Table 2 Summary of findings.

From: The acute effect of fasted exercise on energy intake, energy expenditure, subjective hunger and gastrointestinal hormone release compared to fed exercise in healthy individuals: a systematic review and network meta-analysis

Ad libitum meal energy intake
Total studies: 14	Relative effect (95% CI)	Confidence in evidence	Ranking	Interpretation of findings
Total participants: 217	Relative effect (95% CI)	Confidence in evidence	Ranking	Interpretation of findings
Fasted exercise with a standardised post-exercise meal (1 study; 10 participants)	7 kJ	⊕⊕⊝⊝		Unlikely inferior or superior
	(−703 to 717 kJ)	Low	3
	Combined estimate	Due to within-study bias and imprecision^a
Fasted exercise without a standardised post-exercise meal (5 studies; 88 participants)	338 kJ	⊕⊕⊝⊝		Probably inferior
	(−174 to 850 kJ)	Low	4
	Combined estimate	Due to within-study bias, imprecision and heterogeneity^b
Fed exercise with a standardised post-exercise meal (6 studies; 93 participants)	−489 kJ	⊕⊕⊝⊝		Probably superior
	(-898 to -79 kJ)	Low	1
	Combined estimate	Due to within-study bias and heterogeneity^c
Fed exercise without a standardised post-exercise meal	Reference comparator	Reference comparator	2	Reference comparator
Within-lab energy intake
Total studies: 14	Relative effect (95% CI)	Confidence in evidence	Ranking	Interpretation of findings
Total participants: 217	Relative effect (95% CI)	Confidence in evidence	Ranking	Interpretation of findings
Fasted exercise with a standardised post-exercise meal (1 study; 10 participants)	−39 kJ	⊕⊕⊝⊝		Unlikely inferior or superior
	(−1113 to 1035 kJ)	Low	3
	Combined estimate	Due to within-study bias and imprecision^a
Fasted exercise without a standardised post-exercise meal (5 studies; 88 participants)	−1316 kJ	⊕⊕⊝⊝		Probably Superior
	(−2096 to −536 kJ)	Low	1
	Combined estimate	Due to within-study bias and heterogeneity^d
Fed exercise with a standardised post-exercise meal (6 studies; 93 participants)	389 kJ	⊕⊕⊕⊝		Probably inferior
	(−249 to 1028 kJ)	Moderate	4
	Combined estimate	Due to within-study bias, imprecision and heterogeneity^e
Fed exercise without a standardised post-exercise meal	Reference comparator	Reference comparator	2	Reference comparator
24-h energy intake
Total studies: 6	Relative effect (95% CI)	Confidence in evidence	Ranking	Interpretation of findings
Total participants: 83	Relative effect (95% CI)	Confidence in evidence	Ranking	Interpretation of findings
Fasted exercise with a standardised post-exercise meal (1 study; 10 participants)	−161 kJ	⊕⊕⊝⊝		Unlikely inferior or superior
	(−2120 to 1798 kJ)	Low	2
	Combined estimate	Due to within-study bias and imprecision^f
Fasted exercise without a standardised post-exercise meal (2 studies; 36 participants)	−2095 kJ	⊕⊕⊝⊝		Probably superior
	(−3910 to −280 kJ)	Low	1
	Combined estimate	Due to within-study bias and heterogeneity^d
Fed exercise with a standardised post-exercise meal (1 studies; 13 participants)	680 kJ	⊕⊕⊝⊝		Unlikely inferior or superior
	(−1194 to 2553 kJ)	Low	4
	Combined estimate	Due to within-study bias and imprecision^g
Fed exercise without a standardised post-exercise meal	Reference comparator	Reference comparator	3	Reference comparator
Energy expenditure
Total studies: 6	Relative effect (95% CI)	Confidence in evidence	Ranking	Interpretation of findings
Total participants: 69	Relative effect (95% CI)	Confidence in evidence	Ranking	Interpretation of findings
Fasted exercise with a standardised post-exercise meal (5 studies; 43 participants)	0.07 kJ/min	⊕⊕⊕⊝		Unlikely inferior or superior
	(−0.15 to 0.30 kJ/min)	Moderate	1
	Combined estimate	Due to within-study bias^h
Fasted exercise without a standardised post-exercise meal (1 study; 7 participants)	−0.67 kJ/min	⊕⊕⊕⊝		Probably inferior
	(−1.10 to −0.23 kJ/min)	Moderate	4
	Combined estimate	Due to within-study bias^h
Fed exercise with a standardised post-exercise meal (0 studies; 0 participants)	0.08 kJ/min	⊕⊕⊕⊕	2	Unlikely inferior or superior
	(−0.66 to 0.81 kJ/min)	High
	Indirect estimate	High
Fed exercise without a standardised post-exercise meal	Reference comparator	Reference comparator	3	Reference comparator
Subjective hunger
Total studies: 11	Relative effect (95% CI)	Confidence in evidence	Ranking	Interpretation of findings
Total participants: 145	Relative effect (95% CI)	Confidence in evidence	Ranking	Interpretation of findings
Fasted exercise with a standardised post-exercise meal (2 studies; 22 participants)	13 mm	⊕⊕⊕⊝		Probably inferior
	(5 to 21 mm)	Moderate	3
	Combined estimate	Due to within-study bias and heterogenityⁱ
Fasted exercise without a standardised post-exercise meal (4 studies; 58 participants)	23 mm	⊕⊕⊝⊝		Probably inferior
	(16 to 30 mm)	Low	4
	Combined estimate	Due to within-study bias^j
Fed exercise with a standardised post-exercise meal (2 studies; 27 participants)	−6 mm	⊕⊕⊝⊝		Probably superior
	(−14 to 2 mm)	Low	1
	Combined estimate	Due to within-study bias, imprecision and heterogeneity^b
Fed exercise without a standardised post-exercise meal	Reference comparator	Reference comparator	2	Reference comparator

Estimates of effects, 95% confidence intervals, and certainty of the evidence for fasted exercise in healthy individuals
Patient or population: healthy individuals
Interventions: fasted exercise with a standardised post-exercise meal, fasted exercise without a standardised post-exercise meal, fed exercise with a standardised meal
Comparator (reference): fed exercise without a standardised post-exercise meal
Setting: laboratory environment
Summary of findings table definitions
*Estimates are expressed as mean differences. CI: confidence interval.
**Rankings are based on P-scores derived from the network meta-analyses.
***Interpretation of findings is in reference to fed exercise without a standardised post-exercise meal.
Confidence in evidence levels
High: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
Explanatory footnotes
^aSome concerns regarding within-study bias (unclear risk of bias in measurement of the outcome) and major concerns regarding imprecision (95% CI extends into clinically important effects in both directions).
^bMajor concerns regarding within-study bias (high risk of bias in measurement of the outcome), some concerns regarding imprecision (95% CI extends from clinically important effect to no effect), and some concerns regarding heterogeneity (prediction interval extends into clinically important or unimportant effects).
^cSome concerns regarding within-study bias (unclear risk of bias arising from the randomisation process) and major concerns regarding heterogeneity (prediction interval extends into clinically important effects in both directions).
^dMajor concerns regarding within-study bias (high risk of bias in measurement of the outcome) and major concerns regarding heterogeneity (prediction interval extends into clinically important effects in both directions).
^eSome concerns regarding within-study bias (unclear risk of bias arising from the randomisation process), some concerns regarding imprecision (95% CI extends from clinically important effect to no effect), and some concerns regarding heterogeneity (prediction interval extends into clinically important or unimportant effects).
^fSome concerns regarding within-study bias (unclear risk of bias arising from the randomisation process and in measurement of the outcome) and major concerns regarding imprecision (95% CI extends into clinically important effects in both directions).
^gSome concerns regarding within-study bias (unclear risk of bias arising from the randomisation process) and major concerns regarding imprecision (95% CI extends into clinically important effects in both directions).
^hSome concerns regarding within-study bias (unclear risk of bias arising from the randomisation process).
ⁱSome concerns regarding within-study bias (unclear risk of bias arising from the randomisation process and in measurement of the outcome) and heterogeneity (prediction interval extends into clinically important or unimportant effects).
^jMajor concerns regarding within-study bias (measurement of outcome).

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Table 2 Summary of findings.

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