The Effect of an Exercise Intervention Program on Bone Health After Bariatric Surgery: A Randomized Controlled Trial

Abstract

Exercise has been suggested as a therapeutic approach to attenuate bone loss induced by bariatric surgery (BS), but its effectiveness remains unclear. Our aim was to determine if an exercise‐training program could induce benefits on bone mass after BS. Eighty‐four patients, submitted to gastric bypass or sleeve gastrectomy, were randomized to either exercise (EG) or control group (CG). One month post‐BS, EG underwent a 11‐month supervised multicomponent exercise program, while CG received only standard medical care. Patients were assessed before BS and at 1, 6, and 12 months post‐BS for body composition, areal bone mineral density (BMD), bone turnover markers, calciotropic hormones, sclerostin, bone material strength index, muscle strength, and daily physical activity. A primary analysis was conducted according to intention‐to‐treat principles and the primary outcome was the between‐group difference on lumbar spine BMD at 12 months post‐BS. A secondary analysis was also performed to analyze if the exercise effect depended on training attendance. Twelve months post‐BS, primary analysis results revealed that EG had a higher BMD at lumbar spine (+0.024 g∙cm−2 [95% confidence interval (CI) 0.004, 0.044]; p = .015) compared with CG. Among total hip, femoral neck, and 1/3 radius secondary outcomes, only 1/3 radius BMD improved in EG compared with CG (+0.013 g∙cm−2 [95% CI 0.003, 0.023]; p = .020). No significant exercise effects were observed on bone biochemical markers or bone material strength index. EG also had a higher lean mass (+1.5 kg [95% CI 0.1, 2.9]; p = .037) and higher number of high impacts (+51.4 [95% CI 6.6, 96.1]; p = .026) compared with CG. In addition, secondary analysis results suggest that exercise‐induced benefits may be obtained on femoral neck BMD but only on those participants with ≥50% exercise attendance compared with CG (+5.3% [95% CI 2.0, 8.6]; p = .006). Our findings suggest that an exercise program is an effective strategy to ameliorate bone health in post‐BS patients. © 2020 American Society for Bone and Mineral Research (ASBMR).

Effect of exercise training before and after bariatric surgery: A systematic review and meta‐analysis

“…27,49 The meta-analysis of these two reviews showed a lower weight regain in the exercise group, with an MD between groups of 4.7 kg [95% CI: A more recent study reported similar findings. 63 This is likely to be an important benefit of exercise training given the increased risk of fracture that has been reported after bariatric surgery, especially after gastric bypass surgery. 64 The effects of exercise on cardiometabolic health are less conclusive in this setting.…”

Exercise and bariatric surgery: A systematic review and meta-analysis of the feasibility and acceptability of exercise and controlled trial methods

“…34,35,42,52,54,55 Most (k=18, 64.3%) studies had samples comprising ≥75% women 32-34, 36, 37, 39-47, 49, 54, 56, 58 and 21.4% (k=6) comprised only women. 35,38,48,[51][52][53] Beyond providing data on age and sex/gender, 39.3% (k=11) of articles reported other sociodemographic data, 30,32,33,35,39,44,45,49,51,52,56 and 42.9% (k=12) reported comorbidities prevalence. 32, 33, 35, 36, 39, 46, 49, 51-53, 56, 58 Among the 6 articles (21.4%) reporting ethnicity/race, all had samples comprising ≥50% White participants.…”

“…30, 34-39, 42-45, 47, 48, 50-53, 55-13 58 Most (k=16, 57.1%) lasted ≤13 weeks (range 4-104 weeks), 32, 33, 35, 38, 40-46, 52, 55-58 89.3% (k=25) were supervised exercise, 30, 32-37, 39-41, 43-54, 56-58 and 35.7% (k=10) held sessions individually. 30, 32, 35, 36, 41-43, 51, 56, 57 Exercise sessions were performed: in hospitals, clinics, or medical centers (k=10, 35.7%), 33,40,43,49,[51][52][53][56][57][58] at home (k=4, 14.3%), 30,36,41,42 in research centers (k=3, 10.7%), 35,46,47 in community or fitness centers (k=3, 10.7%), 44,50,54 or at a facility (k=3, 10.7%), 32,39,45 location was not specified in 17.9% (k=5) of articles. 34,37,38,48,55 Most (k=19, 67.9%) interventions initiated after bariatric surgery started during the first year after the surgery was performed, 30, 34-39, 42-44, 48, 50-53, 55-58 ranging from 0 to 36 months after bariatric surgery.…”

“…Only 7.1% (k=2) intervention were initiated ≥2 years after bariatric surgery. 45,47 Training consisted of: endurance training (k=6, 21.4%), 35,36,41,48,49,56 , resistance training (k=5, 17.9%), 38,39,44,45,53 combination of resistance and endurance training (k=16, 57.1%), 30, 32-34, 37, 40, 42, 43, 46, 47, 50-52, 54, 57, 58 and balance training (k=1, 3.6%). 55…”

“…Among the 57.1% (k=16) of articles reporting on whether there were adverse events during exercise, 33, 35-37, 39, 41, 43-45, 48, 51-54, 56, 58 32.1% (k=9) reported none, 36,41,[43][44][45][51][52][53][54] 14.3% (k=4) reported occasional pain, fatigue, or dyspnea, 33,35,39,56 7.1% (k=2) reported hypoglycemia or hypotension, 33,58 and 3.6% (k=1) reported back bruise after a fall. 39 Main reasons reported for exercise intervention dropout were: lack of time (12 participants from 3 articles 36,37,56 ), work or other commitments (7 participants from 2 articles 35,49 ), lack of motivation (3 participants from 1 article 48 ), dislike of exercise (2 participants from 1 article 35 ), and postponed surgery or complications (2 participants from 2 articles 43,49 ). Satisfaction with the exercise intervention was only reported in 3.6% (k=1) of articles.…”