Physical Exercise following bariatric surgery in women with Morbid obesity: Study protocol clinical trial (SPIRIT compliant)

Alberto Soriano-Maldonado, Sonia Martínez-Forte, Manuel Ferrer-Márquez, Elena Martínez-Rosales, Alba Hernández-Martínez, Alejandro Carretero-Ruiz, Emilio Villa-González, Yaira Barranco-Ruiz, Manuel A Rodríguez-Pérez, María José Torrente-Sánchez, Lorena Carmona-Rodríguez, Pablo Soriano-Maldonado, José A Vargas-Hitos, Antonio J Casimiro-Andújar, Enrique G Artero, Ana M Fernández-Alonso, Alberto Soriano-Maldonado, Sonia Martínez-Forte, Manuel Ferrer-Márquez, Elena Martínez-Rosales, Alba Hernández-Martínez, Alejandro Carretero-Ruiz, Emilio Villa-González, Yaira Barranco-Ruiz, Manuel A Rodríguez-Pérez, María José Torrente-Sánchez, Lorena Carmona-Rodríguez, Pablo Soriano-Maldonado, José A Vargas-Hitos, Antonio J Casimiro-Andújar, Enrique G Artero, Ana M Fernández-Alonso

Abstract

Background: Severe and morbid obesity are increasing globally, particularly in women. As BMI increases, the likelihood of anovulation is higher. The primary aim of the EMOVAR clinical trial is to examine, over the short (16 weeks) and medium (12 months) term, the effects of a supervised physical exercise program (focused primarily on aerobic and resistance training) on ovarian function in women with severe/morbid obesity who have undergone bariatric surgery. Secondary objectives are to examine the effects of the intervention on chronic inflammation, insulin resistance, arterial stiffness, physical fitness, and health-related quality of life.

Methods: This is a randomized controlled trial in which ∼40 female bariatric surgery patients, aged between 18 and 45 years old, will be included. Participants assigned to the experimental group will perform a total of 48 sessions of supervised concurrent (strength and aerobic) training (3 sessions/week, 60 min/session) spread over 16 weeks. Patients assigned to the control group will receive lifestyle recommendations. Outcomes will be assessed at baseline, week 16 (i.e., after the exercise intervention) and 12 months after surgery. The primary outcome is ovarian function using the Sex-Hormone Binding Globuline, measured in serum. Secondary outcomes are serum levels of anti-mullerian hormone, TSH, T4, FSH, LH, estradiol, prolactine, and free androgen index, as well as oocyte count, the diameters of both ovaries, endometrial thickness, and uterine arterial pulsatility index (obtained from a transvaginal ultrasound), the duration of menstrual bleeding and menstrual cycle duration (obtained by personal interview) and hirsutism (Ferriman Gallwey Scale). Other secondary outcomes include serum markers of chronic inflammation and insulin resistance (i.e., C-reactive protein, interleukin 6, tumor necrosis factor-alpha, leptin, glomerular sedimentation rate, glucose, insulin and the HOMA-IR), arterial stiffness, systolic, diastolic and mean blood pressure, body composition, and total weight loss. Physical fitness (including cardiorespiratory fitness, muscular strength, and flexibility), health-related quality of life (SF-36 v2) and sexual function (Female Sexual Function Index) will also be measured.

Discussion: This study will provide, for the first time, relevant information on the effects of exercise training on ovarian function and underlying mechanisms in severe/morbid obese women following bariatric surgery.

Trial registration number: ISRCTN registry (ISRCTN27697878).

Conflict of interest statement

This work was supported by Ministerio de Economía y Competitividad (MINECO), Plan Nacional de I+D+i call RETOS 2018 (grant n° RTI2018-093302-A-I00). EM-R was funded by the Spanish Ministry of Science, Innovation and Universities (FPU18/01107) and AH-M by the Gerty Cory pre-doctoral program for deficit areas at the University of Almería. The funding sources approved this study although they had no role in the design of this study and will not have any role during its execution, analyses, interpretation of the data, writing manuscripts, or decision to submit for publication.

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Study power curve to detect a 10 nmol/L increase in the primary outcome (SHBG) for different standard deviations of the between-group difference in the change from baseline.
Figure 2
Figure 2
Graphical representation of the data-collection planning.

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