Research proves exercise improves results of bariatric surgery
Roux-en-Y gastric bypass (RYGB) surgery is an effective treatment for severe obesity, leading to weight loss and better cardiometabolic risk profile. Exercise can also lower cardiometabolic risk regardless of weight, but it is unknown whether it can further improve RYGB surgery patients along with their weight loss. Research from the Universities of Pittsburgh and East Carolina suggests that moderate aerobic exercise does provide added benefits for glucose disposal and cardiorespiratory fitness at the same time as RYGB surgery–induced weight loss. These findings warrant the inclusion of an exercise program to complement health benefits during active weight loss after RYGB surgery.
The improvement in glucose control in type 2 diabetes patients after RYGB surgery may result from energy restriction–induced improvements in liver function and a modified postprandial gut hormone reaction in the days/weeks following the operation. Improvements seem to be more related to longer-term weight loss, though. Research confirms that there is room for additional improvements through lifestyle interventions, such as an exercise program of more than 120 minutes per week. This is the first study to suggest that an exercise intervention was not only possible, but was also effective for severely obese RYGB surgery patients. This is consistent with the finding that a 12-week exercise program after RYGB and gastric banding improved glucose tolerance. In the current study, exercise-induced improvements cannot be accounted for by any other effect of exercise on reduced body mass or adiposity. This does not exclude the possibility that improvements with exercise were associated with changes in intramyocellular lipids, inflammation, or other factors that influence insulin action, though.
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These data also indicate that an exercise program during RYGB surgery–induced weight loss may promote metabolic health by both insulin-dependent and -independent mechanisms. Previous research supports the contention that exercise-mediated improvements in RYGB patients are a physiologically and potentially clinically important finding, though the mechanism by which this takes place has not been established.
Exercise after RYGB surgery also improved cardiorespiratory fitness. This is similar to other reports of improvements in fitness with exercise in post–bariatric surgery patients and is clinically important, since cardiorespiratory fitness is inversely correlated with body mass index and improved cardiorespiratory fitness is related to a lower risk of all-cause mortality. Thus, not only is an aerobic exercise training program possible, but it is also effective at improving cardiorespiratory fitness, a result that flies in the face of the perception that severely obese people cannot respond to lifestyle interventions. Additional randomized controlled exercise trials are needed to better understand the implications of components of exercise prescription on long-term weight loss maintenance and health in RYGB surgery patients.
Augmented physical activity following bariatric surgery has been reported to contribute to additional weight loss. As it runs out, though, the majority of these were non-randomized, retrospective, and observational studies that measured physical activity by questionnaire and self report methods, which may result in an overestimation of exercise participation in obese subjects, including those who have undergone bariatric surgery. Semi-supervised exercise intervention are in line with those of Shah et al., who proved that a high-volume exercise prescription after bariatric surgery had no effect on body weight and waist circumference when patients were compared with a control group. These observations are extended by demonstrating that abdominal adipose depots, measured by computed tomography, are not especially impacted by a 6-month exercise training intervention in RYGB surgery patients. In summary, RYGB surgery patients who regularly perform a moderate amount of exercise experience improvements in addition to those from RYGB surgery–induced weight loss on its own. From this follows that exercise can be a helpful addendum to therapy for RYGB surgery patients to promote cardiometabolic health and physical fitness.