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Abstract

Obesity is a major public health issue in the United States. Sleeve gastrectomy has become one of the most frequently performed bariatric procedures due to its effectiveness in achieving substantial and sustained weight loss in patients with severe obesity. Despite these benefits, postoperative outcomes, such as quality of life, body mass index maintenance, and muscular strength, are significantly influenced by lifestyle factors, especially physical activity. PURPOSE: The purpose of this study is to examine the relationship between physical activity and quality of life, body mass index, and muscular strength in patients following sleeve gastrectomy. METHODS: This cross-sectional study included 25 patients who had undergone sleeve gastrectomy. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) and expressed as total MET-minutes per week. Quality of life (QoL) was evaluated using the EQ-5D-5L index. Muscular strength and sarcopenia risk were assessed using the SARC-F questionnaire. Body mass index (BMI) was recorded before and after surgery. Data normality was tested using the Shapiro–Wilk test. As most variables did not meet the assumption of normality, non-parametric statistical tests (Mann–Whitney U, Kruskal–Wallis, and Wilcoxon signed-rank tests) were applied. Associations between physical activity and clinical outcomes were examined using Spearman correlation and multivariable linear regression adjusted for age, sex, and postoperative duration. Statistical significance was set at α = 0.05. Data are presented as median (interquartile range, IQR). RESULTS: Median total physical activity level after surgery was 2,600 MET-minutes/week (IQR 1,788–3,480). The overall median EQ-5D-5L index was 0.87 (IQR 0.84–0.90). The prevalence of sarcopenia risk based on SARC-F was 64.0%. Median BMI significantly decreased from 40.7 kg/m² (IQR 39.0–41.5) before surgery to 29.3 kg/m² (IQR 27.4–30.9) after surgery (p < 0.001). Physical activity increased significantly across postoperative periods (p = 0.004), while sarcopenia risk decreased from 75–85.7% at 3–9 months to 40% at 9–12 months. Total METs showed a strong positive correlation with QoL (r = 0.83, p < 0.001) and strong negative correlations with postoperative BMI (r = −0.75, p < 0.001) and SARC-F score (r = −0.94, p < 0.001). In multivariable regression analysis, each additional 100 MET-minutes/week was independently associated with higher EQ-5D-5L index (p = 0.001), lower postoperative BMI (p = 0.041), and lower SARC-F score (p < 0.001). Longer postoperative duration was also associated with greater physical activity, improved QoL, and reduced sarcopenia risk. CONCLUSION: In patients undergoing sleeve gastrectomy, higher levels of physical activity are strongly and independently associated with better quality of life, lower body mass index, and greater muscular strength with reduced sarcopenia risk. These findings emphasize the importance of structured physical activity and long-term exercise programs as integral components of postoperative care to optimize functional and metabolic outcomes.

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