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Enhancing Sarcopenia-Related Outcomes After Bariatric Surgery: A Systematic Review and Meta-Analysis of Exercise
Mohammadmahdi Abbasi1, Fezzeh Elyasinia2, Ali Jahromi3
1Tehran University of Medical Sciences, Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran, Islamic Republic of Iran. mohamadmahdiabasi@gmail.com.
Background:
Sarcopenia is a common complication following metabolic and bariatric surgery (MBS) and may adversely affect postoperative outcomes. This review aimed to investigate the effects of structured exercise interventions (SEI) on sarcopenia-related outcomes in patients undergoing bariatric surgery.
Methods:
Randomized and non-randomized trials were included if they used a control group that did not engage in structured exercise, reported at least one relevant outcome, and used SEI either before or after MBS in adults aged over 18 with a BMI ≥ 35 kg/m². Scopus, PubMed, Cochrane Library, Web of Science, and Google Scholar were searched on April 3, 2025. The ROB and ROBINS-I tools were used to evaluate the risk of bias. Quantitative data synthesis was conducted using the random-effects model. The review protocol was registered in the PROSPERO database (ID: CRD420251020805).
Results:
A total of 4,618 records were screened, of which thirty-three studies (n = 1,545 participants; mean age = 41.3 years; mean BMI = 42.1 kg/m²; 82.2% female) were included. SEI significantly reduced body weight (WMD=-1.96 [-3.37,-0.54] kg) and BMI (WMD=-0.67 [-1.04,-0.29] kg/m2) following bariatric surgery, particularly through aerobic training. SEI was also effective in preserving fat-free mass, with the largest effect size observed for combined exercise interventions (WMD = 1.87 [0.91,2.83] kg). Muscle strength improved significantly following SEI, especially in response to resistance training (SMD = 0.74 [0.03,1.45]). Functional and aerobic capacity improved as reflected in the 6-minute walk test, sit-to-stand test, and VO₂ peak. Overall physical activity improved (SMD = 0.54 [0.02,1.06]), but step count and resting metabolic rate did not change significantly.
Conclusions:
Supervised combined exercise programs should be considered in the early postoperative period and sustained for a minimum of six months. Aerobic training should be considered for continuation and may be appropriately transitioned to unsupervised formats without compromising effectiveness.
