The ActivityStat hypothesis: the concept, the evidence and the methodologies.

BACKGROUND The ActivityStat hypothesis suggests that when physical activity is increased or decreased in one domain, there will be a compensatory change in another domain, in order to maintain an overall stable level of physical activity or energy expenditure over time. The ActivityStat debate is gaining momentum in the literature and most of the research to date is based on observational studies. OBJECTIVE The objective of this paper is to conceptually clarify the ActivityStat hypothesis and to examine the experimental research aiming to demonstrate or refute compensation using a systematic review process. METHODS A systematic review was conducted using electronic database searches with the aim of detecting studies experimentally investigating the ActivityStat hypothesis or compensation in physical activity or energy expenditure. Included studies were critically appraised using a specifically designed tool to address the conceptual considerations of the ActivityStat hypothesis. RESULTS Searches identified 28 studies that met the inclusion criteria. Publications spanned 26 years and had multiple methodological approaches, including randomized and non-randomized controlled trials, crossover designs, cluster randomized controlled trials and pre-post trials. Populations of the included studies ranged from children, to adults and the elderly, across a range of weight statuses and used both aerobic, resistance and mixed-exercise interventions. The timeframe of interventions ranged from 1 day to 4 years and outcomes were measured using doubly labelled water, accelerometry, heart rate monitoring, resting metabolic rate, indirect calorimetry, pedometry, subjective recall questionnaire and the activity-related time index. Fifteen of 28 included studies provided evidence of compensation, while 13 did not. Subgroup analyses by population, type and duration of intervention, weight status and study quality also showed mixed findings. CONCLUSION There is a substantial body of experimental literature investigating compensation that has largely been overlooked in the ActivityStat debate. However, this evidence is currently inconclusive and lacks a cohesive approach to the question of an ActivityStat. Recommendations for the design of future experimental research investigating the ActivityStat hypothesis are presented.