Quality of Life Research

, Volume 27, Issue 12, pp 3113–3122 | Cite as

Physical training following gastric bypass: effects on physical activity and quality of life—a randomized controlled trial

  • Charlotte Røn StolbergEmail author
  • Lene Hymøller Mundbjerg
  • Else-Marie Bladbjerg
  • Peter Funch-Jensen
  • Bibi Gram
  • Claus Bogh Juhl



Obesity is associated with physical inactivity and impaired health-related quality of life (HRQoL). We aim to test the hypothesis that Roux-en-Y gastric bypass (RYGB) followed by supervised physical training improves physical activity (PA) levels and HRQoL.


Sixty patients, qualified for RYGB, were at 6 months post-surgery randomized to 26 weeks of a supervised physical training intervention (INT) or to a control (CON) group. PA was assessed by accelerometry and using the questionnaire RPAQ. HRQoL was measured by the SF-36 questionnaire. All assessments were performed pre-surgery and 6, 12, and 24 months post-surgery.


RYGB did not improve objectively or self-reported PA, but improved all domains of SF-36 (all p < 0.01). Objectively measured light PA, moderate to vigorous PA, and step counts tended to increase in INT compared to CON 12 months after RYGB (0.05 < p < 0.09), but the effects failed to persist. The SF-36 domain “general health” increased in INT compared to CON 24 months after RYGB (p = 0.041).


RYGB improves HRQoL, but does not increase PA. Supervised physical training intervention improves general health 24 months after RYGB and tends to improve certain domains of PA right after the intervention period, but fails to increase the patients’ overall PA level over time. Clinical Trial Registration Registered at—no. NCT01690728.


Accelerometry Exercise Recent physical activity questionnaire RPAQ Roux-en-Y gastric bypass SF36 questionnaire 



The authors would like to thank the study participants for their contribution to this study. We would also like to thank the physiotherapists involved in this study, for putting a large amount of effort into the supervised physical training intervention.

Author Contributions

CRS, LHM, and BG carried out the experiments. CRS analyzed data. All authors were involved in writing the paper and final approval of the submitted and published versions.


The research was supported by the Department of Regional Health Research, University of Southern Denmark and Hospital of Southwest Jutland, Denmark; the Department of Medicine/Endocrinology, Hospital of Southwest Jutland, Denmark; The Region of Southern Denmark; The Karola Jørgensen Research Foundation; The Edith and Vagn Hedegaard Jensens Foundation; and The Family Hede Nielsens Foundation.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

The study was conducted according to the Helsinki Declaration, approved by the local ethics committee (Project-ID: S-20120112), and registered at (No. NCT01690728).

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Pi-Sunyer, F. X. (1999). Comorbidities of overweight and obesity: Current evidence and research issues. Medicine & Science in Sports & Exercise, 31(11 Suppl), S602–S608.CrossRefGoogle Scholar
  2. 2.
    Fontaine, K. R., & Barofsky, I. (2001). Obesity and health-related quality of life. Obesity Reviews, 2(3), 173–182.CrossRefGoogle Scholar
  3. 3.
    Afshin, A., Forouzanfar, M. H., Reitsma, M. B., Sur, P., Estep, K., Lee, A., et al. (2017). Health effects of overweight and obesity in 195 countries over 25 years. The New England Journal of Medicine, 377(1), 13–27. Scholar
  4. 4.
    Sjöström, L., Narbro, K., Sjöström, C. D., Karason, K., Larsson, B., Wedel, H., et al. (2007). Effects of bariatric surgery on mortality in Swedish obese subjects. The New England Journal of Medicine, 357, 741–752. Scholar
  5. 5.
    Sjöström, L. (2008). Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. International Journal of Obesity, 32(Suppl 7), S93–S97. Scholar
  6. 6.
    Karlsson, J., Taft, C., Ryden, A., Sjostrom, L., & Sullivan, M. (2007). Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: The SOS intervention study. International Journal of Obesity (London), 31(8), 1248–1261. Scholar
  7. 7.
    Hansen, B. H., Holme, I., Anderssen, S. A., & Kolle, E. (2013). Patterns of objectively measured physical activity in normal weight, overweight, and obese individuals (20–85 years): A cross-sectional study. PLoS ONE, 8(1), e53044. Scholar
  8. 8.
    Bond, D. S., Jakicic, J. M., Vithiananthan, S., Thomas, J. G., Leahey, T. M., Sax, H. C., et al. (2010). Objective quantification of physical activity in bariatric surgery candidates and normal-weight controls. Surgery for Obesity and Related Diseases, 6(1), 72–78. Scholar
  9. 9.
    Kesaniemi, Y. K., Danforth, E. Jr., Jensen, M. D., Kopelman, P. G., Lefebvre, P., & Reeder, B. A. (2001). Dose-response issues concerning physical activity and health: An evidence-based symposium. Medicine & Science in Sports & Exercise, 33(6 Suppl), S351–S358.Google Scholar
  10. 10.
    Haskell, W. L., Lee, I. M., Pate, R. R., Powell, K. E., Blair, S. N., Franklin, B. A., et al. (2007). Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation, 116(9), 1081–1093. Scholar
  11. 11.
    Karmali, S., Brar, B., Shi, X., Sharma, A. M., de Gara, C., & Birch, D. W. (2013). Weight recidivism post-bariatric surgery: A systematic review. Obesity Surgery, 23(11), 1922–1933. Scholar
  12. 12.
    Bond, D. S., Jakicic, J. M., Unick, J. L., Vithiananthan, S., Pohl, D., Roye, G. D., et al. (2010). Pre- to postoperative physical activity changes in bariatric surgery patients: Self report vs. objective measures. Obesity (Silver Spring), 18(12), 2395–2397. Scholar
  13. 13.
    Tully, M. A., Panter, J., & Ogilvie, D. (2014). Individual characteristics associated with mismatches between self-reported and accelerometer-measured physical activity. PLoS ONE, 9(6), e99636. Scholar
  14. 14.
    Bond, D. S., Phelan, S., Wolfe, L. G., Evans, R. K., Meador, J. G., Kellum, J. M., et al. (2009). Becoming physically active after bariatric surgery is associated with improved weight loss and health-related quality of life. Obesity (Silver Spring), 17(1), 78–83. Scholar
  15. 15.
    Colles, S. L., Dixon, J. B., & O’Brien, P. E. (2008). Hunger control and regular physical activity facilitate weight loss after laparoscopic adjustable gastric banding. Obesity Surgery, 18(7), 833–840. Scholar
  16. 16.
    Sjöström, L., Lindroos, A.-K., Peltonen, M., Torgerson, J., Bouchard, C., Carlsson, B., et al. (2004). Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. The New England Journal of Medicine, 351, 2683–2693. Scholar
  17. 17.
    Berglind, D., Willmer, M., Eriksson, U., Thorell, A., Sundbom, M., Udden, J., et al. (2015). Longitudinal assessment of physical activity in women undergoing Roux-en-Y gastric bypass. Obesity Surgery, 25(1), 119–125. Scholar
  18. 18.
    King, W. C., Chen, J. Y., Bond, D. S., Belle, S. H., Courcoulas, A. P., Patterson, E. J., et al. (2015). Objective assessment of changes in physical activity and sedentary behavior: Pre- through 3 years post-bariatric surgery. Obesity (Silver Spring), 23(6), 1143–1150. Scholar
  19. 19.
    Herring, L. Y., Stevinson, C., Davies, M. J., Biddle, S. J., Sutton, C., Bowrey, D., et al. (2016). Changes in physical activity behaviour and physical function after bariatric surgery: A systematic review and meta-analysis. Obesity Reviews, 17(3), 250–261. Scholar
  20. 20.
    Shah, M., Snell, P. G., Rao, S., Adams-Huet, B., Quittner, C., Livingston, E. H., et al. (2011). High-volume exercise program in obese bariatric surgery patients: A randomized, controlled trial. Obesity (Silver Spring, Md.), 19, 1826–1834. Scholar
  21. 21.
    Coen, P. M., Tanner, C. J., Helbling, N. L., Dubis, G. S., Hames, K. C., Xie, H., et al. (2015). Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity. The Journal of Clinical Investigation, 125(1), 248–257. Scholar
  22. 22.
    Herring, L. Y., Stevinson, C., Carter, P., Biddle, S. J., Bowrey, D., Sutton, C., et al. (2017). 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 (London). Scholar
  23. 23.
    Coleman, K. J., Caparosa, S. L., Nichols, J. F., Fujioka, K., Koebnick, C., McCloskey, K. N., et al. (2017). Understanding the capacity for exercise in post-bariatric patients. Obesity Surgery, 27(1), 51–58. Scholar
  24. 24.
    Hassannejad, A., Khalaj, A., Mansournia, M. A., Rajabian Tabesh, M., & Alizadeh, Z. (2017). The effect of aerobic or aerobic-strength exercise on body composition and functional capacity in patients with BMI ≥ 35 after Bariatric Surgery: A Randomized Control Trial. Obesity Surgery. Scholar
  25. 25.
    Carnero, E. A., Dubis, G. S., Hames, K. C., Jakicic, J. M., Houmard, J. A., Coen, P. M., et al. (2017). Randomized trial reveals that physical activity and energy expenditure are associated with weight and body composition after RYGB. Obesity (Silver Spring), 25(7), 1206–1216. Scholar
  26. 26.
    Bize, R., Johnson, J. A., & Plotnikoff, R. C. (2007). Physical activity level and health-related quality of life in the general adult population: A systematic review. Preventive Medicine, 45(6), 401–415. Scholar
  27. 27.
    Brown, D. W., Balluz, L. S., Heath, G. W., Moriarty, D. G., Ford, E. S., Giles, W. H., et al. (2003). Associations between recommended levels of physical activity and health-related quality of life. Findings from the 2001 Behavioral Risk Factor Surveillance System (BRFSS) survey. Preventive Medicine, 37(5), 520–528.CrossRefGoogle Scholar
  28. 28.
    Mundbjerg, L. H., Stolberg, C. R., Cecere, S., Bladbjerg, E. M., Funch-Jensen, P., Gram, B., et al. (2018). Supervised physical training improves weight loss after Roux-en-Y Gastric Bypass Surgery: A Randomized Controlled Trial. Obesity, 26(5), 828–837. doi.CrossRefPubMedGoogle Scholar
  29. 29.
    Tudor-Locke, C., Brashear, M. M., Johnson, W. D., & Katzmarzyk, P. T. (2010). Accelerometer profiles of physical activity and inactivity in normal weight, overweight, and obese U.S. men and women. International Journal of Behavioral Nutrition and Physical Activity, 7, 60. Scholar
  30. 30.
    Besson, H., Brage, S., Jakes, R. W., Ekelund, U., & Wareham, N. J. (2010). Estimating physical activity energy expenditure, sedentary time, and physical activity intensity by self-report in adults. American Journal of Clinical Nutrition, 91, 106–114. Scholar
  31. 31.
    Ainsworth, B. E., Haskell, W. L., Leon, A. S., Jacobs, D. R. Jr., Montoye, H. J., Sallis, J. F., et al. (1993). Compendium of physical activities: Classification of energy costs of human physical activities. Medicine & Science in Sports & Exercise, 25(1), 71–80.CrossRefGoogle Scholar
  32. 32.
    Bjorner, J. B., Thunedborg, K., Kristensen, T. S., Modvig, J., & Bech, P. (1998). The Danish SF-36 Health Survey: Translation and preliminary validity studies. Journal of Clinical Epidemiology, 51, 991–999.CrossRefGoogle Scholar
  33. 33.
    Donnelly, J. E., Blair, S. N., Jakicic, J. M., Manore, M. M., Rankin, J. W., & Smith, B. K. (2009). American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Medicine & Science in Sports & Exercise, 41(2), 459–471. Scholar
  34. 34.
    Bond, D. S., Vithiananthan, S., Thomas, J. G., Trautvetter, J., Unick, J. L., Jakicic, J. M., et al. (2015). Bari-Active: A randomized controlled trial of a preoperative intervention to increase physical activity in bariatric surgery patients. Surgery for Obesity and Related Diseases, 11(1), 169–177. Scholar
  35. 35.
    Bond, D. S. (2017). Intervention-related increases in preoperative physical activity are maintained 6-months after Bariatric surgery: Results from the bari-active trial. International Journal of Obesity, 41(3), 467–470. Scholar
  36. 36.
    van den Hoek, D. J., Miller, C. T., Fraser, S. F., Selig, S. E., & Dixon, J. B. (2017). Does exercise training augment improvements in quality of life induced by energy restriction for obese populations? A systematic review. Quality of Life Research. Scholar
  37. 37.
    Bond, D. S., Thomas, J. G., King, W. C., Vithiananthan, S., Trautvetter, J., Unick, J. L., et al. (2015). Exercise improves quality of life in bariatric surgery candidates: results from the Bari-Active trial. Obesity (Silver Spring), 23(3), 536–542. Scholar
  38. 38.
    Kolotkin, R. L., Davidson, L. E., Crosby, R. D., Hunt, S. C., & Adams, T. D. (2012). Six-year changes in health-related quality of life in gastric bypass patients versus obese comparison groups. Surgery for Obesity and Related Diseases, 8(5), 625–633. Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Medicine/EndocrinologyHospital of Southwest JutlandEsbjergDenmark
  2. 2.Department of Regional Health Research/Center Southwest JutlandUniversity of Southern Denmark/Hospital of Southwest JutlandEsbjergDenmark
  3. 3.OPEN, Odense Patient data Explorative NetworkOdense University HospitalOdenseDenmark
  4. 4.Unit for Thrombosis Research, Department of Clinical BiochemistryHospital of Southwest JutlandEsbjergDenmark
  5. 5.Department of Clinical MedicineAarhus University HospitalAarhusDenmark

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