Exercise Training in Metabolic and Bariatric Surgery

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. Accordingly, the current overview of reviews was conducted to create a single cohesive resource to aid clinicians and researchers by exploring the effects of pre- and postoperative exercise training on health outcomes. A literature search of seven electronic databases was performed (updated 09/2023) and 25 reviews met preset PICOS eligibility criteria and were included: 4 exploring preoperative exercise training, 14 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". According to systematic reviews, "we currently know" that postoperative exercise training has a (1) positive effect on weight, waist circumference, 6-minute walking test distance and muscle strength and (2) non-significant effects on lean body/fat-free mass, diastolic blood pressure, fasting insulin/glucose, total cholesterol, low density lipoprotein and triglycerides. 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 next research steps are made.