Exercise In Women Undergoing Bariatric Surgery: Impact On The Ovarian Function And Cardiometabolic Risk Factors - The Emovar Study

BackgroudThis study aimed to assess the effects of a 16-week supervised exercise intervention on ovarian function in women undergoing bariatric surgery (BS); and to examine potential mechanisms associated with the changes in ovarian function. Materials and MethodsA randomized, two-arm parallel-group trial was conducted from October 2019 to September 2022. Participants were reproductive-aged women with severe obesity (BMI [≥]40 kg/m2 or BMI [≥]35 with comorbidities) recruited from the BS services from two hospitals. Participants were randomly assigned to BS+usual care (n = 25) or BS+exercise (n = 21), consisting of 16 weeks of three-weekly supervised exercise sessions. Outcomes were assessed before surgery, at week 16, and 1-year. The primary outcome was the change in sex-hormone binging globulin (SHBG). Secondary outcomes were related to ovarian function (obtained from both serum and transvaginal ultrasound), weight loss, body composition, fitness, inflammation, cardiometabolic and nuclear magnetic resonance-derived metabolomic profiles. ResultsA total of 42 participants (91%; 18 in BS+EX; 24 in BS+usual care) were included in the primary analyses. There were no between-group differences at week 16. At 1-year, the exercise group increased serum SHBG levels (+36.3 nmol/L; 95%CI 2.3 to 70.2; p=0.037), oocyte count (+3.1 follicles; 95%CI 0.9 to 5.3; p=0.007), and reduced the uterine artery mean pulsatility index (UtA-PI) (-1.3; 95%CI -2.1 to -0.5; p=0.003) compared to usual care, despite comparable weight loss and changes in secondary/exploratory outcomes. The 1-year changes in metabolomic profile predicted 97% of the increase in SHBG in the exercise group. Interestingly, the decrease in serum amino acid levels was associated with increased SHBG levels at 1-year, only in the exercise group. Sensitivity analyses corroborated the results. ConclusionThe EMOVAR trial suggests that a 16-week supervised exercise program improves relevant markers of ovarian function, such as SHBG, oocyte count, and UtA-PI, at 1-year compared to usual care.