We
have seen before that higher protein diets and exercise, especially
weight training have additive effects on lean body mass maintenance or
even
gain of lean body mass in a caloric deficit. Higher protein diets and
supplemental exercise tends to increase weight loss, but has greater
effects on body composition through the preservation of lean body mass
while increasing fat loss.
A minimum of 150 min per week of moderate-intensity physical activity for
overweight and obese adults was recommend to improve health and 200-300 min per
week was recommended for long-term weight loss (1). An update of that evidence
indicates that more physical activity may be necessary to prevent weight regain
after weight loss. Moderate-intensity physical
activity between 150 and 250 min per week improve weight loss in addition to moderate
diet restriction but not severe diet restriction (2). Weight maintenance is
improved with physical activity >250 min per week, and while resistance
training does not enhance weight loss it may increase fat-free mass and
increase loss of fat mass (2).
A dose-response relationship exists between amount of
exercise and long-term weight loss
(3). In one randomized controlled trial (RCT), 115 overweight women
completed an 18 month behavioral weight control program. Women were divided
into 3 groups: long-bout exercise (LB), multiple short-bout exercise (SB), or
multiple short-bout exercise with home exercise equipment (SBEQ) using a
treadmill. After 18months mean (SD) weight
loss was significantly greater in individuals exercising more than
200 min/week (-13.1 kg) compared
with individuals exercising 150 to 200 min/week (-8.5kg) or less than 150 min/week (-3.5kg) (3).
Another RCT with 52 obese men randomly assigned to one of four study groups (diet-induced
weight loss, exercise-induced weight loss, exercise without weight loss, and
control) for 3 months observed greater
average reductions (1.3kg) in the exercise-induced weight loss group than in the diet-induced weight
loss group (4). Weight loss induced by increased daily physical activity
without caloric restriction substantially reduced obesity (particularly
abdominal obesity) and insulin resistance. Exercise
without weight loss reduces abdominal fat and prevents further weight gain.
More RCTs support
the additive role of exercise while dieting in preserving lean body mass. Strength training but not aerobic training
preserved more lean body mass in a group with a diet of energy content at
70% of resting metabolic rate (RMR) and
protein intake ≥ 1.5 g/kg of ideal body
weight and 1g/kg of actual body weight (5).
In another RCT, 40 obese women were given a
deficit of 1000kcal with a diet with 50% carbs, 27 % protein and 23 % fats. Protein supplements were given to
ensure ≥ 1 g/kg of protein. Exercise plus diet preserved more
lean body mass (0.43kg) than diet without exercise (-0.91kg) after 8 weeks (6).
Furthermore, upper-arm muscle areas increased also increased more
for dieting plus exercise (11.2 cm2) compared with diet without
exercise (2.1 cm2). This is yet another RCT among many to show that adding weight training exercise to a
caloric restriction program results in maintenance of LBW compared with
diet alone.
A more recent study in healthy, premenopausal, overweight, and obese women, compared
the effect of 3 diets for 16 weeks: high protein, high dairy with 1.3g/kg of total protein (HPHD); adequate protein, medium dairy
with 0.84g/kg of total protein (APMD),
and adequate protein, low dairy with 0.72g/kg
of total protein (APLD) differing in the quantity of total dietary protein and
dairy food-source protein consumed with 28 and 15%, 18 and 7.5%, or 16 and
<2% of energy, respectively. Carbohydrate
content also varied, with 41% for the HPHD group, 58% for the APMD and 56%
for the APLD group.
All women were put in a diet with a deficit
of 500 kcal per day and participated in resistance training 2 days per week (upper body, lower body split)
with 3 sets of 10 repetitions, and aerobic
training 7 days per week. In each workout participants expended 250 kcal.
Despite similar total weight
loss between diets, there was significantly greater fat mass loss and lean mass preservation in women consuming
higher protein/dairy (1.3 g/kg of total protein with 15% %
from dairy). In fact, the higher
protein/dairy group in this study was able to gain lean body mass (0.7kg)
during the weight loss intervention (despite having the lower carbohydrate
content), meaning that the weight lost was exclusively accounted for by fat (7).
Lean body mass remained unchanged in
the APMD group (−0.2 kg), and decreased in the APLD group (−0.7kg).
In another
study, Paoli et al. (8) subjected elite
gymnasts to a 30-day ketogenic diet during which they performed their
normal training. The diet consumed was
primarily made of beef and veal, poultry, fish, raw and cooked green vegetables
without restriction, cold cuts (dried beef, carpaccio and cured ham), eggs and
seasoned cheese (e.g. parmesan). The percentage distribution of total daily
energy macronutrients was 54.8% fat, 40.7%
protein (200g) and 4.5% carbohydrates (22g). During the ketogenic diet
subjects consumed 1266 KJ (302kcal) less than during the western diet
(crossover) with 47% carbs (266g), 15%
protein (83g) and 38% fat.
After the
diet, subjects experienced a -1.9kg decrease of body weight in the form fat
mass, with a non-significant
increase in muscle mass, and no decrements in performance (8).
Finally comes a more recent study from Stu Phillips et al., also experimenting with different amounts of
protein and exercise during an energy
deficit of 40% for 4 weeks (9). Subjects were overweight but not obese and were randomly assigned (n = 20/group) to consume either a lower-protein (1.2 g/kg) control diet
(CON) or a higher-protein (2.4 g/kg)
diet (PRO). All participants were “recreationally
active” and at the time were not regularly performing resistance exercise nor
were they were regularly performing structured progressive aerobic or anaerobic
training. All subjects performed resistance exercise training
combined with high-intensity interval training for 6 d/wk.
Participants were
provided with all meals and beverages to consume throughout the intervention
period. The control group consumed 15%
protein, 50% carbohydrates, and 35%
fat vs. 35% protein, 50% carbohydrates,
and 15% fat in the PRO group. Both
groups consumed the same carbohydrate content at 50%. (Carbohydrate content
of a hypocaloric diet will become important in the last article of this
series).
After 4 weeks LBM
increased in the PRO group (1.2 kg) and to a greater extent compared with
the CON group (0.1 kg). The PRO group
had a greater loss of fat mass than did the CON group (-4.8kg vs. -3.5 kg). Note that even the control group with 1.2g/kg of protein was
able to maintain LBM.
Results
showed that, during a marked energy deficit, consumption of a diet containing 2.4 g/kg of protein was more effective than
consumption of a diet containing 1.2 g/kg of protein in promoting increases in LBM and losses of fat mass when combined with a high volume of resistance
and anaerobic exercise (9).
Such results are in contrast with a previous study by
Pasiakos et al (10), discussed in the previous article Successful
Dieting [2/5]: Protein Intake.
Briefly, in that study there was a deficit of 30%, with protein intakes of RDA
(0.8g/kg), 2xRDA (1.6g/kg) and 3x RDA (2.4g/kg). Results indicated then that
the 2x RDA group with 1.6g/kg lost more body fat and less lean body mass and
was better in both regards than 3x RDA with 2.4g/kg; in other words dietary
protein three times the current RDA failed to confer further fat free mass
protection or protein metabolic advantage.
A difference between these two studies was the exercise type. Pasiakos et al. included a daily low-to-moderate–intensity (40–60%
GraphicO2max) treadmill and cycling as well as thrice weekly lower-intensity resistive-type exercise
(3 sets of 15 repetitions). Phillips et al. involved intense high-volume resistance exercise and HIT/SIT: a full-body
resistance exercise circuit (2 times/wk with no rest between exercises) of 10
repetitions/set for 3 sets at 80% of 1RM,
with the last set of each exercise to volitional failure; HIT/SIT (2 times/wk); a weekly 250-kJ time trial on a cycle ergometer during which participants were
instructed to complete the trial as quickly as possible while self-adjusting
the ergometer resistance; and a plyometric
body weight circuit with a 30-s rest between exercises.
This difference in exercise type and intensity may account
for the differences seen in both studies. However there is another difference
regarding study participants. Pasiakos et al. used physically active military personnel
while Phillips et al. used “recreationally active” subjects.
Taking a
closer look at the data we can see that subjects were already bench pressing 99-107g pre-intervention
and increased to 126-146kg (+27-39kg) after 4 weeks. They were also leg
pressing 162-171kg pre-intervention and increased to 318-340kg (+156-169kg) after
4 weeks. Does that look like only
recreationally active subjects? Subjects were more likely detrained and quickly regained strength
and LBM, in fact Stu Phillips himself said they were detrained (somewhere in
social media).
There is yet another
possible reason for the disparity of results between these 2 studies, and
also between Pasiakos et al. and other similar studies! But I will save that
for later! You better stay tuned.
In
conclusion, there is a synergism between
resistance exercise training and high-protein intakes during weight loss, resulting in an even greater ratio of fat to
lean mass loss when the two strategies
are combined as more studies show (11,12,13).
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Summary of 34 articles with
36.528 words and 1121 references on
Exercise and nutrition
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