Sedentary adults (N = 379) were randomly assigned in a 2 x 2 design to walk 30 min per day at a frequency of either 3-4 or 5-7 days per week, at an intensity of either 45%-55% or 65%-75% of maximum heart rate reserve. Analyses of exercise accumulated over 6 months showed greater amounts completed in the higher frequency (p = .0001) and moderate intensity (p = .021) conditions. Analyses of percentage of prescribed exercise completed showed greater adherence in the moderate intensity(p = .02) condition. Prescribing a higher frequency increased the accumulation of exercise without a decline in adherence, whereas prescribing a higher intensity decreased adherence and resulted in the completion of less exercise.

Background: Rural counties in the United States have higher rates of obesity, sedentary lifestyle, and associated chronic diseases than nonrural areas, yet the management of obesity in rural communities has received little attention from researchers.Methods: Obese women from rural communities who completed an initial 6-month weight-loss program at Cooperative Extension Service offices in 6 medically underserved rural counties (n = 234) were randomized to extended care or to an education control group. The extended-care programs entailed problem-solving counseling delivered in 26 biweekly sessions via telephone or face to face. Control group participants received 26 biweekly newsletters containing weight-control advice.Results: Mean weight at study entry was 96.4 kg. Mean weight loss during the initial 6-month intervention was 10.0 kg. One year after randomization, participants in the telephone and face-to-face extended-care programs regained less weight (mean [SE],1.2[0.7] and 1.2[0.6] kg, respectively) than those in the education control group (3.7[0.7] kg; P =.03 and .02, respectively). The beneficial effects of extended-care counseling were mediated by greater adherence to behavioral weight-management strategies, and cost analyses indicated that telephone counseling was less expensive than face-to-face intervention.Conclusions: Extended care delivered either by telephone or in face-to-face sessions improved the 1-year maintenance of lost weight compared with education alone. Telephone counseling constitutes an effective and cost-efficient option for long-term weight management. Delivering lifestyle interventions via the existing infrastructure of the Cooperative Extension Service represents a viable means of adapting research for rural communities with limited access to preventive health services.

Exercise counseling with a prescription for walking at either a HardI or a HiF produced significant long-term improvements in cardiorespiratory fitness. More exercise or the combination of HardI plus HiF exercise may provide additional benefits, including larger fitness changes and improved lipid profiles.

ObjectiveTo evaluate the effects and costs of three doses of behavioral weight-loss treatment delivered via Cooperative Extension Offices in rural communities.Design and MethodsObese adults (N=612) were randomly assigned to low, moderate or high doses of behavioral treatment (i.e., 16, 32 or 48 sessions over two years) or to a control condition that received nutrition education without instruction in behavior modification strategies.ResultsTwo-year mean reductions in initial body weight were 2.9% (95% Credible Interval=1.7–4.3), 3.5% (2.0–4.8), 6.7% (5.3–7.9), and 6.8% (5.5–8.1) for the control, low, moderate, and high-dose conditions, respectively. The moderate-dose treatment produced weight losses similar to the high-dose condition and significantly larger than the low-dose and control conditions (posterior probability > .996). The percentages of participants who achieved weight reductions ≥ 5% at two years were significantly higher in the moderate-dose (58%) and high-dose (58%) conditions compared with low-dose (43%) and control (40%) conditions (posterior probability > .996). Cost-effectiveness analyses favored the moderate-dose treatment over all other conditions.ConclusionA moderate dose of behavioral treatment produced two-year weight reductions comparable to high-dose treatment but at a lower cost. These findings have important policy implications for the dissemination of weight-loss interventions into communities with limited resources.Trial RegistrationClinicalTrials.gov number, NCT00912652.