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Randomized Controlled Trial
. 2015 Dec;23(12):2454-61.
doi: 10.1002/oby.21332. Epub 2015 Nov 5.

Dose response of exercise training following roux-en-Y gastric bypass surgery: A randomized trial

Tracey L Woodlief  1   2 , Elvis A Carnero  1 , Robert A Standley  1   2 , Giovanna Distefano  1   2 , Steve J Anthony  2   3 , Gabe S Dubis  4 , John M Jakicic  5 , Joseph A Houmard  4 , Paul M Coen  1   2 , Bret H Goodpaster  1   2
Affiliations
Randomized Controlled Trial

Dose response of exercise training following roux-en-Y gastric bypass surgery: A randomized trial

Tracey L Woodlief et al. Obesity (Silver Spring). 2015 Dec.

Abstract

Objective: Roux-en-Y gastric bypass (RYGB) surgery can cause profound weight loss and improve overall cardiometabolic risk factors. Exercise (EX) training following RYGB can provide additional improvements in insulin sensitivity (SI ) and cardiorespiratory fitness. However, it remains unknown whether a specific amount of EX post-RYGB is required to achieve additional benefits.

Methods: We performed a post hoc analysis of participants who were randomized into either a 6-month structured EX program or a health education control (CON). The EX group (n = 56) was divided into tertiles according to the amount of weekly exercise performed, compared with CON (n = 42): low-EX = 54 ± 8; middle-EX = 129 ± 4; and high-EX = 286 ± 40 min per week.

Results: The high-EX lost a significantly greater amount of body weight, total fat mass, and abdominal deep subcutaneous abdominal fat compared with CON (P < 0.005). SI improved to a greater extent in both the middle-EX and high-EX compared with CON (P < 0.04). Physical fitness (VO2 max) significantly improved in the high-EX (9.3% ± 4.2%) compared with CON (-6.0 ± 2.4%) (P < 0.001). Skeletal muscle mitochondrial State 4 (P < 0.002) and 3 (P < 0.04) respiration was significantly higher in the high-EX compared with CON.

Conclusions: A modest volume of structured exercise provides additional improvements in insulin sensitivity following RYGB, but higher volumes of exercise are required to induce additional weight loss, changes in body composition, and improvements in cardiorespiratory fitness and skeletal muscle mitochondrial capacity.

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Conflict of interest statement

DISCLOSURE STATEMENT: No potential conflicts of interest relevant to this article were reported.

Figures

Figure 1
Figure 1
Flow of participant assessment and post-hoc analysis.
Figure 2
Figure 2
Tertiles of minutes per week of exercise training. Data are mean ± SEM, post-hoc analysis of the average minutes per week of exercise training during the last 3-months of the intervention.
Figure 3
Figure 3
A: Percent change in total fat mass. B: Percent change in abdominal fat. Data are shown as mean ± SEM. ** different across groups, p< 0.05
Figure 4
Figure 4
Cardiorespiratory fitness (VO2peak). A: Pre intervention (black bars) and post intervention (gray bars). B: percent change from pre intervention. Data are mean ± SEM. ** post different from pre, p<0.05.
Figure 5
Figure 5
A and B, Insulin sensitivity (SI); and C and D, disposition index (DI). Data are mean ± SEM. A and C, pre intervention (black bars) and post intervention (gray bars), ** post different from pre. B and D, ** different between groups, all p<0.05.
Figure 6
Figure 6
A: Mitochondrial respiration in various respiratory states, including Leak (LI) respiration, complex I supported OXPHOS (PI) respiration, complex I and II supported OXPHOS respiration (PI&II) and electron transfer system capacity or maximal uncoupled respiration (EI&II). O2 flux was normalized to the fiber bundle dry weight. B: Complete Palmitate Oxidation. C: Incomplete palmitate oxidation. D: Ratio of complete/incomplete. Data are mean ± SEM. ** post different from pre; all p < 0.05
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