JMIR Publications

ABSTRACT

Background:

Obesity affects over one billion people globally and is a leading contributor to chronic disease. For those with clinically severe obesity, metabolic and bariatric surgery (MBS) is the most effective intervention for long-term weight loss. However, surgery is often delayed due to systemic barriers, during which time patients may experience further health decline. Low cardiorespiratory fitness is a known risk factor for perioperative complications, prompting recommendations for prehabilitation to target readiness for surgery. Despite this, few patients meet physical activity guidelines, and supervised pre-operative exercise programs are rarely offered in routine care. Telehealth-delivered exercise programs offer a promising solution, but evidence of their feasibility, acceptability, and impact in the MBS setting remains limited.

Objective:

This study (BARI-Prehab) aims to assess the effectiveness and acceptability of a telehealth-delivered prehabilitation exercise program in improving cardiometabolic health among patients awaiting MBS.

Methods:

In this multi-centre, open-label, randomized controlled trial, 48 adult participants will be randomized (1:1) to either usual care (control group) or a 4-week telehealth exercise intervention. The primary outcome is aerobic capacity (VO₂ in ml.kg-1.min-1 at the anaerobic threshold), measured via cardiopulmonary exercise testing. Secondary outcomes include resting heart rate, heart rate variability, resting metabolic rate, body composition, grip strength, and 7-day physical activity. Intervention acceptability will also be evaluated.

Results:

Data collection and analysis are ongoing. This trial will evaluate the capacity of a telehealth exercise program to improve cardiometabolic health and determine its suitability for implementation in the MBS pre-operative pathway.

Conclusions:

The BARI-Prehab trial will provide evidence on the acceptability and impact of a remotely-delivered exercise intervention in the context of MBS. These findings will have implications for the design of accessible, scalable pre-operative care models. The significance of this research lies in its potential to guide clinical practice, inform policy, and improve health outcomes for patients undergoing MBS. Clinical Trial: ClinicalTrials.gov: Identifier NCT05235945.