Impact of bariatric surgery on physical functioning in obese adults

Abstract

Obesity is associated with a profound impairment in the ability to perform the basic physical activities required for everyday function. This impacts on quality of life and contributes to disability. Bariatric surgery leads to weight loss and metabolic improvements in severe obesity; however, less is known about its effect on physical functioning. This narrative review summarizes current evidence on the effect of bariatric surgery on this outcome with a consideration of the mechanisms involved. Nine longitudinal observational studies reporting objective measures of physical functioning were identified. Inclusion criteria, follow-up time and outcomes reported varied considerably between studies and sample sizes were small. They all showed a significant improvement in performance following surgery despite variations in baseline patient characteristics. Additionally, six studies were found in which subjects were subjected to exercise testing protocols. Performance of the test protocol improved in all. Where reported, peak oxygen uptake related to body weight improved; however, absolute values were either unchanged or decreased. In conclusion, observational evidence suggests that patients' physical functioning improves following bariatric surgery. More evidence is required regarding mechanisms involved; however, it may be due to improved efficiency in performing activities as opposed to absolute improvements in cardiorespiratory or muscle function.

Change in Pain and Physical Function Following Bariatric Surgery for Severe Obesity

“…The findings from this study reinforce shorter-term results from studies that have reported significant improvements in SF-36 bodily pain and physical function scores, 29–32 WOMAC scores, 29,33,34 walking capacity (as measured by the LDCW or the 6-minute walk test), 30,31,35,36 resting heart rate, 35,36 or other measures of pain and function 10–12 in the first 3 to 12 months following RYGB or LAGB. Few studies have reported on pain and function from longer-term follow-up of these procedures.…”

“…8,9 Although evidence of improvements in pain and physical function following bariatric surgery is increasing, the variability and durability of improvement have not been well described—with most studies limited by small sample size and follow-up of 1 year or less or by the study of obsolete surgical procedures. 10–12 …”

The effects of supervised exercise training 12–24 months after bariatric surgery on physical function and body composition: a randomised controlled trial

“…These functional abilities are often limited in obese individuals, hence exercise training that improves physical function is important 5 . The ISWT is a valid field based test of functional capacity and aerobic fitness as it strongly relates to VO 2 max 22 .…”

“…However, there is increasing evidence of weight regain in patients after bariatric surgery 2,3 , generally occurring between 12 and 24 months post-operatively 2,4 . Weight regain increases the risk of physical function decline which negatively affects an individual's ability to undertake activities of daily living 5 . Weight regain also increases the likelihood of obesity related co-morbidities returning 6 , hence the importance of recommendations on diet and physical activity after bariatric surgery to prevent weight regain 7 .…”

The Amount of Weight Loss Six Months after Bariatric Surgery: It Makes a Difference

“…Nevertheless, in the group which had more than 18% weight reduction, VO 2 peak (mL/min) was significantly reduced after surgery. Thus, improvement of physical functioning in patients after bariatric surgery is more a mechanical phenomenon of consequential weight loss than an absolute improvement of cardiopulmonary and muscle function [35]. Therefore, the risk of poor cardiorespiratory and muscle function may persist postsurgically in patients despite their weight loss.…”