Background

Patients who undergo bariatric surgery experience loss in strength and skeletal muscle, which can negatively impact daily function and longevity. This systematic review aims to determine if resistance training is effective in improving and maintaining body composition, physical fitness and relevant health markers among patients who received bariatric surgery. This review was conducted per PRISMA 2020 guidelines. It included studies published from January 1991 to May 2023, conducted on adults who underwent bariatric surgery and received resistance training intervention following surgery. A search strategy was used to retrieve pertinent articles, which were then screened to determine eligibility. Primary outcomes included changes in body composition and strength as well as exercise adherence. Thirty studies were included, consisting of observational studies and controlled trials. Resistance training following bariatric surgery reliably improved strength, lean body mass and skeletal muscle mass. In combination with aerobic exercise, it improves cardiovascular fitness and flexibility. HDL, diabetes mellitus, cortisol, inflammation, endothelial function, bone density, and control of food intake also showed improvement after resistance training. Two studies showed improvement in strength, which was not sustained after 2 and 5 year follow-up. Adherence to resistance training protocols varied, ranging from 50 to 100%. Four of the 5 studies with 100% adherence included 2-3 60-minute sessions per week for 12 weeks. One study demonstrated only 8.2% of subjects participated in resistance training at 5-year follow-up. Resistance training after bariatric surgery has demonstrated significant benefits in strength, body composition and other markers of health. Long-term adherence remains a challenge.