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. Author manuscript; available in PMC: 2022 Jul 1.
Published in final edited form as: Exerc Sport Sci Rev. 2021 Jul 1;49(3):197–204. doi: 10.1249/JES.0000000000000253

Figure 4.

Figure 4.

Schematic view of the effects of bariatric surgery alone or combined with exercise training in multiple health biomarkers. Outcomes were assessed at baseline, 3 (POST3), and 9 (POST9) months after the surgery. The 6-month exercise intervention started at POST3. In summary, bariatric surgery (Panel A) induced transient improvements in TNF-α, flow-mediated dilation (FMD), and insulin levels, which were not sustained 9 months after surgery in the absence of exercise. The inclusion of exercise in the post-operative period (Panel B) sustained, or even enhanced, the improvements in these variables brought about by surgery alone. In addition, as seen in Panel A, there were detrimental effects of surgery on bone and muscle mass and strength across time. Exercise following surgery (Panel B) reversed (or attenuated, in case of bone mineral density [BMD]) these responses. Panel C summarizes the outcomes for surgery alone (RYGB) or surgery plus exercise training (RYGB + ET). Upward arrows indicate increases; downward arrows indicate decreases; diagonal arrow indicates partial attenuation. Data derived from (22, 24, 33, 42, 45).