Simancas-Racines Daniel, Parise-Vasco Juan Marcos, Angamarca-Iguago Jaime, Cuzco-Macias Ashley Carolina, Soria Carlos, Tramontano Salvatore, Rossetti Gianluca, Cobellis Francesco, Cobellis Luigi, Pilone Vincenzo, Barrea Luigi, Frias-Toral Evelyn, Reytor-González Claudia, Schiavo Luigi
Universidad UTE, Facultad de Ciencias de la Salud Eugenio Espejo, Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Quito 170527, Ecuador.
Servicio de Cardiología, Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires C1425AGP, Argentina.
J Clin Med. 2025 Sep 1;14(17):6170. doi: 10.3390/jcm14176170.
: Obesity affects over one billion people globally. Bariatric surgery is the most effective long-term intervention for severe obesity. However, postoperative outcomes can vary considerably, with such factors as baseline fitness and cardiorespiratory reserve influencing surgical outcomes. This systematic review aimed to evaluate the effects of preoperative exercise or physical activity, compared to standard care or no intervention, on preoperative fitness parameters and perioperative surgical outcomes in adults with obesity undergoing metabolic and bariatric surgery. : A systematic review was conducted in accordance with the recommendations of the and the PRISMA guidelines. Randomized controlled trials, non-randomized controlled trials, and cohort studies with control groups evaluating preoperative exercise interventions were included. Two independent reviewers conducted study selection, data extraction, and risk of bias assessment using Cochrane tools. Meta-analyses were performed using random effects models, with standardized mean differences calculated for continuous outcomes. Evidence certainty was assessed using the GRADE approach. : A total of 15 studies, including 1378 participants, were identified for qualitative synthesis, with 12 contributing data for quantitative meta-analysis. Preoperative exercise interventions significantly improved six-minute walk test distance (SMD 2.01; 95% CI: 0.51 to 3.50; = 0.009) and VO peak (SMD 1.02; 95% CI: 0.52 to 1.51; < 0.0001). BMI reduction was significant (SMD -0.96; 95% CI: -1.75 to -0.16; = 0.02), while weight change was not statistically significant (SMD -0.81; 95% CI: -1.72 to 0.09; = 0.08). One study reported a reduction in hospital length of stay of 0.64 days (95% CI: -0.86 to -0.42; < 0.00001). Evidence certainty was rated as very low to low across all outcomes. : Preoperative exercise interventions have been shown to significantly improve cardiorespiratory fitness in bariatric surgery candidates, with large effect sizes for functional capacity measures. Despite the low certainty of the evidence, these findings suggest that supervised exercise programs should be incorporated into the preoperative care of bariatric surgery patients.
肥胖影响着全球超过10亿人。减肥手术是治疗重度肥胖最有效的长期干预措施。然而，术后结果可能差异很大，诸如基线健康状况和心肺储备等因素会影响手术结果。本系统评价旨在评估与标准护理或无干预相比，术前运动或体育活动对接受代谢和减肥手术的肥胖成年人术前健康参数和围手术期手术结果的影响。
按照Cochrane协作网和PRISMA指南的建议进行了一项系统评价。纳入了评估术前运动干预的随机对照试验、非随机对照试验以及有对照组的队列研究。两名独立的评价者使用Cochrane工具进行研究选择、数据提取和偏倚风险评估。使用随机效应模型进行荟萃分析，对连续结局计算标准化均数差。采用GRADE方法评估证据的确定性。
共确定了15项研究，包括1378名参与者，用于定性综合分析，其中12项为定量荟萃分析提供了数据。术前运动干预显著改善了6分钟步行试验距离（标准化均数差2.01；95%置信区间：0.51至3.50；P = 0.009）和最大摄氧量（标准化均数差1.02；95%置信区间：0.52至1.51；P < 0.0001）。体重指数降低显著（标准化均数差-0.96；95%置信区间：-1.75至-0.16；P = 0.02），而体重变化无统计学意义（标准化均数差-0.81；95%置信区间：-1.72至0.09；P = 0.08）。一项研究报告住院时间缩短了0.64天（95%置信区间：-0.86至-0.42；P < 0.00001）。所有结局的证据确定性被评为极低至低。
术前运动干预已被证明能显著改善减肥手术候选者的心肺功能，对功能能力指标有较大效应量。尽管证据的确定性较低，但这些发现表明，有监督的运动计划应纳入减肥手术患者的术前护理中。
