Table 2. Intervention characteristics and outcomes of the included studies.
| Study | Exercise and intensity | Intervention protocol | Comparison | Strength measures | Outcomes / Main results | p1 |
|---|---|---|---|---|---|---|
| Stegen et al., 2011 | WU 10 min + Resistance 25 min (UL/LL, stack-weight, 2–3 sets of 15–10 rep, 60–75% 1RM)+ Aerobic 30 min (cycling, walking and stepping, 10 min each, 60–75% HR reserve) + CD 10 min |
12 weeks, 3x/week, 75 min, Supervised |
Usual Care | 1RM (UL/LL); STS (30s); Handgrip |
1RM Biceps(kg): IG 21.8±8.0 to 25.9±13.0 CG 27.3±9.6 to 20.8±8.8 |
0.001 |
| 1RM Triceps(kg): IG 24.3±10.2 to 30.7±23.0 CG 30.1±10.5 to 22.0±6.6 |
0.038 | |||||
| 1RM Quadriceps(kg): IG 35.5±11.4 to 58.0±25.6 CG 57.3±28.2 to 45.9±25.1 |
0.002 | |||||
| 1RM Hamstrings(kg): IG 30.5±13.3 to 45.4±17.3 CG 39.0±35.0 to 35.3±27.8 |
0.094 | |||||
| STS(rep): IG 13.0±3.0 to 16.0±4.0 CG 15.0±4.0 to 15.0±3.0 |
0.081 | |||||
| Handgrip(kg): IG 76.5±30.4 to 67.6±20.2 CG 95.9±24.9 to 78.7±22.2 |
0.340 | |||||
| Huck, 2015 | WU 10 min + Resistance 45 min (UL/LL, free/body/stack-weights/ resistive bands, 1–3 sets of 8–12 rep, 60–75% 1RM) + CD (stretching) 5 min |
12 weeks, 2x/week (for 6 weeks), 3x/week (for 6 weeks), 60 min, Supervised |
Usual Care Encouraged to increase daily PA and to consume protein shakes |
1RM (UL/LL); 5-STS; Relative handgrip3 |
1RM Leg press(kg): IG 114.70±12.77 to 148.07±17.13 CG did not perform this test |
0.001 2 |
| 1RM Chest press(kg): IG 28.15±5.32 to 39.63±6.26 CG did not perform this test |
<0.001 2 | |||||
| Handgrip(kg): IG 1.09±0.30 to 1.21±0.24 CG 1.19±0.12 to 1.34±0.11 |
0.419 | |||||
| Campanha-Versiani et al., 2017 | Resistance 60 min (UL/LL, weight-bearing, 1–3 sets of 10–12 rep, 10RM) + Aerobic 25 min (treadmill, 70–80% HRmax) PES was used to load evolution |
36 weeks, 2x/week, 85 min, Supervised |
Usual Care Instructed to maintain their usual PA and return for subsequent reevaluations |
10RM (UL/LL) |
10RM Ankle leg press(kg): IG 26.6±10.1 to 68.9±21.4 CG 26.6±18.9 to 45.8±19.5 |
<0.01 |
| 10RM Seated leg curls(kg): IG 20.8±5.0 to 45.0±12 CG 20.8±14.0 to 32.6±12.3 |
<0.01 | |||||
| 10RM Bench press(kg): IG 13.9±6.3 to 30.0±14.6 CG 13.4±9.0 to 21.3±10.4 |
<0.01 | |||||
| 10RM Posterior shoulder(kg): IG 14.7±6.3 to 28.1±9.4 CG 11.6±6.9 to 13.7±6.6 |
<0.01 | |||||
| Coleman et al., 2017 | Resistance (body weight, functional exercises) + Aerobic + Flexibility (dynamic balance and mobility) All exercises had intensity/difficulty levels and patients were allowed to increase the frequency and intensity of activities as they mastered lower levels of exercise |
26 weeks, 2x/week (60 min structured exercise class), 3x/week (self-directed), Total: at least 150 min/week of moderate- to-vigorous PA, Semi-supervised |
Usual Care Routine laboratory testing, weight assessment, and phone calls to encourage dietary changes and regular moderate-to-vigorous PA (2 weeks of surgery, at 2 and 6 months) |
STS (30s); Arm curl |
STS(rep): IG 11.0±3.4 to 11.6±4.2 CG 11.0±3.5 to 11.6±3.8 |
>0.05 |
| Arm curl(rep): IG 15.1±6.1 to 17.4±5.8 CG 15.0±3.8 to 16.2±4.0 |
0.02 | |||||
| Hassannejad et al., 2017 | Aerobic (moderate intensity walking, 12–14 PES) OR Aerobic (moderate intensity walking, 12–14 PES) + Resistance 20–30 min (UL/LL, elastic bands) |
12 weeks, 1–4 weeks (both groups): Aerobic 150min/week, 5–12 weeks: Aerobic: 3-5x/week 150-200min/week Resistance: 3x/week (+aerobic), Not Supervised |
Usual Care No exercise was prescribed to the control group |
1RM (UL); STS (60s) |
1RM(kg) Resistance + Aerobic 17.7±9.4 to 18.7±9.0 CG 12.5±6.7 to 11.9±7.0 |
0.004 |
| 1RM(kg) Aerobic 15.9±7.1 to 14.8±6.2 CG 12.5±6.7 to 11.9±7.0 |
0.348 | |||||
| 1RM(kg) Resistance + Aerobic: 17.7±9.4 to 18.7±9.0 Aerobic: 15.9±7.1 to 14.8±6.2 |
0.031 | |||||
| STS(rep) Resistance + Aerobic 15.3±4.6 to 24.6±6.0 CG 7.8±5.3 to 17.0±6.2 |
0.142 | |||||
| STS(rep) Aerobic 13.6±6.6 to 22.2±8.4 CG 7.8±5.3 to 17.0±6.2 |
0.267 | |||||
| STS(rep) Resistance + Aerobic: 15.3±4.6 to 24.6±6.0 Aerobic: 13.6±6.6 to 22.2±8.4 |
0.608 | |||||
| Herring et al., 2017 | WU 5 min + Resistance 10–20 min (LL, stack-weight/core, 3 sets of 12 rep, 60% 1RM) + Aerobic 35–45 min (64–77% HRmax / 12–14 PES) + CD |
12 weeks, 3x/week, 60 min Supervised |
Usual Care | Handgrip; 5-STS |
Handgrip(kg): IG 27.6±8.7 to 29.99±7.9 CG 28.5±9.6 to 27.57±9.04 |
0.036 |
| STS(s): IG 13.7±6.8 to 9.9±3.7 CG 12.2±2.9 to 12.4±4.4 |
0.010 | |||||
| Daniels et al., 2018 | WU and stretching 5–10 min + Resistance 50–60 min (UL/LL, core exercises and lifts, 1–4 sets of 8–15 rep, 50->80% 1RM) CD 5–10 min (stationary bicycle) |
12 weeks, 3x/week, 60–80 min, NA if supervised or not |
Usual Care Instructed to continue their normal daily activities during the 12-week study |
1RM Leg press(kg): IG 163.4±34.4 to 222.8±42.4 CG 131.1±33.5 to 126.3±37.9 |
<0.001 | |
| 1RM Leg extension(kg): IG 32.5±6.0 to 38.3±6.4 CG 26.9±5.3 to 26.2±5.5 |
0.014 | |||||
| 1RM (LL); muscle quality4 |
Muscle quality (kg/cm2): IG 1.4±0.4 to 2.1±0.6 leg press CG 1.2±0.3 to 1.2±0.3 |
<0.001 | ||||
| Muscle quality (kg/cm2): IG 0.62±0.22 to 0.74±0.27 leg extension CG 0.51±0.07 to 0.52±0.14 |
<0.001 | |||||
| Mundbjerg et al., 2018 | Resistance 10 min (UL, free/stack-weights, 10–20 rep, 60–75% 1RM) + Aerobic 30 min (bike training + stair climbing OR treadmill walking OR rowing machine, PES and 50–70% VO2max) + Free access to the training facility and recommended a minimum of 3.5 h of PA per week (not supervised) |
26 weeks, 2x/week, 40 min, Supervised |
Usual Care Received standard information about the recommendation of PA post-surgery. There was no restriction on the amount of PA during the study period. |
Isometric Dynamometer (LL/ UL); STS (30s) |
Hip adduction(N): IG 145.2±36.2 to 153.5±40.0 CG 137.1±46.3 to 132.2±47.5 |
0.007 |
| Hip abduction(N): IG 141.7±36.6 to 147.1±34.9 CG 137.2±37.5 to 133.5±38.9 |
0.097 | |||||
| Hip extension(N): IG 203.2±46.6 to 198.9±50.4 CG 198.7±60.0 to 196.0±58.8 |
0.678 | |||||
| Shoulder adduction(N): IG 214.0±61.6 to 224.3±68.6 CG 196.9±67.1 to 193.3±77.5 |
0.199 | |||||
| Shoulder abduction(N): IG 170.5±42.3 to 178.3±56.6 CG 160.1±54.9 to 166.1±65.9 |
0.889 | |||||
| STS(rep): IG 15.0±3.5 to 16.1±3.2 CG 16.1±3.8 to 16.8±3.7 |
0.365 | |||||
| Kelley, 2019 | Eccentric 5–30 min (LL, isokinetic machine, speed set at 23 rep/min, >138% 1RM) OR Concentric (LL, 70–80% 1RM, PES at least 7) |
16 weeks, 3x/week 5–30 min Supervised |
Usual care Counseling to obtain 150 minutes of moderate PA and 2 days of resistance training per week, regardless of group assignment. |
1RM (LL); STS (30s); Isokinetic dynamometer (LL); Isometric dynamometer (LL) |
1RM Leg press (kg): EcG 94.7±37.0 to 163.0±29.5 CcG 105.8±58.1 to 284.2±74.2 CG 107.6±39.3 to 123.5±48.3 |
0.003 |
| STS(rep): EcG 13.6±1.5 to 19.6±1.6 CcG 12.1±1.4 to 18.3±1.9 CG 13.3±1.5 to 17.6±1.6 |
0.67 | |||||
| Knee extension (Nm): EcG 269.5±56.2 to 117.9±26.3 isokinetic CcG 242.4±54.5 to 146.5±22.0 CG 239.7±47.6 to 119.2±22.0 |
0.058 | |||||
| Knee extension (Nm): EcG 297.3±71.2 to 138.6±26.3 isometric CcG 313.6±70.5 to 195.5±62.4 CG 247.5±75.6 to 149.8±33.0 |
0.198 | |||||
| Noack-Segovia et al., 2019 | Resistance (UL, 1RM) + Aerobic (Treadmill 30 min, 54% of capacity and resistance frequency intensity, then modified to 59% of said frequency + cycle ergometer 15 min, without load); + CD (elongation/respiratory exercises) |
24 weeks, 3x/week, 90 min Supervised |
Usual care Monthly control by a physician and a nutritionist. |
Handgrip | Handgrip(kg): IG 34.19±7.32 to 31.57±6.72 CG 34.18±8.91 to 31.91±9.12 |
>0.05 |
| Gallé et al., 2020 | WU 10 min + Aerobic 25 min (brisk walking 50–70% HRmax or 4 PES) + Resistance 15 min (UL/LL, 3 sets of 12 rep, 70–85% 1RM) + CD 5 min (agility/balance) + Flexibility 5 min (static/dynamic) |
54 weeks, 2x/week, 60 min Supervised |
Usual Care Meeting with bariatric surgeon at 1 and 12 months after surgery, and counseling regarding diet and PA. Possibility to see a dietitian upon request |
STS (rep until exhaustion); Handgrip |
Handgrip(kg): IG 32.9±10.5 to 49.2±15.1 CG 32.8±11.9 to 34.0±11.6 |
<0.01 |
| STS(rep): IG 51.8±21.2 to 98.8±26.5 CG 49.2±19.1 to 47.9±13.6 |
<0.01 | |||||
| de Oliveira Junior et al., 2021 | WU 5 min + Resistance ≈60 min (UL/LL, 4–5 sets of 10–15 rep, 6–8 PES, home-based) + Aerobic 30–50 min (walking/running/stair climbing, 10 min progression every 4 weeks, 6–8 PES) |
12 weeks 3x/week ≈90–110 min Semi-supervised |
Usual care | Handgrip; STS (30s) |
Handgrip(kg): IG 35.4±9.6 to 34.0±8.2 CG 35.3±11.0 to 33.9±11.2 |
0.99 |
| STS(rep): IG 12.8±2.2 to 15.0±2.6 CG 13.4±2.5 to 13.8±2.5 |
<0.01 | |||||
| Diniz-Souza et al., 2021 | WU 5 min + High impact 20 min (high ground-reaction force exercises, 183 to 209 gravitational loading peaks above 4.9 g) + Balance 10 min (static/dynamic) + Resistance 35 min (UL/LL, 2–3 sets of 4–12 rep, 65–85% 1RM) + CD 5 min |
48 weeks, 3x/week, 75 min Supervised |
Usual care Verbal recommendation to increase PA |
Isokinetic dynamometer (LL) | Knee extension: IG 156.19±36.85 to 133.76±35.45 (Nm) CG 156.31±32.71 to 130.39±32.02 |
>0.05 |
| Knee flexion: IG 79.69±18.42 to 76.04±17.48 (Nm) CG 80.55±16.57 to 69.73±16.07 |
>0.05 | |||||
| Gil et al., 2021 | WU 5 min + Resistance ≈40 min (UL/LL, 3 sets of 8–12 rep, 5% load progression when ≥ 2 rep were performed than previously determined) + Aerobic 30–60 min (treadmill, 10 min progression every 4 weeks, 50% of the delta difference between the ventilatory anaerobic threshold and respiratory compensation point) |
24 weeks, 3x/week 70–100 min Supervised |
Usual care | 1RM (UL/LL); STS (30s) |
1RM Bench press (kg): IG 26.31±7.28 to 31.07±7.55 CG 26.87±7.25 to 24.77±5.57 |
<0.0001 |
| 1RM Leg press (kg): IG 148.77±50.50 to 214.63±59.79 CG 130.36±49.03 to 120.37±47.40 |
<0.0001 | |||||
| STS(rep): IG 14.0±2.0 to 18.0±3.0 CG 13.0±2.0 to 14.0±1.0 |
<0.0001 | |||||
| Lamarca et al., 2021 | WU 10 min + Resistance 40 min (UL/LL, stack/free weights, 3 sets of 8–12 reps, 6–8 OMNI-RES) + CD 10 min (elongation/respiratory exercises) |
12 weeks, 3x/week, 60 min Supervised |
Usual care All participants received general training on healthy eating |
Isokinetic dynamometer (LL); STS(30s) | Knee extension(Nm): IG 153.2±52.1 to 164.8±54.4 CG 124.2±23.8 to 122.3±23.0 |
<0.05 |
| STS(rep): IG 14.75±2.0 to 17.64±2.33 CG 15.29±2.47 to 16.0±3.14 |
>0.05 |
CcG, Concentric group; CD, Cooldown; CG, Control group; CM, centimeter; EcG, Eccentric group; HR, Heart rate; IG, Intervention group; LL, Lower limb; Max, Maximum; Min, Minutes; N, Newton; NA, Not available; OMNI-RES, OMNI-Resistance Exercise Scale; PA, Physical Activity; PES, Borg’s Perceived Exertion Scale; Rep, repetitions; RM, Repetition maximum; S, Seconds; STS, Sit-to-stand test; UL, Upper limb; VO2, volume of oxygen; WU, Warmup
1P value compared to the control group;
2 P value compared to baseline;
3 (Right hand + left hand)/fat-free mass;
4Muscle quality = 1RM muscle strength/muscle cross-sectional of the right tight (kg/cm2);