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Exercise for counteracting weight recurrence after bariatric surgery: a systematic review and meta-analysis of randomized controlled trials

Published:December 19, 2022DOI:https://doi.org/10.1016/j.soard.2022.12.029

      Highlights

      • Exercise has potential to prevent weight recurrence after bariatric surgery.
      • Exercise interventions had a small effect on weight beyond ≥1-year post surgery.
      • Methodological limitations undermine confidence that the observed effect is accurate.
      • Rigorous testing of exercise effects on postsurgical weight recurrence is needed.

      Abstract

      Exercise is recommended to prevent post-surgical weight recurrence. Yet, whether exercise interventions are efficacious in this regard has not been systematically evaluated. Moreover, clinicians lack evidence-based information to advise patients on appropriate exercise frequency, intensity, time, and type (FITT) for preventing weight recurrence. Thus, we conducted a meta-analysis of randomized controlled trials (RCTs) involving exercise interventions specifying FITT and weight measurement ≥12 months post-surgery. We reviewed scientific databases up through February 2022 for RCTs comparing exercise interventions reporting FITT and a nonexercise control group on weight ≥12 months post-surgery. Procedures following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were registered at the international prospective register of systematic reviews (PROSPERO: CRD42022342337). Of 1368 studies reviewed, 5 met inclusion criteria (n = 189; 47.8 ± 4.2 yr, 36.1 6 ± 3.8 kg·m2, 83.2 ± 9.5% female; 61.7% underwent Roux-en-Y gastric bypass). Exercise interventions were largely supervised, lasted 12–26 weeks, and prescribed 80–210 minutes/week of moderate-to-vigorous intensity combined aerobic and resistance exercise over ≤5 days. Within-group effects showed non-statistically significant weight loss for exercise (d = − .15, 95% confidence interval [CI]: −1.96, 1.65; −1.4 kg; P = .87) and weight gain for control (d = .11, 95% CI: −1.70,1.92; +1.0 kg; P = .90), with no difference between these groups (d = −2.26, 95% CI: −2.07, 1.55; −2.4 kg; P = .78). Exercise elicited an additional 2.4 kg weight loss versus control, although this effect was small and statistically non-significant. Ability to draw definitive conclusions regarding efficacy of exercise interventions for counteracting post-surgical weight recurrence was limited by the small number of trials and methodological issues. Findings highlight the need for more rigorous RCTs of exercise interventions specifically designed to reduce post-surgical weight recurrence.

      Keywords

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