Increase in Physical Activity After Bariatric Surgery Demonstrates Improvement in Weight Loss and Cardiorespiratory Fitness

Abstract

Background: Low cardiorespiratory fitness is strongly associated with cardiovascular diseases and mortality. Although increased physical activity can improve cardiorespiratory fitness, this relationship has not been examined in a large bariatric population undergoing perioperative care focusing on long-term lifestyle change.

Objectives: To evaluate changes in physical activity, weight loss, and cardiorespiratory fitness up to 24 months after bariatric surgery, and to evaluate the relationships of change in physical activity with weight loss and change in cardiorespiratory fitness.

Materials and methods: Four thousand seven hundred eighty-five patients who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy between January 2012 and December 2014 were included. Physical activity was assessed by the Baecke questionnaire (work, leisure, and sport activity) and cardiorespiratory fitness, defined as VO₂max relative to fat-free mass (VO₂max/FFM), was assessed by the Åstrand test.

Results: Twenty-four months postoperative, significant improvements were seen in sport and leisure activity assessments (n = 3548, P < 0.001), weight loss (n = 3695, P < 0.001), and VO₂max/FFM (n = 1852, P < 0.001). Furthermore, regression analysis showed that change in leisure activity was positively associated with weight loss (n = 3535, ß = 1.352, P < 0.001) and change in sport activity was positively associated with change in VO₂max/FFM (n = 1743, ß = 1.730, P < 0.001).

Conclusion: Bariatric surgery complemented by a comprehensive bariatric care program can lead to improvement in physical activity, as well as weight loss and improvement in cardiorespiratory fitness. The positive associations of change in leisure activity with weight loss and change in sport activity with cardiorespiratory fitness suggest that bariatric care programs can enhance postoperative outcomes by improving the patient's physical activity.

Keywords: Bariatric care; Cardiorespiratory fitness; Physical activity; VO2max; Weight loss.

Fig. 1

Flow chart of participant follow-up

Fig. 2

Baseline and follow-up mean (± standard deviation) physical activity scores of Baecke leisure, work, and sport subscales for the entire study population. *P < 0.001 compared to respective baseline; n = 2452, 4118, and 3535 at 9, 15, and 24 months, respectively

Fig. 3

a Patient retention for weight loss assessment through 24 months postoperative. b %EWL and %TWL through 24 months postoperative. c BMI (BMI, kg/m²) through 24 months postoperative. *P < 0.001 compared to respective baseline

Fig. 4

a Baseline and follow-up mean (± standard deviation) Åstrand bicycle test outcomes, showing VO₂Max/FFM (ml/kg FFM/min). *P < 0.001 compared to baseline; n = 1900, 2072, and 1825 at 9, 15, and 24 months respectively. b VO₂Max/FFM from females (81%) and males (19%). *P < 0.001 compared to respective baseline