Effects of supervised exercise immediately after bariatric surgery: results from the EFIBAR randomized trial.

INTRODUCTION: Bariatric surgery is the most effective treatment for severe obesity. We evaluated whether a 16-week supervised exercise program initiated immediately post-surgery improves weight loss, body composition, cardiometabolic health, inflammation, and physical fitness compared with usual care. METHODS: In this randomized clinical trial, 80 participants undergoing bariatric surgery were assessed before surgery, 4- and 12-month post-surgery. The intervention consisted of 16 weeks of individually supervised concurrent exercise training initiated ~ 10 days post-surgery, with three 60-min sessions/week including progressive resistance training (50-75% of one-repetition maximum) and aerobic training (65-85% heart rate reserve). Adherence was monitored throughout the intervention. The main outcome was percent of total weight loss (%TWL). RESULTS: No significant differences between groups were observed for the primary outcome. At 4 months, %TWL was 24.9% in the exercise group and 23.4% in the control group; corresponding values at 12 months were 37.0% and 37.2%, respectively. Compared with usual care, the exercise group showed greater reductions in systolic blood pressure (- 6.5 mmHg; 95% CI, - 12.7 to - 0.2; p = 0.040) and glycated hemoglobin (- 0.3%; 95% CI, - 0.5 to - 0.1; p = 0.018) at 4 months. These differences were not maintained at 12 months. No significant between-group differences were observed in body composition, inflammatory markers, or physical fitness outcomes at any timepoint. CONCLUSION: A 16-week supervised concurrent exercise program initiated ~ 10 days after bariatric surgery did not improve weight loss compared with usual care. Although short-term improvements in systolic blood pressure and glycated hemoglobin were observed, these were not sustained at 12 months.