Impact of physical activity associated with bariatric surgery on systemic arterial hypertension control: a systematic review
Keywords:
Exercise, Hypertension, Bariatric surgery, Blood pressure control, Lifestyle intervention, Weight-loss surgery outcomes, Cardiovascular risk reductionAbstract
BACKGROUND: Obesity is a highly prevalent condition frequently associated with systemic arterial hypertension (SAH). Bariatric surgery (BS) is an effective strategy for weight loss and has been shown to improve blood pressure (BP) control, whereas physical activity (PA) is recognized as an important adjuvant therapy for treatment of SAH. Nevertheless, evidence regarding the combined impact of BS and PA on BP reduction remains inconsistent.
OBJECTIVES: This review aimed to evaluate whether BS combined with PA contributes to additional BP reduction in individuals with obesity.
METHODS: The review followed PRISMA guidelines and was registered in PROSPERO (CRD42024628299). Eligible studies included randomized controlled trials, cohort and cross-sectional studies involving adults who underwent BS, with or without PA. Searches were performed in CENTRAL, PubMed, LILACS, and BVS. Methodological quality was assessed using the RoB2 and JBI tools, and the certainty of evidence was graded according to GRADE.
RESULTS: Of the 406 records screened, nine studies were included (n = 504 participants). BS alone was associated with significant reductions in BP. When PA was combined with BS, additional reductions were reported; however, the findings were heterogeneous and supported by low to very low certainty of evidence. The follow-up duration across studies ranged from 4 months to 5 years.
CONCLUSION: The combination of BS and PA provides modest but clinically relevant benefits in BP reduction. However, the limited number of studies and short follow-up periods preclude definitive conclusions. High-quality, long-term randomized clinical trials are warranted to clarify the role of PA in optimizing BP control after BS.
CLINICAL TRIAL OR SYSTEMATIC REVIEW REGISTRATION: The review followed PRISMA guidelines and was registered in PROSPERO (CRD42024628299).
Downloads
References
Cunha CLPD. Obesity-induced hypertension. Arq Bras Cardiol. 2023 Jul;120(7):e20230391. PMID: 37585897; https://doi.org/10.36660/abc.20230391.
Hall JE, Carmo JM, Silva AA, Wang Z, Hall ME. Obesity-induced hypertension: interaction of neurohumoral and renal mechanisms. Circ Res. 2015 Mar 13;116(6):991–1006. PMID: 25767285; https://doi.org/10.1161/CIRCRESAHA.116.305697.
Parvanova A, Reseghetti E, Abbate M, Ruggenenti P. Mechanisms and treatment of obesity-related hypertension. Part 1: Mechanisms. Clin Kidney J. 2023 Nov 13;17(1):sfad282. PMID: 38186879; https://doi.org/10.1093/ckj/sfad282.
Shams E, Kamalumpundi V, Peterson J, Gismondi RA, Oigman W, Gusmão Correia ML. Highlights of mechanisms and treatment of obesity-related hypertension. J Hum Hypertens. 2022 Sep;36(9):785–93. PMID: 35001082; https://doi.org/10.1038/s41371-021-00644-y.
Natsis M, Antza C, Doundoulakis I, Stabouli S, Kotsis V. Hypertension in obesity: novel insights. Curr Hypertens Rev. 2020;16(1):30–6. PMID: 30987571; https://doi.org/10.2174/1573402115666190415154603.
Outón S, Galceran I, Pascual J, Oliveras A. Central blood pressure in morbid obesity and after bariatric surgery. Nefrologia (Engl Ed). 2020 May–Jun;40(3):217–22. PMID: 31864863; https://doi.org/10.1016/j.nefro.2019.09.004.
Climent E, Oliveras A, Pedro-Botet J, Goday A, Benaiges D. Bariatric surgery and hypertension. J Clin Med. 2021 Sep 7;10(18):4049. PMID: 34575161; https://doi.org/10.3390/jcm10184049.
Schiavon CA, Cavalcanti AB, Oliveira JD, et al. Randomized trial of effect of bariatric surgery on blood pressure after 5 years. J Am Coll Cardiol. 2024 Feb 13;83(6):637–48. PMID: 38325988; https://doi.org/10.1016/j.jacc.2023.11.032.
Thompson PD, Buchner D, Pina IL, et al.; American Heart Association Council on Clinical Cardiology Subcommittee on Exercise, Rehabilitation, and Prevention; American Heart Association Council on Nutrition, Physical Activity, and Metabolism Subcommittee on Physical Activity. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation. 2003 Jun 24;107(24):3109–16. PMID: 12821592; https://doi.org/10.1161/01.CIR.0000075572.40158.77.
Bond DS, Jakicic JM, Vithiananthan S, et al. Objective quantification of physical activity in bariatric surgery candidates and normal-weight controls. Surg Obes Relat Dis. 2010 Jan–Feb;6(1):72–8. PMID: 19837009; https://doi.org/10.1016/j.soard.2009.08.012.
Huck CJ. Effects of supervised resistance training on fitness and functional strength in patients succeeding bariatric surgery. J Strength Cond Res. 2015 Mar;29(3):589–95. PMID: 25226310; https://doi.org/10.1519/JSC.0000000000000667.
Mendes BF, Improta-Caria AC, Diniz E, et al. Resistance training reduces blood pressure: putative molecular mechanisms. Curr Hypertens Rev. 2024;20(1):52–6. PMID: 38258772; https://doi.org/10.2174/0115734021277791240102041632.
Egberts K, Brown WA, Brennan L, O’Brien PE. Does exercise improve weight loss after bariatric surgery?: a systematic review. Obes Surg. 2012 Feb;22(2):335–41. PMID: 22038571; https://doi.org/10.1007/s11695-011-0544-5.
Ren ZQ, Lu GD, Zhang TZ, Xu Q. Effect of physical exercise on weight loss and physical function following bariatric surgery: a meta-analysis of randomised controlled trials. BMJ Open. 2018 Oct 31;8(10):e023208. PMID: 30385445; https://doi.org/10.1136/bmjopen-2018-023208.
Fagevik Olsén M, Wiklund M, Sandberg E, Lundqvist S, Dean E. Long-term effects of physical activity prescription after bariatric surgery: a randomized controlled trial. Physiother Theory Pract. 2022 Nov;38(11):1591–601. PMID: 33576284; https://doi.org/10.1080/09593985.2021.1885087.
Hall ME, Cohen JB, Ard JD, et al.; American Heart Association Council on Hypertension; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Lifestyle and Cardiometabolic Health; and Stroke Council. Weight-loss strategies for prevention and treatment of hypertension: a scientific statement from the American Heart Association. Hypertension. 2021 Nov;78(5):e38–e50. PMID: 34538096; https://doi.org/10.1161/HYP.0000000000000202.
Oppert JM, Bellicha A, Van Baak MA, et al. Exercise training in the management of overweight and obesity in adults: synthesis of the evidence and recommendations from the European Association for the Study of Obesity Physical Activity Working Group. Obes Rev. 2021 Jul;22(Suppl 4):e13273. PMID: 34076949; https://doi.org/10.1111/obr.13273.
Fernstrom JD, Courcoulas AP, Houck PR, Fernstrom MH. Long-term changes in blood pressure in extremely obese patients who have undergone bariatric surgery. Arch Surg. 2006 Mar;141(3):276–83. PMID: 16549693; https://doi.org/10.1001/archsurg.141.3.276.
Keleidari B, Mahmoudie M, Anaraki AG, et al. Six month-follow up of laparoscopic sleeve gastrectomy. Adv Biomed Res. 2016 Mar 16;5:49. PMID: 27110546; https://doi.org/10.4103/2277-9175.178786.
Serés L, Lopez-Ayerbe J, Coll R, et al. Increased exercise capacity after surgically induced weight loss in morbid obesity. Obesity (Silver Spring). 2006 Feb;14(2):273–9. PMID: 16571853; https://doi.org/10.1038/oby.2006.35.
Costa Pereira LM, Aidar FJ, Matos DG, et al. Assessment of cardiometabolic risk factors, physical activity levels, and quality of life in stratified groups up to 10 years after bariatric surgery. Int J Environ Res Public Health. 2019 Jun 4;16(11):1975. PMID: 31167365; https://doi.org/10.3390/ijerph16111975.
Jankiewicz-Wika J, Kołomecki K, Cywiński J, et al. Impact of vertical banded gastroplasty on body weight, insulin resistance, adipocytokine, inflammation and metabolic syndrome markers in morbidly obese patients. Endokrynol Pol. 2011;62(2):109–19. PMID: 21528472.
Valezi AC, Machado VHS. Emagrecimento e desempenho cardíaco. ABCD, Arq Bras Cir Dig. 2011 Jun;24(2):131–5. https://doi.org/10.1590/S0102-67202011000200008.
Moriconi D, Manca L, Rebelos E, et al. Long-term effects of physical activity on weight loss, metabolic parameters and blood pressure in subjects undergoing bariatric surgery: a 5-year follow-up study. Am J Surg. 2024 Aug;234:143–9. PMID: 38679511; https://doi.org/10.1016/j.amjsurg.2024.04.020.
Mundbjerg LH, Stolberg CR, Cecere S, et al. Supervised physical training improves weight loss after Roux-en-Y gastric bypass surgery: a randomized controlled trial. Obesity (Silver Spring). 2018 May;26(5):828–37. PMID: 29566463; https://doi.org/10.1002/oby.22143.
Belzile D, Auclair A, Roberge J, et al. Heart rate variability after bariatric surgery: the add-on value of exercise. Eur J Sport Sci. 2023 Mar;23(3):415–22. PMID: 34890532; https://doi.org/10.1080/17461391.2021.2017488.
Castello V, Simões RP, Bassi D, Catai AM, Arena R, Borghi-Silva A. Impact of aerobic exercise training on heart rate variability and functional capacity in obese women after gastric bypass surgery. Obes Surg. 2011 Nov;21(11):1739–49. PMID: 21104041; https://doi.org/10.1007/s11695-010-0319-4.
Poirier P, Cornier MA, Mazzone T, et al.; American Heart Association Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation. 2011 Apr 19;123(15):1683–701. PMID: 21403092; https://doi.org/10.1161/CIR.0b013e3182149099.
Huang R, Jing ZQ, Liu YH, Li ZY, Wu SS. Bariatric surgery and blood pressure control in patients with hypertension: a systematic review and meta-analysis. Eur Heart J. 2023 Nov 9;44(Suppl 2):ehad655.2353. https://doi.org/10.1093/eurheartj/ehad655.2353.
Van Brussel PM, Van Den Bogaard B, De Weijer BA, et al. Blood pressure reduction after gastric bypass surgery is explained by a decrease in cardiac output. J Appl Physiol (1985). 2017 Feb 1;122(2):223–9. PMID: 27765843; https://doi.org/10.1152/japplphysiol.00362.2016.
Khan NS, Song CY, Jennings BL, et al. Cytosolic phospholipase A2α is critical for angiotensin II-induced hypertension and associated cardiovascular pathophysiology. Hypertension. 2015 Apr;65(4):784–92. PMID: 25667212; https://doi.org/10.1161/HYPERTENSIONAHA.114.04803.
Hu C, Sun D, Fang Y, et al. Mixed comparison of different exercise interventions on physical functioning in adult patients with morbid obesity following bariatric surgery: a systematic review and network meta-analysis. Front Endocrinol (Lausanne). 2024 Oct 18;15:1465718. PMID: 39493779; https://doi.org/10.3389/fendo.2024.1465718.
Carretero-Ruiz A, Martínez-Rosales E, Cavero-Redondo I, et al. Impact of exercise training after bariatric surgery on cardiometabolic risk factors: a systematic review and meta-analysis of controlled trials. Rev Endocr Metab Disord. 2021 Dec;22(4):891–912. PMID: 33860904; https://doi.org/10.1007/s11154-021-09651-3.
Climent E, Oliveras A, Pedro-Botet J, Goday A, Benaiges D. Bariatric surgery and hypertension. J Clin Med. 2021 Sep 7;10(18):4049. PMID: 34575161; https://doi.org/10.3390/jcm10184049.
Bäckdahl J, Rydén M. Bariatric surgery helps to reduce blood pressure: insights from GATEWAY trial. Cardiovasc Res. 2018 Mar 1;114(3):e19–e21. PMID: 29481648; https://doi.org/10.1093/cvr/cvy008.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 São Paulo Medical Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.
