Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical Studies and Practice

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

International Journal of Obesity volume 41, pages 909–916 (2017)Cite this article

Subjects

Abstract

Background:

Bariatric surgery is effective for the treatment of stage II and III obesity and its related diseases, although increasing evidence is showing weight regain ~12–24 months postsurgery. Weight regain increases the risk of physical function decline, which negatively affects an individual's ability to undertake activities of daily living. The study assessed the effects of a 12-week supervised exercise intervention on physical function and body composition in patients between 12 and 24 months post bariatric surgery.

Methods:

Twenty-four inactive adult bariatric surgery patients whose body mass index remained ⩾30 kg m2 12 to 24 months post surgery were randomised to an exercise intervention (n=12) or control group (n=12). Supervised exercise consisted of three 60-min gym sessions per week of moderate intensity aerobic and resistance training for 12 weeks. Control participants received usual care. The incremental shuttle walk test (ISWT) was used to assess functional walking performance after the 12-week exercise intervention, and at 24 weeks follow-up. Measures of anthropometric, physical activity, cardiovascular and psychological outcomes were also examined. Using an intention-to-treat protocol, independent t-tests were used to compare outcome measures between groups.

Results:

Significant improvements in the exercise group were observed for the ISWT, body composition, physical function, cardiovascular and self-efficacy measures from baseline to 12 weeks. A large baseline to 12-week change was observed for the ISWT (exercise: 325.00±117.28 m; control: 355.00±80.62 m, P<0.001). The exercise group at 24 weeks recorded an overall mean improvement of 143.3±86.6 m and the control group recorded a reduction of −32.50±75.93 m. Findings show a 5.6 kg difference between groups in body mass change from baseline to 24 weeks favouring the exercise group.

Conclusions:

A 12-week supervised exercise intervention led to significant improvements in body mass and functional walking ability post intervention, with further improvements at the 24-week follow-up.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Colquitt JL, Picot J, Loveman E, Clegg AJ . Surgery for obesity. Cochrane Database Syst Rev 2009; 15: 1–243.

    Google Scholar 

  2. Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351: 2683–2693.

    Article  Google Scholar 

  3. Courcoulas AP, Christian NJ, Belle SH, Berk PD, Flum DR, Garcia L et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. J Am Med Assoc 2013; 310: 2416–2425.

    CAS  Google Scholar 

  4. Magro DO, Geloneze B, Delfini R, Pareja BC, Callejas F, Pareja JC . Long-term weight regain after gastric bypass: a 5-year prospective study. Obes Surg 2008; 18: 648–651.

    Article  Google Scholar 

  5. Steele T, Cuthbertson DJ, Wilding JP . Impact of bariatric surgery on physical functioning in obese adults. Obes Rev 2015; 16: 248–258.

    Article  CAS  Google Scholar 

  6. Shah M, Simha V, Garg A . Long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab 2006; 91: 4223–4231.

    Article  CAS  Google Scholar 

  7. National Institute for Health and Care Excelence (NICE). Obesity: identification, assessment and management of overweight and obesity in children, young people and adults. In: NICE Clinical Guideline, 189 edn. NICE, 2014.

  8. Josbeno DA, Jakicic JM, Hergenroeder A, Eid GM . Physical activity and physical function changes in obese individuals after gastric bypass surgery. Surg Obes Relat Dis 2010; 6: 361–366.

    Article  Google Scholar 

  9. Stegen S, Derave W, Calders P, Van Laethem C, Pattyn P . Physical fitness in morbidly obese patients: effect of gastric bypass surgery and exercise training. Obes Surg 2011; 21: 61–70.

    Article  Google Scholar 

  10. Castello V, Simões RP, Bassi D, Catai AM, Arena R, Borghi-Silva A . Impact of aerobic exercise training on heart rate variability and functional capacity in obese women after gastric bypass surgery. Obes Surg 2010; 21: 1739–1749.

    Article  Google Scholar 

  11. Coen PM, Tanner CJ, Helbling NL, Dubis GS, Hames KC, Xie H et al. Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity. J Clin Invest 2015; 125: 248–257.

    Article  Google Scholar 

  12. Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA et al. Resistance exercise in individuals with and without cardiovascular disease: 2007 update. A Scientific Statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation 2007; 116: 572–584.

    Article  Google Scholar 

  13. Lewis ME, Newall C, Townend JN, Hill SL, Bonser RS . Incremental shuttle walk test in the assessment of patients for heart transplantation. Heart 2001; 86: 183–187.

    Article  CAS  Google Scholar 

  14. MacSween A, Brydson G, Creed G, Capell HA . A preliminary validation of the 10-metre incremental shuttle walk test as a measure of aerobic capacity in women with rheumatoid arthritis. Physiotherapy 2001; 87: 38–44.

    Article  Google Scholar 

  15. Kushner RF, Kunigk A, Alspaugh M, Andronis PT, Leitch CA, Schoeller DA . Validation of bioelectrical-impedance analysis as a measurement of change in body composition in obesity. Am J Clin Nutr 1990; 52: 219–223.

    Article  CAS  Google Scholar 

  16. Santos-Lozano A, Marin PJ, Torres-Luque G, Ruiz JR, Lucia A, Garatachea N . Technical variability of the GT3X accelerometer. Med Eng Phys 2012; 34: 787–790.

    Article  Google Scholar 

  17. Freedson PS, Melanson E, Sirard J . Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc 1998; 30: 777–781.

    Article  CAS  Google Scholar 

  18. Bond DS, Phelan S, Wolfe LG, Evans RK, Meador JG, Kellum JM et al. Becoming physically active after bariatric surgery is associated with improved weight loss and health-related quality of life. Obesity 2008; 17: 78–83.

    Article  Google Scholar 

  19. Bandura A . Self-Efficacy Beliefs of Adolescents. Information Age Publishing Inc.: Charlotte, NC, USA, 2006.

    Google Scholar 

  20. Gersovitz M, Madden JP, Smiciklas-Wright H . Validity of the 24-hr. dietary recall and seven-day record for group comparisons. J Am Diet Assoc 1978; 73: 48–55.

    CAS  PubMed  Google Scholar 

  21. Singh SJ, Jones PW, Evans R, Morgan MD . Minimum clinically important improvement for the incremental shuttle walking test. Thorax 2008; 63: 775–777.

    Article  CAS  Google Scholar 

  22. Singh SJ, Morgan MD, Hardman AE, Rowe C, Bardsley PA . Comparison of oxygen uptake during a conventional treadmill test and the shuttle walking test in chronic airflow limitation. Eur Respir J 1994; 7: 2016–2020.

    CAS  PubMed  Google Scholar 

  23. World Health Organisation (WHO). Global strategy on diet, physical activity and health In: Physical Activity and Adults—Recommended Levels of Physical Activity for Adults Aged 18–64 Years: WHO: Geneva, Switzerland, 2015.

  24. De Feo P . Is high-intensity exercise better than moderate-intensity exercise for weight loss? Nutr Metab Cardiovasc Dis 2013; 23: 1037–1042.

    Article  CAS  Google Scholar 

  25. King WC, Hsu JY, Belle SH, Courcoulas AP, Eid GM, Flum DR et al. Pre- to postoperative changes in physical activity: report from the longitudinal assessment of bariatric surgery-2 (LABS-2). Surg Obes Relat Dis 2012; 8: 522–532.

    Article  Google Scholar 

  26. American Society of Metabolic and Bariatric Surgery. ASMBS Public and Professional Education Committee Bariatric Surgery: Postoperative Concerns, 2008. Report no. http://s3.amazonaws.com/publicASMBS/GuidelinesStatements/Guidelines/asbs_bspc.pdf.

  27. Huck CJ . Effects of supervised resistance training on fitness and functional strength in patients succeeding bariatric surgery. J Strength Cond Res 2014; 29: 589–595.

    Article  Google Scholar 

  28. Castello V, Simões PR, Beltrame T, Bassi D, Maria Catai A, Arena R et al. Effects of aerobic exercise training on variability and heart rate kinetic during submaximal exercise after gastric bypass surgery—a randomized controlled trial. Disabil Rehabil 2013; 35: 334–342.

    Article  Google Scholar 

  29. Marchesi F, De Sario G, Reggiani V, Tartamella F, Giammaresi A, Cecchini S et al. Road running after gastric bypass for morbid obesity: rationale and results of a new protocol. Obes Surg 2015; 25: 1162–1170.

    Article  Google Scholar 

  30. Das SK, Roberts SB, McCrory MA, Hsu LKG, Shikora SA, Kehayias JJ et al. Long-term changes in energy expenditure and body composition after massive weight loss induced by gastric bypass surgery. Am J Clin Nutr 2003; 78: 22–30.

    Article  CAS  Google Scholar 

  31. O'Brien PE, McPhail T, Chaston TB, Dixon JB . Systematic review of medium-term weight loss after bariatric operations. Obes Surg 2006; 16: 1032–1040.

    Article  Google Scholar 

  32. Herring LY, Wagstaff C, Scott A . The efficacy of 12 weeks supervised exercise in obesity management. Clin Obes 2014; 4: 220–227.

    CAS  PubMed  Google Scholar 

  33. Bond DS, Evans RK, DeMaria E, Wolfe L, Meador J, Kellum J et al. Physical activity and quality of life improvements before obesity surgery. Am J Health Behav 2006; 30: 422–434.

    Article  Google Scholar 

  34. Bond DS, Vithiananthan S, Thomas JG, Trautvetter J, Unick JL, Jakicic JM et al. Bari-Active: a randomized controlled trial of a preoperative intervention to increase physical activity in bariatric surgery patients. Surg Obes Relat Dis 2015; 11: 169–177.

    Article  Google Scholar 

Download references

Acknowledgements

The research was supported by the National Institute for Health Research (NIHR) Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, which is a partnership between University Hospitals of Leicester NHS Trust, Loughborough University and the University of Leicester; the NIHR Collaboration for Leadership in Applied Health Research and Care—East Midlands (NIHR CLAHRC—EM), and the Leicester Clinical Trials Unit. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Author information

Authors and Affiliations

  1. School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK

    L Y Herring & C Stevinson

  2. University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK

    L Y Herring, D Bowrey & C Sutton

  3. Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK

    P Carter

  4. The University of Leicester, Diabetes Research Centre, Leicester, UK

    P Carter & M J Davies

  5. Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, VIC, Australia

    S J H Biddle

Authors
  1. L Y Herring
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C Stevinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P Carter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S J H Biddle
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D Bowrey
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C Sutton
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M J Davies
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L Y Herring.

Ethics declarations

Competing interests

Professor MJD has acted as consultant, advisory board member and speaker for Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp and Dohme, Boehringer Ingelheim, AstraZeneca and Janssen and as a speaker for Mitsubishi Tanabe Pharma Corporation. She has received grants in support of investigator and investigator initiated trials from Novo Nordisk, Sanofi-Aventis and Lilly. Professor SJHB reports that funding has been received since 2013 for consultancy work from Fitness First, Nuffield Health and Unilever. None of these are currently active. Funding was received in 2016 for consultancy work for Halpern Limited. In-kind support through the provision of a sit-to-stand desk was provided by Ergotron from 2012 to 2014. Advice has been requested by and offered to Active Working, Get Britain Standing and Bluearth, none with funding. DJB reports grants and non-financial support from Fresenius-Kabi, non-financial support from Nutricia, outside the submitted work. The other authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Herring, L., 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 41, 909–916 (2017). https://doi.org/10.1038/ijo.2017.60

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2017.60

This article is cited by

Search

Advanced search

Quick links