Effectiveness of exercise training after bariatric surgery—a systematic literature review and meta‐analysis

Abstract

We aimed to conduct a systematic review and meta-analysis of controlled trials assessing exercise training programs in patients with obesity undergoing bariatric surgery. We systematically searched exercise training studies performed after bariatric surgery published up to June 2017. Studies reporting changes in body composition, physical fitness, functional capacity, objectively measured physical activity, quality of life or relevant health outcomes were included. The review protocol is available from PROSPERO (CRD42017069380). Meta-analyses were conducted using random-effects models when data were available from at least five articles. Twenty articles were included, describing 16 exercise training programs, of which 15 were included in the meta-analysis. Overall, exercise training was associated with higher weight loss (mean difference: -2.4 kg, 95% CI: -4.2; -0.6, I = 49%, n = 12), higher fat mass loss (-2.7 kg, 95% CI: -4.5; -1.0, I = 50%, n = 8) and improved VO max and functional walking (standardized mean difference: 0.86, 95% CI: 0.29; 1.44, I = 57%, n = 6; 1.45, 95% CI: 0.32; 2.58, I = 89%, n = 6, respectively). Exercise training was not associated with lean body mass changes. In conclusion, exercise training programs performed after bariatric surgery were found effective to optimize weight loss and fat mass loss and to improve physical fitness, although no additional effect on lean body mass loss was found.

Accelerometer-measured versus self-reported physical activity levels in women before and up to 48 months after Roux-en-Y Gastric Bypass

“…Patients may also be encouraged to use mobile apps or own advices that measures physical activity (like pedometers, smart watches or apps that continuously measures daily physical activity) to learn their own physical activity behavior and to see how different activities are registered in different physical activity levels. They may also get information about the existing physical activity guidelines and what advantages sufficient physical activity can have on their health as well as how physical activity can optimize their results of the surgery [15,45]. As concluded, bariatric patients highly overestimate their physical activity up to 48 months after surgery, and therefore accelerometers may play a role in helping patients to understand and, hopefully, increase their physical activity behaviors post-surgery.…”

“…Bariatric surgery, such as Roux-en-Y Gastric Bypass (RYGB), is the most effective method for sustainable weight loss [7,8]. Physical activity, and especially MVPA, after bariatric surgery is of importance as it helps improve surgical outcomes [9,10], contribute to a greater weight loss [11], maintain the post-surgery weight loss, improve body composition [12][13][14][15], and increase cardiorespiratory fitness [13]. Moreover, there is some evidence of an association between sedentary time and fat-free mass loss post-surgery [16] and exercise post-surgery can attenuate the loss of fatfree mass and increase muscle strength [17,18].…”

“…Moreover, there is some evidence of an association between sedentary time and fat-free mass loss post-surgery [16] and exercise post-surgery can attenuate the loss of fatfree mass and increase muscle strength [17,18]. However, a recent meta-analysis did not find any associations between exercise and changes in lean body mass [15]. Previous studies, using self-reported questionnaires, have shown that bariatric surgery patients increase, often with over 20%, their time spent in MVPA post-surgery [9].…”

One-year follow-up of a dissonance-based intervention on quality of life, wellbeing, and physical activity after Roux-en-Y gastric bypass surgery: a randomized controlled trial

“…Stolberg et al [13] tried to improve HRQoL by increasing physical activity with some positive results. Exercise interventions involving bariatric surgery patients, in general, improve weight loss, fat mass loss, and physical fitness [14], supporting the importance of physical activity for this patient group. Usual care after bariatric surgery in Sweden differs between hospitals, but in most hospitals, there are no support groups, sessions with a psychologist, or anything else tailored to improve post-surgery HRQoL and wellbeing.…”

An exercise-based educational and motivational intervention after surgery can improve behaviors, physical fitness and quality of life in bariatric patients

“…However, exercise-based interventions are often focused exclusively on training to prevent weight regain and do not include motivational nor educational programs that may support patients in adopting new healthy behaviors, in order to guarantee the long-lasting maintenance of weight loss. Furthermore, little is known about the possible effects of these interventions in improving muscular strength and joint flexibility of bariatric patients beyond their weight condition [ 24 ].…”