Physical activity substitution: An overlooked constraint on energy expenditure during exercise and physical activity interventions
Authors' conclusion
Physical activity substitution has the potential to erode the increase in daily energy expenditure during prescribed exercise interventions, and to introduce marked heterogeneity in the treatment response (change in energy expenditure). Successful mitigation of physical activity substitution could potentially increase the effectiveness of physical activity interventions.
Study context
- Population
- Patients aged 63 ± 6 years recruited in the south-west of England
- Participants
- 242 patients
- Comparison
- LOW vs HIGH prescribed exercise scenarios, accounting for physical activity substitution vs additive models
- Outcome
- Increase in net daily energy expenditure after subtraction of pre-existing physical activity at the time of the modelled prescribed exercise (accounting for substitution)
Methodological detailstwo modelled prescribed exercise scenarios (LOW and HIGH)
- Two modelled prescribed exercise scenarios (LOW and HIGH)
Main finding
As reported in the abstract
Increase in daily energy expenditure after accounting for substitution, as % of potential increase under additive models
Further findings
Heterogeneity in predicted change in daily energy expenditure
- Substitution introduced considerable heterogeneity, most evident in the LOW scenario
Original publication
Physical activity substitution: An overlooked constraint on energy expenditure during exercise and physical activity interventions. Diabetes Obes Metab. Published 3 September 2025. doi:10.
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