Skip to main content

Changes in Cardiorespiratory Fitness After Gastric Bypass: Relations with Accelerometry-Assessed Physical Activity



Exercise training optimizes cardiorespiratory fitness (CRF) after bariatric surgery, but the effect of spontaneous physical activity is not well known. This study aimed to objectively quantify changes in CRF and habitual physical activity 6 months after bariatric surgery and to examine whether change in CRF was related to change in physical activity.


Secondary analyses were performed on data from women who underwent Roux-en-Y gastric bypass (RYGB) between 2010 and 2014. Measurements were performed before and 6 months after RYGB and included V̇O2peak (graded maximal exercise test on a cycle ergometer), habitual physical activity (Actigraph GT3x accelerometer worn during 7 days), and body composition (DXA absorptiometry). Changes after RYGB were analyzed using Wilcoxon signed-rank test. Relations between change in CRF and change in physical activity were analyzed with Spearman correlations adjusted on age and preoperative BMI.


Forty-five women (median [P25–P75] age, 43.0 [38.0–51.0] year; BMI, 42.6 [40.0–45.5] kg/m2) were included. Mean (SD) weight loss 6 months after RYGB was − 27.5 (7.9) kg (P < 0.001). Absolute V̇O2peak decreased by 0.35 (0.50) L/min (P < 0.001) and relative V̇O2peak tended to increase by 1.7 (5.3) mL/kg/min (P = 0.06), both with large inter-individual variability. Based on objective accelerometry data, daily steps and moderate-to-vigorous physical activity increased by 1275 (3164) steps/day and 7.6 (19.3) min/day, respectively (both P < 0.05). Change in absolute V̇O2peak was positively related to change in moderate-to-vigorous physical activity (r = 0.35; P = 0.03).


The decrease in absolute CRF observed 6 months after RYGB might be prevented by increasing habitual physical activity.

Trial Registration identifier: NCT01113996

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21(Suppl 1):S1–27.

    Article  CAS  Google Scholar 

  2. Sjostrom L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65.

    Article  PubMed  Google Scholar 

  3. Ross R, Blair SN, Arena R, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association. Circulation. 2016;134(24):e653–e99.

    Article  PubMed  Google Scholar 

  4. U.S. Department of Health and Human Services. Physical activity guidelines for Americans. Washington: 2008.

  5. ACSM. American College of Sports Medicine’s guidelines for exercise testing and prescription. 9th edition. Baltimore: Lippincott; 2014.

    Google Scholar 

  6. Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301(19):2024–35.

    Article  CAS  PubMed  Google Scholar 

  7. Fogelholm M. Physical activity, fitness and fatness: relations to mortality, morbidity and disease risk factors. A systematic review. Obes Rev. 2010;11(3):202–21.

    Article  CAS  PubMed  Google Scholar 

  8. McCullough PA, Gallagher MJ, Dejong AT, et al. Cardiorespiratory fitness and short-term complications after bariatric surgery. Chest. 2006;130(2):517–25.

    Article  PubMed  Google Scholar 

  9. Seres L, Lopez-Ayerbe J, Coll R, et al. Increased exercise capacity after surgically induced weight loss in morbid obesity. Obesity (Silver Spring). 2006;14(2):273–9.

    Article  Google Scholar 

  10. Kanoupakis E, Michaloudis D, Fraidakis O, et al. Left ventricular function and cardiopulmonary performance following surgical treatment of morbid obesity. Obes Surg. 2001;11(5):552–8.

    Article  CAS  PubMed  Google Scholar 

  11. de Souza SA, 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.

    Article  PubMed  Google Scholar 

  12. Wilms B, Ernst B, Thurnheer M, et al. Differential changes in exercise performance after massive weight loss induced by bariatric surgery. Obes Surg. 2013;23(3):365–71.

    Article  PubMed  Google Scholar 

  13. Lund MT, Hansen M, Wimmelmann CL, et al. Increased post-operative cardiopulmonary fitness in gastric bypass patients is explained by weight loss. Scand J Med Sci Sports. 2016;26(12):1428–34.

    Article  CAS  PubMed  Google Scholar 

  14. Neunhaeuserer D, Gasperetti A, Savalla F, et al. Functional evaluation in obese patients before and after sleeve gastrectomy. Obes Surg. 2017;27(12):3230–9.

    Article  PubMed  Google Scholar 

  15. Bouchard C, Rankinen T. Individual differences in response to regular physical activity. Med Sci Sports Exerc. 2001;33(6 Suppl):S446–51. discussion S52–3

    Article  CAS  PubMed  Google Scholar 

  16. Bellicha A, Ciangura C, Poitou C, et al. Effectiveness of exercise training after bariatric surgery-a systematic literature review and meta-analysis. Obes Rev. 2018;19(11):1544–56.

    Article  CAS  PubMed  Google Scholar 

  17. da Silva ALG, Sardeli AV, Andre LD, et al. Exercise training does improve cardiorespiratory fitness in post-bariatric surgery patients. Obes Surg. 2019:1.

  18. Tettero OM, Aronson T, Wolf RJ, et al. Increase in physical activity after bariatric surgery demonstrates improvement in weight loss and cardiorespiratory fitness. Obes Surg. 2018;28(12):3950–7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Oppert JM, Bellicha A, Roda C, et al. Resistance training and protein supplementation increase strength after bariatric surgery: a randomized controlled trial. Obesity (Silver Spring). 2018;26(11):1709–20.

    Article  CAS  Google Scholar 

  20. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society. Circulation. 2014;129(25 Suppl 2):S102–38.

    Article  PubMed  Google Scholar 

  21. Bond DS, Jakicic JM, Unick JL, et al. Pre- to postoperative physical activity changes in bariatric surgery patients: self report vs. objective measures. Obesity (Silver Spring). 2010;18(12):2395–7.

    Article  Google Scholar 

  22. Freedson PS, Melanson E, Sirard J. Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc. 1998;30(5):777–81.

    Article  CAS  PubMed  Google Scholar 

  23. Troiano RP, Berrigan D, Dodd KW, et al. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181–8.

    Article  PubMed  Google Scholar 

  24. Tudor-Locke C, Brashear MM, Johnson WD, et al. Accelerometer profiles of physical activity and inactivity in normal weight, overweight, and obese U.S. men and women. Int J Behav Nutr Phys Act. 2010;7:60.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. JAMA. 2018;320(19):2020–8.

    Article  PubMed  Google Scholar 

  26. Kaminsky LA, Imboden MT, Arena R, et al. Reference standards for cardiorespiratory fitness measured with cardiopulmonary exercise testing using cycle ergometry: data from the Fitness Registry and the Importance of Exercise National Database (FRIEND) registry. Mayo Clin Proc. 2017;92(2):228–33.

    Article  PubMed  Google Scholar 

  27. Giusti V, Theytaz F, Di Vetta V, et al. Energy and macronutrient intake after gastric bypass for morbid obesity: a 3-y observational study focused on protein consumption. Am J Clin Nutr. 2016;103(1):18–24.

    Article  CAS  PubMed  Google Scholar 

  28. Berglind D, Willmer M, Eriksson U, et al. Longitudinal assessment of physical activity in women undergoing Roux-en-Y gastric bypass. Obes Surg. 2015;25(1):119–25.

    Article  PubMed  Google Scholar 

  29. Afshar S, Seymour K, Kelly SB, et al. Changes in physical activity after bariatric surgery: using objective and self-reported measures. Surg Obes Relat Dis. 2016;13(3):474–83.

    Article  PubMed  Google Scholar 

  30. Liu X, Lagoy A, Discenza I, et al. Metabolic and neuroendocrine responses to Roux-en-Y gastric bypass. I: energy balance, metabolic changes, and fat loss. J Clin Endocrinol Metab. 2012;97(8):E1440–50.

    Article  CAS  PubMed  Google Scholar 

  31. 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.

    Article  CAS  PubMed  Google Scholar 

  32. 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(1):72–8.

    Article  PubMed  Google Scholar 

  33. King WC, Chen JY, Bond DS, et al. Objective assessment of changes in physical activity and sedentary behavior: Pre- through 3 years post-bariatric surgery. Obesity (Silver Spring). 2015;23(6):1143–50.

    Article  Google Scholar 

  34. Glazer NL, Lyass A, Esliger DW, et al. Sustained and shorter bouts of physical activity are related to cardiovascular health. Med Sci Sports Exerc. 2013;45(1):109–15.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Saint-Maurice PF, Troiano RP, Matthews CE, et al. Moderate-to-vigorous physical activity and all-cause mortality: do bouts matter? J Am Heart Assoc. 2018;7(6)

  36. PAGAC. Physical Activity Guidelines Advisory Comittee Report. Washington, DC: US Department of Health and Human Services; 2018.

    Google Scholar 

Download references


We recognize the contribution of the Unité de Recherche Clinique/Clinical Unit Research, Pitie-Salpetriere Hospital, Paris, France, in data acquisition and management. We express our thanks to the patients for their participation in this study.


This work was supported by PHRC Programme Hospitalier de Recherche Clinique-Ile de France (AOR 09 059).

Author information

Authors and Affiliations


Corresponding author

Correspondence to Jean-Michel Oppert.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bellicha, A., Ciangura, C., Roda, C. et al. Changes in Cardiorespiratory Fitness After Gastric Bypass: Relations with Accelerometry-Assessed Physical Activity. OBES SURG 29, 2936–2941 (2019).

Download citation

  • Published:

  • Issue Date:

  • DOI: