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Commentary by Timmerman

Regular exercise is of paramount importance for both health promotion and disease prevention. The authors of this well-designed study address this important topic using reversal theory to individualize the education plus monitoring intervention. I am pleased to note that the comparison group received a monitoring-only intervention with the same number of telephone contacts as the other intervention group. Using this attention-control group strategy, the primary difference between the two interventions focused on using reversal theory to individualized recommendations in the education plus monitoring intervention. By having a comparable intervention for the comparison group, a more rigorous test of the reversal theory–based intervention was possible. This reduces the common problem in intervention research of not being able to determine what part of the intervention was effective and controls for the Hawthorne effect. As noted in the authors’ discussion, one of the most important findings of this study was that participants in the education plus monitoring intervention (guided by the reversal theory) had significantly more consistent exercisers than did the comparison group. Consistency of exercising is a more desirable intervention outcome than is weight loss or percentage of body fat for several reasons. First, low fitness level from lack of exercise is a greater predictor than is fatness of mortality rates (Blair & Holder, 2002). Fitness regardless of weight status is likely to improve health status, making consistent exercise a high-priority goal. Second, exercise alone has a relatively modest impact on initial weight loss (about 3 to 6 pounds) but is crucial for weight maintenance and prevention weight gain (Blair & Holder, 2002; National Heart, Lung, and Blood Institute Obesity Education Initiative Expert Panel, 1998). This intervention appears promising for improving consistency of exercising, but further research is needed to look at the optimal length (i.e., dose) of the intervention along with long-term follow-up to determine effectiveness at preventing weight gain. Another recommendation for future intervention studies that target behavior change is applying the transtheoretical model or stages of change to either (a) select specific participants based on their stage of change or (b) use participants’ stage of change as a potential confounding variable that may be useful in explaining study results. The transtheoretical model