Body fat loss and compensatory mechanisms in response

to different doses of aerobic exercise a randomized

controlled trial in overweight sedentary males

Mads Rosenkilde, Pernille Auerbach, Michala Holm Reichkendler, Thorkil Ploug, Bente
Merete Stallknecht and Anders Sjdin
Am J Physiol Regul Integr Comp Physiol 303:R571-R579, 2012. First published 1 August 2012;
doi: 10.1152/ajpregu.00141.2012
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Am J Physiol Regul Integr Comp Physiol 303: R571R579, 2012.

First published August 1, 2012; doi:10.1152/ajpregu.00141.2012.

Integrative and Translational Physiology: Integrative Aspects

of Energy Homeostasis and Metabolic Diseases
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Body fat loss and compensatory mechanisms in response to different doses of

aerobic exercisea randomized controlled trial in overweight sedentary males

Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; and 2Department of Human
Nutrition, University of Copenhagen, Copenhagen, Denmark
Submitted 2 April 2012; accepted in final form 30 July 2012

Rosenkilde M, Auerbach P, Reichkendler MH, Ploug T,

Stallknecht BM, Sjdin A. Body fat loss and compensatory mechanisms in response to different doses of aerobic exercisea randomized controlled trial in overweight sedentary males. Am J Physiol
Regul Integr Comp Physiol 303: R571R579, 2012. First published
August 1, 2012; doi: 10.1152/ajpregu.00141.2012.The amount of
weight loss induced by exercise is often disappointing. A diet-induced
negative energy balance triggers compensatory mechanisms, e.g.,
lower metabolic rate and increased appetite. However, knowledge
about potential compensatory mechanisms triggered by increased
aerobic exercise is limited. A randomized controlled trial was performed in healthy, sedentary, moderately overweight young men to
examine the effects of increasing doses of aerobic exercise on body
composition, accumulated energy balance, and the degree of compensation. Eighteen participants were randomized to a continuous sedentary control group, 21 to a moderate-exercise (MOD; 300 kcal/day),
and 22 to a high-exercise (HIGH; 600 kcal/day) group for 13 wk,
corresponding to 30 and 60 min of daily aerobic exercise, respectively. Body weight (MOD: 3.6 kg, P 0.001; HIGH: 2.7 kg,
P 0.01) and fat mass (MOD: 4.0 kg, P 0.001 and HIGH: 3.8
kg, P 0.001) decreased similarly in both exercise groups. Although
the exercise-induced energy expenditure in HIGH was twice that of
MOD, the resulting accumulated energy balance, calculated from
changes in body composition, was not different (MOD: 39.6 Mcal,
HIGH: 34.3 Mcal, not significant). Energy balance was 83% more
negative than expected in MOD, while it was 20% less negative than
expected in HIGH. No statistically significant changes were found in
energy intake or nonexercise physical activity that could explain the
different compensatory responses associated with 30 vs. 60 min of
daily aerobic exercise. In conclusion, a similar body fat loss was
obtained regardless of exercise dose. A moderate dose of exercise
induced a markedly greater than expected negative energy balance,
while a higher dose induced a small but quantifiable degree of
compensation.
exercise; body weight regulation; compensatory mechanisms; energy
balance

lifestyle along with overeating

has been put forward as Big Two factors in the etiology of
obesity (3, 10, 29), the outcomes of structured exercise programs designed to promote weight loss are often modest (42,
58). This has led to the general (mis)conception that exercise,

ALTHOUGH A MODERN SEDENTARY

Address for reprint requests and other correspondence: M. Rosenkilde, Dept.

of Biomedical sciences, Univ. of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark (e-mail: [email protected]).
http://www.ajpregu.org

in itself, is a poor weight management strategy (20, 42, 49).

Apart from a potential lack of compliance, the discrepancy between predicted and observed weight loss is likely due to a
combination of physiological and behavioral compensatory
changes affecting energy balance. These compensatory changes
cause the accumulated energy balance during an exercise intervention to be less negative than would be theoretically predicted
from the exercise-induced energy expenditure (ExEE), i.e., the
total amount of energy expenditure that is caused by the exercise
intervention (12, 32, 34).
Body energy stores are protected against long-term negative
energy balance resulting from caloric restriction by a greater
than predicted reduction in resting energy expenditure (REE)
(28), a decrease in nonexercise activity thermogenesis (NEAT)
(40, 45), an increase in the metabolic efficiency of physical
activity (16, 35), and an increase in hedonic (21) and hormonal
mediators of appetite (53). During a diet-induced weight loss,
it is generally accepted that fat mass and fat free mass (FFM)
decrease proportionally (25). In contrast, FFM is at least
preserved (5) or sometimes even increased (20, 48) during
exercise-induced weight loss. Even when body weight is only
marginally affected, exercise may lead to a negative energy
balance resulting in a healthy loss of fat mass (14, 43).
In the elegant DREW study (12) on dose-response effects of
exercise in postmenopausal overweight women, Church et al.
(12) reported a substantial discrepancy between observed and
predicted weight loss with increasing exercise dose. It was
suggested that compensatory changes with increasing amounts
of exercise attenuate weight loss. Activity behavior based on
registration of step counts and energy intake (EI) based on food
records were not significantly affected; nevertheless, increased
EI was suggested as the likely compensatory change. Others
have suggested that decreased NEAT occurs as a compensatory
response to a strenuous exercise regime (52, 56) and results in
less than expected weight loss. In addition, dietary composition
also seems to play a role; a high-fat diet, compared with a
low-fat diet, seems to induce a less negative energy balance
during a short-term (7 days) structured aerobic exercise regime
in lean young men (52). Thus, several factors seem to impact
the compensatory response to aerobic exercise.
Although it is well known that habitual exercise reduces
body fat, and in particular, in the abdominal region (47), it is
poorly understood how different doses of increased ExEE
impacts on compensatory responses (i.e., increased EI and/or

0363-6119/12 Copyright 2012 the American Physiological Society

R571

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Mads Rosenkilde,1 Pernille Auerbach,1 Michala Holm Reichkendler,1 Thorkil Ploug,1

Bente Merete Stallknecht,1 and Anders Sjdin2

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EFFECT OF EXERCISE ON ENERGY BALANCE IN OVERWEIGHT MEN

MATERIALS AND METHODS

The Four-IN-onE project (http://fine.ku.dk) on metabolic and cultural health in moderately overweight men was conducted between
December 2009 and July 2011. The study adhered to the declaration
of Helsinki, was approved by the Ethical Committee of Copenhagen
(H-4-2009-089), and was registered at clinicaltrials.gov (identifier:
NCT01430143).
Study subjects. We recruited young (20 40 yr) Caucasian males,
with no first-degree relatives with Type 2 diabetes, from the Copenhagen area. At a screening visit, 64 subjects that were moderately
overweight (BMI: 2530 kg/m2, fat percentage 25%), sedentary
[not engaged in regular exercise, maximal oxygen consumption

O2 max) 45 ml O2kg body mass1min1], healthy (blood pres(V

sure 140/90 mmHg, fasting blood glucose 6.1 mmol/l, no regular
medication), not engaged in dieting to lose weight and willing to
adhere to the protocol were found eligible for randomization (Fig. 1).
Subjects signed an informed consent after receiving detailed oral and
written information regarding the study. Withdrawal of consent or
insufficient training compliance resulted in exclusion from the study.
Participants received a payment for successful participation in the
study.
Study design. The study was a randomized controlled trial, including a 13-wk exercise intervention of moderate (MOD) or high (HIGH)
dose, and a control group (CON) that maintained a sedentary lifestyle.
Subjects in CON were offered consultations regarding healthy
lifestyle changes after completion of the study. The randomization
procedure was done in three blocks (from January 2010 to February
2011), and in the beginning of each block, identical group allocations
were available.
Subjects in MOD and HIGH were instructed to perform aerobic
exercise (e.g., running and cycling) corresponding to a traininginduced energy expenditure (TrEE) of 300 or 600 kcal/day, respectively, i.e., the energy expenditure only associated with the exercise
bout. Missed sessions (unless due to injury or illness) were to be
compensated for during the following sessions. Three times per week,
O2 max, based on the
sessions were intense, i.e., higher than 70% of V
heart rate (HR) reserve method (31). Exercise intensity at the remaining sessions was self-selected.

Fig. 1. Participant flow chart.

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reduced NEAT). We have found no long-term randomized

controlled exercise interventions closely monitoring exercise
compliance, which have investigated changes in body composition assessing accumulated energy balance and quantifying
the degree of compensation. Therefore, the primary aim of the
present study was to examine the effects of increasing doses of
aerobic exercise on body weight and composition. Secondarily,
accumulated energy balance and the degree of compensation
were assessed on the basis of changes in body composition.
Additionally, we wanted to identify potential underlying mechanisms, i.e., EI, dietary macronutrient composition, NEAT, and
REE, which could explain any apparent compensation.

EFFECT OF EXERCISE ON ENERGY BALANCE IN OVERWEIGHT MEN

Diets were provided to the subjects for ad libitum consumption

during an 8-day period at baseline and at the 13th week. The diets
were provided in a randomized double-blinded order and consisted of
four consecutive days of either high-carbohydrate or low-carbohydrate diet, respectively, to objectively evaluate whether an increase in
EI in the end of the exercise intervention was dependent on the dietary
macronutrient composition. The diets comprised similar type of meals
with similar energy density and palatability but differed in macronutrient composition: high-carbohydrate diet: 65% carbohydrate, and
20% fat, 15% protein; and low-carbohydrate diet: 35% carbohydrate,
50% fat, and 15% protein. All food components within a single meal
were interchangeable, since they had the same macronutrient composition. Approximately double the expected daily energy needs were
provided to allow ad libitum feeding. Subjects were instructed to
select freely from the food items provided and to eat until comfortably
satiated. All leftovers were returned and weighed, and energy intake
was subsequently calculated. Ad libitum EI during the last 3 days of
each feeding regimen and pooled data from all 8 diet days were
analyzed.
Calculations. The accumulated energy balance was calculated from
changes in body energy stores. Over a longer period, changes in body
composition reflect changes in energy balance; thus, the accumulated
gain or loss of different body tissues should reflect energy balance
over the exercise intervention. We define the accumulated balance as
the energy balance reflected by changes in body fat and FFM and
assume that a gain of 1-kg fat mass or 1-kg FFM corresponds to
12,000 and 1,780 kcal, respectively (18). We assumed that a loss of 1
kg fat mass or 1 kg FFM corresponds to 9,417 and 884 kcal,
respectively (19).
ExEE was calculated from measured TrEE. Here 15% of excess
postexercise energy expenditure was added (4), but a conservative
sedentary physical activity level (REE 1.2) was removed: ExEE
(TrEE 0.15) (TrEE training duration REE 1.2).
The degree of compensation in response to the increase in ExEE
was assessed through a compensation index: Degree of compensation (ExEE AEB)/ExEE 100%.
This index provides an estimation of the degree of compensation.
When the degree of compensation equals zero, then changes in body
composition (calculated as accumulated energy balance) equals the
amount of calories spent due to exercising (ExEE) during the given
time frame. A change in body composition, indicating a less negative
energy balance than what could be expected is defined as (positive)
compensation and, correspondingly, a larger than expected negative
energy balance is referred to as a negative compensation.
Linear regression at baseline (n 61) based on observed REE and
FFM was used to derive an equation to predict REE at follow-up.
Residuals between observed and predicted REE were calculated to
estimate adaptations in REE that could not be attributed to changes in
FFM (39).
Statistical analysis. The study was primarily an efficacy study, and
results are presented as per-protocol analyses. Descriptive baseline
data are tabulated as means SE. Between-group differences were
assessed using analysis of covariance with group baseline values and
group assignment as covariates. The differences in follow-up values
among the randomization groups are presented as adjusted leastsquare means with two-sided 95% confidence intervals (CI), and all
pairwise comparisons were adjusted using the Tukey procedure.
Within-group differences were tested using t-tests. Data that did not
comply with the criteria for the statistical model (i.e., unequal variance) were log transformed.
An intention-to-treat analysis, including subjects that were excluded or dropped out after randomization, was also conducted for
changes in body composition, for the degree of compensation, and for
compensatory changes. If the subject dropped out of the intervention,
the baseline values were carried forward (i.e., last observation carried
forward). If the subject were excluded due to compliance issues, the
post value was analyzed as randomized.

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Exercise was individually prescribed on the basis of body mass,

O2 max, and these variables were
resting and maximal HR, and V
subsequently entered into a HR monitor (RS400; Polar Electro OY,
Kempele, Finland) that was used to monitor the training intervention.
After 2, 6, and 10 wk, individual exercise target HR and training time
O2 max and body weight.
were recalculated depending on changes in V
To verify and control exercise sessions, subjects wore HR monitors
during all exercise sessions that stored exercise HR, number, and
duration of exercise sessions, and calculated TrEE (13).
To promote high compliance to the exercise regimen, subjects were
required to report their performed training (including HR monitor
files) to the research staff for supervision every second day during the
2 first weeks and every 4th day thereafter, throughout the intervention.
Subjects were excluded if they deviated more than 20% from the
prescribed exercise dose. Additionally, two of the following three
criteria had to be met: 1) at least 80% of the intervention days should
include exercise, 2) 80% of exercise sessions should include registration of HR, and 3) less than 20% of days without training due to
illness or injury. All subjects had free access to a fitness center, but
subjects in CON group only gained access after participation in the
study.
We attempted to blind subjects to the appetite/EI part of the study,
and thus, they were informed that the aim of the project was to
investigate the effects of different doses of exercise on metabolic
parameters. Additionally, they were told not to impose any dietary
restrictions during study participation but to select food items without
restraint.
Measurements. All subjects underwent a 3-wk baseline test regimen after which subjects were randomized to CON, MOD, or HIGH.
Follow-up testing started after 10-wk intervention and continued for 3
wk, during which subjects adhered to the intervention protocol as
randomized.
Body weight and composition were measured after an overnight
fast. Weight was measured on an electronic scale, height was measured using a stadiometer, and body composition was assessed using
dual-energy X-ray absorptiometry (DPX-IQ X-ray bone densitometer
4.7e; Lunar Corporation, Madison, WI, USA).
Resting energy expenditure was assessed in a supine position using
a respiratory calorimetry system (Oxycon Pro, Jaeger, Wrzburg,
Germany). Respiratory gas exchange was measured for 30 min after
25 min of rest. The first 10 min was discarded, and REE was
calculated using the Weir equation (55).
O2 max was assessed using an electronically braked bicycle (Lode
V
Excalibur, Groeningen, Netherlands) and respiratory calorimetry.
Workload was increased with 25-W increments every minute after
O2 max was accepted
warm-up until exhaustion, and attainment of V
using previously defined criteria (46).
Total physical activity was assessed using Actigraph GT1-M (Actigraph, Pensacola, FL, USA), which measured total daily activity
counts for three consecutive days at baseline and in the 6th and 11th
wk after randomization. Subjects were instructed to wear the monitor
throughout the day and were allowed to take off the monitor when
showering. Accelerometry data were downloaded as 1-min epochs,
and activity measures were considered valid if at least 2 out of 3 days
had activity counts throughout the day (except for the sleeping period).
In the exercise groups, nonexercise activity was assessed by subtracting
activity counts obtained during prescribed exercise from total activity
counts (38). Activity counts obtained at the 6th and 11th wk were
averaged and then pooled for further analysis. Data derived from the
Actigraph were analyzed using a conservative approach, in which activity
counts, rather than energy expenditure, were assessed in the analysis.
Habitual EI was calculated from food records on the same weekdays at baseline and in week 11. All subjects were told to carefully
weigh and record all foods and drinks consumed for 3 days. The
recordings were processed using appropriate software (Dankost 3000;
Dankost, Copenhagen, Denmark).

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EFFECT OF EXERCISE ON ENERGY BALANCE IN OVERWEIGHT MEN

Table 1. Baseline characteristics of 61 randomized subjects and 53 completers

All randomized (n 61)

CON (n 17)

MOD (n 18)

HIGH (n 18)

Age, mean (SD), yr

Anthropometric variables, mean (SD)
Weight, kg
Body Mass Index, kg/m2
Fat mass, kg
Fat free mass, kg
Waist circumference, cm
Diet registration, mean (SD)
Habitual energy intake, kcal/day
E% carbohydrate*,
E% fat*,
E% protein*,
E% alcohol*,
Ad libitum diet delivery, mean (SD)
High-CHO, kcal/day
High-CHO, kcal day1 kg1 body wt
Low-CHO, kcal/day
Low-CHO, kcal/day body wt
Pooled caloric intake 8 days, kcal/day
Pooled caloric intake 8 days, kcal/day body wt
Resting variables, mean (SD)
Resting energy expenditure, kcal/day
Respiratory exchange ratio*
Resting heart rate, bpm
Exercise test variables, mean (SD)
O2max, ml kg1 min1
V
Respiratory exchange ratio
Maximal heart rate, bpm
Peak power output, W

29 (6)

31 (6)

30 (7)

28 (5)

91.8 (7.8)
27.9 (1.8)
28.4 (4.8)
63.4 (5.8)
95 (5)

92.8 (8.5)
28.0 (2.3)
29.0 (6.0)
63.9 (2.8)
96 (6)

93.2 (8.1)
28.6 (1.8)
30.0 (4.6)
63.3 (6.9)
97 (5)

91.3 (7.2)
27.6 (1.4)
27.4 (4.2)
64.0 (5.7)
94 (6)

2690 (560)
47 (8)
31 (6)
16 (3)
6 (7)

2670 (490)
48 (9)
31 (8)
16 (3)
5 (8)

2550 (440)
48 (9)
29 (6)
16 (3)
6 (8)

2820 (680)
47 (5)
31 (5)
16 (4)
6 (5)

2640 (600)
29 (7)
3170 (670)
35 (8)
2920 (580)
32 (7)

2740 (630)
30 (7)
3240 (770)
35 (8)
3010 (620)
33 (6)

2600 (750)
28 (9)
3090 (710)
34 (9)
2860 (650)
31 (8)

2540 (490)
28 (6)
3150 (630)
35 (8)
2840 (520)
31 (6)

1810 (178)
0.87 (0.09)
56 (7)

1809 (157)
0.86 (0.07)
55 (7)

1832 (226)
0.87 (0.11)
56 (8)

1833 (169)
0.87 (0.10)
56 (6)

35.1 (4.9)
1.25 (0.06)
185 (8)
247 (40)

35.9 (4.8)
1.24 (0.06)
186 (99)
257 (45)

34.6 (4.1)
1.26 (0.07)
185 (7)
250 (33)

36.2 (5.3)
1.24 (0.05)
187 (9)
249 (37)

*5 subjects were not analyzed because of lack of compliance with food records; Percentages may not sum to 100 because of rounding; 4 subjects did not
receive diet delivery due to time constraints; 5 Subjects were not analyzed due to equipment malfunction. bpm, beats per minute; CHO, carbohydrate; CON,
control group; E%, percentage contribution to total energy intake; HIGH, high-dose exercise group; H-CHO, high-carbohydrate diet, L-CHO, low carbohydrate
O2, volume oxygen consumed.
diet; MOD, moderate-dose exercise group; V

Power and sample size calculations were based on changes in fat mass.
Approximately 3 20 persons were necessary to detect a 25% reduction
in fat mass in the intervention groups compared with CON. With a
coefficient of variation of 20%, a statistical power of 80% is obtained. A
level of P 0.05 was considered significant. Statistical analyses were
conducted in SAS Enterprise Guide 4.2 (SAS Institutes, Cary, NC, USA).
RESULTS

Of the 64 subjects eligible for inclusion, 3 subjects withdrew

their consent during baseline testing, and 61 subjects were
randomized (CON, n 18; MOD, n 21; HIGH, n 22).
Return rate to follow-up was 82 to 94% across groups. With-

drawal of informed consent (n 2) or insufficient training

compliance (n 6) resulted in subsequent exclusion of eight
subjects (Fig. 1). The baseline data for the study population are
presented in Table 1. During the intervention, average adherence to the prescribed exercise was 99% for MOD (CI: 96,
102) and 96% for HIGH (CI: 93, 99%) (P 0.14), and there
was no difference in exercise intensity and number of exercise
sessions conducted per week (P 0.12) (Table 2). The
O2 max of 18% for
intervention resulted in an increase in V
MOD (CI: 1225) and 17% for HIGH (CI: 1121) (Table 2).
This was a larger increase for both exercise groups compared

Table 2. Descriptive training data for subjects who completed the exercise intervention
CON (n 17)

Training adherence, mean (SD)

Training energy expenditure, kcal/session
Exercise sessions/wk
Duration, min/session
O2max
Exercise intensity, %V
Intervention length, days
Days without training
Sick days
Exercise test variables, mean change (95% CI)
O2max, ml kg1 min1
V
Respiratory exchange ratio
Maximal heart rate, bpm
Peak power output, W

n.a.
n.a.
n.a.
n.a.
76 (14)
n.a.
n.a.
1.3 (1.0; 3.5)
0 (0.05; 0.04)
2 (8; 5)
1 (27; 30)

MOD (n 18)

335 (8)
6.2 (0.6)
29.9 (8.2)
66.2 (6.6)
72 (4)
8 (6)
1 (2)
7.7 (5.4; 9.9)*#
0.05 (0.01; 0)*
7 (1; 13)*
24 (1; 48)#

HIGH (n 18)

653 (10)$
6.2 (0.4)
55.2 (6.6)$
67.3 (6.5)
74 (5)
8 (4)
3 (6)
7.0 (5.1; 8.8)*#
0.03 (0; 0.07)
6 (0; 12)*
46 (21; 71)*#$

O2max in the MOD and HIGH group. *P 0.05

CI, confidence interval. Data are based on variables that are adjusted for changes in body composition and V
within group. #P 0.05 compared with control (CON). $P 0.05 compared with MOD.
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Characteristics

EFFECT OF EXERCISE ON ENERGY BALANCE IN OVERWEIGHT MEN

Changes in body composition at follow-up

Least sqaure means, kg

-2

Body weight
Body fat
Fat free mass

-4

-6

CON

* #* #

*#
*#

MOD

HIGH

Exercise groups

Change in daily energy balance at follow-up

Least sqaure means, kcal

600
400
200
0
-200
-400
-600
-800
-1000
-1200
-1400

ExEE/day
Accumulated energy balance/day
CON

MOD

HIGH

Exercise groups

Fig. 2. Effects of the intervention on the degree of compensation A: changes

(follow-up minus baseline) in body composition over the intervention in the
control (CON, n 17), moderate-dose exercise (MOD, n 18), and
high-dose exercise group (HIGH, n 18) as measured by DEXA scan.
B: energy balance per day during the intervention in CON (n 17), MOD
(n 18), and HIGH (n 18). Data are least square means, and error bars
represent 95% confidence intervals. *P 0.01 within group. #P 0.01
compared with control (CON). Abbreviations: CON, control group; DEXA,
dual-energy X-ray absorptiometry; ExEE: exercise-induced energy expenditure; HIGH, high-dose exercise group; MOD, moderate-dose exercise
group.

The changes in body energy stores indicated that both

exercise regimes resulted in substantial negative accumulated
energy balance compared with CON (MOD: 39.6 Mcal, CI:
57.1; 22.0, P 0.001; HIGH: 34.3 Mcal, CI: 51.9;
16.7, P 0.001) over the course of the intervention. Thus,
average daily accumulated energy balance was 550 kcal in
MOD (CI: 770; 320, P 0.001) and 470 kcal in HIGH
(CI: 690: 240, P 0.001) compared with CON (Fig. 2B).
The average daily ExEE was 300 kcal (CI: 290, 305) for MOD
and 580 kcal (CI: 560, 600) for HIGH, which corresponded to
doubled ExEE in HIGH compared with MOD (193%, CI: 187:
200, P 0.001), as intended in the study design (Fig. 2B). The
changes in accumulated energy balance and ExEE resulted in
a 20% (CI: 6: 46) degree of compensation in HIGH and a
83% (CI: 134: 33) degree of compensation in MOD.
Accordingly, the moderate dose of exercise resulted in a
negative accumulated energy balance considerably in excess of
what could be expected from the accumulated ExEE. The
degree of compensation differed substantially between MOD
and HIGH (104%, CI: 159, 49, P 0.001).
REE increased more in HIGH compared with both MOD
(205 kcal/day, CI: 89, 322, P 0.001) and CON (129 kcal/
day, CI: 11, 247, P 0.03) (Fig. 3A). REE also increased more
in HIGH compared with MOD when corrected for changes in
FFM (2.9 kcalday1kg1 FFM, CI: 0.03, 5.7, P 0.05). At
baseline, REE was regressed against FFM [REE (kcal/day)
928.14 14.055 FFM, R 0.5, P 0.001], and at follow-up,
the observed REE was greater than the predicted REE in HIGH
compared with both MOD (192 kcal/day, CI: 81, 305, P 0.001)
and CON (115 kcal/day, CI: 1, 228, P 0.05). With intentionto-treat analysis, a difference between predicted and observed
REE was still observed between HIGH and MOD (141 kcal/day
CI: 31, 251, P 0.009), but not between MOD and CON (95
kcal/day, CI: 19, 211, P 0.12).
Total physical activity (total activity counts as detected by
accelerometry) increased for both MOD (13.9 103 counts/
day, CI: 2.8, 25.0, P 0.01) and HIGH (19.3 103 counts/
day, CI: 8.1, 30.6, P 0.001) compared with CON, which was
also apparent within the intention-to-treat population. When
the exercise component (activity counts during exercise sessions) was subtracted from the total activity counts, there was
no significant difference in nonexercise activity between any of
the groups (Fig. 2B). However, nonexercise activity was numerically increased by 37% in MOD compared with CON
(8.8 103 counts/day, CI: 1.0, 18.7, P 0.09).
There was no difference in habitual EI as a response to the
intervention between or within groups (Table 3). Furthermore,
the intervention did not change the relative contribution of
dietary macronutrients between or within the groups (P 0.13,
Table 3). No changes between or within groups were observed
when ad libitum EI was expressed as total EI or relative to
body weight during a high-carbohydrate or low-carbohydrate
diet, or combined over 8 days (Table 3).
DISCUSSION

Over the course of the exercise intervention, engagement in

daily aerobic exercise induced a clinically meaningful weight
loss (14% body fat reduction) in sedentary, moderately overweight men. Although one group of men (HIGH) increased
their ExEE twice as much as the other (MOD), body weight

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with CON (MOD: 6.0 ml O2min1kg1, CI: 2.7, 9.2, P

0.001; HIGH: 5.8 ml O2min1kg1, CI: 2.5, 9.0, P 0.001)
(Table 2).
Body weight and composition remained unchanged in CON
(P 0.36). There was a modest decrease in body weight in
both MOD (4%; CI: 25) and HIGH (3%; CI: 1 4), and a
substantial reduction in body fat in MOD (14%; CI: 10 18)
and HIGH (13% CI: 10 17). Compared with CON, both body
weight (MOD: 3.6 kg, CI: 5.7; 1.5 kg, P 0.001; HIGH:
2.7 kg, CI: 4.8; 0.6, P 0.01) and fat mass (MOD: 4.0
kg CI: 5.6; 2.3 kg, P 0.001; HIGH: 3.8 kg CI: 5.6;
2.1, P 0.001) decreased in MOD and HIGH. A tendency
toward an increase in FFM was observed in HIGH compared
with CON (1.0 kg, CI: 0.1, 2.2, P 0.06) (Fig. 2A). In the
intention-to-treat population, similar changes were observed
except for the change in FFM (0.9 kg, CI: 0.2, 1.9; P
0.12).

R575

R576

EFFECT OF EXERCISE ON ENERGY BALANCE IN OVERWEIGHT MEN

Resting energy expenditure at baseline and follow-up

Pre
Post

*#$

2000

1500

1000

500

CON

MOD

HIGH

Exercise groups

Least square means, activity counts /day 103

B Activity behavior over the course of the intervention

60
50

Baseline Activity
Follow-up Activity
Follow-up non-exercise activity

*#

40
30

20
10
0

CON

MOD

HIGH

Exercise groups

Fig. 3. Effects of the intervention on components of energy expenditure.

A: resting energy expenditure measured by indirect calorimetry at baseline
(black bars) and after the intervention (gray bars). B: activity behavior
measured by actigraphy before the intervention (black bars) and after the
intervention (white bars), and nonexercise activity after the intervention (gray
bars). Data are least square means, and error bars represents 95% confidence
intervals, *P 0.05 within group. #P 0.05 compared to CON. $P 0.001
compared with MOD. Resting energy expenditure: CON, n 15; MOD, n
16; HIGH, n 13. Activity behavior: CON, n 15; MOD, n 16; HIGH,
n 17. CON, control group; HIGH, high-dose exercise group; MOD,
moderate-dose exercise group.

and fat mass losses were similar in both groups. On the basis
of our calculations, the accumulated negative energy balance
was 20% less than could be explained by the exercise
intervention in HIGH, whereas it was 80% greater than
expected in MOD.
The concept of compensation in response to an exercise
intervention is not new. Bouchard et al. (7, 8) showed that
highly controlled exercise (ExEE: 1,000 kcal/day) for 100
days under conditions of a maintained EI resulted in fat mass
reduction ranging from 3 to 12 kg in young, moderately
overweight men, suggesting large variability in compensation
even when attempts were made to limit potential compensation
to factors influencing EE. Recent studies (12, 34) have predicted expected weight loss using a static estimate of 7,700
kcal/kg body wt lost based on the assumption of a 70:30

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Least sqaure means, kcal/day

2500

relationship between fat and lean tissue lost. Using this

method, Church et al. (12) reported a dose-dependent attenuation of predicted weight loss with increasing amounts of
aerobic exercise in overweight and obese postmenopausal
women. This finding is in line with our results, suggesting a
threshold in which further increase of exercise does not necessarily induce a more negative accumulated energy balance
and, therefore, no additional weight loss or loss of fat mass
should be expected. However, this threshold appears to have
large individual variation (6, 12, 34) and is likely to depend on
sex (15, 23) and the type of exercise (14). King et al. (34)
reanalyzed the concept of compensation in response to their
earlier supervised exercise intervention in overweight and
obese men and women, focusing on changes in body composition. The degree of compensation in response to the increased
ExEE was not quantified. However, since the fat mass contribution of body weight lost clearly exceeded 70% in both
compensators and noncompensators (33), it is evident that
previously reported data have overestimated the degree of
compensation in response to exercise. Thus, the compensation
index, which is based on changes in fat mass and FFM rather
than on weight, represents in our opinion a more precise
estimate when the impact of exercise interventions (increased
ExEE) on energy balance is quantified.
In the present trial, both exercise regimes (30 as well as 60
min of daily aerobic exercise) led to identical negative accumulated energy balance when calculated from actual changes
in body composition over the intervention period. The resulting
weight loss in the present trial comprised exclusively of fat
mass, demonstrating that even a modest exercise-induced
weight loss can be a meaningful healthy weight loss (11, 47).
Current guidelines for physical activity varies somewhat between countries, but in the adult population, 150 min of
physical activity per week (54, 59) or 30 min/day (44) is
generally recommended to benefit health, while higher doses of
physical activity are often recommended to obtain weight loss
or to prevent weight gain (27). However, we observed a greater
than predicted negative accumulated energy balance in moderately overweight men exercising only 30 min/day, suggesting
a bonus effect. Somewhat surprisingly, we found no additional benefit from doubling the exercise dose. Therefore, we
challenge the basis for the current recommendations regarding
exercise for weight management. A deeper understanding of
the mechanisms responsible for lower or greater than predicted
change in accumulated energy balance in response to exercise
is of interest when recommendations regarding exercise for
weight management in different groups are compiled in the
future.
Resting energy expenditure is an essential part of total EE,
and it decreases in response to caloric restriction, often beyond
what would be expected as a result of decreased FFM (28). In
this study, exercise was shown to protect FFM and will thereby
attenuate any decrease in REE. The decrease in REE observed
in MOD is most likely related to the lack of increase in FFM
in combination with the negative energy balance (17, 28, 35),
whereas the increase in REE in HIGH clearly was driven by the
increase in FFM (51). Hence, changes in REE cannot help to
explain the difference in compensation between MOD and
HIGH found in the present study.
The regulation of NEAT in response to exercise is not well
understood, and it is probably influenced by age (22, 26), sex

EFFECT OF EXERCISE ON ENERGY BALANCE IN OVERWEIGHT MEN

R577

Table 3. Dietary outcomes for subjects who completed the intervention

Mean (SD)
Intervention Group

No. of Participants

Follow-Up Value

15
16
17

2670 (630)
2570 (510)
2950 (760)

Mean (95% CI)

Within-Group Change

Between-Group Comparison CON vs.

Intervention Groups

Pairwise P Value

Habitual EI based on diet registrations, kcal/day

CON
MOD
HIGH

0 (440; 430)
20 (370; 400)
130 (370; 640)

60 (660; 540)
300 (280; 880)

0.57
0.45

140 (210; 490)

120 (240; 480)

0.69
0.61

2.3 (1.4; 6.1)

2.6 (1.1; 6.3)

0.29
0.20

50 (310; 410)
20 (310; 410)

0.98
0.98

1.6 (2.5; 5.3)

1.3 (2.6; 5.6)

0.60
0.68

70 (210; 360)
90 (190; 360)

0.81
0.73

1.8 (1.2; 4.8)

2.0 (0.9; 5.0)

0.32
0.22

H-CHO, kcal/day
16
16
18

2540 (580)
2580 (630)
2560 (480)

200 (480; 90)

20 (250; 200)
20 (210; 250)

H-CHO, kcal day1 kg body wt1

CON
MOD
HIGH

16
16
18

2.3 (5.4; 0.7)

0.6 (1.9; 3.1)
1.0 (1.5; 3.5)

27 (6)
29 (7)
29 (6)

L-CHO, kcal/day
CON
MOD
HIGH

16
16
18

3050 (730)
2990 (580)
3010 (680)

190 (420; 40)

100 (340; 150)
140 (370; 90)

L-CHO, kcal day1 kg body wt1

CON
MOD
HIGH

16
16
18

33 (7)
34 (7)
34 (8)

2.1 (4.7; 0.5)

0.1 (2.8; 2.5)
0.7 (3.5; 2.2)
Diet 8-day, kcal/day

CON
MOD
HIGH

16
16
18

2870 (640)
2830 (550)
2820 (440)

150 (340; 50)

30 (240; 170)
10 (190; 160)

Diet 8-day, kcal day1 kg body wt1

CON
MOD
HIGH

16
16
18

31 (6)
32 (6)
32 (6)

1.7 (3.8; 0.3)

0.5 (1.7; 2.7)
0.7 (1.3; 2.8)

Diet 8-day, pooled caloric intake from H-CHO and L-CHO. EI, energy intake; E%, percentage contribution to total energy intake.

(57), and type of exercise (30, 56). Exercise that is not too
strenuous might increase or at least not lead to a decrease in
NEAT (2, 56) but lower NEAT after an exercise regime has
been associated with lower than predicted loss of fat mass in
some individuals (39), suggesting a potential causal effect
under certain conditions. The larger than expected negative
accumulated energy balance in MOD could potentially be
explained by an increase in NEAT. Although not statistically
significant, we found 37% higher (P 0.09) nonexercise
activity in MOD compared with CON at follow-up. Determination of changes in free-living NEAT is a technical challenge
(36), and clearly, we are limited by the accelerometer-based
approach. Nonexercise activity thermogenesis has, furthermore, been reported to vary considerably from day to day (37),
and our samplings are limited to a few days, and, in addition,
we cannot pick up small ambulatory movements and fidgeting
using accelerometers (36, 37).
It is also well recognized that habitual EI is difficult to
measure due to unintentional, as well as potential intentional
restrictions in food intake, underreporting, and considerable
variability in EI between days. Nevertheless, there is some
indication that EI increased in HIGH, driving the small but
quantifiable degree of compensation. We applied two different
methods for assessing changes in EI and, although not statis-

tically significant, the methods showed similar tendencies toward a numerical increase in EI. A similar potential compensation as seen in HIGH, probably explained by an increase in
homeostatic and/or hedonic drive to eat, has been demonstrated
in previous exercise interventions comparable to the intervention in HIGH (33, 41).
Several limitations could affect the interpretation of the
study. One apparent limitation is that the study is statistically
powered to calculate the degree of compensation, while it is
not powered to detect small, but relevant, changes in the
compensatory mechanisms, largely due to the variation associated with these measures (accuracy). Furthermore, the calculation of the degree of compensation was based on previously
published assumptions for energy equivalents for gain or loss
in fat mass and FFM. However, there is no consensus in the
literature for absolute values derived for the synthesis or
liberation of energy during breakdown/oxidation of fat mass
and FFM (24, 50).
We conclude that a similar meaningful loss of body fat was
obtained regardless of exercise dose. On the basis of our
calculations of accumulated energy balance, 30 min of daily
exercise resulted in a greater than expected negative energy
balance, whereas 60 min of daily exercise induced a small, but
quantifiable, amount of compensation. Thus, the degree of

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CON
MOD
HIGH

R578

EFFECT OF EXERCISE ON ENERGY BALANCE IN OVERWEIGHT MEN

compensation in response to an increase in ExEE as a result of

introduction of regular endurance exercise is dependent on
exercise dose. The number of subjects in the present study was
sufficient for assessment of energy balance but not to adequately elucidate the compensatory mechanisms involved.
However, on the basis of the present findings, we propose that
the introduction of a moderate dose of exercise may actually
lead to an increase in NEAT without any increase in EI
resulting in a bonus effect, whereas a higher dose of exercise
may lead to an increase in EI and, thereby, a degree of
compensation and less than expected loss of FM.

Obesity, as a result of long-term positive energy balance, is

a major risk factor for many preventable diseases, such as
coronary heart disease and Type 2 diabetes. Although well
recognized as an important means for weight loss maintenance
(9), the role of habitual endurance training in weight loss is
scrutinized, and it has been suggested that exercise leads to
compensatory responses. In the current study, we show that
despite that one group undertook twice the amount of endurance training, the reduction in body weight and, more importantly, in body fat was the same as the weight loss and was
equal among the two groups (a healthy weight loss). Surprisingly, the reduction with the moderate-dose exercise was far
greater than what could be explained by the increased energy
expenditure from the training itself (no compensation). Thus,
when addressing obesity reduction and compensatory changes
in response to exercise in the future, using weight loss as the
only determinant for success is inadequate (47). Well-controlled, long-term cost-benefit studies that are designed to
find the most efficacious feasible exercise interventions for
healthy weight loss and to address the identification of potential compensatory responses in different groups of overweight
individuals are needed.
ACKNOWLEDGMENTS
We acknowledge and thank all of the subjects who participated in the study.
We thank all students and technical staff that made this intervention work:
Astrid Pernille Jespersen, Julie Bnnelycke, Thomas Christian Bonne, Line
Quist Bendsen, Charlotte Stephansen, Marie-Louise Udengaard, Martin Bk
Pedersen, Finna Sigurdardottir, Signe Winther Nielsen, Helle Roager Jensen,
Jonas Salling Kjeldsen, Mia Lundby Kragelund, Anne Sofie Gram, Anders
Lagerberg, Jannie stergaard, Hanne Thorvig, Julie Sams Agerschou, Smita
Kunwar, Thomas Beck, Gerda Hau, Jakob Utzon Franck. We thank assistant
professor Lene Theil Skovgaard for statistical assistance.
GRANTS
This work is carried out as a part of the research program of the UNIK:
Food, Fitness & Pharma for Health and Disease (see http://foodfitnesspharma.ku.dk). The UNIK project is supported by the Danish Ministry of Science,
Technology and Innovation. Further financial support was obtained from the
Novo Nordisk Foundation.
DISCLOSURES
No conflicts of interest, financial or otherwise, are declared by the authors.
AUTHOR CONTRIBUTIONS
Author contributions: M.R., T.P., B.M.S., and A.S. conception and design
of research; M.R., P.L.A., M.H.R., T.P., and B.M.S. performed experiments;
M.R. and A.S. analyzed data; M.R., T.P., B.M.S., and A.S. interpreted results
of experiments; M.R. prepared figures; M.R. and A.S. drafted manuscript;
M.R., B.M.S., and A.S. edited and revised manuscript; M.R., P.L.A., M.H.R.,
T.P., B.M.S., and A.S. approved final version of manuscript.

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