title: Dose response of exercise training following roux-en-Y gastric bypass surgery: A randomized trial.
abstract: OBJECTIVE
  Roux-en-Y gastric bypass (RYGB) surgery can cause profound weight loss and improve overall cardiometabolic risk factors. Exercise (EX) training following RYGB can provide additional improvements in insulin sensitivity (SI ) and cardiorespiratory fitness. However, it remains unknown whether a specific amount of EX post-RYGB is required to achieve additional benefits.
  
  
  METHODS
  We performed a post hoc analysis of participants who were randomized into either a 6-month structured EX program or a health education control (CON). The EX group (n = 56) was divided into tertiles according to the amount of weekly exercise performed, compared with CON (n = 42): low-EX = 54 ± 8; middle-EX = 129 ± 4; and high-EX = 286 ± 40 min per week.
  
  
  RESULTS
  The high-EX lost a significantly greater amount of body weight, total fat mass, and abdominal deep subcutaneous abdominal fat compared with CON (P < 0.005). SI improved to a greater extent in both the middle-EX and high-EX compared with CON (P < 0.04). Physical fitness (VO2 max) significantly improved in the high-EX (9.3% ± 4.2%) compared with CON (-6.0 ± 2.4%) (P < 0.001). Skeletal muscle mitochondrial State 4 (P < 0.002) and 3 (P < 0.04) respiration was significantly higher in the high-EX compared with CON.
  
  
  CONCLUSIONS
  A modest volume of structured exercise provides additional improvements in insulin sensitivity following RYGB, but higher volumes of exercise are required to induce additional weight loss, changes in body composition, and improvements in cardiorespiratory fitness and skeletal muscle mitochondrial capacity.
authors.affiliation: Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida, USA.|Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Tracey L
authors.initials: TL
authors.lastname: Woodlief
authors.affiliation: Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida, USA.
authors.forename: Elvis A
authors.initials: EA
authors.lastname: Carnero
authors.affiliation: Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida, USA.|Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Standley
authors.affiliation: Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida, USA.|Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Distefano
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.|Health and Human Performance, East Carolina University, Greenville, North Carolina, USA.
authors.forename: Steve J
authors.initials: SJ
authors.lastname: Anthony
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Gabe S
authors.initials: GS
authors.lastname: Dubis
authors.affiliation: Department of Health and Physical Activity, University of Pittsburgh, Pennsylvania, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Jakicic
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Houmard
authors.affiliation: Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida, USA.|Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Coen
authors.affiliation: Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida, USA.|Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Bret H
authors.initials: BH
authors.lastname: Goodpaster
mesh_terms: D000328:Adult; D001823:Body Composition; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D015444:Exercise / Q000502:physiology; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D015390:Gastric Bypass / Q000534:rehabilitation*; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000628:therapy*; D010809:Physical Fitness; D011184:Postoperative Period; D012307:Risk Factors; D013997:Time Factors; D015431:Weight Loss