Changes in Lean Mass, Absolute and Relative Muscle Strength, and Physical Performance After Gastric Bypass Surgery

Context: Bariatric surgery results in reduced muscle mass as weight is lost, but postoperative changes in muscle strength and performance are incompletely understood. Objective: To examine changes in body composition, strength, physical activity, and physical performance following Roux-en-Y gastric bypass (RYGB). Design, Participants, Outcomes: In a prospective cohort of 47 adults (37 women, 10 men) aged 45 +/- 12 years (mean +/- SD) with body mass index (BMI) 44 +/- 8 kg/m(2), we measured body composition by dual-energy X-ray absorptiometry, handgrip strength, physical activity, and physical performance (chair stand time, gait speed, 400-m walk time) before and 6 and 12 months after RYGB. Relative strength was calculated as absolute handgrip strength/BMI and as absolute strength/appendicular lean mass (ALM). Results: Participants experienced substantial 12-month decreases in weight (-37 +/- 10 kg or 30% +/- 7%), fat mass (-48% +/- 12%), and total lean mass (-13% +/- 6%). Mean absolute strength declined by 9% +/- 17% (P < 0.01). In contrast, relative strength increased by 32% +/- 25% (strength/BMI) and 9% +/- 20% (strength/ALM) (P < 0.01 for both). There were clinically significant postoperative improvements in all physical performance measures, including mean improvement in gait speed of >0.1 m/s (P < 0.01) and decrease in 400-m walk time of nearly a full minute. Conclusions: In the setting of dramatic weight loss, lean mass and absolute grip strength declined after RYGB. However, relative muscle strength and physical function improved meaningfully and are thus noteworthy positive outcomes of gastric bypass.