OBJECTIVES: We tested a community-based intervention designed to reduce cardiovascular disease risk in sedentary midlife and older women who were overweight or obese. METHODS: In a randomized controlled trial conducted in 8 counties in Arkansas and Kansas, counties were assigned to the intervention (a 12-week twice-weekly heart health program) group or to the delayed-intervention control group. Ten to fifteen women were selected from each site, and participantsʼ weight, waist circumference, diet, physical activity, and self-efficacy were measured before and after the intervention. Data were analyzed with multiple regressions. RESULTS: Compared with the control group, participants in the intervention group had a significant decrease in body weight (−2.1 kg; 95% confidence interval [CI] = −3.2, −1.0), waist circumference (-2.3 in; 95% CI = −4.2, −0.5), and energy intake (-390 kcal/day; 95% CI = −598, −183); an increase in activity (+1637 steps/day; 95% CI = 712, 2562); and an increase in self-efficacy for dietary and physical activity behaviors. CONCLUSIONS: Our results suggest that a community-based program can improve self-efficacy, increase physical activity, and decrease energy intake, resulting in decreased waist circumference and body weight among at-risk women.