ECSS Paris 2023: OP-MH10
INTRODUCTION: Obesity is linked to various health issues, including type 2 diabetes and cardiovascular diseases. Bariatric surgery has been proposed as an effective weight reduction method. This study aimed to determine the impact of a 16-week concurrent exercise program on body composition, fitness, cardiometabolic, and metabolomic profile in participants undergoing bariatric surgery. METHODS: Eighty individuals with severe obesity (body mass index ≥35 kg/m2) were randomized to an exercise group (n=40) or a control group (n=40) following bariatric surgery. Baseline, week 16-and 12-months post-surgery assessments included measurements of body composition (i.e., fat-free mass) using a bioimpedance device (Inbody 270). Cardiometabolic parameters, such as glucose and lipid metabolism (i.e., insulin, triglycerides...), inflammatory cytokines (i.e., TNF- α), and liver function (i.e., glomerular filtration rate), were obtained through blood serum. Nuclear magnetic resonance (NMR) spectroscopy was used to assess metabolite concentrations. Health-related fitness parameters, including cardiorespiratory fitness (VO2max), handgrip strength, 30-second chair stand, and back-scratch tests, were also measured at the specified time points. The exercise program consisted of 48 sessions (three times per week over 16 weeks) of 60-min sessions that include (1) warm up at 50–65% of HR reserve (HRR), (2) compensatory training (i.e., core stability and stabilizer muscle exercises), (3) strength training (whole-body exercises progressing from 1 to 3 sets, from 12 to 6 repetitions per set, from 24 to 10 repetitions maximum (RM) (≈50 to 75% of 1RM), (4) aerobic training (on a treadmill, progressing from 15 to 25 min, from 65 to 85% of HRR), and (5) cool down. Analyses were conducted using a per-protocol approach, with statistical significance set at p < 0.05, and R software (v. 4.2). RESULTS: Both groups improved body composition and fitness parameters at week 16 and 12 months. However, no significant between-group differences were observed. Related to liver function, the variable glomerular filtration rate (mL/min) showed a significant between-group difference at 12 months (-4.7 mL/min, (95% Confidence Interval [CI]) 95%CI [-8.7 to -0.7], p < 0.05) but not at 16 weeks. We observed that 38% of the metabolites exhibited a significant reduction, but non-significant group or group x time interactions were reported. Results were consistent across sensitivity analyses. CONCLUSION: Our study provides insights into the impact of a 16-week concurrent exercise program on individuals undergoing bariatric surgery for severe obesity. However, the complex interplay of exercise, surgery, and metabolic responses warrants ongoing investigation for a more comprehensive understanding and optimization of health outcomes in individuals with severe obesity.
Read CV Elena Martínez-RosalesECSS Paris 2023: OP-MH10
INTRODUCTION: Metabolic bariatric surgery (MBS) is the most effective treatment for morbid obesity, yet the impact of exercise training regimens on body composition and cardiometabolic changes post-MBS remains largely unexplored. METHODS: A six-month randomized controlled trial was conducted with participants randomly allocated to exercise training intervention groups: aerobic (n=13), strength (n=11) or combined (n=10) exercise, and a control group (n=11) receiving routine care. The supervised exercise intervention gradually increased to 3 sessions/week for six months after MBS. Pre- and post-intervention participants were assessed for changes in body composition using Dual-x-ray absorptiometry (DEXA), abdominal adipose tissue distribution by 3-Tesla magnetic resonance imaging (MRI), cardiometabolic blood markers and body function and strength through handgrip, six-minute walk test, sit to stand and one repetition maximum test (1RM). RESULTS: In our preliminary results among 45 participants (aged 39.2+9.4y, 75.6% females, BMI 42.3+4.2kg/m2) mean weight loss was 31.7+8.8 kg, and 67.8+16.6% of excess weight loss percentage. Fat mass decreased by -10.6+4.6% (p>0.001) and fat-free mass (FFM) by 6.2+2.8 Kg (p<0.001). Following six months of intervention, the combined and the aerobic groups achieved greater preservation of FFM compared to the control group (-4.6+1.8, -4.59+1.67 vs. -8.67+2.3kg, respectively; p<0.05). Additionally, no significant differences were observed between the combined and strength groups regarding FFM preservation. There was a trend for a higher reduction in deep subcutaneous adipose tissue (DSAT) in the aerobic group compared to the control group (relative percentage change -35.8+15.4% vs. -16.3+12.8%, p=0.061). Additionally, the aerobic group showed a higher decrease in alanine aminotransferase levels compared to the control group (-39.1 +25.6% vs. 4.7+33.6% respectively, p<0.05). The physical activity regime was independently associated with the change in blood glucose levels after controlling for FFM loss (β=0.426, p=0.046). Physical function improved across all groups with the most notable enhancement in the aerobic and combined groups. CONCLUSION: This study underscores the beneficial impact of exercise interventions after MBS on muscle mass preservation, adipose tissue distribution and metabolic markers, emphasizing the importance of exercise in comprehensive obesity management.
Read CV Ariela GoldenshlugerECSS Paris 2023: OP-MH10
INTRODUCTION: Approximately 50% of individuals experience weight regain within five years following bariatric surgery (BS). This is primarily attributed to decreased resting metabolic rate (RMR), driven by fat-free mass (FFM) loss post-BS. This study aimed to investigate the impact of exercise training on RMR and examine the association between changes in RMR and body composition after BS. METHODS: Sixty candidates (39.2±10.7y, 114.3±17.5kg, 41.7±4.4kg/m2) for BS were enrolled in a six-month open-label randomized controlled clinical trial. Participants were randomly assigned to one of four groups: control group (receiving standard care), aerobic, resistance, or combined online supervised training. Training sessions gradually increase to 60 minutes/session, 3 times/week. Pre- and post-intervention RMR measured by indirect calorimetry and body composition (FFM and fat mass) measured by dual-energy X-ray. RESULTS: The 38 participants (aerobic; n=11, strength; n=10, combined; n=11, control; n=6) that completed the study by February 2024, demonstrated a significant (p<0.01) decrease in body weight (-31.1±8.7 kg), FFM (-6.61± 2.6 kg), fat mass (-24.4±7.4 kg), and absolute-RMR (-397± 264kcal/day). Yet, all study groups demonstrated similar and significant (p<0.01) increase in RMR adjusted to body weight (2.09±2.58 kcal/kg/day). The aerobic group displayed a significant correlation between FFM loss and absolute RMR six months post-surgery (r=0.646, p<0.05). In the combined group, RMR changes were associated with both weight loss (r=0.698, p=0.01) and fat mass loss (r=0.751, p=0.01). CONCLUSION: Relative to body weight, RMR increased following BS with or without exercise training. Despite the notable loss of FFM, the decline in absolute RMR values following BS may not necessarily signify future weight regain.
Read CV Lior FriedmanECSS Paris 2023: OP-MH10