Internalization of body shape ideals and body dissatisfaction: A systematic review and meta-analysis.

OBJECTIVE: The present meta-analysis summarizes existing evidence on the relationship between the internalization of body shape ideals (IBSI) and body dissatisfaction. METHOD: Pooled effect sizes (r) were computed using a random-effects model. The robustness of the results was examined using influence analyses. Potential predictors of effect heterogeneity were examined using subgroup analysis and univariable/multivariable meta-regressions. Publication bias was examined using the three-parameter selection model (3PSM). RESULTS: A total of 141 effect-sizes from 78 studies (N = 39,491) were retrieved. Results revealed medium (r = .25; muscular/athletic-ideal internalization) to very large (r = .43, general attractiveness-ideal internalization; and r = .45, thin-ideal internalization) relationships, all these being largely similar in male and female individuals. DISCUSSION: IBSI and body dissatisfaction were strongly linked: (a) in younger individuals (general attractiveness-ideal internalization); (b) when IBSI was operationalized in terms of endorsement rather than mere awareness of appearance ideals; (c) in studies of lower methodological quality (muscular/athletic-ideal internalization); and (d) when IBSI was assessed using instruments involving social comparisons. Given the largely cross-sectional nature of data included in this meta-analysis, further testing in prospective and experimental studies is needed to confirm hypotheses about causality of observed associations. Such findings would have impact for prevention and intervention studies.

OBJETIVO: El presente metanálisis resume la evidencia existente sobre la relación entre la internalización de los ideales de la figura corporal (IBSI) y la insatisfacción corporal. MÉTODO: Los tamaños de los efectos agrupados (r) se calcularon utilizando un modelo de efectos aleatorios. La robustez de los resultados se examinó mediante análisis de influencia. Los predictores potenciales de heterogeneidad del efecto se examinaron mediante análisis de subgrupos y metarregresión univariable/multivariable. El sesgo de publicación se examinó mediante la inspección visual de la simetría de la gráfica de embudo y la prueba de Egger. RESULTADOS: Se recuperó un total de 141 tamaños de efectos de 78 estudios (N = 39 491). Los resultados revelaron relaciones medias (r = .25; internalización muscular/atlética-ideal) a relaciones muy grandes (r = .43, internalización ideal de atractivo general; y r = .45, internalización delgada-ideal), siendo todas ellas en gran parte similares en individuos masculinos y femeninos. DISCUSIÓN: La Internalización de los Ideales de la Figura Ideal (IBSI) y la insatisfacción corporal fueron ligados fuertemente: (i) en individuos más jovenes (internalización atractivo-ideal general); (ii) cuando IBSI se puso en marcha en términos de aprobación en lugar de la mera conciencia de los ideales de apariencia; (iii) en estudios de menor calidad metodológica (internalización muscular/atlética-ideal); y (iv) cuando IBSI fue evaluado utilizando instrumentos que implican comparaciones sociales. Dada la gran naturaleza transversal de los datos incluidos en este metanálisis, se necesitan pruebas adicionales en estudios prospectivos y experimentales para confirmar hipótesis sobre la causalidad de las asociaciones observadas. Tales hallazgos tendrían impacto para los estudios de prevención e intervención.

Body and appearance-related self-conscious emotions and exercise addiction in Brazilian adolescents: A person-centred study.

The present study aimed to identify profiles of adolescents based upon body and appearance-related self-conscious emotions, and to examine whether these profiles differed from each other in terms of their exercise addiction (EA) symptoms. A sample of 703 Brazilian adolescents (41% girls) completed a self-report questionnaire. The results from a two-step cluster analysis identified four profiles: prideful (19.5%), low self-consciousness (31.7%), moderately high self-consciousness (29.2%), and shameful-guilty (19.6%). The prideful profile was characterized by a greater presence of boys, as well as by higher frequency/intensity levels of exercise than the remaining groups. The shameful-guilty profile was characterized by a greater presence of girls and by higher levels of BMI compared to the remaining groups. Regarding EA symptoms, the results from the ANCOVA/MANCOVA analyses revealed that the prideful profile showed (i) higher salience and tolerance levels than the low-level balanced self-consciousness profile, and (ii) higher salience and lower conflict compared to the shameful-guilty profile. Additionally, the moderately high self-consciousness profile showed (i) higher salience and tolerance levels than the low self-consciousness profile, and (ii) higher salience levels than the shameful-guilty profile. Identifying subgroups on the basis of body appearance-related self-conscious emotions contributes to explaining different EA symptoms in adolescents.

Fitness-Related Self-Conscious Emotions and Risk for Exercise Addiction: Examining the Mediating Role of Passion.

Fitness-related self-conscious emotions (SCEs) have been proposed as antecedents of exercise addiction (EA). However, the potential mechanisms underlying such a relationship remain unexplored. The present study examined the relationship between fitness-related SCEs and risk of EA, as well as the mediating role of passion for exercise. A total of 296 male runners (M = 40.35 years, SD = 10.69) completed a survey assessing weekly exercise frequency/hours, fitness-related SCEs, passion for exercise, and the risk of EA. The relationships between the study variables were examined using structural equation modeling. After controlling for age and weekly exercise frequency/hours, fitness-related SCEs of shame, guilt, and hubristic pride were positively associated with risk of EA. However, while guilt had direct effects on risk of EA, shame and hubristic pride showed indirect effects via obsessive passion. The results of the study are discussed, and some practical implications and future research directions are presented.

Examining the role of social physique anxiety on the relationship between physical appearance comparisons and disordered eating symptoms among Spanish emerging adults.

The present study extends previous research by examining the moderating/mediating role of social physique anxiety (SPA) on the relationship between physical appearance comparisons (PAC) and symptoms of disordered eating (DE) in adolescent population. A total of 555 emerging adults (59% women) ranging from 18 to 30 years of age (M = 21.34, SD = 2.80) were recruited from two public universities from Spain using a non-probabilistic sampling technique. Participants completed a self-reported questionnaire comprising the variables of research interest. Once the effects of sex (i.e., being men or women), age, body mass index, and depressive symptoms were controlled for, the results from bootstrapping cross-sectional regression analyses supported both the moderating and mediating effect of SPA on the relationship between PAC and DE. Sex did not moderate any of these relationships. From these findings, it follows that incorporating strategies aimed at decreasing PAC and SPA may contribute to improved prevention efforts aimed at decreasing DE among Spanish emerging adults of both sexes.

Effects of Resistance Training on Arterial Stiffness in Healthy People: A Systematic Review.

The influence of aerobic training on cardiovascular disorders has already been demonstrated. However, the effect of resistance training is less well known. Arterial stiffness is an increasingly important measure in cardiovascular health. Therefore, this review attempted to study the results of resistance training-based interventions on arterial stiffness in healthy people, for both acute and chronic interventions. A literature search was conducted for randomized controlled trials on the acute and chronic effects of strength training. Studies published in PubMed and SportDiscus databases between 1999 and April 2019 were analyzed. In chronic strength training effects, the majority of groups showed large (d = -1.49 to -1.20) and moderate (d = -1.07) decreases, and small and trivial changes in arterial stiffness. In acute effects interventions, a very large decrease (d = -3.92) was observed, while large (d = 1.24-1.48) and very large (d = 3.88) increases were also found. A resistance training-based intervention of more than four weeks' duration with a frequency of two days per week seems not to compromise cardiovascular health, due to decreases in arterial stiffness. However, there is a general trend towards both increasing and maintaining arterial stiffness after isolated strength training sessions.

Exploring the differentiated relationship between appearance and fitness-related social anxiety and the risk of eating disorders and depression in young adults.

Appearance-related social anxiety has been identified as a relevant risk factor in the development of eating disorders (ED) and depression in young adults. However, less is known about the role that fitness-related social anxiety may play on the emergence of these two psychopathological conditions. The present study aimed to examine whether appearance/fitness social anxiety may independently contribute to explaining the increased risk of ED and depressive symptoms in young adults. A total of 545 undergraduate students (46% women, Mage  = 21.36, SDage  = 2.93) recruited in two Spanish public universities completed a self-reported questionnaire. After controlling for self-reported BMI and appearance-related social anxiety, the results from the regression analyses revealed that fitness-related social anxiety positively and significantly (p < 0.05) contributed to explaining both the risk of ED (in women and men) and depressive symptoms (in women). The inclusion of the interaction term within the appearance/fitness-related term positively contributed to explaining additional variance for both the risk of ED and depressive symptoms in men, but not in women. The regression models explained 48% (women) and 35% (men) of the ED risk and 25% (women) and 19% (men) of depressive symptoms. These findings suggest that not only appearance, but also fitness-related social anxiety experiences may contribute to explaining the emergence of ED and depression in young adults.

Influence of Body Composition on Arterial Stiffness in Middle-Aged Adults: Healthy UAL Cross-Sectional Study.

Background and objectives: Several anthropometric and body composition parameters have been linked to arterial stiffness (AS) as a biomarker of cardiovascular disease. However, little is known about which of these closely related factors is more strongly associated with AS. The aim of the present study was to analyze the relationship of different anthropometric and body composition parameters with AS in middle-aged adults. Materials and Methods: This cross-sectional study included 186 middle-aged participants (85 women, 101 men; age = 42.8 ± 12.6 years) evaluated as part of the Healthy UAL study, a population study conducted at the University of Almería with the main purpose of analyzing the etiology and risk factors associated with cardio-metabolic diseases. Anthropometric measures included neck, waist, and hip circumferences, as well as the waist-to-height ratio (WHtr). Bioimpedance-derived parameters included fat-free mass index (FFMI), fat mass index (FMI), and percent of body fat (%BF). AS was measured by pulse wave velocity (PWV). The relationships of interest were examined through stepwise regression analyses in which age and sex were also introduced as potential confounders. Results: Neck circumference (in the anthropometric model; R2: 0.889; ß: age = 0.855, neck = 0.204) and FFMI (in the bio-impedance model; R2: 0.891; ß: age = 0.906, FFMI = 0.199) emerged as significant cross-sectional predictors of AS. When all parameters were included together (both anthropometry and bio-impedance), both neck circumference and FFMI appeared again as being significantly associated with AS (R2: 0.894; ß: age = 0.882, FFMI = 0.126, neck = 0.093). Conclusion: It was concluded that FFMI and neck circumference are correlated with AS regardless of potential confounders and other anthropometric and bioimpedance-derived parameters in middle-aged adults.

Effects of resistance training on performance in previously trained endurance runners: A systematic review.

The aim of this work was to identify, synthesize and evaluate the results of randomized controlled trials examining the effects of resistance training on performance indicators in previously trained endurance runners. A database search was carried out in PubMed, Science Direct, OvidSPMedLine, Wiley, Web of Science, ProQuest and Google Scholar. In accordance with the PRISMA checklist, 18 published articles dated prior to May 2016 involving 321 endurance runners were reviewed using the PEDro scale. Resistance training led to general improvements in muscular strength, running economy, muscle power factors, and direct performance in distances between 1,500 and 10,000 m. Such improvements were not accompanied by a significant increase in body mass or signs of overtraining. However, improvements did not occur in all cases, suggesting that they might depend on the specific characteristics of the resistance training applied. Although current evidence supports the effectiveness of resistance training to improve performance in already trained endurance runners, the methodological inconsistencies identified suggest that the results should be interpreted with caution. Future studies ought to investigate the benefits of resistance training in endurance runners while considering the existence of possible differentiated effects based on the specific characteristics of the resistance training carried out.

Problematic smartphone use and academic achievement: A systematic review and meta-analysis.

Background and aims: The present study aimed to synthesize existing quantitative evidence on the relationship between problematic smartphone use (PSU) and academic achievement with a focus on quantifying its magnitude and examining its potential moderators. Methods: Eligible studies were searched for up to February 10, 2023 in six different databases (i.e., MEDLINE, Current Contents Connect, PsycINFO, Web of Science, SciELO, and Dissertations & Theses Global). Studies were considered eligible if they provided information derived from self-report instruments that allowed statistical calculation of the relationship between PSU and academic achievement. Pooled effect sizes (r) were computed using a random-effects model. Meta-regressions were conducted to test the influence of study-level moderators on the relationship of interest. Influence analyses and a three-parameter selection model (3PSM) were conducted to examine the robustness of the results and publication bias, respectively. Results: A total of 33 effect sizes from 29 studies (n = 48,490) were retrieved. Results showed a small effect size (r = -0.110), which tended to be larger in samples consisting of students from elementary and middle schools. Discussion and Conclusions: Findings from the present study contribute to the understanding of a potential determinant of decreased academic achievement by providing evidence that PSU may be one of them.

Psychometric Examination of the Body, Eating, and Exercise Comparison Orientation Measure (BEECOM) among Spanish Adolescents and Young Adults.

The Body, Eating, and Exercise Comparison Orientation Measure (BEECOM) has been frequently used within the context of research on eating disorders (ED). Although both long (BEECOM-L) and short (BEECOM-S) versions of the instrument exist, their psychometric properties have not yet been concurrently investigated across different populations in terms of age and gender. The present study aimed to compare the psychometric properties of both the BEECOM-L and the BEECOM-S among Spanish male and female non-clinical adolescents and young adults. Data from 4 samples including 1213 middle school and college students enrolled in 10 education centers from southern Spain (age ranging from 12 to 35 years, Mage = 17.796, SDage = 4.796, 53% females) were analyzed using factorial, correlation, and regression analysis techniques. Results provided evidence that support the reliability, measurement invariance according to age and gender, and convergent/incremental validity for the scores from both the BEECOM-L and BEECOM-S. Concerning factorial validity, marginally acceptable and adequate goodness-of-fit indices were obtained for the BEECOM-L and BEECOM-S, respectively. The BEECOM-S proves to be a psychometrically sound instrument with potential value for assessing social comparisons focused on body, eating, and exercise in non-clinical adolescents and young adults from Spain.

Social physical anxiety and eating disorders: A systematic review and meta-analysis.

The present study's aim was to summarize existing quantitative evidence linking social physique anxiety (SPA) and eating disorders (ED). Eligible studies were searched for up to June 2, 2022 in six databases: MEDLINE, Current Contents Connect, PsycINFO, Web of Science, SciELO, and Dissertations & Theses Global. Studies were considered eligible if they included information derived from self-report instruments that allowed for computing the relationship between SPA and ED. Pooled effect sizes (r) were computed using three-level meta-analytic models. Potential sources of heterogeneity were examined using univariable and multivariable meta-regressions. Influence analyses and a three-parameter selection model (3PSM) were used for the purpose of examining the robustness of the results and publication bias, respectively. Results summarizing 170 effect sizes from 69 studies (N = 41,257) showed two main groups of findings. Firstly, that SPA and ED were very largely related (i.e., r = .51). Secondly, that this relationship was stronger (i) among individuals from Western countries, and (ii) when ED scores concerned the diagnostic feature of bulimia/anorexia nervosa involving body image disturbances. The present study adds to the current understanding of ED by suggesting that SPA is a maladaptive emotion with a potential role in the onset and maintenance of these group of pathologies.

Effects of Pubertal Timing and Pubertal Tempo on Social Physique Anxiety, Self-determined Motivation, and Exercise in Early Adolescent Girls.

PURPOSE: Research has shown that there is a decrease in physical activity levels during early adolescence, especially for girls. Previous studies have shown that the social physique anxiety (SPA) may be a controlling factor influencing exercise motivation and engagement in this behavior; however, the potential role that puberty plays in this decrease has not been considered until now. The objective of the present study was to examine the impact of pubertal timing and pubertal tempo on SPA and exercise motivation and behavior. METHODS: Data from 328 early adolescent girls, aged between 9 and 12 at the time of joining the study, were collected in 3 waves over a 2-year period. Using structural equation modeling techniques, different 3-time-point growth models were estimated to examine if earlier maturing and compressed maturing in girls had differential effects on SPA and exercise motivation and behavior. RESULTS: The results from growth analyses suggest that early maturing (according to all the pubertal indicators considered, except menstruation) tends to translate into (1) an increase in SPA levels and (2) a decrease in exercise - in the latter case, by reducing self-determined motivation. However, no differential effects from any of the pubertal indicators were found for compressed maturing in girls. DISCUSSION: These results highlight the need for increased efforts toward developing programs aimed at helping early maturing girls to cope with the challenges of puberty with a particular focus on SPA experiences and exercise motivation and behavior.

A survey of eating styles in eight countries: Examining restrained, emotional, intuitive eating and their correlates.

INTRODUCTION: Restrained, emotional and intuitive eating were examined in relation to each other and as correlates of participants' weight status, body image and self-esteem. In some past research, restrained and emotional eating have been associated with higher weight status and poorer mental health, while intuitive eating is more frequently linked to lower weight status and more positive well-being. However, these eating styles have rarely been examined together and never in a large cross-country sample. METHOD: Six-thousand two-hundred and seventy-two (6272) emerging adults (M age = 21.54 years, SD = 3.13) completed scales from the Three-Factor Eating Questionnaire, the Eating Disorders Examination Questionnaire, the Intuitive Eating Scale-2, the Multidimensional Body Self Relations Questionnaire, the Rosenberg Self-Esteem Scale, and provided weight and height information that was used to calculate body mass index (BMI). Participants resided in Australia, Belgium, Canada, China, Italy, Japan, Spain and the United States and provided information using an online survey. RESULTS: Path analyses for the entire sample revealed significant pathways between higher intuitive eating and higher body satisfaction and self-esteem, and lower BMIs among participants. Higher levels of restrained and emotional eating were associated with lower body satisfaction and self-esteem, and higher BMIs among participants. Minor cross-country differences were evident in these patterns of relations, but intuitive eating emerged as a consistent predictor across countries. CONCLUSION: Overall, findings suggest that efforts should be made to increase intuitive eating among emerging adults and to support individual and macrolevel interventions to decrease restrained and emotional eating behaviours.

Examining the reliability of the scores of self-report instruments assessing problematic exercise: A systematic review and meta-analysis.

Background and aims: Problematic exercise (PE) has mainly been assessed with self-report instruments. However, summarized evidence on the reliability of the scores derived from such instruments has yet to be provided. The present study reports a reliability generalization meta-analysis of six well-known self-report measures of PE (Commitment to Exercise Scale, Compulsive Exercise Test, Exercise Addiction Inventory, Exercise Dependence Questionnaire, Exercise Dependence Scale, and Obligatory Exercise Questionnaire). Methods: Pooled effect sizes were computed using a random-effect model employing a restricted maximum likelihood estimation method. Univariable and multivariable meta-regressions analyses were employed for testing moderator variables. Results: Data retrieved from 255 studies (741 independent samples, N = 254,174) identified three main groups of findings: (i) pooled alpha values that, ranging from 0.768 to 0.930 for global scores and from 0.615 to 0.907 for subscale scores, were found to be sensitive to sociodemographic and methodological characteristics; (ii) reliability induction rates of 47.58%; and (iii) the virtually non-existent testing of the assumptions required for the proper applicability of alpha. Data unavailability prevented the provision of summarized reliability estimates in terms of temporal stability. Discussion: These findings highlight the need to improve reliability reporting of the scores of self-reported instruments of PE in primary studies. This implies providing both prior justification for the appropriateness of the index employed and reliability data for all the subpopulation of interest. The values presented could be used as a reference both for comparisons with those obtained in future primary studies and for correcting measurement-related artefacts in quantitative meta-analytic research concerning PE.

A Review of the Components of Problematic Exercise in Psychometric Assessment Instruments.

Backgrounds: The range of theoretical conceptualizations of problematic exercise in psychometric assessment instruments makes it difficult to identify the components that define this phenomenon. A better understanding of the underlying components of problematic exercise may contribute to progress toward providing scientific evidence that allows for deciding whether problematic exercise should be considered a substantive mental health disorder. The objective of the present review was to examine and compare, through a content analysis of their items, the components of problematic exercise in psychometric assessment instruments identified in a recent systematic review. Methods: A total of 33 components of problematic exercise were identified in the 17 assessment instruments included in the present review. Results: The results show that, despite the lack of consensus in the operational definition of their factors and the variety of ways of wording their items, the instruments reflect some common components that might indicate core criteria (i.e., salience, withdrawal, and mood modification) or candidate components (i.e., conflict, and continuance despite problems) of problematic exercise. However, other components of different nature were shown to be specific to some of the problematic exercise conceptualizations on which the assessment instruments are based. Conclusion: In the interest of reaching a consensus that allows to advance in this research field, further studies are needed to resolve which components are inherently problematic.

Testing of a model for risk factors for eating disorders and higher weight among emerging adults: Baseline evaluation.

Although a range of risk factors have been identified for disordered eating and weight status, the breadth of risk factors have been rarely considered within a single, comprehensive model. The robustness of these findings across countries also remains an open question. The present study sampled 6272 participants aged 18-30 years from eight countries in an attempt to evaluate combined and unique predictors for these two conditions, and to explore possible cross-country differences in these models. Participants completed a range of demographic, biological, behavioral, psychological, and sociocultural measures to test a comprehensive model of the contributions of these predictors for disordered eating and weight-related constructs (binge eating, body mass index, compensatory behaviors, dietary restraint, drive for muscularity, and drive for leanness). Structural invariance testing within a multigroup path analysis framework revealed that a single model across the eight countries provided poor model fit. Freeing of 22% of parameters across countries provided excellent fit and a satisfactory compromise for country-invariant and country-variant parameters in the model. Overall, predictors accounted for between 15% and 60% of variance in the outcome measures, with lowest explained variance for the disordered eating outcomes. Significant unique contributions to prediction were observed for each of the five risk factor variable types and across the eight countries. Thus, the findings show strong support for this model as an explanatory framework of both disordered eating and weight status.

Theoretical conceptualisations of problematic exercise in psychometric assessment instruments: A systematic review.

BACKGROUND AND AIMS: The aim of the present systematic review was to identify psychometric tools developed to assess problematic exercise in order to identify and compare their theoretical conceptualisations on which they are based. METHODS: A systematic literature search was conducted in the electronic databases Web of Science, Scielo, PsychINFO, PsycTEST and SCOPUS from their inception to January 2020. RESULTS: Seventeen assessment instruments met the eligibility criteria to be included in the present review. The instruments were classified according to their conceptualisation into five groups: (i) problematic exercise as an end of an exercise continuum, (ii) problematic exercise as a means of regulating body size and weight, (iii) problematic exercise as dependence, (iv) problematic exercise as a behavioural addiction and (v) no clear conceptualisation. DISCUSSION: The results suggest that the conceptualisations of the assessment instruments have resulted in a strong dichotomy in relation to the primary or secondary character of the problematic exercise that might be limiting the capacity of the instruments to adequately capture the multidimensionality of this construct. CONCLUSIONS: Given the interest in understanding the complexity surrounding the problematic exercise, future research should develop more comprehensive definitions of this construct. This would allow a greater conceptual consensus to be reached that would allow progress to be made in the study of the problematic exercise.

A Systematic Review and Meta-Analysis on the Relationship between Body Dissatisfaction and Morbid Exercise Behaviour.

BACKGROUND: The present study aimed to quantify the relationship between body dissatisfaction and morbid exercise behaviour (MEB). METHODS: The electronic databases MEDLINE, PsycINFO, Web of Science, SciELO, and Dissertations & Theses Global were searched from inception to September 2020. Pooled effect sizes corrected for sampling errors (r+) were computed using a bare-bones meta-analysis. The robustness of the results was examined by influence analyses. The presence of moderators was examined by inspection of the variance in r+ attributable to sampling errors and 80% credibility intervals, followed by subgroup analysis and univariable/multivariable meta-regressions. Publication bias was examined by visual inspection of funnel plot symmetry, cumulative meta-analysis, and Egger's test. RESULTS: A total of 41 effect sizes from 33 studies (n = 8747) were retrieved. Results showed a significant and near to moderate effect size (r+ = 0.267, 95% CI = 0.226 to 0.307), and this did not differ by gender, BMI, age, percentage of Whites, study quality, or MEB measure. Conversely, effect sizes were found to be stronger in published and more recently conducted studies. CONCLUSION: The findings indicate that body dissatisfaction is one of the likely causes underlying MEB. This suggests the need for further longitudinal research aimed at confirming the potential causal nature of this relationship.

Psychometric properties of the body and appearance self-conscious emotions scale in Brazilian adolescents.

This study examined the psychometric properties of the Body and Appearance Self-Conscious Emotions Scale in Brazilian adolescents. A sample of 827 adolescents (55% boys) filled out a questionnaire comprising the Body and Appearance Self-Conscious Emotions Scale and instruments assessing social physique anxiety, positive/negative affect, and self-esteem. After removing one item originally proposed for the guilt factor (Item 7), the results supported a 4-factor structure that was invariant across gender and weight status. Evidence supporting the internal consistency, temporal stability, and convergent validity of the Body and Appearance Self-Conscious Emotions Scale cores were also obtained. These results support the Body and Appearance Self-Conscious Emotions Scale as a psychometrically robust instrument to assess body and appearance self-conscious emotions in Brazilian adolescents.

Supervised Exercise Immediately After Bariatric Surgery: the Study Protocol of the EFIBAR Randomized Controlled Trial.

BACKGROUND: Previous studies have investigated weight loss caused by exercise following bariatric surgery. However, in most cases, the training program is poorly reported; the exercise type, volume, and intensity are briefly mentioned; and the sample size, selection criteria, and follow-up time vary greatly across studies. PURPOSE: The EFIBAR study aims to investigate over 1 year the effects of a 16-week supervised exercise program, initiated immediately after bariatric surgery, on weight loss (primary outcome), body composition, cardiometabolic risk, physical fitness, and quality of life in patients with severe/extreme obesity. MATERIAL AND METHODS: The EFIBAR study is a parallel-group, superiority, randomized controlled trial (RCT), comprising 80 surgery patients. Half of the participants, randomly selected, perform a 16-week supervised exercise program, including both strength and aerobic training, starting immediately after the surgery (7-14 days). For each participant, all primary and secondary outcomes are measured at three different time points: (i) before the surgery, (ii) after the intervention (≈4 months), and (iii) 1 year after the surgery. CONCLUSION: The EFIBAR study will provide new insights into the multidimensional benefits of exercise in adults with severe/extreme obesity following bariatric surgery. TRIAL REGISTRATION: EFIBAR randomized controlled trial was prospectively registered at Clinicaltrials.gov (NCT03497546) on April 13, 2018.