Current Evidence for Physical Activity in the Bariatric Surgery Patient for Weight Loss Success

Abstract

Leading a physically active lifestyle is critical for optimal health. Observation and intervention studies show that behavioral weight loss in overweight and class 1 obesity (body mass index=30-34.9 kg/m2) interventions are more successful in the long-term by adhering to a physical activity regimen, including at least 150 minutes per week of moderate intensity exercise. Although substantial research has been conducted in behavioral based weight loss programs, there are very limited studies that have investigated the effect that physical activity has on weight and body composition outcomes in bariatric surgery patients. In that bariatric weight loss surgery is accepted as the most effective short and long-term weight loss intervention for morbid obesity, research in this area needs to be a priority. This review summarizes the current evidence in this realm by examining both pre- and post-surgical studies that have been conducted in this field. Observational studies in individuals eligible for bariatric weight loss surgery indicate the majority of patients have zero minutes of vigorous activity and less than one-half of the recommended moderate activity minutes. In the pre-surgical patient, there have just been a few feasibility studies to investigate the incorporation of physical activity into the behavioral intervention to support weight loss and lifestyle change. These studies were generally confined to a walking program for the surgery patients. Importantly, these did not examine post-operative outcomes. Although weight loss following bariatric surgery is superior to behavioral interventions in severely obese individuals, there is still significant variability in the amount of weight loss achieved. Physical activity is one possible factor that has been examined that may contribute to the variability. Post-surgical observation studies consistently show a positive association between physical activity and improved weight loss, with physical activity and sedentary behaviors being the highest predictors for post-surgery weight loss. In spite of this evidence there are currently no large-scale, long-term randomized trials that have investigated a structured, well-controlled, physical activity intervention in post-surgical patients. The intervention studies to date have been small in number, nonrandomized in design, and were for a short duration. Future directions in this area are many, with questions on the type of exercise prescription that is going to be the most successful for long-term weight loss success and health improvements being on the forefront.