Physical activity in patients after bariatric surgery - a literature review
DOI:
https://doi.org/10.12775/QS.2025.37.57448Keywords
Sport, Physical activity, obesity,, bariatric surgeryAbstract
Introduction: Obesity is a growing global health concern, leading to severe comorbidities such as cardiovascular disease, diabetes, and depression. Bariatric surgery is an effective treatment for severe obesity, providing significant weight loss and health improvements. However, physical activity (PA) plays a critical role in enhancing these outcomes, including sustained weight loss, improved fitness, and better mental health.
Materials and methods: The authors searched PubMed, UpToDate, Google Scholar, Cochrane Library, and Science Direct to review the available medical literature about physical activity after bariatric surgery. The following keywords: sport, physical activity, obesity, bariatric surgery were used to search for papers.
Results: This review examines the benefits of PA after bariatric surgery, highlighting its impact on reducing weight regain, maintaining lean body mass, and improving quality of life. It also explores the unique challenges associated with primary obesity and post-bariatric surgery, such as joint pain, loose skin, nutritional deficiencies, and psychological barriers, which often prevent patients from engaging in PA.
Conclusions: The review emphasizes the need for clear guidelines, tailored interventions, and multidisciplinary support to address these challenges. By promoting PA and providing comprehensive care, healthcare providers can ensure long-term success and improved quality of life for bariatric patients.
References
1. Bluher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019;15(5):288-98.
2. Via M. The malnutrition of obesity: micronutrient deficiencies that promote diabetes. ISRN Endocrinol. 2012;2012:103472.
3. Prospective Studies C, Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083-96.
4. Chooi YC, Ding C, Magkos F. The epidemiology of obesity. Metabolism. 2019;92:6-10.
5. Engin A. The Definition and Prevalence of Obesity and Metabolic Syndrome: Correlative Clinical Evaluation Based on Phenotypes. Adv Exp Med Biol. 2024;1460:1-25.
6. Wolfe BM, Kvach E, Eckel RH. Treatment of Obesity: Weight Loss and Bariatric Surgery. Circ Res. 2016;118(11):1844-55.
7. Hsu WC, Araneta MR, Kanaya AM, Chiang JL, Fujimoto W. BMI cut points to identify at-risk Asian Americans for type 2 diabetes screening. Diabetes Care. 2015;38(1):150-8.
8. Topart P. Obesity surgery: Which procedure should we choose and why? J Visc Surg. 2023;160(2S):S30-S7.
9. Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ. 2014;349:g3961.
10. Blair SN, Morris JN. Healthy hearts--and the universal benefits of being physically active: physical activity and health. Ann Epidemiol. 2009;19(4):253-6.
11. Wang T, Yang L, Xu Q, Dou J, Clemente FM. Effects of recreational team sports on the metabolic health, body composition and physical fitness parameters of overweight and obese populations: A systematic review. Biol Sport. 2024;41(3):243-66.
12. Szmodis M, Zsakai A, Blasko G, Feher P, Annar D, Sziraki Z, et al. Effects of regular sport activities on stress level in sporting and non-sporting university students. Physiol Int. 2022;109(2):293-304.
13. Maggisano M, Maeda A, Okrainec A, Wnuk S, Sockalingam S, Jackson T. Physical activity and its association with psychosocial health following bariatric surgery. Appl Physiol Nutr Metab. 2019;44(12):1379-82.
14. Bellicha A, van Baak MA, Battista F, Beaulieu K, Blundell JE, Busetto L, et al. Effect of exercise training before and after bariatric surgery: A systematic review and meta-analysis. Obes Rev. 2021;22 Suppl 4(Suppl 4):e13296.
15. Zabatiero J, Smith A, Hill K, Hamdorf JM, Taylor SF, Hagger MS, et al. Do factors related to participation in physical activity change following restrictive bariatric surgery? A qualitative study. Obes Res Clin Pract. 2018;12(3):307-16.
16. Tettero OM, Aronson T, Wolf RJ, Nuijten MAH, Hopman MTE, Janssen IMC. Increase in Physical Activity After Bariatric Surgery Demonstrates Improvement in Weight Loss and Cardiorespiratory Fitness. Obes Surg. 2018;28(12):3950-7.
17. Beltran-Carrillo VJ, Jimenez-Loaisa A, Jennings G, Gonzalez-Cutre D, Navarro-Espejo N, Cervello E. Exploring the socio-ecological factors behind the (in)active lifestyles of Spanish post-bariatric surgery patients. Int J Qual Stud Health Well-being. 2019;14(1):1626180.
18. Tabesh MR, Maleklou F, Ejtehadi F, Alizadeh Z. Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: a Practical Guideline. Obes Surg. 2019;29(10):3385-400.
19. Dikareva A, Harvey WJ, Cicchillitti MA, Bartlett SJ, Andersen RE. Exploring Perceptions of Barriers, Facilitators, and Motivators to Physical Activity Among Female Bariatric Patients: Implications for Physical Activity Programming. Am J Health Promot. 2016;30(7):536-44.
20. Wouters EJ, Larsen JK, Zijlstra H, van Ramshorst B, Geenen R. Physical activity after surgery for severe obesity: the role of exercise cognitions. Obes Surg. 2011;21(12):1894-9.
21. James JD, Hardeman W, Goodall M, Eborall H, Sprung VS, Bonnett LJ, et al. A systematic review of interventions to increase physical activity and reduce sedentary behaviour following bariatric surgery. Physiotherapy. 2022;115:1-17.
22. Kaidar-Person O, Person B, Szomstein S, Rosenthal RJ. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Part A: vitamins. Obes Surg. 2008;18(7):870-6.
23. Steenackers N, Van der Schueren B, Mertens A, Lannoo M, Grauwet T, Augustijns P, et al. Iron deficiency after bariatric surgery: what is the real problem? Proc Nutr Soc. 2018;77(4):445-55.
24. Ishida RK, Faintuch J, Paula AM, Risttori CA, Silva SN, Gomes ES, et al. Microbial flora of the stomach after gastric bypass for morbid obesity. Obes Surg. 2007;17(6):752-8.
25. ten Broeke R, Bravenboer B, Smulders FJ. Iron deficiency before and after bariatric surgery: the need for iron supplementation. Neth J Med. 2013;71(8):412-7.
26. Kushner RF. Micronutrient deficiencies and bariatric surgery. Current Opinion in Endocrinology, Diabetes and Obesity. 2006;13(5):405-11.
27. Majumder S, Soriano J, Louie Cruz A, Dasanu CA. Vitamin B12 deficiency in patients undergoing bariatric surgery: preventive strategies and key recommendations. Surg Obes Relat Dis. 2013;9(6):1013-9.
28. Brolin RE, Gorman JH, Gorman RC, Petschenik AJ, Bradley LJ, Kenler HA, et al. Are vitamin B12 and folate deficiency clinically important after roux-en-Y gastric bypass? J Gastrointest Surg. 1998;2(5):436-42.
29. Krzizek EC, Brix JM, Stockl A, Parzer V, Ludvik B. Prevalence of Micronutrient Deficiency after Bariatric Surgery. Obes Facts. 2021;14(2):197-204.
30. Tefferi A. Anemia in adults: a contemporary approach to diagnosis. Mayo Clin Proc. 2003;78(10):1274-80.
31. Mohapatra S, Gangadharan K, Pitchumoni CS. Malnutrition in obesity before and after bariatric surgery. Dis Mon. 2020;66(2):100866.
32. Vinolas H, Barnetche T, Ferrandi G, Monsaingeon-Henry M, Pupier E, Collet D, et al. Oral Hydration, Food Intake, and Nutritional Status Before and After Bariatric Surgery. Obes Surg. 2019;29(9):2896-903.
33. Aman MW, Stem M, Schweitzer MA, Magnuson TH, Lidor AO. Early hospital readmission after bariatric surgery. Surg Endosc. 2016;30(6):2231-8.
34. Carpentieri GB, Goncalves S, Mourad WM, Pinto LGC, Zanella MT. Hypoglycemia post bariatric surgery: drugs with different mechanisms of action to treat a unique disorder. Arch Endocrinol Metab. 2023;67(3):442-9.
35. Capristo E, Panunzi S, De Gaetano A, Spuntarelli V, Bellantone R, Giustacchini P, et al. Incidence of Hypoglycemia After Gastric Bypass vs Sleeve Gastrectomy: A Randomized Trial. J Clin Endocrinol Metab. 2018;103(6):2136-46.
36. Goldfine AB, Patti ME. How common is hypoglycemia after gastric bypass? Obesity (Silver Spring). 2016;24(6):1210-1.
37. Hazlehurst J, Khoo B, Lobato CB, Ilesanmi I, Abbott S, Chan T, et al. Society for Endocrinology guidelines for the diagnosis and management of post-bariatric hypoglycaemia. Endocr Connect. 2024;13(5).
38. Zhang Q, Chen Y, Li J, Chen D, Cheng Z, Xu S, et al. A meta-analysis of the effects of bariatric surgery on fracture risk. Obes Rev. 2018;19(5):728-36.
39. Rousseau C, Jean S, Gamache P, Lebel S, Mac-Way F, Biertho L, et al. Change in fracture risk and fracture pattern after bariatric surgery: nested case-control study. BMJ. 2016;354:i3794.
40. Tenforde AS, Fredericson M. Influence of sports participation on bone health in the young athlete: a review of the literature. PM R. 2011;3(9):861-7.
41. Diniz-Sousa F, Veras L, Boppre G, Sa-Couto P, Devezas V, Santos-Sousa H, et al. The Effect of an Exercise Intervention Program on Bone Health After Bariatric Surgery: A Randomized Controlled Trial. J Bone Miner Res. 2021;36(3):489-99.
42. Ahlin S, Peltonen M, Sjoholm K, Anveden A, Jacobson P, Andersson-Assarsson JC, et al. Fracture risk after three bariatric surgery procedures in Swedish obese subjects: up to 26 years follow-up of a controlled intervention study. J Intern Med. 2020;287(5):546-57.
43. Magro DO, Ueno M, Coelho-Neto JS, Callejas-Neto F, Pareja JC, Cazzo E. Long-term weight loss outcomes after banded Roux-en-Y gastric bypass: a prospective 10-year follow-up study. Surg Obes Relat Dis. 2018;14(7):910-7.
44. Rutledge T, Groesz LM, Savu M. Psychiatric factors and weight loss patterns following gastric bypass surgery in a veteran population. Obes Surg. 2011;21(1):29-35.
45. Coen PM, Goodpaster BH. A role for exercise after bariatric surgery? Diabetes Obes Metab. 2016;18(1):16-23.
46. Velapati SR, Shah M, Kuchkuntla AR, Abu-Dayyeh B, Grothe K, Hurt RT, et al. Weight Regain After Bariatric Surgery: Prevalence, Etiology, and Treatment. Curr Nutr Rep. 2018;7(4):329-34.
47. Romagna EC, Lopes KG, Mattos DMF, Farinatti P, Kraemer-Aguiar LG. Physical Activity Level, Sedentary Time, and Weight Regain After Bariatric Surgery in Patients Without Regular Medical Follow-up: a Cross-Sectional Study. Obes Surg. 2021;31(4):1705-13.
48. Santos C, Carvalho M, Oliveira L, Palmeira A, Rodrigues LM, Gregorio J. The Long-Term Association between Physical Activity and Weight Regain, Metabolic Risk Factors, Quality of Life and Sleep after Bariatric Surgery. Int J Environ Res Public Health. 2022;19(14).
49. Odom J, Zalesin KC, Washington TL, Miller WW, Hakmeh B, Zaremba DL, et al. Behavioral predictors of weight regain after bariatric surgery. Obes Surg. 2010;20(3):349-56.
50. Bond DS, Graham Thomas J, Vithiananthan S, Webster J, Unick J, Ryder BA, et al. Changes in enjoyment, self-efficacy, and motivation during a randomized trial to promote habitual physical activity adoption in bariatric surgery patients. Surg Obes Relat Dis. 2016;12(5):1072-9.
51. Bond DS, Vithiananthan S, Thomas JG, Trautvetter J, Unick JL, Jakicic JM, et al. Bari-Active: a randomized controlled trial of a preoperative intervention to increase physical activity in bariatric surgery patients. Surg Obes Relat Dis. 2015;11(1):169-77.
52. Kovacs SJ, Courcoulas AP, Rogers RJ, Davis KK, Jakicic JM. Psychosocial factors associated with physical activity in patients who have undergone bariatric surgery. Surg ObesRelat Dis. 2020;16(12):1994-2005.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Martyna Śliwińska, Anna Podraza, Małgorzata Wirkijowska, Jakub Wirkijowski, Katarzyna Wójtowicz, Agata Walczak, Wiktoria Gajek-Flanczewska, Sebastian Flanczewski, Paulina Woźniak, Ewa Wietrzykowska, Dominika Sobolewska, Katarzyna Michalczyk-Fraszka
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 19
Number of citations: 0