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The literature evaluating multi-component interventions for long-term weight loss in adolescents with intellectual disabilities (ID) is extremely limited.To compare the effectiveness of two delivery strategies, face-to-face (FTF) or remote delivery (RD), and two diets, enhanced Stop Light diet (eSLD) or conventional diet (CD) on weight change across 12 and 18 months. in response to an 18 months. weight management intervention (6 months Weight loss/12 months. Weight maintenance) in adolescents with ID.Adolescents with ID were randomized to one of three arms: FTF /CD, RD/CD, RD/eSLD and asked to attend individual education sessions with a health educator which were delivered during FTF home visits or remotely using video conferencing. The CD followed the US dietary guidelines. The eSLD utilized the Stop Light guide and was enhanced with portion-controlled meals. Participants were also asked to increase their physical activity (PA) and to self-monitor diet, PA and body weight across the 18-month.Weight was obtained from 92(84%) and 89(81%) randomized adolescents at 12 and 18 months, respectively. Weight change across 12 months. Differed significantly by diet (RD/eSLD: -7.0% vs. RD/CD: -1.1%, p = 0.002) but not by delivery strategy (FTF/CD: +1.1% vs. RD/CD: -1.1%, p = 0.21). Weight change across 18 months. Was minimal in all intervention arms and did not differ by diet (RD/eSLD: -2.6% vs. RD/CD: -0.5%; p = 0.28) or delivery strategy (FTF/CD: +1.6% vs. RD/CD: -0.5%; p = 0.47).Additional research is required to identify effective strategies to improve long-term weight loss in adolescents with ID.

Objective This study aimed to evaluate the effectiveness of three levels of exercise on weight regain subsequent to clinically meaningful weight loss (WL). Methods Adults with overweight or obesity (n = 298) initiated a 3-month behavioral WL intervention, which included reduced energy intake, increased exercise, and weekly behavioral counseling. Participants achieving ≥5% WL (n = 235) began a 12-month behavioral WL maintenance intervention and were randomized to 150 min/wk (n = 76), 225 min/wk (n = 80), or 300 min/wk (n = 79) of partially supervised moderate-to-vigorous-intensity exercise. Results Participants randomized to 150, 225, and 300 minutes of exercise completed 129 ± 30, 153 ± 49 and 179 ± 62 min/wk of exercise (supervised + unsupervised), respectively. Mean WL at 3 months (9.5 ± 3.1 kg) was similar across randomized groups (P = 0.68). Weight change across 12 months was 1.1 ± 6.5 kg, 3.2 ± 5.7 kg, and 2.8 ± 6.9 kg in the 150, 225, and 300 min/wk groups, respectively. Intent-to-treat analysis revealed no significant overall trend across the three treatment groups (P = 0.09), effects for group (P = 0.08), or sex (P = 0.21). Conclusions This study found no evidence for an association between the volume of moderate-to-vigorous-intensity exercise and weight regain across 12 months following clinically relevant WL. Further, results suggest that exercise volumes lower than those currently recommended for WL maintenance, when completed in conjunction with a behavioral weight-maintenance intervention, may minimize weight regain over 12 months.

OBJECTIVES In this randomized trial, we compared the effectiveness of 2 diets (enhanced stop light diet [eSLD] versus conventional meal plan diet [CD]) and 2 delivery strategies (face–to–face [FTF] versus remote delivery [RD]) on weight loss across 6 months in adolescents with intellectual and developmental disabilities who were overweight or obese. METHODS Participants were randomly assigned to 1 of 3 arms (FTF/CD, RD/CD, or RD/eSLD) and asked to attend one-on-one sessions with a health educator every 2 weeks to aid in maintaining compliance with recommendations for a reduced-energy diet and increased physical activity. The CD followed the US dietary guidelines. The eSLD used the stop light guide and was enhanced with portion-controlled meals. The FTF arm was delivered during in-person home visits. The RD arms were delivered by using video conferencing. RESULTS A total of 110 adolescents with intellectual and developmental disabilities (aged ∼16 years, 53% female, BMI 33) were randomly assigned to the FTF/CD (n = 36), RD/CD (n = 39), or RD/eSLD (n = 35) group. Body weight at 6 months was obtained from 97%, 100%, and 86% of participants in the FTF/CD, RD/CD, and RD/eSLD arms, respectively. The eSLD elicited significantly greater weight loss than the CD: RD/eSLD (−5.0 ± 5.9 kg; −6.4%) versus RD/CD (−1.8 ± 4.0 kg; −2.4%) (P = .01). However, weight loss did not differ by delivery strategy: FTF/CD (−0.3 ± 5.0 kg; −0.2%) versus RD/CD (−1.8 ± 4.0 kg; −2.4%) (P = .20). CONCLUSIONS The eSLD elicited significantly greater 6-month weight loss compared with a CD when both interventions were delivered remotely. Minimal 6-month weight loss, which did not differ significantly between FTF delivery and RD, was observed with a CD.

BACKGROUND: High-intensity functional training (HIFT) may offer an attractive, time-efficient alternative to traditional aerobic exercise. However, limited information is available in the literature regarding HIFT meeting exercise guidelines for energy expenditure (improve health outcomes: ≥1000 kcal/wk; weight management: ≥2000 kcal/wk) and level of intensity (moderate: 3–6 metabolic equivalents [METs], vigorous: ≥6 METs) elicited by this approach. Thus, the primary aim was to objectively measure energy expenditure and intensity of HIFT sessions. METHODS: Energy expenditure was assessed in 20 adults (18–50 y, 50% females). The HIFT session format included the following segments: warm-up (~5 min), exercise (~35 min), and cooldown (~5 min). Participant oxygen consumption (COSMED, L/min and mL/kg/min), heart rate (Polar RS400), and physical activity (ActiGraph GT3X+) were collected in 15-second intervals. Average kcal per minute, METs, total kcal per session, and percent maximum heart rate (HR(max)) were calculated. RESULTS: METs ranged from 5.5 to 11.6 for the complete session (including warm-up and cooldown). Participant’s HR(max) was ~80% (range: 69%–100%). Average energy expenditure was ~485 kcal per session (~1400 kcal/wk). The vigorous-intensity exercise portion (~35 min) contributed to 80% of total energy expenditure. CONCLUSIONS: HIFT has the potential to meet the recommendations for exercise to improve health outcomes.

Background:There is limited data regarding objectively measured energy cost and intensity of classroom instruction. Therefore, the purpose of current study was to objectively measure energy cost and subsequently calculate MET values using a portable indirect calorimeter (IC) for both normal classroom instruction (NCI) and active classroom instruction (ACI).Methods:We assessed energy expenditure (EE) and intensity levels (METs) in elementary school children (17 boys and 15 girls) using an IC (COSMED K4b2). Independent t-tests were used to evaluate potential sex and grade level differences for age, BMI, VO2, EE, and METs.Results:The average EE for NCI and ACI were 1.8 ± 0.4 and 3.9 ± 1.0, respectively. The average intensity level for NCI and ACI were 1.9 ± 0.4 and 4.2 ± 0.9 METs, respectively.Conclusions:PA delivered through ACI can elicit EE at a moderate intensity level. These results provide evidence for ACI as a convenient/feasible avenue for increasing PA in youth without decreasing instruction time.

Background/objectives Circadian physiology has been linked to body weight regulation and obesity. To date, few studies have assessed the association between exercise timing and weight related outcomes. The aim of this secondary analysis was to explore the impact of exercise timing (i.e., 24 h clock time of exercise session) on weight loss and components of energy balance. Subjects/methods Overweight/obese (BMI 25.0–39.9 kg/m2), physically inactive, young adults (~51% female) completed a 10-month supervised exercise program (400 or 600 kcal/session for 5 days/week) or served as non-exercise controls (CON). Participants were categorized based on the time of day in which they completed exercise sessions (Early-Ex: >50% of sessions completed between 7:00 and 11:59 am; (n = 21), Late-Ex: >50% of sessions completed between 3:00 and 7:00 pm; (n = 25), Sporadic-Ex: n = 24), and CON; (n = 18)). Body weight, energy intake (EI; digital photography), and non-exercise physical activity (NEPA; accelerometer) were assessed at baseline, 3.5, 7, and 10 months. Total daily energy expenditure (TDEE; doubly labeled water), was assessed at baseline and 10 months. Results At month 10, weight loss was significantly greater in both Early-EX (−7.2 ± 1.2%; p p = 0.01) vs CON (+0.5 ± 1.0%), and Early-EX vs Late-EX (−2.1 ± 1.0%; p P > 0.05). A significant group × time interaction (p = 0.02) was observed for NEPA (counts/min), however, after adjusting for multiple comparisons, group effects were no longer significant. Conclusions Despite minimal differences in components of energy balance, Early-EX lost significantly more weight compared with Late-Ex. Although the mechanisms are unclear, the timing of exercise may be important for body weight regulation.

Adults with intellectual and developmental disabilities (IDD) represent an underserved segment of the US population with a high prevalence of obesity and limited options for weight management. Previous research has demonstrated clinically meaningful weight loss of 7% of total body weight in in adults with IDD using an enhanced Stop Light Diet (eSLD) in combination with monthly at-home face-to-face (FTF) behavioral sessions, and a recommendation for increased physical activity. However, the time and cost associated with FTF delivery (travel + sessions) limits the potential for scaling and implementation and suggests the need for the evaluation of less costly and burdensome strategies for intervention delivery. Therefore, we will conduct a 24-mo. randomized trial to compare a weight management intervention (6 mos. weight loss, 12 mos. maintenance, 6 mos. no-contact follow-up) delivered to 120 overweight/obese adults with IDD in their home, either remotely (RD) using video conferencing on a tablet computer, or during FTF visits. Our primary aim is whether RD is non-inferior to FTF for weight loss (0–6 mos.). Secondarily, we will compare the RD and FTF groups on mean weight loss, the proportion of participants who achieve clinically meaningful weight loss, and changes in quality of life across 24 months. We will also conduct cost analysis, cost-effectiveness, and contingent valuation analyses to compare the RD and FTF groups.

Accumulating moderate-to-vigorous physical activity (MVPA) in bouts of 10 min is associated with improved cardio-metabolic risk factors (CMRF) in adults.To assess the association between the lengths of MVPA bouts and CMRF in elementary school age children.The sample included 396, 2nd and 3rd grade students from eastern Kansas (182 boys, 214 girls; age 7.6 ± 0.6 years; Body Mass Index Percentile [BMI%ile]: 61.6 ± 9.3) in the fall of 2011. Analyses were conducted in 2014. MVPA bouts were defined as sporadic (5 min), short (5-10 min) or medium-to-long (≥10 min). Latent profile analysis was used to identify distinct subgroups (classes) based on the composition of MVPA bouts. Bayesian probability-based Wald chi-square test was used to compare CMRF between classes controlling for age, sex, BMI%ile, and total moderate and total vigorous PA.Three classes of accumulated physical activity were identified: A (n=78); 97% sporadic 2%, short, 1% medium-to-long bouts; B (n=174); 93% sporadic, 5% short, 2% medium-to-long; C (n=144); and 86% sporadic, 9% short, 5% medium-to-long bouts. Class C had significantly lower BMI%ile (57.3 ± 2.3 (SE)), waist circumference (WC; 55.8 ± 0.5 cm) compared with Class A (BMI%ile=70.9±0.5, p0.01.030, WC=61.0 ± 1.0 cm, p=0.0.01). Class B had significantly lower WC (56.6 ± 0.6 cm), p0.01 than Class A. No significant differences between classes were shown in other outcomes.Children who accumulated MVPA with a higher percentage of short (5-10 min) and medium-to-long bouts (≥10min) had lower BMI%ile, and WC compared with children who accumulated MVPA with a lower percentage short and medium-to-long bouts.

Background Previous research indicates that individuals with intellectual and developmental disabilities (IDDs) are at risk for poor diet quality. Objective The purpose of this secondary analysis was to determine whether two different weight-loss diets affect energy intake, macronutrient intake, and diet quality as measured by the Healthy Eating Index-2010 (HEI-2010) during a 6-month weight-loss period and 12-month weight-management period, and to examine differences in energy intake, macronutrient intake, and HEI-2010 between groups. Design Overweight/obese adults with IDDs took part in an 18-month randomized controlled trial and were assigned to either an enhanced Stop Light Diet utilizing portion-controlled meals or a conventional diet consisting of reducing energy intake and following the 2010 Dietary Guidelines for Americans. Proxy-assisted 3-day food records were collected at baseline, 6 months, and 18 months, and were analyzed using Nutrition Data System for Research software. HEI-2010 was calculated using the data from Nutrition Data System for Research. Participants/setting The study took place from June 2011 through May 2014 in the greater Kansas City metropolitan area. Main outcome measures This was a secondary analysis of a weight-management intervention for adults with IDDs randomized to an enhanced Stop Light Diet or conventional diet, to examine differences in energy intake, macronutrient intake, and HEI-2010 across time and between groups. Statistical analyses performed Independent- and paired-samples t tests and general mixed modeling for repeated measures were performed to examine group differences and changes at baseline, 6 months, and 18 months between the enhanced Stop Light Diet and conventional diet groups. Results One hundred and forty six participants (57% female, mean±standard deviation age=36.2±12.0 years) were randomized to either the enhanced Stop Light Diet or conventional diet group (77 enhanced Stop Light Diet, 69 conventional diet) and provided data for analysis at baseline, 124 completed the 6-month weight-loss period, and 101 completed the 18-month study. Participants on the enhanced Stop Light Diet diet significantly reduced energy intake at 6 and 18 months (both P P =0.13). However, when accounting for age, sex, race, education level, and support level (mild vs moderate IDD), there was a significant decrease during the 18-month intervention in energy intake for the enhanced Stop Light Diet and conventional diet groups combined ( P P =0.39 for group-by-time interaction). There was no significant change in total HEI-2010 score at 6 and 18 months ( P =0.05 and P =0.38 for the enhanced Stop Light Diet group; P =0.22 and P =0.17 for the conventional diet group), and no significant group difference at 6 and 18 months ( P =0.08 and P =0.42). However, when participants' age, sex, race, education level, and support level were accounted for, mixed modeling indicated a significant increase in total HEI-2010 scores for the enhanced Stop Light Diet and conventional diet groups combined during the 18-month intervention ( P =0.01 for time effect). Conclusions The results of this study found that after controlling for demographic factors, individuals with IDDs can decrease their energy intake and increase their diet quality, with no significant differences between the enhanced Stop Light Diet and conventional diet groups.

The prevalence of obesity is high resulting from chronic imbalances between energy intake and expenditure. On the expenditure side, regular exercise is associated with health benefits, including enhanced brain function. The benefits of exercise are not immediate and require persistence to be realized. Brain regions associated with health-related decisions, such as whether or not to exercise or controlling the impulse to engage in immediately rewarding activities (e.g., sedentary behavior), include reward processing and cognitive control regions. A 9 month aerobic exercise study will be conducted in 180 sedentary adults (n = 90 healthy weight [BMI = 18.5 to 26.0 kg/m(2)]; n = 90 obese [BMI = 29.0 to 41.0 kg/m(2)) to examine the brain processes underlying reward processing and impulse control that may affect adherence in a new exercise regimen. The primary aim is to use functional magnetic resonance imaging (fMRI) to examine reward processing and impulse control among participants that adhere (exercise >80% of sessions) and those that do not adhere to a nine-month exercise intervention with secondary analyses comparing sedentary obese and sedentary healthy weight participants. Our results will provide valuable information characterizing brain activation underlying reward processing and impulse control in sedentary obese and healthy weight individuals. In addition, our results may identify brain activation predictors of adherence and success in the exercise program along with measuring the effects of exercise and improved fitness on brain activation.

We compared changes in academic achievement across 3 years between children in elementary schools receiving the Academic Achievement and Physical Activity Across the Curriculum intervention (A+PAAC), in which classroom teachers were trained to deliver academic lessons using moderate-to-vigorous physical activity (MVPA) compared to a non-intervention control. Elementary schools in eastern Kansas (n=17) were cluster randomized to A+PAAC (N=9, target ≥ 100 min/wk.) or control (N=8). Academic achievement (math, reading, spelling) was assessed using the Wechsler Individual Achievement Test-Third Edition (WIAT-III) in a sample of children (A+PAAC = 316, Control = 268) in grades 2 and 3 at baseline (Fall 2011) and repeated each spring across 3 years. On average 55 min/wk. of A+PACC lessons were delivered each week across the intervention. Baseline WIAT-III scores (math, reading, spelling) were significantly higher in students in A+PAAC compared with control schools and improved in both groups across 3 years. However, linear mixed modeling, accounting for baseline between group differences in WIAT-III scores, ethnicity, family income, and cardiovascular fitness, found no significant impact of A+PAAC on any of the academic achievement outcomes as determined by non-significant group by time interactions. A+PAAC neither diminished or improved academic achievement across 3-years in elementary school children compared with controls. Our target of 100 min./wk. of active lessons was not achieved; however, students attending A+PAAC schools received an additional 55 min./wk. of MVPA which may be associated with both physical and mental health benefits, without a reduction in time devoted to academic instruction.

The aim of this investigation was to develop an equation to estimate physical activity energy expenditure (PAEE) during a 10-min physically active academic lesson using The System for Observing Fitness Instruction Time (SOFIT) and demographic information. PAEE (portable indirect calorimeter) and physical activity (SOFIT) were simultaneously assessed in 38, 2nd through 5th grade children. PAEE and SOFIT were 3.04 ± 1.1 (kcal/min) and 3.8 ± 0.4 (score), respectively. PAEE was predicted from SOFIT score and body weight [PAEE (kcal/min) = (1.384*SOFIT + 0.084*weight (kg)—5.126), R = .81, SEE = 1.23 kcal/min]. PAEE measured by indirect calorimeter and predicted from SOFIT and body weight were 3.04 ± 1.1 (kcal/min) and 3.04 ± 0.9 kcal/min) respectively. SOFIT and body weight may provide a useful measure of PAEE associated with classroom based physical activity.

Summary Purpose To develop and validate a REE prediction equation for young adults. Methods Baseline data from two studies were pooled ( N = 318; women = 52%) and randomly divided into development ( n = 159) and validation samples ( n = 159). REE was measured by indirect calorimetry. Stepwise regression was used to develop an equation to predict REE (University of Kansas (KU) equation). The KU equation and 5 additional REE prediction equations used in clinical practice (Mifflin–St. Jeor, Harris–Benedict, Owens, Frankenfield (2 equations)) were evaluated in the validation sample. Results There were no significant differences between predicted and measured REE using the KU equation for either men or women. The Mifflin–St. Jeor equation showed a non-significant mean bias in men; however, mean bias was statistically significant in women. The Harris–Benedict equation significantly over-predicted REE in both men and women. The Owens equation showed a significant mean bias in both men and women. Frankenfield equations #1 and #2 both significantly over-predicted REE in non-obese men and women. We found no significant differences between measured REE and REE predicted by the Frankenfield #2 equations in obese men and women. Conclusion The KU equation, which uses easily assessed characteristics (age, sex, weight) may offer better estimates of REE in young adults compared with the 5 other equations. The KU equation demonstrated adequate prediction accuracy, with approximately equal rates of over and under-prediction. However, enthusiasm for recommending any REE prediction equations evaluated for use in clinical weight management is damped by the highly variable individual prediction error evident with all these equations.

Background Recent reports have questioned the adequacy of self-report measures of dietary intake as the basis for scientific conclusions regarding the associations of dietary intake and health, and reports have recommended the development and evaluation of better methods for the assessment of dietary intake in free-living individuals. We developed a procedure that used pre- and post-meal digital photographs in combination with dietary recalls (DP+R) to assess energy intake during ad libitum eating in a cafeteria setting. Objective To compare mean daily energy intake of overweight and obese young adults assessed by a DP+R method with mean total daily energy expenditure assessed by doubly labeled water (TDEE DLW ). Methods Energy intake was assessed using the DP+R method in 91 overweight and obese young adults (age = 22.9±3.2 years, body mass index [BMI; calculated as kg/m 2 ]=31.2±5.6, female=49%) over 7 days of ad libitum eating in a university cafeteria. Foods consumed outside the cafeteria (ie, snacks, non-cafeteria meals) were assessed using multiple-pass recall procedures, using food models and standardized, neutral probing questions. TDEE DLW was assessed in all participants over the 14-day period. Results The mean energy intakes estimated by DP+R and TDEE DLW were not significantly different (DP+R=2912±661 kcal/d; TDEE DLW =2849±748 kcal/d, P =0.42). The DP+R method overestimated TDEE DLW by 63±750 kcal/d (6.8±28%). Conclusion Results suggest that the DP+R method provides estimates of energy intake comparable to those obtained by TDEE DLW .

This study aimed to examine compensatory changes in nonexercise energy expenditure (NEEx) and nonexercise physical activity (NEPA) in response to an aerobic exercise training program.Ninety-two overweight/obese (body mass index, 25-39.9 kg·m) sedentary young adults (18-30 yr) completed a 10-month randomized clinical efficacy trial of aerobic exercise 5 d·wk at either 400 kcal per session (n = 37), 600 kcal per session (n = 37), or control (n = 18). Total daily energy expenditure (TDEE) and resting metabolic rate (RMR) were measured at months 0 and 10. NEPA was measured by an accelerometer at months 0, 3.5, 7, and 10. NEEx was calculated by the following formula: [(total daily energy expenditure × 0.9) - RMR] - net EEEx (EEEx-RMR). Mixed modeling was used to examine differences between groups (group effect), within groups (time effect), and group-time interaction for NEEx and NEPA.Within the exercise groups, there were no significant effects (all P0.05) of group, time, or group-time interaction for NEPA. In addition, there were no significant within- or between-group differences for change in NEEx. However, activity counts per minute were significantly higher (P0.001) in the 600-kcal-per-session group (346 ± 141 min·d) versus controls (290 ± 106 min·d) at month 7 and significantly higher (P0.001) in both the 600-kcal-per-session (345 ± 163 min·d) and 400-kcal-per-session groups (317 ± 146 min·d) versus controls (277 ± 116 min·d) at 10 months.A 10-month aerobic exercise training program in previously sedentary, overweight and obese young adults was not associated with compensatory decreases in NEEx or NEPA. Results suggest that overweight and obese individuals do not become less physically active or spend more time in sedentary pursuits in response to exercise.

To compare energy intake, total daily energy expenditure (TDEE), nonexercise energy expenditure (NEEx), resting metabolic rate (RMR), nonexercise physical activity (NEPA), and sedentary time between participants with weight loss5% (nonresponders) vs. ≥5% (responders) in response to exercise.Adults (18-30 years) with overweight/obesity (BMI 25-40 kg/m(2) ) were randomized to exercise: 5 days/week, 400 or 600 kcal/session, 10 months.Of the participants, 40 responded and 34 did not respond to the exercise protocol. Nonresponder energy intake was higher vs. responders, significant only in men (P=0.034). TDEE increased only in responders (P=0.001). NEEx increased in responders and decreased in nonresponders, significant only in men (P=0.045). There were no within- or between-group differences for change in RMR. NEPA increased in responders and decreased in nonresponders (group-by-time interactions: total sample, P=0.049; men, P=0.016). Sedentary time decreased in both groups, significant only in men.Men who did not lose weight in response to exercise (5%) had higher energy intake and lower NEEx when compared with men losing ≥5%. No significant differences in any parameters assessed were observed between women who lost5% vs. those losing ≥5%. Factors associated with the weight loss response to exercise in women warrant additional investigation.

Background Differences in biological changes from weight loss by energy restriction and/or exercise may be associated with differences in long-term weight loss/regain. Objective To assess the effect of weight loss method on long-term changes in weight, body composition and chronic disease risk factors. Data Sources PubMed and Embase were searched (January 1990-October 2013) for studies with data on the effect of energy restriction, exercise (aerobic and resistance) on long-term weight loss. Twenty articles were included in this review. Study Eligibility Criteria Primary source, peer reviewed randomized trials published in English with an active weight loss period of >6 months, or active weight loss with a follow-up period of any duration, conducted in overweight or obese adults were included. Study Appraisal and Synthesis Methods Considerable heterogeneity across trials existed for important study parameters, therefore a meta-analysis was considered inappropriate. Results were synthesized and grouped by comparisons (e.g. diet vs. aerobic exercise, diet vs. diet + aerobic exercise etc.) and study design (long-term or weight loss/follow-up). Results Forty percent of trials reported significantly greater long-term weight loss with diet compared with aerobic exercise, while results for differences in weight regain were inconclusive. Diet+aerobic exercise resulted in significantly greater weight loss than diet alone in 50% of trials. However, weight regain (∼55% of loss) was similar in diet and diet+aerobic exercise groups. Fat-free mass tended to be preserved when interventions included exercise.

Weight reduction in overweight and obese individual’s results in physiological and behavioral changes that make the prevention of weight regain more difficult than either initial weight loss or the prevention of weight gain. Exercise is recommended for the prevention of weight regain by both governmental agencies and professional organizations. To date, the effectiveness of exercise recommendations for the prevention of weight regain has not been evaluated in a properly designed, adequately powered trial. Therefore, we will conduct a randomized trial to evaluate the effectiveness of 3 levels of exercise on the prevention of weight regain, in initially overweight and obese sedentary men and women. Participants will complete a 3 month weight loss intervention of decreased energy intake (EI) and increased exercise (100 minutes/week). Participants achieving clinically significant weight loss (≥ 5% of initial weight), will then be randomly assigned to 12 months of verified exercise at 3 levels (150, 225 or 300 minutes/week). This study will evaluate: 1) the effectiveness of 3 levels of exercise on the prevention of weight regain over 12 months subsequent to clinically significant weight loss (≥ 5%); 2) gender differences in weight regain in response to 3 levels of exercise; and 3) potential compensatory changes in daily physical activity (PA) and EI on weight regain in response to 3 levels of exercise. Results of this investigation will provide information to develop evidenced based recommendations for the level of exercise associated with the prevention of weight regain.

Improving academic achievement and reducing the rates of obesity in elementary school students are both of considerable interest. Increased physical activity during academic instruction time during school offers a potential intervention to address both issues. A program titled “Physical Activity Across the Curriculum” (PAAC) was developed in which classroom teachers in 22 elementary schools were trained to deliver academic instruction using physical activity with a primary aim of preventing increased BMI. A secondary analysis of data assessed the impact of PAAC on academic achievement using the Weschler Individual Achievement Test-II and significant improvements were shown for reading, math and spelling in students who participated in PAAC. Based on the results from PAAC, an adequately powered trial will be conducted to assess differences in academic achievement between intervention and control schools called, “Academic Achievement and Physical Activity Across the Curriculum (A + PAAC).” Seventeen elementary schools were cluster randomized to A + PAAC or control for a 3-year trial. Classroom teachers were trained to deliver academic instruction through moderate-to-vigorous physical activity with a target of 100+ minutes of A + PAAC activities per week. The primary outcome measure is academic achievement measured by the Weschler Individual Achievement Test-III, which was administered at baseline (Fall 2011) and will be repeated in the spring of each year by assessors blinded to condition. Potential mediators of any association between A + PAAC and academic achievement will be examined on the same schedule and include changes in cognitive function, cardiovascular fitness, daily physical activity, BMI, and attention-to-task. An extensive process analysis will be conducted to document the fidelity of the intervention. School and student recruitment/randomization, teacher training, and baseline testing for A + PAAC have been completed. Nine schools were randomized to the intervention and 8 to control. A random sample of students in each school, stratified by gender and grade (A + PAAC = 370, Control = 317), was selected for outcome assessments from those who provided parental consent/child assent. Baseline data by intervention group are presented. If successful, the A + PAAC approach could be easily and inexpensively scaled and disseminated across elementary schools to improve both educational quality and health. Funding source: R01- DK85317. Trial registration: US NIH Clinical Trials, http://NCT01699295 .

We evaluated weight loss response to 16 months of supervised exercise (45 min/day, 5 days/week, 75% heart-rate-reserve) in sedentary, overweight/obese participants without energy restriction in the Midwest Exercise Trial (MET1). Results indicated men lost weight, women did not. The gender differences were associated with differences in the energy expenditure of exercise (EEEx) (men=667±116; women=439±88 kcal/session) when exercise was prescribed by frequency, intensity and duration. MET2 is a randomized control trial designed and powered to examine differences in weight loss and gender in response to EEEx for men and women of 400 or 600 kcal/session, 5 days/week, for 10 months without energy restriction. One hundred forty-one participants will be randomized to 1 of 2 exercise groups or a non-exercise control. EEEx will be verified by indirect calorimetry monthly during the intervention. This study will evaluate: (1) the weight change response to two levels of EEEx versus non-exercise control; (2) gender differences in weight response to two levels of EEEx; (3) potential compensatory changes in energy intake and/or daily physical activity that may explain the observed weight changes. Results from this study may impact how exercise is prescribed for weight loss and prevention of weight regain and may clarify if men and women differ in response to exercise.

Long-term resistance training (RT) may result in a chronic increase in 24-h energy expenditure (EE) and fat oxidation to a level sufficient to assist in maintaining energy balance and preventing weight gain. However, the impact of a minimal RT program on these parameters in an overweight college-aged population, a group at high risk for developing obesity, is unknown.We aimed to evaluate the effect of 6 months of supervised minimal RT in previously sedentary, overweight (mean +/- SEM, BMI = 27.7 +/- 0.5 kg x m(-2)) young adults (21.0 +/- 0.5 yr) on 24-h EE, resting metabolic rate (RMR), sleep metabolic rate (SMR), and substrate oxidation using whole-room indirect calorimetry 72 h after the last RT session.Participants were randomized to RT (one set, 3 d x wk(-1), three to six repetition maximums, nine exercises; N = 22) or control (C, N = 17) groups and completed all assessments at baseline and at 6 months.There was a significant (P0.05) increase in 24-h EE in the RT (527 +/- 220 kJ x d(-1)) and C (270 +/- 168 kJ x d(-1)) groups; however, the difference between groups was not significant (P = 0.30). Twenty-four hours of fat oxidation (g x d(-1)) was not altered after RT; however, reductions in RT assessed during both rest (P0.05) and sleep (P0.05) suggested increased fat oxidation in RT compared with C during these periods. SMR (8.4 +/- 8.6%) and RMR (7.4 +/- 8.7%) increased significantly in RT (P0.001) but not in C, resulting in significant (P0.001) between-group differences for SMR with a trend for significant (P = 0.07) between-group differences for RMR.A minimal RT program that required little time to complete (11min per session) resulted in a chronic increase in energy expenditure. This adaptation in energy expenditure may have a favorable impact on energy balance and fat oxidation sufficient to assist with the prevention of obesity in sedentary, overweight young adults, a group at high risk for developing obesity.

Physical activity is frequently a component of interventions designed to diminish weight gain in children. It is essential to determine whether the energy expenditure (EE) elicited by these interventions is sufficient to reduce the rate of weight gain.To quantify the EE of the Physical Activity across the Curriculum (PAAC) intervention. This intervention involved two 10-min physically active academic lessons per day, taught by classroom teachers.We assessed EE of PAAC in 19 males and 19 females using both an indirect calorimeter (IC) (COSMED K4b(2)) and an accelerometer (ActiGraph) (AC). Independent t-tests were used to evaluate gender differences. Dependent t-tests were used to examine the difference between EE assessed by IC and AC. The agreement between EE measured by IC and estimated by AC was evaluated using a Bland-Altman plot. A Pearson correlation between EE measured by IC and estimated by AC was calculated.There were no significant gender differences for age, BMI, or EE; therefore, analyses by gender were not performed. The mean EE measured by IC was 3.1 +/- 1.0 kcal x min(-1) (3.4 METs). Mean EE estimated by AC (1.8 +/- 0.9 kcal x min(-1)) was significantly lower (P0.05) than EE measured by IC (mean underestimation = 1.3 kcal x min(-1)). The Bland-Altman plot suggested increased underestimation with increased levels of EE. The 95% limits of agreement were large (-2.8 to +0.3 kcal x min(-1)). The correlation between EE measured by IC and estimated by AC was r = 0.68 (P0.001).PAAC elicited a level of EE that may prevent excessive weight gain in children. AC significantly underestimated the EE of PAAC lessons and may not provide useful EE estimates in this context.

Objective: Identifying client factors that predict dropout is critical for the development of effective weight-loss programs. Although demographic predictors are studied, there are few consistent findings. The purpose of this study was to identify predictors of dropout in a large clinic-based weight-loss program using readily attainable demographic variables. Research Methods and Procedures: All 866 weight-loss patients in a clinic-based weight-loss program enrolled during 1998 to 1999 were followed. Attrition and retention rates were measured at 8 and 16 weeks. Six variables (sex, race, marital status, age, BMI, and treatment protocol) were evaluated using bivariate and multivariable statistics for relative association with dropout. Results: The overall attrition rate for the 16-week program was 31%. The retention rate was 69%. Significant risk for dropout, measured as bivariate relative risk (95% confidence interval), was found among patients who were: females, 1.32 (1.01 to 1.73); divorced, 1.54 (1.13 to 2.09); African Americans, 1.68 (1.26 to 2.23); age < 40, 1.66 (1.27 to 2.18); and ages 40 to 50, 1.33 (1.01 to 1.76). There were no significant differences in retention rates by BMI group or program protocol. After logistic regression analysis to control for all variables, young age < 50 years had the only significant association with dropout [odds ratio = 1.39 (1.02 to 1.90)]. Discussion: Multivariable modeling was helpful for prioritizing risk factors for program dropout. These findings have important implications for improving weight-loss program effectiveness and reducing attrition. By knowing the groups at risk for dropout, we can improve or target program treatments to these populations.

Background The magnitude of the negative energy balance induced by exercise may be reduced due to compensatory increases in energy intake. Objective To address the question: Does increased exercise or physical activity alter ad-libitum daily energy intake or macronutrient composition in healthy adults? Data Sources 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. Results 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. Limitations 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. Conclusions We found no consistent evidence that increased physical activity or exercise effects energy or macronutrient intake.