EXERCISE IN WOMEN UNDERGOING BARIATRIC SURGERY: IMPACT ON THE OVARIAN FUNCTION AND CARDIOMETABOLIC RISK FACTORS – THE EMOVAR STUDY
Discuss this preprint
Start a discussion What are Sciety discussions?Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Backgroud
This study aimed to assess the effects of a 16-week supervised exercise intervention on ovarian function in women undergoing bariatric surgery (BS); and to examine potential mechanisms associated with the changes in ovarian function.
Materials and Methods
A randomized, two-arm parallel-group trial was conducted from October 2019 to September 2022. Participants were reproductive-aged women with severe obesity (BMI ≥40 kg/m 2 or BMI ≥35 with comorbidities) recruited from the BS services from two hospitals. Participants were randomly assigned to BS+usual care ( n = 25) or BS+exercise ( n = 21), consisting of 16 weeks of three-weekly supervised exercise sessions. Outcomes were assessed before surgery, at week 16, and 1-year. The primary outcome was the change in sex-hormone binging globulin (SHBG). Secondary outcomes were related to ovarian function (obtained from both serum and transvaginal ultrasound), weight loss, body composition, fitness, inflammation, cardiometabolic and nuclear magnetic resonance-derived metabolomic profiles.
Results
A total of 42 participants (91%; 18 in BS+EX; 24 in BS+usual care) were included in the primary analyses. There were no between-group differences at week 16. At 1-year, the exercise group increased serum SHBG levels (+36.3 nmol/L; 95%CI 2.3 to 70.2; p= 0.037), oocyte count (+3.1 follicles; 95%CI 0.9 to 5.3; p= 0.007), and reduced the uterine artery mean pulsatility index (UtA-PI) (−1.3; 95%CI −2.1 to −0.5; p= 0.003) compared to usual care, despite comparable weight loss and changes in secondary/exploratory outcomes. The 1-year changes in metabolomic profile predicted 97% of the increase in SHBG in the exercise group. Interestingly, the decrease in serum amino acid levels was associated with increased SHBG levels at 1-year, only in the exercise group. Sensitivity analyses corroborated the results.
Conclusion
The EMOVAR trial suggests that a 16-week supervised exercise program improves relevant markers of ovarian function, such as SHBG, oocyte count, and UtA-PI, at 1-year compared to usual care.
