Physical activity and weight loss: does prescribing higher physical activity goals improve outcome? 1 2

Recommending increased physical activity facilitates long-term weight loss, but the optimal level of physical activity to recommend is unknown. The objective of the study was to evaluate the efficacy for long-term weight loss of recommendations for much higher physical activity than those normally used in behavioral treatments. Overweight men and women ( n = 202) were randomly assigned to either a standard behavior therapy (SBT) for obesity, incorporating an energy expenditure (EE) goal of 1000 kcal/wk, or to a high physical activity (HPA) treatment, in which the goal was an EE of 2500 kcal/wk. To help HPA treatment group participants achieve this high exercise goal, their treatment included encouragement to recruit 1–3 exercise partners into the study, personal counseling from an exercise coach, and small monetary incentives. The HPA treatment group reported achieving higher mean (± SD) physical activity levels than did the SBT group at 6 mo (EE of 2399 ± 1571 kcal/wk compared with 1837 ± 1431 kcal/wk), 12 mo (EE of 2249 ± 1751 kcal/wk compared with 1565 ± 1309 kcal/wk), and 18 mo (EE of 2317 ± 1854 kcal/wk compared with 1629 ± 1483 kcal/wk) (all P < 0.01). Mean (± SEM) cumulative weight losses at 6, 12, and 18 mo in the HPA treatment group were 9.0 ± 7.1, 8.5 ± 7.9, and 6.7 ± 8.1 kg, respectively. In the SBT group, the corresponding weight losses were 8.1 ± 7.4, 6.1 ± 8.8, and 4.1 ± 7.3 kg, respectively. Between-group differences in weight loss were significant at 12 and 18 mo. These results suggest that recommendations of higher levels of physical activity (EE of 2500 kcal/wk) promote long-term weight loss better than do conventional recommendations.