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Prescribing Exercise at Varied Levels of Intensity and Frequency
A Randomized Trial
Glen E. Duncan, PhD, RCEPSM;
Stephen D. Anton, PhD;
Sumner J. Sydeman, PhD;
Robert L. Newton, Jr, PhD;
Joyce A. Corsica, PhD;
Patricia E. Durning, PhD;
Timothy U. Ketterson, PhD;
A. Daniel Martin, PhD, PT;
Marian C. Limacher, MD;
Michael G. Perri, PhD
Arch Intern Med. 2005;165:2362-2369.
Background Regular physical activity produces beneficial effects on health, but the exercise prescription needed to improve cardiovascular disease risk factors in free-living sedentary individuals remains unclear.
Methods Sedentary adults (N = 492, 64.0% women) were randomized to 1 of 4 exercise-counseling conditions or to a physician advice comparison group. The duration (30 minutes) and type (walking) of exercise were held constant, while exercise intensity and frequency were manipulated to form 4 exercise prescriptions: moderate intensity–low frequency, moderate intensity–high frequency (HiF), hard intensity (HardI)–low frequency, and HardI-HiF. Comparison group participants received physician advice and written materials regarding recommended levels of exercise for health. Outcomes included 6- and 24-month changes in cardiorespiratory fitness (maximum oxygen consumption), high-density lipoprotein cholesterol (HDL-C) level, and the total cholesterol–HDL-C ratio.
Results At 6 months, the HardI-HiF, HardI–low-frequency, and moderate-intensity–HiF conditions demonstrated significant increases in maximum oxygen consumption (P<.01 for all), but only the HardI-HiF condition showed significant improvements in HDL-C level (P<.03), total cholesterol–HDL-C ratio (P<.04), and maximum oxygen consumption (P<.01) compared with physician advice. At 24 months, the increases in maximum oxygen consumption remained significantly higher than baseline in the HardI-HiF, HardI–low-frequency, and moderate-intensity–HiF conditions and in the HardI-HiF group compared with physician advice (P<.01 for all), but no significant effects on HDL-C level (P = .57) or total cholesterol–HDL-C ratio (P = .64) were observed.
Conclusions 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.
Author Affiliations: Department of Epidemiology, Nutritional Sciences Program, University of Washington, Seattle (Dr Duncan); Department of Health Behavior, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge (Drs Anton and Newton); Department of Psychology, Northern Arizona University, Flagstaff (Dr Sydeman); Department of Psychology, Rush University Medical Center, Chicago, Ill (Dr Corsica); and Departments of Clinical and Health Psychology (Drs Durning, Ketterson, and Perri), Physical Therapy (Dr Martin), and Medicine (Dr Limacher), University of Florida, and Brain Rehabilitation Research Center VA RR&D Center of Excellence (Dr Ketterson), Gainesville.
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