IMPORTANCE: Despite guidelines that recommend physical activity (PA), little is known about which types of behavior change strategies (BCSs) effectively promote sustained increases in PA in older adults who are insufficiently active. OBJECTIVE: To determine whether intrapersonal BCSs (eg, goal setting) or interpersonal BCSs (eg, peer-to-peer sharing or learning) combined with the Otago Exercise Program (17 strength and balance exercises and a walking program that are learned and individually tailored, with instruction to perform 3 times per week at home or location of choice) and a wearable PA monitor help older adults sustain increases in their PA. DESIGN, SETTING, AND PARTICIPANTS: This 2 x 2 factorial randomized clinical trial (Community-Based Intervention Effects on Older Adults' Physical Activity) of community-dwelling older adults 70 years or older with PA levels below minimum national PA guidelines was conducted in urban community centers. Dates of enrollment were from November 17, 2017, to June 15, 2021, with final follow-up assessments completed on September 2, 2022. INTERVENTIONS: Participants were randomized to intrapersonal (eg, goal setting) BCSs, interpersonal (eg, problem-solving with peer-to-peer sharing and learning) BCSs, intrapersonal and interpersonal BCSs, or an attention control group. All interventions included a PA monitor and 8 weekly small-group meetings with discussion, practice, and instructions to implement the exercise program and relevant BCSs independently between meetings and after the intervention. MAIN OUTCOMES AND MEASURES: The primary outcome was daily minutes of objectively measured total PA (light, moderate, or vigorous intensities) averaged over 7 to 10 days, measured at baseline and after the intervention at 1 week, 6 months, and 12 months. RESULTS: Among 309 participants (mean (SD) age 77.4 (5.0) years; 240 women (77.7%)), 305 (98.7%) completed the intervention, and 302 (97.7%) had complete data. Participants receiving PA interventions with interpersonal BCS components exhibited greater increases in total PA than did those who did not at 1 week (204 versus 177 PA minutes per day; adjusted difference, 27.1 (95% CI 17.2 to 37.0); p < 0.001), 6 months (195 versus 175 PA minutes per day; adjusted difference, 20.8 (95% CI 10.0 to 31.6); p < 0.001), and 12 months (195 versus 168 PA minutes per day; adjusted difference, 27.5 (95% CI 16.2 to 38.8); p < 0.001) after the intervention. Compared with participants who did not receive interventions with intrapersonal BCS components, participants who received intrapersonal BCSs exhibited no significant changes in total PA at 1 week (192 versus 190 PA minutes per day; adjusted difference, 1.8 (95% CI -8.6 to 12.2); p = 0.73), 6 months (183 versus 187 PA minutes per day; adjusted difference, -3.9 (95% CI -15.0 to 7.1); p = 0.49), or 12 months (177 versus 186 PA minutes per day; adjusted difference, -8.8 (95% CI -20.5 to 2.9); p = 0.14) after the intervention. Interactions between intrapersonal and interpersonal BCSs were not significant. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, older adults with low levels of PA who received interpersonal BCSs, the exercise program, and a PA monitor exhibited significant increases in their PA for up to 12 months after the intervention. Intrapersonal BCSs elicited no significant PA changes and did not interact with interpersonal BCSs. Our findings suggest that because effects of a PA intervention on sustained increases in older adults' PA were augmented with interpersonal but not intrapersonal BCSs, approaches to disseminating and implementing the intervention should be considered. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03326141.

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