Exercise-induced Energy Expenditure Research Articles

Dose-response effects of physical exercise standardized volume on peripheral biomarkers, clinical response, and brain connectivity in Parkinson's disease: a prospective, observational, cohort study.

Exercise has been proposed as the "Universal Prescription for Parkinson's Disease"; however, the specificity of exercise dose in terms of frequency, intensity, duration, and type to be prescribed remains to be elucidated. The 2018 US updated guidelines and WHO Guidelines on Physical Activity and Sedentary Behavior recommend older adults (> 65+ years) to achieve weekly minimal activity levels, indicating the intensity of aerobic exercise as the metabolic equivalent of task and duration as minutes/week (150-300 min/week at a moderate intensity of 3-5.9 MET- or 75-150 min/week of a vigorous intensity of ≥6 MET). Translating these recommendations to PD patients, the study aimed to assess the dose-response effects of standardized volume of structured exercise, measured as METs-minutes/week (weekly energy expenditure) of two different rehabilitation settings to quantify the change in neurotrophic factors. The exercise-induced benefits between the two rehabilitation settings will be evaluated based on motor and non-motor symptoms, kinematic parameters of gait, cognitive function, quality of life, and cortical activity and brain connectivity. METEX-PD is a pilot, prospective, observational, cohort study. The study will enroll consecutively thirty (N = 30) participants with mild-to-moderate Parkinson's disease diagnosis to be assigned to a non-intensive or intensive rehabilitation group. The non-intensive rehabilitation group will achieve a range of 180-270 METs-min/week (90 min/week of low-intensity aerobic exercise, 2-3 METs), while the intensive rehabilitation group will exercise at 1350-1980 METs-min/week (225 min/week of high-intensity aerobic exercise, 6-8.8 METs). The METEX-PD trial will last 12 weeks, including 4 weeks of aerobic training program and two follow-ups. Assessments will be performed at baseline (T0), at the end of the exercise program (T1-end of the program), and 4- and 8 weeks after the end of the training program (FU-1 and FU-2). The primary outcome is the change from baseline in peripheral blood BDNF levels. Secondary outcomes are differences in peripheral biomarkers, functional-motor assessments, clinical-functional evaluations, and brain imaging. METEX-PD trial will enable us to estimate the change in BDNF levels and other peripheral biomarkers under precise exercise-induced energy expenditure. The primary results of the METEX-PD study will allow the development of a larger multicenter randomized controlled trial to investigate the molecular pathways inducing the change in selected neurotrophic factors, such as BDNF, IGF-1, or irisin, and the downstream mechanisms of neuroplasticity in PD patients.

Post-exercise energy replacement might lead to reduced subsequent energy intake in women with constitutional thinness: Exploratory results from the NUTRILEAN project

While people with Constitutional Thinness (CT) declare a deep willingness to gain weight, there appetitive responses to energy balance manipulations remain unclear. The present work compares the effect of an acute exercise combined or not with an energy replacement load, on subsequent energy intake, appetite and food reward, between normal weight and women with CT. Anthropometric measurements, body composition (Dual X-ray absorptiometry–DXA) and aerobic capacity (VO2max) were assessed in 10 normal-weight (Body Mass Index-BMI): 20–25 kg/m2) and 10 C T (BMI<17.5 kg/m2) women (18–30 years). They randomly performed i) a resting session (CON); ii) an exercise session (EX); iii) an exercise session with energy replacement (EX + R). Their subsequent ad libitum intake, appetite feelings and food reward were evaluated (Leeds-Food-Preference-Questionnaire). CT showed a lower weight (p < 0,001), BMI(p < 0,001), Fat-Mass (%) (p = 0,003) and Fat-Free Mass (kg) (p < 0,001). CT showed a lower ad libitum energy intake on EX + R compared with CON (p = 0,008) and a higher Relative Energy Intake (REI) on CON compared with EX (p = 0,007) and EX + R (p < 0,001). A lower was observed during EX and EX + R compared with CON (p = 0,006,p = 0,009 respectively) in CT. No condition nor group effect was found for hunger. NW only showed a higher pre-meal fullness on EX + R compared to CON and EX (p < 0,001). Choice (p = 0,030), Explicit Liking (p = 0,016), Explicit Wanting (p = 0,004) and Implicit Wanting (p = 0,035) for taste were higher on EX + R than CON and EX. The decreased EI observed in CT when the exercise-induced energy expenditure is compensated by the ingestion of an equivalent energy load, might contribute to explain the difficulty to increase their energy balance and then induce weight gain. Further studies are needed to better understand their energy balance regulation to propose adapted weight gain strategies.

Altered motivation states for physical activity and 'appetite' for movement as compensatory mechanisms limiting the efficacy of exercise training for weight loss.

Weight loss is a major motive for engaging in exercise, despite substantial evidence that exercise training results in compensatory responses that inhibit significant weight loss. According to the Laws of Thermodynamics and the CICO (Calories in, Calories out) model, increased exercise-induced energy expenditure (EE), in the absence of any compensatory increase in energy intake, should result in an energy deficit leading to reductions of body mass. However, the expected negative energy balance is met with both volitional and non-volitional (metabolic and behavioral) compensatory responses. A commonly reported compensatory response to exercise is increased food intake (i.e., Calories in) due to increased hunger, increased desire for certain foods, and/or changes in health beliefs. On the other side of the CICO model, exercise training can instigate compensatory reductions in EE that resist the maintenance of an energy deficit. This may be due to decreases in non-exercise activity thermogenesis (NEAT), increases in sedentary behavior, or alterations in sleep. Related to this EE compensation, the motivational states associated with the desire to be active tend to be overlooked when considering compensatory changes in non-exercise activity. For example, exercise-induced alterations in the wanting of physical activity could be a mechanism promoting compensatory reductions in EE. Thus, one's desires, urges or cravings for movement-also known as "motivation states" or "appetence for activity"-are thought to be proximal instigators of movement. Motivation states for activity may be influenced by genetic, metabolic, and psychological drives for activity (and inactivity), and such states are susceptible to fatigue-or reward-induced responses, which may account for reductions in NEAT in response to exercise training. Further, although the current data are limited, recent investigations have demonstrated that motivation states for physical activity are dampened by exercise and increase after periods of sedentarism. Collectively, this evidence points to additional compensatory mechanisms, associated with motivational states, by which impositions in exercise-induced changes in energy balance may be met with resistance, thus resulting in attenuated weight loss.

Compensatory Responses to Exercise Training As Barriers to Weight Loss: Changes in Energy Intake and Non-exercise Physical Activity.

Exercise can increase total energy expenditure to very high levels and therefore induce sizable energy deficits that, under carefully controlled conditions, elicit clinically significant weight loss. In real life, however, this is seldom the case among people with overweight or obesity, suggesting the existence of compensatory mechanisms that mitigate exercise-induced negative energy balance. Most studies have focused on possible compensatory changes in energy intake, and comparably little attention has been paid to compensatory changes in the physical activity patterns outside of the prescribed exercise, i.e., non-exercise physical activity (NEPA). The purpose of this paper is to review studies that have assessed changes in NEPA in response to an increase in exercise-induced energy expenditure. The available studies examining changes in NEPA in response to exercise training are methodologically heterogeneous, conducted in participants with different age, gender, and body adiposity, and examined responses to varying exercise regimens over a varying duration. About 67% of all studies-80% of short-term (≤ 11 wks, n = 5) and 63% of long-term (> 3months, n = 19) studies-demonstrate a compensatory decrease in NEPA upon starting a structured exercise training program. A compensatory decrease in other physical activities of daily life upon starting exercise training is a relatively common compensatory response-and probably more common than an increase in energy intake-that may be instrumental in attenuating the energy deficit caused by exercise, and thus preventing weight loss.

Effects of aquatic exercise on appetitive responses in adolescents with obesity: An exploratory study

Aquatic exercise has been suggested as a beneficial modality to improve weight loss, cardiorespiratory fitness and quality of life in adolescents with obesity; however, its impact on appetite control in youth remains unknown. The aim of this preliminary study was to examine the effect of an acute aquatic exercise session on energy intake (EI), appetite feelings and food reward in adolescents with obesity. Twelve adolescents with obesity (12–16 years, Tanner stage 3–5, 9 males) randomly completed two conditions: i) control (CON); ii) aquatic exercise session (AQUA). One hour before lunch, the adolescents stayed at rest outside the water in a quiet room for 45 min on CON while they performed a 45-min aquatic exercise session on AQUA. Ad libitum EI and macronutrients were assessed at lunch and dinner, subjective appetite feelings taken at regular intervals, and food reward measured before and after lunch. Paired T-test showed that EI was not different between CON and AQUA at lunch (1333 ± 484 kcal vs 1409 ± 593 kcal; p = 0.162) and dinner (528 ± 218 kcal vs 513 ± 204 kcal; p = 0.206). Total daily ad libitum EI was significantly higher on AQUA (1922 ± 649 kcal) compared with CON (1861 ± 685 kcal; p = 0.044) but accounting for the exercise-induced energy expenditure, relative energy intake did not differ (2263 ± 732 kcal vs 2117 ± 744 kcal, p = 0.304). None of the appetite feelings (hunger, fullness, prospective food consumption and desire to eat) and food reward dimensions were significantly different between conditions. These preliminary and exploratory results suggest that an acute aquatic-exercise session might not induce energy compensatory responses in adolescents with obesity.

Circulating and skeletal muscle microRNA profiles are more sensitive to sustained aerobic exercise than energy balance in males.

MicroRNAs (miRNAs) regulate molecular processes governing muscle metabolism. Physical activity and energy balance influence both muscle anabolism and substrate metabolism, but whether circulating and skeletal muscle miRNAs mediate those effects remains unknown. This study assessed the impact of sustained physical activity with participants in energy balance (BAL) or deficit (DEF) on circulating and skeletal muscle miRNAs. Using a randomized cross-over design, 10 recreational active healthy males (mean±SD, 22±5 years, 87±11kg) completed 72h of high aerobic exercise-induced energy expenditures in BAL (689±852kcal/day) or DEF (-2047±920kcal/day). Blood and muscle samples were collected under rested/fasted conditions before (PRE) and immediately after 120min load carriage exercise bout at the end (POST) of the 72h. Trials were separated by 7days. Circulating and skeletal muscle miRNAs were measured using microarray RT-qPCR. Independent of energy status, 36 circulating miRNAs decreased (P<0.05), while 10 miRNAs increased and three miRNAs decreased in skeletal muscle (P<0.05) at POST compared to PRE. Of these, miR-122-5p, miR-221-3p, miR-222-3p and miR-24-3p decreased in circulation and increased in skeletal muscle. Two circulating (miR-145-5p and miR-193a-5p) and four skeletal muscle (miR-21-5p, miR-372-3p, miR-34a-5p and miR-9-5p) miRNAs had time-by-treatment effects (P<0.05). These data suggest that changes in miRNA profiles are more sensitive to increased physical activity compared to energy status, and that changes in circulating miRNAs in response to high levels of daily aerobic exercise are not reflective of changes in skeletal muscle miRNAs. KEY POINTS: Circulating and skeletal muscle miRNA profiles are more sensitive to high levels of aerobic exercise-induced energy expenditure compared to energy status. Changes in circulating miRNA in response to high levels of daily sustained aerobic exercise are not reflective of changes in skeletal muscle miRNA.

Carbohydrate-Energy Replacement Following High-Intensity Interval Exercise Blunts Next-Day Glycemic Control in Untrained Women.

BackgroundImproved glycemic control has been reported for ∼24 h following low-volume high-intensity interval exercise (HIIE), but it is unclear if this is a direct effect of exercise or an indirect effect of the exercise-induced energy deficit. The purpose of this study was to investigate the effect of carbohydrate-energy replacement after low-volume HIIE on 24 h glycemic control in women.MethodsSeven untrained women (age: 22 ± 2 yr; BMI: 22 ± 3 kg/m2; VO2peak: 33 ± 7 ml/kg/min) completed three 2-day trials in the mid-follicular phase of the menstrual cycle. Continuous glucose monitoring was used to measure blood glucose concentrations during, and for 24 h following three conditions: (1) HIIE followed by a high-carbohydrate energy replacement drink (EX-HC); (2) HIIE followed by a non-caloric taste-matched placebo drink (EX-NC); and (3) seated control with no drink (CTL). HIIE involved an evening session (1,700 h) of 10 × 1-min cycling efforts at ∼90% maximal heart rate with 1 min recovery. Diet was standardized and identical across all three 2-day trials, apart from the post-exercise carbohydrate drink in EX-HC, which was designed to replenish the exercise-induced energy expenditure. Postprandial glycemic responses to the following days breakfast, snack, lunch, and dinner, as well as 24 h indices of glycemic control, were analyzed.ResultsThe day after HIIE, postprandial glycemia following breakfast and snack were reduced in EX-NC compared to EX-HC, as reflected by lower 3 h glucose mean (breakfast: 5.5 ± 0.5 vs. 6.7 ± 1, p = 0.01, Cohen’s d = 1.4; snack: 4.9 ± 0.3 vs. 5.7 ± 0.8 mmol/L, p = 0.02, d = 1.4) and/or area under the curve (AUC) (breakfast: 994 ± 86 vs. 1,208 ± 190 mmol/L x 3 h, p = 0.01, d = 1.5). Postprandial glycemic responses following lunch and dinner were not different across conditions (p > 0.05). The 24 h glucose mean (EX-NC: 5.2 ± 0.3 vs. EX-HC: 5.7 ± 0.7 mmol/L; p = 0.02, d = 1.1) and AUC (EX-NC: 7,448 ± 425 vs. EX-HC: 8,246 ± 957 mmol/L × 24 h; p = 0.02, d = 1.1) were reduced in EX-NC compared to EX-HC.ConclusionPost-exercise carbohydrate-energy replacement attenuates glycemic control the day following a single session of low-volume HIIE in women.

Effect of exercise-meal timing on energy intake, appetite and food reward in adolescents with obesity: The TIMEX study

The present study manipulated the delay between exercise and test meal to investigate its effect on energy intake, appetite sensations and food reward in adolescents with obesity.Fifteen adolescents with obesity randomly completed 3 experimental sessions: i) rest without exercise (CON); ii) 30 min of exercise 180 min before lunch (EX-180); iii) 30 min of exercise 60 min before lunch (EX-60). Ad libitum energy intake was assessed at lunch and dinner, and food reward (LFPQ) assessed before and after lunch. Appetite sensations were assessed at regular intervals.Absolute energy intake was not different between conditions despite a 14.4% lower intake in EX-60 relative to CON. Lunch relative energy intake (REI: energy intake – exercise-induced energy expenditure) was higher in CON compared with EX-60 (p < 0.001). Lunch fat intake was lower in EX-60 compared with CON (p = 0.01) and EX-180(p = 0.02). Pre-lunch hunger in CON was lower than EX-180 (p = 0.02). Pre-lunch prospective food consumption and desire to eat were lower in CON compared with both exercise conditions (p = 0.001). A significant condition effect was found for explicit liking for high-fat relative to low-fat foods before lunch (p = 0.03) with EX-60 being significantly lower than EX-180 (p = 0.001). The nutritional and food reward adaptations to exercise might be dependent on the timing of exercise, which is of importance to optimize its effect on energy balance in adolescents with obesity. Clinical trial referenceNCT03807609.

Effects of Exercise With and Without Energy Replacement on Substrate Utilization in the Fasting State

Objective: The present study aimed to examine the interactive effect of exercise and energy balance on energy expenditure and substrate utilization.Method: Seven men and 7 women underwent three 2-day experimental protocols in a random order. Each protocol consisted of no exercise (NE), exercise only (EO), or exercise with a matched energy replacement (ER) on day 1 followed by metabolic testing that occurred after a 12-hour overnight fasting on day 2. Both EO and ER involved treadmill running at 60% maximal oxygen uptake (VO2max) that induced an energy expenditure of ∼ 500 kcal. The replacement meal used in ER contained ∼ 500 kcal made up of 45% carbohydrate, 30% fat, and 25% protein. During metabolic testing, oxygen uptake (VO2), heart rate (HR), respiratory exchange ratio (RER), and rates of carbohydrate (COX) and fat oxidation (FOX) were determined in three successive 15-minute periods including rest and exercise at 50% and 70% VO2max.Results: No differences in VO2 and HR were found at rest among NE, EO, and ER. However, RER was lower in EO than NE (0.840 ± 0.014 vs 0.889 ± 0.012, p < 0.05), COX (g·min−1) was lower in ER than NE (0.144 ± 0.016 vs 0.197 ± 0.019, p < 0.05), and FOX (g·min−1) was higher in EO or ER than NE (0.054 ± 0.010 or 0.057 ± 0.009 vs 0.034 ± 0.007, p < 0.05). No treatment effects were observed for all variables at either intensity.Conclusions: This study demonstrates that an exercise of moderate intensity can increase resting fat oxidation even when the exercise-induced energy expenditure is balanced by energy intake. This finding suggests that muscle action is vital in augmenting fat utilization.

Physiological Predictors of Weight Regain at 1-Year Follow-Up in Weight-Reduced Adults with Obesity.

ObjectiveThis study aimed to assess whether changes in resting metabolic rate (RMR), exercise‐induced energy expenditure (EIEE), and appetite following weight loss (WL) are associated with weight regain at 1 year.MethodsThirty‐six adults with obesity underwent 8 weeks of a very‐low‐energy diet, followed by 4 weeks of refeeding and a 1‐year maintenance program. RMR, EIEE, appetite ratings, and active ghrelin, peptide YY, glucagon‐like peptide‐1, cholecystokinin, and insulin concentrations were measured at baseline, week 13, and 1 year.ResultsA 17% WL (−20 ± 5 kg [mean ± SD]; range: −11.7 to −32.2 kg; P < 0.001) was achieved at week 13. After 1 year, weight regain was 2.5 ± 9.0 kg (not significant), ranging from −18.2 to 22.5 kg. Both fat mass and fat‐free mass were reduced at week 13 (−17.9 ± 4.8 and −2.9 ± 2.7 kg, respectively; P < 0.001), while only loss of fat mass was sustained at 1 year. WL was associated with reduced RMR, EIEE, and fasting/postprandial insulin (all P < 0.001), as well as increased fasting hunger (P < 0.01) and fasting/postprandial active ghrelin (P < 0.001). There were no significant correlations between changes in RMR, EIEE, or appetite with WL and weight regain at 1 year.ConclusionsNo clear evidence emerged that changes in RMR, EIEE, or appetite following WL can predict weight regain at 1 year, but larger studies are needed to confirm these results.

Timeline of changes in adaptive physiological responses, at the level of energy expenditure, with progressive weight loss.

Diet-induced weight loss (WL) is associated with reduced resting and non-resting energy expenditure (EE), driven not only by changes in body composition but also potentially by adaptive thermogenesis (AT). When exactly this happens, during progressive WL, remains unknown. The aim of this study was to determine the timeline of changes in RMR and exercise-induced EE (EIEE), stemming from changes in body composition v. the presence of AT, during WL with a very-low-energy diet (VLED). In all, thirty-one adults (eighteen men) with obesity (BMI: 37 (sem 4·5) kg/m2; age: 43 (sem 10) years) underwent 8 weeks of a VLED, followed by 4 weeks of weight maintenance. Body weight and composition, RMR, net EIEE (10, 25 and 50 W) and AT (for RMR (ATRMR) and EIEE (ATEIEE)) were measured at baseline, day 3 (2 (sem 1) % WL), after 5 and 10 % WL and at weeks 9 (16 (sem 2) %) and 13 (16 (sem 1) %). RMR and fat mass were significantly reduced for the first time at 5 % WL (12 (sem 8) d) (P<0·01 and P<0·001, respectively) and EIEE at 10 % WL (32 (sem 8) d), for all levels of power (P<0·05), and sustained up to week 13. ATRMR was transiently present at 10 % WL (-460 (sem 690) kJ/d, P<0·01). A fall in RMR should be anticipated at ≥5 % WL and a reduction in EIEE at ≥10 % WL. Transient ATRMR can be expected at 10 % WL. These physiological adaptations may make progressive WL difficult and will probably contribute to relapse.

Increased Protein Requirements in Female Athletes after Variable-Intensity Exercise.

Protein requirements are primarily studied in the context of resistance or endurance exercise with little research devoted to variable-intensity intermittent exercise characteristic of many team sports. Further, female populations are underrepresented in dietary sports science studies. We aimed to determine a dietary protein requirement in active females performing variable-intensity intermittent exercise using the indicator amino acid oxidation (IAAO) method. We hypothesized that these requirements would be greater than current IAAO-derived estimates in nonactive adult males. Six females (21.2 ± 0.8 yr, 68.8 ± 4.1 kg, 47.1 ± 1.2 mL O2·kg·min; mean ± SE) completed five to seven metabolic trials during the luteal phase of the menstrual cycle. Participants performed a modified Loughborough Intermittent Shuttle Test before consuming eight hourly mixed meals providing the test protein intake (0.2-2.66 g·kg·d), 6 g·kg·d CHO and sufficient energy for resting and exercise-induced energy expenditure. Protein was provided as crystalline amino acid modeling egg protein with [C]phenylalanine as the indicator amino acid. Phenylalanine turnover (Q) was determined from urinary [C]phenylalanine enrichment. Breath CO2 excretion (FCO2) was analyzed using mixed effects biphase linear regression with the breakpoint and upper 95% confidence interval approximating the estimated average requirement and recommended dietary allowance, respectively. Protein intake had no effect on Q (68.7 ± 7.3 μmol·kg·h; mean ± SE). FCO2 displayed a robust biphase response (R = 0.66) with an estimated average requirement of 1.41 g·kg·d and recommended dietary allowance of 1.71 g·kg·d. The protein requirement estimate of 1.41 and 1.71 g·kg·d for females performing variable-intensity intermittent exercise is greater than the IAAO-derived estimates of adult males (0.93 and 1.2 g·kg·d) and at the upper range of the American College of Sports Medicine athlete recommendations (1.2-2.0 g·kg·d).

Influence of Hot and Cold Environments on the Regulation of Energy Balance Following a Single Exercise Session: A Mini-Review

Understanding the regulation of human food intake in response to an acute exercise session is of importance for interventions with athletes and soldiers, as well as overweight individuals. However, the influence of hot and cold environments on this crucial function for the regulation of body mass and motor performance has not been summarized. The purpose of this review was to exhaustively search the literature on the effect of ambient temperature during an exercise session on the subsequent subjective feeling of appetite, energy intake (EI) and its regulation. In the absence of stress due to environmental temperature, exercise-induced energy expenditure is not compensated by EI during an ad libitum meal following the session, probably due to decreased acylated ghrelin and increased peptide tyrosine tyrosine (PYY), glucagon-like peptide 1 (GLP-1), and pancreatic polypeptide (PP) levels. No systematic analysis has been yet made for major alterations of relative EI in cold and hot environments. However, observed eating behaviors are altered (proportion of solid/liquid food, carbohydrate/fat) and physiological regulation appears also to be altered. Anorexigenic signals, particularly PYY, appear to further increase in hot environments than in those that are thermoneutral. Ghrelin and leptin may be involved in the observed increase in EI after exercise in the cold, in parallel with increased energy expenditure. The potential influence of ambient thermal environment on eating behaviors after an exercise session should not be neglected.

Is setting a criterion for ‘clinically significant weight loss’ necessary?

The prevention and treatment of obesity remain major public health challenges. Obesity management guidelines worldwide have identified weight loss as the primary target to determine treatment success as weight loss is associated with benefit across a wide range of health outcomes (1). How much weight loss is required for health benefit, however, continues to be the source of uncertainly and debate. In recent years, it has been suggested that “clinically significant weight loss” should be set at a threshold of 5% (2). Although it is true that for most health outcomes a 5% weight loss is associated with benefit, it is also true that for adults who adopt and sustain physical activity combined with a healthful diet, significant health benefits are achieved in association with very modest (less than 3%) or even no weight loss (3). Strong evidence in support of this notion comes from the Diabetes Prevention Study wherein participants who increased physical activity for about 150 min per week but did not achieve “clinically significant weight loss,” reduced diabetes incidence by 44% (4), observations consistent with the findings of the Diabetes Prevention Program (5). The findings from these and numerous randomized controlled trials (3) consistently report that physical activity is associated with benefit for many health outcomes with or without weight loss. In the present issue of Obesity, Swift et al. (6) report the findings of an ancillary study designed to determine the effects of exercise amount on body weight and selected cardiometabolic risk factors. A total of 330 women performed 6 months of aerobic exercise at 4 kcal per kilogram per week (4KKW), 8KKW, or 12 KKW (50%, 100%, and 150% of recommended levels, respectively). The authors distinguished the participants by the weight loss they achieved; those who lost between 3% and 4.9% were classified as having modest weight loss (MWL), whereas those who lost at least 5% were identified as having achieved clinically significant weight loss (CWL). The findings of this rigorously controlled study suggest that exercise performed for about 150 min or less per week may not be sufficient to achieve a 5% weight loss for many adults over a relatively short duration. Given the rather low levels of exercise-induced energy expenditure in this trial, the findings are not surprising and confirm the positive dose-response relationship between exercise and weight loss (7). In fact, 300 min of weekly exercise is recommended if weight loss in the order of 5% to 10% is desired (8). An extremely important observation in this study was that the statistically significant reductions in insulin resistance observed within the MWL group was not different from the CWL group, thus confirming that improvements in insulin action are achievable in association with very modest exercise-induced weight loss. That the authors did not observe significant reductions in other risk factors regardless of weight loss is likely explained by the remarkably normal cardiometabolic risk profile prior to intervention. It is suggested that the 5% clinically significant weight loss threshold for effective obesity management is “here to stay” (2). While the veracity of this contention will continue to be the source of debate among academics, its interpretation for many practitioners and obese adults may well be that, for effective obesity management, substantial weight loss is required for benefit. This would be an unfortunate interpretation and one that may lead obese adults who are unable to make the major changes in behavior required to sustain a 5% weight loss in today's environment to become frustrated and consequently discontinue physical activity and/or the consumption of a healthy diet. Given that the health benefits of lifestyle-induced weight loss typically occur in a dose-response manner (1, 3-5), the need to establish “clinically significant” weight loss targets, a strategy with little evidence of success, seems unnecessary. A revised approach would be to target the causal behaviors—physical activity combined with a healthful diet. Given the plethora of health benefits associated with increasing physical activity regardless of weight loss, and that sustained weight loss is unlikely to occur without increasing physical activity (8), changing the focus for effective obesity management from the bathroom scale to the adoption of healthy behaviors is an idea worth considering.

Beneficial effects of exercise: shifting the focus from body weight to other markers of health*

Background: Exercise is widely promoted as a method of weight management, while the other health benefits are often ignored. The purpose of this study was to examine whether exercise-induced improvements in health are influenced by changes in body weight. Methods: Fifty-eight sedentary overweight/obese men and women (BMI 31.8 (SD 4.5) kg/m2 ) participated in a 12-week supervised aerobic exercise intervention (70% heart rate max, five times a week, 500 kcal per session). Body composition, anthropometric parameters, aerobic capacity, blood pressure and acute psychological response to exercise were measured at weeks 0 and 12. Results: The mean reduction in body weight was -3.3 (3.63) kg (p&lt;0.01). However, 26 of the 58 participants failed to attain the predicted weight loss estimated from individuals’ exercise-induced energy expenditure. Their mean weight loss was only -0.9 (1.8) kg (p&lt;0.01). Despite attaining a lower-than-predicted weight reduction, these individuals experienced significant increases in aerobic capacity (6.3 (6.0) ml/kg/min; p&lt;0.01), and a decreased systolic (-6.00 (11.5) mmHg; p&lt;0.05) and diastolic blood pressure (-3.9 (5.8) mmHg; p&lt;0.01), waist circumference (-3.7 (2.7) cm; p&lt;0.01) and resting heart rate (-4.8 (8.9) bpm, p&lt;0.001). In addition, these individuals experienced an acute exercise-induced increase in positive mood. Conclusions: These data demonstrate that significant and meaningful health benefits can be achieved even in the presence

Exercise Makes More than an Energy Deficit: Toward Improved Protocols for the Management of Obesity?

Exercise Makes More than an Energy Deficit: Toward Improved Protocols for the Management of Obesity?

Full or hypocaloric nutritional support for the critically ill patient: is less really more?

In critically ill patients we typically observe a catabolic response and changes in metabolic demands varying from increased energy expenditure during the initial inflammatory response to decreased energy expenditure in later phases of critical illness. In addition, sedation and immobilization may reduce exercise-induced energy expenditure in all stages of intensive care unit (ICU) stay. Therefore, it is recommended to estimate energy expenditure based on indirect calorimetry. However, the availability of such devices in ICUs is low. As a consequence most healthcare providers still use formulae to calculate the estimated energy expenditure, although these estimates have been shown to be unreliable (1).

Improvement of energy expenditure prediction from heart rate during running

We aimed to develop new equations that predict exercise-induced energy expenditure (EE) more accurately than previous ones during running by including new parameters as fitness level, body composition and/or running intensity in addition to heart rate (HR). Original equations predicting EE were created from data obtained during three running intensities (25%, 50% and 70% of HR reserve) performed by 50 subjects. Five equations were conserved according to their accuracy assessed from error rates, interchangeability and correlations analyses: one containing only basic parameters, two containing VO2max or speed at VO2max and two including running speed with or without HR. Equations accuracy was further tested in an independent sample during a 40 min validation test at 50% of HR reserve. It appeared that: (1) the new basic equation was more accurate than pre-existing equations (R2 0.809 versus. 0,737 respectively); (2) the prediction of EE was more accurate with the addition of VO2max (R2 = 0.879); and (3) the equations containing running speed were the most accurate and were considered to have good agreement with indirect calorimetry. In conclusion, EE estimation during running might be significantly improved by including running speed in the predictive models, a parameter readily available with treadmill or GPS.

The Effects of Imposed Sedentary Behavior and Exercise on Energy Intake in Adolescents With Obesity

Exercise has been shown to decrease subsequent energy intake, without modification of appetite, in adolescents who are obese. This study compared the impact of acute exercise with imposed sedentary behaviors on the daily nutritional adaptations and energy balance of youths with obesity. Body composition and maximal oxygen uptake were assessed in 10 12- to 15-year-old adolescents with obesity. Energy consumption, appetite, and energy expenditure were assessed during 3 experimental sessions: (1) exercise session (EX), (2) bed rest session (BR), and (3) control session (CON). Total and morning energy expenditures were significantly higher during EX compared to CON and BR sessions (p < .001), and no differences were found during the afternoon energy expenditure between conditions (BR: 1056.5 ± 121.5; CON: 1185.7 ± 173; EX: 996.1 ± 153.4 Kcal). Total energy intake was significantly reduced on EX (p < .001). Dinner energy intake was significantly reduced during EX (491.65 ± 75.74 Kcal) and CON (666.55 ± 152.09 Kcal) compared with BR (818.87 ± 122.97 Kcal) (p < .001). Appetite was not affected. Whereas intense exercise reduces daily energy balance in adolescents with obesity by mainly affecting ad libitum dinner energy consumption, imposed sedentary behaviors lead to increased energy intake and then positive energy balance. The impact of exercise or imposed sedentary behaviors on the energy balance of adolescents with obesity is not only related to the exercise-induced energy expenditure, but also to their energy intake.

Influence of netball-based exercise on energy intake, subjective appetite and plasma acylated ghrelin in adolescent girls

This study explored 5-day regulation of exercise-induced energy expenditure, energy intake, and hormonal appetite, via acylated ghrelin, after acute exercise. Using a randomized crossover design, 10 female adolescents (13-15 years old) completed two 7-day treatment weeks (2 days of maintenance, 1 day of treatment, and a 4-day follow-up), interspersed with a 1-week period. On day 3, 47 min of netball-based exercise or sedentary activity was imposed with a test meal 1 h later. Measures of energy expenditure, subjective appetite, test meal energy intake, plasma acylated ghrelin, insulin, and glucose were taken during this period. Energy intake compensation for the exercise period was calculated. Four-day follow-up measures were daily subjective appetite, energy intake, energy expenditure, and energy balance. Girls felt more full 20 min during the netball-based exercise bout compared with sedentary activity (87 ± 15 mm vs. 75 ± 24 mm). An energy intake compensation of 27% was identified for the netball-based exercise. Compared with immediately before exercise or sedentary activity, plasma acylated ghrelin was elevated 45 min after netball (103.8 ± 56.9 pg·mL(-1) vs. 85.7 ± 26.9 pg·mL(-1); n = 7) and sedentary activity (98.2 ± 27.1 pg·mL(-1) vs. 60.8 ± 33.5 pg·mL(-1); n = 7) but not different between treatments. Adolescent girls (13-15 years old) only partially compensated for the netball-based exercise-induced energy expenditure. The effect of exercise on appetite needs to be further explored in adolescents, whereby nutritional behaviour is tracked for more than 1 week to investigate full compensation for acute exercise.