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      Can exercise promote additional benefits on body composition in patients with obesity after bariatric surgery? A systematic review and meta‐analysis of randomized controlled trials


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          Bariatric surgery is the most effective treatment for patients with severe obesity, but success rates vary substantially. Exercise is recommended after bariatric surgery to reduce weight regain but the effectiveness remains undetermined on weight loss due to conflicting results. It is also unclear what should be the optimal exercise prescription for these patients. A systematic review and meta‐analysis of randomized controlled trials on the effects of exercise on body weight (BW), anthropometric measures, and body composition after bariatric surgery was performed.


          PubMed/MEDLINE ®, EBSCO ®, Web of Science ® and Scopus ® databases were searched to identify studies evaluating exercise effectiveness.


          The analysis comprised 10 studies ( n = 487 participants). Exercise favored BW (−2.51kg; p = 0.02), waist circumference (−4.14cm; p = 0.04) and body mass index (−0.84kg·m −2; p = 0.02) reduction but no improvements in body composition. Combined exercise interventions were the most effective in reducing BW (−5.50kg; p < 0.01) and body mass index (−1.86kg·m −2; p < 0.01). Interventions starting >6‐months after bariatric surgery were more successful in reducing BW (−5.02kg; p < 0.01) and body mass index (−1.62kg·m −2; p < 0.01).


          Exercise, combined exercise regimens and interventions starting >6‐months after bariatric surgery were effective in promoting BW, waist circumference and body mass index reduction. Exercise following bariatric surgery does not seem to favor body composition improvements.

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          Most cited references64

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

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            Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes

            Background Long-term results from randomized, controlled trials that compare medical therapy with surgical therapy in patients with type 2 diabetes are limited. Methods We assessed outcomes 5 years after 150 patients who had type 2 diabetes and a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 27 to 43 were randomly assigned to receive intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy. The primary outcome was a glycated hemoglobin level of 6.0% or less with or without the use of diabetes medications. Results Of the 150 patients who underwent randomization, 1 patient died during the 5-year follow-up period; 134 of the remaining 149 patients (90%) completed 5 years of follow-up. At baseline, the mean (±SD) age of the 134 patients was 49±8 years, 66% were women, the mean glycated hemoglobin level was 9.2±1.5%, and the mean BMI was 37±3.5. At 5 years, the criterion for the primary end point was met by 2 of 38 patients (5%) who received medical therapy alone, as compared with 14 of 49 patients (29%) who underwent gastric bypass (unadjusted P=0.01, adjusted P=0.03, P=0.08 in the intention-to-treat analysis) and 11 of 47 patients (23%) who underwent sleeve gastrectomy (unadjusted P=0.03, adjusted P=0.07, P=0.17 in the intention-to-treat analysis). Patients who underwent surgical procedures had a greater mean percentage reduction from baseline in glycated hemoglobin level than did patients who received medical therapy alone (2.1% vs. 0.3%, P=0.003). At 5 years, changes from baseline observed in the gastric-bypass and sleeve-gastrectomy groups were superior to the changes seen in the medical-therapy group with respect to body weight (-23%, -19%, and -5% in the gastric-bypass, sleeve-gastrectomy, and medical-therapy groups, respectively), triglyceride level (-40%, -29%, and -8%), high-density lipoprotein cholesterol level (32%, 30%, and 7%), use of insulin (-35%, -34%, and -13%), and quality-of-life measures (general health score increases of 17, 16, and 0.3; scores on the RAND 36-Item Health Survey ranged from 0 to 100, with higher scores indicating better health) (P<0.05 for all comparisons). No major late surgical complications were reported except for one reoperation. Conclusions Five-year outcome data showed that, among patients with type 2 diabetes and a BMI of 27 to 43, bariatric surgery plus intensive medical therapy was more effective than intensive medical therapy alone in decreasing, or in some cases resolving, hyperglycemia. (Funded by Ethicon Endo-Surgery and others; STAMPEDE ClinicalTrials.gov number, NCT00432809 .).
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              Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity

              Despite decades of unequivocal evidence that waist circumference provides both independent and additive information to BMI for predicting morbidity and risk of death, this measurement is not routinely obtained in clinical practice. This Consensus Statement proposes that measurements of waist circumference afford practitioners with an important opportunity to improve the management and health of patients. We argue that BMI alone is not sufficient to properly assess or manage the cardiometabolic risk associated with increased adiposity in adults and provide a thorough review of the evidence that will empower health practitioners and professional societies to routinely include waist circumference in the evaluation and management of patients with overweight or obesity. We recommend that decreases in waist circumference are a critically important treatment target for reducing adverse health risks for both men and women. Moreover, we describe evidence that clinically relevant reductions in waist circumference can be achieved by routine, moderate-intensity exercise and/or dietary interventions. We identify gaps in the knowledge, including the refinement of waist circumference threshold values for a given BMI category, to optimize obesity risk stratification across age, sex and ethnicity. We recommend that health professionals are trained to properly perform this simple measurement and consider it as an important ‘vital sign’ in clinical practice.

                Author and article information

                Obes Sci Pract
                Obes Sci Pract
                Obesity Science & Practice
                John Wiley and Sons Inc. (Hoboken )
                13 July 2021
                February 2022
                : 8
                : 1 ( doiID: 10.1002/osp4.v8.1 )
                : 112-123
                [ 1 ] Research Center in Physical Activity Health and Leisure (CIAFEL) Faculty of Sport University of Porto Porto Portugal
                [ 2 ] Laboratory for Integrative and Translational Research in Population Health (ITR) Porto Portugal
                Author notes
                [*] [* ] Correspondence

                Giorjines Fernando Boppre, Faculty of Sport, University of Porto, Rua Dr. Plácido Costa, 91 4200‐450 Porto, Portugal.

                Email: giorjines_boppre@ 123456hotmail.com

                Author information
                © 2021 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                : 04 June 2021
                : 21 January 2021
                : 15 June 2021
                Page count
                Figures: 3, Tables: 2, Pages: 12, Words: 7374
                Funded by: Fundação para a Ciência e a Tecnologia , doi 10.13039/501100001871;
                Award ID: SFRH/BD/146976/2019
                Funded by: Programa Operacional Temático Factores de Competitividade Portugal , doi 10.13039/501100011929;
                Custom metadata
                February 2022
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.0 mode:remove_FC converted:01.02.2022

                bariatric surgery,body composition,exercise training


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