BACKGROUND: Abdominally obese women can reduce their health risk through regular physical activity. There is, however, little evidence on the effectiveness of interventions that promote physical activity long-term, such as cycling and walking to and from work. METHODS: This intervention focused on physically active commuting (cycling and walking) in middle-aged (30 to 60 years), abdominally obese (waist circumference >= 88 cm) women (n = 120), recruited by newspaper advertisement. The intervention group was a moderate-intensity programme with physician meetings, physical activity prescriptions, group counselling and bicycles. The control group was a low-intensity group support programme with pedometers. We used a randomized, controlled, 2-armed design with 18 months duration and intention-to-treat analysis (data collection 2005 to 2006). Treatment success was defined as bicycling >= 2 km/d (primary) or walking 10,000 steps per day (secondary). RESULTS: At baseline, mean (SD) age was 48.2 years (7.4), waist circumference 103.8 cm (7.8), walking 8,471 steps per day (2,646), bicycling 0 km per day. Attrition at 18 months was 10% for the intervention group and 25% in the control group (p = 0.03). The intervention group was more likely to achieve treatment success for cycling than controls: 38.7 versus 8.9% (odds ratio (OR) 7.8 (95% confidence interval 4.0 to 15.0, p < 0.001)), but with no difference for compliance with the walking recommendation: 45.7 versus 39.3% (OR 1.2 (95% CI 0.7 to 2.0, p = 0.50)). Commuting by car and public transport were reduced by 34% (p < 0.01) and 37% (p < 0.001), respectively, with no differences between groups. Both groups attained similar waist reductions (-2.1 and -2.6 cm, p = 0.72). CONCLUSIONS: Abdominally obese women can increase PA long-term through moderate-intensity behavioural support aimed at changing commuting habits.

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