Exercise Improves Bone Mass After Bariatric Surgery

By Lisa Rapaport

January 22, 2021

(Reuters Health) - People who have bariatric surgery may have healthier bones afterward if they participate in a supervised exercise program, a randomized controlled trial suggests.

Researchers recruited 84 patients who underwent gastric bypass or sleeve gastrectomy and randomly assigned them one month postoperatively to follow a supervised exercise program or usual care for 11 months. All of the participants had assessments of body composition, bone mineral density (BMD), bone turnover markers, muscle strength and daily physical activity before surgery and again at 1, 6, and 12 months afterward.

At 12 months, lumbar spine BMD was significantly higher for the exercise group (by 0.024 g/cm2) than for the control group, researchers reported in the Journal of Bone Mineral Research.

"Our findings showed that our exercise training program, which was specifically tailored to mitigate bariatric surgery-induced bone mass loss, was in fact effective," said lead study author Florencio Diniz-Sousa of the University of Porto in Portugal.

"The exercise-induced benefits on bone mass, a key factor in bone health, may be particularly important because they might prevent or significantly delay the onset of bone fragility following bariatric surgery and therefore reduce the risk of bone fracture," Diniz-Sousa said by email.

Participants in the exercise group had supervised 75-minute workouts on three nonconsecutive days per week that focused on high impact movements like running and jumping on an intermittent circuit, as well as movements for balance and resistance training. The exercise programs were tailored for each patient and designed to include gravitational impact loads as well as muscle contraction forces.

In a subgroup analysis based on levels of adherence to the exercise program, researchers found that people who attended at least half of their sessions had significantly better BMD than those who attended less often. Higher adherence to the exercise program was associated with 3.5% higher BMD at the lumbar spine and 5.3% higher BMD at the femoral neck.

Ten participants in the exercise group experienced health issues that required modifications to their workout programs such as knee or lower back pain.

Low adherence to the exercise program was a major limitation of the study, researchers note, and more research is needed to determine what factors might influence and improve adherence.

Still, the results underscore the importance of physical activity after bariatric surgery, particularly exercises that promote muscle growth, said Dr. Dominique Hansen a professor of rehabilitation and exercise physiology in cardiometabolic diseases at Hasselt University in Belgium.

"Although spectacular decreases in body weight are often observed after bariatric surgery, that doesn't mean that these patients are no longer in need of follow-up and proper post-operative care: many different organ systems still seem to suffer from this rapid weight loss which could cause harm in the long term," Dr. Hansen, who wasn't involved in the study, said by email. "Because bone remodeling is a slow process, good adherence to long-term exercise programs - more than 12 months -- is thus important."

SOURCE: https://bit.ly/3sDtOoA Journal of Bone Mineral Research, online December 9, 2020.

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