BACKGROUND: Physical activity (PA) interventions for the promotion of weight-management may benefit from increased choice and flexibility to overcome commonly-perceived barriers to PA. The aim of this study was to investigate the effects of a novel "points-based" approach to PA on body composition in inactive women, who are overweight or obese. METHODS: Seventy-six overweight or obese, inactive women were randomly allocated to one of three conditions: 'points-based' PA (PBPA; 30 "PA points"/week), structured exercise (StructEx; 150 min moderate-intensity exercise/week) or control (CONT; continue habitual inactive lifestyle) for a 24-week intervention. PA points for activities were adapted from MET values, and 30 points was equivalent to 150 min of brisk walking. Measures of body composition (dual-energy x-ray absorptiometry) and anthropometry were obtained at weeks 0, 4, 12 and 24. Self-report activities were recorded weekly, with objective measures of PA (tri-axial accelerometry) and self-report measures of food intake obtained at weeks 0 and 24. RESULTS: Fifty-eight women completed the study and provided data for primary outcomes. Of these, n = 41 and n = 19 provided data for food intake and objectively assessed PA. Mixed-design ANOVAs demonstrated that those in PBPA achieved a significant weight-loss at 24 weeks of -3.3 +/- 5.9 kg (-3.4 +/- 7.1%, p = 0.004). Waist circumference was reduced in PBPA at 24 weeks (-2.8 +/- 4.6 cm), compared with CONT (+2.1 +/- 6.6 cm, p = 0.024). There was a trend for greater reductions in fat mass for those in PBPA versus CONT (-2.3 +/- 4.6 kg versus +0.1 +/- 2.0 kg, p = 0.075). Android fat was reduced in PBPA at both 12 weeks (-6.1 +/- 12.6%, p = 0.005) and 24 weeks (-10.1 +/- 18.4%, p = 0.005), while there was a trend for greater reductions in visceral adipose tissue in PBPA (-5.8 +/- 26.0%) versus CONT at 24 weeks (+7.8 +/- 18.3%, p = 0.053). Body composition, body weight and waist circumference were unchanged in StructEx. There were trends for increases in light-activity and reductions in sedentary time in PBPA. There was a trend for a reduction in daily energy intake of -445 +/- 564 kcal (p = 0.074), and a significant reduction in daily fat intake (p = 0.042) in PBPA. CONCLUSION: A "points-based" approach to physical activity appears to be an effective strategy for inducing modest reductions in body weight and body fat in inactive women with overweight and obesity. TRIAL REGISTRATION: NCT02020239. Registered 12th December 2013.

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