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Effects of Exercise Training on Weight Loss in Patients Who Have Undergone Bariatric Surgery: a Systematic Review and Meta-Analysis of Controlled Trials

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A Correction to this article was published on 19 August 2019

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Abstract

The combination of bariatric surgery and physical exercise has been suggested as a promising strategy to positively influence obesity, not only body weight but also all associated comorbidities. An electronic search of intervention studies was carried out in which an exercise training program was implemented after bariatric surgery. The quality of each study was assessed and the data were meta-analyzed using a random effect model. Twenty-six articles were included in the systematic review and 16 in the meta-analysis. As the main conclusion, exercise in patients who have undergone bariatric surgery does not seem to be effective in enhancing weight loss (SMD = 0.15; 95% CI = − 0.02, 0.32; p = 0.094). However, the variability in the protocols used makes it too early to reach a definite conclusion.

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Change history

  • 19 August 2019

    In the original article the name of author Enrique G. Artero was misspelled.

Abbreviations

95% CI:

95% confidence intervals

BMI:

Body mass index

C.G:

Control group

D/W:

Days per week

HR:

Heart rate

I.G:

Intervention group

M/W:

Minutes per week

MIP:

Maximum inspiratory pressure

non-RCTs:

Non-randomized control trials

NR:

Not reported

PA:

Physical activity

RCTs:

Randomized controlled trials

RM:

Repetition maximum

RYGB:

Roux-en-Y gastric bypass

SDs:

Standard deviations

SMD:

Standardized mean difference

VO2max:

Maximum oxygen consumption

References

  1. World Health Organization. Obesity : Preventing and Managing the Global Epidemic. World Health Organization 2000.

  2. World Health Organization. WHO obesity and overweight fact sheet no 311. 2006;311:4–7. Available from: http://who.ubt.neduacebter.factsheet.fs311. Accesed 15 May 2019.

  3. Hu F. Obesity epidemiology. Oxford University Press. 2008

  4. Flegal KM, Kit BK, Orpana H, et al. Association of all-cause mortality with overweight and obesity using standard body mass index categories a systematic review and meta-analysis. Jama. 2013;309:71–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. MacMahon S, Baigent C, Duffy S, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373:1083–96.

    Article  Google Scholar 

  6. Cawley J. An economy of scales: a selective review of obesity’s economic causes, consequences, and solutions. J Health Econ. 2015;43:244–68.

    Article  PubMed  Google Scholar 

  7. Pi-Sunyer X, Blackburn G, Brancati F, et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care. 2007;30:1374–83.

    Article  PubMed  Google Scholar 

  8. Neter JE, Stam BE, Kok FJ, et al. Influence of weight reduction on blood pressure a meta-analysis of randomized controlled trials. Hypertension. 2003;42:878–84.

    Article  CAS  PubMed  Google Scholar 

  9. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. Jama. 2004;292:1724–37.

    Article  CAS  PubMed  Google Scholar 

  10. Wolfe BM, Kvach E, Eckel RH. Treatment of obesity: weight loss and bariatric surgery. Circ Res. 2016;118:1844–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Donnelly JE, Blair SN, Jakicic JM, et al. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41:459–71.

    Article  PubMed  Google Scholar 

  12. Soriano-Maldonado A, Aparicio VA, Félix-Redondo FJ, et al. Severity of obesity and cardiometabolic risk factors in adults: sex differences and role of physical activity. The HERMEX study. Int J Cardiol. 2016;223:352–9.

    Article  PubMed  Google Scholar 

  13. Swift DL, Lavie CJ, Johannsen NM, et al. Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention. Circ J. 2013;77:281–92.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Freitas PD, Silva AG, Ferreira PG, et al. Exercise improves physical activity and comorbidities in obese adults with asthma. Eur Respir J. 2018;52

  15. Bell J, Hamer M, van Hees H, Singh-Manoux A, Kivimäki M, Sabia S. Healthy obesity and objective physical activity. Am J Clin Nutr 2015;102:268–275.

  16. Swift DL, Johannsen NM, Lavie CJ, et al. The role of exercise and physical activity in weight loss and maintenance. Prog Cardiovasc Dis. 2014;56:441–7.

    Article  PubMed  Google Scholar 

  17. Basterra-Gortari FJ, Beunza JJ, Bes-Rastrollo M, et al. Increasing trend in the prevalence of morbid obesity in Spain: from 1.8 to 6.1 per thousand in 14 years. Rev Esp Cardiol. 2011;64:424–6.

    Article  PubMed  Google Scholar 

  18. Ricci C, Gaeta M, Rausa E, et al. Long-term effects of bariatric surgery on type II diabetes, hypertension and hyperlipidemia: a meta-analysis and meta-regression study with 5-year follow-up. Obes Surg. 2015;25:397–405.

    Article  PubMed  Google Scholar 

  19. Coen PM, Carnero EA, Goodpaster BH. Exercise and bariatric surgery: an effective therapeutic strategy. Exerc Sport Sci Rev. 2018;46:262–70.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Egberts K, Brown WA, Brennan L, et al. Does exercise improve weight loss after bariatric surgery? A Systematic Review. Obes Surg. 2012;22:335–41.

    Article  PubMed  Google Scholar 

  21. Livhits M, Mercado C, Yermilov I, et al. Exercise following bariatric surgery : systematic review. Obes Surg. 2010;20:657–65.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bellicha A, Ciangura C, Portero P, et al. Effectiveness of exercise training after bariatric surgery—a systematic literature review and meta-analysis. Obes Rev. 2018;19:1544–56.

    Article  CAS  PubMed  Google Scholar 

  23. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–9.

    Article  PubMed  Google Scholar 

  24. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration. 2008.

  25. Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    Article  PubMed  PubMed Central  Google Scholar 

  26. National Collaborating Centre for Methods and Tools. Quality assessment tool for quantitative studies. Effective Public Health Practice Project. McMaster University. 2010.

  27. Armijo-Olivo S, Stiles CR, Hagen NA, et al. Assessment of study quality for systematic reviews: a comparison of the Cochrane collaboration risk of bias tool and the effective public health practice project quality assessment tool: methodological research. J Eval Clin Pract. 2012;18:12–8.

    Article  PubMed  Google Scholar 

  28. Cavero-Redondo I, Peleteiro B, Álvarez-Bueno C, et al. The effect of physical activity interventions on glycosylated haemoglobin (HbA 1c) in non-diabetic populations: a systematic review and Meta-analysis. Sports Med. 2018;48:1151–64.

    Article  PubMed  Google Scholar 

  29. Hedges LV, Olkin I. Statistical methods for meta-analysis. San Diego: Academic Press; 1985.

    Google Scholar 

  30. Fu R, Vandermeer BW, Shamliyan TA, O’Neil ME, Yazdi F, Fox SH, Morton SC. Handling continuous outcomes in quantitative synthesis. Methods Guide for Effectiveness and Comparative Effectiveness Reviews [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008-. AHRQ Methods for Effective Health Care. 2013.

  31. Balk EM, Earley A, Patel K, Trikalinos TA, Dahabreh IJ. Empirical assessment of within-arm correlation imputation in trials of continuous outcomes. Methods Research Report. AHRQ Publication No. 12(13)-EHC141-EF. Rockville, MD: Agency for Healthcare Research and Quality. 2012.

  32. Dersimonian R, Laird N. Meta-analysis in clinical trials*. Control Clin Trials. 1986;7:177–88.

    Article  CAS  PubMed  Google Scholar 

  33. Pouwels S, Wit M, Teijink JAW, et al. Aspects of exercise before or after bariatric surgery: a systematic review. Obes Facts. 2015;8:132–46.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Creasy SA, Rogers RJ, Davis KK, et al. Effects of supervised and unsupervised physical activity programmes for weight loss. Obes Sci Pract. 2017;3:143–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Dalton JA, Higgins MK, Miller AH, et al. Changes in enjoyment, self-efficacy, and motivation during a randomized trial to promote habitual physical activity adoption in bariatric surgery patients dale. Surg Obes Relat Dis. 2016;12:1072–9.

    Article  Google Scholar 

  36. Ho SS, Dhaliwal SS, Hills AP, et al. The effect of 12 weeks of aerobic, resistance or combination exercise training on cardiovascular risk factors in the overweight and obese in a randomized trial. BMC Public Health. 2012;12:704.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Garber CE, Blissmer B, Deschenes MR, et al. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43:1334–59.

    Article  PubMed  Google Scholar 

  38. Pedersen BK, Saltin B. Association of atrial fibrillation and oral anticoagulant use with perioperative outcomes after major noncardiac surgery. Scand J Med Sci Sports. 2006;16:3–63.

    Article  PubMed  Google Scholar 

  39. Taylor NF, Dodd KJ, Shields N, et al. Therapeutic exercise in physiotherapy practice is beneficial: a summary of systematic reviews 2002-2005. Aust J Physiother. 2007;53:7–16.

    Article  PubMed  Google Scholar 

  40. Pedersen BK, Saltin B. Exercise as medicine—evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25:1–72.

    Article  PubMed  Google Scholar 

  41. Coen PM, Carnero EA, Goodpaster BH. Exercise and bariatric surgery: an effective therapeutic strategy. Exerc Sport Sci Rev US. 2018;46:262–70.

    Article  Google Scholar 

  42. Campanha-versiani L, Aparecida D, Pereira G, et al. The effect of a muscle weight-bearing and aerobic exercise program on the body composition , muscular strength , biochemical markers, and bone mass of obese patients who have undergone gastric bypass surgery. Obes Surg. 2017;27:2129–37.

    Article  PubMed  Google Scholar 

  43. Carnero EA, Dubis GS, Hames KC, et al. Randomized trial reveals that physical activity and energy expenditure are associated with weight and body composition after RYGB. Elvis. 2017;25:1206–16.

    Google Scholar 

  44. Casali C, Pereira APM, Martinez JAB, et al. Effects of inspiratory muscle training on muscular and pulmonary function after bariatric surgery in obese patients. Obes Surg. 2011;21:1389–94.

    Article  PubMed  Google Scholar 

  45. Castello V, Simões RP, Bassi D, et al. Impact of aerobic exercise training on heart rate variability and functional capacity in obese women after gastric bypass surgery. Obes Surg. 2011;21:1739–49.

    Article  PubMed  Google Scholar 

  46. Castello-simões V, Simões RP, Beltrame T, et al. Effects of aerobic exercise training on variability and heart rate kinetic during submaximal exercise after gastric bypass surgery—a randomized controlled trial rate kinetic during submaximal exercise after gastric bypass surgery—a randomized control. Disabil Rehabil. 2013;35:334–42.

    Article  PubMed  Google Scholar 

  47. Coen PM, Tanner CJ, Helbling NL, et al. Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity. J Clin Invest. 125:248–57.

    Article  Google Scholar 

  48. Coen PM, Menshikova EV, Distefano G, et al. Exercise and weight loss improve muscle mitochondrial respiration, lipid partitioning , and insulin sensitivity after gastric bypass surgery. Diabetes. 2015;64:3737–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Coleman KJ, Caparosa SL, Nichols JF, et al. Understanding the capacity for exercise in post-bariatric patients. Obes Surg. 2017;27:51–8.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Creel DB, Schuh LM, Reed CA, et al. A randomized trial comparing two interventions to increase physical activity among patients undergoing bariatric surgery. Obesity. 2016;24:1660–8.

    Article  PubMed  Google Scholar 

  51. Daniels P, Burns RD, Brusseau TA, et al. Effect of a randomised 12-week resistance training programme on muscular strength , cross- sectional area and muscle quality in women having undergone Roux-en-Y gastric bypass. J Sports Sci. 2018;36:529–35.

    Article  PubMed  Google Scholar 

  52. Hassannejad A, Khalaj A, Mansournia MA, et al. The effect of aerobic or aerobic-strength exercise on body composition and functional capacity in patients with BMI ≥ 35 after bariatric surgery : a randomized control. Obes Surg. 2017;27:2792–801.

    Article  PubMed  Google Scholar 

  53. Huck CJH. Effects of supervised resistance training on fitness and functional strength in patients succeeding bariatric surgery. J Strength Cond Res. 2015;29:589–95.

    Article  PubMed  Google Scholar 

  54. Lopez YN, Coen PM, Goodpaster BH, et al. Gastric bypass surgery with exercise alters plasma microRNAs that predict improvements in cardiometabolic risk. Int J Obes. 2017;41:1121–30.

    Article  CAS  Google Scholar 

  55. Marchesi F, De Sario G, Reggiani V, et al. Road running after gastric bypass for morbid obesity : rationale and results of a new protocol. Obes Surg. 2015;25:1162–70.

    Article  PubMed  Google Scholar 

  56. Mundbjerg LH, Stolberg CR, Cecere S, et al. Supervised physical training improves weight loss after Roux-en-Y gastric bypass surgery: a randomized controlled trial. Obesity. 26:828–37.

    Article  PubMed  Google Scholar 

  57. Mundbjerg LH, Stolberg CR, Bladbjerg EM, et al. Effects of 6 months supervised physical training on muscle strength and aerobic capacity in patients undergoing roux-en-Y gastric bypass surgery: a randomized controlled trial. Clin Obes. 2018;8:227–35.

    Article  CAS  PubMed  Google Scholar 

  58. de Oliveira JJJ, de Freitas ACT, de Almeida AA. Postoperative effect of physical therapy related to functional capacity and respiratory muscle strength in patients submitted to bariatric surgery. Arq Bras Cir Dig. 2016;29:43–7.

    Article  PubMed Central  Google Scholar 

  59. Onofre T, Carlos R, Oliver N, et al. Effects of a physical activity program on cardiorespiratory fitness and pulmonary function in obese women after bariatric surgery : a pilot study. Obes Surg. 2017;27:2026–33.

    Article  PubMed  Google Scholar 

  60. Rojhani-Shirazi Z, Mansoriyan SA, Hosseini SV. The effect of balance training on clinical balance performance in obese patients aged 20–50 years old undergoing sleeve gastrectomy. Eur Surg. 2016;48:105–9.

    Article  Google Scholar 

  61. Shah M, Snell PG, Rao S, et al. High-volume exercise program in obese bariatric surgery patients a randomized. Controlled Trial Obes. 2011;19:1826–34.

    Google Scholar 

  62. Stegen S, Derave W, Calders P, et al. Physical fitness in morbidly obese patients : effect of gastric bypass surgery and exercise training. Obes Surg. 2011;21:61–70.

    Article  PubMed  Google Scholar 

  63. Stolberg CR, Mundbjerg LH, Funch-Jensen P, et al. Effects of gastric bypass surgery followed by supervised physical training on in fl ammation and endothelial function: a randomized controlled trial. Atherosclerosis. 2018;273:37–44.

    Article  CAS  PubMed  Google Scholar 

  64. Stolberg CR, Mundbjerg LH, Bladbjerg EM, et al. Physical training following gastric bypass: effects on physical activity and quality of life—a randomized controlled trial. Qual Life Res. 2018;27:3113–22.

    Article  PubMed  Google Scholar 

  65. Wiklund M, Sundqvist E, Olsén MF. Physical activity in the immediate postoperative phase in patients undergoing roux-en-Y gastric bypass—a randomized controlled trial. Obes Surg. 2015;25:2245–50.

    Article  PubMed  Google Scholar 

  66. Woodlief TL, Carnero EA, Standley RA, et al. Dose response of exercise training following roux-en-Y gastric bypass surgery: a randomized trial. Obesity. 2015;23:2454–61.

    Article  PubMed  Google Scholar 

  67. Herring LY, Stevinson C, Carter P, et al. The effects of supervised exercise training 12–24 months after bariatric surgery on physical function and body composition: a randomised controlled trial. Int J Obes. 2017;41:909–16.

    Article  CAS  Google Scholar 

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Funding

This work was supported by the Spanish Ministry of Economy and Competitiveness (MINECO), Plan Nacional de I+D+i call RETOS 2016, reference DEP2016-74926-R.

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Authors and Affiliations

  1. Department of Education, Faculty of Education Sciences, University of Almería, Ctra. Sacramento s/n, La Cañada de San Urbano, 04120, Almería, Spain

    Alejandro Carretero-Ruiz, Alberto Soriano-Maldonado & Enrique G. Arter

  2. SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain

    Alejandro Carretero-Ruiz, Alberto Soriano-Maldonado & Enrique G. Arter

  3. Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Granada, Spain

    María del Carmen Olvera-Porcel

  4. Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain

    Iván Cavero-Redondo, Celia Álvarez-Bueno & Vicente Martínez-Vizcaíno

  5. Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay

    Iván Cavero-Redondo & Celia Álvarez-Bueno

  6. Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile

    Vicente Martínez-Vizcaíno

  7. Bariatric Surgery Department, Complejo Hospitalario Torrecárdenas, Almería, Spain

    Manuel Ferrer-Márquez

Authors
  1. Alejandro Carretero-Ruiz
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  2. María del Carmen Olvera-Porcel
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  3. Iván Cavero-Redondo
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  8. Enrique G. Arter
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Correspondence to Alejandro Carretero-Ruiz.

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Carretero-Ruiz, A., Olvera-Porcel, M., Cavero-Redondo, I. et al. Effects of Exercise Training on Weight Loss in Patients Who Have Undergone Bariatric Surgery: a Systematic Review and Meta-Analysis of Controlled Trials. OBES SURG 29, 3371–3384 (2019). https://doi.org/10.1007/s11695-019-04096-9

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