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ARTICLE

Is Exercise Effective for Weight Loss With Ad


Libitum Diet? Energy Balance, Compensation, and
Gender Differences
Joseph E. Donnelly and Bryan K. Smith
Center for Physical Activity and Weight Management, Schiefelbusch Life Span Institute, University of Kansas,
Lawrence, Kansas
DONNELLY, J.E., and B.K. SMITH. Is exercise effective for weight loss with ad libitum diet? Energy balance, compensation,
and gender differences. Exerc. Sport Sci. Rev., Vol. 33, No. 4, pp. 169 174, 2005. Exercise generally results in less weight loss
than expected and it is frequently observed that men and women do not respond equally to exercise for weight loss. This may be
caused by differences in compensation by other components of energy balance or to differences in the energy expenditure of exercise
observed between genders. Key Words: exercise, weight loss, energy balance, energy expenditure, gender

INTRODUCTION

WHAT IS ENERGY BALANCE?

Increased exercise is recommended during weight reduction


by virtually every public health organization; however, the
role of exercise is generally considered secondary to energy
restriction for the treatment of obesity. The classic explanation for the secondary role of exercise is that exercise alone
cannot generate enough energy expenditure to create a negative energy balance to the extent possible with energy
restriction and thus the role of exercise is diminished for
weight loss.
This review discusses the interactive components of energy
balance, the magnitude of exercise that is necessary for
weight loss, and the difference between genders for weight
loss in response to exercise, including potential compensation in the components of energy balance. Finally, we propose a model based on previous research to test for gender
differences for weight loss in response to exercise.

Energy balance refers to an equal amount of energy intake


and energy expenditure. Obesity is the result of excess energy
intake compared to energy expenditure. To lose weight, a
negative energy balance must be evoked, and to maintain lost
weight, energy balance must be maintained. To illustrate,
Figure 1 shows energy intake, energy expenditure, and the
standard components of energy balance.
Although the concept of energy balance appears simple, it
is deceptively so. Energy intake consists of all ingested foods
and beverages with an energy value. Control of energy intake
is subject to a host of environmental, behavioral, biological,
and genetic influences. Measurement of energy intake is
notoriously difficult and prone to error. Men and women
routinely underestimate energy intake by 30 to 50%. Energy
expenditure consists of resting metabolic rate (RMR), the
thermic effect of foods (TEF), spontaneous physical activity
(SPA), and exercise. Energy expenditure can be measured
with reasonable precision in the laboratory, but the cost is
appreciable, it has a high burden on the individual, and it is
not suitable for population studies.
It may appear that calculating energy intake and energy
expenditure is a relatively simple matter of addition and
subtraction, and this is frequently the method used to calculate a negative energy balance in the attempt to lose weight.
Unfortunately, it is not so simple because the components of
energy balance are interactive, as shown in Figure 2. As
energy expenditure increases, a second component or multiple components of energy balance may change or compensate and, in turn, weight loss may not occur. For example, an

Address for correspondence: Joseph E. Donnelly, Ed. D., 1301 Sunnyside Ave, Room 100,
Robinson Center, University of Kansas, Lawrence, KS 66045 (E-mail: jdonnelly@
ku.edu).
Accepted for publication: April 5, 2005.
0091-6331/3304/169 174
Exercise and Sport Sciences Reviews
Copyright 2005 by the American College of Sports Medicine

169

TEF were under voluntary control, an individual could


simply overeat and increase their RMR or TEF and remain
weight-stable.
Exercise can account for almost no energy expenditure or
a great deal of energy expenditure across a 24-h period.
Exercise is generally thought of as planned behavior that is
different from SPA. Although SPA requires energy expenditure, it is apparent that many individuals do not achieve a
great deal of energy expenditure with SPA on a routine basis
as evidenced by the dramatic increase in overweight and
obesity. Thus, during the attempt at weight loss, individuals
are generally counseled to maintain SPA and increase exercise in the attempt to create a gap between energy intake and
expenditure.
EXERCISE AND MAGNITUDE OF WEIGHT LOSS

Figure 1.
Static model of energy balance. (A) Weight gain; (B) weight
loss; (C) weight maintenance. PRO, protein; CHO, carbohydrate; SPA,
spontaneous physical activity; TEF, thermic effect of food; RMR, resting
metabolic rate.

individual may attempt to lose weight with a 500-kcal negative energy balance using a reduced energy diet. However,
diets have been shown to diminish RMR and SPA; therefore,
the intended energy deficit may be less than planned or
absent altogether.

The existent literature appears to provide little evidence


that exercise alone is a potent strategy for weight loss. Epstein
and Wing (5) completed the first review of weight loss studies
using meta-analytic techniques in 1980 and found that exercise alone showed a 1.15-kg weight loss in a typical 12-wk
program. More recently, The American College of Sports
Medicine Position Stand, Appropriate intervention strategies for weight loss and prevention of weight regain for
adults, acknowledges that there is little evidence to suggest
exercise alone will provide the amount of weight loss similar
to that generally achieved by diet restriction (7). The lack of
efficacy for exercise to promote weight loss may in part be
caused by the relatively low levels that have been used in
exercise studies. Frequently, levels are derived from exercise
standards that are intended to promote cardiovascular fitness,
not to promote weight loss. For example, a recent 12-month
randomized controlled trial (RCT) used an energy equivalent
of approximately 1200 kcalwk1 (low) or approximately
2000 kcalwk1 (high) with overweight men and women
(13). The group with the low energy equivalent lost only
approximately 1% of baseline weight and the group with high
energy equivalent lost approximately 3.5% of baseline
weight, both below the NHLBI recommendations.
Current evidence indicates that higher levels of exercise
than previously recommended may be necessary to promote

WHY USE EXERCISE TO ALTER ENERGY BALANCE


FOR WEIGHT LOSS?
There are limited choices an individual can make in the
attempt to evoke a negative energy balance for weight loss.
The most common method for weight loss is dietary restriction; however, diet does not provide a long-term solution
because more than 50% of individuals who lose weight
through diet eventually regain the weight they lost. Among
the reasons, exercise should be considered for weight
reduction is the simplistic argument that it can be. That
is, exercise and SPA are the only components of energy
expenditure that are under voluntary control. If RMR or
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Exercise and Sport Sciences Reviews

Figure 2.
Dynamic model of energy expenditure. Illustrates the possible changes in the components of energy balance that may occur with an
increase in exercise. SPA, spontaneous physical activity, TEF, thermic effect
of food. RMR, resting metabolic rate.
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weight loss. The Institute of Medicine has issued guidelines


suggesting that 1 h of moderately vigorous exercise may be
necessary for weight management. This is supported by two
studies from Ross et al., who determined that energy expenditure of exercise of 500 700 kcal per day for 12 wk provided
weight loss of approximately 6 kg for women (11) and approximately 8 kg for men (10). In both of these studies,
energy intake was closely controlled to baseline levels and
dietary counseling was provided throughout.
Similar findings have been shown in men, but not women,
in a long-term RCT that provided a minimum of 400
kcald1 of energy expenditure of exercise with ad libitum
diet (3). Using identical exercise prescription criteria (intensity, frequency, duration), men achieved approximately 3000
kcal energy expenditure of exercise per week, and this was
effective to provide a weight loss of approximately 6% for
men (Fig. 3). Women undergoing an identical exercise program achieved a verified energy equivalent of approximately
2000 kcalwk1 and were weight-stable, but did not lose
weight (Fig. 3). Thus, with increased levels of energy expenditure of exercise, weight loss has been shown in men, but to
a lesser extent in women. This suggests a gender difference or
differences in compensation in response to exercise and this
possibility is further discussed.

Figure 3. Body weight across 16 months between exercisers and controls by gender. (A) Men. (B) Women. EX, exercise; CON, control. Means
with different letters are different within the exercise group, P 0.05.
*Significant differences between exercise and control groups.
Volume 33 Number 4 October 2005

DO MEN AND WOMEN RESPOND DIFFERENTLY TO


EXERCISE FOR WEIGHT LOSS?
Although men generally show greater weight loss than
women in response to exercise (1), men and women are
frequently reported together when expressing the results from
exercise trials, and this makes it difficult to discern gender
effects. When data for men and women are combined, the
only comparison that can be made is a between-group comparison. If gender data are combined and there are significant
differences between the exercise and control groups, it is not
possible to determine whether one of the genders is primarily
responsible for between groups differences or if both genders
contributed equally. The ability to determine gender effects
is further compromised because approximately 70 published
studies of exercise for weight loss since 1960 do not report
final sample size by gender (6).
Although there are difficulties interpreting the literature
for differences for genders in response to exercise for weight
loss, there is reason to believe the difference in the energy
expenditure of exercise for men and women plays an important role. However, investigation of this premise is compromised because the energy expenditure of exercise is rarely
measured and reported in investigations of exercise for
weight loss. In addition, it is not adequate to use an energy
expenditure of exercise that has been estimated from a test of
maximal oxygen consumption completed at baseline and that
is not updated across the duration of the study. The energy
expenditure of exercise will decrease as the individual becomes more efficient, as fitness improves, and as weight is
lost. In turn, this may diminish the magnitude of weight loss.
In most investigations, exercise is prescribed and reported
as intensity, frequency, and duration. Frequency and duration
are easily quantified; however, intensity is generally reported
either as a target heart rate or at a subjective level such as
brisk walking. With this prescription, heavier individuals
will usually have greater energy expenditures compared to
lighter individuals, as will men compared to women, even
when all individuals are performing the same relative levels
of exercise. For example, in a 16-month RCT of exercise
alone for weight loss, men and women received identical
exercise prescriptions based on intensity, duration, and frequency, and the energy expenditure of exercise was measured
at 4-month intervals using indirect calorimetry (3). Verified
exercise heart rates for men were 154 11 bpm and 156
9 bpm for women. Using 24-h energy expenditure from
doubly labeled water (DLW) and RMR from indirect calorimetry, the Physical Activity Index (PAI) was calculated as
24-h energy expenditure divided by RMR. Men and women
showed increases from baseline to 16 months of PAI 1.51
0.34 to PAI 1.83 0.55 and from PAI 1.60 0.23 to PAI
1.74 0.15 at 16 months, respectively. Men achieved an
average of 667 116 kcal per exercise session compared with
women, who achieved an average of 438 88 kcal per
exercise session, for a mean difference of 229 kcal per exercise
session. When kilocalories were expressed per unit of fat-free
mass, men had an energy expenditure of exercise of 6.7 0.8
kcalkg1 fat-free mass and women had 5.4 kcalkg1 fat-free
mass (P 0.05). As a result of this exercise program prescribed at relative intensity, men lost 5.2 4.7 kg, and
Exercise, Energy Balance, and Weight Loss

171

women gained 0.6 3.8 kg. Thus, either a gender difference


exists and women compensate for exercise to a greater extent
than men (i.e., SPA, energy intake, etc.) or the difference
was caused by the different levels of energy expenditure of
exercise found when prescribing exercise by relative amount
rather than targeting the desired energy expenditure of exercise. The discrepancy between the energy expenditure of
exercise for men and women may contribute to the observation that women generally lose less weight than men in
response to exercise.

POTENTIAL COMPENSATION IN ENERGY BALANCE


IN RESPONSE TO EXERCISE
For exercise to be effective for weight loss, the real question is, will exercise provide a negative energy balance
without substantial compensation from other components of
the energy balance equation? It is apparent that the expected weight loss when calculated from energy expenditure
of exercise is usually greater than what is actually observed.
That is, when using a static model of energy balance it is
possible to calculate the energy deficit (in theory) created by
the energy expenditure of exercise and an energy value for a
pound of weight loss may be assigned, and this is generally
3500 kcal. For example, if an individual were to have a
calculated energy expenditure of 7000 kcal, the expected
weight loss would be 2 lb (7000 kcal/3500 kcal 2 lb).
It is now known that energy balance cannot be accurately
determined from a calculation using a static model. The
components of energy balance are dynamic and likely react to
changes in one component with compensation in another
component. For example, it is well known that when energy
intake is restricted, RMR decreases. Likewise, Liebel et al. (9)
demonstrated that when overfed, men and women did not
gain as much weight as calculated, and when underfed they
did not lose as much weight as calculated.
Resting Metabolic Rate
Although RMR decreases during energy restriction, there
is considerable evidence that RMR is preserved when weight
loss is caused by exercise (15). Thus, the components of
energy balance most likely to be responsible for compensation during exercise for weight loss are energy intake and
SPA. It is well known that energy intake is underreported by
as much as 20 to 50%, that women underreport more so than
men, and that underreporting increases as overweight and
obesity increases (12). For example, Donnelly et al. (3) reported a small increase in weight in response to 438 88
kcal per exercise session (approximately 2000 kcalwk1) for
16 months in women. During this time, energy intake was
monitored for six 2-wk periods in a cafeteria, and energy and
macronutrient content was calculated using weigh-and-measure techniques. Additionally, 24-h energy expenditure was
measured by DLW. Women had no changes for energy or
macronutrient content of their diet and increased 24-h energy expenditure by 209 555 kcal, yet lost no weight. Any
compensatory mechanisms for increased energy expenditure
of exercise by other components of energy expenditure (i.e.,
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Exercise and Sport Sciences Reviews

2resting metabolic rate, SPA) were not sufficient to diminish the effects of exercise as evidenced by the increase in 24-h
energy expenditure. Thus, in women, compensation through
increases in energy intake is suspect.
Spontaneous Physical Activity
SPA is difficult to measure with accuracy. For example,
Jakicic et al. (8) have reported that 45% of overweight and
obese individuals overestimate the amount of SPA they
achieve when self-report was compared to data from accelerometry. Perhaps the best estimation of SPA is derived from
the estimation of 24-h energy expenditure from DLW combined with measurements of RMR, an estimation of TEF
(i.e., 10% of 24-h energy expenditure), and measurement of
planned exercise. In this fashion, SPA is estimated as the
energy left when these components are subtracted from 24-h
energy expenditure derived from DLW. Washburn et al. (14)
compared SPA obtained from DLW in 45 overweight sedentary men and women and found no significant differences
across 16 months of exercise. When SPA from DLW was
compared to SPA from physical activity questionnaires,
women estimated SPA more accurately compared to men,
and both men and women overestimated SPA with increased
levels of overweight.

Figure 4.
Individual 16-month weight change in exercise groups by
gender. (A) Women. (B) Men.
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Figure 5. Theoretical model of body weight response to supervised exercise. Wt, weight; EX, exercise; RMR, resting metabolic rate; TEF, thermic effect
of food; SPA, spontaneous physical activity.

To further complicate the issue, anecdotally it has been


observed that when an exercise program is initiated, SPA
temporarily declines because of fatigue but returns to baseline
levels at some time point and may increase as fitness increases. Because it is the objective of an exercise program to
add to total 24-h energy expenditure, it would be of value to
know the time course for any potential changes in SPA;
however, these data are not available in the literature. Thus,
although exercise may evoke compensatory changes in the
components of energy expenditure that would diminish the
energy gap for weight loss, there is little evidence that this is
the case and a more likely suspect for compensation is energy
intake, especially in women.

INDIVIDUAL VARIATION FOR MEN AND WOMEN


All individuals do not respond to exercise in an identical
fashion for weight loss. Bouchard et al. (2) reported the
results from a highly controlled study in which participants
were sequestered in an isolated research station and energy
intake and exercise were tightly controlled for a 4-month
period. Energy intake was prescribed at a level to maintain
baseline weight and exercise was prescribed to create a 1000kcal daily energy deficit. Reductions in body weight ranged
from 3 to 12 kg, or 5 to 12% of initial body weight.
Even more variations for weight loss may be shown between genders for the response to exercise. Our laboratory
has completed two long-term exercise studies: one with
women only (4) and one with men and women (3). In both
studies women showed an almost equal response of either
weight loss or weight gain, whereas men almost universally
showed weight loss (Fig. 4). Thus, in addition to the potential for compensation caused by the interactive nature of the
components of energy balance, there is wide individual variation in weight loss in response to exercise, and women
appear to have less weight loss in response to exercise compared to men.
Volume 33 Number 4 October 2005

TARGETED STRATEGIES WITH EQUAL ENERGY


EXPENDITURE OF EXERCISE
In our estimation, it appears that women may show a
reduced weight loss compared to men in response to exercise
because it is likely women have a smaller energy expenditure
of exercise and show compensation for increased energy
intake in response to exercise. Men have shown greater than
5% weight loss in response to exercise; thus, it can be argued
that exercise alone is an effective public health strategy for
men. Behavioral strategies that are designed to increase exercise in men are warranted to increase the number of men
who exercise for weight loss.
For women, it is important to determine the level of energy
expenditure of exercise that will not be overcome with compensation from the other components of the energy balance
equation and that will therefore provide weight loss of approximately 5% of baseline weight or more. It is a logical step
to determine whether women can show weight loss in response to approximately 600 kcal energy expenditure of exercise per day, 5 dwk1, or approximately 3000 kcalwk1 as
shown by men. This will help determine whether a gender
difference in the response to exercise alone for weight loss is
shown by women. In Figure 5, we have predicted that it is
unlikely that compensation will come from decreases in either RMR or SPA as previously discussed. It is likely that
some level of compensation to exercise will occur with increases in energy intake. However, if compensation in energy
intake is not complete, weight loss will result. For example,
if the energy expenditure of exercise is 400 kcal and compensation for energy intake is 400 kcal, then men and women
will be weight-stable. If the energy expenditure of exercise is
increased to 600 kcal and compensation for energy intake
remains less than 600 kcal (i.e., 400 kcal), then weight loss
will occur. Thus, in this model, the question to be tested is,
with ad libitum diet and at 600-kcal energy expenditure of
exercise, 5 dwk1, will women fail to completely compensate
with increased energy intake, resulting in weight loss as
Exercise, Energy Balance, and Weight Loss

173

previously shown by men? If there is no gender effect, men


and women will remain weight-stable at 400 kcal of exercise
and will lose weight in similar fashion at 600 kcal of exercise.

SUMMARY
Exercise is recommended to alter energy balance in conjunction with weight loss programs, although it receives a
secondary role to energy restriction. The diminished role for
exercise may be because of the perception that exercise does
not provide a great enough energy gap to generate a significant amount of weight loss. Surprisingly little information is
available for the ability of exercise to reduce risk of overweight and obesity for men and women consuming ad libitum
diets from randomized controlled trials in which exercise is
supervised, the energy expenditure of exercise is known, and
the interactive components of energy balance are measured.
Compensation for the energy expenditure of exercise is likely
and actual weight loss is generally diminished from the expected amount of weight loss. Differences between men and
women for weight loss in response to exercise may come from
increased energy intake for women and a lower energy expenditure of exercise shown in women compared to men,
although a direct test of this notion is lacking and is warranted. A better understanding of the components of energy
balance likely to show compensation for men and women in
response to exercise will allow for targeting of weight loss
intervention strategies and should result in improved weight
loss outcomes.
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