Exercise Enhances the Effect of Bariatric Surgery in Markers of Cardiac Autonomic Function

Bariatric surgery improves cardiovascular health, which might be partly ascribed to beneficial alterations in the autonomic nervous system. However, it is currently unknown whether benefits from surgery on cardiac autonomic regulation in post-bariatric patients can be further improved by adjuvant therapies, namely exercise. We investigated the effects of a 6-month exercise training program on cardiac autonomic responses in women undergoing bariatric surgery. Sixty-two women eligible for bariatric surgery were randomly allocated to either standard of care (control) or an exercise training intervention. At baseline (PRE) and 3 (POST3) and 9 (POST9) months after surgery, we assessed chronotropic response to exercise (CR%; i.e., percentage change in heart rate from rest to peak exercise) and heart rate recovery (HRR30s, HRR60s, and HRR120s; i.e., decay of heart rate at 30, 60, and 120 s post exercise) after a maximal exercise test. Between-group absolute changes revealed higher CR% (Δ = 8.56%, CI95% 0.22–19.90, P = 0.04), HRR30s (Δ = 12.98 beat/min, CI95% 4.29–21.67, P = 0.01), HRR60s (Δ = 22.95 beat/min, CI95% 11.72–34.18, P = 0.01), and HRR120s (Δ = 34.54 beat/min, CI95% 19.91–49.17, P < 0.01) in the exercised vs. non-exercised group. Our findings demonstrate that exercise training enhanced the benefits of bariatric surgery on cardiac autonomic regulation. These results highlight the relevance of exercise training as a treatment for post-bariatric patients, ensuring optimal cardiovascular outcomes.