Behavioral Compensatory Adjustments to Exercise Training in Overweight Women

Acute Vigorous Exercise Decreases Subsequent Nonexercise Physical Activity and Body Temperature Linked to Weight Gain

PURPOSE

Exercise benefits the body and mind, but its weight loss effect is less than generally expected. Although this phenomenon is likely due to an exercise intensity-dependent decrease in non-exercise physical activity (NEPA), resulting in a decrease in non-exercise activity thermogenesis, the underlying mechanisms and effects of exercise intensity remain unknown. Here we show that acute vigorous exercise decreases subsequent NEPA and body temperature (BT) in association with body weight gain.

METHODS

Adult male C57BL/6J mice were categorized into three groups: sedentary, moderate exercise, and vigorous exercise, with exercise groups undergoing a 30-min treadmill session. Using an intraperitoneally implanted activity monitor, NEPA and BT were monitored for 2 d before and 3 d after exercise. The daily synchrony between NEPA and BT was evaluated using a cross-correlation function. Plasma corticosterone was also detected 6 and 24 h after exercise.

RESULTS

Notably, only the vigorous exercise group exhibited a decline in both NEPA and BT, resulting in body weight gain the following day, despite no observed changes in food intake. Furthermore, vigorous exercise induces a distinct delay in the daily dynamics of NEPA compared with BT. A positive correlation was observed between plasma corticosterone levels and changes in NEPA levels before and after exercise across all exercise groups.

CONCLUSIONS

Our findings provide evidence for vigorous exercise-specific reduction in subsequent NEPA, BT, and their synchrony linked to weight gain, likely due to the disturbed circadian rhythm of corticosterone. This is an initial investigation redefining the significance of exercise intensity in beneficial effects beyond the energy expenditure of the exercise itself.

The Effects of an Acute Bout of Aerobic or Resistance Exercise on Nonexercise Physical Activity

Introduction/Purpose

A reduction in nonexercise physical activity (NEPA) after exercise may reduce the effectiveness of exercise interventions on weight loss in adults with overweight or obesity. Aerobic exercise (AEx) and resistance exercise (REx) may have different effects on NEPA. The purpose of this secondary analysis was to examine the effect of a single bout of AEx or REx on NEPA and sedentary behavior in inactive adults with overweight or obesity.

Methods

Adults with overweight or obesity (n = 24; 50% male; age, 34.5 ± 1.5 yr; body mass index, 28.5 ± 0.9 kg·m-2) not meeting current physical activity guidelines completed a single 45-min bout of AEx, REx, or a sedentary control on different days in random order. After each condition, participants' NEPA was recorded for 84 h by accelerometer. Time spent sedentary and in light, moderate, and vigorous physical activity; steps; metabolic equivalent of task (MET)-hours; and sit-to-stand transitions were calculated using activity count data.

Results

No differences were observed in the percent of waking time spent sedentary and in light, moderate, and vigorous activity between conditions (P > 0.05). No differences were observed in steps, MET-hours, or sit-to-stand transitions between conditions (P > 0.05). NEPA responses were variable among individuals, with approximately half of participants reducing and half increasing NEPA over the 84 h after each exercise condition.

Conclusion

NEPA was not reduced after an acute bout of AEx or REx in a sample of inactive adults with overweight or obesity.

Effects of exercise training programmes on fasting gastrointestinal appetite hormones in adults with overweight and obesity: A systematic review and meta-analysis

A systematic review and meta-analysis was performed to determine the effect of exercise training on fasting gastrointestinal appetite hormones in adults living with overweight and obesity. For eligibility, only randomised controlled trials (duration ≥ four weeks) examining the effect of exercise training interventions were considered. This review was registered in the International Prospective Register of Systematic Reviews (CRD42020218976). The searches were performed on five databases: MEDLINE, EMBASE, Cochrane Library, Web of Science, and Scopus. The initial search identified 13204 records. Nine studies, which include sixteen exercise interventions, met the criteria for inclusion. Meta-analysis was calculated as the standardised mean difference (Cohen's d). Exercise training had no effect on fasting concentrations of total ghrelin (d: 1.06, 95% CI -0.38 to 2.50, P = 0.15), acylated ghrelin (d: 0.08, 95% CI: -0.31 to 0.47, P = 0.68) and peptide YY (PYY) (d = -0.16, 95% CI: -0.62 to 0.31, P = 0.51) compared to the control group. Analysis of body mass index (BMI) (d: -0.31, 95% CI: -0.50 to -0.12, P < 0.01) and body mass (d: -0.22, 95% CI: -0.42 to -0.03, P = 0.03) found a significant reduction after exercise compared to controls. Overall, exercise interventions did not modify fasting concentrations of total ghrelin, acylated ghrelin, and PYY in individuals with overweight or obesity, although they reduced body mass and BMI. Thus, any upregulation of appetite and energy intake in individuals with overweight and obesity participating in exercise programmes is unlikely to be related to fasting concentrations of gastrointestinal appetite hormones.

Compensatory effects of different exercise durations on non-exercise physical activity, appetite, and energy intake in normal weight and overweight adults

Objectives: To examine compensatory changes of different exercise durations on non-exercise physical activity (NEPA), appetite, and energy intake (EI) in normal and overweight adults, and to determine if different body mass index of individuals interact with these compensatory effects.

Methods: Ten normal weight adults (nine females and one male; age: 24.0 ± 0.4 years; BMI: 20.7 ± 0.5 kg/m²) and ten overweight adults (six females and four males; age: 24.5 ± 0.9 years; BMI: 25.9 ± 0.4 kg/m²) participated in this study. The participants completed two exercise trials: short-duration continuous training (SDCT) and long-duration continuous training (LDCT), i.e., a 40 min short-duration and an 80 min long-duration continuous training in a randomized order. Total physical activity and NEPA were monitored using an accelerometer for seven consecutive days, which involved a two-day baseline observation period (C-pre-Ex), three-day exercise intervention period (Ex), and two-day follow-up period (C-post-Ex). Blood samples were collected for appetite-related hormone analysis. Appetite score was assessed using the visual analogue scale. Energy intake was evaluated by weighing the food and recording diaries.

Results: The NEPA evaluation showed that it was higher for SDCT than for LDCT in the C-post-Ex period (F (1, 19) = 8.508, p = 0.009) in the total sample. Moreover, results also indicated that NEPA was lower for LDCT (F (2, 18) = 6.316, p = 0.020) and higher for SDCT (F (2, 18) = 3.889, p = 0.026) in the C-post-Ex period than in the C-pre-Ex and Ex periods in overweight group. Acyl-ghrelin revealed a main effect of time in the total sample and in normal weight and overweight groups; it was lower in the C-post-Ex period than in the C-pre-Ex and Ex periods (all p < 0.05). Total EI analysis revealed no significant changes in either the total sample or in the normal weight and overweight groups.

Conclusion: These findings demonstrate that short duration exercise led to a compensatory increment in NEPA, whereas long duration exercise induced a compensatory decrease in NEPA. Moreover, there was a higher and delayed compensatory response in overweight adults than in normal weight adults. Nevertheless, energy intake was not changed across time, regardless of exercise duration.

Effect of exercise training interventions on energy intake and appetite control in adults with overweight or obesity: A systematic review and meta-analysis

This systematic review examined the impact of exercise training interventions on energy intake (EI) and appetite control in adults with overweight/obesity (≥18 years including older adults). Articles were searched up to October 2019. Changes in EI, fasting appetite sensations, and eating behavior traits were examined with random effects meta-analysis, and other outcomes were synthesized qualitatively. Forty-eight articles were included (median [range] BMI = 30.6 [27.0-38.4] kg/m² ). Study quality was rated as poor, fair, and good in 39, seven, and two studies, respectively. Daily EI was assessed objectively (N = 4), by self-report (N = 22), with a combination of the two (N = 4) or calculated from doubly labeled water (N = 1). In studies rated fair/good, no significant changes in pre-post daily EI were found and a small but negligible (SMD < 0.20) postintervention difference when compared with no-exercise control groups was observed (five study arms; MD = 102 [1, 203] kcal). There were negligible-to-small pre-post increases in fasting hunger and dietary restraint, decrease in disinhibition, and some positive changes in satiety and food reward/preferences. Within the limitations imposed by the quality of the included studies, exercise training (median duration of 12 weeks) leads to a small increase in fasting hunger and a small change in average EI only in studies rated fair/good. Exercise training may also reduce the susceptibility to overconsumption (PROSPERO: CRD42019157823).

Effect of Combined Interval and Continuous Exercise Training on Gastric Emptying, Appetite, and Adaptive Responses in Men With Overweight and Obesity

Background/Objectives: Characterizing compensatory and adaptive responses to exercise assists in understanding changes in energy balance and health outcomes with exercise interventions. This study investigated the effects of a short-term exercise intervention (combining high intensity interval (HII) and continuous exercise) on (1) gastric emptying, appetite and energy intake; and (2) other adaptive responses including cardiorespiratory fitness, in inactive men with overweight/obesity. Methods: Fifteen men (BMI: 29.7 ± 3.3 kg/m-2) completed a 4-wk supervised exercise intervention, consisting of 5 exercise sessions per week alternating between HII (30 s at 100% VO2max followed by 30 s recovery) and continuous (at 50% VO2max) training on a cycle ergometer, progressing from 30 to 45 min session duration. Gastric emptying (13C-octanoic acid breath test), appetite (visual analog scale), energy intake (ad libitum lunch meal), body composition (air displacement plethysmography), non-exercise activity (accelerometery) VO2max, blood pressure, and fasting concentrations of glucose, insulin, and ghrelin were measured before and after (≥48 h) the intervention. Results: Gastric emptying, glucose, insulin and ghrelin were unchanged, but energy intake at the ad libitum lunch test meal significantly increased at post-intervention (+171 ± 116 kcal, p < 0.01). Body weight (-0.9 ± 1.1 kg), waist circumference (-2.3 ± 3.5 cm) and percent body fat (-0.9 ± 1.1%) were modestly reduced (P < 0.05). VO2max increased (+4.4 ± 2.1 ml.kg.min-1) by 13% and systolic (-6.2 ± 8.4 mmHg) and diastolic (-5.8 ± 2.2 mmHg) blood pressure were significantly reduced (P ≤ 0.01 for all). Conclusions: Four weeks of exercise training did not alter gastric emptying, indicating gastric emptying may only adapt to a higher volume/longer duration of exercise or changes in other characteristics associated with regular exercise. The combination of HII and continuous exercise training had beneficial effects on body composition, cardiorespiratory fitness, and blood pressure and warrants further investigation in larger randomized controlled trials.

The Effect of High-Intensity Power Training on Habitual, Intervention and Total Physical Activity Levels in Older Adults with Type 2 Diabetes: Secondary Outcomes of the GREAT2DO Randomized Controlled Trial

BACKGROUND

We examined the effect of power training on habitual, intervention and total physical activity (PA) levels in older adults with type 2 diabetes and their relationship to metabolic control.

MATERIALS AND METHODS

103 adults with type 2 diabetes were randomized to receive supervised power training or sham exercise three times/week for 12 months. Habitual, intervention, and total PA, as well as insulin resistance (HOMA2-IR) and glycosylated hemoglobin (HbA1c), were measured.

RESULTS

Participants were aged 67.9 ± 5.5 yrs, with well-controlled diabetes (HbA1c = 7.1%) and higher than average habitual PA levels compared to healthy peers. Habitual PA did not change significantly over 12 months (p = 0.74), and there was no effect of group assignment on change over time in habitual PA over 0-6 (p = 0.16) or 0-6-12 months (p = 0.51). By contrast, intervention PA, leg press tonnage and total PA increased over both 6- and 12-month timepoints (p = 0.0001), and these changes were significantly greater in the power training compared to the sham exercise group across timepoints (p = 0.0001). However, there were no associations between changes in any PA measures over time and changes in metabolic profile.

CONCLUSION

Structured high-intensity power training may be an effective strategy to enhance overall PA in this high-risk cohort.

The compensatory effect of exercise on physical activity and energy intake in young men with overweight: The EFECT randomised controlled trial

BACKGROUND

The compensatory effect of exercise on total volume of physical activity and food intake has been described as a possible explanation for the limited body weight loss observed during exercise interventions.

OBJECTIVE

To investigate the effect of different exercise intensities on total volume of physical activity and energy intake amongst active men with overweight.

DESIGN

Young men with overweight from a naval academy (n = 72; mean ± SD, age 21 ± 2 years, BMI 27.9 ± 2.13 kg/m²) were randomised to a control group (CG), moderate-intensity (MEG), or vigorous-intensity exercise group (VEG). MEG and VEG performed exercise sessions three times per week, for 60 min, during a 2-week period. Physical activity was assessed using triaxial accelerometers for 13 days. Energy intake was assessed at four time-points by 24-hour food recall. Intention-to-treat analyses were performed using linear mixed effect models.

RESULTS

MEG and VEG presented a greater compensatory effect in the total volume of physical activity over time compared to CG, with a significant difference in the rate of change between VEG and CG (∆ = -250,503 counts vs. ∆ = -61,306 counts, respectively; p = 0.01), and MEG and CG (∆ = -253,336 counts vs. ∆ = -61,306 counts, respectively; p = 0.01). There was no difference between MEG and VEG (p = 0.97). Changes in energy intake were not different between groups (p = 0.18); however, MEG presented greater energy intake compared to CG (β=491 kcal/day; p = 0.01) and VEG (β=319 kcal/day; p = 0.07). VEG presented a greater reduction in body weight compared to MEG (-1.3 kg vs. -0.4 kg; p = 0.03) and CG (-1.3 kg vs. -0.6 kg; p = 0.07).

CONCLUSIONS

Two weeks of exercise promoted a compensatory effect in total volume of physical activity in active men with overweight, regardless of exercise intensity. The compensatory effect was not observed for energy intake, although there was a trend for higher absolute energy intake in the MEG. Consequently, individuals in the VEG showed greater reduction in body weight over the intervention period.

Weight Loss after 12 Weeks of Exercise and/or Nutritional Guidance Is Not Obligatory for Induced Changes in Local Fat/Lean Mass Indexes in Adults with Excess of Adiposity

The objectives of this secondary analysis are (1) to investigate the differential effects of exercise training modalities-high-intensity interval training (HIIT), resistance training (RT), combined training (CT = HIIT + RT), and/or nutritional guidance (NG) alone-on local fat/lean mass indexes in adults with excess of adiposity; (2) to identify the individual patterns of response based on either a clinical criterion of weight loss (≥5%) and/or technical error (TE) of measurement of local fat/lean mass indexes; and (3) to assess the individual change for body composition parameters assigned either to HIIT, RT, CT, and/or NG groups utilizing a TE. A 12-week trial was conducted in 55 participants randomized to one of the four interventions. The primary outcome was clinical change in body weight (i.e., weight loss of ≥5%). Secondary outcomes included change in ratio of android and gynoid fat mass, as well as local fat and lean mass indexes (arms, trunk, and legs), before and after intervention. The main findings from the current analysis revealed that (i) after 12 weeks of follow-up, significant decreases in several body composition indexes were found including body weight, arm, trunk, and legs fat mass, and android and gynecoid fat mass were observed in HIIT, RT, and CT groups (p < 0.05); (ii) a significant proportion of individuals showed a positive response following 12 weeks of training, led by the HIIT group with 44% and followed by RT with 39% in 9 indexes; (iii) the HIIT group showed lowest rates of adverse responders with (6%); and (iv) the individual patterns of response utilizing clinically meaningful weight loss were not necessarily associated with the corresponding individual training-induced changes in body composition indexes in adults with excess of adiposity. Overall, the study suggests that HIIT has an important ability to reduce the prevalence of non-response to improve body composition indexes.

Validity of predictive equations to estimate RMR in females with varying BMI

Estimation of RMR using prediction equations is the basis for calculating energy requirements. In the present study, RMR was predicted by Harris-Benedict, Schofield, Henry, Mifflin-St Jeor and Owen equations and measured by indirect calorimetry in 125 healthy adult women of varying BMI (17-44 kg/m2). Agreement between methods was assessed by Bland-Altman analyses and each equation was assessed for accuracy by calculating the percentage of individuals predicted within ± 10 % of measured RMR. Slopes and intercepts of bias as a function of average RMR (mean of predicted and measured RMR) were calculated by regression analyses. Predictors of equation bias were investigated using univariate and multivariate linear regression. At group level, bias (the difference between predicted and measured RMR) was not different from zero only for Mifflin-St Jeor (0 (sd 153) kcal/d (0 (sd 640) kJ/d)) and Henry (8 (sd 163) kcal/d (33 (sd 682) kJ/d)) equations. Mifflin-St Jeor and Henry equations were most accurate at the individual level and predicted RMR within 10 % of measured RMR in 71 and 66 % of participants, respectively. For all equations, limits of agreement were wide, slopes of bias were negative, and intercepts of bias were positive and significantly (P < 0⋅05) different from zero. Increasing age, height and BMI were associated with underestimation of RMR, but collectively these variables explained only 15 % of the variance in estimation bias. Overall accuracy of equations for prediction of RMR is low at the individual level, particularly in women with low and high RMR. The Mifflin-St Jeor equation was the most accurate for this dataset, but prediction errors were still observed in about one-third of participants.

Unprompted vigorous physical activity is associated with higher levels of subsequent sedentary behaviour in participants with low cardiorespiratory fitness: a cross-sectional study

Performing physical activity is considered health promoting but may induce a need for subsequent rest periods. This study aimed to determine the within-day interactions between vigorous physical activity (VPA) and sedentary behaviour (SB) in participants with low cardiorespiratory fitness. We tested the hypothesis that VPA is associated with a temporary subsequent increase in SB. One week of accelerometer data containing a minimum of one 10-min bout of VPA from 62 participants with low cardiorespiratory fitness (31-50 years old) were obtained from the MILE study. A comparison of SB was made between days with a bout of VPA and days without (control). Due to a positive association between VPA and number and duration of sedentary bouts, the time accumulated in both uninterrupted and total sedentary bouts were 27 (95% CI, 10-45) min and 29 (95% CI, 9-50) min higher on VPA days compared to control days (P < 0.05). Our results indicate that in participants with low cardiovascular fitness, unprompted VPA is positively associated with an increase in subsequent sedentary time. We propose that such VPA-associated sedentary time may be viewed as part of a healthy activity pattern.

Benatti F, Lopes de Campos-Ferraz P, Coelho D, Roble OJ, Sabatini F, Perez I, Aburad L, Vessoni A, Fernandez Unsain R, Macedo Rogero M, Toporcov TN, de Sá-Pinto AL, Gualano B, B. Scagliusi F. Effects of a new intervention based on the Health at Every Size approach for the management of obesity: The "Health and Wellness in Obesity" study

Health at Every Size® (HAES®) is a weight-neutral approach focused on promoting healthy behaviors in people with different body sizes. This study examined multiple physiological, attitudinal, nutritional, and behavioral effects of a newly developed, intensive, interdisciplinary HAES®-based intervention in obese women. This was a prospective, seven-month, randomized (2:1), controlled, mixed-method clinical trial. The intervention group (I-HAES®; n = 39) took part in an intensified HAES®-based intervention comprising a physical activity program, nutrition counseling sessions, and philosophical workshops. The control group (CTRL; n = 19) underwent a traditional HAES®-based intervention. Before and after the interventions, participants were assessed for physiological, psychological, and behavioral parameters (quantitative data) and took part in focus groups (qualitative data). Body weight, body mass index, and waist and hip circumferences did not significantly differ within or between groups (P > 0.05). I-HAES® showed increased peak oxygen uptake and improved performance in the timed-stand test (P = 0.004 and P = 0.004, between-group comparisons). No significant within- or between-group differences were observed for objectively measured physical activity levels, even though the majority of the I-HAES® participants indicated that they were engaged in or had plans to include physical activity in their routines. I-HAES® resulted in improvements in eating attitudes and practices. The I-HAES® group showed significantly improved all Body Attitude Questionnaire subscale and all Figure Rating Scale scores (P ≤ 0.05 for all parameters, within-group comparisons), whereas the CTRL group showed slight or no changes. Both groups had significant improvements in health-related quality of life parameters, although the I-HAES® group had superior gains in the "physical health," "psychological health," and "overall perception of quality of life and health" (P = 0.05, 0.03, and 0.02, respectively, between-group comparisons) domains. Finally, most of the quantitative improvements were explained by qualitative data. Our results show that this new intensified HAES®-based intervention improved participants' eating attitudes and practices, perception of body image, physical capacity, and health-related quality of life despite the lack of changes in body weight and physical activity levels, showing that our novel approach was superior to a traditional HAES®-based program.

Physical fitness improvement in overweight postmenopausal women who do not lose fat mass in response to exercise training

OBJECTIVE

The aim of this study was to examine if overweight postmenopausal women who do not experience fat mass loss after a 1-year aerobic exercise (AE) and resistance training (RT) program can still improve physical fitness.

METHODS

Thirty-one overweight women (body mass index 28-40 kg/m or waist circumference ≥88 cm) participated in three weekly supervised AE and RT sessions for 1 year. All women were categorized according to their fat mass changes after the intervention: 14 women were considered as responders (fat mass loss ≥5% of initial fat mass) and 17 as nonresponders (fat mass loss <5% of initial fat mass). The main outcome measures were absolute and relative body strength, peak aerobic capacity, lower limbs power, flexibility, and body composition (DXA). Total energy intake (3-day dietary record) and physical activity level (physical activity scale for the elderly questionnaire) were also measured before, halfway through and after the intervention.

RESULTS

At baseline, nonresponders participants had higher body mass index (P = 0.04). After the intervention, relative and absolute upper and lower body strength, peak aerobic capacity (all P < 0.005), and flexibility increased similarly in the nonresponders and responders groups (P = 0.01).

CONCLUSIONS

Although some participants did not respond to exercise by decreasing fat mass, they still experienced important physical fitness benefits from AE and RT. These results suggest that body composition changes should not be the sole indicator of the benefits of exercise in overweight postmenopausal women.

The effect of exercise on non-exercise physical activity and sedentary behavior in adults

It is widely assumed that structured exercise causes an additive increase in physical activity energy expenditure (PAEE) and total daily energy expenditure (TDEE). However, the common observation that exercise often leads to a less than expected decrease in body weight, without changes in energy intake, suggests that some compensatory behavioral adaptations occur. A small number of human studies have shown that adoption of structured exercise can lead to decreases in PAEE, which is often interpreted as a decrease in physical activity (PA) behavior. An even smaller number of studies have objectively measured PA, and with inconsistent results. In animals, high levels of imposed PA induce compensatory changes in some components of TDEE. Recent human cohort studies also provide evidence that in those at the highest levels of PA, TDEE is similar when compared to less physically active groups. The objective of this review is to summarize the effects of structured exercise training on PA, sedentary behavior, PAEE and TDEE. Using models from ecological studies in animals and observational data in humans, an alternative model of TDEE in humans is proposed. This model may serve as a framework to investigate the complex and dynamic regulation of human energy budgets.

Obesity and energy balance: What is the role of physical activity?

Despite billions of dollars spent over decades of research, debate remains over the causes and solutions of the obesity epidemic. The specific role of physical activity in the prevention or treatment of obesity seems a particularly contentious issue, with opposing views put forth in both academic and popular media. In an attempt to provide context and clarity to the specific question of the role of physical activity in determination of body weight, we have attempted to identify evidence or lack thereof in the scientific literature and provide a summary of our findings. Areas covered: Topics included in this narrative review are an overview of energy balance, the relationship between physical activity and energy expenditure, compensatory responses in non-exercise energy expenditure and energy intake, and the relationship between physical activity and obesity. Expert commentary: Based on a review of the existing literature, daily physical activity and structured exercise has beneficial effects on an individual's body weight. In most instances, exercise occurring in adequate amounts will increase total daily energy expenditure and create an acute energy deficit, without compensatory decreases in non-exercise physical activity or energy expenditure nor compensatory increases in energy intake. Several gaps in the literature exist, both in terms of the number of adequately powered clinical trials with rigorous assessments of both energy intake and expenditure, and with a variety of study populations (by age, sex, race, etc.) and with varying exercise volumes and intensities.

Examining the effect of binge eating and disinhibition on compensatory changes in energy balance following exercise among overweight and obese women

Some women behaviorally compensate for the energy expended during exercise by increasing their energy intake or becoming more sedentary, thereby decreasing their energy expenditure. Although behavioral compensation can attenuate or even reverse the energy deficit generated by exercise, few data are available on predictors of compensatory responses to exercise. The present study aimed to identify eating-related predictors of compensatory changes in energy balance following exercise. Overweight and obese, physically inactive women (N=48) completed self-report measures of disinhibition and binge eating and participated in two experimental conditions, exercise and rest, in counterbalanced order. Energy intake and expenditure were measured for 24-hours following each experimental condition to estimate energy balance. On average, women were 21.33±2.09years old and 63% were white. Of the sample, 63% compensated for the energy expended during exercise by increasing their energy intake or decreasing their energy expenditure. Linear mixed effects modeling with repeated measurement showed that disinhibition was not predictive of behavioral compensation. However, there was a significant difference between the negative energy balance observed following the rest condition and the positive energy balance observed following the exercise condition among women who reported binge eating, which was driven by a tendency to spend less time being physically active and more time being sedentary following exercise. These findings indicate that women who binge eat may be at greatest risk of compensating for exercise. Future research is needed to better understand psychosocial predictors and common mechanisms through which behavioral compensation is promoted.

Effects of a 12-week aerobic exercise intervention on eating behaviour, food cravings, and 7-day energy intake and energy expenditure in inactive men

This study examined effects of 12 weeks of moderate-intensity aerobic exercise on eating behaviour, food cravings, and weekly energy intake and expenditure in inactive men. Eleven healthy men (mean ± SD: age, 26 ± 5 years; body mass index, 24.6 ± 3.8 kg·m^-2; maximum oxygen uptake, 43.1 ± 7.4 mL·kg^-1·min^-1) completed the 12-week supervised exercise programme. Body composition, health markers (e.g., blood pressure), eating behaviour, food cravings, and weekly energy intake and expenditure were assessed before and after the exercise intervention. There were no intervention effects on weekly free-living energy intake (p = 0.326, d = -0.12) and expenditure (p = 0.799, d = 0.04) or uncontrolled eating and emotional eating scores (p > 0.05). However, there was a trend with a medium effect size (p = 0.058, d = 0.68) for cognitive restraint to be greater after the exercise intervention. Total food cravings (p = 0.009, d = -1.19) and specific cravings of high-fat foods (p = 0.023, d = -0.90), fast-food fats (p = 0.009, d = -0.71), and carbohydrates/starches (p = 0.009, d = -0.56) decreased from baseline to 12 weeks. Moreover, there was a trend with a large effect size for cravings of sweets (p = 0.052, d = -0.86) to be lower after the exercise intervention. In summary, 12 weeks of moderate-intensity aerobic exercise reduced food cravings and increased cognitive restraint, but these changes were not accompanied by changes in other eating behaviours or weekly energy intake and expenditure. The results indicate the importance of exercising for health improvements even when reductions in body mass are modest.

Energy and Macronutrient Intake in the Midwest Exercise Trial 2 (MET-2)

PURPOSE

This study aimed to examine the effect of exercise training over 10 months at two levels of energy expenditure on energy and macronutrient intake in a sample of previously sedentary, overweight/obese young adults.

METHODS

We conducted a 10-month trial in 141 young adults who were randomized to either supervised exercise 5 d·wk(-1) at 400 and 600 kcal per session or nonexercise control. Participants were instructed to maintain their usual ad libitum diet. Energy/macronutrient intake was assessed at baseline and 3.5, 7, and 10 months over 7-d periods of ad libitum eating in a university cafeteria using digital photography. Foods consumed outside the cafeteria were assessed using multiple-pass recalls.

RESULTS

There were no significant between-group differences in absolute energy intake at baseline or at any other time point in the total sample or in men. In women, absolute energy intake was significantly greater in the 600-kcal-per-session group versus controls at both 3.5 and 7 months. There were no significant between-group differences in relative energy intake (kcal·kg·d(-1)) at any time point in the total sample, in men or women. There were no significant within- or between-group differences of change in absolute or relative energy intake in any of the three study groups in the total sample or in men or women. No clinically relevant changes in macronutrient intake were observed.

CONCLUSIONS

Aerobic exercise training does not significantly alter energy or macronutrient intake in overweight and obese young adults. The possibility of a threshold level beyond which increased exercise energy expenditure fails to produce a more negative energy balance and potential sex differences in the energy intake response to increased levels of exercise are potentially important.

Effect of Exercise Intensity on Spontaneous Physical Activity Energy Expenditure in Overweight Boys: A Crossover Study

Objective

Evaluate the effect of different exercise intensities on spontaneous physical activity energy expenditure in overweight adolescents.

Methods

A crossover study was developed with a control session, followed by moderate and vigorous exercise sessions, with six days of monitoring each. Twenty-four adolescents, 11–13 years old, male and overweight were selected. Spontaneous physical activity energy expenditure was assessed by accelerometers. Linear mixed effects models were used to evaluate the differences per session across time.

Results

Energy expenditure during the 1st hour was different between all three sessions, with averages of 82, 286 and 343 kcal to the control, moderate and vigorous sessions, respectively (p <0.001). The same pattern of difference in energy expenditure between the sessions remained after 24 hours (704 vs 970 vs 1056 kcal, p <0.001). However, energy expenditure during the six days indicates compensation from second to the sixth day, although small differences remained at the end of the 6-day period (5102 vs 5193 vs 5271 kcal, p <0.001).

Conclusions

A single aerobic session seems to modify the spontaneous physical activities in overweight adolescents but still keeping the vigorous session with higher total energy expenditure during the follow-up period. Despite the observed compensatory effect, the greater energy expenditure observed in both moderate and vigorous exercise sessions indicates that physical activity should be recommended to promote an increased energy expenditure in adolescents.

Trial Registration

ClinicalTrials.gov NCT 02272088

Predictors of fat mass changes in response to aerobic exercise training in women

Aerobic exercise training in women typically results in minimal fat loss, with considerable individual variability. We hypothesized that women with higher baseline body fat would lose more body fat in response to exercise training and that early fat loss would predict final fat loss. Eighty-one sedentary premenopausal women (age: 30.7 ± 7.8 years; height: 164.5 ± 7.4 cm; weight: 68.2 ± 16.4 kg; fat percent: 38.1 ± 8.8) underwent dual-energy x-ray absorptiometry before and after 12 weeks of supervised treadmill walking 3 days per week for 30 minutes at 70% of (Equation is included in full-text article.). Overall, women did not lose body weight or fat mass. However, considerable individual variability was observed for changes in body weight (-11.7 to +4.8 kg) and fat mass (-11.8 to +3.7 kg). Fifty-five women were classified as compensators and, as a group, gained fat mass (25.6 ± 11.1 kg to 26.1 ± 11.3 kg; p < 0.001). The strongest correlates of change in body fat at 12 weeks were change in body weight (r = 0.52) and fat mass (r = 0.48) at 4 weeks. Stepwise regression analysis that included change in body weight and body fat at 4 weeks and submaximal exercise energy expenditure yielded a prediction model that explained 37% of the variance in fat mass change (R = 0.37, p < 0.001). Change in body weight and fat mass at 4 weeks were moderate predictors of fat loss and may potentially be useful for identification of individuals who achieve less than expected weight loss or experience unintended fat gain in response to exercise training.

Change in energy expenditure and physical activity in response to aerobic and resistance exercise programs

Exercise is considered an important component of a healthy lifestyle but there remains controversy on effects of exercise on non-exercise physical activity (PA). The present study examined the prospective association of aerobic and resistance exercise with total daily energy expenditure and PA in previously sedentary, young men. Nine men (27.0 ± 3.3 years) completed two 16-week exercise programs (3 exercise sessions per week) of aerobic and resistance exercise separated by a minimum of 6 weeks in random order. Energy expenditure and PA were measured with the SenseWear Mini Armband prior to each intervention as well as during week 1, week 8 and week 16 of the aerobic and resistance exercise program. Body composition was measured via dual x-ray absorptiometry. Body composition did not change in response to either exercise intervention. Total daily energy expenditure on exercise days increased by 443 ± 126 kcal/d and 239 ± 152 kcal/d for aerobic and resistance exercise, respectively (p < 0.01). Non-exercise moderate-to-vigorous PA, however, decreased on aerobic exercise days (−148 ± 161 kcal/d; p = 0.03). There was no change in total daily energy expenditure and PA on non-exercise days with aerobic exercise while resistance exercise was associated with an increase in moderate-to-vigorous PA during non-exercise days (216 ± 178 kcal/d, p = 0.01). Results of the present study suggest a compensatory reduction in PA in response to aerobic exercise. Resistance exercise, on the other hand, appears to facilitate non-exercise PA, particularly on non-exercise days, which may lead to more sustainable adaptations in response to an exercise program.

Reciprocal Compensation to Changes in Dietary Intake and Energy Expenditure within the Concept of Energy Balance

An imbalance between energy intake and energy expenditure is the primary etiology for excess weight gain. Increased energy expenditure via exercise and energy restriction via diet are commonly used approaches to induce weight loss. Such behavioral interventions, however, have generally resulted in a smaller than expected weight loss, which in part has been attributed to compensatory adaptations in other components contributing to energy balance. Current research points to a loose coupling between energy intake and energy expenditure on a daily basis, and evidence for long-term adaptations has been inconsistent. The lack of conclusive evidence on compensatory adaptations in response to alterations in energy balance can be attributed to differences in intervention type and study population. Physical activity (PA) levels may be reduced in response to aerobic exercise but not in response to resistance exercise. Furthermore, athletic and lean adults have been shown to increase their energy intake in response to exercise, whereas no such response was observed in obese adults. There is also evidence that caloric restriction is associated with a decline in PA. Generally, humans seem to be better equipped to defend against weight loss than avoid weight gain, but results also show a large individual variability. Therefore, individual differences rather than group means should be explored to identify specific characteristics of "compensators" and "noncompensators." This review emphasizes the need for more research with simultaneous measurements of all major components contributing to energy balance to enhance the understanding of the regulation of energy balance, which is crucial to address the current obesity epidemic.

Energy intake, nonexercise physical activity, and weight loss in responders and nonresponders: The Midwest Exercise Trial 2

OBJECTIVE

To compare energy intake, total daily energy expenditure (TDEE), nonexercise energy expenditure (NEEx), resting metabolic rate (RMR), nonexercise physical activity (NEPA), and sedentary time between participants with weight loss <5% (nonresponders) vs. ≥5% (responders) in response to exercise.

METHODS

Adults (18-30 years) with overweight/obesity (BMI 25-40 kg/m(2) ) were randomized to exercise: 5 days/week, 400 or 600 kcal/session, 10 months.

RESULTS

Of the participants, 40 responded and 34 did not respond to the exercise protocol. Nonresponder energy intake was higher vs. responders, significant only in men (P=0.034). TDEE increased only in responders (P=0.001). NEEx increased in responders and decreased in nonresponders, significant only in men (P=0.045). There were no within- or between-group differences for change in RMR. NEPA increased in responders and decreased in nonresponders (group-by-time interactions: total sample, P=0.049; men, P=0.016). Sedentary time decreased in both groups, significant only in men.

CONCLUSIONS

Men who did not lose weight in response to exercise (<5%) had higher energy intake and lower NEEx when compared with men losing ≥5%. No significant differences in any parameters assessed were observed between women who lost <5% vs. those losing ≥5%. Factors associated with the weight loss response to exercise in women warrant additional investigation.

Predictors of Energy Compensation during Exercise Interventions: A Systematic Review

Weight loss from exercise-induced energy deficits is usually less than expected. The objective of this systematic review was to investigate predictors of energy compensation, which is defined as body energy changes (fat mass and fat-free mass) over the total amount of exercise energy expenditure. A search was conducted in multiple databases without date limits. Of 4745 studies found, 61 were included in this systematic review with a total of 928 subjects. The overall mean energy compensation was 18% ± 93%. The analyses indicated that 48% of the variance of energy compensation is explained by the interaction between initial fat mass, age and duration of exercise interventions. Sex, frequency, intensity and dose of exercise energy expenditure were not significant predictors of energy compensation. The fitted model suggested that for a shorter study duration, lower energy compensation was observed in younger individuals with higher initial fat mass (FM). In contrast, higher energy compensation was noted for younger individuals with lower initial FM. From 25 weeks onward, energy compensation was no longer different for these predictors. For studies of longer duration (about 80 weeks), the energy compensation approached 84%. Lower energy compensation occurs with short-term exercise, and a much higher level of energy compensation accompanies long-term exercise interventions.

Consistency in compensatory eating responses following acute exercise in inactive, overweight and obese women

It is often assumed that some individuals reliably increase energy intake (EI) post-exercise ('compensators') and some do not ('non-compensators'), leading researchers to examine the characteristics that distinguish these two groups. However, it is unclear whether EI post-exercise is stable over time. The present study examined whether compensatory eating responses to a single exercise bout are consistent within individuals across three pairs of trials. Physically inactive, overweight/obese women (n 28, BMI 30·3 (SD 2·9) kg/m²) participated in three pairs of testing sessions, with each pair consisting of an exercise (30 min of moderate-intensity walking) and resting testing day. EI was measured using a buffet meal 1 h post-exercise/rest. For each pair, the difference in EI (EIdiff = EIex - EIrest) was calculated, where EIex is the EI of the exercise session and EIrest is the EI of the resting session, and women were classified as a 'compensator' (EIex > EIrest) or 'non-compensator' (EIex ≤ EIrest). The average EI on exercise days (3328·0 (SD 1686·2) kJ) was similar to those on resting days (3269·4 (SD 1582·4) kJ) (P= 0·67). Although EI was reliable within individuals across the three resting days (intraclass correlation coefficient (ICC) 0·75, 95 % CI 0·60, 0·87; P< 0·001) and three exercise days (ICC 0·83, 95 % CI 0·70, 0·91; P< 0·001), the ICC for EIdiff across the three pairs of trials was low (ICC 0·20, 95 % CI -0·02, 0·45; P= 0·04), suggesting that compensatory eating post-exercise is not a stable construct. Moreover, the classification of 'compensators'/'non-compensators' was not reliable (κ = -0·048; P= 0·66). The results were unaltered when 'relative' EI was used, which considers the energy expenditure of the exercise/resting sessions. Acute compensatory EI following an exercise bout is not reliable in overweight women. Seeking to understand what distinguishes 'compensators' from 'non-compensators' based on a single eating episode post-exercise is not justified.

Football Fans in Training (FFIT): a randomised controlled trial of a gender-sensitised weight loss and healthy living programme for men – end of study report

Background

The prevalence of male obesity is increasing alongside low uptake of existing weight management programmes by men. Football Fans in Training (FFIT) is a group-based, weight management and healthy living programme delivered by community coaches.

Objectives

To assess (1) the effectiveness and cost-effectiveness of FFIT, (2) fidelity of delivery and (3) coach and participant experiences of FFIT.

Design

A two-arm, pragmatic, randomised controlled trial; associated cost-effectiveness [in terms of incremental cost per quality-adjusted life-year (QALY) within trial and over individuals’ lifetimes]; and process evaluation. Participants were block randomised in a 1 : 1 ratio, stratified by club; the intervention group started FFIT within 3 weeks and the comparison group were put on a 12-month waiting list.

Setting

Thirteen professional football clubs in Scotland, UK.

Participants

A total of 747 men aged 35–65 years with an objectively measured body mass index (BMI) of ≥ 28 kg/m2.

Interventions

FFIT was gender sensitised in context, content and style of delivery. A total of 12 weekly sessions delivered at club stadia combined effective behaviour change techniques with dietary information and physical activity sessions. Men carried out a pedometer-based walking programme. A light-touch maintenance programme included six e-mails and a reunion session at 9 months. At baseline, both groups received a weight management booklet, feedback on their BMI and advice to consult their general practitioner if blood pressure was high.

Primary outcome

Mean difference in weight loss between groups at 12 months expressed as absolute weight and a percentage. Intention-to-treat analyses used all available data.

Data sources

Objective measurements, questionnaires, observations, focus groups and coach interviews.

Results

A total of 374 men were allocated to the intervention and 333 (89%) completed 12-month assessments; a total of 374 were allocated to the comparator and 355 (95%) completed 12-month assessments. At 12 months, the mean difference in weight loss between groups, adjusted for baseline weight and club, was 4.94 kg [95% confidence interval (CI) 3.95 kg to 5.94 kg]; percentage weight loss, similarly adjusted, was 4.36% (95% CI 3.64% to 5.08%), in favour of the intervention (p < 0.0001). Sensitivity analyses gave similar results. Pre-specified subgroup analyses found no significant predictors of primary outcome. Highly significant differences in favour of the intervention were observed for objectively measured waist, percentage body fat, systolic and diastolic blood pressure, and self-reported physical activity, diet and indicators of well-being and physical aspects of quality of life. Eight serious adverse events were reported, of which two were reported as related to FFIT participation. From the within-trial analysis, FFIT was estimated to cost £862 per additional man maintaining a 5% weight reduction at 12 months and £13,847 per additional QALY, both compared with no intervention. For a cost-effectiveness threshold of £20,000/QALY, the probability that FFIT is cost-effective, compared with no active intervention, is 0.72. This probability rises to 0.89 for a cost-effectiveness threshold of £30,000/QALY. From the longer-term analysis, FFIT was estimated to cost £2535 per life-year gained and £2810 per QALY gained. FFIT was largely delivered as intended. The process evaluation demonstrated the powerful draw of football to attract men at high risk of ill health. FFIT was popular and analyses suggest that it enabled lifestyle change in ways that were congruent with participants’ identities.

Conclusions

Participation in FFIT led to significant reductions in weight at 12 months. It was cost-effective at standard levels employed in the UK, attracted men at high risk of future ill health and was enjoyable. Further research should investigate whether or not participants retained weight loss in the long term, how the programme could be optimised in relation to effectiveness and intensity of delivery and how group-based programmes may operate to enhance weight loss in comparison with individualised approaches.

Study registration

Current Controlled Trials ISRCTN32677491.

Funding

Scottish Government and The Football Pools funded the delivery of FFIT. National Institute for Health Research Public Health Research programme funded the evaluation and will be published in full inPublic Health Research; Vol. 3, No. 2. See the NIHR Journals Library website for further project information.

Resistance to exercise-induced weight loss: compensatory behavioral adaptations

In many interventions that are based on an exercise program intended to induce weight loss, the mean weight loss observed is modest and sometimes far less than what the individual expected. The individual responses are also widely variable, with some individuals losing a substantial amount of weight, others maintaining weight, and a few actually gaining weight. The media have focused on the subpopulation that loses little weight, contributing to a public perception that exercise has limited utility to cause weight loss. The purpose of the symposium was to present recent, novel data that help explain how compensatory behaviors contribute to a wide discrepancy in exercise-induced weight loss. The presentations provide evidence that some individuals adopt compensatory behaviors, that is, increased energy intake and/or reduced activity, that offset the exercise energy expenditure and limit weight loss. The challenge for both scientists and clinicians is to develop effective tools to identify which individuals are susceptible to such behaviors and to develop strategies to minimize their effect.

Does increased prescribed exercise alter non-exercise physical activity/energy expenditure in healthy adults? A systematic review

Prescribed physical activity/exercise training may reduce non-exercise physical activity resulting in no change in total daily energy expenditure and no or minimal exercise-induced weight loss. This systematic review evaluated cross-sectional, short-term (2-14 d), randomized and non-randomized trials which reported on the effect of prescribed physical activity/exercise on non-exercise physical activity/energy expenditure in healthy adults. PubMed and Embase were searched (from January 1990 to March 2013) for articles that presented data on the change in non-exercise physical activity/energy expenditure in response to prescribed physical activity/exercise training. Thirty-one articles were included in this review. One-hundred per cent of cross-sectional studies (n = 4), 90% of short-term studies (n = 10), 50% of non-randomized trials (n = 10) and 100% of randomized trials (n = 7) reported no reductions in non-exercise physical activity/energy expenditure in response to prescribed physical activity/exercise training. We found minimal evidence to support the hypothesis that prescribed physical activity/exercise training results in decreased non-exercise physical activity/energy expenditure in healthy adults. However, this literature is limited by the lack of adequately powered trials designed specifically to evaluate this hypothesis which have included assessments of both the energy expenditure of prescribed exercise and non-exercise energy expenditure using state-of-the-art techniques, i.e. indirect calorimetry and doubly labelled water, respectively.

Does increased exercise or physical activity alter ad-libitum daily energy intake or macronutrient composition in healthy adults? A systematic review

BACKGROUND

The magnitude of the negative energy balance induced by exercise may be reduced due to compensatory increases in energy intake.

OBJECTIVE

TO ADDRESS THE QUESTION: Does increased exercise or physical activity alter ad-libitum daily energy intake or macronutrient composition in healthy adults?

DATA SOURCES

PubMed and Embase were searched (January 1990-January 2013) for studies that presented data on energy and/or macronutrient intake by level of exercise, physical activity or change in response to exercise. Ninety-nine articles (103 studies) were included.

STUDY ELIGIBILITY CRITERIA

Primary source articles published in English in peer-reviewed journals. Articles that presented data on energy and/or macronutrient intake by level of exercise or physical activity or changes in energy or macronutrient intake in response to acute exercise or exercise training in healthy (non-athlete) adults (mean age 18-64 years).

STUDY APPRAISAL AND SYNTHESIS METHODS

Articles were grouped by study design: cross-sectional, acute/short term, non-randomized, and randomized trials. Considerable heterogeneity existed within study groups for several important study parameters, therefore a meta-analysis was considered inappropriate. Results were synthesized and presented by study design.

RESULTS

No effect of physical activity, exercise or exercise training on energy intake was shown in 59% of cross-sectional studies (n = 17), 69% of acute (n = 40), 50% of short-term (n = 10), 92% of non-randomized (n = 12) and 75% of randomized trials (n = 24). Ninety-four percent of acute, 57% of short-term, 100% of non-randomized and 74% of randomized trials found no effect of exercise on macronutrient intake. Forty-six percent of cross-sectional trials found lower fat intake with increased physical activity.

LIMITATIONS

The literature is limited by the lack of adequately powered trials of sufficient duration, which have prescribed and measured exercise energy expenditure, or employed adequate assessment methods for energy and macronutrient intake.

CONCLUSIONS

We found no consistent evidence that increased physical activity or exercise effects energy or macronutrient intake.

The independent and combined effects of exercise training and reducing sedentary behavior on cardiometabolic risk factors

This pilot study examined if the combination of exercise training and reducing sedentary time (ST) results in greater changes to health markers than either intervention alone. Fifty-seven overweight/obese participants (19 males/39 females) (mean ± SD; age, 43.6 ± 9.9 years; body mass index (BMI), 35.1 ± 4.6 kg·m(-2)) completed the 12-week study and were randomly assigned to (i) EX: exercise 5 days·week(-1) for 40 min·session(-1) at moderate intensity; (ii) rST: reduce ST and increase nonexercise physical activity; (iii) EX-rST: combination of EX and rST; and (iv) CON: maintain behavior. Fasting lipids, blood pressure (BP), peak oxygen uptake, BMI, and 2-h oral glucose tolerance tests were completed pre- and post-intervention. EX and EX-rST increased peak oxygen uptake by ∼10% and decreased systolic BP (both p < 0.001). BMI decreased by -3.3% (95% confidence interval: -4.6% to -1.9%) for EX-rST and -2.2% (-3.5% to 0.0%) for EX. EX-rST significantly increased composite insulin-sensitivity index by 17.8% (2.8% to 32.8%) and decreased insulin area under the curve by 19.4% (-31.4% to -7.3%). No other groups improved in insulin action variables. rST group decreased ST by 7% (∼50 min·day(-1)); however, BP was the only health-related outcome that improved. EX and EX-rST improved peak oxygen uptake and BMI, providing further evidence that moderate-intensity exercise is beneficial. The within-group analysis provides preliminary evidence that exercising and reducing ST may result in improvements in metabolic biomarkers that are not seen with exercise alone, though between-group differences did not reach statistical significance. Future studies, with larger samples, should examine health-related outcomes resulting from greater reductions in ST over longer intervention periods.

The ActivityStat hypothesis: the concept, the evidence and the methodologies

BACKGROUND

The ActivityStat hypothesis suggests that when physical activity is increased or decreased in one domain, there will be a compensatory change in another domain, in order to maintain an overall stable level of physical activity or energy expenditure over time. The ActivityStat debate is gaining momentum in the literature and most of the research to date is based on observational studies.

OBJECTIVE

The objective of this paper is to conceptually clarify the ActivityStat hypothesis and to examine the experimental research aiming to demonstrate or refute compensation using a systematic review process.

METHODS

A systematic review was conducted using electronic database searches with the aim of detecting studies experimentally investigating the ActivityStat hypothesis or compensation in physical activity or energy expenditure. Included studies were critically appraised using a specifically designed tool to address the conceptual considerations of the ActivityStat hypothesis.

RESULTS

Searches identified 28 studies that met the inclusion criteria. Publications spanned 26 years and had multiple methodological approaches, including randomized and non-randomized controlled trials, crossover designs, cluster randomized controlled trials and pre-post trials. Populations of the included studies ranged from children, to adults and the elderly, across a range of weight statuses and used both aerobic, resistance and mixed-exercise interventions. The timeframe of interventions ranged from 1 day to 4 years and outcomes were measured using doubly labelled water, accelerometry, heart rate monitoring, resting metabolic rate, indirect calorimetry, pedometry, subjective recall questionnaire and the activity-related time index. Fifteen of 28 included studies provided evidence of compensation, while 13 did not. Subgroup analyses by population, type and duration of intervention, weight status and study quality also showed mixed findings.

CONCLUSION

There is a substantial body of experimental literature investigating compensation that has largely been overlooked in the ActivityStat debate. However, this evidence is currently inconclusive and lacks a cohesive approach to the question of an ActivityStat. Recommendations for the design of future experimental research investigating the ActivityStat hypothesis are presented.

Activity related energy expenditure, appetite and energy intake: potential implications for weight management

The aim was to investigate relationships between activity related energy expenditure (AREE), appetite ratings and energy intake (EI) in a sample of 40 male (26.4years; BMI 23.5kg/m(2)) and 42 female (26.9years; BMI 22.4kg/m(2)) participants. AREE was expressed as the residual value of the regression between total daily EE (by doubly labeled water) and resting EE (by indirect calorimetry). EI was measured using an ad libitum buffet meal and visual analogue scales measured subjective appetite ratings before and after the meal. AREE was divided into low, middle and high sex-specific tertiles. General linear models were used to investigate differences in appetite ratings and EI across AREE tertiles. Before the meal, males in the high AREE tertile had significantly lower desire to eat and lower prospective food consumption and higher feelings of fullness compared to those in the low tertile. Males in the middle tertile had significantly higher satiety quotients after the meal and lower EI compared to the other tertiles. No significant differences across tertiles were found in females. Sex differences in relationships between AREE, appetite ratings and EI may lead to differing patterns of EI and subsequent weight maintenance.

Football Fans in Training: the development and optimization of an intervention delivered through professional sports clubs to help men lose weight, become more active and adopt healthier eating habits

Background

The prevalence of obesity in men is rising, but they are less likely than women to engage in existing weight management programmes. The potential of professional sports club settings to engage men in health promotion activities is being increasingly recognised. This paper describes the development and optimization of the Football Fans in Training (FFIT) programme, which aims to help overweight men (many of them football supporters) lose weight through becoming more active and adopting healthier eating habits.

Methods

The MRC Framework for the design and evaluation of complex interventions was used to guide programme development in two phases. In Phase 1, a multidisciplinary working group developed the pilot programme (p-FFIT) and used a scoping review to summarize previous research and identify the target population. Phase 2 involved a process evaluation of p-FFIT in 11 Scottish Premier League (SPL) clubs. Participant and coach feedback, focus group discussions and interviews explored the utility/acceptability of programme components and suggestions for changes. Programme session observations identified examples of good practice and problems/issues with delivery. Together, these findings informed redevelopment of the optimized programme (FFIT), whose components were mapped onto specific behaviour change techniques using an evidence-based taxonomy.

Results

p-FFIT comprised 12, weekly, gender-sensitised, group-based weight management classroom and ‘pitch-side’ physical activity sessions. These in-stadia sessions were complemented by an incremental, pedometer-based walking programme. p-FFIT was targeted at men aged 35-65 years with body mass index ≥ 27 kg/m². Phase 2 demonstrated that participants in p-FFIT were enthusiastic about both the classroom and physical activity components, and valued the camaraderie and peer-support offered by the programme. Coaches appreciated the simplicity of the key healthy eating and physical activity messages. Suggestions for improvements that were incorporated into the optimized FFIT programme included: more varied in-stadia physical activity with football-related components; post-programme weight management support (emails and a reunion session); and additional training for coaches in SMART goal setting and the pedometer-based walking programme.

Conclusions

The Football Fans in Training programme is highly acceptable to participants and SPL coaches, and is appropriate for evaluation in a randomised controlled trial.

Effects of exercise before or after meal ingestion on fat balance and postprandial metabolism in overweight men

It is unclear how timing of exercise relative to meal ingestion influences substrate balance and metabolic responses. The present study aimed to compare the effects of exercise performed before or after breakfast on fat balance and postprandial metabolism. A total of ten sedentary overweight men (aged 28·1 (sem 10·7) years, BMI 29·0 (sem 2·8) kg/m2) underwent three trials in random order involving: (1) performing no exercise (CON), or walking for 60 min at 50 % maximal O2 uptake either (2) before (Ex-Meal) or (3) after (Meal-Ex) consuming a standardised breakfast meal. In each trial an ad libitum lunch was provided 3·5 h after breakfast. Substrate utilisation was assessed by indirect calorimetry and blood was taken at regular intervals over an 8·5 h observation period. At the end of the observation period, fat balances in the Ex-Meal ( − 1043 (sem 270) kJ) and Meal-Ex ( − 697 (sem 201) kJ) trials were both significantly lower than CON (204 (sem 165) kJ) and fat balance in the Ex-Meal trial was significantly lower than in the Meal-Ex trial (all P <0·0001). Compared with the CON trial, the 8·5 h postprandial TAG response was only significantly lowered in the Ex-Meal trial ( − 17 %, P =0·025) and not in the Meal-Ex trial ( − 11 %, P =0·20). Both the Ex-Meal and Meal-Ex trials showed significantly lowered insulin responses relative to the CON trial (by 19 and 24 %, respectively, P <0·01 for both). There were no differences in lunch energy intake between trials. The present findings suggest that there may be an advantage for body fat regulation and lipid metabolism in exercising before compared with after breakfast. However, further study is needed to determine whether the present findings extend over the long term under free-living conditions.

Submitted for your consideration: potential advantages of a novel clinical trial design and initial patient reaction

In many circumstances, individuals do not respond identically to the same treatment. This phenomenon, which is called treatment response heterogeneity (TRH), appears to be present in treatments for many conditions, including obesity. Estimating the total amount of TRH, predicting an individual's response, and identifying the mediators of TRH are of interest to biomedical researchers. Clinical investigators and physicians commonly postulate that some of these mediators could be genetic. Current designs can estimate TRH as a function of specific, measurable observed factors; however, they cannot estimate the total amount of TRH, nor provide reliable estimates of individual persons' responses. We propose a new repeated randomizations design (RRD), which can be conceived as a generalization of the Balaam design, that would allow estimates of that variability and facilitate estimation of the total amount of TRH, prediction of an individual's response, and identification of the mediators of TRH. In a pilot study, we asked 118 subjects entering a weight loss trial for their opinion of the RRD, and they stated a preference for the RRD over the conventional two-arm parallel groups design. Research is needed as to how the RRD will work in practice and its relative statistical properties, and we invite dialog about it.

Results of the Heart Healthy and Ethnically Relevant Lifestyle trial: a cardiovascular risk reduction intervention for African American women attending community health centers

OBJECTIVES

We evaluated a theory-based lifestyle intervention targeting physical activity and dietary fat intake among African American women at high risk for cardiovascular disease.

METHODS

The Heart Healthy and Ethnically Relevant Lifestyle trial (2005-2008) randomly assigned 266 low-income African American women aged 35 years and older who were patients of South Carolina community health care centers into comprehensive or standard care interventions. Comprehensive participants received standard care (stage-matched provider counseling and assisted goal setting) plus 12 months of telephone counseling and tailored newsletters. Primary outcomes were 6- and 12-month self-reported physical activity and dietary fat intake.

RESULTS

Comprehensive participants were more likely than were standard care participants to decrease total physical activity (odds ratio [OR] = 3.13; 95% confidence interval [CI] = 1.18, 8.25) and increase leisure-time physical activity (OR = 3.82; 95% CI = 1.41, 10.3) at 6 months (no 12-month differences). Mean reductions in Dietary Risk Assessment score occurred in both groups but were greater among comprehensive participants than among standard care participants (6 months, -8.50 vs -5.34; 12 months, -7.16 vs -3.37; P < .001).

CONCLUSIONS

The comprehensive intervention improved women's leisure-time physical activity and dietary fat intake, highlighting a replicable model to help primary care providers implement lifestyle counseling.

Exercise intensity influences nonexercise activity thermogenesis in overweight and obese adults

PURPOSE

The purpose of this study was to determine the effect of acute bouts of moderate- and high-intensity walking exercise on nonexercise activity thermogenesis (NEAT) in overweight and obese adults.

METHODS

Sixteen participants performed a single bout of either moderate-intensity walking exercise (MIE) or high-intensity walking exercise (HIE) on two separate occasions. The MIE consisted of walking for 60 min on a motorized treadmill at 6 km·h(-1). The 60-min HIE session consisted of walking in 5-min intervals at 6 km·h(-1) and 10% grade followed by 5 min at 0% grade. NEAT was assessed by accelerometer 3 d before, on the day of, and 3 d after the exercise sessions.

RESULTS

There was no significant difference in NEAT vector magnitude (counts per minute) between the preexercise period (days 1-3) and the exercise day (day 4) for either the MIE or the HIE protocol. In addition, there was no change in NEAT during the 3 d after the MIE session; however, NEAT increased by 16% on day 7 (postexercise) compared with the exercise day (P = 0.32). However, during the postexercise period after the HIE session, NEAT was increased by 25% on day 7 compared with the exercise day (P = 0.08) and by 30%-33% compared with the preexercise period (days 1, 2, and 3; P = 0.03, 0.03, and 0.02, respectively).

CONCLUSION

A single bout of either MIE or HIE did not alter NEAT on the exercise day or on the first 2 d after the exercise session. However, monitoring NEAT on a third day allowed the detection of a 48-h delay in increased NEAT after performing HIE. A longer-term intervention is needed to determine the effect of accumulated exercise sessions over a week on NEAT.

Acute and long-term effects of exercise on appetite control: is there any benefit for weight control?

PURPOSE OF REVIEW

To examine the relationship between energy intake, appetite control and exercise, with particular reference to longer term exercise studies. This approach is necessary when exploring the benefits of exercise for weight control, as changes in body weight and energy intake are variable and reflect diversity in weight loss.

RECENT FINDINGS

Recent evidence indicates that longer term exercise is characterized by a highly variable response in eating behaviour. Individuals display susceptibility or resistance to exercise-induced weight loss, with changes in energy intake playing a key role in determining the degree of weight loss achieved. Marked differences in hunger and energy intake exist between those who are capable of tolerating periods of exercise-induced energy deficit, and those who are not. Exercise-induced weight loss can increase the orexigenic drive in the fasted state, but for some this is offset by improved postprandial satiety signalling.

SUMMARY

The biological and behavioural responses to acute and long-term exercise are highly variable, and these responses interact to determine the propensity for weight change. For some people, long-term exercise stimulates compensatory increases in energy intake that attenuate weight loss. However, favourable changes in body composition and health markers still exist in the absence of weight loss. The physiological mechanisms that confer susceptibility to compensatory overconsumption still need to be determined.