BACKGROUND: Alternate day fasting combined with exercise is effective for weight loss. OBJECTIVE: The aim of this study was to examine the behavioral adaptations that occur when ADF is combined with exercise, and to determine how these changes affect weight loss. DESIGN: Obese subjects (n = 64) were randomized to 1 of 4 groups: (1) combination (ADF plus endurance exercise), (2) ADF, (3) exercise, or (4) control, for 12 weeks. RESULTS: Body weight decreased (p < 0.05) in the combination group (6 +/- 4 kg), ADF (3 +/- 1 kg), exercise group (1 +/- 0 kg), with no change in the control group (0 +/- 0 kg). When given the choice, subjects chose to exercise the same amount (p = 0.790) on the fast days (48 +/- 2%) as feed days (52 +/- 2%). Percent of exercise sessions performed on fast day mornings (20 +/- 6%) did not differ (p = 0.453) from fast day afternoons (28 +/- 5%). Likeliness to cheat on the fast day was not higher if the subject exercised in the afternoon (17 +/- 7%) versus the morning (10 +/- 5%). Hunger decreased (p < 0.05) while satisfaction and fullness increased (p < 0.05) post-treatment in the ADF group only. Restrained eating increased (p < 0.05) and uncontrolled eating decreased (p < 0.05) in the combination and ADF groups. CONCLUSION: These findings suggest that endurance exercise is an excellent adjunct therapy to ADF, as it leads to positive behavioral changes that may contribute to long-term steady weight loss.

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