Enhancing Sarcopenia-Related Outcomes After Bariatric Surgery: A Systematic Review and Meta-Analysis of Exercise Interventions Publisher



Abbasi M ; Elyasinia F ; Jahromi A ; Farsi F ; Jebeli Fard R ; Jahromi N ; Pirisedigh A ; Soroush A ; Hasaniranjbar S
Source: Obesity Surgery Published:2026

Abstract

Background: Sarcopenia is a common complication following metabolic and bariatric surgery (MBS) and may adversely affect postoperative outcomes. This review aimed to investigate the effects of structured exercise interventions (SEI) on sarcopenia-related outcomes in patients undergoing bariatric surgery. Methods: Randomized and non-randomized trials were included if they used a control group that did not engage in structured exercise, reported at least one relevant outcome, and used SEI either before or after MBS in adults aged over 18 with a BMI ≥ 35 kg/m². Scopus, PubMed, Cochrane Library, Web of Science, and Google Scholar were searched on April 3, 2025. The ROB and ROBINS-I tools were used to evaluate the risk of bias. Quantitative data synthesis was conducted using the random-effects model. The review protocol was registered in the PROSPERO database (ID: CRD420251020805). Results: A total of 4,618 records were screened, of which thirty-three studies (n = 1,545 participants; mean age = 41.3 years; mean BMI = 42.1 kg/m²; 82.2% female) were included. SEI significantly reduced body weight (WMD=-1.96 [-3.37,-0.54] kg) and BMI (WMD=-0.67 [-1.04,-0.29] kg/m2) following bariatric surgery, particularly through aerobic training. SEI was also effective in preserving fat-free mass, with the largest effect size observed for combined exercise interventions (WMD = 1.87 [0.91,2.83] kg). Muscle strength improved significantly following SEI, especially in response to resistance training (SMD = 0.74 [0.03,1.45]). Functional and aerobic capacity improved as reflected in the 6-minute walk test, sit-to-stand test, and VO₂ peak. Overall physical activity improved (SMD = 0.54 [0.02,1.06]), but step count and resting metabolic rate did not change significantly. Conclusions: Supervised combined exercise programs should be considered in the early postoperative period and sustained for a minimum of six months. Aerobic training should be considered for continuation and may be appropriately transitioned to unsupervised formats without compromising effectiveness. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026.