The primary aim will be to determine how different types of exercise regimens (resistance,
aerobic, or combined exercise regimens) can be used to minimize muscle loss and mobilize body
fat in severely obese patients after BS, despite the rapid surgery-induced weight loss.
Secondary aims will include: I. To examine the effect of different exercise regimens on the
composition and diversity of microbiomes, and their role in mediating muscle mass
preservation following BS. II.Evaluate changes in cardiometabolic markers and endocrine
response to different exercise regimens and evaluates microbiome mediation of these changes
after BS. III.Assess the effect of different exercise regimens on physical function among
patients following BS. IV.Clarify the mechanisms of muscle preservation and fat loss
involving hormonal response and atrophy related-genes expression.
After baseline measurements (detailed below), participants will be randomized into one of
four groups: 1. control group (n=15) that includes routine health care; 2. aerobic exercise
training group (n=15), 3. resistance exercise training group (n=15), 4. combined aerobic and
resistance exercise training group (n=15). Training sessions will be both in-person and as
online exercise supervision. All groups will be supported by a dietitian as part of the
routine health care after the bariatric surgery. The dietetic program for all groups will
consist of a balanced diet by diet progression guidelines for bariatric patients (XX,ZZ) and
the bariatric food pyramid (55). The protein content will be a minimum of 60 gr/protein per
day, according to current guidelines (XX,ZZ) . Each training session will increase gradually
up to 60 minutes per session, three times a week. Participants will be randomized into 4
groups for 26 weeks of intervention including aerobic, resistance, combined exercise training
(aerobic + resistance) and a control group without exercise training.
All exercise training will be matched in metabolic equivalent (METs) and the time of training
per week. Participants will begin a two weeks exercise adaptation period at 3-4 postoperative
weeks. The activity adaptation plan will consist of 15-20 min. of walking, three times per
week, at an intensity of 40-60% of peak oxygen consumption (VO2) or rate of perceived
exertion (RPE) 4-6 on the Borg scale for all intervention groups. Following this period, each
group will participate in a specific progressive training with the following regimen:
Aerobic exercise training group, weeks 5-8 after surgery: this training will consist of
30 min. of walking, 3 times per week at an intensity of 60-70% of peak VO2 or RPE 6-7 on
Borg scale.
Weeks 9-26 after surgery: this training will consist of 60 minutes of exercise, 3 times
per week at an intensity of 65-80% of peak VO2 or RPE 6-8 on the Borg scale. The aerobic
exercises will consist of a treadmill or outside walking or running, stationary cycling
or elliptical trainer in continuous and interval training.
Resistance exercise training group, weeks 5-8 after surgery: this training will consist
of 5-10 minutes of warmup, followed by 6-8 multi-joint exercises for major muscle
groups, comprising 2 sets of 10 to 25 repetitions at 40% of the one-repetition maximum
(1-RM) for each exercise. The intensity will increase on weeks 9-26 after surgery to
8-10 multi-joint exercises of 3-4 sets of 10 to 25 repetitions. For this training
participants will use free-weights and bodyweight exercises.
The combination exercise training will consist of a combined aerobic and resistance
exercise training sessions three times weekly. At weeks 5-8 after surgery, the sessions
will include 5-10 minutes of warmup, followed by 3-4 multi-joint exercises for major
muscle groups, comprising 2 sets of 10 to 25 repetitions at 40% of the one-repetition
maximum (1-RM) for each exercise. Afterward, the aerobic part of the training will
consist of 10-15 minutes of aerobic exercises (treadmill or outside walking or running,
stationary cycling or outdoors or elliptical trainer) at 60-70% of peak VO2 or RPE 6-7
at Borg scale.
The intensity will increase on weeks 9-26 after surgery to 4-5 multi-joint exercises of
3-4 sets of 10 to 25 repetitions and 30 minutes of aerobic exercises at 65-80% of peak
VO2 or RPE 6-8 at Borg scale.
The control group will receive conventional treatment so as the other groups (medical
and nutritional follow up).