Carlos Gómez-Navarro

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.