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Time-based physical activity interventions for weight loss: a randomized trial
Jakicic JM, Rickman AD, Lang W, Davis KK, Gibbs BB, Neiberg R, Marcus MD
Medicine and Science in Sports and Exercise 2015 May;47(5):1061-1069
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

PURPOSE: To examine whether enhancing standard behavior weight loss interventions (SBWP) with additional strategies at the initiation of the intervention (ADOPT) or providing the additional strategies at predetermined times over the intervention period (MAINTAIN) enhances 18 month weight loss. METHODS: This was a clinical trial with participants (n = 195; age 43.2 +/- 8.6 yrs; BMI 33.0 +/- 3.4 kg/m) randomized to SBWP, ADOPT, or MAINTAIN. All were prescribed an energy restricted diet and physical activity, with group intervention sessions delivered over 18 months. ADOPT received additional phone contact (months 1 to 3), supervised exercise (months 1 to 6), and behavior campaigns (months 4 to 9). MAINTAIN received additional phone contact (months 4 to 6), supervised exercise (months 7 to 12), and behavior campaigns (months 13 to 18). RESULTS: There was a significant group x time interaction for weight loss (p = 0.0032). SBWP lost 9.3 +/- 0.9, 7.8 +/- 1.1, and 5.9 +/- 1.2 kg at 6, 12, and 18 months, respectively. ADOPT lost 8.9 +/- 0.9, 7.6 +/- 1.2, and 5.8 +/- 1.2 kg, and MAINTAIN lost 9.7 +/- 0.9, 11.0 +/- 1.2, and 9.0 +/- 1.2 kg at 6, 12, and 18 months, respectively. The group x time interaction for SBWP versus MAINTAIN (p = 0.0033) and ADOPT versus MAINTAIN (p = 0.0075) was significant. There was a significant group x time interaction for change in fitness (p = 0.0060). The group x time interaction for MAINTAIN versus ADOPT (p = 0.0018) was significant with a trend for MAINTAIN versus SBWP (p = 0.0525). CONCLUSIONS: MAINTAIN improved 18-month weight loss compared to SBWP and ADOPT, with statistical trends that MAINTAIN resulted in greater improvements in fitness. These results suggest that time-based strategies emphasizing physical activity conferred greater benefits when delivered later and over the full course of intervention. This provides valuable information for the implementation of time-based strategies to improve long-term weight loss and fitness in overweight and obese adults.

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