Effect of severe compared with moderate energy restriction on physical activity among postmenopausal female adults with obesity: a prespecified secondary analysis of the Type of Energy Manipulation for Promoting optimum metabolic health and body composition in Obesity (TEMPO) Diet randomized controlled Trial.

Xingzhong Jin, Alice A Gibson, Zubeyir Salis, Radhika V Seimon, Claudia Harper, Tania P Markovic, Nuala M Byrne, Shelley E Keating, Emmanuel Stamatakis, Elif Inan-Eroglu, Felipe Q da Luz, Julie Ayre, Amanda Sainsbury

Journal: The American journal of clinical nutrition 2022;115(5):1393-1403

PMID: 35102380

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Abstract

BACKGROUND

An under-explored strategy for increasing physical activity is the dietary treatment of obesity, but empirical evidence is lacking.

OBJECTIVES

We aimed to compare the effects of weight loss via severe as opposed to moderate energy restriction on physical activity over 36 mo.

METHODS

A total of 101 postmenopausal female adults (45-65 y, BMI 30-40 kg/m2, <180 min/wk of structured exercise) were randomly assigned to either 12 mo of moderate energy restriction (25%-35% of energy requirement) with a food-based diet, or a severe intervention involving 4 mo of severe energy restriction (65%-75% of energy requirement) with a total meal replacement diet, followed by 8 mo of moderate energy restriction. Physical activity was encouraged, but no tailored or supervised exercise prescription was provided. Physical activity was assessed with an accelerometer worn for 7 d before baseline (0 mo) and 0.25, 1, 4, 6, 12, 24, and 36 mo after intervention commencement.

RESULTS

Compared with the moderate group, the severe group exhibited greater mean: total volume of physical activity; duration of moderate-to-vigorous-intensity physical activity (MVPA); duration of light-intensity physical activity; step counts, as well as lower mean duration of sedentary time. All these differences (except step counts) were apparent at 6 mo [e.g., 1006 metabolic equivalent of task (MET)-min/wk; 95% CI: 564, 1449 MET-min/wk for total volume of physical activity], and some were also apparent at 4 and/or 12 mo. There were no differences between groups in the 2 other outcomes investigated (self-efficacy to regulate exercise; and proportion of participants meeting the WHO's 2020 Physical Activity Guidelines for MVPA). When the analyses were adjusted for weight at each time point, the differences between groups were either attenuated or abolished.

CONCLUSIONS

Among female adults with obesity, including a dietary component to reduce excess body weight-notably one involving severe energy restriction-could potentially enhance the effectiveness of physical activity interventions.This trial was registered at www.anzctr.org.au as ACTRN12612000651886.

Address: Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.; The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.; Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia.; Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.; Metabolism & Obesity Service, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.; School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia.; School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.; Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.; Eating Disorders Program (AMBULIM), Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.; School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia.

DOI: 10.1093/ajcn/nqac024