Burn and earn: a randomized controlled trial incentivizing exercise during fall semester for college first-year students.

OBJECTIVE: To examine the viability of monetary incentives to increase fitness-center use and maintain/improve the Body Mass Indexes (BMIs) of first-year students over the fall semester. METHOD: Randomized-controlled trial with no-treatment and incentive conditions involving 117 first-year students. For 12 weeks, students in the incentive condition received monetary payments ranging from $10 to $38.75 for meeting researcher-set fitness-center use goals that were identical across conditions. Fitness-center use was monitored through electronic ID-card check-in and check-out records at the campus fitness center. RESULTS: 63% of incentive-condition participants met the weekly fitness-center use goals on average compared to only 13% of control-condition participants, a significant difference, p<0.001. Goal achievement significantly decreased over time, p<0.01 and at roughly the same rate in the control and incentive conditions, p=0.23. Average BMI increases over the fall semester in the control (24.2 (0.6) to 24.6 (0.6)kg/m(2)) versus incentive condition (23.1 (0.4) to 23.5 (0.4)kg/m(2)) were not significantly different (p=0.70). CONCLUSION: Weekly monetary incentives resulted in significantly more first-year students meeting weekly fitness-center use goals. However, the increased fitness-center use by the incentive condition did not prevent an increase in BMI during fall semester.

The accuracy of weight reported in a web-based obesity treatment program.

OBJECTIVE: The overall goal of the study was to understand the accuracy of self-reported weight over a 6-month Web-based obesity program. MATERIALS AND METHODS: As part of a larger study, subjects (n=323; 93% female; 28% African American) were randomized to a 6-month Internet-based behavioral weight loss program with weekly group meetings delivered either: (1) entirely by online synchronous chats or (2) by a combination of online chats plus monthly in-person group sessions. Observed weights were obtained at 0 and 6 months for all participants. Self-reported weights were submitted weekly to the study Web site. Differences in Observed and Reported weights were examined by gender, race, and condition. RESULTS: Observed and Reported weight were significantly correlated at 0 and 6 months (r=0.996 and 0.996, ps <0.001 respectively). However, Reported weight underestimated Observed weight by 0.86 kg (p<0.001) at 6 months. Further, there was a significant weight loss effect (p<0.001) with those losing more weight more accurately estimating their Reported weight at 6 months. Additionally, 6-month Reported weight change differed from Observed weight change (difference=0.72 kg, p<0.001), with weight change using Reported weights estimating a slightly larger weight loss than Observed weights. CONCLUSIONS: In general, the accuracy of self-reported weight is high for individuals participating in an Internet-based weight loss treatment program. Accuracy differed slightly by amount of weight lost and was not improved with periodic in-person assessment. Importantly, weight change by self-report was comparable to observed, suggesting that it is suitable for Web-based obesity treatment.

High-calorie-expenditure exercise: a new approach to cardiac rehabilitation for overweight coronary patients.

BACKGROUND: More than 80% of patients entering cardiac rehabilitation (CR) are overweight, and >50% have metabolic syndrome. Current CR exercise protocols result in little weight loss and minimal changes in cardiac risk factors. We sought to design an exercise protocol that would lead to greater weight loss and risk factor change. METHODS AND RESULTS: We performed a randomized controlled clinical trial to evaluate the effect of high-calorie-expenditure exercise (3000- to 3500-kcal/wk exercise-related energy expenditure) compared with standard CR exercise (7 to 800 kcal/wk) on weight loss and risk factors in 74 overweight patients with coronary heart disease. Both groups were counseled for weight loss and taking evidence-based preventive medications. High-calorie-expenditure exercise resulted in double the weight loss (8.2+/-4 versus 3.7+/-5 kg; P<0.001) and fat mass loss (5.9+/-4 versus 2.8+/-3 kg; P<0.001) and a greater waist reduction (-7+/-5 versus -5+/-5 cm; P=0.02) than standard CR exercise at 5 months. High-calorie-expenditure exercise reduced insulin resistance, measured with the euglycemic hyperinsulinemic clamp, along with the ratio of total to high-density lipoprotein cholesterol and components of the metabolic syndrome, more than standard CR exercise (each P<0.01). Overall, fat mass loss best predicted improved metabolic risk, and the prevalence of metabolic syndrome decreased from 59% to 31%. Changes in cardiac risk factors included decreased insulin resistance, increased high-density lipoprotein cholesterol, and decreased measures of insulin, triglycerides, blood pressure, plasminogen activator inhibitor-1, and the ratio of total to high-density lipoprotein cholesterol (each P<0.05). Significant weight loss was maintained at 1 year. CONCLUSIONS: High-calorie-expenditure exercise promotes greater weight loss and more favorable cardiometabolic risk profiles than standard CR for overweight coronary patients.

Differences in home food availability of high- and low-fat foods after a behavioral weight control program are regional not racial.

BACKGROUND: Few studies, if any, have examined the impact of a weight control program on the home food environment in a diverse sample of adults. Understanding and changing the availability of certain foods in the home and food storage practices may be important for creating healthier home food environments and supporting effective weight management. METHODS: Overweight adults (n = 90; 27% African American) enrolled in a 6-month behavioral weight loss program in Vermont and Arkansas. Participants were weighed and completed measures of household food availability and food storage practices at baseline and post-treatment. We examined baseline differences and changes in high-fat food availability, low-fat food availability and the storage of foods in easily visible locations, overall and by race (African American or white participants) and region (Arkansas or Vermont). RESULTS: At post-treatment, the sample as a whole reported storing significantly fewer foods in visible locations around the house (-0.5 ± 2.3 foods), with no significant group differences. Both Arkansas African Americans (-1.8 ± 2.4 foods) and Arkansas white participants (-1.8 ± 2.6 foods) reported significantly greater reductions in the mean number of high-fat food items available in their homes post-treatment compared to Vermont white participants (-0.5 ± 1.3 foods), likely reflecting fewer high-fat foods reported in Vermont households at baseline. Arkansas African Americans lost significantly less weight (-3.6 ± 4.1 kg) than Vermont white participants (-8.3 ± 6.8 kg), while Arkansas white participants did not differ significantly from either group in weight loss (-6.2 ± 6.0 kg). However, home food environment changes were not associated with weight changes in this study. CONCLUSIONS: Understanding the home food environment and how best to measure it may be useful for both obesity treatment and understanding patterns of obesity prevalence and health disparity.

Internet delivered behavioral obesity treatment.

OBJECTIVES: To evaluate the efficacy of an Internet behavioral weight loss program; and determine if adding periodic in-person sessions to an Internet intervention improves outcomes. METHODS: 481 healthy overweight adults (28% minority) were randomized to one of 3 delivery methods of a behavioral weight loss program with weekly meetings: Internet (n=161), InPerson (n=158), or Hybrid (Internet+InPerson, n=162). Outcome variables were weight at baseline and 6 months and percent of subjects achieving a 5 and 7% weight loss. The study took place in two centers in Vermont and Arkansas from 2003 to 2008. RESULTS: Conditions differed significantly in mean weight loss [8.0 (6.1) kg vs. 5.5 (5.6) kg vs. 6.0 (5.5) kg], for InPerson, Internet, and Hybrid respectively, p<0.01, n=462). Weight loss for InPerson was significantly greater than the Internet and Hybrid conditions (p<0.05). Although the proportion reaching a 5% weight loss did not differ, the proportion losing 7% did differ significantly (56.3% vs. 37.3% vs. 44.4% for InPerson, Internet, and Hybrid respectively, p<0.01). CONCLUSIONS: These results demonstrate that the Internet is a viable alternative to in-person treatment for the delivery and dissemination of a behavioral weight-control intervention. The addition of periodic in-person sessions did not improve outcomes.

Neighborhood impact on healthy food availability and pricing in food stores.

Availability and price of healthy foods in food stores has the potential to influence purchasing patterns, dietary intake, and weight status of individuals. This study examined whether demographic factors of the store neighborhood or store size have an impact on the availability and price of healthy foods in sample of grocery stores and supermarkets. The Nutrition Environment Measures Study-Store (NEMS-S) instrument, a standardized observational survey, was utilized to evaluate food stores (N = 42) in a multi-site (Vermont and Arkansas) study in 2008. Census data associated with store census tract (median household income and proportion African-American) were used to characterize store neighborhood and number of cash registers was used to quantify store size. Median household income was significantly associated with the NEMS healthy food availability score (r = 0.36, P < 0.05); neither racial composition (r = -0.23, P = 0.14) nor store size (r = 0.27, P = 0.09) were significantly related to the Availability score. Larger store size (r = 0.40, P < 0.01) was significantly associated with the NEMS-S Price scores, indicating more favorable prices for healthier items; neither racial composition nor median household income were significantly related to the Price score (P's > 0.05). Even among supermarkets, healthier foods are less available in certain neighborhoods, although, when available, the quality of healthier options did not differ, suggesting that targeting availability may offer promise for policy initiatives. Furthermore, increasing access to larger stores that can offer lower prices for healthier foods may provide another avenue for enhancing food environments to lower disease risk.

Associations of internet website use with weight change in a long-term weight loss maintenance program.

BACKGROUND: The Weight Loss Maintenance Trial (WLM) compared two long-term weight-maintenance interventions, a personal contact arm and an Internet arm, with a no-treatment control after an initial six-month Phase I weight loss program. The Internet arm focused on use of an interactive website for support of long-term weight maintenance. There is limited information about patterns of website use and specific components of an interactive website that might help promote maintenance of weight loss. OBJECTIVE: This paper presents a secondary analysis of the subset of participants in the Internet arm and focuses on website use patterns and features associated with long-term weight maintenance. METHODS: Adults at risk for cardiovascular disease (CVD) who lost at least 4 kilograms in an initial 20-week group-based, behavioral weight-loss program were trained to use an interactive website for weight loss maintenance. Of the 348 participants, 37% were male and 38% were African American. Mean weight loss was 8.6 kilograms. Participants were encouraged to log in at least weekly and enter a current weight for the 30-month study period. The website contained features that encouraged setting short-term goals, creating action plans, and reinforcing self-management habits. The website also included motivational modules, daily tips, and tailored messages. Based on log-in and weight-entry frequency, we divided participants into three website use categories: consistent, some, and minimal. RESULTS: Participants in the consistent user group (n = 212) were more likely to be older (P = .002), other than African American (P = .02), and more educated (P = .01). While there was no significant difference between website use categories in the amount of Phase I change in body weight (P = .45) or income (P = .78), minimal website users (n = 75) were significantly more likely to have attended fewer Phase I sessions (P = .001) and had a higher initial body mass index (BMI) (P < .001). After adjusting for baseline characteristics including initial BMI, variables most associated with less weight regain included: number of log-ins (P = .001), minutes on the website (P < .001), number of weight entries (P = .002), number of exercise entries (P < .001), and sessions with additional use of website features after weight entry (P = .002). CONCLUSION: Participants defined as consistent website users of an interactive behavioral website designed to promote maintenance of weight loss were more successful at maintaining long-term weight loss. TRIAL REGISTRATION: NCT00054925; http://clinicaltrials.gov/ct2/show/NCT00054925 (Archived by WebCite at http://www.webcitation.org/5rC7523ue).

The use of nutritional labels by college students in a food-court setting.

OBJECTIVE: Between January and September 2006, the authors examined when, why, if, and how nutrition labels impact food purchase decisions of college students. PARTICIPANTS: Participants were 16 college-aged students at a large northeastern university. METHODS: As part of a larger study undertaken at a large northeastern university on the effect of nutrition labels in restaurant settings on food purchases, the authors held a focus group to look more deeply at when and why nutrition labeling impacted college student food purchases. RESULTS: Although results of the large study are still being discerned, the focus group results reveal that college women and men were interested in the provision of nutrition labels in the food court-like setting found at the university, and that those exposed to labels over the course of the study noticed these labels and often referred to them when making purchase decisions. Additional findings reveal that price and convenience also play a role in food purchases and that, of those items listed on each label, calories and fat were most important to the study population. CONCLUSIONS: Although more research is needed, this qualitative study finds that students want nutrition labels and would use them to make food purchasing decisions.

Internet-based weight control: the relationship between web features and weight loss.

Internet-based weight control programs have been showing promising results; however, as of yet, it is unclear which website components are critical for producing and maintaining weight loss. The aim of this study is to examine the utilization patterns of a weight control website and the relationship of the Web features to weight loss and maintenance. One hundred and twenty three (N = 123) participants took part in a 12-month behavioral weight control program over the Internet and their website utilization patterns were monitored. When examining the clustering of Web feature utilization and weight loss, the "feedback" factor (progress charts, physiological calculators, and past journals) was the best predictor of weight loss during the treatment period (baseline to 6 months), while the "social support" factor (Web chats and biographical information/e-mail addresses of participants) was the best predictor during maintenance. Weight loss in an online weight control program was related to dynamic Web features that provided feedback, support, and motivation to participants.

Knowledge of current dietary guidelines and food choice by college students: better eaters have higher knowledge of dietary guidance.

College students enrolled in university dining plans are exposed daily to a food environment characterized by foods high in energy, fats, and added sugars, and low in nutrient density. Their decisions about what to eat are currently made in an environment where no nutrition labeling is required. To fill the gap in current literature regarding whether or not increased nutrition knowledge of dietary guidance actually translates into positive behavior, this cross-sectional study investigated self-reported eating patterns of 200 college students. An Internet-based survey was used to identify how closely respondents followed the Dietary Guidelines for Americans 2005, and whether their eating patterns were related to their knowledge of dietary guidance. It was observed that, for fruit, dairy, protein, and whole grains, increased knowledge is related to increased likelihood of meeting dietary guidelines. Moreover, when asked about individual food choices, nutrition knowledge was related to making more healthful choices in every case. Ultimately, increased knowledge of dietary guidance appears to be positively related to more healthful eating patterns. This suggests that guidelines such as the Dietary Guidelines for Americans 2005, in conjunction with effective public-awareness campaigns, may be a useful mechanism for promoting change in what foods consumers choose to eat.

The use of a personal digital assistant for dietary self-monitoring does not improve the validity of self-reports of energy intake.

Underreporting of energy intake is a pervasive problem and resistant to improvement, especially among people with overweight and obesity. The goal of this study was to investigate whether the use of a personal digital assistant (PDA) for dietary self-monitoring would reduce underreporting prevalence and improve the validity of self-reported energy intake. Adults with overweight and obesity (n=61, 92% women, mean age 48.2 years, mean body mass index 32.3) were provided with a PalmZire 21 (Palm, Inc, Sunnyvale, CA) loaded with Calorie King's Diet Diary software (version 3.2.2, 2002, Family Health Network, Costa Mesa, CA). Subjects participated in a 24-week in-person behavioral weight control program and were asked to self-monitor their diet and exercise habits using the PDA. Basal metabolic rate and physical activity level were estimated at baseline. Energy intake from 7-day electronic food records were collected within the first month of the weight-control program. As subjects were actively losing weight, Bandini's adjustments were used to correct self-reported energy intake for weight loss. In this group, where 41% of the subjects were categorized as low-energy reporters, the use of a PDA did not improve validity of energy reporting when compared to what is reported in the literature.

Consumers may not use or understand calorie labeling in restaurants.

This study was an investigation of the possible utility of calorie labeling legislation in restaurants in community (n=649) and college student (n=316) samples. Only 48% to 66% of participants presently looked at food labels, and 64% to 73% were able to report accurate knowledge of daily caloric needs. Furthermore, 44% to 57% reported that they were not likely to use food label information in restaurants if it were available. Therefore, public education campaigns focused on calorie requirements may need to precede restaurant labeling, and perhaps other possibilities in labeling formats should be considered (eg, defining foods as "low," "moderate," and "high" calorie).

Participation in a behavioral weight-loss program worsens the prevalence and severity of underreporting among obese and overweight women.

Underreporting of energy intake is a serious and pervasive problem, especially among women with overweight and obesity. The aim of this study was to determine if the prevalence and severity of underreporting changed after participating in a behavioral weight-loss program. Women with overweight and obesity (N=156, mean age 39.4 years, mean body mass index 31.9) completed a 6-month behavioral weight-loss program. Basal metabolic rate, physical activity level, and energy intake from 7-day food records were collected at baseline and 6 months. The major finding was that underreporting significantly increased in prevalence (39.7% vs 60.3%; P<.001), as did severity of misreporting (-105+/-583 vs -415+/-504 kcal/day; P<.001) following the behavioral weight-loss program. Thus, after completing a behavioral weight-loss program, the prevalence of underreporting and severity of misreporting became significantly worse among women with overweight and obesity.

Association of maternal obesity and depressive symptoms with television-viewing time in low-income preschool children.

BACKGROUND: Decreasing television (TV)-viewing time may improve child health and well-being. These viewing patterns are shaped during the preschool years. Because mothers play an important role in determining how much TV their preschool children watch, a better understanding is needed of the maternal factors that influence children's TV viewing. OBJECTIVE: To examine the relationship of depressive symptoms and obesity in low-income mothers with TV-viewing time in their preschool children. METHODS: Cross-sectional, self-administered survey of 295 low-income mothers of 3- and 4-year-old children (92% white) enrolled in the Vermont Special Supplemental Nutrition Program for Women, Infants, and Children. Mothers reported children's usual weekday and weekend-day TV-viewing time. Maternal depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Maternal body mass index was calculated from self-reported height and weight measurements (weight in kilograms divided by height in meters squared). RESULTS: Children watched a mean of 2.2 +/-1.2 hours of TV per day. Those in the upper quartile of TV-viewing time (high TV viewers) watched 3 or more hours of TV per day. Of the mothers, 12% had both obesity (BMI > or =30) and depressive symptoms (CES-D score > or =16), 19% were obese only, and 18% had depressive symptoms only. Children were more likely to be high TV viewers if their mothers had clinically significant depressive symptoms (35% vs 23%; P =.03) or if their mothers were obese (35% vs 22%; P =.03). Forty-two percent of children were high TV viewers if the mother had both depressive symptoms and obesity, 30% if the mother had only depressive symptoms, 29% if the mother had only obesity, and 20% if the mother had neither depressive symptoms nor obesity (P =.06 overall; P for trend =.009 using the chi2 test). CONCLUSIONS: Among low-income preschool children, those whose mothers had either depressive symptoms or obesity were more likely to watch 3 or more hours of TV a day. Strategies to reduce TV viewing in young children should consider the role that maternal obesity and depressive symptoms may play in how preschool children spend their time.

Depressive symptoms in low-income mothers and emotional and social functioning in their preschool children.

OBJECTIVE: To determine which factors modify the relationship between maternal depressive symptoms and emotional and social functioning in low-income preschool children. METHODS: A cross-sectional, self-administered survey of 295 low-income (< or =185% poverty level) mothers of 3- and 4-year-old children. Both child emotional functioning and social functioning were measured with the Pediatric Quality of Life Inventory. Low emotional functioning and social functioning were defined as scores in the lowest tertile for each measure. Maternal depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS: Of the children, 92% were white and 55% were boys. Of the mothers, 31% had clinically significant depressive symptoms (CES-D scores > or =16) and 30% were smokers. Among girls, the percentage with low emotional functioning was significantly higher in those whose mothers had clinically significant depressive symptoms than in those whose mothers did not (62% vs 27%, P <.001), but the same was not true among boys (36% vs 30%, P = NS). When mothers were smokers, the percentage of children with low social functioning was higher if mothers had clinically significant depressive symptoms (54% vs 29%, P =.02); however, this was not the case when mothers were nonsmokers (25% vs 28%, P =.69). Maternal education, marital status, and age did not modify the relationship between maternal depressive symptoms and child emotional or social functioning. CONCLUSIONS: Among low-income preschool children, both the sex of the child and the smoking status of the mother appear to influence the relationship between maternal depressive symptoms and children's emotional and social functioning.

The feasibility of using Internet support for the maintenance of weight loss.

This pilot study examined the acceptability and feasibility of conducting a weight loss maintenance intervention over the Internet. Obese adults participated in a 15-week behavioral weight control intervention and were then randomly assigned to one of the following three maintenance conditions: (a) in-person, therapist-led (TL); (b) Internet, therapist-led (I); and (c) control (C). Both maintenance interventions met biweekly for 22 weeks using the same program content. Results showed that TL participants were more likely to attend their meetings and feel more satisfied with their group assignment. However, there were no differences between the TL and I groups in overall attrition or number of peer support contacts made. There was also no significant difference in weight loss between the groups. Thus, the Internet may hold promise as a method for maintaining contact with patients to facilitate long-term behavior change.

Patterns of success: online self-monitoring in a web-based behavioral weight control program.

OBJECTIVES: Online weight control technologies could reduce barriers to treatment, including increased ease and convenience of self-monitoring. Self-monitoring consistently predicts outcomes in behavioral weight loss programs; however, little is known about patterns of self-monitoring associated with success. METHOD: The current study examines 161 participants (92% women; 31% African American; mean body mass index = 35.7 ± 5.7) randomized to a 6-month online behavioral weight control program that offered weekly group "chat" sessions and online self-monitoring. Self-monitoring log-ins were continuously monitored electronically during treatment and examined in association with weight change and demographics. Weekend and weekday log-ins were examined separately and length of periods of continuous self-monitoring were examined. RESULTS: We found that 91% of participants logged in to the self-monitoring webpage at least once. Over 6 months, these participants monitored on an average of 28% of weekdays and 17% of weekend days, with most log-ins earlier in the program. Women were less likely to log-in, and there were trends for greater self-monitoring by older participants. Race, education, and marital status were not significant predictors of self-monitoring. Both weekday and weekend log-ins were significant independent predictors of weight loss. Patterns of consistent self-monitoring emerged early for participants who went on to achieve greater than a 5% weight loss. CONCLUSIONS: Patterns of online self-monitoring were strongly associated with weight loss outcomes. These results suggest a specific focus on consistent self-monitoring early in a behavioral weight control program might be beneficial for achieving clinically significant weight losses.

Effect of exercise training and weight loss on platelet reactivity in overweight patients with coronary artery disease.

PURPOSE: Obesity is associated with increased platelet reactivity. Greater platelet reactivity presages adverse events in patients with coronary artery disease (CAD). We investigated whether exercise training and weight loss reduce platelet reactivity in overweight subjects with CAD. METHODS: Study subjects (N = 46) were enrolled in a prospective randomized study of exercise training and behavioral weight loss, which contrasted the amount of exercise performed (750 vs. >3000 kcal/week). Platelet reactivity was assessed with the use of flow cytometry as the percentage of platelets expressing P-selectin or capable of binding fibrinogen in response to 1 µM adenosine diphosphate in blood before and after a 4-month program of exercise and behavioral weight loss. Markers of inflammation (high-sensitivity C-reactive protein), procoagulant activity (tissue plasminogen activator, plasminogen activator inhibitor 1), insulin sensitivity, body composition, physical activity, and fitness were also recorded. RESULTS: Platelet reactivity as assessed by P-selectin expression was decreased after exercise training and weight loss in study participants (from 34 ± 17% to 29 ± 17%; P = .01). The decrease was more pronounced in women (by 13% vs. 2% in men; P < .01). The change in platelet reactivity was not independently associated with measures of body composition or fitness. After controlling for exercise group and gender, the change in platelet reactivity was associated with changes in high-sensitivity C-reactive protein (r = 0.46) and insulin sensitivity (r = 0.46). CONCLUSIONS: In overweight patients with CAD, exercise training and weight loss are associated with a decrease in platelet reactivity that may predict an improved prognosis.

Undergrad and overweight: an online behavioral weight management program for college students.

OBJECTIVE: Explore the feasibility of an online behavioral weight management program for college students. METHODS: The program focused on behavioral strategies to modify eating and exercise behaviors of students interested in losing weight and/or developing a healthy lifestyle. Specific tools included weekly chat meetings with a facilitator, calorie and fat gram recommendations, daily food logs, and exercise guidance. RESULTS: Three hundred thirty-six students participated from 2 northeastern universities. Overweight/obese students wanting to lose weight had a mean body mass index of 30.6 kg/m(2) at baseline and lost an average of 5.1 ± 6.0 lbs. Those of healthy weight wanting to lose weight had a mean body mass index of 22.0 kg/m(2) at baseline and lost an average of 1.8 ± 3.2 lbs. Twenty-three percent of students lost > 5% of their baseline weight. CONCLUSIONS AND IMPLICATIONS: Use of an online behavioral weight management program may be a feasible way to help college students develop healthy eating and exercise behaviors.

Change of energy expenditure from physical activity is the most powerful determinant of improved insulin sensitivity in overweight patients with coronary artery disease participating in an intensive lifestyle modification program.

The objective was to evaluate the determinants of change (Δ) in insulin sensitivity in overweight coronary artery disease male patients without diabetes after an intensive lifestyle intervention. All patients received nutritional counseling and performed 4 months of exercise training (ET) according to 1 of 2 protocols: aerobic ET (65%-70% of peak aerobic capacity [VO(2)]) 25 to 40 minutes 3 times a week (n = 30) or walking (50%-60% of peak VO(2)) 45 to 60 minutes at least 5 times a week (n = 30). Data from participants of both ET groups were pooled, and post-intensive lifestyle intervention results were compared with baseline data. The primary outcome was Δ insulin sensitivity (m-value) assessed by the criterion standard technique, the euglycemic-hyperinsulinemic clamp. Changes in weight, body mass index, total and percentage fat mass (by dual-energy x-ray absorptiometry scan), waist circumference, total abdominal and visceral fat (by computed tomographic scan), high-sensitivity C-reactive protein, peak VO(2), daily energy intake, and physical activity energy expenditure (PAEE) (by doubly labeled water technique) were also assessed. Daily energy intake decreased by 335 kcal, and PAEE increased by 482 kcal/d (all P < .0001). The mean weight loss was 6.4 kg, and the mean improvement in m-value was 1.6 mg/kg fat-free mass per minute. Univariate determinants of Δ m-value were low baseline PAEE, walking protocol, Δ weight, Δ body mass index, Δ total and percentage fat mass, Δ waist circumference, Δ total abdominal and visceral fat, and Δ PAEE (all P < .05). In multivariate analysis, the only significant determinant of Δ m-value was Δ PAEE (P < .02). In this analysis, the most powerful determinant of improved insulin sensitivity in overweight coronary artery disease patients is the change in PAEE.