- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03497546
Exercise Following Bariatric Surgery for Severe/Morbid Obesity (EFIBAR) (EFIBAR)
Supervised Exercise Following Bariatric Surgery in the Treatment of Severe/Morbid Obesity: a Randomized Controlled Trial
Severe/morbid obesity is an international public health issue that importantly increases the risk of cardiovascular events and cardiovascular and all-cause mortality. Likewise, severe/morbid obesity increases the risk of illness, reduces quality of life, and raises health-care costs. Bariatric surgery is the election method for the treatment of severe/morbid obesity, resulting in significant weight loss and remission of comorbidities. However, a relatively large proportion of bariatric patients regain weight and continue to be at high risk for cardiovascular disease and premature mortality. A healthy lifestyle following bariatric surgery is essential for optimizing and maintaining weight loss. Observational studies suggest that physical activity following bariatric surgery might be associated with additional weight loss and more effective weigh loss maintenance over time. However, very little experimental evidence exists regarding the effects of supervised exercise on obesity-related outcomes in this specific population.
The aim of the EFIBAR (Ejercicio FÍsico tras cirugía BARiátrica) randomized controlled trial is to determine the effects of a 16-week supervised concurrent (aerobic and strength) exercise intervention program, on weight loss (primary outcome), body composition, cardiometabolic risk, physical fitness and quality of life (secondary outcomes) in patients with severe/morbid obesity following bariatric surgery.
According to the study aims the investigators pursue the following hypothesis: Supervised exercise will result in larger weight loss than control.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Almería, Spain, 04009
- Complejo Hospitalario Torrecárdenas (CHT)
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
To comply with local bariatric surgery criteria:
- Patients with BMI ≥ 40 kg/m2 (or 35 kg/m2 with comorbidities).
- Acceptable surgical risk (defined by the approval of anesthetist).
- Obesity maintained for over 5 years.
- Failure of previous treatments.
- To sign informed consent for surgical treatment.
- Not to present contraindications for supervised physical exercise.
- To reside in the city of Almeria (Spain) or willingness/predisposition to attend the training sessions 3 times a week during 16 weeks
Exclusion Criteria:
- Severe psychiatric or neurological disorders such as schizophrenia, epilepsia, Alzheimer, Parkinson, personality disorders, eating behaviour disorders, untreated depression or suicidal tendencies.
- Adrenal or thyroid pathology that might cause obesity.
- Uncontrolled addiction to alcohol or drugs.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Exercise
Usual care PLUS concurrent (aerobic and strength) supervised exercise program of 16 weeks (3 sessions/week, 60 min/session, progressively increasing in volume and intensity).
The program will be conducted by certified Exercise Science professionals.
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Concurrent (aerobic and strength) supervised exercise program: the program comprises 3 sessions/week (60 min/session) of aerobic and strength exercises of progressive volume and intensity.
The program will follow the Consensus on Exercise Reporting Template (CERT) guidelines.
Other Names:
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No Intervention: Control
Usual care routinely delivered after bariatric surgery, based on national (Spanish) and international recommendations, focused on nutritional status monitoring and diet/physical activity counseling.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percent total weight loss (%TWL) [Biospace Co., InBody 270, USA]
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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%TWL = [(pre-surgery weight - post-surgery weight) / (pre-surgery weight)] x 100
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Changes from baseline to 4-month and 1-year follow-up
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Body composition: body fat
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Percent body fat (%) assessed by bioimpedance analysis (InBody 270, Biospace Co., USA)
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Changes from baseline to 4-month and 1-year follow-up
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Body composition: fat-free mass
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Fat-free mass (kg) assessed by bioimpedance analysis (InBody 270, Biospace Co., USA)
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Changes from baseline to 4-month and 1-year follow-up
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Body composition: fat-free mass index
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Fat-free mass index (kg/m2) assessed by bioimpedance analysis (InBody 270, Biospace Co., USA)
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Changes from baseline to 4-month and 1-year follow-up
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Body composition: central body fat
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Waist and hip circumferences (measured in cm with an anthropometric tape), waist / height ratio
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Changes from baseline to 4-month and 1-year follow-up
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Lipid profile assessed from blood sample
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Total cholesterol (mg/dl), HDL-cholesterol (mg/dl), LDL-cholesterol (mg/dl) and triglycerides (mg/dl)
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Changes from baseline to 4-month and 1-year follow-up
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Blood markers of glucose metabolism: glucose
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Glucose (mg/dL)
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Changes from baseline to 4-month and 1-year follow-up
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Blood markers of glucose metabolism: insulin
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Insulin (μUI/mL)
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Changes from baseline to 4-month and 1-year follow-up
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Blood markers of glucose metabolism: HOMA-IR
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Homeostasis Model Assessment of Insulin Resistance (HOMA-IR)
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Changes from baseline to 4-month and 1-year follow-up
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Blood markers of glucose metabolism: glycated hemoglobin HbA1c
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Glycated hemoglobin HbA1c (%)
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Changes from baseline to 4-month and 1-year follow-up
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Brachial and central blood pressures (mmHg)
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Systolic and diastolic blood pressures assessed by Mobil-O-Graph
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Changes from baseline to 4-month and 1-year follow-up
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Arterial stiffness
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Pulse wave velocity (PWV, m/s) by Mobil-O-Graph
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Changes from baseline to 4-month and 1-year follow-up
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Plasma concentrations of inflammatory markers
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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High-sensitivity C-reactive protein (hs-CRP)
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Changes from baseline to 4-month and 1-year follow-up
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Plasma concentrations of inflammatory markers
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Tumor necrosis factor (TNF-alpha)
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Changes from baseline to 4-month and 1-year follow-up
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Plasma concentrations of inflammatory markers
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Interleukin 6 (IL-6)
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Changes from baseline to 4-month and 1-year follow-up
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Plasma concentrations of liver metabolism enzymes
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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GGT (gamma-glutamyltransferase)
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Changes from baseline to 4-month and 1-year follow-up
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Plasma concentrations of liver metabolism enzymes
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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GPT (glutamate-pyruvate transaminase)
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Changes from baseline to 4-month and 1-year follow-up
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Plasma concentrations of liver metabolism enzymes
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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GOT (glutamate-oxalacetate transaminase)
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Changes from baseline to 4-month and 1-year follow-up
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Plasma levels of Vitamin D
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Concentrations of 25-hydroxyvitamin D (ng/mL)
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Changes from baseline to 4-month and 1-year follow-up
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Heart rate variability (HRV)
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Assessed by heart rate monitor (Polar V800)
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Changes from baseline to 4-month and 1-year follow-up
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Health-related physical fitness: cardiorespiratory fitness
Time Frame: Changes from baseline to 4-month and and 1-year follow-up
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Cardiorespiratory fitness, assessed using a maximal treadmill test
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Changes from baseline to 4-month and and 1-year follow-up
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Health-related physical fitness: upper body muscular strength
Time Frame: Changes from baseline to 4-month and and 1-year follow-up
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Upper body muscular strength, assessed using handgrip dynamometry (kg)
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Changes from baseline to 4-month and and 1-year follow-up
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Health-related physical fitness: lower body muscular strength
Time Frame: Changes from baseline to 4-month and and 1-year follow-up
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Lower body muscular strength, assessed using the 30-seconds chair-stand test (number of repetitions)
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Changes from baseline to 4-month and and 1-year follow-up
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Health-related physical fitness: upper body flexibility
Time Frame: Changes from baseline to 4-month and and 1-year follow-up
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Upper body flexibility, assessed using the back scratch test (cm)
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Changes from baseline to 4-month and and 1-year follow-up
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Objectively-measured physical activity
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Assessed by accelerometry (ActiGraph, software ActiLife)
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Changes from baseline to 4-month and 1-year follow-up
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Health-Related Quality of Life (HRQoL): SF-36
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Measured by the 36-item Short Form Health Survey (SF-36)
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Changes from baseline to 4-month and 1-year follow-up
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Health-Related Quality of Life (HRQoL): EQ-5D-3L
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Measured by European Quality of Life - 5 Dimensions-3Levels (EQ-5D-3L)
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Changes from baseline to 4-month and 1-year follow-up
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Symptomatology and function of hip / knee osteoarthritis: Pain
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Measured by the WOMAC (Western Ontario and McMaster Universities) Osteoarthritis Index.
The PAIN scale within the WOMAC questionnaire contains 5 items, each one scoring from 0 (Nothing) to 4 (Very much), what makes a total score ranging from 0 (better) to 20 (worse).
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Changes from baseline to 4-month and 1-year follow-up
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Symptomatology and function of hip / knee osteoarthritis: Function
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Measured by the WOMAC (Western Ontario and McMaster Universities) Osteoarthritis Index.
The FUNCTION scale within the WOMAC questionnaire contains 17 items, each one scoring from 0 (No trouble) to 4 (Very much difficult), what makes a total score ranging from 0 (better) to 68 (worse).
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Changes from baseline to 4-month and 1-year follow-up
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Symptomatology and function of hip / knee osteoarthritis: Stiffness
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Measured by the WOMAC (Western Ontario and McMaster Universities) Osteoarthritis Index.
The STIFFNESS scale within the WOMAC questionnaire contains 2 items, each one scoring from 0 (Nothing) to 4 (Very much), what makes a total score ranging from 0 (better) to 8 (worse).
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Changes from baseline to 4-month and 1-year follow-up
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Depression, anxiety and stress
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Measured by the Depression, Anxiety and Stress Scale short form (DASS-21).
The DASS-21 comprises three sub-scales assessing specific psychiatric symptoms (i.e., depression, anxiety, and stress).
Each of these symptoms is assessed using seven items rated on a 4-point Likert-type scale (i.e., 0 = ''Did not apply to me at all''; 3 = ''Applied to me very much, or most of the time'').
Summed score for each psychiatric symptom ranges from 0 to 21.
Higher scores in each sub-scale indicate higher levels of depressive, anxiety or stress symptomatology.
According to the specific nature of the three psychiatric symptoms assessed by the DASS-21, these are treated independently so that no total score is available.
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Changes from baseline to 4-month and 1-year follow-up
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Emotional, psychological and social well-being
Time Frame: Changes from baseline to 4-month and 1-year follow-up
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Measured by the Mental Health Continuum-Short Form (MHC-SF)
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Changes from baseline to 4-month and 1-year follow-up
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Cost-effectiveness analysis (CEA)
Time Frame: From baseline to 1-year follow-up
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The costs will consider those related to the surgery, the exercise program, prescription medication, sick leave, post-surgery complications and readmission rates, time and effort requiring each treatment, as well as possible dietary and informal care costs.
Effectiveness will be considered as changes observed in the main clinical outcomes: weight loss and cardiometabolic risk (remission/relapse of hypertension, dyslipidemia and type 2 diabetes).
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From baseline to 1-year follow-up
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Cost-utility analysis (CUA)
Time Frame: From baseline to 1-year follow-up
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The costs will consider those related to the surgery, the exercise program, prescription medication, sick leave, post-surgery complications and readmission rates, time and effort requiring each treatment, as well as possible dietary and informal care costs.
Utility will evaluate variation in quality of life experienced by participants, computed as changes in quality-adjusted life years (QALY) using SF-36 questionnaire.
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From baseline to 1-year follow-up
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Cost-utility analysis (CUA)
Time Frame: From baseline to 1-year follow-up
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The costs will consider those related to the surgery, the exercise program, prescription medication, sick leave, post-surgery complications and readmission rates, time and effort requiring each treatment, as well as possible dietary and informal care costs.
Utility will evaluate variation in quality of life experienced by participants, computed as changes in quality-adjusted life years (QALY) using EQ-5D-3L questionnaire.
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From baseline to 1-year follow-up
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Enrique G Artero, Ph.D., Universidad de Almeria
Publications and helpful links
General Publications
- Villa-Gonzalez E, Barranco-Ruiz Y, Rodriguez-Perez MA, Carretero-Ruiz A, Garcia-Martinez JM, Hernandez-Martinez A, Torrente-Sanchez MJ, Ferrer-Marquez M, Soriano-Maldonado A, Artero EG; EFIBAR Study Group. Supervised exercise following bariatric surgery in morbid obese adults: CERT-based exercise study protocol of the EFIBAR randomised controlled trial. BMC Surg. 2019 Sep 5;19(1):127. doi: 10.1186/s12893-019-0566-9.
- Artero EG, Ferrez-Marquez M, Torrente-Sanchez MJ, Martinez-Rosales E, Carretero-Ruiz A, Hernandez-Martinez A, Lopez-Sanchez L, Esteban-Simon A, Romero Del Rey A, Alcaraz-Ibanez M, Rodriguez-Perez MA, Villa-Gonzalez E, Barranco-Ruiz Y, Martinez-Forte S, Castillo C, Gomez Navarro C, Aceituno Cubero J, Reyes Parrilla R, Aparicio Gomez JA, Femia P, Fernandez-Alonso AM, Soriano-Maldonado A. Supervised Exercise Immediately After Bariatric Surgery: the Study Protocol of the EFIBAR Randomized Controlled Trial. Obes Surg. 2021 Oct;31(10):4227-4235. doi: 10.1007/s11695-021-05559-8. Epub 2021 Jul 15.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- DEP2016-74926-R
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
- CSR
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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