Bariatric surgery is currently regarded as a safe and effective long-term procedure for the treatment of obesity and related comorbidities. We analyzed the association between physical activity (PA), weight regain, metabolic risk factors and quality of life in patients submitted to bariatric surgery. This study also aimed to preliminarily assess how physical activity and weight regain may be associated with sleep quality and sedentary behavior. This was an observational study, with retrospective data collection and a cross-sectional survey. Retrospective clinical data were collected from a sample of 84 individuals who had undergone bariatric gastric bypass surgery at least five years prior to the study period in an Integrated Responsibility Center for Obesity and Metabolic Diseases Surgery. The survey, developed from validated questionnaires and applied in telephone interviews, focused on health data, associated comorbidities, quality of life, physical activity, sedentary behavior and sleep. Descriptive and comparative statistics were performed with a 95% confidence level. Bariatric surgery induced a significant weight loss in the first year after surgery. Our analysis also revealed that lower levels of PA were associated with weight regain. Quality of life as well as sleep quality were inversely related to weight regain, as well as sedentary behavior in general. Primary and secondary outcomes of bariatric surgery can be better achieved if the practice of PA could be maintained for consecutive years.

Bariatric surgery is one of the treatments for severe obesity, with proven efficacy in reducing weight and diseases associated with obesity. Weight loss associated with bariatric surgery is greatly associated with a significant reduction of skeletal muscle and bone mineral mass, which leads us to induce that after bariatric surgery, patients incur an increased risk of sarcopenia. The need for prophylactic programs that prevent sarcopenia in bariatric surgery patients seems to be one of the crucial points for the long-term surgical success of bariatric and metabolic surgery. The aim of this randomized clinical trial will be to study the effects of a 16-week supervised exercise intervention program on the prevention of sarcopenia, in patients undergoing bariatric surgery. As a secondary purpose, it is also intended to characterize metabolic risk factors, physical fitness, and quality of life in post-bariatric surgery patients. A total of 45 patients on the waiting list for bariatric surgery and who have subsequently perfurgery, will be include on EXPOBAR (EXercise POst BARiatric) and randomized into 2 groups, experimental and control. The intervention starts one month after surgery, for a total of 16 weeks. Parameters of body composition, metabolic risk, quality of life, physical activity, physical fitness, and sedentary behavior will be determined. For each participant, outcomes are measured at five different time points: before the surgery, before the exercise program, after the exercise program, six and twelve months after de exercise program. This study will provide the effects of a physical exercise on sarcopenia, in patients after bariatric surgery. The trial was registered at Clinicaltrials.gov NCT03497546.

The role of obesity in contributing to inflammation is an influential factor in the progression of obesity-associated medical issues. Metabolic and bariatric surgery has been proven as effective in obtaining weight loss and associated conditions remission. The Systemic Immune Inflammation Index (SII) was developed to offer more comprehensive data on inflammation and is presented as a prognostic indicator regarding many adverse conditions. The present study aimed to investigate the association between SII and bariatric surgery in patients with sarcopenic obesity and evaluate the eventual impact of exercise on SII. All participants were sarcopenic patients with obesity, underwent bariatric surgery - RYGP - and were randomized to participate in a structured physical exercise or to control group. The assessments were performed following standardized procedures, with the data evaluated during routine clinic follow-up at preoperative and 20-weeks postoperative after the exercise program. At baseline, before surgery, patients in both groups had similar anthropometrics, body composition, muscle strength variables and percentage of comorbidities. SII was also similar in both groups. To better understand the association of SII with the different variables, a Pearson correlation test was performed at baseline using SII. There was an inverse association of SII with BMC, handgrip strength and ASMM at baseline, which was maintained 5 months after surgery. At the end of the study, the combined results of the two groups showed that weight, BMI, % of body fat, muscle mass and muscle strength, the 30s sit-to-stand test and bone mineral density all decreased significantly as expected, along with the SII that also decreased significantly. The intervention group showed higher ASMM, handgrip strength, 30s Sit-to-stand test and 400-m walk test and bone mineral density when compared with the control group. However, SII showed no difference between both groups (p > 0.05). The results of the current research show a positive impact of bariatric surgery on weight and associated conditions control and a negative impact on muscle mass and function. SII responded very favorably to surgery with or without exercise, with a clear decrease in its score. Higher SII is associated with lower muscle mass and function, and this may be a reflex of the compromise that obesity causes on health, in this case, increasing systemic inflammation and decreasing muscle mass and function. The role of physical exercise in the management of surgical bariatric patients is still not clear. After surgery, the patients in the physical exercise program group had better results in muscle mass and function when compared to the patients in the control group (without exercise). However, there were no differences in SII score between the two groups, which may be interpreted as a lack of positive effect of physical exercise per se in the short-term on the systemic inflammatory condition present in obesity.

Bariatric surgery is the treatment for severe obesity, with proven efficacy in reducing weight. Weight loss associated with bariatric surgery is greatly associated with a significant reduction of skeletal muscle and bone mineral mass, which leads us to induce that after bariatric surgery, patients incur an increased risk of sarcopenia. Prophylactic programs that prevent sarcopenia in bariatric surgery patients seems to be one of the crucial points for the long-term surgical success of bariatric and metabolic surgery. This article presents a initial data set of skeletal muscle mass index, body composition and strength to determinate sarcopenia in bariatric patients. The data were collected in a Central Hospital and in the University. In total, is necessary to recruit 46 patients waiting for bariatric surgery, between 18 and 60 years, men, and woman, without contradiction for exercise. The patients are randomized in two groups, for exercise group and control group. The evaluation is made on five points of timeline, before the surgery, after the surgery, after de exercise program, six months, and twelve months after the exercise program.

Introduction: Leptin and ghrelin are two hormones that play a role in weight homeostasis. Leptin, which is produced primarily by adipocytes and is dependent on body fat mass, suppresses appetite and increases energy expenditure. Conversely, ghrelin is the “hunger hormone”, it stimulates appetite and promotes fat storage. Bariatric surgery significantly alters the levels and activity of these hormones, contributing to weight loss and metabolic improvements. Clarifying the interplay between bariatric surgery, weight loss, physical exercise, leptin, and ghrelin is essential in developing comprehensive strategies for optimizing the long-term outcomes for candidates who have undergone bariatric surgery, especially for sarcopenic patients. Methods: This was a randomized controlled study with two groups (n = 22). The patients in both groups had obesity and sarcopenia. A Roux-en-Y-gastric bypass (RYGB) procedure was performed on all patients. The intervention group participated in a structured exercise program three times per week, beginning one month after surgery and lasting 16 weeks. Patient assessment was performed before surgery (baseline) and after the completion of the exercise program. The control group received the usual standard of care and was assessed similarly. Results: After surgery, weight, BMI, and lean mass decreased significantly in both groups between the baseline and the second assessment. Leptin levels were not significantly different between baseline and the second assessment in the physical exercise group, but were significantly lower in the control group (p = 0.05). Ghrelin levels increased over time in both groups, but the differences were not significant. When we associated leptin (the dependent variable) with weight (the independent variable), we found that lower weight was associated with lower leptin levels. A similar relationship was also observed between the leptin and sarcopenia parameters (muscle strength and mass), as well as in the bone health parameters (bone mineral density and t-score). Higher ghrelin levels were significantly associated with higher t-scores and z-scores (p < 0.05). Conclusion: Exercise has been shown to have a significant effect on leptin and ghrelin levels after bariatric surgery. By incorporating regular physical activity into their lifestyle, bariatric patients can optimize their weight loss outcomes and improve their overall health. After the physical exercise protocol, patients in the intervention group revealed more established leptin levels, which may indicate a protected pattern concerning decreased leptin levels. An unfavorable profile was evidenced, according to which greater weight loss, sarcopenia, and osteoporosis were associated with lower leptin levels.