvement in knee extensor strength relative to control subjects . Older male exercisers achieved significant differences relative to controls in perceived anger , tension , and overall social functioning . Male exercisers , in general , achieved significant improvement in perceived vigor . Women did not report psychological benefits following participation in the program . CONCLUSION Study results reveal that the Strong for Life program , design ed to be widely disseminated to the nondisabled older population , has many short-term positive benefits BACKGROUND A significant proportion of older adults in The Netherl and s do not participate regularly in leisure-time physical activity . The Groningen Active Living Model ( GALM ) was developed to change this situation for the better . Longitudinal results of the validation of the GALM behavioral change model are presented . METHODS We obtained data on potentially mediating variables of physical activity behavior change ( self-efficacy , social support , perceived fitness , and enjoyment ) from 96 participants in a prospect i ve study during the 18 months the GALM strategy lasted . RESULTS Prospect i ve analyses revealed significant differences in several potentially mediating variables , although some of these differences were contrary to our hypothesis . Discriminant analysis result ed in canonical correlations of 0.50 after 6 months and 0.66 after 18 months of program participation between adherers and nonadherers , respectively ; 73.8 and 80.0 % of the subjects were classified correctly . CONCLUSIONS Based on the results , it can be concluded that we partially succeeded in manipulating the potentially mediating variables by means of our GALM strategy . Several mediating variables were identified that reliably discriminated long-term adherers from nonadherers , exp and ing the generalizability of social cognitive theory-driven variables to a Dutch population BACKGROUND Project Active is a r and omized clinical trial that compares a lifestyle physical activity intervention with a traditional structured exercise intervention . The purpose of this paper is to report 6-month results of these interventions on cardiovascular disease ( CVD ) risk factors among healthy , sedentary , middle-aged men and women , and to examine the psychological strategies used in each group ( Lifestyle and Structured ) to reach the level of physical activity recommended by the Centers for Disease Control and Prevention ( CDC ) and American College of Sports Medicine ( ACSM ) and to achieve changes in these CVD risk factors . METHODS A total of 116 initially sedentary men ( mean + /- SD self-reported physical activity , 33.2 + /- 1.4 kcal.kg-1.day-1 ) and 119 women ( 32.9 + /- 1.0 kcal.kg-1.day-1 ) , ages 35 - 60 years ( 46.0 + /- 6.7 years ) were r and omly assigned to a 6-month lifestyle physical activity counseling intervention or a 6-month gymnasium-based structured program . At baseline and 6 months , changes in lipid and lipoprotein-cholesterol concentrations , blood pressure , and body composition and cognitive and behavioral measures of change were assessed . One-way analyses of variance with covariate adjustment were used to test for between-group differences in CVD risk factors . Associations between achieving the CDC/ACSM criterion and changes in cognitive and behavioral measures were assessed with multiple logistic regression models . RESULTS After 6 months of intervention , 78 % of Lifestyle participants and 85 % of Structured participants were meeting or exceeding the CDC/ACSM recommendation of accumulating 30 min or more of moderate-intensity physical activity on most , preferably all , days of the week . This was verified by a significant increase in cardiorespiratory fitness in both groups . The adjusted mean increase in maximal METs ( VO2peak divided by 3.5 ml.kg-1.min-1 ) between treadmill tests was 0.4 kcal.kg-1.hr-1 ( P < 0.001 ) for Lifestyle and 1.1 kcal.kg-1.hr-1 ( P < 0.001 ) for Structured . There was a significant difference between intervention groups for this outcome . Both groups had significant reductions in total cholesterol , total cholesterol/HDL-C ratio , diastolic blood pressure , and percentage of body fat . There were no significant between-group differences in changes in these outcomes . Adjusted mean changes in total cholesterol , systolic blood pressure , and percentage of body fat in Lifestyle [ in Structured ] participants were -0.2 [ -0.3 ] mmol . L-1 , -3.2[-1.8 ] mm Hg , and -1.4 [ -1.7 ] % , respectively . There were significant associations between achieving the CDC/ACSM physical activity criterion and greater use of the cognitive and behavioral strategies of change . Both groups changed self-efficacy and many of the behavioral measures , but there were no significant differences between intervention groups . CONCLUSIONS These results demonstrate that lifestyle physical activity counseling is as effective as structured exercise programs in increasing physical activity and improving CVD risk factors after 6 months among initially sedentary men and women . Furthermore , specific cognitive and behavioral counseling strategies were increased significantly as a result of the intervention . These strategies are effective and could be used in a wide variety of setting OBJECTIVE To compare the effects on blood pressure of a 12-week moderate-intensity aerobic exercise program and a T'ai Chi program of light activity . DESIGN A r and omized clinical trial . SETTING A suburban clinic in the Baltimore , MD , area . PARTICIPANTS Sixty-two sedentary older adults ( 45 % black , 79 % women , aged > or = 60 years ) with systolic blood pressure 130 - 159 mm Hg and diastolic blood pressure < 95 mm Hg ( not on antihypertensive medication ) . INTERVENTION Participants were r and omized to a 12-week aerobic exercise program or a light intensity T'ai Chi program . The goal of each condition was to exercise 4 days per week , 30 minutes per day . MEASUREMENTS Blood pressure was measured during three screening visits and every 2 weeks during the intervention . Estimated maximal oxygen uptake and measures of physical activity level were determined at baseline and at the end of the intervention period . RESULTS Mean ( SD ) baseline systolic and diastolic blood pressures were 139.9 ( 9.3 ) mm Hg and 76.0 ( 7.3 ) mm Hg , respectively . For systolic blood pressure , adjusted mean ( SE ) changes during the 12-week intervention period were -8.4 ( 1.6 ) mm Hg and -7.0 ( 1.6 ) mm Hg in the aerobic exercise and T'ai Chi groups , respectively ( each within-group P < .001 ; between-group P = .56 ) . For diastolic blood pressure , corresponding changes were -3.2 ( 1.0 ) mm Hg in the aerobic exercise group and -2.4 ( 1.0 ) mm Hg in the T'ai Chi group ( each within-group P < .001 ; between-group P = .54 ) . Body weight did not change in either group . Estimated maximal aerobic capacity tended to increase in aerobic exercise ( P = .06 ) but not in T'ai Chi ( P = .24 ) . CONCLUSIONS Programs of moderate intensity aerobic exercise and light exercise may have similar effects on blood pressure in previously sedentary older individuals . If additional trials confirm these results , promoting light intensity activity could have substantial public health benefits as a means to reduce blood pressure in older aged persons The main aim of this study was to assess the effects of a fitness assessment and exercise consultation on physical activity over 1 year in non-regularly active participants drawn from a socially and economically deprived community . Of 3000 people invited to volunteer for either intervention , 225 fitness assessment volunteers  were r and omly assigned to an experimental or control group ; 145 exercise consultation volunteers  were similarly assigned . Physical activity was measured at baseline , 4 weeks , 3 months ( plus an intervention re-test ) , 6 months and 1 year . Analysis of variance and follow-up Bonferroni analysis showed that , for those not regularly active at baseline , physical activity increased significantly to 4 weeks , was maintained to 6 months but had fallen by 1 year . Only those receiving an exercise consultation significantly increased their physical activity after 1 year . Compared with fitness assessment s , chi-square analysis showed that significantly more non-regularly active participants volunteered for an exercise consultation and those receiving an exercise consultation had significantly better long-term study adherence than those receiving a fitness assessment . The study also showed that , contrary to popular opinion , those in a socially and economically deprived community are not ' hard to reach ' and respond well to physical activity interventions OBJECTIVE To evaluate a culturally appropriate intervention to increase activity in overweight Mexican American women . METHODS Participants were r and omly assigned to a physical activity program or wait-list control . RESULTS Treated participants were not more active than controls at 6 or 12 months . In addition , we found no significant differences in the proportion of individuals who met an objective criterion for physical activity from baseline to 6 months in the treatment or control groups . CONCLUSION The intervention did not increase physical activity in this population . Differences in baseline activity and contamination of the control group may partially account for the outcome In order to evaluate the effectiveness of a cognitive behavioural group therapy programme for the treatment of obesity in clinical practice , 122 patients from 14 general practice s ( n = 70 ) were r and omised into either a treatment or a control arm with a ratio of 3 to 2 . The  group treatment programme  was also assessed in a clinical centre ( n = 52 ; University Hospital Basel ) . Before therapy , a clinical interview and a mental disorder examination were carried out on all patients . The instructors of the programme ( practitioners ; clinic physicians ) were trained during two afternoon meetings to supervise the group sessions . The treatment programme consisted of 16 group sessions of 90 min each , and contained psycho-educational elements concerning a balanced diet , instruction for the integration of more activity in everyday life ( lifestyle activity ) , problemsolving strategies , and the cognitive restructuring of dysfunctional cognition regarding the own body . All the patients who were treated in the various setting s demonstrated a benefit from therapy . Compared to the control groups which received usual medical care , they were able to reduce their starting weight by around 5 % ( p < 0.001 for the group treated by practitioners ) at the end of treatment and stabilise it until follow up after one year . In regard to psychological factors the treatment groups showed an increased sense of control over eating behaviour , and feelings of distractibility and hunger were reduced after treatment and at follow up ( p < 0.05 ) . All treatment groups showed statistically relevant increases in feelings of attractiveness regarding their body and shape ( p < 0.05 ) . These results support the effectiveness of the integrated cognitive behavioural treatment programme in clinical practice over a duration of 12 months BACKGROUND This study was design ed to test different ways of meeting the new ACSM/CDC recommendations for physical activity stating that all Americans at least 2 years of age should obtain 30 minutes of moderate intensity activity on most days of the week . METHODS Thirty-two sedentary 18- to 55-year-old adults were r and omly assigned to three groups of brisk walking/6 days per week : 30 continuous minutes , three 10-minute bouts , and 30 minutes in any combination of bouts as long as each bout was at least 5 minutes .  Aerobic fitness , blood pressure , body composition , and physical activity were assessed at baseline , at end of program ( 16 weeks ) , and at follow-up ( 32 weeks ) . RESULTS All groups significantly ( P < /= 0.05 ) improved their aerobic fitness and systolic blood pressure and increased their physical activity at the end of the program . At follow-up all groups maintained these changes , while additionally reducing their percentage body fat and diastolic blood pressure . CONCLUSION These findings demonstrate that a walking prescription of 30 minutes per day on most days of the week with the choice to walk in as little as 5 minute bouts can improve cardiovascular health and body composition , as well as help sedentary people maintain those improvements over time . This is supported by all participants indicating that " making walking part of my lifestyle " was the most important factor in maintaining their walking habits OBJECTIVE To test 2 interventions to increase older women 's physical activity . METHODS A r and omized 2-way factorial experimental design compared the effects of 2 limited-contact interventions , motivational sessions and periodic prompts , among 190 women . Experimental participants received a 3-encounter motivational intervention . Those r and omized to prompts received weekly telephone or mail-delivered cues . RESULTS The prompting intervention consistently increased exercise and physical activity scores . The motivational intervention did not affect outcome scores . CONCLUSIONS Prompting is a low-cost strategy for increasing exercise and physical activity among older women . Future research should examine alternative modes for prompt delivery This study compared three forms of mail-mediated exercise behavior change strategies on the weekly leisure time exercise behavior of individuals at different stages of exercise ( SOE ) . Subjects were 113 healthy females , 22 to 50 years old ( M = 36.9 ) . After being classified by SOE , subjects were r and omly assigned to receive one of three treatments : lifestyle exercise packet ( LEP ) ; structured exercise packet ( SEP ) ; or control packet . Packets were mailed to subjects at their worksite . After 31-days , 108 ( 95 % ) subjects responded to a query about their previous week 's leisure-time exercise behavior . A 3 ( SOE ) x3 ( Exercise group ) x2 ( Time ) REANOVA revealed main effects for SOE ( p < 0.0001 ) , exercise group ( p < 0.05 ) , and time ( p < 0.0001 ) . No significant interactions were observed . Post-hoc testing showed that those in the action/maintenance stages differed from those in the preparation and precontemplation/contemplation stages ( p < 0.01 ) , and that LEP subjects reported significantly more weekly leisure-time exercise post-intervention compared to controls ( p < 0.01 ) . These findings suggest the LEP was the most effective strategy for encouraging weekly leisure-time exercise . Future research should be directed at corroborating these findings and determining the potential long-term value of this strategy in comparison to more traditional strategies OBJECTIVE To assess efficacy of 2 worksite health promotion interventions . METHODS R and omly assign 3 fire stations to ( a ) team-based curriculum , ( b ) individual counselor meetings , and ( c ) control . RESULTS Both interventions were feasible and acceptable , and they result ed in significant reductions in LDL cholesterol . The team approach significantly increased coworker cohesion , personal exercise habits , and coworkers ' healthy behaviors . The one-on-one strategy significantly increased dietary self-monitoring , decreased fat intake , and reduced depressed feelings . CONCLUSIONS Although both interventions promoted healthy behaviors , specific outcomes differed and reflected their conceptual underpinnings . The team-based curriculum is innovative and may enlist influences not accessed with individual formats BACKGROUND Although exercise parameters such as intensity and format have been shown to influence exercise participation rates and physiological outcomes in the short term , few data are available evaluating their longer-term effects . The study objective was to determine the 2-year effects of differing intensities and formats of endurance exercise on exercise participation rates , fitness , and plasma HDL cholesterol levels among healthy older adults . METHODS AND RESULTS Higher-intensity , group-based exercise training ; higher-intensity , home-based exercise ; and lower-intensity , home-based exercise were compared in a 2-year r and omized trial . Participants were 149 men and 120 postmenopausal women 50 to 65 years of age who were sedentary and free of cardiovascular disease . Recruitment was achieved through a r and om digit-dial community telephone survey and media promotion . All exercise occurred in community setting s. For higher-intensity exercise training , three 40-minute endurance training sessions per week were prescribed at 73 % to 88 % of peak treadmill heart rate . For lower-intensity exercise , five 30-minute endurance training sessions per week were prescribed at 60 % to 73 % of peak treadmill heart rate . Treadmill exercise performance , lipoprotein levels and other heart disease risk factors , and exercise adherence were evaluated at baseline and across the 2-year period . Treadmill exercise test performance improved for all three training conditions during year 1 and was successfully maintained during year 2 , particularly for subjects in the higher-intensity , home-based condition . Subjects in that condition also showed the greatest year 2 exercise adherence rates ( P < .003 ) . Although no significant increases in HDL cholesterol were observed during year 1 , by the end of year 2 subjects in the two home-based training conditions showed small but significant HDL cholesterol increases over baseline ( P < .01 ) . The increases were particularly pronounced for subjects in the lower-intensity condition , whose exercise prescription required more frequent exercise sessions per week . For all exercise conditions , increases in HDL cholesterol were associated with decreases in waist-to-hip ratio in both men and women ( P < .04 ) . CONCLUSIONS While older adults can benefit from initiating a regular regimen of moderate-intensity exercise in terms of improved fitness levels and small improvements in HDL cholesterol levels , the time frame needed to achieve HDL cholesterol change ( 2 years ) may be longer than that reported previously for younger population s. Frequency of participation may be particularly important for achieving such changes . Supervised home-based exercise regimens represent a safe , attractive alternative for achieving sustained participation We examined the effects of physical exercise on  smoking relapse . Twenty previously sedentary female smokers were r and omly assigned to smoking cessation plus exercise or smoking cessation with frequency contact control . The smoking cessation program included 12 professionally led sessions over 12 weeks . Exercise treatment included three supervised exercise sessions per week for 15 weeks . Contact control included three women 's health/wellness lectures per week for 15 weeks . Smoking abstinence was vali date d by carbon monoxide and saliva cotinine . Mean exercise attendance for exercise subjects was 88 % with an increase in estimated VO2 of 25 % . The percentage of subjects who quit for 24 hours was 80 % for the exercise and 90 % for the contact group . One subject in the contact group remained abstinent at the end of the 12-week treatment and at 1- , 3- , and 12-month follow-ups , whereas three subjects in the exercise group were abstinent at these time points . These results suggest that exercise training improves short-term quit rates and may prove a useful strategy for long-term maintenance of smoking cessation CONTEXT Physical inactivity contributes to weight gain , but only 22 % of Americans are regularly active . OBJECTIVE To examine short- and long-term changes in weight , body composition , and cardiovascular risk profiles produced by diet combined with either structured aerobic exercise or moderate-intensity lifestyle activity . DESIGN Sixteen-week r and omized controlled trial with 1-year follow-up , conducted from August 1995 to December 1996 . PARTICIPANTS AND SETTING Forty obese women ( mean body mass index [ weight in kilograms divided by the square of height in meters ] , 32.9 kg/m2 ; mean weight , 89.2 kg ) with a mean age of 42.9 years ( range , 21 - 60 years ) seen in a university-based weight management program . INTERVENTIONS Structured aerobic exercise or moderate lifestyle activity ; low-fat diet of about 1200 kcal/d . MAIN OUTCOME MEASURES Changes in body weight , body composition , cardiovascular risk profiles , and physical fitness at 16 weeks and at 1 year . RESULTS Mean ( SD ) weight losses during the 16-week treatment program were 8.3 ( 3.8 ) kg for the aerobic group and 7.9 ( 4.2 ) kg for the lifestyle group ( within groups , P<.001 ; between groups , P = .08 ) . The aerobic group lost significantly less fat-free mass ( 0.5 [ 1.3 ] kg ) than the lifestyle group ( 1.4 [ 1.3 ] kg ; P = .03 ) . During the 1-year follow-up , the aerobic group regained 1.6 [ 5.5 ] kg , while the lifestyle group regained 0.08 ( 4.6 ) kg . At week 16 , serum triglyceride levels and total cholesterol levels were reduced significantly ( P<.001 ) from baseline ( 16.3 % and 10.1 % reductions , respectively ) but did not differ significantly between groups and were not different from baseline or between groups at week 68 . CONCLUSIONS A program of diet plus lifestyle activity may offer similar health benefits and be a suitable alternative to diet plus structured aerobic activity for obese women OBJECTIVE --To determine the effectiveness of group- vs home-based exercise training of higher and lower intensities among healthy , sedentary older adults . DESIGN --Year-long r and omized , controlled trial comparing ( 1 ) higher-intensity group-based exercise training ; ( 2 ) higher-intensity home-based exercise training ; ( 3 ) lower-intensity home-based exercise training ; or ( 4 ) assessment -only control . SETTING --General community located in northern California . PARTICIPANTS --One hundred sixty women and 197 men 50 to 65 years of age who were sedentary and free of cardiovascular disease . One out of nine persons contacted through a community r and om-digit-dial telephone survey and citywide promotion were r and omized . INTERVENTIONS --For higher-intensity exercise training , three 40-minute endurance training sessions per week were prescribed at 73 % to 88 % of peak treadmill heart rate . For lower-intensity exercise training , five 30-minute endurance training sessions per week were prescribed at 60 % to 73 % of peak treadmill heart rate . MAIN OUTCOME MEASURES --Treadmill exercise test performance , exercise participation rates , and heart disease risk factors . RESULTS --Compared with controls , subjects in all three exercise training conditions showed significant improvements in treadmill exercise test performance at 6 and 12 months ( P less than .03 ) . Lower-intensity exercise training achieved changes comparable with those of higher-intensity exercise training . Twelve-month exercise adherence rates were better for the two home-based exercise training conditions relative to the group-based exercise training condition ( P less than .0005 ) . There were no significant training-induced changes in lipid levels , weight , or blood pressure . CONCLUSIONS --We conclude that ( 1 ) this community-based exercise training program improved fitness but not heart disease risk factors among sedentary , healthy older adults ; ( 2 ) home-based exercise was as effective as group exercise in producing these changes ; ( 3 ) lower-intensity exercise training was as effective as higher-intensity exercise training in the home setting ; and ( 4 ) the exercise programs were relatively safe The purpose of this study was to test the feasibility of the WALC intervention ( Walk ; Address pain , fear , fatigue during exercise ; Learn about exercise ; Cue by self-modeling ) , and determine its effects on self-efficacy and outcome expectations , exercise activity and free living activity , physical and mental health status , and falls and fall-related injuries . A total of 17 sedentary older women with a mean age of 88 + /- 3.7 years were r and omly assigned to receive either the  WALC intervention or routine care .  Ninety percent of those in the treatment group initiated and engaged in a regular exercise program during the 6 months of the study . There was a statistically significant difference in self-efficacy expectations , exercise behavior , and overall activity between the two groups . Those in the treatment group had stronger self-efficacy expectations related to exercise ; engaged in more exercise and more free living activity ; and although not statistically significant , had stronger outcome expectations following exposure to the WALC intervention when compared with those who received routine care . To help older adults initiate and adhere to an exercise program , nurses can easily implement the WALC intervention in a variety of setting BACKGROUND This study examines whether the adolescents ' current levels of physical activity are increased by their physicians ' advice provided in the office , in accordance with the American Medical Association recommendation . METHODS The first adolescent ( 12 - 21 years old ) of whichever age and gender , passing through six family physicians ' offices during a 6-month period was assigned to the intervention group , and the second adolescent of the same age and gender was assigned to the control group .  Each patient was classified as active , partially active , and inactive , according to how they answered the questions about their physical activity levels , and patients in the intervention group were then provided with reinforcement , increase , or initiation counseling , respectively . Identical procedures were repeated at the 6- and 12-month office visits . Changes in prevalence of activity , as well as , duration , frequency , and intensity of exercise and /or sports were verified at each visit . RESULTS Of the 87.5 % of the original sample that completed the survey , 6- and 12-month data were available for 70.1 % . Among the 392 adolescents that finished the study , those provided with counseling had 41.5 % more active adolescents , as well as 26.8 % , 38.0 % and 26.2 % higher duration , frequency and intensity , respectively , than the control group . CONCLUSIONS The proportion of active adolescents , as well as , the duration , frequency and intensity of leisure time exercise and /or sports are increased by physician advice Exercise is recommended to enhance bone health but data on the maintenance of the exercise-induced bone benefit is sparse . The purpose of the study was to assess the maintenance of the musculoskeletal benefits obtained in an 18-month intervention of  high-impact exercise  in premenopausal women ( 34 former trainees and 31 controls ) . Physical performance and areal bone mineral density ( aBMD , g/cm2 ) were measured at baseline , after 18 months , and after 5 years . All significant 18-month improvements relative to controls in the trainees ’ neuromuscular performance ( isometric leg press , and vertical jump with and without additional 10 % weight of the body mass ) had been lost at the 5-year follow-up . However , since the changes in aBMD in both former trainees and controls by time were similar , the  exercise-induced aBMD gain ( i.e. the mean statistically significant intergroup differences of 1–3 % in favor of the trainees ) was maintained at the femoral neck , distal femur , patella , proximal tibia , and calcaneus at the 5-year follow-up . At lumbar spine , the difference was 1.7 % at both 18-month and at the 5-year follow-ups but the difference was not statistically significant ( NS ) in the latter follow-up . At the trochanter and unloaded distal radius , the intergroup aBMD differences were NS at both the 18-month and 5-year follow-ups . In conclusion , the bone sites aBMD increased in response to the 18-month intervention , also demonstrated maintenance of this gain 3.5 years after the intervention . In contrast , the exercise-induced improvements in the neuromuscular performance vanished during the post intervention follow-up . These findings suggest the possibility of long-term bone benefits of high-impact training in women Objective : To determine if a written exercise prescription increases physical activity when added to verbal advice . Methods : Forty-nine community-dwelling older adults supplied their geriatricians with baseline data on their exercise levels using a question naire . Participants were r and omly placed in a verbal advice only group or a verbal advice plus written prescription , “ green ” prescription , group . Outcomes were assessed after 6 weeks . Results : Both groups showed a significant increase in time spent in physical activity . However , no significant differences between groups due to the effects of the different advice modalities were found . Conclusions : Geriatricians can effectively promote physical activity among sedentary older adults through goal -oriented physical activity advice BACKGROUND Although disuse of skeletal muscle and undernutrition are often cited as potentially reversible causes of frailty in elderly people , the efficacy of interventions targeted specifically at these deficits has not been carefully studied . METHODS We conducted a r and omized , placebo-controlled trial comparing progressive resistance exercise training , multinutrient supplementation , both interventions , and neither in 100 frail nursing home residents over a 10-week period . RESULTS The mean ( + /- SE ) age of the 63 women and 37 men enrolled in the study was 87.1 + /- 0.6 years ( range , 72 to 98 ) ; 94 percent of the subjects completed the study .  Muscle strength increased by 113 + /- 8 percent in the subjects who underwent exercise training , as compared with 3 + /- 9 percent in the nonexercising subjects ( P < 0.001 ) . Gait velocity increased by 11.8 + /- 3.8 percent in the exercisers but declined by 1.0 + /- 3.8 percent in the nonexercisers ( P = 0.02 ) . Stair-climbing power also improved in the exercisers as compared with the nonexercisers ( by 28.4 + /- 6.6 percent vs. 3.6 + /- 6.7 percent , P = 0.01 ) , as did the level of spontaneous physical activity . Cross-sectional thigh-muscle area increased by 2.7 + /- 1.8 percent in the exercisers but declined by 1.8 + /- 2.0 percent in the nonexercisers ( P = 0.11 ) . The nutritional supplement had no effect on any primary outcome measure . Total energy intake was significantly increased only in the exercising subjects who also received nutritional supplementation . CONCLUSIONS High-intensity resistance exercise training is a feasible and effective means of counteracting muscle weakness and physical frailty in very elderly people . In contrast , multi-nutrient supplementation without concomitant exercise does not reduce muscle weakness or physical frailty The effects of one year of exercise training on cardiorespiratory fitness , levels of daily leisure activity , and blood lipids ( cholesterol and high density lipoproteins ) were studied in a prospect i ve , r and omized clinical trial . Two hundred and twenty-four men aged 55 to 65 years volunteered for the study and were r and omly allocated to a control ( n = 111 ) or an activity ( n = 113 ) group with stratification on blue or white collar job classification . After the attrition due to loss to follow-up , 100 men remained in each of the control and activity groups . The exercising men met an average of 2.5 times per week over the year and their VO2 max or peak VO2 ( ml X kg-1 X min-1 ) increased significantly ( p = .001 , 11 % ) compared with controls . There were no significant changes in maximal heart rate ( 155 bpm ) and respiratory exchange ratio ( 1.1 ) , although ventilation ( 80 to 90 l X min-1 ) increased significantly in the trained group . In addition , the VO2 at a heart rate of 125 bpm increased significantly ( p less than .001 ) in the trained group ( 14.7 % ) over that observed in the control ( 1.9 % ) . There were no significant differences between the groups with respect to the remaining end-points INTRODUCTION We examined the need for counselling and the effect on willingness and ability to change life-style , and subsequent changes in risk factors for CHD . MATERIAL AND METHODS All 152 male employees in a computer company , 25 - 45 years of age , were invited to participate in a controlled intervention study over one year . The subjects were r and omised to an intervention group ( I group ) and a control group . The I group was divided into subgroups based on baseline behaviour and risk factor status . Changes were evaluated after one year . After an initial health examination , participants in the I group were counselled at baseline and at 5 months . RESULTS Eighty-five ( 56 % ) men participated . Twenty-nine were assigned to a control group and 56 to an intervention group ( I group ) ( dropouts = 8) . An exercise group ( E group ) was advised to take up aerobics exercise three times/week , a diet group to reduce the intake of saturated fat and increase fish products , and smokers to stop smoking . Forty were recommended one or more behavioural changes and eight had no need . Thirty-four were willing to make behavioural changes . Compared to the control group , the fitness level increased ( p < 0.01 ) and body weight decreased in the I group ( p < 0.05 ) . DISCUSSION Individual counselling promotes regular exercise with subsequent improvements in CHD risk factors . The diet and smoking counselling models were less successful in terms of compliance To assess the effectiveness of physician prescribed exercise , health education , and patient self-monitoring , 124 firefighters were medically screened and r and omly allocated to a control and two treatment groups .  Physiologic and reporting methods were employed to assess adherence to regular exercise at three months and six months after the initial exercise prescription . Addition of a health education program significantly improved compliance over that achieved by a physician consultation .  Self-monitoring did not produce a further increase in compliance . Improvement in the treatment groups was limited to three months after prescription ; at six months , the treatment and control population s had similar exercise patterns An adequate level of physical activity may maintain or promote work ability in aging workers . Project Active is a r and omized trial comparing a Lifestyle physical activity program with a Structured exercise program in sedentary but healthy adults aged 35 to 60 years . Subjects in both groups received 6 months of intensive intervention followed by 18 months of active follow-up .  The total number of subjects was 235 , from which 80 subjects participated in the work ability assessment . Primary outcome measures were energy expenditure ( kcal · kg−1 · day−1 ) , cardiorespiratory fitness ( peak oxygen uptake in ml · min−1 · kg−1 ) , and the Work Ability Index . At 6 months , daily energy expenditure had increased significantly over baseline ( mean ± SD , from 33.0 ± 0.9 to 34.4 ± 1.8 kcal · kg−1 · day−1 ) and was maintained over baseline at 24 months ( 34.0 ± 2.5 kcal · kg−1 · day−1 ) . The significant increase in energy expenditure was observed particularly in moderate levels of activity . The average percentage of body fat was significantly higher at baseline compared with 6 months and 24 months . Peak oxygen uptake increased from baseline significantly during the first 6 months ( from 29.6 ± 5.7 to 30.6 ± 6.3 ml · min−1 · kg−1 ) and decreased to the baseline level ( 29.1 ± 5.5 ml · min−1 · kg−1 ) at 24 months . At baseline , the average Work Ability Index was 44.2 ± 4.0 , and it remained unchanged at 6 months ( 44.4 ± 3.9 ) and at 24 months ( 44.2 ± 3.1 ) . In conclusion , a 2-year physical activity intervention increased daily energy expenditure , reduced body fat , and maintained peak oxygen uptake in healthy , middle-aged , sedentary subjects .  The average Work Ability Index score at baseline was excellent and did not change during the 2-year physical activity interventions OBJECTIVE To determine whether provision of individualised physical activity advice by an exercise specialist in general practice is effective in modifying physical activity and cardiovascular risk factors  in older adults . DESIGN R and omised controlled trial of individualised physical activity advice , reinforced at three and six months ( intervention ) versus no advice ( control ) . SETTING Two general practice s in Adelaide , South Australia , 1996 . PARTICIPANTS 299 adults aged 60 years or more who were healthy , sedentary and living in the community . MAIN OUTCOME MEASURES Changes to physical activity ( frequency and duration of walking and vigorous exercise ) , selected cardiovascular risk factors ( blood pressure , body weight , serum lipid levels ) and quality of life over 12 months . RESULTS Self-reported physical activity increased over the 12 months in both groups ( P < 0.001 ) . The increase was greater for the intervention than the control group for all measures except time spent walking ( P < 0.05 ) . More intervention than control participants increased their intention to exercise ( P < 0.001 ) . Serum levels of total and low-density lipoprotein cholesterol and triglycerides fell significantly over the 12 months to a similar extent in the two groups . No other significant changes in cardiovascular risk factors were seen . Quality -of-life scores decreased over the 12 months . The decrease was significantly greater among intervention than control women , but not men , for emotional well-being ( P = 0.02 ) , physical well-being ( P = 0.04 ) and social functioning ( P = 0.04 ) . DISCUSSION Provision of general practice -based physical activity advice reinforced three-monthly produced a sustained increase in self-reported physical activity . However , there were no associated changes in clinical measures of cardiovascular risk factors and minimal changes in quality -of-life measures R and omized trial of 527 corporate employees was conducted to evaluate an exercise intervention based on the transtheoretical model and tailored to individual stages of change . No significant difference in physical activity by stage was evident at baseline among three treatment groups . At follow-up , the group receiving a staged-based message increased activity by 13 % and a significant difference was evident in the magnitude and direction of movement across stages , suggesting that tailored messages to stages of change may be an effective strategy for physical activity interventions Purpose . This study compares the efficacy of a self-help intervention tailored to the individual 's stage of motivational readiness for exercise adoption with a st and ard self-help exercise promotion intervention . Design . Interventions were delivered at baseline and 1 month ; assessment s were collected at baseline and 3 months . Setting . Eleven worksites participating in the Working Healthy Research Trial . Subjects . Participants ( n = 1559 ) were a sub sample of employees at participating worksites , individually r and omized to one of two treatment conditions . Intervention . Printed self-help exercise promotion material s either ( 1 ) matched to the individual 's stage of motivational readiness for exercise adoption ( motivationally tailored ) , or ( 2 ) st and ard material s ( st and ard ) . Measures . Measures of stage of motivational readiness for exercise and items from the 7-Day Physical Activity Recall . Results . Among intervention completers ( n = 903 ) , chi-square analyses showed that , compared to the st and ard intervention , those receiving the motivationally tailored intervention were significantly more likely to show increases ( 37 % vs. 27 % ) and less likely to show either no change ( 52 % vs. 58 % ) or regression ( 11 % vs. 15 % ) in stage of motivational readiness . Multivariate analyses of variance showed that changes in stage of motivational readiness were significantly associated with changes in self-reported time spent in exercise . Conclusions . This is the first prospect i ve , r and omized , controlled trial demonstrating the efficacy of a brief motivationally tailored intervention compared to a st and ard self-help intervention for exercise adoption . These findings appear to support treatment approaches that tailor interventions to the individual 's stage of motivational readiness for exercise adoption Eighty-seven healthy volunteers aged 60 - 81 years were r and omly allocated to either an aerobic exercise class or a health education group . Only 6 subjects dropped out during the 32-week study , and the average compliance with the interventions was 83 % for exercise ( on average 83/100 individual exercise sessions were attended ) and 71 % for health education . The health education group showed improvements from the baseline in physical activity levels , pulse rate , blood pressure and self-rating of mood . The exercise group improved from baseline in knee and spine flexibility , leg and back strength , pulse rate , blood pressure , maximum physical exertion levels , self-rating of mood and perceived health status . Between group comparison at the end of the study showed the exercise group significantly better than the health education group in terms of spine flexion ( p < 0.0001 ) , perceived health status ( p < 0.05 ) , life satisfaction ( p = 0.05 ) and maximal physical exertion ( p = 0.01 ) . This study has demonstrated the acceptability and effectiveness of an aerobic exercise class for the elderly , and the effectiveness of health education for this age group
target: The heterogeneity in reported effects was reduced in higher quality studies , when physical activity was self-directed with some professional guidance and when there was on-going professional support .
  Our review suggests that physical activity interventions have a moderate effect on self reported physical activity and cardio-respiratory fitness , but not on achieving a predetermined level of physical activity .
  Due to the clinical and statistical heterogeneity of the studies , only limited conclusions can be drawn about the effectiveness of individual components of the interventions .
background: BACKGROUND Little is known about the effectiveness of strategies to enable people to achieve an increase in their physical activity .
  OBJECTIVES To assess the effects of interventions for promoting physical activity in adults aged 16 years and older , not living in an institution .