Sao Paulo Med J. 2026 Jun 29;144(2):e20253540. doi: 10.1590/1516-3180.2025.3540.23022026. eCollection 2026.
ABSTRACT
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).
PMID:42384999 | DOI:10.1590/1516-3180.2025.3540.23022026