Research Article| Volume 37, ISSUE 8, P758-765, August 1988

Effects of aerobic exercise on energy expenditure and nitrogen balance during very low calorie dieting

  • Stephen D. Phinney
    Address reprint requests to Stephen D. Phinney, MD, PhD, Division of Clinical Nutrition, School of Medicine, TB-156, University of California, Davis, CA 95616.
    General Clinical Research Center, University of Vermont College of Medicine, Burlington, VT, USA.

    Metabolic Unit, University of Vermont College of Medicine, Burlington, VT, USA.
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  • Betty M. LaGrange
    General Clinical Research Center, University of Vermont College of Medicine, Burlington, VT, USA.

    Metabolic Unit, University of Vermont College of Medicine, Burlington, VT, USA.
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  • Maureen O'Connell
    General Clinical Research Center, University of Vermont College of Medicine, Burlington, VT, USA.

    Metabolic Unit, University of Vermont College of Medicine, Burlington, VT, USA.
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  • Elliot Danforth Jr
    General Clinical Research Center, University of Vermont College of Medicine, Burlington, VT, USA.

    Metabolic Unit, University of Vermont College of Medicine, Burlington, VT, USA.
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      Aerobic exercise in addition to severe caloric restriction was studied for its effects on resting energy expenditure (REE), weight loss, and lean tissue preservation in adult women. A formula diet providing 1.5 g protein and 0.5 g carbohydrate (CHO) per kilogram of ideal body weight daily (mean intake 720 kcal/d) was given to 12 overweight inpatients for 4 to 5 weeks. Six subjects remained sedentary (group 1), while the other six subjects (group 2) performed supervised endurance exercise (a total of 27 hours at 50% of maximal oxygen uptake (V̇O2max) over 4 weeks). Lean tissue preservation was excellent in both groups and was unaffected by the group 2 exercise regimen. Weight loss over 4 weeks in the two groups did not differ (group 1, 6.9 ± 0.7 kg; group 2, 6.5 ± 0.7 kg). The V̇O2max was not increased after 4 weeks of exercise compared with controls. The resting oxygen consumption (rV̇O2) of both groups declined 10% (P < .001) in the first seven days of dieting. Thereafter the rV̇O2 in group 1 remained stable, but a further 17% reduction occurred in group 2 (P < .03) by the third week of exercise. The free triiodothyronine (fT3) concentration also fell more in group 2 (P < .05), suggesting a relationship between fT3 and energy expenditure during severe caloric restriction. The ergometer exercise for up to two hours daily was well tolerated. The absence of either a training effect or accelerated weight loss in group 2 may be due to the limited duration (4 weeks) or intensity of the exercise. The significant reduction in rV̇O2 as a measure of REE is both surprising and difficult to explain. The lack of objective benefits from aggressive aerobic exercise concurrent with a severely restricted diet suggests that these therapeutic modalities be employed sequentially, rather than simultaneously, in the multidisciplinary approach to obesity.
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        • Bjorntorp P
        • Sjostrom L
        • Sullivan L
        The role of physical exercise in the management of obesity.
        in: Munro JF The Treatment of Obesity. MTP, Lancaster, England1979: 123-137
        • Stern JS
        • Schultz C
        • Mole P
        • et al.
        Effect of caloric restriction and exercise on basal metabolism and thyroid hormone.
        Alimen Nutr Metab. 1980; 1: 361
        • Lennon D
        • Nagle F
        • Stratmen F
        • et al.
        Diet and exercise training effects on resting metabolic rate.
        Int J Obes. 1985; 9: 39-47
        • Donahoe Jr, CP
        • Daria HL
        • Kirschenbaum DS
        • et al.
        Metabolic consequences of dieting and exercise in the treatment of obesity.
        J Consult Clin Psychol. 1984; 52: 827-836
        • Apfelbaum M
        The effects of very restrictive high protein diets.
        Clin Endocrinol Metab. 1976; 5: 417-430
        • Blackburn GL
        • Flatt JP
        • Clowes GHA
        • et al.
        Protein sparing therapy during periods of starvation with sepsis and trauma.
        Ann Surg. 1973; 177: 588-594
        • Genuth SM
        • Castro JH
        • Vertes V
        Weight reduction in obesity by outpatient semistarvation.
        J Am Med Assoc. 1974; 230: 987-991
        • Sours HE
        • Frattali VP
        • Brand CD
        • et al.
        Sudden death associated with very low calorie weight reduction regimens.
        Am J Clin Nutr. 1981; 34: 453-461
        • Lantigua RA
        • Amatruda JM
        • Biddle TL
        • et al.
        Cardiac arrhythmias associated with a liquid protein diet for the treatment of obesity.
        N Engl J Med. 1980; 303: 735-738
        • Felig P
        Four questions about protein diets.
        N Engl J Med. 1978; 298: 1025-1026
        • Van Itallie TB
        Liquid protein mayhem.
        J Am Med Assoc. 1978; 240: 140-145
        • Felig P
        Editorial Retrospective: Very-low-calorie protein diets.
        N Engl J Med. 1984; 310: 589-591
        • Marliss EB
        • Murray FT
        • Nakhooda AF
        The metabolic response to hypocaloric protein diets in obese man.
        J Clin Invest. 1978; 62: 468-479
        • Bistrian BR
        • Blackburn GL
        • Flatt JP
        • et al.
        Nitrogen metabolism and insulin requirements in obese diabetic adults on a protein-sparing modified fast.
        Diabetes. 1976; 25: 494-504
        • Hoffer LJ
        • Bistrian BR
        • Young VR
        • et al.
        Metabolic effects of very low calorie weight reduction diets.
        J Clin Invest. 1984; 73: 750-758
        • Wadden TA
        • Stunkard AJ
        • Brownell KD
        Very low calorie diets: Their efficacy, safety, and future.
        Ann Intern Med. 1983; 99: 675-684
        • Hultman E
        Studies on muscle metabolism of glycogen and active phosphate in man with special reference to exercise and diet.
        Scand J Clin Lab Med. 1967; 19: 1-63
        • Phinney SD
        • Horton ES
        • Sims EAH
        • et al.
        Capacity for moderate exercise in obese subjects after adaptation to a hypocaloric ketogenic diet.
        J Clin Invest. 1980; 66: 1152-1161
        • Phinney SD
        • Bistrian BR
        • Evans WJ
        • et al.
        The human metabolic response to chronic ketosis without caloric restriction: Preservation of submaximal exercise capability with reduced carbohydrate oxidation.
        Metabolism. 1983; 32: 769-776
        • Bogardus C
        • LaGrange BM
        • Horton ES
        • et al.
        Comparison of carbohydrate-containing and carbohydrate-restricted hypocaloric diets in the treatment of obesity.
        J Clin Invest. 1981; 68: 399-404
        • Society of Actuaries
        ed 9. Build and Blood Pressure Study. vols 1 and 2. Society of Actuaries, Chicago1959
        • National Research Council
        ed 9. Recommended Dietary Allowances. National Academy of Sciences, Washington, DC1980
        • Ward MWN
        • Owens CWI
        • Rennie MJ
        Nitrogen estimation in biological samples by use of chemoluminescence.
        Clin Chem. 1980; 26: 1336-1339
        • Calloway DH
        • Odell ACF
        • Margen S
        Sweat and miscellaneous nitrogen losses in human balance studies.
        J Nutr. 1971; 101: 775-786
        • Bergmeyer HV
        ed 2. Methods of Enzymatic Analysis. Academic, San Diego1971
        • Scheidegger K
        • O'Connell M
        • Robbins DC
        • et al.
        Effects of chronic beta-receptor stimulation on sympathetic nervous system activity, energy expenditure, and thyroid hormones.
        J Clin Endocrinol Metab. 1984; 58: 1-9
        • Saltin B
        • Blomqvist G
        • Mitchell JH
        • et al.
        Response to exercise after bedrest and after training.
        Circulation. 1968; 38: 1-78
        • American College of Sports Medicine
        Position statement on proper and improper weight loss programs.
        Med Sci Sports Exerc. 1983; 15: ix-xiii
        • Maehlum S
        • Grandmontagne M
        • Newsholme EA
        • et al.
        Magnitude and duration of excess postexercise oxygen consumption in healthy young subjects.
        Metabolism. 1986; 35: 425-429
        • Taylor HL
        • Buskirk ER
        • Brozek J
        • et al.
        Performance capacity and effects of caloric restriction with hard physical work on young men.
        J Appl Physiol. 1957; 10: 421-429
        • Warwick PM
        • Garrow JS
        The effect of addition of exercise to a regimen of dietary restriction on weight loss, nitrogen balance, resting metabolic rate and spontaneous physical activity in three women in a metabolic ward.
        Int J Obes. 1981; 5: 25-32
        • Buskirk ER
        • Thompson RH
        • Lutwak L
        • et al.
        Energy balance of obese patients during weight reduction: Influence of diet restriction and exercise.
        Ann NY Acad Sci. 1963; 110: 918-940
        • Woo R
        • Garrow JS
        • Pi-Sunyer F-X
        Voluntary food intake during prolonged exercise in obese women.
        Am J Clin Nutr. 1982; 36: 478-484
        • Krotkiewski M
        • Toss L
        • Bjorntorp P
        • et al.
        The effect of a very-low-calorie diet with and without chronic exercise on thyroid and sex hormones, plasma proteins, oxygen uptake, insulin and c-peptide concentrations in obese women.
        Int J Obes. 1981; 5: 287-293
        • Kelleher PC
        • Phinney SD
        • Sims EAH
        • et al.
        Effects of carbohydrate containing and carbohydrate-restricted hypocaloric and eucaloric diets on serum concentrations of retinol binding protein, thyroxine binding prealbumin, and transferrin.
        Metabolism. 1983; 32: 95-101
        • Stockholm KH
        Decrease in serum free triiodothyronine, thyroxine-binding globulin, and thyroxine-binding prealbumin whilst taking a very low calorie diet.
        Int J Obes. 1980; 4: 133-138
        • Balsam A
        • Leppo LE
        Effect of physical training on the metabolism of thyroid hormones in man.
        J Appl Physiol. 1975; 38: 212-215
        • Gervino EV
        The effects of a protein sparing modified fast and acute exercise on fibrinolytic activity and lipoprotein patterns in obese women.
        in: ed 2. Doctoral thesis. Boston University, Sargent College, 1982