Changes in physical activity behaviour and physical function after bariatric surgery: a systematic review and meta‐analysis

Abstract

Summary Although physical activity performed after bariatric surgery is associated with enhanced weight loss outcomes, there is limited information on patients' physical activity behaviour in this context. This systematic review and meta‐analysis assessed pre‐operative to post‐operative changes in physical activity and physical function outcomes among obese adults undergoing bariatric surgery. A total of 50 studies met inclusion criteria with 26 papers reporting data for meta‐analysis. Increases in both objectively recorded and self‐reported physical activity at 12 months were demonstrated. Studies indicated that there was a shift towards a greater amount of active time, but of a lower intensity within the first 6 months of bariatric surgery, suggested by a reduction in moderate to vigorous physical activity but an increase in step count. A standardized mean difference (SMD) of 1.53 (95% CI: 1.02–2.04) based on nine studies indicated improved walking performance at 12 months. Similarly, analysis of five studies demonstrated increased musculoskeletal function at 3–6 months (SMD: 1.51; 95% CI: 0.60–2.42). No relationship was identified between changes in weight and walking performance post‐surgery. More studies assessing physical activity, physical function and weight loss would help understand the role of physical activity in optimizing post‐operative weight and functional outcomes.

Physical capacity outcomes in patients with severe obesity after 12 months of physician‐led multidisciplinary team care: A case series from a public hospital clinical obesity service

“…We observed a statistically significant change in the mean (±SD) 6MWT distance of 78 (±91) m, which is at least 2‐fold larger than the minimal clinically important difference reported for multiple patient groups . This effect on walking capacity is comparable to the improvements reported in other countries following hospital‐based non‐surgical clinical obesity services, but approximately 50% smaller than what has been reported following bariatric surgery at 12 months . Despite this relatively smaller effect, our analysis shows that improvements in walking capacity were positively associated with weight loss and is consistent with some previous studies of surgical and non‐surgical treatments.…”

“…Despite this relatively smaller effect, our analysis shows that improvements in walking capacity were positively associated with weight loss and is consistent with some previous studies of surgical and non‐surgical treatments. Although findings of a recently published systematic review reported no correlation between change in walking performance and weight loss at 12 months following weight‐loss surgery, this inconsistency might be partially explained by a lack of exercise intervention in those studies review. Results of another recently published systematic review with meta‐analysis showed that physical exercise programmes result in additional improvements in 6MWT distance by approximately 30 m compared with controls after bariatric surgery …”

“…This is consistent with previous research suggesting that improvements in walking capacity are associated with changes in echocardiographic diastolic function in patients with severe obesity following 12 months of exercise and diet intervention . Physical exercise may result in additional improvements in 6MWT distance by approximately 30 m compared with controls after bariatric surgery and this benefit appears to be independent of weight loss . Collectively, the existing evidence underscores the important role of exercise in the management of clinically severe obesity in patients, particularly among those with cardiovascular disease.…”

Understanding the Capacity for Exercise in Post-Bariatric Patients

“…However, there is still relatively little known about what types of exercise programs are tolerated well by post-bariatric patients and what exercises are best for improvements in daily functioning. (15) We adapted an effective program for adults with arthritis(16) for use with post-bariatric patients and tested it using a randomized controlled trial. This pilot was called Fitness and Exercise for Post-Bariatric Patients (FEPP).…”

Practising Physical Activity Following Weight-Loss Surgery: The Significance of Joy, Satisfaction, and Well-Being

“…With its biomedical perspective and quantitative research methods, this literature emphasizes levels of physical activity in which weight loss is the ultimate goal. Increased levels of physical activity are regarded as paramount in achieving sufficient weight loss, preventing weight regain, and improving functional health outcomes (Herring et al, 2016;King & Bond, 2013;Mechanick et al, 2013). However, a review of the literature reveals that the vast majority of those who undergo WLS do not make significant behavioural changes in respect of their level of physical activity (PA) (Bergh et al, 2017;King et al, 2015;Reid et al, 2015).…”