Obesity Surgery

, Volume 21, Issue 4, pp 457–464 | Cite as

Cardiorespiratory Fitness and Health-Related Quality of Life in Bariatric Surgery Patients

  • Ronette L. KolotkinEmail author
  • Michael J. LaMonte
  • Sheldon Litwin
  • Ross D. Crosby
  • Richard E. Gress
  • Frank G. Yanowitz
  • Steven C. Hunt
  • Ted D. Adams
Clinical Research


Health-related quality of life (HRQOL) is impaired in severely obese individuals presenting for bariatric surgery. Little is known about the relationship between cardiorespiratory fitness (CRF) and HRQOL in these individuals. We hypothesized that better HRQOL would be reported by those with higher CRF. In 326 gastric bypass patients (mean BMI = 46.5 ± 7.0; mean age = 40.9 ± 10.1; 83.4% female), pre-surgical CRF was quantified as duration (minutes) of a submaximal treadmill test to 80% of age-predicted maximal heart rate (MHR). Patients completed both a general measure of HRQOL [the Medical Outcome Short Form 36 (SF-36)] and a weight-specific measure of HRQOL [Impact of Weight on Quality of Life—Lite]. Mean HRQOL scores were examined, controlling for age, gender, and BMI. Mean treadmill duration was 9.9 ± 3.1 min, and percent age-predicted MHR was 81.2 ± 3.0%. Higher cardiorespiratory fitness tended to be associated with better physical and weight-specific HRQOL. Adjustment for differences in gender, age, and BMI attenuated the significance of associations between fitness and physical measures from the SF-36, whereas adjustment eliminated significance of associations between fitness and weight-specific HRQOL in most cases. Results suggest that CRF confers some HRQOL benefits in severely obese adults, though these benefits may largely be explained by differences in age, gender, and BMI.


Cardiorespiratory fitness Health-related quality of life IWQOL-Lite SF-36 Gastric bypass surgery Treadmill test 



This research was supported by grants from the NIH/NIDDK (DK-55006) and the National Center for Research Resources (MO1-RR00064).


Dr. Kolotkin received consulting fees from University of Utah for her participation in this NIH-funded study. She also receives royalties from Duke University for the use of the IWQOL-Lite.


  1. 1.
    Choban PS, Onyejekwe J, Burge JC, et al. A health status assessment of the impact of weight loss following Roux-en-Y gastric bypass for clinically severe obesity. J Am Coll Surg. 1999;188:491–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Dixon JB, Dixon ME, O'Brien PE. Quality of life after lap-band placement: influence of time, weight loss, and comorbidities. Obes Res. 2001;9:713–21.CrossRefPubMedGoogle Scholar
  3. 3.
    Sullivan M, Karlsson J, Sjostrom L, et al. Swedish obese subjects (SOS)—an intervention study of obesity. Baseline evaluation of health and psychosocial functioning in the first 1743 subjects examined. Int J Obes. 1993;1743:503–12.Google Scholar
  4. 4.
    Schok M, Geenen R, van Antwerpen T, et al. Quality of life after laparoscopic adjustable gastric banding for severe obesity: postoperative and retrospective preoperative evaluations. Obes Surg. 2000;10:502–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Kolotkin RL, Crosby RD, Williams GR. Health-related quality of life varies among obese subgroups. Obes Res. 2002;10:748–56.CrossRefPubMedGoogle Scholar
  6. 6.
    Kolotkin RL, Crosby RD, Pendleton R, et al. Health-related quality of life in patients seeking gastric bypass surgery vs. non-treatment-seeking controls. Obes Surg. 2003;13:371–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Karlsson J, Sjostrom L, Sullivan M. Swedish obese subjects (SOS)—an intervention study of obesity. Two-year follow-up of health-related quality of life (HRQL) and eating behavior after gastric surgery for severe obesity. Int J Obes Relat Metab Disord. 1998;22:113–26.CrossRefPubMedGoogle Scholar
  8. 8.
    Doll HA, Petersen SEK, Stewart-Brown SL. Obesity and physical and emotional well-being: associations between body mass index, chronic illness, and the physical and mental components of the SF-36 questionnaire. Obes Res. 2000;8:160–70.CrossRefPubMedGoogle Scholar
  9. 9.
    Torquati A, Lutfi RE, Richards WO. Predictors of early quality-of-life improvement after laparoscopic gastric bypass surgery. Am J Surg. 2007;193:471–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Barofsky I, Fontaine KR, Cheskin LJ. Pain in the obese: impact on health-related quality-of-life. Ann Behav Med. 1997;19:408–10.CrossRefPubMedGoogle Scholar
  11. 11.
    Kolotkin RL, Westman EC, Ostbye T, et al. Does binge eating disorder impact weight-related quality of life? Obes Res. 2004;12:999–1005.CrossRefPubMedGoogle Scholar
  12. 12.
    Rieger E, Wilfley DE, Stein RI, et al. A comparison of quality of life in obese individuals with and without binge eating disorder. Int J Eat Disord. 2005;37:234–40.CrossRefPubMedGoogle Scholar
  13. 13.
    Kolotkin RL, Crosby RD, Gress RE, et al. Health and health-related quality of life: differences between men and women who seek gastric bypass surgery. Surg Obes Relat Dis. 2008;4:651–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Sloan RA, Sawada SS, Martin CK, et al. Associations between cardiorespiratory fitness and health-related quality of life. Health Qual Life Outcomes. 2009;7:47. doi: 10.1186/1477-7525-7-47.CrossRefPubMedGoogle Scholar
  15. 15.
    Galper DI, Trivedi MH, Barlow CE, et al. Inverse association between physical inactivity and mental health in men and women. Med Sci Sports Exerc. 2006;38:173–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Rejeski WJ, Lang W, Neiberg RH, et al. Correlates of health-related quality of life in overweight and obese adults with type 2 diabetes. Obesity (Silver Spring). 2006;14:870–83.CrossRefGoogle Scholar
  17. 17.
    Painter P, Krasnoff J, Paul SM, et al. Physical activity and health-related quality of life in liver transplant recipients. Liver Transplant. 2001;7:213–9.CrossRefGoogle Scholar
  18. 18.
    Martin CK, Church TS, Thompson AM, et al. Exercise dose and quality of life: a randomized controlled trial. Arch Intern Med. 2009;169:269–78.CrossRefPubMedGoogle Scholar
  19. 19.
    Adams TD, Avelar E, Cloward T, et al. Design and rationale of the Utah obesity study. A study to assess morbidity following gastric bypass surgery. Contemp Clin Trials. 2005;26:534–51.CrossRefPubMedGoogle Scholar
  20. 20.
    Kolotkin RL, Crosby RD, Kosloski KD, et al. Development of a brief measure to assess quality of life in obesity. Obes Res. 2001;9:102–11.CrossRefPubMedGoogle Scholar
  21. 21.
    Kolotkin RL, Crosby RD. Psychometric evaluation of the impact of weight on quality of life-lite questionnaire (IWQOL-Lite) in a community sample. Qual Life Res. 2002;11:157–71.CrossRefPubMedGoogle Scholar
  22. 22.
    Ware J, Snow K, Kosinski M, et al. Health survey: manual and interpretation guide. 1993, Boston. New England Medical Center: The Health Institute; 1993.Google Scholar
  23. 23.
    Kolotkin RL, Norquist JM, Crosby RD, et al. One-year health-related quality of life outcomes in weight loss trial participants: comparison of three measures. Health Qual Life Outcomes. 2009;7:53. doi: 10.1186/1477-7525-7-53.CrossRefPubMedGoogle Scholar
  24. 24.
    American College of Sports Medicine. Guidelines for exercise testing and prescription. 7th ed. Philadelphia: Lippincott Williams and Wilkins; 2006.Google Scholar
  25. 25.
    Ekelund LG, Haskell WL, Johnson JL, et al. Physical fitness as a predictor of cardiovascular mortality in asymptomatic North American men. The lipid research clinics mortality follow-up study. N Engl J Med. 1988;319:1379–84.CrossRefPubMedGoogle Scholar
  26. 26.
    Slattery ML, Jacobs Jr DR. Physical fitness and cardiovascular disease mortality. The US railroad study. Am J Epidemiol. 1988;127:571–80.PubMedGoogle Scholar
  27. 27.
    Royston P, Altman DG, Sauerbrei W. Dichotomizing continuous predictors in multiple regression: a bad idea. Stat Med. 2006;25:127–41.CrossRefPubMedGoogle Scholar
  28. 28.
    McCullough PA, Gallagher MJ, Dejong AT, et al. Cardiorespiratory fitness and short-term complications after bariatric surgery. Chest. 2006;130:517–25.CrossRefPubMedGoogle Scholar
  29. 29.
    Bond DS, Jakicic JM, Vithiananthan S. et al. Objective quantification of physical activity in bariatric surgery candidates and normal-weight controls. Surg Obes Relat Dis. 2010;6:72–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Bond DS, Phelan S, Wolfe LG, et al. Becoming physically active after bariatric surgery is associated with improved weight loss and health-related quality of life. Obesity (Silver Spring). 2009;17:78–83.CrossRefGoogle Scholar
  31. 31.
    LaMonte MJ, Chumlea WC. Obesity and health: survival of the fittest? Int J Body Compo Res. 2006;4:19–25.Google Scholar

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Ronette L. Kolotkin
    • 1
    • 2
    Email author
  • Michael J. LaMonte
    • 3
  • Sheldon Litwin
    • 4
  • Ross D. Crosby
    • 5
    • 6
  • Richard E. Gress
    • 4
  • Frank G. Yanowitz
    • 7
  • Steven C. Hunt
    • 4
  • Ted D. Adams
    • 4
    • 7
  1. 1.Obesity and Quality of Life ConsultingDurhamUSA
  2. 2.Department of Community and Family MedicineDuke University Medical CenterDurhamUSA
  3. 3.Department of Social and Preventive MedicineState University of New York at BuffaloBuffaloUSA
  4. 4.Cardiovascular Genetics Division, Department of Internal MedicineUniversity of UtahSalt Lake CityUSA
  5. 5.Neuropsychiatric Research InstituteFargoUSA
  6. 6.University of North Dakota School of Medicine and Health SciencesFargoUSA
  7. 7.The Health and Fitness Institute, LDS HospitalIntermountain HealthcareSalt Lake CityUSA

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