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 randomized 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 to 60 years) seen in a university-based weight management program. INTERVENTIONS: Structured aerobic exercise or moderate lifestyle activity; low-fat diet of about 1,200 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 < 0.001; between groups, p = 0.08). The aerobic group lost significantly less fat-free mass (0.5 (1.3) kg) than the lifestyle group (1.4 (1.3) kg; p = 0.03). 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 < 0.001) 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.

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