Optimizing cardiorespiratory fitness after bariatric surgery - highly effective with very low adherence: HIT BAR randomized controlled trial.

Background: Cardiovascular disease and obesity-related comorbidities are key factors addressed by metabolic-bariatric surgery (MBS). Although High intensity interval training (HIIT) has been proven effective in healthy cohorts, limited evidence exists regarding HIIT and adherence towards HIIT after MBS. This study aims to test feasibility and cardiorespiratory effect of HIIT after MBS.

Methods: 201 patients undergoing MBS were included in a four-week training protocol with 3 training groups (B-D) including different HIIT protocols on a bicycle designed for patients with obesity and one control group (A) at a university medical center in Germany. Ergometry with estimated VO2max, maximum blood lactate, maximum resistance, time spent on ergometer, and heart rate were performed prior to and after 4 weeks of training.

Results: A significant effect of the four-week training could be shown through reduction of heart rate at 100 W, increase of maximum blood lactate, and maximum resistance when comparing the training groups to the control group (Δ 9,67 BPM; Δ 1.02 mmol/l; Δ 12 W respectively, all p < 0.05) However, adherence of the recruited patient group was very low, shown by a notably high drop-out rate of 78.1% overall (44 patients completed training). The majority of patients dropped out prior to the first training session.

Conclusions: HIIT bicycle training in post-MBS patients is possibly very effective, however, adherence is extremely low. Although this study shows promising results, an effect on large patient groups cannot be expected if improvement of adherence and a wide range of training methods are not addressed first.

Study registration: German Registry for Clinical Trials (DRKS) trial registration number DRKS00024939 on 20/09/2021.