The magnitude of the negative energy balance induced by exercise may be reduced due to compensatory increases in energy intake.
To address the question: Does increased exercise or physical activity alter ad-libitum daily energy intake or macronutrient composition in healthy adults?
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.
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.
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.
Citation: Donnelly JE, Herrmann SD, Lambourne K, Szabo AN, Honas JJ, Washburn RA (2014) Does Increased Exercise or Physical Activity Alter Ad-Libitum Daily Energy Intake or Macronutrient Composition in Healthy Adults? A Systematic Review. PLoS ONE 9(1): e83498. https://doi.org/10.1371/journal.pone.0083498
Editor: Guillermo López Lluch, Universidad Pablo de Olavide, Centro Andaluz de Biología del Desarrollo-CSIC, Spain
Received: August 30, 2013; Accepted: November 4, 2013; Published: January 15, 2014
Copyright: © 2014 Donnelly et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This review was funded by the International Life Sciences Institute. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: JD and RW are investigators of individual trials included in this review. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials. The authors declare that they have no other competing interests.
Data from the 2009–2010 National Health and Nutrition Examination Survey (NHANES) suggest that 68.8% of those age ≥20 years are overweight (Body Mass Index [BMI]≥25 kg/m2) while 35.7% are obese (BMI≥30 kg/m2)  with approximately 51% of US adults predicted to be obese by 2030 Finkelstein . Medical expenditures associated with the treatment of obesity and obesity related conditions are estimated at greater than $147 billion annually . Data from the NHANES (2003–2008) indicated that among adults (18–54 years) approximately 75% of women and 54% of men expressed a desire to lose weight while 61% of women and 39% of men were actively pursuing weight control .
Exercise is recommended for weight management by several governmental agencies and professional organizations including the Association for the Study of Obesity , the Institute of Medicine , the U.S. Federal guidelines on physical activity , Healthy People 2020  and the American College of Sports Medicine . Compared with weight loss induced by energy restriction, weight loss achieved by exercise is composed predominantly of fat mass, while fat-free mass is preserved – and resting metabolic rate (RMR) is generally unchanged , , or slightly increased , , factors that may be associated with improved long term weight loss maintenance. However, several reports have demonstrated that the accumulated energy balance induced by an exercise intervention alone produces less of a negative energy balance than theoretically predicted for the imposed level of exercise-induced energy expenditure –. The energy balance induced by exercise training may be reduced due to compensatory changes in energy intake, non-exercise physical activity, or both –; thereby reducing the magnitude of observed weight loss. Although several narrative reviews regarding the impact of exercise on energy intake and appetite hormones have been conducted –, we are aware of only one systematic review/meta-analysis on this topic. Schubert et al.  recently published a meta-analysis on the effect of acute exercise on subsequent energy intake that included only studies that assessed energy intake for ≤24 hours post-exercise in healthy (lean and/or obese), non-smoking individuals. To date, no systematic reviews on the effect of exercise and energy and macronutrient intake have been conducted that evaluated both the effects of acute exercise and exercise training and have included data from studies utilizing a variety of designs, e.g. cross-sectional, acute-crossover, non-randomized and randomized trials. Therefore, the aim of this systematic review was to identify and evaluate studies that have employed a variety of designs to assess the impact of both acute exercise and exercise training on energy and macronutrient intake. Results of this review will clarify our understanding of the association between exercise and energy intake and identify both exercise parameters including mode, frequency, intensity and duration and participant characteristics including age, gender, body weight, activity level that may impact this association. Such information will be useful for the design of weight management trials utilizing exercise, the potential identification of groups of participants for whom exercise may be most effective, and to identify areas for future investigation.
The objective of this systematic review was to address the question:
Does increased exercise or physical activity alter ad-libitum daily energy intake or macronutrient composition in healthy adults?
Primary source articles published in English in peer-reviewed journals were eligible for inclusion in this systematic review if data were presented 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. Specific eligibility criteria included: Types of studies: Cross-sectional, acute/short-term (exercise duration ranging from a single 30-min exercise bout to daily exercise over 14 days), and both non-randomized and randomized trials. Types of participants: Healthy adults (age 18–65 years). Types of exercise interventions: Aerobic and resistance exercise. Types of outcome measures: No restrictions were placed on the assessment methods for the primary outcome (energy/macronutrient intake). Other criteria: There were no restrictions on the length of interventions or the types of comparisons. We included cross-sectional comparisons between participants differing by level of exercise or physical activity and longitudinal pre/post within group changes vs. non-exercise control or vs. a different level of exercise. Articles were excluded if they provided no data on energy or macronutrient intake by level of exercise or physical activity, manipulated or controlled energy intake, or were conducted in non-recreational athletes or individuals with chronic disease(s).
Studies were identified by searching electronic data bases, related article reference lists, and consulting with experts in the field. The search was applied to PubMed (1990-present) and adapted for Embase (1990-present). The last search was conducted on January 4, 2013. The search was developed as a collaborative effort of the research team in consultation with a Kansas University reference librarian and conducted by a co-author (SDH). No attempts were made to contact study investigators or sponsors to acquire any information missing from the published article.
We used the following search terms in PubMed and Embase to identify potential articles with abstracts for review: exercise[ti (title), ab (abstract) ] or “physical activity”[ti,ab] or “energy expenditure”[ti,ab] OR “resistance training”[ti,ab] OR “strength training”[ti,ab]) AND (diets[ti,ab] OR diet[ti,ab] OR dieting[ti,ab] or “energy intake”[ti,ab] OR “energy restriction”[ti,ab] OR “nutrient composition”[ti,ab] OR “appetite”[ti,ab]). Additional search terms were applied to eliminate case reports and studies involving participants with chronic disease, and to retrieve studies published in English and conducted in adults (age 18–65 years). Word truncation and the use of wildcards allowed for variations in spelling and word endings.
Retrieved abstracts were independently assessed for eligibility for inclusion in the review by 2 investigators and coded as “yes”, “no” or “maybe.” All investigators who participated in eligibility assessments were trained regarding study inclusion/exclusion criteria and completed practice eligibility assessments on 50 test abstracts prior to actual coding. Eligibility assessments on the practice abstracts were reviewed by the primary author (JED) and any coding problems were discussed. Disagreements regarding eligibility for inclusion were resolved via development of consensus among all co-authors. Full text articles for abstracts coded as “yes” or “maybe” were retrieved and reviewed by 2 independent co-authors prior to inclusion in the review. An excel spread sheet was developed and used to track eligibility status.
Extracted data was entered into the University of Kansas secure, REDCap (Research Electronic Data Capture, Version 4.14.5) data base . A REDCap data extraction form was developed, pilot tested on a sample of 10 studies (at least 2 studies of each of the 4 study designs included in this review), and revised accordingly. Relevant data were extracted from each manuscript by one author and verified by a second author. Disagreements were resolved by group discussion. Data extracted from each article included basic study information (design, sample size, groups compared, exercise or physical activity groups/intervention(s), participant characteristics (age, gender, BMI, minority status), energy and macronutrient assessment method, and results.
Risk of Bias in Individual Studies
Risk of bias for randomized trials was independently evaluated by two authors using the Cochrane risk of bias tool . Risk of bias was assessed in the following domains: selection bias, performance bias, detection bias, attrition bias, reporting bias, and other bias. A third reviewer resolved any discrepancies in bias coding. Studies were not excluded on the basis of risk of bias.
Synthesis of Results
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. These parameters included: 1) participant characteristics (age, gender, BMI), 2) physical activity assessment methods (questionnaires, pedometers, accelerometers), 3) exercise prescriptions (mode, frequency, intensity, duration), 4) comparison groups (interventions: pre vs. post-exercise, exercise vs. non-exercise control, varying amounts), 5) intervention length, and 6) energy and macronutrient assessment methods (food frequency questionnaire, weighed and un-weighed food records, direct observation weigh and measure technique). A meta-analysis was therefore considered inappropriate. Results based on the extracted data were instead synthesized and presented grouped by study design.
The initial database search plus hand searching identified 4,668 unique records of which 4,490 were excluded based on review of title and abstract. Full-text articles for the remaining 178 citations were reviewed of which 79 articles did not satisfy our inclusion criteria and were excluded. Thus 99 articles representing 101 studies were included in the review (Figure 1).
The 17 cross-sectional studies identified comprised ∼17% of the total number of studies included in this review (Table 1).
Cross-Sectional Studies: Study Characteristics
Median (range) sample size for studies that included both men and women was 447 (14–921) for men and 428 (10–1483) for women. In studies that included only men or women the median sample size for men was 137 (one study) and women was 60 (21–38,876).
Seven studies compared 2 groups (active vs. sedentary) , –. Six studies compared 3 groups – while 3 studies compared physical activity over 4 or more groups –. One study reported the correlation between physical activity level and energy intake .
Physical activity assessment.
Seven studies (∼41%) employed a physical activity questionnaire , , , , , , , 5 studies (∼29%) used a single item self-report or self-report physical activity rating scale , , , , , and one study used a physical activity diary. Two studies used objective assessments of physical activity (accelerometers/pedometers) ,  while 2 studies recruited participants based on their self-reported participation in recreational aerobic sports , .
Energy/Macronutrient intake assessment.
Food frequency questionnaires were used in 6 studies –, , ,  while 4 studies used non-weighed 3-day food records , –. One , 4 ,  and 7-day  non-weighed food records, 3  and 7-day weigh and measure food records  and repeated 24-hour recalls were also employed in 2 studies , .
Cross-Sectional Studies: Participant Characteristics
Cross-Sectional Studies: Results
Seven of 17 (41%) cross-sectional studies indicated significantly higher absolute (kcal/day) , –,  or relative (kcal/kg/day) energy intake ,  in active compared with less active groups. There were no apparent differences in either basic study design parameters including sample size, assessment methods for both energy intake and physical activity, the number and type of comparison groups, or participant characteristics such as age, gender or BMI between studies that did and did not report a significant association between physical activity and energy intake.
Thirteen of 17 studies presented data on the intake of one or more macronutrients (fat, carbohydrate, protein). All 13 studies included data on fat intake. Six studies (46%) reported either lower absolute (grams) ,  or relative fat intake (% total energy intake) , , , , ,  in groups with higher levels of physical activity while 7 studies (54%) that reported fat intake by activity level failed to find a significant association , , , , , , . Eleven studies provided data on both carbohydrate and protein intake. Two studies (18%) reported higher carbohydrate intake in active groups , , while 9 studies (82%) found no association between the level of physical activity and carbohydrate intake , , , , , , , , . Relative protein intake was higher (2 studies) , , lower (one study)  or not different (8 studies) , –, , , ,  between groups reporting higher vs. lower levels of physical activity.
The 40 acute studies comprised ∼40% of the total studies identified for this review (Table 2). All acute studies employed cross-over designs, which compared energy intake assessed over a time frame of 24 hours or less following an acute exercise bout.
Acute Studies: Study Characteristics
The median (range) exercise intensity was 70% (60–75%) of HRMax, and 70% (30–75%) of maximal oxygen uptake. Five studies did not provide information on exercise intensity. The median (range) exercise duration was 50 min (3–90 min). Four acute studies dosed exercise by level of energy expenditure –.
Energy intake assessment.
Single ad-libitum test meals with energy intake assessed by the weigh and measure technique were utilized in the majority (25/40, 63%) of acute studies. Multiple ad-libitum meals , –, a combination of ad-libitum meal plus energy intake over the rest of the day by recall , –, diet recalls alone , and the consumption of specific food items, e.g. sandwiches , pasta salad  or cookies and chips  were also utilized.
Acute Studies: Participant Characteristics
No studies described the racial or ethnic composition of the study sample or reported post-exercise energy intake by race or ethnicity.
Participant activity level.
Participants recruited for the majority of acute studies (24/40–60%) were physically active and/or aerobically fit , , –, , , , , , , , –. Eleven studies (∼28%) recruited sedentary or moderately active participants , , , , , , , , ,  while 5 studies (∼13% ) did not describe baseline participant physical activity , , , .
Acute Studies: Results
Nine of 40 acute studies (∼23%) , , , , , , , ,  reported a significant increase in absolute energy intake (∼80 to 470 kcal/day) following exercise compared with non-exercise control while 27 studies (∼68%) found no difference in absolute energy intake between exercise and control conditions , –, , , , , –, –. Four studies (10%) reported a significant decrease in absolute energy intake (∼125 to 240 kcal/day) following exercise compared with non-exercise control , , , . Fifteen studies (∼38%) reported a significant decrease in relative energy intake (energy intake - exercise energy expenditure) following exercise compared with control –, , –, , , , , , , –; 5 of those studies also reported significant increases in absolute energy intake , , , ,  suggesting only partial compensation in energy intake following acute exercise.
Sixteen of the 40 acute studies (40%) reported data on macronutrient intake –, , , , –, , . Fifteen studies showed no effect, while one study indicated significantly higher fat and protein intake following exercise compared with non-exercise control .
Effect of Study Parameters on Energy Intake
Three studies provided information relative to the effect of exercise mode on post-exercise energy intake. Balaguera-Cortes et al.  reported no effect of either aerobic (treadmill) or resistance exercise while King et al.  showed no effect of swimming on absolute post-exercise energy intake. These results are in contrast to those of Laan et al.  who showed an increase in absolute post-exercise energy intake following both aerobic (cycling) and resistance exercise; however, relative energy intake was lower following aerobic exercise compared to resistance exercise or control.
Six acute studies reported the effect of exercise intensity on post-exercise energy intake. Four studies found no effect of exercise intensity on absolute energy intake following exercise , , , ; however, Imbeault et al.  reported a lower relative energy intake following high intensity exercise (75% VO2 max) compared with low intensity exercise (35% VO2 max) or non-exercise control. One study  showed a significant increase in absolute energy intake for high (70% VO2 peak) but not low intensity exercise (40% VO2 peak); however relative energy intake was lower in both the high and low intensity exercise groups compared with non-exercise controls. One study reported a significant decrease in absolute energy intake following strenuous (40 min/90 W cycle ergometer) but not moderate exercise (40 min/30 W cycle ergometer) in non-obese but not in obese women .
Two studies evaluated the role of exercise duration on post-exercise energy intake with divergent results. King et al.  reported no effect of exercise duration on post-exercise energy intake; however, Erdman et al.  reported that absolute energy intake was not significantly greater than control following cycle ergometer exercise bouts of 30 and 60 min, but was significantly greater than control following 120 minutes of exercise.
Exercise time of day.
Two studies evaluated the effect of the time of day of aerobic exercise on post-exercise energy intake , . Both studies found no significant difference in absolute post-exercise energy intake between exercise performed in the morning (7 and 8:15 AM) compared to the same exercise performed in the evening (5 and 7:15 PM). However, O'Donoghue et al.  showed that relative energy intake at breakfast was lower after morning exercise compared with afternoon exercise or control while relative energy intake at dinner was lower post afternoon exercise compared with control.
Composition of test meals.
Four studies evaluated the effect of the macronutrient composition of the test meal on post-exercise energy intake. Three studies found no significant differences in absolute post-exercise energy intake compared to rest between low or high fat test meals , , . King et al.  found no difference in absolute post-exercise energy intake when either high fat/low carbohydrate or low fat/high carbohydrate test meals were presented; however, relative energy intake was significantly lower in the low fat/high carbohydrate, but not the high fat/low carbohydrate condition compared with control.
Time between the end of exercise and the presentation of the test meal.
In the one acute study that investigated the effect of time between exercise and presentation of the test meal on energy intake, Verger et al.  showed that absolute energy intake increased as the time post-exercise that the test meals were presented increased (immediate to 120 min).
Effect of Participant Characteristics on Energy Intake
No studies evaluated the effect of age on post-exercise energy intake. Studies were generally conducted in young adults with a median age of 23 years.
Although 6 studies included both men and women – the data were presented separately in only one study. Verger et al.  showed significant increases in absolute EI following exercise (2 hours of non-stop submaximal aerobic athletic activities) in both men and women.
Three studies provided data on the effect of weight status on post-exercise energy intake , , . George et al.  found non-significant differences in absolute post-exercise energy intake between normal and overweight women. Kissileff et al.  reported significant decreases in post-exercise energy intake in non-obese, but not obese women, while Ueda et al.  found larger energy deficits (i.e. decreased energy intake) induced by exercise in obese compared with normal weight men.
Three studies evaluated the effect of combinations of weight, dieting status or level of eating restraint on post-exercise energy intake. Harris et al.  found no differences in post-exercise energy intake in a sample of men across 5 groups: 1) normal weight/low dietary restraint/non-dieting; 2) normal weight/high dietary restraint/non-dieting; 3) overweight/low dietary restraint/non-dieting; 4) overweight/high dietary restraint/non-dieting; and 5) overweight/high dietary restraint/dieting. In a sample of normal weight young women, Lluch et al.  found increased absolute post-exercise energy intake in women classified as unrestrained eaters and decreased energy intake in restrained eaters. Relative energy intake compared with rest was greater in restrained compared with unrestrained eaters. Visonia et al.  demonstrated a significant interaction between dieting/eating restraint status and study condition (exercise vs. control) on 12-hour energy intake in sample of women. The mean difference in 12-hour energy intake between the exercise and control day was significantly higher for the dieting-high restraint group compared with the non-dieting high restraint group.
Two studies evaluated the effect of activity level on post-exercise energy intake. Jokisch et al.  showed a significant decrease in post-exercise energy intake compared with control in inactive but not in active men. Larson-Meyer et al.  found non-significant differences between post-exercise energy intake and control in a normal weight sample of both habitual walkers (≥3 days/wk for ≥60 min/day) and habitual runners (≥32 km/wk); however, relative post-exercise energy intake was significantly lower in runners compared with controls, but not in walkers vs. controls.
The 10 short-term studies comprised ∼9% of the total studies identified for this review (Table 2). These studies employed cross-over designs that compared energy intake assessed over a time frame of 2–14 days during which participants engaged in exercise with energy intake during an equivalent period of no imposed exercise.
Short-Term Studies: Study Characteristics
One study prescribed exercise intensity at 70% of heart rate max (HRMax). Five studies prescribed intensity relative to VO2 max (median [range] 60% [44–75%]). Three studies did not report exercise intensity relative to VO2 or HRMax , , . Eight of 10 short-term studies (80%) dosed exercise by energy expenditure; 3 relative to body weight –, 3 relative to resting or baseline daily energy expenditure –, and 2 to an absolute exercise energy expenditure goal , . Two studies prescribed exercised by time that ranged from 60  to 100 min/day . Prescriptions ranged from 21.4  to 57.1 kJ/kg body weight , 1.4 to 1.8 times RMR , 12.5%  to 29% above baseline total energy expenditure  and net exercise energy expenditure from 2.8  to 2.98 MJ/day .
Short-Term Studies: Participant Characteristics
No studies describe the racial or ethnic composition of the study sample or reported an association between exercise level and energy intake by race or ethnicity.
Participant activity level.
Participants recruited for the majority of short-term studies (7/10 - 70%) were sedentary or moderately active –, , , . Two studies (20%) recruited active participants ,  while one study (10%) did not describe baseline participant physical activity .
Short-Term Studies: Results
Five of 10 short-term studies (50%) reported increased absolute energy intake (∼200–335 kcal/day) over periods of 2 to14 days when exercise was imposed compared with a non-exercise control period , , , , . Three studies that reported increased absolute energy intake showed relative energy intake at a level to maintain a negative energy balance during the exercise period , , ; however, Tremblay et al  showed that participants achieved a positive energy balance when presented with a high fat diet.
Seven of the 10 short-term studies (70%) reported macronutrient intake –, , , . Four of 7 studies (57%) showed no effect of exercise on macronutrient intake , , , . Farah et al.  reported increased intake of carbohydrate and protein while Stubbs et al.  observed increased intake of carbohydrate and fat with exercise compared to control. Whybrow et al.  noted increased intake of carbohydrate, fat and protein with exercise vs. control in men but not in women.
Effect of Study Parameters on Energy Intake
The one study that compared the effect of aerobic and resistance exercise reported no significant difference between exercise and control for short-term energy intake during either aerobic or resistance training .
Level of exercise energy expenditure.
Four studies evaluated the effect of increased levels of exercise energy expenditure on short-term energy intake –. Levels of energy compared were 12.5% vs. 25% above baseline energy expenditure , 21.4 vs. 42.8 kJ/kg/day ,  and 28.6 vs.57.1 kJ/kg/day . Three studies observed no effect , , . The study by Whybrow et al.  reported increased short-term energy intake associated with higher levels of exercise energy expenditure (57.1 vs. 28.6 kJ/kg/day) in men but not in women.
No studies evaluated the effect of exercise intensity on short-term energy intake.
Composition of test meals.
The one study that compared the effect of the composition of test meals (mixed, high fat, low fat) on short-term energy intake noted increased energy intake when high fat, but not low or mixed fat meals were presented .
Effect of Participant Characteristics on Energy Intake
No short-term studies evaluated the effect of age on post-exercise energy intake. Studies were generally conducted in young adults with a median age of 28.3 years.
Results from the two studies that evaluated gender differences in short-term energy intake with exercise reported that absolute energy intake increased in men but not in women , . Results from 2 separate studies that used identical exercise and energy intake protocols in samples of men  and women  found increased energy intake with exercise in women, but not in men.
The 12 non-randomized trials comprised ∼12% of the total studies identified for this review (Table 3). Most trials (11/12) evaluated changes in energy intake in a single group (no control) assigned to complete a longitudinal exercise training program , , – while one study observed differences in energy intake between women who participated in an 8 week exercise program at a commercial exercise facility with a group of non-exercise volunteer controls .
Non-Randomized Trials: Study Characteristics
Sample size/completion rate.
The median (range) sample size across the 12 non-randomized trials was 31 (10–107). The median (range) rate of trial completion in the 5 trials that provided data on this parameter was 83% (68–87%) of participants who started the intervention –, .
Six of 12 non-randomized trials involved laboratory based aerobic exercise conducted on cycle ergometers/rowers/steppers/treadmills , , , –, 5 trials employed indoor or outdoor walking , , , , while one trial required participants to complete a combination of gym activities (jogging/coordination/resistance) .
Exercise prescription (intensity).
Three trials prescribed intensity as a percentage of maximal VO2 –, 5 by percentage of HRMax , , , , , one by heart-rate-reserve  and one by ratings of perceived exertion . The median (range) of intensity prescriptions were: 40% (40–80%) max VO2; 73% (70–75%) HRMax, 59–67% heart-rate-reserve; and perceived exertion 11–13 on a 15 point scale. Prescribed exercise intensity was not reported in 2 trials , .
Exercise prescription (duration).
Six trials prescribed exercise duration by time , –, , 4 by level of exercise energy expenditure , , , , one by walking distance  and one by pedometer steps/day . The median (range) duration for the 6 trials prescribing exercise by time was 40 (30–60) min/day. All 4 studies prescribing exercise by energy expenditure assigned 500 kcal/exercise session. Prescribed walking distance was 3–6 km/day, and pedometer steps were to increase steps by 2,000 per day above baseline over 2 weeks.
Compliance with the exercise protocol.
Seven studies presented data relative to participant compliance with the exercise protocol , , –, , . Five trials reported the percentage of exercise sessions attended (range 82–100%) , , , , , 1 reported the level of exercise energy expenditure (prescribed 10.5 MJ/wk; achieved 9.9 MJ/wk)  and one trial reported pedometer steps/day (prescribed 2,000; achieved 2,677 steps/day) .
Energy and macronutrient assessment.
Five trials used non-weighed food records , , , , , 2 used weighed food records , , 3 used test meals , , , 1 used 12 hour recall  and one used a combination of food records and 24-hour recalls . Six studies assessed energy intake at baseline and end , , , , , , 3 studies completed energy intake assessments at 4 time points , , , one study at 3 time points  while 2 studies collected daily estimates of energy intake over the course of the intervention , .
Non-Randomized Trials: Participant Characteristics
The median (range) BMI was 29.3 (21.5–32.5) kg/m2. Five of 12 studies (42%) had a mean sample BMI in the overweight category (i.e. ≥25 kg/m2) , , , , , while the mean sample BMI was classified as obese (i.e. ≥30 kg/m2) in 5 trials , , , ,  and normal weight (i.e. BMI<25 kg/m2) in 2 trials , .
No non-randomized trials described the racial or ethnic composition of the study sample or reported an association between exercise level and energy intake by race or ethnicity.
Participant activity level.
Eleven of 12 non-randomized trials described inclusion criteria for level of baseline physical activity or aerobic fitness. With the exception of the trial of Koulouri et al.  who recruited regularly active participants, non-randomized trials were conducted in participants categorized as sedentary , , , , , , , or with low aerobic fitness , .
Non-Randomized Trials: Results
Eleven of 12 (92%) of non-randomized trials reported no change in energy intake in response to exercise training , –. One non-randomized trial reported a significant increase in energy intake (∼84 kcal/day) as a result of participating in an exercise training program .
Effect of Study Parameters on Energy Intake
No studies evaluated the effect of exercise mode on changes in energy intake in response to exercise training.
Level of exercise energy expenditure/duration.
No studies evaluated the effect of exercise energy expenditure/duration on energy intake in response to exercise training.
No studies evaluated the effect of exercise intensity on energy intake in response to exercise training.
Effect of Participant Characteristics on Energy Intake
No studies evaluated the effect of age on changes in energy intake in response to exercise training.
Three non-randomized trials provided data on gender differences , , . Two trials reported no differences for change in energy intake between men and women in response to exercise training , , while one trial found no effect in men or lean women, and a significant decrease in energy intake with exercise training in obese women .
The 24 randomized trials constituted ∼24% of the total number of studies identified for this review (Table 4). The majority of trials (16/24; ∼67%) evaluated the effect of exercise training on energy and macronutrient intake between participants randomized to exercise compared with non-exercise controls –. The effect of specific exercise training parameters on energy intake including mode (resistance/resistance plus aerobic/swim) –, , , intensity –, volume , ,  and timing (intermittent vs. continuous)  were also reported. The majority of randomized trials employed an efficacy design; however, reports from Jakicic et al.  and Foster-Schubert et al.  employed an intent-to-treat design, and Rosenkilde et al.  reported both efficacy and intent-to-treat results.
Randomized Trials: Study Characteristics
Sample size/completion rate.
The median (range) sample size across the 24 randomized trials was 43.5 (12–411). The median (range) proportion of randomized participants who completed the intervention and provided data for energy intake for the 23 trials that provided data on this parameter was 74% (21–100%).
Eight of 24 randomized trials involved laboratory based aerobic exercise where participants used a variety of modalities including cycle ergometers, rowers, recumbent cycles, steppers and treadmills , , , , , , , 8 evaluated indoor/outdoor walk/jog , , , , , , , , 5 trials employed primarily laboratory based treadmill walking/jogging , , , , , 4 trials involved resistance training only , , , , 2 trials used a combination of resistance and aerobic training ,  and one trial each involved swimming  and laboratory cycle ergometer exercise .
All exercise sessions were supervised in 15/24 (63%) of randomized trials , –, , , –, , –, , partially supervised in 6 trials (25%) , , , , ,  and unsupervised in 3 trials (∼13%) , , .
Exercise prescription (frequency).
The median (range) exercise frequency was 4 (2–7) days/wk in trials/groups randomized to aerobic exercise and 3 (2–4) days/wk for participants randomized to resistance training.
Exercise prescription (intensity).
Seven randomized trials prescribed intensity as a percentage of maximal VO2 , , , , , , , 8 trials used a percentage of HRMax , , , , , –, 6 used a percentage of heart-rate-reserve , , , , ,  and in 2 trials intensity was “self-paced” , . The median (range) of intensity prescriptions were: 65% (50–85%) maximal VO2; 70% (50–90%) HRMax, and 65% (50–75%) heart-rate-reserve.
Exercise prescription (duration).
Sixteen randomized trials prescribed exercise duration by time –, –, , , , –, 3 by level of exercise energy expenditure , , , and one each by energy expenditure/kg body weight , caloric equivalent of walking 12 miles/wk  and walking distance . The median (range) duration for the 16 trials prescribing exercise by time was 42 (30–60) min/day. Exercise prescriptions by level of energy expenditure were 300 kcal/day , 600 kcal/day  and both 300 and 600 kcal/day . Church et al.  randomized participants to energy expenditure groups of 4, 8 and 12 kcal/kg/wk, while Bales et al.  assigned participants to a combination of aerobic exercise modes (treadmill, elliptical, cycle ergometer) at a caloric equivalent of 12 miles/wk and Brandon et al.  prescribed walking 3 miles/session.
Compliance with the exercise protocol.
Eighteen studies presented data relative to participant compliance with the exercise training protocol , –, , , , –, –. Fifteen trials reported the percentage of exercise sessions attended [(median(range) 95% (74–100%)] , –, , , , –, , –, while 3 trials compared the prescribed with actual minutes of actual exercise completed. Bryner et al.  prescribed 40–45 min/day, 4 days/wk and observed 45 min/day, 4.1 days/wk. Cox et al.  prescribed 90 and achieved 124 min/wk while Nordby et al.  prescribed 600 kcal/session and achieved 576 kcal/session.
Energy and macronutrient assessment.
Twelve trials used non-weighed food records over 2 to 7 days , , , , , , , , , , , , 2 used weighed 3-day food records , , 5 used food frequency questionnaires , , , , , 3 used a combination of food records and 24 hour recalls , , , and one study each employed repeated 24 hour recalls , one study used weigh and measure ad libitum eating over 2 weeks , and one study used test meals offered over 8 days . Nine studies assessed energy intake only at baseline and end , , –, , , , 7 studies completed energy intake assessments at 3 time points –, , , , and 4 studies at 4 time points , , ,  and 4 at more than 4 time points , , , .
Randomized Trials: Participant Characteristics
Eleven trials (∼46%) included only women , , –, , , –, , 9 men only , , , –, , ,  and four studies (∼17%) included both men and women , , , ; however, only 2 of these studies provided separate result data by gender , .
The median (range) BMI for participants over the 24 randomized trials was 28.3 (25.0–32.4) kg/m2. Thirteen of the 24 randomized trials (∼54%) evaluated overweight participants (i.e. BMI>25 to ≤30 kg/m2) , , –, , , –, , , , while the mean sample BMI was classified as obese (i.e. ≥30 kg/m2) in 8 trials , , , , , , ,  and normal weight (i.e. BMI≤25 kg/m2) in 3 trials , , .
The median (range) percentage of non-white participants was 19% (0–60%) for the 9 randomized that provided information relative to the racial or ethnic composition of the study sample , –, , , , .
Participant activity level.
With the exception of the trial by Broeder et al. , who studied active but untrained participants; all randomized trials were conducted in participants who were sedentary or minimally active at baseline.
Randomized Trials: Results
Eighteen of 24 randomized trials (75%) found no significant change in energy intake in response to exercise training –, –, –, –. Five randomized trials reported significant decreases (∼200–500 kcal/day) in energy intake in response to exercise training , , , , . One randomized trial reported a significant increase in energy intake (Brandon 06). However, energy intake increased only in African American, but not white women, where energy intake decreased .
Eighteen of the 23 randomized trials (∼78%) that provided data on macronutrient intake found no change as a result of exercise training , , , –, , –, . Results from the 5 randomized trials that reported significant changes in macronutrient intake as a result of exercise training were mixed , , , , . For example, Brandon et al.  reported a significant increase in absolute carbohydrate intake in white, but not African American women, while Kirkwood et al.  reported a significant increase in the intake of fat as a percentage of total energy intake, with no change in the percentage of energy intake from carbohydrate or protein. Studies reported significant decreases in the absolute intake of carbohydrate , , , fat , ,  and protein ,  as well as decreases in the intake of fat as a percentage of total energy intake .
Effect of Study Parameters on Energy Intake
Two randomized trials compared change in energy intake in response to aerobic and resistance training. Broeder et al.  reported no change in energy intake in either the aerobic or resistance training groups while Bales et al.  reported a significant decrease in energy intake induced by aerobic, but not resistance training. A combination of aerobic plus resistance training was compared with aerobic training alone in 2 trials. Bales et al.  reported no between group differences for the change in energy intake with significant decreases in energy intake in both groups. Shaw et al.  reported significant decreases in energy intake in the aerobic plus resistance training group but not the aerobic training group. No significant changes in energy intake were reported in the 2 trials that evaluated energy intake in response to resistance training compared with non-exercise controls ,  or between participants who completed swim vs. walking training programs .
Level of exercise energy expenditure/duration.
No between group differences for change in energy intake in response to aerobic exercise training at difference levels of exercise energy expenditure were reported in the 4 trials that evaluated this parameter , , , .
Four randomized trials compared changes in energy intake in response to aerobic exercise training at low or high intensity –, . No significant between group differences for change in energy intake were reported in any of the 4 trials.
Intermittent vs. continuous exercise.
The one randomized trial that compared changes in energy intake in response to continuous (one-30 minute sessions/day) vs. intermittent exercise (2–15 minute sessions/day) reported no between or within group differences .
Composition of test meals.
Rosenkilde et al.  found no differences in energy intake with exercise training when low or high carbohydrate test meals were offered.
Effect of Participant Characteristics on Energy Intake
No randomized trials evaluated the effect of age on changes in energy intake in response to exercise training.
Two randomized trials provided data on gender differences for changes in energy intake in response to exercise training , . Donnelly et al.  reported no between group (exercise vs. control) for change in energy intake in response to 16 months of supervised exercise in either men or women. Similarly, Washburn et al.  found no between group differences (exercise vs. control) for change in energy intake in response to 6 months of supervised resistance training in either men or women.
Other participant characteristics.
No randomized trials were identified that specifically evaluated the effect of weight status, level of physical activity or level of dietary restraint on the energy intake response to exercise training.
Risk of bias.
The risk of bias for all randomized trials is presented in Table 5. The description of the procedures for random sequence generation were unclear in the majority of trials (16/24 - ∼67%). Six trials adequately described randomization procedures and were considered low risk of bias , , , , , , while 2 trials were considered high risk for randomization bias based on failure to provide any description of the randomization process  or randomization based on level of occupational and lifestyle physical activity . With the exception of the trial reported by Cox et al. , which adequately described procedures for allocation concealment (low bias) all other randomized trials (96%) provided no description of procedures for allocation concealment. Blinding participants and personnel is not feasible in an exercise trial. Blinding of personnel performing outcome assessments is feasible in exercise trials; however, this was described in only 2 trials , . Twenty one trials provided no information relative to blinding of outcome assessments, while one trial directly stated that outcome assessments were not blinded . Based on an effectiveness study paradigm the risk of attrition bias is high in the majority of the 24 randomized trials included in this review. Fifty-four percent of trials reported completion rates of less than 80%; however, 22 of 24 of these studies were conducted as efficacy trials where data from participants who were non-adherence to the exercise intervention or outcome assessment protocols were not included in the analysis.
Summary of Evidence
In this paper we systematically reviewed 99 studies that employed a variety of study designs including cross-sectional, acute/short-term, non-randomized and randomized trials to address the question: Does increased exercise or physical activity alter ad-libitum daily energy intake or macronutrient composition in healthy adults? Our results can be summarized as follows.
It is commonly believed that individuals increase energy intake in response to increased physical activity or exercise training. However overall, we found no consistent, compelling evidence that any level of increased physical activity or exercise has any impact on energy intake. Forty-one percent of cross-sectional studies reported higher energy intake among active compared with inactive individuals. However, cross-sectional data precludes determination of cause and effect. Likewise, it is not possible to determine if the higher energy intake observed among inactive individuals meets or exceeds their level of daily energy expenditure or how between group differences in body weight may impact the results of cross-sectional studies. In agreement with the results of the recent meta-analysis by Schubert et al.  on acute exercise and subsequent energy intake, our results from both acute and short-term trials suggest that any observed increase in post-exercise energy intake only partially compensates for the energy expended during exercise. Thus, in the short-term, exercise results in a negative energy balance. Results from both non-randomized and randomized trials are in agreement with the results from acute and short-term trials. Only 2 of 36 (∼6%) non-randomized and randomized trials, ranging in duration from 3 to 72 weeks, report an increase in absolute energy intake in response to exercise training, thus implying that exercise does not result in a compensatory increase in energy intake. A limited number of studies across all study designs have evaluated the effect of exercise parameters and participant characteristics on energy intake. Our results suggest no effect of either exercise parameters including mode (aerobic, resistance), intensity, duration/energy expenditure or participant characteristics including age, gender, weight or physical activity level on energy intake. These results are in contrast to those of Schubert et al.  from their meta-analysis on the acute effect of exercise on absolute post-exercise energy intake where they noted individuals with low to moderate levels of physical activity were more likely to reduce energy intake in response to exercise compared to their more active counterparts.
Data on macronutrient intake was reported in 67 of the 99 studies (68%) included in this review. Irrespective of study design we found no consistent evidence for an effect of exercise on macronutrient intake. Forty-four of 54 acute/short-term, non-randomized and randomized trials (81%) reported no effect of exercise on macronutrient intake, while results of the 10 trials reporting an association were mixed. Thus, it appears individuals do not spontaneously alter the composition of their diets in response to physical activity or exercise.
Limitations in the Available Literature
There are several important limitations in the literature available for this systemic review. The most critical limitation in the available literature is the lack of studies that have been specifically designed and adequately powered to detect significant between or within group differences in energy intake in response to exercise training. With the exception of 2 acute studies ,  no studies included in this review were statistically powered to detect between or within group differences in energy or macronutrient intake. Only 5 of 12 non-randomized trials (∼42%) , , – and 3 of 24 randomized trials (∼13%) were conducted specifically to evaluate the effect of exercise training on energy and macronutrient intake , , . The sample size in each of these 3 trials was <20 participants/group. Inadequate statistical power may explain the disconnect between the results of our review, which found no effect of exercise training on energy intake and other trials that have evaluated the effect of exercise on body weight. For example, studies have reported high individual variability in weight loss in response to the same level of exercise energy expenditure  and no significant increase in weight loss in response to increased level of exercise energy expenditure , . Both of these observations suggest compensatory increases in energy intake in response to exercise training; however, changes in resting metabolic rate and non-exercise physical activity may also play a role.
Because most exercise training studies did not prescribe exercise by level of energy expenditure, assess exercise energy expenditure, or employ adequate methods for the assessment of energy intake, it is not possible to determine the level of exercise induced energy imbalance actually achieved. Only 7 of the 36 non-randomized and randomized trials included in this review (∼19%) prescribed exercise by level of energy expenditure , , , , , ,  while only 3 of those trials included assessments of the actual level of exercise energy expenditure by indirect calorimetry , , . Furthermore, the heterogeneity of exercise/physical activity prescriptions prohibits the identification of a specific level that may elicit compensatory changes in energy intake. Only 5 of 36 non-randomized and randomized trials employed more precise estimates of dietary intake such as weigh and measure test meals , , ,  or observed weigh and measure ad-libitum eating . Two of the 3 trials that measured exercise energy expenditure used only 1 day assessments of energy intake using test meals at baseline and end study , , while one trial employed 4 day food records at baseline, mid and end study . Thus, reported estimates of energy balance should be cautiously interpreted. The available literature is also limited by a preponderance of data from acute/short-term studies as compared to non-randomized and randomized longitudinal trials. For example, approximately 50% of studies reviewed evaluated the acute or short-term (2–14 days) effect of exercise on energy and macronutrient intake. While acute/short-term studies have employed precise methods for the assessment of energy intake (weigh and measure test meals), the short time frame over which energy intake was assessed may be insufficient to demonstrate significant adaptations in energy intake that may be induced by changes in parameters such as aerobic fitness, body weight or hormonal status etc. associated with longer term exercise training. For example, in overweight men and women Kirk et al.  have shown that changes in aerobic fitness and weight takes 4 months and does not level off until 9 months in an exercise program with a typical progressive exercise protocol
Approximately 60% of acute studies reviewed recruited participants who were relatively young (median age = 23 years), normal weight, and physically active or aerobically fit. Thus, results from acute trials do not generalize to the older, sedentary overweight population in need of weight management. The available literature is also limited by an insufficient number of studies that have evaluated the impact of exercise parameters (e.g. mode, frequency, intensity, duration, time of day, time course) or participant characteristics (e.g. age, gender, ethnicity, weight, activity level) on energy and/or macronutrient intake.
Limitations of this Review
Our conclusions should be cautiously interpreted as they are based on both data from sub-optimal study designs (e.g. cross-sectional, acute/short-term, non-randomized trials) and from randomized trials with a high risk of one or more forms of bias. In addition, we did not contact authors to obtain missing data or for clarification of any information presented in the published reports; therefore missing information may reflect reporting bias as opposed to any limitations in the conduct of the study.
The present systematic review found limited evidence to suggest that acute exercise or exercise training has a significant effect on energy or macronutrient intake. However, as previously discussed the available literature on this topic suffers numerous methodological shortcomings. Therefore, we recommend additional randomized trials to specifically evaluate the impact of exercise training on energy and macronutrient intake that: 1) are powered specifically to detect clinically significant differences in energy and/or macronutrient intake; 2) utilize state-of-the-art techniques for the assessment of energy intake such as direct observation weigh and measure or picture-plate-waste and provide multiple measures across the duration of the study; 3) include assessments of exercise energy expenditure across the duration of the study; 4) evaluate and compare levels of exercise for weight management currently recommended by governmental agencies or professional organizations such as the International Association for the Study of Obesity, the Institute of Medicine, and the American College of Sports Medicine (i.e. 60–90 min/day, moderate intensity) to determine differential effects on energy and macronutrient intake; 5) include overweight and obese, sedentary middle-age or older adults; and 6) evaluate both the effect of exercise parameters (e.g. mode, frequency, intensity duration, time course) and participant characteristics (e.g. age, gender, body weight, activity level, ethnicity) on the association between exercise and energy and macronutrient intake.
Conceived and designed the experiments: JD RW SH KL JH AS. Performed the experiments: JD RW SH KL JH AS. Analyzed the data: JD RW SH KL JH AS. Contributed reagents/materials/analysis tools: JD RW SH KL JH AS. Wrote the paper: JD RW SH KL JH AS.
- 1. Flegal KM, Carroll MD, Kit BK, Ogden CL (2012) Prevalence of Obesity and Trends in the Distribution of Body Mass Index Among US Adults, 1999–2010. Journal of the American Medical Association 307: 491–497.
- 2. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W (2009) Annual Medical Spending Attributable To Obesity: Payer-And Service-Specific Estimates. Health Affairs 28: w822–w831.
- 3. Yaemsiri S, M SM, K AS (2011) Perceived weight status, overweight diagnosis, and weight control among US adults: the NHANES 2003–2008 Study. International Journal of Obesity 35: 1063–1070.
- 4. Saris WH, Blair SN, van Baak MA, Eaton SB, Davies PS, et al. (2003) How much physical activity is enough to prevent unhealthy weight gain? Outcome of the IASO 1st Stock Conference and consensus statement. Obes Rev 4: 101–114.
- 5. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Natl Academy Pr
- 6. (2008) 2008 Physical Activity Guidelines for Americans. Available: http://www.health.gov/paguidelines: Office of Disease Prevention & Health Promotion.
- 7. Healthy People 2020. Office of Disease Prevention and Health Promotion. Washington, DC. Available: http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=29. Accessed 2012 Mar 16.
- 8. Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, et al. (2009) American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc 41: 459–471.
- 9. Donnelly JE, Hill JO, Jacobsen DJ, Potteiger J, Sullivan DK, et al. (2003) Effects of a 16-month randomized controlled exercise trial on body weight and composition in young, overweight men and women: the Midwest Exercise Trial. Arch Intern Med 163: 1343–1350.
- 10. Slentz CA, Duscha BD, Johnson JL, Ketchum K, Aiken LB, et al. (2004) Effects of the amount of exercise on body weight, body composition, and measures of central obesity - STRRIDE - A randomized controlled study. Archives of Internal Medicine 164: 31–39.
- 11. Donnelly JE, Honas JJ, Smith BK, Mayo MS, Gibson CA, et al. (2013) Aerobic exercise alone results in clinically significant weight loss for men and women: midwest exercise trial 2. Obesity (Silver Spring) 21: E219–228.
- 12. Wilmore JH, Stanforth PR, Hudspeth LA, Gagnon J, Daw EW, et al. (1998) Alterations in resting metabolic rate as a consequence of 20 wk of endurance training: the HERITAGE Family Study. Am J Clin Nutr 68: 66–71.
- 13. Stiegler P, Cunliffe A (2006) The role of diet and exercise for the maintenance of fat-free mass and resting metabolic rate during weight loss. Sports Med 36: 239–262.
- 14. Gilliat-Wimberly M, Manore MM, Woolf K, Swan PD, Carroll SS (2001) Effects of habitual physical activity on the resting metabolic rates and body compositions of women aged 35 to 50 years. J Am Diet Assoc 101: 1181–1188.
- 15. Potteiger JA, Kirk EP, Jacobsen DJ, Donnelly JE (2008) Changes in resting metabolic rate and substrate oxidation after 16 months of exercise training in overweight adults. Int J Sport Nutr Exerc Metab 18: 79–95.
- 16. Church TS, Martin CK, Thompson AM, Earnest CP, Mikus CR, et al. (2009) Changes in weight, waist circumference and compensatory responses with different doses of exercise among sedentary, overweight postmenopausal women. PLoS One 4: e4515.
- 17. King NA, Caudwell P, Hopkins M, Byrne NM, Colley R, et al. (2007) Metabolic and behavioral compensatory responses to exercise interventions: barriers to weight loss. Obesity (Silver Spring) 15: 1373–1383.
- 18. King NA, Hopkins M, Caudwell P, Stubbs RJ, Blundell JE (2008) Individual variability following 12 weeks of supervised exercise: identification and characterization of compensation for exercise-induced weight loss. Int J Obes (Lond) 32: 177–184.
- 19. Stubbs RJ, Hughes DA, Johnstone AM, Whybrow S, Horgan GW, et al. (2004) Rate and extent of compensatory changes in energy intake and expenditure in response to altered exercise and diet composition in humans. Am J Physiol Regul Integr Comp Physiol 286: R350–358.
- 20. Westerterp K (2001) Pattern and intensity of physical activity. Nature 410: 539.
- 21. Manthou E, Gill JMR, Wright A, Malkova D (2010) Behavioral compensatory adjustments to exercise training in overweight women. Med Sci Sports Exerc 42: 1221–1228.
- 22. Blundell JE, Stubbs RJ, Hughes DA, Whybrow S, King NA (2003) Cross talk between physical activity and appetite control: does physical activity stimulate appetite? Proceedings of the Nutrition Society 62: 651–661.
- 23. Martins C, Robertson MD, Morgan LM (2008) Effects of exercise and restrained eating behaviour on appetite control. Proceedings of the Nutrition Society 67: 28–41.
- 24. Martins C, Morgan L, Truby H (2008) A review of the effects of exercise on appetite regulation: an obesity perspective. International Journal of Obesity 32: 1337–1347.
- 25. King NA, Horner K, Hills AP, Byrne NM, Wood RE, et al. (2012) Exercise, appetite and weight management: understanding the compensatory responses in eating behaviour and how they contribute to variability in exercise-induced weight loss. British Journal of Sports Medicine 46: 315–322.
- 26. Hopkins M, King NA, Blundell JE (2010) Acute and long-term effects of exercise on appetite control: is there any benefit for weight control? Current Opinion in Clinical Nutrition and Metabolic Care 13: 635–640.
- 27. Stensel D (2010) Exercise, appetite and appetite-regulating hormones: implications for food intake and weight control. Annals of Nutrition and Metabolism 57: 36–42.
- 28. Melzer K, Kayser B, Saris WHM, Pichard C (2005) Effects of physical activity on food intake. Clinical Nutrition 24: 885–895.
- 29. Prentice A, Jebb SA (2004) Energy Intake/Physical Activity Interactions in the Homeostasis of Body Weight Regulation. Nutrition Reviews 62: S98–S104.
- 30. Schubert MM, Desbrow B, Sabapathy S, Leveritt M (2013) Acute exercise and subsequent energy intake. A meta-analysis. Appetite 63: 92–104.
- 31. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzce PC, et al. (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Journal of Clinical Epidemiology 62: e1–e34.
- 32. Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, et al. (2010) CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol 63: e1–37.
- 33. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, et al. (2009) Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42: 377–381.
- 34. Higgins JP, Green S, Collaboration C (2008) Cochrane handbook for systematic reviews of interventions: Wiley Online Library.
- 35. Camoes M, Lopes C (2008) Dietary intake and different types of physical activity: Full-day energy expenditure, occupational and leisure-time. Public Health Nutrition 11: 841–848.
- 36. Eaton CB, McPhillips JB, Gans KM, Garber CE, Assaf AR, et al. (1995) Cross-sectional relationship between diet and physical activity in two southeastern New England communities. American Journal of Preventive Medicine 11: 238–244.
- 37. Lake AA, Townshend T, Alvanides S, Stamp E, Adamson AJ (2009) Diet, physical activity, sedentary behaviour and perceptions of the environment in young adults. Journal of Human Nutrition and Dietetics 22: 444–454.
- 38. Rintala M, Lyytikainen A, Leskinen T, Alen M, Pietilainen KH, et al. (2011) Leisure-time physical activity and nutrition: a twin study. Public Health Nutr 14: 846–852.
- 39. Van Walleghen EL, Orr JS, Gentile CL, Davy KP, Davy BM (2007) Habitual physical activity differentially affects acute and short-term energy intake regulation in young and older adults. International Journal of Obesity 31: 1277–1285.
- 40. Van Pelt RE, Dinneno FA, Seals DR, Jones PP (2001) Age-related decline in RMR in physically active men: Relation to exercise volume and energy intake. American Journal of Physiology - Endocrinology and Metabolism 281: E633–E639.
- 41. D'Angelo E, Di Blasio A, Di Donato F, Di Gregorio S, Di Renzo D, et al. (2010) Relationships between physical exercise practice, dietary behaviour and body composition in female university students. J Sports Med Phys Fitness 50: 311–317.
- 42. Duvigneaud N, Wijndaele K, Matton L, Philippaerts R, Lefevre J, et al. (2007) Dietary factors associated with obesity indicators and level of sports participation in Flemish adults: A cross-sectional study. Nutrition Journal 6.
- 43. Hornbuckle LM, Bassett DR Jr, Thompson DL (2005) Pedometer-determined walking and body composition variables in African-American women. Medicine and Science in Sports and Exercise 37: 1069–1074.
- 44. Lee IM, Djousse L, Sesso HD, Wang L, Buring JE (2010) Physical activity and weight gain prevention. JAMA - Journal of the American Medical Association 303: 1173–1179.
- 45. Lissner L, Heitmann BL, Bengtsson C (1997) Low-fat diets may prevent weight gain in sedentary women: prospective observations from the population study of women in Gothenburg, Sweden. Obes Res 5: 43–48.
- 46. Mulligan K, Butterfield GE (1990) Discrepancies between energy intake and expenditure in physically active women. British Journal of Nutrition 64: 23–36.
- 47. Matthews CE, Hebert JR, Ockene IS, Saperia G, Merriam PA (1997) Relationship between leisure-time physical activity and selected dietary variables in the worcester area trial for counseling in hyperlipidemia. Medicine and Science in Sports and Exercise 29: 1199–1207.
- 48. Perry AC, Shaw MH, Hsia L, Nash MS, Kaplan T, et al. (1992) Plasma lipid levels in active and sedentary premenopausal females. International Journal of Sports Medicine 13: 210–215.
- 49. Jago R, Nicklas T, Yang SJ, Baranowski T, Zakeri I, et al. (2005) Physical activity and health enhancing dietary behaviors in young adults: Bogalusa Heart Study. Preventive Medicine 41: 194–202.
- 50. Butterworth DE, Nieman DC, Underwood BC, Lindsted KD (1994) The relationship between cardiorespiratory fitness, physical activity, and dietary quality. Int J Sport Nutr 4: 289–298.
- 51. Imbeault P, Saint-Pierre S, Almeras N, Tremblay A (1997) Acute effects of exercise on energy intake and feeding behaviour. British Journal of Nutrition 77: 511–521.
- 52. Pomerleau M, Imbeault P, Parker T, Doucet E (2004) Effects of exercise intensity on food intake and appetite in women. American Journal of Clinical Nutrition 80: 1230–1236.
- 53. Unick JL, Otto AD, Goodpaster BH, Helsel DL, Pellegrini CA, et al. (2010) Acute effect of walking on energy intake in overweight/obese women. Appetite 55: 413–419.
- 54. Melby CL, Osterberg KL, Resch A, Davy B, Johnson S, et al. (2002) Effect of carbohydrate ingestion during exercise on post-exercise substrate oxidation and energy intake. Int J Sport Nutr Exerc Metab 12: 294–309.
- 55. O'Donoghue KJM, Fournier PA, Guelfi KJ (2010) Lack of effect of exercise time of day on acute energy intake in healthy men. International Journal of Sport Nutrition and Exercise Metabolism 20: 350–356.
- 56. King JA, Wasse LK, Stensel DJ (2011) The acute effects of swimming on appetite, food intake, and plasma acylated ghrelin. J Obes 2011.
- 57. King JA, Miyashita M, Wasse LK, Stensel DJ (2010) Influence of prolonged treadmill running on appetite, energy intake and circulating concentrations of acylated ghrelin. Appetite 54: 492–498.
- 58. King JA, Wasse LK, Broom DR, Stensel DJ (2010) Influence of brisk walking on appetite, energy intake, and plasma acylated ghrelin. Med Sci Sports Exerc 42: 485–492.
- 59. King NA, Blundell JE (1995) High-fat foods overcome the energy expenditure induced by high-intensity cycling or running. European Journal of Clinical Nutrition 49: 114–123.
- 60. King NA, Burley VJ, Blundell JE (1994) Exercise-induced suppression of appetite: Effects on food intake and implications for energy balance. European Journal of Clinical Nutrition 48: 715–724.
- 61. Harris CL, George VA (2008) The impact of dietary restraint and moderate-intensity exercise on post-exercise energy intake in sedentary males. Eating Behaviors 9: 415–422.
- 62. Visona C, George VA (2002) Impact of dieting status and dietary restraint on postexercise energy intake in overweight women. Obes Res 10: 1251–1258.
- 63. Maraki M, Tsofliou F, Pitsiladis YP, Malkova D, Mutrie N, et al. (2005) Acute effects of a single exercise class on appetite, energy intake and mood. Is there a time of day effect? Appetite 45: 272–278.
- 64. Erdmann J, Tahbaz R, Lippl F, Wagenpfeil S, Schusdziarra V (2007) Plasma ghrelin levels during exercise - Effects of intensity and duration. Regulatory Peptides 143: 127–135.
- 65. Laan DJ, Leidy HJ, Lim E, Campbell WW (2010) Effects and reproducibility of aerobic and resistance exercise on appetite and energy intake in young, physically active adults. Appl Physiol Nutr Metab 35: 842–847.
- 66. Schneider KL, Spring B, Pagoto SL (2009) Exercise and energy intake in overweight, sedentary individuals. Eating Behaviors 10: 29–35.
- 67. Verger P, Lanteaume MT, Louis-Sylvestre J (1992) Human intake and choice of foods at intervals after exercise. Appetite 18: 93–99.
- 68. Martins C, Morgan LM, Bloom SR, Robertson MD (2007) Effects of exercise on gut peptides, energy intake and appetite. J Endocrinol 193: 251–258.
- 69. Finlayson G, Bryant E, Blundell JE, King NA (2009) Acute compensatory eating following exercise is associated with implicit hedonic wanting for food. Physiology and Behavior 97: 62–67.
- 70. Lluch A, King NA, Blundell JE (2000) No energy compensation at the meal following exercise in dietary restrained and unrestrained women. Br J Nutr 84: 219–225.
- 71. Lluch A, King NA, Blundell JE (1998) Exercise in dietary restrained women: no effect on energy intake but change in hedonic ratings. Eur J Clin Nutr 52: 300–307.
- 72. Tsofliou F, Pitsiladis YP, Malkova D, Wallace AM, Lean ME (2003) Moderate physical activity permits acute coupling between serum leptin and appetite-satiety measures in obese women. Int J Obes Relat Metab Disord 27: 1332–1339.
- 73. George VA, Morganstein A (2003) Effect of moderate intensity exercise on acute energy intake in normal and overweight females. Appetite 40: 43–46.
- 74. King NA, Snell L, Smith RD, Blundell JE (1996) Effects of short-term exercise on appetite responses in unrestrained females. European Journal of Clinical Nutrition 50: 663–667.
- 75. Kissileff HR, Pi-Sunyer FX, Segal K, Meltzer S, Foelsch PA (1990) Acute effects of exercise on food intake in obese and nonobese women. Am J Clin Nutr 52: 240–245.
- 76. Larson-Meyer DE, Palm S, Bansal A, Austin KJ, Hart AM, et al. (2012) Influence of running and walking on hormonal regulators of appetite in women. Journal of Obesity 2012.
- 77. Balaguera-Cortes L, Wallman KE, Fairchild TJ, Guelfi KJ (2011) Energy intake and appetite-related hormones following acute aerobic and resistance exercise. Appl Physiol Nutr Metab 36: 958–966.
- 78. Jokisch E, Coletta A, Raynor HA (2012) Acute energy compensation and macronutrient intake following exercise in active and inactive males who are normal weight. Appetite 58: 722–729.
- 79. Kelly PJ, Guelfi KJ, Wallman KE, Fairchild TJ (2012) Mild dehydration does not reduce postexercise appetite or energy intake. Med Sci Sports Exerc 44: 516–524.
- 80. Vatansever-Ozen S, Tiryaki-Sonmez G, Bugdayci G, Ozen G (2011) The effects of exercise on food intake and hunger: Relationship with acylated ghrelin and leptin. Journal of Sports Science and Medicine 10: 283–291.
- 81. Deighton K, Zahra JC, Stensel DJ (2012) Appetite, energy intake and resting metabolic responses to 60 min treadmill running performed in a fasted versus a postprandial state. Appetite 58: 946–954.
- 82. King JA, Wasse LK, Ewens J, Crystallis K, Emmanuel J, et al. (2011) Differential acylated ghrelin, peptide YY3-36, appetite, and food intake responses to equivalent energy deficits created by exercise and food restriction. Journal of Clinical Endocrinology and Metabolism 96: 1114–1121.
- 83. Verger P, Lanteaume MT, Louis-Sylvestre J (1994) Free food choice after acute exercise in men. Appetite 22: 159–164.
- 84. Shorten AL, Wallman KE, Guelfi KJ (2009) Acute effect of environmental temperature during exercise on subsequent energy intake in active men. Am J Clin Nutr 90: 1215–1221.
- 85. Ueda SY, Yoshikawa T, Katsura Y, Usui T, Fujimoto S (2009) Comparable effects of moderate intensity exercise on changes in anorectic gut hormone levels and energy intake to high intensity exercise. Journal of Endocrinology 203: 357–364.
- 86. Ueda SY, Yoshikawa T, Katsura Y, Usui T, Nakao H, et al. (2009) Changes in gut hormone levels and negative energy balance during aerobic exercise in obese young males. J Endocrinol 201: 151–159.
- 87. Stubbs RJ, Sepp A, Hughes DA, Johnstone AM, King N, et al. (2002) The effect of graded levels of exercise on energy intake and balance in free-living women. International Journal of Obesity 26: 866–869.
- 88. Whybrow S, Hughes DA, Ritz P, Johnstone AM, Horgan GW, et al. (2008) The effect of an incremental increase in exercise on appetite, eating behaviour and energy balance in lean men and women feeding. British Journal of Nutrition 100: 1109–1115.
- 89. Stubbs RJ, Sepp A, Hughes DA, Johnstone AM, Horgan GW, et al. (2002) The effect of graded levels of exercise on energy intake and balance in free-living men, consuming their normal diet. European Journal of Clinical Nutrition 56: 129–140.
- 90. Keim NL, Barbieri TF, Belko AZ (1990) The effect of exercise on energy intake and body composition in overweight women. Int J Obes 14: 335–346.
- 91. Keim NL, Canty DJ, Barbieri TF, Wu MM (1996) Effect of exercise and dietary restraint on energy intake of reduced-obese women. Appetite 26: 55–70.
- 92. Stubbs RJ, Hughes DA, Johnstone AM, Horgan GW, King N, et al. (2004) A decrease in physical activity affects appetite, energy, and nutrient balance in lean men feeding ad libitum. American Journal of Clinical Nutrition 79: 62–69.
- 93. Staten MA (1991) The effect of exercise on food intake in men and women. American Journal of Clinical Nutrition 53: 27–31.
- 94. King NA, Lluch A, Stubbs RJ, Blundell JE (1997) High dose exercise does not increase hunger or energy intake in free living males. European Journal of Clinical Nutrition 51: 478–483.
- 95. Tremblay A, Almeras N, Boer J, Kranenbarg EK, Despres JP (1994) Diet composition and postexercise energy balance. American Journal of Clinical Nutrition 59: 975–979.
- 96. Farah NM, Malkova D, Gill JM (2010) Effects of exercise on postprandial responses to ad libitum feeding in overweight men. Med Sci Sports Exerc 42: 2015–2022.
- 97. Koulouri AA, Tigbe WW, Lean MEJ (2006) The effect of advice to walk 2000 extra steps daily on food intake. Journal of Human Nutrition and Dietetics 19: 263–266.
- 98. Martins C, Kulseng B, King NA, Holst JJ, Blundell JE (2010) The effects of exercise-induced weight loss on appetite-related peptides and motivation to eat. Journal of Clinical Endocrinology and Metabolism 95: 1609–1616.
- 99. Snyder KA, Donnelly JE, Jabobsen DJ, Hertner G, Jakicic JM (1997) The effects of long-term, moderate intensity, intermittent exercise on aerobic capacity, body composition, blood lipids, insulin and glucose in overweight females. International Journal of Obesity 21: 1180–1189.
- 100. Westerterp KR, Meijer GA, Janssen EM, Saris WH, Ten Hoor F (1992) Long-term effect of physical activity on energy balance and body composition. Br J Nutr 68: 21–30.
- 101. Andersson B, Xu X, Rebuffe-Scrive M, Terning K, Krotkiewski M, et al. (1991) The effects of exercise training on body composition and metabolism in men and women. International Journal of Obesity 15: 75–81.
- 102. Suzuki S, Urata G, Ishida Y, Kanehisa H, Yamamura M (1998) Influences of low intensity exercise on body composition, food intake and aerobic power of sedentary young females. Appl Human Sci 17: 259–266.
- 103. Bryant EJ, Caudwell P, Hopkins ME, King NA, Blundell JE (2012) Psycho-markers of weight loss. The roles of TFEQ Disinhibition and Restraint in exercise-induced weight management. Appetite 58: 234–241.
- 104. Caudwell P, Gibbons C, Hopkins M, King N, Finlayson G, et al. (2013) No Sex Difference in Body Fat in Response to Supervised and Measured Exercise. Medicine and Science in Sports and Exercise 45: 351–358.
- 105. Di Blasio A, Ripari P, Bucci I, Di Donato F, Izzicupo P, et al. (2012) Walking training in postmenopause: effects on both spontaneous physical activity and training-induced body adaptations. Menopause-the Journal of the North American Menopause Society 19: 23–32.
- 106. Keytel LR, Lambert MI, Johnson J, Noakes TD, Lambert EV (2001) Free living energy expenditure in post menopausal women before and after exercise training. International Journal of Sport Nutrition 11: 226–237.
- 107. Brandon LJ, Elliott-Lloyd MB (2006) Walking, body composition, and blood pressure dose-response in African American and White women. Ethnicity and Disease 16: 675–681.
- 108. Broeder CE, Burrhus KA, Svanevik LS, Wilmore JH (1992) The effects of either high-intensity resistance or endurance training on resting metabolic rate. American Journal of Clinical Nutrition 55: 802–810.
- 109. Donnelly JE, Kirk EP, Jacobsen DJ, Hill JO, Sullivan DK, et al. (2003) Effects of 16 mo of verified, supervised aerobic exercise on macronutrient intake in overweight men and women: the Midwest Exercise Trial. Am J Clin Nutr 78: 950–956.
- 110. Foster-Schubert KE, Alfano CM, Duggan CR, Xiao L, Campbell KL, et al. (2012) Effect of Diet and Exercise, Alone or Combined, on Weight and Body Composition in Overweight-to-Obese Postmenopausal Women. Obesity 20: 1628–1638.
- 111. Kirkwood L, Aldujaili E, Drummond S (2007) Effects of advice on dietary intake and/or physical activity on body composition, blood lipids and insulin resistance following a low-fat, sucrose-containing, high-carbohydrate, energy-restricted diet. International Journal of Food Sciences and Nutrition 58: 383–397.
- 112. Nieman DC, Haig JL, Fairchild KS, De Guia ED, Dizon GP, et al. (1990) Reducing-diet and exercise-training effects on serum lipids and lipoproteins in mildly obese women. American Journal of Clinical Nutrition 52: 640–645.
- 113. Nordby P, Auerbach PL, Rosenkilde M, Kristiansen L, Thomasen JR, et al. (2012) Endurance training per se increases metabolic health in young, moderately overweight men. Obesity 20: 2202–2212.
- 114. Pritchard JE, Nowson CA, Wark JD (1997) A worksite program for overweight middle-aged men achieves lesser weight loss with exercise than with dietary change. J Am Diet Assoc 97: 37–42.
- 115. Ready AE, Drinkwater DT, Ducas J, Fitzpatrick D, Brereton DG, et al. (1995) Walking program reduces elevated cholesterol in women postmenopause. Canadian Journal of Cardiology 11: 905–912.
- 116. Ready AE, Naimark B, Ducas J, Sawatzky JAV, Boreskie SL, et al. (1996) Influence of walking volume on health benefits in women post-menopause. Medicine and Science in Sports and Exercise 28: 1097–1105.
- 117. Reseland JE, Anderssen SA, Solvoll K, Hjermann I, Urdal F, et al. (2001) Effect of long-term changes in diet and exercise on plasma leptin concentrations. American Journal of Clinical Nutrition 73: 240–245.
- 118. Shaw BS, Shaw I, Mamen A (2010) Contrasting effects in anthropometric measures of total fatness and abdominal fat mass following endurance and concurrent endurance and resistance training. J Sports Med Phys Fitness 50: 207–213.
- 119. Van Etten LM, Westerterp KR, Verstappen FT, Boon BJ, Saris WH (1997) Effect of an 18-wk weight-training program on energy expenditure and physical activity. J Appl Physiol 82: 298–304.
- 120. Washburn RA, Kirk EP, Smith BK, Honas JJ, Lecheminant JD, et al. (2012) One set resistance training: effect on body composition in overweight young adults. J Sports Med Phys Fitness 52: 273–279.
- 121. Rosenkilde M, Auerbach P, Reichkendler MH, Ploug T, Stallknecht BM, et al. (2012) Body fat loss and compensatory mechanisms in response to different doses of aerobic exercise-a randomized controlled trial in overweight sedentary males. American Journal of Physiology - Regulatory Integrative and Comparative Physiology 303: R571–R579.
- 122. Jakicic JM, Otto AD, Lang W, Semler L, Winters C, et al. (2011) The Effect of Physical Activity on 18-Month Weight Change in Overweight Adults. Obesity 19: 100–109.
- 123. Bales CW, Hawk VH, Granville EO, Rose SB, Shields T, et al. (2012) Aerobic and resistance training effects on energy intake: the STRRIDE-AT/RT study. Med Sci Sports Exerc 44: 2033–2039.
- 124. Cox KL, Burke V, Beilin LJ, Puddey IB (2010) A comparison of the effects of swimming and walking on body weight, fat distribution, lipids, glucose, and insulin in older women–the Sedentary Women Exercise Adherence Trial 2. Metabolism 59: 1562–1573.
- 125. Bryner RW, Toffle RC, Ullrich IH, Yeater RA (1997) The effects of exercise intensity on body composition, weight loss, and dietary composition in women. Journal of the American College of Nutrition 16: 68–73.
- 126. Grediagin A, Cody M, Rupp J, Benardot D, Shern R (1995) Exercise intensity does not effect body composition change in untrained, moderately overfat women. J Am Diet Assoc 95: 661–665.
- 127. Miyashita M, Eto M, Sasai H, Tsujimoto T, Nomata Y, et al. (2010) Twelve-week jogging training increases pre-heparin serum lipoprotein lipase concentrations in overweight/obese middle-aged men. Journal of Atherosclerosis and Thrombosis 17: 21–29.
- 128. Donnelly JE, Jacobsen DJ, Heelan KS, Seip R, Smith S (2000) The effects of 18 months of intermittent vs continuous exercise on aerobic capacity, body weight and composition, and metabolic fitness in previously sedentary, moderately obese females. International Journal of Obesity 24: 566–572.
- 129. Cox KL, Burke V, Morton AR, Beilin LJ, Puddey IB (2003) The independent and combined effects of 16 weeks of vigorous exercise and energy restriction on body mass and composition in free-living overweight men–a randomized controlled trial. Metabolism 52: 107–115.
- 130. Kirk EP, Jacobsen DJ, Gibson C, Hill JO, Donnelly JE (2003) Time course for changes in aerobic capacity and body composition in overweight men and women in response to long-term exercise: the Midwest Exercise Trial (MET). Int J Obes Relat Metab Disord 27: 912–919.