This chapter describes the development of a controlled clinical trial conducted with a rural older adult population, illustrating the dialectic between methodologic rigor and therapeutic obligation, and giving examples of successful resolution of tensions. The interactive effects of biological aging, chronic disease, and inactivity, mediated through losses in neurologic control, motor performance, and energy metabolism, place elderly persons at risk for functional decline incompatible with psychological well-being, performance of social roles, and maintenance of self-care at home. Students and faculty from the University of North Carolina in Chapel Hill began working in Johnston County in the 1970s under the leadership of a medical anthropologist, Tony Whitehead, and later, his colleague in the School of Public Health, Harold Cook. The National Institute on Aging, through the Sheps Health Research Center and its North Carolina Rural Aging Project, provided initial funding of our pilot study, with supplemental funding from the National Institute of Arthritis and Musculoskeletal Diseases through the Thurston Arthritis Center.