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Effect of different doses of supervised exercise on food intake, metabolism, and non-exercise physical activity: the E-MECHANIC randomized controlled trial
Martin CK, Johnson WD, Myers CA, Apolzan JW, Earnest CP, Thomas DM, Rood JC, Johannsen NM, Tudor-Locke C, Harris M, Hsia DS, Church TS
The American Journal of Clinical Nutrition 2019 Sep;110(3):1478-1489
clinical trial
7/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Exercise is recommended for weight management, yet exercise produces less weight loss than expected, which is called weight compensation. The mechanisms for weight compensation are unclear. OBJECTIVE: The aim of this study was to identify the mechanisms responsible for compensation. METHODS: In a randomized controlled trial conducted at an academic research center, adults (n = 198) with overweight or obesity were randomized for 24 wk to a no-exercise control group or 1 of 2 supervised exercise groups: 8 kcal/kg of body weight/wk (KKW) or 20 KKW. Outcome assessment occurred at weeks 0 and 24. Energy intake, activity, and resting metabolic rate (RMR) were measured with doubly labeled water (DLW; with and without adjustments for change in RMR), armband accelerometers, and indirect calorimetry, respectively. Appetite and compensatory health beliefs were measured by self-report. RESULTS: A per-protocol analysis included 171 participants (72.5% women; mean +/- SD baseline body mass index: 31.5 +/- 4.7 kg/m2). Significant (p < 0.01) compensation occurred in the 8 KKW (mean 1.5 kg; 95% CI 0.9 to 2.2 kg) and 20 KKW (mean 2.7 kg; 95% CI 2.0 to 3.5 kg) groups, and compensation differed significantly between the exercise groups (p = 0.01). Energy intake by adjusted DLW increased significantly (p < 0.05) in the 8 KKW (mean 90.7 kcal/d; 95% CI 35.1 to 146.4 kcal/d) and 20 KKW (mean 123.6 kcal/d; 95% CI 64.5 to 182.7 kcal/d) groups compared with control (mean -2.3 kcal/d; 95% CI -58.0 to 53.5 kcal/d). Results were similar without DLW adjustment. RMR and physical activity (excluding structured exercise) did not differentially change among the 3 groups. Participants with higher compared with lower compensation reported increased appetite ratings and beliefs that healthy behaviors can compensate for unhealthy behaviors. Furthermore, they increased craving for sweet foods, increased sleep disturbance, and had worsening bodily pain. CONCLUSIONS: Compensation resulted from increased energy intake and concomitant increases in appetite, which can be treated with dietary or pharmacological interventions. Compensation was not due to activity or metabolic changes. This trial was registered at ClinicalTrials.gov as NCT01264406.
Copyright by the American Society for Clinical Nutrition.

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