Impact of Pre-operative Aerobic Exercise on Cardiometabolic Health and Quality of Life in Patients Undergoing Bariatric Surgery

Objective Examine the effect of aerobic exercise (EX) combined with standard medical care (SC) (EX + SC) compared to SC alone on cardiometabolic health and quality of life in relation to surgical outcomes. Methods Patients receiving bariatric surgery were match-paired to 30 days of pre-operative SC (n= 7, 1 male, 39.0 +/- 5.3 years, body mass index 46.4 +/- 3.0 kg/m(2); low calorie diet) or EX + SC (n= 7, 0 males, 45.6 +/- 4.8 years, body mass index 43.9 +/- 4.2 kg/m(2); walking 30 min/day, 5 days/week, 65-85% HRpeak). Body mass, waist circumference, cardiorespiratory fitness (VO(2)peak), high sensitivity C-reactive protein (hs-CRP), cytokeratin 18 (CK18), weight related quality of life (QoL), and a 120 min mixed meal tolerance test (MMTT) was performed to assess arterial stiffness via augmentation index normalized to a heart rate of 75 beats per minute (AIx@75), whole-body insulin sensitivity, and glucose total area under the curve (tAUC) pre- and post-intervention (similar to 2 days prior to surgery). Length of hospital stay (admission to discharge) was recorded. Results EX + SC had a greater effect for decreased intake of total calories (P= 0.14; ES = 0.86) compared to SC, but no change in body weight or waist circumference was observed in either group. EX + SC had a greater effect for increased VO(2)peak (P= 0.24; ES = 0.91) and decreased hs-CRP (P= 0.31; ES = 0.69) compared to SC. EX + SC reduced circulating CK18 (P= 0.05; ES = 3.05) and improved QoL (P= 0.02) compared to SC. Although EX + SC had no statistical effect on arterial stiffness compared to SC, we observed a modest effect size for AIx@75 tAUC (P= 0.36; ES = 0.52). EX + SC had a significantly shorter length of hospital stay (P= 0.05; ES = 1.38) than SC, and a shorter length of hospital stay was associated with decreased sugar intake (r= 0.55,P= 0.04). Decreased AIx@75 tAUC significantly correlated with improved whole-body insulin sensitivity (r= -0.59,P= 0.03) and glucose tAUC (r= 0.57,P= 0.04). Conclusion EX with SC for 30 days prior to bariatric surgery may be important for cardiometabolic health, quality of life, and surgical outcomes in the bariatric patient.