title: Effect of an individually tailored one-year energy balance programme on body weight, body composition and lifestyle in recent retirees: a cluster randomised controlled trial Change in physical activity and weight in relation to retirement: the French GAZEL Cohort Study Study protocol of a cluster randomised controlled trial investigating the effectiveness of a tailored energy balance programme for recent retirees Maintaining physical activity among older adults: 24-month outcomes of the Keep Active Minnesota randomized controlled trial. Tailored Print Communication and Telephone Motivational Interviewing Are Equally Successful in Improving Multiple Lifestyle Behaviors in a Randomized Controlled Trial Evidence-based behavioral medicine: What is it and how do we achieve it? Exploring the Efficacy and Moderators of Two Computer-Tailored Physical Activity Interventions for Older Adults: A Randomized Controlled Trial Social support and the likelihood of maintaining and improving levels of physical activity: the Whitehall II Study Prevention of Type II diabetes in subjects with impaired glucose tolerance: the Diabetes Prevention Study (DPS) in Finland
  Study design and 1-year interim report on the feasibility of the lifestyle intervention programme The 'Women's Lifestyle Study', 2-year randomized controlled trial of physical activity counselling in primary health care: rationale and study design One year of caloric restriction in humans: feasibility and effects on body composition and abdominal adipose tissue. Ongoing physical activity advice by humans versus computers: the Community Health Advice by Telephone (CHAT) trial. Vitalum study design: RCT evaluating the efficacy of tailored print communication and telephone motivational interviewing on multiple health behaviors Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study Design of the sex hormones and physical exercise (SHAPE) study The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Influence of retirement on leisure-time physical activity: the atherosclerosis risk in communities study. Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial A new approach to physical activity maintenance: Rationale, design, and baseline data from the Keep Active Minnesota trial Harnessing motivational forces in the promotion of physical activity: the Community Health Advice by Telephone (CHAT) project. Exercise on prescription for women aged 40-74 recruited through primary care: two year randomised controlled trial Effectiveness of a Pragmatic Education Program Designed to Promote Walking Activity in Individuals With Impaired Glucose Tolerance Lifestyle intervention and coronary heart disease risk factor changes over 18 months in postmenopausal women: the Women On the Move through Activity and Nutrition (WOMAN study) clinical trial. The inverse relationship between number of steps per day and obesity in a population-based sample – the AusDiab study Prevention of diabetes mellitus in subjects with impaired glucose tolerance in the Finnish Diabetes Prevention Study: results from a randomized clinical trial. Objective measures of neighborhood environment and physical activity in older women. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. Influence of weekend lifestyle patterns on body weight. Improving aerobic fitness in older adults: effects of a physician-based exercise counseling and prescription program. Effectiveness of a lifestyle intervention and a structured exercise intervention in older adults. Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults. Cost-effectiveness of physical activity counselling in general practice. Intraclass correlation coefficients from three cluster randomised controlled trials in primary and residential health care Aging, retirement, and changes in physical activity: prospective cohort findings from the GLOBE study. Rationale, design and baseline data from the Pre-diabetes Risk Education and Physical Activity Recommendation and Encouragement (PREPARE) programme study: a randomized controlled trial. Exercise effect on weight and body fat in men and women. The long and winding road to physical activity maintenance. Cardiovascular disease risk reduction: the Massachusetts WISEWOMAN project. Health benefits of a pedometer-based physical activity intervention in sedentary workers. Cardiovascular prevention in the Hartslag Limburg project: effects of a high-risk approach on behavioral risk factors in a general practice population. Physical activity and cardiovascular risk factors: effect of advice from an exercise specialist in Australian general practice.
abstract: Background The increased prevalence of overweight and obesity warrants preventive actions , particularly among people in transitional stages associated with lifestyle changes , such as occupational retirement . The purpose is to investigate the effect of a one year low-intensity computer-tailored energy balance programme among recent retirees on waist circumference , body weight and body composition , blood pressure , physical activity and dietary intake . Methods A r and omised controlled trial was conducted among recent retirees ( N = 413 ; mean age 59.5 years ) . Outcome measures were assessed using anthropometry , bio-impedance , blood pressure measurement and question naires . Results Waist circumference , body weight and blood pressure decreased significantly in men of the intervention and control group , but no significant between-group-differences were observed at 12 or at 24-months follow-up . A significant effect of the programme was only observed on waist circumference ( -1.56 cm ( 95%CI : -2.91 to -0.21 ) ) at 12 month follow up among men with low education ( n = 85 ) . Physical activity and dietary behaviours improved in both the intervention and control group during the intervention period . Although , these behaviours changed more favourably in the intervention group , these between-group-differences were not statistically significant . Conclusions The multifaceted computer-tailored programme for recent retirees did not appear to be effective . Apparently the transition to occupational retirement and /or participation in the study had a greater impact than the intervention programme . Trial registration Clinical Trials NCT00122213 Objectives To examine the trajectories of physical activity from preretirement to postretirement and to further clarify whether the changes in physical activity are associated with changes in body weight . Design Prospect i ve . Setting French national gas and electricity company ( GAZEL cohort ) . Participants From the original sample of 20 625 employees , only those retiring between 2001 and 2008 on a statutory basis were selected for the analyses ( analysis 1 : n=2711 , 63 % men ; analysis 2 : n=3812 , 75 % men ) . Persons with data on at least one preretirement and postretirement measurement of the outcome were selected . Primary and secondary outcome measures All outcome data were gathered by question naires . In analysis 1 , the annual prevalence of higher physical activity ( walking ≥5 km/week ) 4 years before and after retirement was analysed . In analysis 2 , changes in leisure-time sport activities ( engagement , frequency and manner ) from preretirement to postretirement were analysed with simultaneous changes in body weight ( kilogram ) . Results In analysis 1 ( n=2711 ) , prevalence estimates for 4 years before and 4 years after retirement showed that higher leisure-time physical activity ( walking at least 5 km/week ) increased by 36 % in men and 61 % in women during the transition to retirement . This increase was also observed among people at a higher risk of physical inactivity , such as smokers and those with elevated depressive symptoms . In a separate sample ( analysis 2 , n=3812 ) , change in weight as a function of preretirement and postretirement  physical activity was analysed . Weight gain preretirement to postretirement was 0.85 ( 95 % CI 0.48 to 1.21 ) to 1.35 ( 0.79 to 1.90 ) kg greater among physically inactive persons ( decrease in activity or inactive ) compared with those physically active ( p<0.001 ) . Conclusions Retirement transition may be associated with beneficial changes in lifestyle and may thus be a good starting point to preventive interventions in various groups of individuals in order to maintain long-term changes Background People in transitional life stages , such as occupational retirement , are likely to gain weight and accumulate abdominal fat mass caused by changes in physical activity and diet . Hence , retirees are an important target group for weight gain prevention programmes , as described in the present paper . Methods / Design A systematic and stepwise approach ( Intervention Mapping ) is used to develop a low-intensity energy balance intervention programme for recent retirees . This one-year , low-intensity multifaceted programme aims to prevent accumulation of abdominal fat mass and general weight gain by increasing awareness of energy balance and influencing related behaviours of participants ' preference . These behaviours are physical activity , fibre intake , portion size and fat consumption . The effectiveness of the intervention programme is tested in a cluster r and omised controlled trial . Measurements of anthropometry , physical activity , energy intake , and related psychosocial determinants are performed at baseline and repeated at 6 months for intermediate effect , at 12 months to evaluate short-term intervention effects and at 24 months to test the sustainability of the effects . Discussion This intervention programme is unique in its focus on retirees and energy balance . It aims at increasing awareness and takes into account personal preferences of the users by offering several options for behaviour change . Moreover , the intervention programme is evaluated at short-term and long-term and includes consecutive outcome measures ( determinants , behaviour and body composition ) OBJECTIVE To evaluate the efficacy at 6- , 12- , and 24-month follow-up of Keep Active Minnesota ( KAM ) , a telephone and mail-based intervention design ed to promote physical activity ( PA ) maintenance among currently active adults age 50 to 70 . METHOD Participants who reported having recently increased their MVPA to a minimum of 2d/wk , 30 min/bout , ( N=1049 ) were recruited in 2004 and 2005 from one large managed care organization in Minnesota , and r and omly assigned to either treatment ( KAM ; N=523 ) , or Usual Care ( UC ; N=526 ) with PA assessed using the CHAMPS question naire , and expressed as kcal/wk energy expenditure . RESULTS We find a sustained , significant benefit of the intervention at 6 , 12 and 24 months . kcal/wk expenditure in moderate or vigorous activities was higher at 6 ( p<.03 , Cohen 's d(6m)=.16 ) , 12 ( p<.04 , d(12 m)=.13 ) and 24 months ( p<.01 , d(24 m)=.16 ) for KAM participants , compared to UC participants . CONCLUSIONS The KAM telephone- and mail-based PA maintenance intervention was effective at maintaining PA in both the short-term ( 6 months ) and longer-term ( 12 and 24 months ) relative to usual care Background Computer tailoring and motivational interviewing show promise in promoting lifestyle change , despite few head-to-head comparative studies . Purpose Vitalum is a r and omized controlled trial in which the efficacy of these methods was compared in changing physical activity and fruit and vegetable consumption in middle-aged Dutch adults . Methods Participants ( n = 1,629 ) were recruited via 23 general practice s and r and omly received either four tailored print letters , four motivational telephone calls , two of each type of intervention , or no information . The primary outcomes were absolute change in self-reported physical activity and fruit and vegetable consumption . Results All three intervention groups ( i.e. , the tailored letters , the motivational calls , and the combined version ) were equally and significantly more effective than the control group in increasing physical activity ( hours/day ) , intake of fruit ( servings/day ) , and consumption of vegetables ( grams/day ) from baseline to the intermediate measurement ( week 25 ) , follow-up 1 ( week 47 ) and 2 ( week 73 ) . Effect sizes ( Cohen ’s d ) ranged from 0.15 to 0.18 . Participants rated the interventions positively ; interviews were more positively evaluated than letters . Conclusions Tailored print communication and telephone motivational interviewing or their combination are equally successful in changing multiple behaviors The goal of evidence -based medicine is ultimately to improve patient outcomes and quality of care .  Systematic review s of the available published evidence are required to identify interventions that lead to improvements in behavior , health , and well-being . Authoritative literature review s depend on the quality of published research and research reports . The Consoli date d St and ards for Reporting Trials ( CONSORT ) Statement ( www.consort-statement.org ) was developed to improve the design and reporting of interventions involving r and omized clinical trials ( RCTs ) in medical journals . We describe the 22 CONSORT guidelines and explain their application to behavioral medicine research and to evidence -based practice . Additional behavioral medicine-specific guidelines ( e.g. , treatment adherence ) are also presented . Use of these guidelines by clinicians , educators , policymakers , and research ers who design , report , and evaluate or review RCTs will strengthen the research itself and accelerate efforts to apply behavioral medicine research to improve the processes and outcomes of behavioral medicine practice Background Important health benefits can be derived when low-cost ( e.g. , computer-tailored ) physical activity interventions for older adults demonstrate sustained effects . Purpose The purpose of the study was to conduct in-depth analysis on the long-term efficacy of two tailored physical activity interventions for older adults . Methods A r and omized controlled trial ( n = 1,971 ) with two computer-tailored interventions  and a no-intervention control group was conducted . The two tailored interventions consisted of three tailored letters , delivered during 4 months . The basic tailored intervention targeted psychosocial determinants alone , while the environmentally tailored intervention additionally targeted environmental determinants , by providing tailored environmental information .  Self-reported behaviors ( i.e. , total physical activity , transport walking and cycling , leisure walking and cycling , and sports ) were measured at baseline and 12 months . Additionally , potential personal , health-related , and psychosocial moderators of the intervention effects were examined . Results The environmentally tailored intervention was effective in changing total physical activity , leisure cycling , and sports compared with the basic intervention and control group . No intervention effects were found for the basic intervention . Moderation analysis revealed that participants with a higher age , lower body mass index , and higher intention were unresponsive to the interventions . Conclusions Providing environmental information is an effective intervention strategy for increasing physical activity behaviors among older adults , especially among certain “ at-risk ” subgroups such as lower educated , overweight , or insufficiently active participants . Moderation analysis was perceived as a promising method for identifying meaningful subgroups that are unaffected by an intervention , which should receive special attention in future interventions Background : Evidence on the association between social support and  leisure time physical activity ( LTPA ) is scarce and mostly based on cross-sectional data with different types of social support collapsed into a single index . The aim of this study was to investigate whether social support from the closest person was associated with LTPA . Methods : Prospect i ve cohort study of 5395 adults ( mean age 55.7 years , 3864 men ) participating in the British Whitehall II study .  Confiding/emotional support and practical support  were assessed at baseline in 1997–99 using the Close Persons Question naire .  LTPA was assessed at baseline and follow-up in ( 2002–04 ) . Baseline covariates included socio-demographics , self-rated health , long-st and ing illnesses , physical functioning and common mental disorders . Results : Among participants who reported recommended levels of LTPA at baseline , those who experienced high confiding/emotional support were more likely to report recommended levels of LTPA at follow-up [ odds ratio ( OR ) : 1.39 , 95 % confidence interval ( CI ) : 1.12–1.70 in a model adjusted for baseline covariates ] . Among those participants who did not meet the recommended target of LTPA at baseline , high confiding/emotional support was not associated with improvement in activity levels . High practical support was associated with both maintaining ( OR : 1.34 , 95 % CI : 1.10–1.63 ) and improving ( OR : 1.25 , 95 % CI : 1.02–1.53 ) LTPA levels . Conclusion : These findings suggest that emotional and practical support from the closest person may help the individual to maintain the recommended level of LTPA . Practical support also predicted a change towards a more active lifestyle Aims /hypothesis . The aim of the Diabetes Prevention Study is to assess the efficacy of an intensive diet-exercise programme in preventing or delaying  Type II ( non-insulin-dependent ) diabetes mellitus in subjects with impaired glucose tolerance , to evaluate the effects of the intervention programme on cardiovascular risk factors and to assess the determinants for the progression to diabetes in persons with impaired glucose tolerance . Methods . A total of 523 overweight subjects with impaired glucose tolerance ascertained by two oral glucose tolerance tests were r and omised to either a control or intervention group . The control subjects received general information at the start of the trial about the lifestyle changes necessary to prevent diabetes and about annual follow-up visits . The intervention subjects had seven sessions with a nutritionist during the first year and a visit every 3 months thereafter aim ed at reducing weight , the intake of saturated fat and increasing the intake of dietary fibre . Intervention subjects were also guided individually to increase their physical activity .  Results . During the first year , weight loss in the first 212 study subjects was 4.7 ± 5.5 vs 0.9 ± 4.1 kg in the intervention and control group , respectively ( p < 0.001 ) . The plasma glucose concentrations ( fasting : 5.9 ± 0.7 vs 6.4 ± 0.8 mmol/l , p < 0.001 ; and 2-h 7.8 ± 1.8 vs 8.5 ± 2.3 mmol/l , p < 0.05 ) were significantly lower in the intervention group after the first year of intervention . Favourable changes were also found in blood pressure , serum lipids and anthropometric indices in the intervention group . Conclusion /interpretation . The interim results show the efficacy and feasibility of the lifestyle intervention programme . [ Diabetologia ( 1999 ) 42 : 793–801 Background Physical inactivity is an independent risk factor for diabetes and heart disease . There is evidence that increasing physical activity can reduce the risk of developing these chronic diseases , but less evidence about effective ways to increase adherence to physical activity . Interventions are therefore needed that produce sustained increases in adherence to physical activity , are cost-effective and improve clinical endpoints . Methods The Women 's Lifestyle Study is a two year r and omized controlled trial involving a nurse-led intervention to increase physical activity in 40–74 year old physically inactive women recruited from primary care . Baseline measures were assessed in a face-to-face interview with a primary care nurse . The intervention involved delivery of a ' Lifestyle script ' by a primary care nurse followed by telephone counselling for nine months and a face-to-face nurse visit at six months . Outcome measurements are assessed at 12 and 24 months . The primary outcome is physical activity measured using a vali date d physical activity question naire . Secondary outcomes include blood pressure , weight , waist circumference , physical fitness ( step test ) , serum HbA1c , fasting glucose , lipids , insulin , and quality of life ( SF36 ) . Costs were measured prospect ively to allow a subsequent cost-effectiveness evaluation if the trial is positive . Discussion Due to report in 2008 , the Women 's Lifestyle Study tests the effectiveness of an enhanced low-cost , evidence -based intervention in increasing physical activity , and improving cardiovascular and diabetes risk indicators over two years . If successful in demonstrating improvements in health outcomes , this r and omized controlled trial will be the first to demonstrate long-term cardiovascular and diabetes risk health benefit , in addition to improvements in physical activity , from a sustainable physical activity intervention based in primary care . Trial Registration Australian Clinical Trials Registry ( ACTR ) , ACTRN012605000490673 BACKGROUND Caloric restriction ( CR ) increases maximal life span in short-lived organisms , and its effects are being explored in nonhuman primates . The objectives of this study were to determine the feasibility of prolonged CR in nonobese adults and to compare the effects of CR- and exercise-induced weight loss on body composition and abdominal adiposity . METHODS A r and omized , controlled trial was conducted with 48 healthy , nonobese women and men , aged 57 + /- 1 ( mean + /- st and ard error [ SE ] ) years , with body mass index 27.3 + /- 0.3 kg/m2 . Participants were r and omly assigned to a 20 % calorically-restricted diet ( CR , n = 19 ) , exercise design ed to produce a similar energy deficit ( EX , n = 19 ) , or a healthy lifestyle control group ( HL , n = 10 ) for 1 year . Assessment s included weight , body composition by dual-energy x-ray absorptiometry , abdominal adipose tissue by magnetic resonance imaging , and energy intake by doubly labeled water . RESULTS The average level of CR achieved by the CR group was 11.5 + /- 2.1 % , and the EX group completed 59 + /- 6.7 % of their prescribed exercise . Weight changes were greater ( p < or=.0005 ) in the CR ( -8.0 + /- 0.9 kg ) and EX ( -6.4 + /- 0.9 ) groups as compared to the HL group ( -1.3 + /- 0.9 kg ) , corresponding to reductions of 10.7 % , 8.4 % , and 1.7 % of baseline weights , respectively . Whole-body fat mass and visceral and subcutaneous abdominal adipose tissue decreased significantly ( p < .005 ) and comparably in the CR and EX groups , but did not change in the HL group . CONCLUSIONS CR for 1 year was feasible , but the level of CR achieved was less than prescribed . CR and exercise were equally effective in reducing weight and adiposity PURPOSE Given the prevalence of physical inactivity among American adults , convenient , low-cost interventions are strongly indicated . This study determined the 6- and 12-month effectiveness of telephone interventions delivered by health educators or by an automated computer system in promoting physical activity . DESIGN Initially inactive men and women age 55 years and older ( N = 218 ) in stable health participated . Participants were r and omly assigned to human advice , automated advice , or health education control . MEASURES The vali date d 7-day physical activity recall interview was used to estimate minutes of moderate to vigorous physical activity . Physical activity differences by experimental arm were verified on a r and om sub sample via accelerometry . RESULTS Using intention-to-treat analysis , at 6 months , participants in both interventions , although not differing from one another , showed significant improvements in weekly physical activity compared with controls . These differences were generally maintained at 12 months , with both intervention arms remaining above the target of 150 min per week of moderate to vigorous physical activity on average . CONCLUSION Automated telephone-linked delivery systems represent an effective alternative for delivering physical activity advice to inactive older adults Background A large proportion of adults fail to meet public health guidelines for physical activity as well as fruit , vegetable and fat intake . Interventions are needed to improve these health behaviors . Both computer tailoring and motivational interviewing have shown themselves to be promising techniques for health behavior change . The Vitalum project aims to compare the efficacy of these techniques in improving the health behaviors of adults aged 45–70 . This paper describes the design of the Vitalum study . Methods / Design Dutch general medical practice s ( N = 23 ) were recruited via a registration network or by personal invitation . The participants were then enrolled through these general practice s using an invitational letter . They ( n = 2,881 ) received a written baseline question naire to assess health behaviors , and potential psychosocial and socio-demographic behavioral determinants . A power analysis indicated that 1,600 participants who were failing to meet the guidelines for physical activity and either fruit or vegetable consumption were needed . Eligible participants were stratified based on hypertension status and r and omized into one of four intervention groups : tailored print communication , telephone motivational interviewing , combined , and control . The first two groups either received four letters or took part in four interviews , whereas the combined group received two letters and took part in two interviews in turns at 5 , 13 , 30 and 43 weeks after returning the baseline question naire . Each letter and interview focused on physical activity or nutrition behavior . The participants also took part in a telephone survey 25 weeks after baseline to gather new information for tailoring . There were two follow-up question naires , at 47 and 73 weeks after baseline , to measure short- and long-term effects . The control group received a tailored letter after the last posttest . The process , efficacy and cost-effectiveness of the interventions will be examined by means of multilevel mixed regression , cost-effectiveness analyses and process evaluation . Discussion The Vitalum study simultaneously evaluates the efficacy of tailored print communication and telephone motivational interviewing , and their combined use for multiple behaviors and people with different motivational stages and education levels . The results can be used by policymakers to contribute to evidence -based prevention of chronic diseases . Trial Registration Dutch Trial Register BACKGROUND The health benefits of leisure-time physical activity are well known , but whether less exercise than the recommended 150 min a week can have life expectancy benefits is unclear . We assessed the health benefits of a range of volumes of physical activity in a Taiwanese population . METHODS In this prospect i ve cohort study , 416,175 individuals ( 199,265 men and 216,910 women ) participated in a st and ard medical screening programme in Taiwan between 1996 and 2008 , with an average follow-up of 8·05 years ( SD 4·21 ) . On the basis of the amount of weekly exercise indicated in a self-administered question naire , participants were placed into one of five categories of exercise volumes : inactive , or low , medium , high , or very high activity . We calculated hazard ratios ( HR ) for mortality risks for every group compared with the inactive group , and calculated life expectancy for every group . FINDINGS Compared with individuals in the inactive group , those in the low-volume activity group , who exercised for an average of 92 min per week ( 95 % CI 71 - 112 ) or 15 min a day ( SD 1·8 ) , had a 14 % reduced risk of all-cause mortality ( 0·86 , 0·81 - 0·91 ) , and had a 3 year longer life expectancy . Every additional 15 min of daily exercise beyond the minimum amount of 15 min a day further reduced all-cause mortality by 4 % ( 95 % CI 2·5 - 7·0 ) and all-cancer mortality by 1 % ( 0·3 - 4·5 ) . These benefits were applicable to all age groups and both sexes , and to those with cardiovascular disease risks . Individuals who were inactive had a 17 % ( HR 1·17 , 95 % CI 1·10 - 1·24 ) increased risk of mortality compared with individuals in the low-volume group . INTERPRETATION 15 min a day or 90 min a week of moderate-intensity exercise might be of benefit , even for individuals at risk of cardiovascular disease . FUNDING Taiwan Department of Health Clinical Trial and Research Center of Excellence and National Health Research Institutes Background Physical activity has been associated with a decreased risk for breast cancer . The biological mechanismn(s ) underlying the association between physical activity and breast cancer is not clear . Most prominent hypothesis is that physical activity may protect against breast cancer through reduced lifetime exposure to endogenous hormones either direct , or indirect by preventing overweight and abdominal adiposity . In order to get more insight in the causal pathway between physical activity and breast cancer risk , we design ed the Sex Hormones and Physical Exercise ( SHAPE ) study . Purpose of SHAPE study is to examine the effects of a 1-year moderate-to-vigorous intensity exercise programme on endogenous hormone levels associated with breast cancer among sedentary postmenopausal women and whether the amount of total body fat or abdominal fat mediates the effects . Methods / Design In the SHAPE study , 189 sedentary postmenopausal women , aged 50–69 years , are r and omly allocated to an intervention or a control group . The intervention consists of an 1-year moderate-to-vigorous intensity aerobic and strenght training exercise programme . Partcipants allocated to the control group are requested to retain their habitual exercise pattern . Primary study parameters measured at baseline , at four months and at 12 months are : serum concentrations of endogenous estrogens , endogenous and rogens , sex hormone binding globuline and insuline . Other study parameters include : amount of total and abdominal fat , weight , BMI , body fat distribution , physical fitness , blood pressure and lifestyle factors . Discussion This study will contribute to the body of evidence relating physical activity and breast cancer risk and will provide insight into possible mechanisms through which physical activity might be associated with reduced risk of breast cancer in postmenopausal women . Trial registration 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 Cross-sectional data suggest that leisure-time physical activity may increase during retirement . Prospect i ve population -based studies are necessary to characterize leisure activity patterns through retirement among the same persons to verify this observation . Therefore , the purpose of this study was to describe the influence of retirement on leisure activity using data from Atherosclerosis Risk in Communities Study cohort participants aged 45 - 64 years at baseline .  Physical activity was measured by the Baecke question naire  in 1,825 African-American and 5,957 White participants who were working at the initial visit ( 1986 - 1989 ) and either retired or working 6 years later ( 1993 - 1995 ) . Participants who retired during follow-up were more likely to increase their sport participation and television watching than those who continued to work over the 6-year period . Among those reporting sport or exercise at baseline , those retiring over follow-up were more likely to maintain their sport and exercise participation than those who continued to work across race-gender groups . Among those not reporting sport or exercise at baseline , those who retired were more likely to adopt activity than those who continued to work except for African-American women . In this study , retirement was associated with gains in sport and exercise participation as well as television watching 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 Background Since many individuals who initiate physical  activity programs are highly likely to return to a sedentary lifestyle , innovative strategies to efforts to increase the number of physically active older adults who successfully maintain beneficial levels of PA for a substantial length of time are needed . Methods / Design The Keep Active Minnesota Trial is a r and omized controlled trial of an interactive phone- and mail-based intervention to help 50–70 year old adults who have recently increased their physical activity level , maintain that activity level over a 24-month period in comparison to usual care . Baseline , 6 , 12 , and 24 month measurement occurred via phone surveys with kilocalories expended per week in total and moderate-to-vigorous physical activity ( CHAMPS Question naire ) as the primary outcome measures . Secondary outcomes include hypothesized mediators of physical activity change ( e.g. , physical activity enjoyment , self-efficacy , physical activity self-concept ) , body mass index , and depression . Seven day accelerometry data were collected on a sub- sample of participants at baseline and 24-month follow-up . Discussion The Keep Active Minnesota study offers an innovative approach to the perennial problem of physical activity relapse ; by focusing explicitly on physical activity maintenance , the intervention holds considerable promise for modifying the typical relapse curve . Moreover , if shown to be efficacious , the use of phone- and mail-based intervention delivery offers potential for widespread dissemination . Trial registration Clinical Trials.gov Identifier : NCT00283452 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 Objective To assess the effectiveness of a primary care based programme of exercise on prescription among relatively inactive women over a two year period . Design R and omised controlled trial . Setting 17 primary care practice s in Wellington , New Zeal and Participants 1089 women aged 40 - 74 not undertaking 30 minutes of moderate intensity physical activity on at least five days of the week  Intervention Brief physical activity intervention led by nurse with six month follow-up visit and monthly telephone support over nine months . Main outcome measure Physical activity assessed at baseline and 12 and 24 months . Secondary outcomes were quality of life ( SF-36 ) , weight , waist circumference , blood pressure , concentrations of fasting serum lipids , glycated haemoglobin ( HbA1c ) , glucose , insulin , and physical fitness . Results Mean age was 58.9 ( SD 7 ) years . Trial retention rates were 93 % and 89 % at 12 and 24 months , respectively . At baseline , 10 % of intervention participants and 11 % of control participants were achieving 150 minutes of at least moderate intensity physical activity a week . At 12 months rates increased to 43 % and 30 % and at 24 months to 39.3 % and 32.8 % ( P<0.001 ) , respectively . SF-36 physical functioning ( P=0.03 ) and mental health ( P<0.05 ) scores improved more in intervention compared with control participants , but role physical scores were significantly lower ( P<0.01 ) . There were no significant differences in clinical outcomes . More falls ( P<0.001 ) and injuries ( P=0.03 ) were recorded in the intervention group . Conclusions This programme of exercise on prescription increased physical activity and quality of life over two years , although falls and injuries also increased . This finding supports the use of exercise on prescription programmes as part of population strategies to reduce physical inactivity . Trial registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) ANZCTRN012605000490673 OBJECTIVE To investigate whether a pragmatic structured education program with and without pedometer use is effective for promoting physical activity and improving glucose tolerance in those with impaired glucose tolerance ( IGT ) . RESEARCH DESIGN AND METHODS Overweight and obese individuals with IGT were recruited from ongoing screening studies at the University Hospitals of Leicester , U.K. Participants were r and omly assigned to one of three groups . Group 1 received a 3-h group-based structured education program design ed to promote walking activity using personalized steps-per-day goals and pedometers . Group 2 received a 3-h group-based structured education program design ed to promote walking activity using generic time-based goals . Group 3 received a brief information leaflet ( control condition ) . Outcomes included an oral glucose tolerance test , st and ard anthropometric measures , ambulatory activity , and psychological variables . Follow-up was conducted at 3 , 6 , and 12 months . RESULTS A total of 87 individuals ( 66 % male , mean age 65 years ) were included in this study . At 12 months , significant decreases in 2-h postchallenge glucose and fasting glucose of −1.31 mmol/l ( 95 % CI −2.20 to −0.43 ) and −0.32 mmol/l ( −0.59 to −0.03 ) , respectively , were seen in the pedometer group compared with the control group . No significant improvements in glucose control were seen in those given the st and ard education program . CONCLUSIONS This study suggests that a pragmatic structured education program that incorporates pedometer use is effective for improving glucose tolerance in those with IGT . This result is likely to have important implication s for future primary care – based diabetes prevention initiatives OBJECTIVES In this paper , we present the results of changes in risk factors by use of hormone therapy ( HT ) at 18 months in the Women On the Move through Activity and Nutrition ( WOMAN ) r and omized trial . METHODS The trial was design ed to test the hypothesis that aggressive dietary changes and increased physical activity to reduce weight , waist circumference ( WC ) , glucose , insulin , and lipoproteins would reduce progression of sub clinical atherosclerosis , carotid intimal media thickness and plaque , coronary artery calcification , and pulse wave velocity ( PWV ) . The study focused on postmenopausal women ( n = 508 ) , mean age of 57 , who were r and omized to the Lifestyle Change ( LC ) or Health Education ( HE ) group .  RESULTS At 18 months of follow-up , there was significant , 17 lb , weight loss and 10 cm WC decrease in the LC group . There were significant differences in changes in low-density lipoprotein cholesterol ( LDL-C ) , insulin , glucose , large LDL , and LDL particles between the LC and HE groups . Risk factor changes were greater for women in the LC who lost a significant amount of weight ( > or=18.8 lb ) . Participants at 18 months were subdivided into women who had stayed on HT , 125 ( 28 % ) ; stopped HT after r and omization , 145 ( 33 % ) ; and not on HT at baseline but stopped an average of 7 months prior to r and omization , 173 ( 39 % ) . Weight loss in the LC was similar for all three groups , but LDL lipoprotein response was better for women who stopped HT after r and omization or were not on HT at baseline . CONCLUSIONS The trial has been successful in increasing exercise and diet changes and reduction in weight and WC and variables related to metabolic syndrome Background : Physical activity ( PA ) is inversely associated with obesity but the effect has been difficult to quantify using question naires . In particular , the shape of the association has not yet been well described . Pedometers provide an opportunity to better characterize the association . Methods : Residents of households over the age of 25 years in r and omly selected census districts in Tasmania were eligible to participate in the AusDiab cross-sectional survey conducted in 1999–2000 . 1848 completed the AusDiab survey and 1126 of these ( 609 women and 517 men ) wore a pedometer for 2-weekdays . Question naire data on  recent PA , TV time  and other factors were obtained . The outcomes were waist circumference ( in cm ) and body mass index ( BMI ) ( kg/m2 ) . Results : Increasing daily steps were associated with a decline in the obesity measures . The logarithmic nature of the associations was indicated by a sharper decline for those with lower daily steps . For example , an additional 2000 steps for those taking only 2000 steps per day was associated with a reduction of 2.8 ( 95 % confidence interval ( CI ) : 2.1,4.4 ) cm in waist circumference among men ( for women ; 2.2 ( 95 % CI : 0.6 , 3.9 cm ) ) with a baseline of only 2000 , steps compared to a 0.7 ( 95 % CI 0.3 , 1.1 ) cm reduction ( for women ; 0.6 ( 95 % CI : 0.2 , 1.0 ) ) for those already walking 10 000 steps daily . In the multivariable analysis , clearer associations were detected for  PA and these obesity measures using daily step number rather than PA time by question naire . Interpretation : Pedometer measures of activity indicate that the inverse association between recent  PA  and obesity is logarithmic in form with the greatest impact for a given arithmetic step number increase seen at lower levels of baseline activity . The findings from this study need to be examined in prospect i ve setting Type 2 diabetes mellitus is increasing worldwide largely as a result from increasing obesity and sedentary lifestyle . The Finnish Diabetes Prevention Study ( DPS ) is the first individually r and omized controlled clinical trial to test the feasibility and efficacy of lifestyle modification in high-risk subjects . We r and omly assigned 522 ( 172 men , 350 women ) middle-aged ( mean age 55 yr ) , overweight ( mean body mass index 31 kg/m(2 ) ) subjects with impaired glucose tolerance either to the lifestyle intervention or control group .  Each subject in the intervention group received individualized counseling aim ed at reducing weight and intake of total and saturated fat , and increasing intake of fiber and physical activity . An oral glucose tolerance test was performed annually to detect incident cases of diabetes and to measure changes in metabolic parameters . The mean ( + /- SD ) weight reduction from baseline to year 1 and to year 2 , respectively , was 4.2 + /- 5.1 kg and 3.5 + /- 5.5 in the intervention group and 0.8 + /- 3.7 kg and 0.8 + /- 4.4 in the control group ( P < 0.001 between the groups ) . At the time of first analysis of the outcome data the mean duration of follow-up was 3.2 yr . The risk of diabetes was reduced by 58 % ( P < 0.001 ) in the intervention group compared with the control group . The reduction in the incidence of diabetes was directly associated with number and magnitude of lifestyle changes made . In conclusion , the DPS is the first controlled trial demonstrating that type 2 diabetes can be prevented by changes in lifestyle in high-risk subjects BACKGROUND Regular physical activity is known to help prevent chronic disease and promote healthy aging . Yet , most older women are not regularly active . This study attempts to identify objective ly measured attributes of the neighborhood environment that may be associated with physical activity levels in older women . METHODS Sociodemographics and  physical activity level , as measured by pedometer , were assessed in 158 overweight Caucasian and African-American postmenopausal women from southwestern Pennsylvania at the baseline evaluation of a r and omized clinical trial in 2002 - 2003 .  Geographic information systems technology was used to obtain neighborhood-level data , including  neighborhood socioeconomic status  ( SES ) indicators , the median year that homes were built ( as a proxy measure for urban form ) , and proximity to businesses and facilities . Multiple linear regression was used to test associations between individuals ' physical activity level and neighborhood characteristics . RESULTS After controlling for individual age , race/ethnicity , education , smoking status , and body mass index , indicators of low neighborhood SES , living in a neighborhood with homes built between 1950 and 1969 ( representing an urban form that is more pedestrian-friendly than after 1969 ) , and living within walking distance ( 1500 m ) of specific types of businesses and facilities were positively associated with individuals ' physical activity level measured by pedometer ( p < 0.05 ) . CONCLUSIONS Results suggest that certain aspects of the neighborhood environment may have an important influence on the physical activity levels of postmenopausal women . Results warrant future research to clarify the role of these environmental attributes in other population BACKGROUND Type 2 diabetes mellitus is increasingly common , primarily because of increases in the prevalence of a sedentary lifestyle and obesity . Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known . METHODS We r and omly assigned 522 middle-aged , overweight subjects ( 172 men and 350 women ; mean age , 55 years ; mean body-mass index [ weight in kilograms divided by the square of the height in meters ] , 31 ) with impaired glucose tolerance to either the intervention group or the control group . Each subject in the intervention group received individualized counseling aim ed at reducing weight , total intake of fat , and intake of saturated fat and increasing intake of fiber and physical activity . An oral glucose-tolerance test was performed annually ; the diagnosis of diabetes was confirmed by a second test . The mean duration of follow-up was 3.2 years . RESULTS The mean ( + /-SD ) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group ; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group ( P<0.001 for both comparisons between the groups ) . The cumulative incidence of diabetes after four years was 11 percent ( 95 percent confidence interval , 6 to 15 percent ) in the intervention group and 23 percent ( 95 percent confidence interval , 17 to 29 percent ) in the control group . During the trial , the risk of diabetes was reduced by 58 percent ( P<0.001 ) in the intervention group . The reduction in the incidence of diabetes was directly associated with changes in lifestyle . CONCLUSIONS Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects OBJECTIVE To determine whether alterations in diet and /or activity patterns during weekends contribute to weight gain or hinder weight loss . METHODS AND PROCEDURES R and omized , controlled trial comparing 1 year of caloric restriction ( CR ) with 1 year of daily exercise ( EX ) . Subjects included 48 healthy adults ( 30F , 18 M ) aged 50 - 60 years with BMI 23.5 - 29.9 kg/m(2 ) . Body weight was measured on 7 consecutive mornings for a total of 165 weeks at baseline and 437 weeks during the 1-year interventions . Daily weight changes were calculated for weekends ( Friday to Monday ) and weekdays ( Monday to Friday ) . Daily energy intake was estimated using food diaries ;  daily physical activity was measured using accelerometers . Both measures were vali date d against doubly labeled water ( DLW ) . RESULTS At baseline , participants consistently gained weight on weekend days ( + 0.06 + /- 0.03 kg/day , ( mean + /- s.e . ) , P = 0.02 ) , but not on weekdays ( -0.02 + /- 0.02 kg/day , P = 0.18 ) . This was attributable to higher dietary intake on Saturdays and lower physical activity on Sundays relative to weekdays ( both P < 0.05 ) . During the interventions , both CR and EX participants were in negative energy balance on weekdays ( P < 0.005 ) . On weekends , however , CR participants stopped losing weight , and EX participants gained weight ( + 0.08 + /- 0.03 kg/day , P < 0.0001 ) due to higher dietary intakes on weekends . This helps to explain the slower-than-expected rate of weight loss during the interventions . DISCUSSION Alterations in lifestyle behaviors on weekends contribute to weight gain or cessation of weight loss on weekends . These results provide one explanation for the relatively slow rates of weight loss observed in many studies , and the difficulty with maintaining significant weight loss OBJECTIVE To determine the effects of adding stages of change-based counseling to an exercise prescription for older , sedentary adults in family practice . DESIGN The Step Test Exercise Prescription Stages of change counseling study was a 12-month cluster r and omized trial . SETTING Forty family practice s in 4 regions of Canada . PARTICIPANTS Healthy , community-dwelling men ( 48 % ) and women ( 52 % ) with a mean ( SD ) age of 64.9 ( 7.1 ) years ( range 55 to 85 years ) . There were a total of 193 participants in the intervention group and 167 in the control group . INTERVENTION Intervention physicians were trained to deliver a tailored exercise prescription and a transtheoretical behaviour change counseling program . Control physicians were trained to deliver the exercise prescription alone . MAIN OUTCOME MEASURES Predicted cardiorespiratory fitness , measured by predicted maximal oxygen consumption ( pVO2max ) , and energy expenditure , measured by 7-day physical activity recall . RESULTS Mean increase in pVO2max was significant for both the intervention ( 3.02 [ 95 % confidence interval 2.40 to 3.65 ] mL/kg/min ) and control ( 2.21 [ 95 % confidence interval 1.27 to 3.15 ] mL/kg/min ) groups at 12 months ( P < .001 ) ; however , there was no difference between groups . Women in the intervention group improved their fitness significantly more than women in the control group did ( 3.20 vs 1.23 mL/kg/min ) . The intervention group had a 4-mm Hg reduction in systolic blood pressure , while the control group 's mean reduction was 0.4 mm Hg ( P < .001 ) . The mean ( SD ) energy expended significantly increased and was higher in the intervention group than in the control group ( 69.06 [ 169.87 ] kcal/d vs -6.96 [ 157.06 ] kcal/d , P < .006 ) . Practice setting characteristics did not significantly affect the primary outcomes . CONCLUSION The Step Test Exercise Prescription Stages of change exercise and behavioural intervention improved fitness and activity and lowered systolic blood pressure across a range of Canadian practice s , but this was not significantly different from the control group , which received only the exercise prescription . Women in the intervention group showed higher levels of fitness than women in the control group did ; men in both groups showed similar improvement OBJECTIVE To evaluate the effects of a lifestyle intervention and a structured exercise intervention on physical activity  in older adults . METHOD Participants were r and omly assigned to a lifestyle intervention ( n=60 ) , including an individualized home-based program supported by phone calls , or to  a structured intervention ( n=60 ) consisting of three weekly supervised sessions . Results were compared with a  control group ( n=66 ) .  Physical activity was measured with self-report question naires , pedometers , and accelerometers before the start ( pretest ) , at the end ( 11 months , posttest ) , and after 23 months ( follow-up ) . The study took place in Belgium from March 2004 until April 2006 . RESULTS At posttest , both intervention groups had significantly increased their total physical activity compared with the control group . At follow-up , the lifestyle group showed significantly larger increases in active transportation and total steps than the control and structured group respectively . There were no longer significant differences between the structured intervention and the control group . CONCLUSIONS The structured and lifestyle interventions were equally effective at the end of the intervention . One year after the intervention the lifestyle group maintained a significant increase in physical activity , which highlights the potential of lifestyle programs in the battle against inactivity in older adults 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 AIM To assess the cost-effectiveness of the ' Green Prescription ' physical activity counselling programme in general practice . METHOD Prospect i ve cost-effectiveness study undertaken as part of a cluster r and omised controlled trial with 12-month follow-up of 878 ' less-active ' patients aged 40 - 79 years in 42 general practice s in the Waikato . The intervention was verbal advice and a written exercise prescription given by general practitioners , with telephone exercise specialist follow-up compared with usual care . Main outcome measures included cost per total and leisure-time physical activity gain from health-funders ' and societal perspectives . RESULTS Significant increases in physical activity were found in the r and omised controlled trial . Programme-cost per patient was NZ170 dollars from a funder 's perspective . The monthly cost-effectiveness ratio for total energy expenditure achieved was 11 dollars per kcal/kg/day . The incremental cost of converting one additional ' sedentary ' adult to an ' active ' state over a twelve-month period was NZ1,756 dollars in programme costs . CONCLUSION Verbal and written physical activity advice given in general practice with telephone follow-up is an inexpensive way of increasing activity for sedentary people , and has the potential to have significant economic impact through reduction in cardiovascular and other morbidity and mortality Objective : This paper provides intraclass correlation coefficients ( ICCs ) for estimation of sample size inflation required in future cluster r and omised trials in primary or residential care There is increased recognition that determinants of health should be investigated in a life-course perspective . Retirement is a major transition in the life course and offers opportunities for changes in physical activity that may improve health in the aging population . The authors examined the effect of retirement on changes in physical activity in the GLOBE Study , a prospect i ve cohort study known by the Dutch acronym for " Health and Living Conditions of the Population of Eindhoven and surroundings , " 1991 - 2004 . They followed respondents ( n = 971 ) by postal question naire who were employed and aged 40 - 65 years in 1991 for 13 years , after which they were still employed ( n = 287 ) or had retired ( n = 684 ) . Physical activity included 1 )  work-related transportation , 2 ) sports participation  , and 3 ) nonsports leisure-time physical activity .  Multinomial logistic regression analyses indicated that retirement was associated with a significantly higher odds for a decline in physical activity from work-related transportation ( odds ratio ( OR ) = 3.03 , 95 % confidence interval ( CI ) : 1.97 , 4.65 ) , adjusted for sex , age , marital status , chronic diseases , and education , compared with remaining employed . Retirement was not associated with an increase in sports participation ( OR = 1.12 , 95 % CI : 0.71 , 1.75 ) or nonsports leisure-time physical activity ( OR = 0.80 , 95 % CI : 0.54 , 1.19 ) . In conclusion , retirement introduces a reduction in physical activity from work-related transportation that is not compensated for by an increase in sports participation or an increase in nonsports leisure-time physical activity OBJECTIVE The PREPARE programme study is a r and omized controlled trial which aims to determine whether structured education can be used to increase physical activity and improve glucose tolerance in individuals with impaired glucose tolerance ( IGT ) . This paper outlines the rationale , design and baseline data from the PREPARE programme study . METHODS Individuals with IGT were recruited from ongoing diabetes screening programmes . Outcomes included an oral glucose tolerance test , physical activity ( piezoelectric pedometer ) and psychological determinants . RESULTS 103 individuals ( male n = 65 ; female n = 38 ) were recruited , 28 % of whom were from a South Asian ethnic background . At baseline the participants ' mean age and BMI were 64 + /- 9 years and 29.4 + /- 4.5 kg/m2 respectively . Steps per day were associated with 2-h glucose ( p = -0.22 , p = 0.03 ) , fasting glucose ( p = 0.22 , p = 0.04 ) , HDL-cholesterol ( p = 0.23 , p = 0.02 ) , triglycerides ( p = -0.22 , p = 0.03 ) and body fat percentage ( p = -0.26 , p = 0.01 ) . Mean self-efficacy scores were significantly ( p < 0.01 ) higher for walking than for any other form of exercise . Participants reported high levels of concern about their IGT status but were confident that exercise would help treat/control IGT . CONCLUSION This study demonstrates the importance of developing effective physical activity and self-management programmes for individuals with IGT . PRACTICE IMPLICATION S This study provides a detailed framework for the promotion of physical activity in a population identified with an increased risk of developing type 2 diabetes which , if successful , could feasibly be implemented in a primary health care or community setting OBJECTIVES The effect of national exercise recommendations on adiposity is unknown and may differ by sex . We examined long-term effects of aerobic exercise on adiposity in women and men . RESEARCH METHODS AND PROCEDURES This was a 12-month r and omized , controlled clinical trial testing exercise effect on weight and body composition in men ( N = 102 ) and women ( N = 100 ) . Sedentary/unfit persons , 40 to 75 years old , were recruited through physician practice s and media . The intervention was facility- and home-based moderate-to-vigorous intensity aerobic activity , 60 min/d , 6 days/wk vs. controls ( no intervention ) . RESULTS Exercisers exercised a mean 370 min/wk ( men ) and 295 min/wk ( women ) , and seven dropped the intervention . Exercisers lost weight ( women , -1.4 vs. + 0.7 kg in controls , p = 0.008 ; men , -1.8 vs. -0.1 kg in controls , p = 0.03 ) , BMI ( women , -0.6 vs. + 0.3 kg/m(2 ) in controls , p = 0.006 ; men , -0.5 kg/m(2 ) vs. no change in controls , p = 0.03 ) , waist circumference ( women , -1.4 vs. + 2.2 cm in controls , p < 0.001 ; men , -3.3 vs. -0.4 cm in controls , p = 0.003 ) , and total fat mass ( women , -1.9 vs. + 0.2 kg in controls , p = 0.001 ; men , -3.0 vs. + 0.2 kg in controls , p < 0.001 ) . Exercisers with greater increases in pedometer-measured steps per day had greater decreases in weight , BMI , body fat , and intra-abdominal fat ( all p trend < 0.05 in both men and women ) . Similar trends were observed for increased minutes per day of exercise and for increases in maximal oxygen consumption . DISCUSSION These data support the U.S. Department of Agriculture and Institute of Medicine guidelines of 60 min/d of moderate-to-vigorous physical activity OBJECTIVES To build upon state-of-the-art theory and empirical data to estimate the strength of multiple mediators of the efficacious Keep Active Minnesota ( KAM ) physical activity ( PA ) maintenance intervention . METHODS The total , direct , and indirect effects through which  KAM helped r and omized participants ( KAM n = 523 ; UC n = 526 ) maintain moderate or vigorous PA ( MVPA ) for up to 2 years were estimated using structural equation modeling . RESULTS Multiple mediators explained half ( beta = .052 , P = .13 ) of the effect of KAM on MVPA ( beta = .105 , P = .004 ) . Self-efficacy was the upstream variable in 2 endogenously mediated effects , and the self-concept mediator emerged as the strongest predictor of MVPA . CONCLUSIONS KAM positively impacted self-efficacy , which was associated with PA enjoyment , integration into the self-concept , and PA maintenance . Successful long-term PA maintenance appears to be influenced by multiple small interrelated mediational pathways . Future research evaluating maintenance models should specify recursive relationships among mediators and outcomes BACKGROUND This report presents the effectiveness of the Massachusetts Well-Integrated Screening and Evaluation for Women Across the Nation ( WISEWOMAN ) Project ( MWWP ) in reducing the cardiovascular disease ( CVD ) risk of uninsured and underinsured women aged > or = 50 . METHODS Healthcare sites were r and omly assigned to an enhanced intervention ( EI ) or minimum intervention ( MI ) . Women enrolled at all sites received CVD risk factor screening , onsite counseling , education , referral , and follow-up as needed . Women enrolled at EI sites received additional services and specially design ed interventions , including one-on-one nutritional and physical activity counseling and group activities , such as walking groups , nutrition classes , and cultural festivals . We report results for 1443 women who attended the initial screening in 10 study sites .  Blood pressure , total cholesterol , number of servings of fruits and vegetables , and level of moderate or vigorous physical activity were assessed at baseline and 12-month follow-up screenings . Baseline data were collected between March and June 1996 ; follow-up data were collected 12 months later . RESULTS The comprehensive screenings significantly lowered the overall prevalence of hypertension , result ing in a 7 % reduction in high blood pressure among women at the EI sites ( p = 0.02 ) and a 9 % reduction at MI sites ( p = 0.009 ) . A significantly greater percentage of women became physically active at the EI sites ( 18 % ) than at the MI sites ( 6 % ) ( p = 0.04 ) . CONCLUSIONS MWWP is a promising model for providing comprehensive preventive healthcare to uninsured and underinsured women BACKGROUND Inactivity is a leading contributor to chronic health problems . Here , we examined the effects of a pedometer-based physical activity intervention ( Prince Edward Isl and -First Step Program , PEI-FSP ) on activity and specific health indices in 106 sedentary workers . METHODS Participants were recruited from five workplaces where most jobs were moderately-highly sedentary . Using subjects as their own control , physical activity ( pedometer-determined steps per day ) was compared before and after a 12-week intervention . Changes in body mass index ( BMI ) , waist girth , resting heart rate , and blood pressure were evaluated . RESULTS The PEI-FSP was completed by 59 % of participants . Steps per day increased from 7,029 + /- 3,100 ( SD ) at baseline to a plateau of 10,480 + /- 3,224 steps/day by 3.96 + /- 3.28 weeks of the intervention . The amount that participants were able to increase their steps per day was not related to their baseline BMI . On average , participants experienced significant decreases in BMI , waist girth , and resting heart rate . Reductions in waist girth and heart rate were significantly related to the increase in steps per day . In contrast , reductions in BMI were predicted by the initial steps per day . CONCLUSIONS The PEI-FSP increased physical activity in a sedentary population . Importantly , those with a higher BMI at baseline achieved relatively similar increases in their physical activity as participants with a lower BMI BACKGROUND This study describes a general- practice -based high-risk cardiovascular prevention approach in Maastricht , The Netherl and s ( 1999 - 2003 ) . The intervention consisted of a complete registration of risk factors , optimization of medical treatment and health counseling on high fat consumption , smoking and physical inactivity . METHODS Behavioral effects were assessed in a trial , r and omization by practice and usual care as control . Vali date d question naires were completed by 1300 patients at baseline , 1174 after 4 months ( 90.3 % ) and 1046 ( 80.5 % ) after 18 months . RESULTS After 4 months , intention-to-treat analyses revealed a decrease in saturated fat intake of 1.3 points ( scale ranging from 7 to 30 points , p=0.000 ) . This was partly sustained after 18 months ( -0.5 points , p=0.014 ) . After 18 months , obese intervention patients were more likely to be sufficiently physically active than their control counterparts ( OR=1.90 , p=0.023 ) . No intervention effects were found for smoking . CONCLUSION Given the multiple factor and multiple component high-risk approach , the intervention had modest effects on only some of the behavioral risk factors addressed . Process data showed that the registration of risk factors and the optimization of medical treatment were only partly implemented , that the health counseling component could be further improved and that the intervention could benefit from additional health promoting strategies 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
target: There was no evidence for a relationship between intervention effectiveness and mode of delivery or number of intervention contacts ; however , interventions which involved individually tailoring with personalized activity goals or provision of information about local opportunities in the environment may be more effective .
  Conclusions Interventions in adults aged 55 to 70 years led to long term improvements in physical activity at 12 months ; however , maintenance beyond this is unclear .
  Identified physical activity improvements are likely to have substantial health benefits in reducing the risk of age-related illnesses .
background: Background Retirement represents a major transitional life stage in middle to older age .
  Changes in physical activity typically accompany this transition , which has significant consequences for health and well-being .
  The aim of this systematic review was to evaluate the evidence for the effect of interventions to promote physical activity in adults aged 55 to 70 years , focusing on studies that reported long-term effectiveness .