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This randomized, controlled trial investigated the effects of exercise training on bariatric surgery\u2010induced loss of muscle mass and function. Additionally, we investigated the effects of the intervention on molecular and histological mediators of muscle remodelling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eighty women with obesity were randomly assigned to a Roux\u2010en\u2010Y gastric bypass (RYGB: <jats:italic>n<\/jats:italic>\u00a0=\u00a040, age\u00a0=\u00a042\u00a0\u00b1\u00a08\u00a0years) or RYGB plus exercise training group (RYGB\u00a0+\u00a0ET: <jats:italic>n<\/jats:italic>\u00a0=\u00a040, age\u00a0=\u00a038\u00a0\u00b1\u00a07\u00a0years). Clinical and laboratory parameters were assessed at baseline, and 3 (POST3) and 9\u00a0months (POST9) after surgery. The 6\u00a0month, three\u2010times\u2010a\u2010week, exercise intervention (resistance plus aerobic exercise) was initiated 3\u00a0months post\u2010surgery (for RYGB\u00a0+\u00a0ET). A healthy, lean, age\u2010matched control group was recruited to provide reference values for selected variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Surgery resulted in a similar (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.66) reduction in lower\u2010limb muscle strength in RYGB and RYGB+ET (\u221226% vs. \u221231%), which was rescued to baseline values in RYGB\u00a0+\u00a0ET (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.21 vs. baseline) but not in RYGB (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01 vs. baseline). Patients in RYGB+ET had greater absolute (214 vs. 120\u00a0kg, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01) and relative (2.4 vs. 1.4\u00a0kg\/body mass, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01) muscle strength compared with RYGB alone at POST9. Exercise resulted in better performance in timed\u2010up\u2010and\u2010go (6.3 vs. 7.1\u00a0s, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.05) and timed\u2010stand\u2010test (18 vs. 14 repetitions, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01) compared with RYGB. Fat\u2010free mass was lower (POST9\u2010PRE) after RYBG than RYGB\u00a0+\u00a0ET (total: \u22127.9 vs. \u22124.9\u00a0kg, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01; lower\u2010limb: \u22123.8 vs. \u22122.7\u00a0kg, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.02). Surgery reduced Types I (~\u00a0\u2212\u00a021%; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.99 between\u2010group comparison) and II fibre cross\u2010sectional areas (~\u00a0\u2212\u00a027%; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.88 between\u2010group comparison), which were rescued to baseline values in RYGB+ET (<jats:italic>P<\/jats:italic>\u00a0&gt;\u00a00.05 vs. baseline) but not RYGB (<jats:italic>P<\/jats:italic>\u00a0&gt;\u00a00.01 vs. baseline). RYGB\u00a0+\u00a0ET showed greater Type I (5187 vs. 3898\u00a0\u03bcm<jats:sup>2<\/jats:sup>, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01) and Type II (5165 vs. 3565\u00a0\u03bcm<jats:sup>2<\/jats:sup>, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01) fCSA than RYGB at POST9. RYGB\u00a0+\u00a0ET also resulted in increased capillarization (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01) and satellite cell content (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01) than RYGB at POST9. Gene\u2010set normalized enrichment scores for the muscle transcriptome revealed that the <jats:italic>ubiquitin\u2010mediated proteolysis<\/jats:italic> pathway was suppressed in RYGB\u00a0+\u00a0ET at POST9 vs. PRE (NES: \u22121.7; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01), but not in RYGB. <jats:italic>Atrogin\u20101<\/jats:italic> gene expression was lower in RYGB\u00a0+\u00a0ET vs. RYGB at POST9 (0.18 vs. 0.71\u2010fold change, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01). From both genotypic and phenotypic perspectives, the muscle of exercised patients resembled that of healthy lean individuals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study provides compelling evidence\u2014from gene to function\u2014that strongly supports the incorporation of exercise into the recovery algorithm for bariatric patients so as to counteract the post\u2010surgical loss of muscle mass and function.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jcsm.12815","type":"journal-article","created":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T11:29:28Z","timestamp":1634815768000},"page":"1440-1455","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["A randomized clinical trial on the effects of exercise on muscle remodelling following bariatric surgery"],"prefix":"10.1002","volume":"12","author":[{"given":"Saulo","family":"Gil","sequence":"first","affiliation":[{"name":"Applied Physiology &amp; 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