The Need For Exercise Recommendations For Children And Adolescents Post-Bariatric Surgery: A Systematic Review

Abstract

Bariatric surgery is an effective treatment option for children and adolescents with severe obesity. Yet, pediatric post-bariatric surgery (PBS) exercise recommendations are elusive. PURPOSE: To perform a systematic review assembling professional pediatric PBS exercise recommendations. METHODS: To gather PBS exercise recommendations, databases were searched from inception to 2/22/19 with terms related to exercise, pediatric obesity, bariatric surgery, and weight status. This search located no records so another PubMed search was performed to identify randomized controlled trials (RCTs), published in peer-reviewed English language journals, examining the effects of exercise on body mass index (BMI) and percent body fat (%BF) among participants 2-19yr with obesity from inception to 3/20/19. The standardized mean difference effect sizes (d+) were calculated following random-effects models for BMI and %BF and then back-converted to the original unit for clinical interpretation. We assessed inconsistencies in d+ with the I2 statistic transformed from the Q statistic. RESULTS: The second search identified 556 reports with 9 qualifying RCTs. Of these, 7 were combined resistance and aerobic and 4 aerobic interventions only. All participants (n=342, 53.8% girls, 13±2yr) had obesity. The moderate-to-vigorous intensity exercise interventions lasted 13.5±4.0 wk, 3.5±0.8 d/wk for 56.8±6.4 min/session. Exercise interventions (k=11) elicited moderate BMI reductions (d+=-0.40, 95%CIs: -0.73, -0.06; -1.03kg·m-2) vs non-exercise control, with moderate-to-high heterogeneity (I2 =61.3%, 95%CIs: 25.3, 80.0). Exercise interventions (k=7) also elicited moderate %BF reductions (d+=-0.61, 95%CIs: -0.90, -0.31; -4.63%) vs non-exercise control, with low heterogeneity (I2 =20.5%, 95%CIs: 0.0, 64.0). CONCLUSIONS: We found limited but favorable evidence of the effects of moderate-to-vigorous exercise training on BMI and %BF among children and adolescents with obesity but were unable to locate any professional pediatric PBS exercise recommendations. Due to the increasing number of pediatric bariatric surgeries performed, there is an urgent need for professional guidance on exercise in this clinical population. Supported by the University of Connecticut Center on Excellence in Teaching and Learning