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Obesity Surgery

, Volume 27, Issue 11, pp 2792–2801 | Cite as

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

  • Alireza Hassannejad
  • Alireza Khalaj
  • Mohammad Ali Mansournia
  • Mastaneh Rajabian Tabesh
  • Zahra Alizadeh
Original Contributions

Abstract

Background

Although previous studies suggested that bariatric surgery is the most effective and sustainable treatment method for morbid obesity in long term, but without changing in lifestyle, maintaining optimal weight loss is almost impossible.

Methods

Sixty morbid obese patients (BMI ≥ 35) were evaluated before and after 12 weeks of bariatric surgery in order to compare the impact of two different exercise programs on body composition and functional capacity outcomes. Participants were divided into three groups: aerobic (A), aerobic-strength (AS), and control (C) group. Aerobic capacity was assessed with 12-min walk-run test (12MWRT). One-repetition maximum (1RM) test was performed to evaluation upper limb muscle strength. Lower extremity functional capacity was assessed by sit-to-stand test.

Results

Weight, percent body fat (PBF), and fat mass (FM) reduced greater in the trial groups in comparison to the C group (P < 0.05). In the AS group, the reduction of fat-free mass (FFM) was significantly lower than that in the other groups. Mean changes in 12MWRT increased significantly in the intervention groups. The mean change in the sit-to-stand scores was not statistically significant between the three groups. Comparing the intervention groups showed that mean changes in 1RM variables increased in AS group (P = 0.03).

Conclusions

The data suggests a positive effect of exercise on weight and PBF decrease after surgery, and it leads to significant improvement on aerobic capacity. Moreover, doing resisted exercise caused greater preserving of lean mass.

Keywords

Bariatric surgery Functional capacity Body composition Exercise Obesity 

Notes

Acknowledgments

This research has been supported by Tehran University of Medical Sciences and Health Services Grant (No: IRCT201512297903N7).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

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

Ethical Approval

All procedures performed in the study were in accordance with the ethical standards of the Tehran University of Medical Sciences (TUMS) and Health Services Grant (No: IRCT201512297903N7) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Eshtiaghi R, Keihani S, Hosseinpanah F, et al. Natural course of metabolically healthy abdominal obese adults after 10 years of follow-up: the Tehran lipid and glucose study. Int J Obes. 2015;39(3):514–9.CrossRefGoogle Scholar
  2. 2.
    Stevens GA, Singh GM, Lu Y, et al. National, regional, and global trends in adult overweight and obesity prevalences. Popul Health Metrics. 2012;10(1):1.CrossRefGoogle Scholar
  3. 3.
    Obesity and overweight. World Health Organization 2016. Available at: http://www.who.int/mediacentre/factsheets/fs311/en/ (last accessed December 2016).
  4. 4.
    Kelly T, Yang W, Chen C-S, et al. Global burden of obesity in 2005 and projections to 2030. Int J Obes. 2008;32(9):1431–7.CrossRefGoogle Scholar
  5. 5.
    Janghorbani M, Amini M, Willett WC, et al. First nationwide survey of prevalence of overweight, underweight, and abdominal obesity in Iranian adults. Obesity. 2007;15(11):2797–808.CrossRefPubMedGoogle Scholar
  6. 6.
    Prevalence of obesity-interactive chart. World Health Organization 2014. Available at: http://gamapserver.who.int/gho/interactive_charts/ncd/risk_factors/obesity/atlas.html (last Accessed December 2016).
  7. 7.
    Lagerros YT, Rössner S. Obesity management: what brings success? Ther Adv Gastroenterol. 2013;6(1):77–88.CrossRefGoogle Scholar
  8. 8.
    Barnes AS. Obesity and sedentary lifestyles: risk for cardiovascular disease in women. Tex Heart Inst J. 2012;39(2):224.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Bertisch SM, Wee CC, McCarthy EP. Use of complementary and alternative therapies by overweight and obese adults. Obesity. 2008;16(7):1610–5.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Lo Presti R, Lai J, Hildebrandt T, et al. Psychological treatments for obesity in youth and adults. Mt Sinai J Med: J Transl Pers Med. 2010;77(5):472–87.CrossRefGoogle Scholar
  11. 11.
    Neff KJ, Ferrannini E, le Roux CW. Treatment of obesity: bariatric surgery. International Textbook of Diabetes Mellitus, Fourth Edition, Fourth Edition. 2015:505–18.Google Scholar
  12. 12.
    Surgery for obesity. Cocharane 2014. Available at: http://www.cochrane.org/CD003641/ENDOC_surgery-for-obesity (last Accessed April 2016).
  13. 13.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.CrossRefPubMedGoogle Scholar
  14. 14.
    Hainer V, Toplak H, Mitrakou A. Treatment modalities of obesity what fits whom? Diabetes Care. 2008;31(Supplement 2):S269–S77.CrossRefPubMedGoogle Scholar
  15. 15.
    Hofsø D, Nordstrand N, Johnson LK, et al. Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention. Eur J Endocrinol. 2010;163(5):735–45.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Sears D, Fillmore G, Bui M, et al. Evaluation of gastric bypass patients 1 year after surgery: changes in quality of life and obesity-related conditions. Obes Surg. 2008;18(12):1522–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Smith BR, Schauer P, Nguyen NT. Surgical approaches to the treatment of obesity: bariatric surgery. Endocrinol Metab Clin N Am. 2008;37(4):943–64.CrossRefGoogle Scholar
  18. 18.
    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. 2009;17(1):78–83.CrossRefPubMedGoogle Scholar
  19. 19.
    Estimate of Bariatric Surgery Numbers, 2011–2015. Available at: https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers (last Accessed 2017).
  20. 20.
    Welch G, Wesolowski C, Piepul B, et al. Physical activity predicts weight loss following gastric bypass surgery: findings from a support group survey. Obes Surg. 2008;18(5):517–24.CrossRefPubMedGoogle Scholar
  21. 21.
    Livhits M, Mercado C, Yermilov I, et al. Exercise following bariatric surgery: systematic review. Obes Surg. 2010;20(5):657–65.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Medicine ACoS. ACSM’s guidelines for exercise testing and prescription: Lippincott Williams & Wilkins; 2013.Google Scholar
  23. 23.
    Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–81.CrossRefPubMedGoogle Scholar
  24. 24.
    Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59.CrossRefPubMedGoogle Scholar
  25. 25.
    LW W. ACSM’s resource manual for guidelines for exercise testing and prescription 2012.Google Scholar
  26. 26.
    Desgorces FD, Berthelot G, Dietrich G, et al. Local muscular endurance and prediction of 1 repetition maximum for bench in 4 athletic populations. J Strength Cond Res. 2010;24(2):394–400.CrossRefPubMedGoogle Scholar
  27. 27.
    Herring LY, Stevinson C, Davies MJ, et al. Changes in physical activity behaviour and physical function after bariatric surgery: a systematic review and meta-analysis. Obes Rev. 2016;17(3):250–61.CrossRefPubMedGoogle Scholar
  28. 28.
    Jacobi D, Ciangura C, Couet C, et al. Physical activity and weight loss following bariatric surgery. Obes Rev. 2011;12(5):366–77.CrossRefPubMedGoogle Scholar
  29. 29.
    Jassil FC, Manning S, Lewis N, Steinmo S, Kingett H, Lough F, et al. Feasibility and impact of a combined supervised exercise and nutritional-behavioral intervention following bariatric surgery: a pilot study. J Obes. 2015;2015.Google Scholar
  30. 30.
    Egberts K, Brown WA, Brennan L, et al. Does exercise improve weight loss after bariatric surgery? A systematic review. Obes Surg. 2012;22(2):335–41.CrossRefPubMedGoogle Scholar
  31. 31.
    Vatier C, Henegar C, Ciangura C, et al. Dynamic relations between sedentary behavior, physical activity, and body composition after bariatric surgery. Obes Surg. 2012;22(8):1251–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Castello V, Simões RP, Bassi D, et al. Impact of aerobic exercise training on heart rate variability and functional capacity in obese women after gastric bypass surgery. Obes Surg. 2011;21(11):1739–49.CrossRefPubMedGoogle Scholar
  33. 33.
    Coleman KJ, Caparosa SL, Nichols JF, Fujioka K, Koebnick C, McCloskey KN, et al. Understanding the capacity for exercise in post-bariatric patients. Obes Surg. 2016:1–8.Google Scholar
  34. 34.
    Huck CJ. Effects of supervised resistance training on fitness and functional strength in patients succeeding bariatric surgery. J Strength Cond Res. 2015;29(3):589–95.CrossRefPubMedGoogle Scholar
  35. 35.
    Shah M, Snell PG, Rao S, et al. High-volume exercise program in obese bariatric surgery patients: a randomized. Control Trial Obes. 2011;19(9):1826–34.Google Scholar
  36. 36.
    Stegen S, Derave W, Calders P, et al. Physical fitness in morbidly obese patients: effect of gastric bypass surgery and exercise training. Obes Surg. 2011;21(1):61–70.CrossRefPubMedGoogle Scholar
  37. 37.
    Webster J, Hesp R, Garrow J. The composition of excess weight in obese women estimated by body density, total body water and total body potassium. Hum Nutr Clin Nutr. 1984;38(4):299–306.PubMedGoogle Scholar
  38. 38.
    Faria SL, Kelly E, Faria OP. Energy expenditure and weight regain in patients submitted to Roux-en-Y gastric bypass. Obes Surg. 2009;19(7):856–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Carey DG, Pliego GJ, Raymond RL, et al. Body composition and metabolic changes following bariatric surgery: effects on fat mass, lean mass and basal metabolic rate. Obes Surg. 2006;16(4):469–77.CrossRefPubMedGoogle Scholar
  40. 40.
    Metcalf B, Rabkin RA, Rabkin JM, et al. Weight loss composition: the effects of exercise following obesity surgery as measured by bioelectrical impedance analysis. Obes Surg. 2005;15(2):183–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Ng D, McClements K, Yeo A, et al. Efficacy of supervised exercise training in patients post bariatric surgery. Physiotherapy. 2015;101:e1083–e4.CrossRefGoogle Scholar
  42. 42.
    Melton GB, Steele KE, Schweitzer MA, et al. Suboptimal weight loss after gastric bypass surgery: correlation of demographics, comorbidities, and insurance status with outcomes. J Gastrointest Surg. 2008;12(2):250–5.CrossRefPubMedGoogle Scholar
  43. 43.
    Te Riele W, Boerma D, Wiezer M, et al. Long-term results of laparoscopic adjustable gastric banding in patients lost to follow-up. Br J Surg. 2010;97(10):1535–40.CrossRefPubMedGoogle Scholar
  44. 44.
    King WC, Engel SG, Elder KA, et al. Walking capacity of bariatric surgery candidates. Surg Obes Relat Dis. 2012;8(1):48–59.CrossRefPubMedGoogle Scholar
  45. 45.
    Stenholm S, Alley D, Bandinelli S, et al. The effect of obesity combined with low muscle strength on decline in mobility in older persons: results from the InCHIANTI study. Int J Obes. 2009;33(6):635–44.CrossRefGoogle Scholar
  46. 46.
    Miller GD, Nicklas BJ, You T, et al. Physical function improvements after laparoscopic Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis. 2009;5(5):530–7.CrossRefPubMedGoogle Scholar
  47. 47.
    King WC, Hsu JY, Belle SH, et al. Pre- to postoperative changes in physical activity: report from the longitudinal assessment of bariatric surgery-2 (LABS-2). Surg Obes Relat Dis. 2012;8(5):522–32.CrossRefPubMedGoogle Scholar
  48. 48.
    de Souza SAF, Faintuch J, Fabris SM, et al. Six-minute walk test: functional capacity of severely obese before and after bariatric surgery. Surg Obes Relat Dis. 2009;5(5):540–3.CrossRefPubMedGoogle Scholar
  49. 49.
    Hue O, Berrigan F, Simoneau M, et al. Muscle force and force control after weight loss in obese and morbidly obese men. Obes Surg. 2008;18(9):1112–8.CrossRefPubMedGoogle Scholar
  50. 50.
    Frezza EE, Shebani KO, Wachtel MS. Laparoscopic gastric bypass for morbid obesity decreases bodily pain, improves physical functioning, and mental and general health in women. J Laparoendosc Adv Surg Tech. 2007;17(4):440–7.CrossRefGoogle Scholar
  51. 51.
    Gorin AA, Raftopoulos I. Effect of mood and eating disorders on the short-term outcome of laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2009;19(12):1685–90.CrossRefPubMedGoogle Scholar
  52. 52.
    Hooper MM, Stellato TA, Hallowell PT, et al. Musculoskeletal findings in obese subjects before and after weight loss following bariatric surgery. Int J Obes. 2007;31(1):114–20.CrossRefGoogle Scholar
  53. 53.
    Hörchner R, Tuinebreijer W. Improvement of physical functioning of morbidly obese patients who have undergone a Lap-Band® operation: one-year study. Obes Surg. 1999;9(4):399–402.CrossRefPubMedGoogle Scholar
  54. 54.
    Huang C-Y, Hsu M-C, Pan K-C, et al. Early health status and health-related quality of life after laparoscopic gastric bypass surgery in morbidly obese patients. Bariatr Nurs Surg Patient Care. 2011;6(4):193–200.CrossRefGoogle Scholar
  55. 55.
    Iossi MF, Konstantakos EK, Teel DD, et al. Musculoskeletal function following bariatric surgery. Obesity. 2013;21(6):1104–10.CrossRefPubMedGoogle Scholar
  56. 56.
    Sarwer DB, Wadden TA, Moore RH, et al. Changes in quality of life and body image following gastric bypass surgery. Surg Obes Relat Dis: Off J Am Soc Bariatr Surg. 2010;6(6):608.CrossRefGoogle Scholar
  57. 57.
    Tompkins J, Bosch PR, Chenowith R, et al. Changes in functional walking distance and health-related quality of life after gastric bypass surgery. Phys Ther. 2008;88(8):928–35.CrossRefPubMedGoogle Scholar
  58. 58.
    Vincent HK, Ben-David K, Conrad BP, et al. Rapid changes in gait, musculoskeletal pain, and quality of life after bariatric surgery. Surg Obes Relat Dis. 2012;8(3):346–54.CrossRefPubMedGoogle Scholar
  59. 59.
    Vargas C, Picolli F, Dani C, et al. Functioning of obese individuals in pre-and postoperative periods of bariatric surgery. Obes Surg. 2013;23(10):1590–5.CrossRefPubMedGoogle Scholar
  60. 60.
    Da Silva RP, Martinez D, Faria CC, et al. Improvement of exercise capacity and peripheral metaboreflex after bariatric surgery. Obes Surg. 2013;23(11):1835–41.CrossRefPubMedGoogle Scholar
  61. 61.
    De Souza SAF, Faintuch J, Sant’Anna AF. Effect of weight loss on aerobic capacity in patients with severe obesity before and after bariatric surgery. Obes Surg. 2010;20(7):871–5.CrossRefPubMedGoogle Scholar
  62. 62.
    Fowler L, Ivezaj V, Saules KK. Problematic intake of high-sugar/low-fat and high glycemic index foods by bariatric patients is associated with development of post-surgical new onset substance use disorders. Eat Behav. 2014;15(3):505–8.CrossRefPubMedGoogle Scholar
  63. 63.
    Josbeno DA, Jakicic JM, Hergenroeder A, et al. Physical activity and physical function changes in obese individuals after gastric bypass surgery. Surg Obes Relat Dis. 2010;6(4):361–6.CrossRefPubMedGoogle Scholar
  64. 64.
    Serés L, Lopez-Ayerbe J, Coll R, et al. Increased exercise capacity after surgically induced weight loss in morbid obesity. Obesity. 2006;14(2):273–9.CrossRefPubMedGoogle Scholar
  65. 65.
    Valezi AC, Machado VHS. Morphofunctional evaluation of the heart of obese patients before and after bariatric surgery. Obes Surg. 2011;21(11):1693–7.CrossRefPubMedGoogle Scholar
  66. 66.
    Wasmund SL, Owan T, Yanowitz FG, et al. Improved heart rate recovery after marked weight loss induced by gastric bypass surgery: two-year follow up in the Utah obesity study. Heart Rhythm. 2011;8(1):84–90.CrossRefPubMedGoogle Scholar
  67. 67.
    Miller GD, Norris A, Fernandez A. Changes in nutrients and food groups intake following laparoscopic Roux-en-Y gastric bypass (RYGB). Obes Surg. 2014;24(11):1926–32.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Quinart S, Mougin F, Simon-Rigaud M-L, et al. Evaluation of cardiorespiratory fitness using three field tests in obese adolescents: validity, sensitivity and prediction of peak. J Sci Med Sport. 2014;17(5):521–5.CrossRefPubMedGoogle Scholar
  69. 69.
    Wiklund M, Olsén MF, Olbers T, et al. Physical fitness and physical activity in Swedish women before and one year after roux-en-Y gastric bypass surgery. Open Obesity J. 2014;6:38–43.CrossRefGoogle Scholar
  70. 70.
    Fukagawa NK, Wolfson L, Judge J, et al. Strength is a major factor in balance, gait, and the occurrence of falls. J Gerontol Ser A Biol Med Sci. 1995;50(Special Issue):64–7.CrossRefGoogle Scholar
  71. 71.
    O’brien PE, McPhail T, Chaston TB, et al. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16(8):1032–40.CrossRefPubMedGoogle Scholar
  72. 72.
    Handrigan G, Hue O, Simoneau M, et al. Weight loss and muscular strength affect static balance control. Int J Obes. 2010;34(5):936–42.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Sports Medicine Research CenterTehran university of Medical SciencesTehranIran
  2. 2.Obesity Treatment Center, Department of SurgeryShahed UniversityTehranIslamic Republic of Iran
  3. 3.Department of Epidemiology and Biostatistics, School of Public HealthTehran University of Medical SciencesTehranIran
  4. 4.Department of Sports and Exercise MedicineTehran University of Medical SciencesTehranIran

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