Effect of a 16-week Combined Supervised Exercise Program after bariatric surgery on Sarcopenia parameters based on FNIH, EWGSOP2, EASO/ESPEN criteria – The results of the EXPOBAR randomized trial program

Introduction: Bariatric surgery is a recognized treatment option for severe obesity, and its effectiveness in reducing weight and controlling obesity-related conditions has been demonstrated. However, it can also lead to decreased skeletal muscle mass and strength, increasing the risk of sarcopenia after surgery. This randomized clinical trial studied the effects of a 16-week supervised combined exercise program on sarcopenia in bariatric surgery patients. Methods Thirty-seven surgery candidates participated in the EXPOBAR (EXercise POst BARiatric) program and were randomized into experimental or control groups. The intervention lasted 16 weeks, starting one month after surgery, and included a supervised combined aerobic and resistance exercise intervention. The outcomes, including body composition and physical fitness parameters, were assessed at four time points. All participants underwent gastric bypass surgery (RYGB). Results The EXPOBAR trial revealed significant and meaningful effects of the exercise intervention on anthropometric indices, such as weight (p = 0.039) and waist circumference (p = 0.010). The EXPOBAR trial also showed that after bariatric surgery, there was a clear decrease in muscle mass, and this loss continued through the duration of follow-up, despite the exercise protocol. The most substantial improvements were observed in physical function and strength metrics (p = 0.005 and p < 0.001, respectively), along with a reduction in fat mass (p = 0.006), indicating the intervention’s effectiveness in enhancing both physical fitness and body composition. Discussion Current findings indicate that following an initial decrease due to bariatric surgery, a combined exercise intervention significantly improves functional physical capacity and strength. The exercise program in this study effectively reversed the surgery-induced loss in function and strength, reducing the number of patients at risk of sarcopenia. Physical and functional capacity are crucial noninvasive indicators for diagnosing muscle quality and sarcopenia. Conclusion Long-term management of sarcopenia and sarcopenic obesity in bariatric surgery patients requires frequent monitoring of body composition and muscle function. This approach is essential for tracking progress and optimizing treatment strategies over time. This study highlights the importance of integrating structured exercise programs into after bariatric surgery care to mitigate the risk of sarcopenia. Future options include nutritional protein supplementation and changes in the exercise protocol. Trial registration : The trial was registered at Clinicaltrials.gov (NCT03497546).