Exercise training in metabolic and bariatric surgery: An overview of systematic reviews

Understanding how to incorporate exercise into metabolic and bariatric surgery programs to optimize treatment outcomes is of great interest, as evidenced by 11 reviews published on this topic in 2022 alone. This overview of reviews was conducted to create a single cohesive resource to aid clinicians and researchers by exploring the effects of pre- and post-operative exercise training on health outcomes. A literature search of 7 electronic databases was performed (updated 09/2023) and 24 reviews met preset PICOS eligibility criteria and were included: 4 exploring preoperative exercise training, 13 postoperative, and 7 both. Comparing reviews, outcome results were organized as concordant, discordant, or inconclusive, and then categorized into "what we currently know", "what we think we know" and "what we still don't know". We do not currently know the effects of pre- or post-operative exercise training on any outcomes, but we think we know that preoperative exercise training has a positive effect on BMI and 6-minute walking test distance, and postoperative exercise training has a positive effect on body weight and BMI, waist circumference, bone mineral density, 6-minute walking test distance, muscle strength, and systolic blood pressure. Despite the abundance of research, much still needs to be done in terms of enhancing methodological rigor and reporting to achieve greater confidence in our conclusions; recommendations for the next research steps are made.