CONTEXT: Even though the strong association between physical inactivity and ill health is well documented, 60% of the population is inadequately active or completely inactive. Traditional methods of prescribing exercise have not proven effective for increasing and maintaining a program of regular physical activity. OBJECTIVE: To compare the 24-month intervention effects of a lifestyle physical activity program with traditional structured exercise on improving physical activity, cardiorespiratory fitness, and cardiovascular disease risk factors. DESIGN: Randomized clinical trial conducted from August 1, 1993, through July 31, 1997. PARTICIPANTS: Sedentary men (n = 116) and women (n = 119) with self-reported physical activity of less than 36 and 34 kcal/kg per day, respectively. INTERVENTIONS: Six months of intensive and 18 months of maintenance intervention on either a lifestyle physical activity or a traditional structured exercise program. MAIN OUTCOME MEASURES: Primary outcomes were physical activity assessed by the 7-Day Physical Activity Recall and peak oxygen consumption (VO2peak) by a maximal exercise treadmill test. Secondary outcomes were plasma lipid and lipoprotein cholesterol concentrations, blood pressure, and body composition. All measures were obtained at baseline and at 6 and 24 months. RESULTS: Both the lifestyle and structured activity groups had significant and comparable improvements in physical activity and cardiorespiratory fitness from baseline to 24 months. Adjusted mean changes (95% confidence intervals (CIs)) were 0.84 (95% CI 0.42 to 1.25 kcal/kg per day; p < 0.001) and 0.69 (95% CI 0.25 to 1.12 kcal/kg day; p = 0.002) for activity, and 0.77 (95% CI 0.18 to 1.36 mL/kg per minute; p = 0.01) and 1.34 (95% CI 0.72 to 1.96 mL/kg per minute; p < 0.001) for VO2peak for the lifestyle and structured activity groups, respectively. There were significant and comparable reductions in systolic blood pressure (-3.63 (95% CI -5.54 to -1.72 mmHg; p < 0.001) and -3.26 (95% CI -5.26 to -1.25 mmHg; p = 0.002)) and diastolic blood pressure (-5.38 (95% CI -6.90 to -3.86 mmHg; p < 0.001) and -5.14 (95% CI -6.73 to -3.54 mmHg; p < 0.001) for the lifestyle and structured activity groups, respectively. Neither group significantly changed their weight (-0.05 (95% CI -1.05 to 0.96 kg; p = 0.93) and 0.69 (95% CI -0.37 to 1.74 kg; p = 0.20)), but each group significantly reduced their percentage of body fat (-2.39% (95% CI -2.92% to -1.85%; p < 0.001) and -1.85% (95% CI -2.41% to -1.28%; p < 0.001)) in the lifestyle and structured activity groups, respectively. CONCLUSIONS: In previously sedentary healthy adults, a lifestyle physical activity intervention is as effective as a structured exercise program in improving physical activity, cardiorespiratory fitness, and blood pressure.

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