Challenges in Improving Fitness: Results of a Community-Based, Randomized, Controlled Lifestyle Change Intervention

Abstract

The intervention produced modest short-term improvements in body composition, but the economic incentive of a free 1-year gym membership provided to all participants was a more potent intervention than the education and social support intervention tested. However, longer-term fitness enhancement remains elusive and demands research and policy attention. These findings have policy implications in that employer-/insurer-subsidized gym memberships may require interventions targeting other levels of change (e.g., physical or social/environmental) to foster sustainable fitness improvements.

Physical Activity as Primary Prevention to Address Cancer Disparities

“…Feelings of discomfort in evaluation sessions might interfere with honesty in self-report measures, and may negatively affect study retention and intervention adherence. For example, in the Fighting Cancer with Fitness study 78 mentioned above, problems arose when young white female college student intern evaluators were tasked with measuring the waist and hip circumferences of obese older African American women. Participants felt that the students' facial expressions and comments conveyed disdain for their body sizes and shapes.…”

“…Timely incentive payments have also been shown to increase retention. 78,93 Researchers can further improve retention rates by having the same staff (preferably from the community) over time, and having these staff be accessible (such as through a toll-free phone number) and familiar with the participants and their families. Intensive followup contact with participants and strong social support have also been recommended.…”

“…77 Furthermore, these studies were low in scientific rigor and had high attrition rates. 77,78 What data that are available suggest that PA interventions are modestly successful, but long-term hard outcomes are equivocal, similar to findings for whites. 55 For example, the Fighting Cancer with Fitness (FCF) study, 78 with greater than 70% retention rate at 1-year follow-up, found significant increases in fitness (as measured by the sub-maximal treadmill test) and PA (self-reported), and decreases in BMI at 2 months post-intervention compared with control participants, but only the PA and fitness improvements remained at the 6-and 12-month follow-up assessments.…”

“…Potential participants may decline to participate unless they receive some sort of treatment, and being assigned to a control group or not knowing their assignment (in the case of double-blind studies) may decrease their motivation to enroll or invest. These barriers can be overcome by using wait-list control groups (or attention control condition in which the alternative or ''control intervention'' is also viewed as valuable and needed 78,84 ), communicating about the utility of randomization and control groups, and reducing participant burden. 85 The trade-off, however, between scientific rigor and successful recruitment must be balanced.…”

“…Providing payments and other incentives (such as free gym memberships 78 ) can increase recruitment, participation, and retention (see below), and ameliorate socioeconomic barriers to participation.…”