{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:01:36Z","timestamp":1787504496571,"version":"build-2736575974"},"reference-count":69,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,8,15]],"date-time":"2022-08-15T00:00:00Z","timestamp":1660521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Obesity is associated with an increased risk of several chronic comorbidities, which may also be determined by dysfunctional autonomic nervous system (ANS). The influence of bariatric surgery (BS) on ANS balance was explored in previous studies, but with high heterogeneity in both the assessment timing and methods employed. In the present observational study, we applied a clinical protocol which considers two subsequent phases. Twenty-nine non-diabetic obese subjects were studied at baseline (T0), after one month of lifestyle modification (prehabilitation) (phase 1-T1), and after eight months following BS (phase 2-T2). ANS regulation was assessed across the three study epochs by means of ANSI, a single composite percent-ranked proxy of autonomic balance, being free of gender and age bias, economical and simple to apply in a clinical setting. The aim of the present study was to investigate the effects of the clinical protocol based on prehabilitation and subsequent BS on the ANS regulation by means of ANSI. Potential intertwined correlations with metabolic parameters were also investigated. Notably, we observed a progressive improvement in ANS control, even by employing ANSI. Moreover, the reduction in the markers of sympathetic overactivity was found to significantly correlate with the amelioration in some metabolic parameters (fasting glucose, insulin levels, and waist circumference), as well as in stress and tiredness perception. In conclusion, this study provides convincing evidence that a unitary proxy of cardiac autonomic regulation (CAR) may reflect the progressive improvement in autonomic regulation following behavioral and surgical interventions in obese patients. Intriguingly, this might contribute to reducing cardiovascular and metabolic risk.<\/jats:p>","DOI":"10.3390\/jpm12081317","type":"journal-article","created":{"date-parts":[[2022,8,15]],"date-time":"2022-08-15T20:58:08Z","timestamp":1660597088000},"page":"1317","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Progressive Additive Benefits of Prehabilitation and Subsequent Bariatric Surgery on Cardiac Autonomic Regulation as Assessed by Means of a Simple Unitary Composite Index: Preliminary Data from an Observational Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8767-7588","authenticated-orcid":false,"given":"Luca","family":"Giovanelli","sequence":"first","affiliation":[{"name":"BIOMETRA Department, University of Milan, 20129 Milan, Italy"},{"name":"Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy"},{"name":"Department of Endocrine and Metabolic Medicine, Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0628-2729","authenticated-orcid":false,"given":"Carlo","family":"Palombo","sequence":"additional","affiliation":[{"name":"Department of Surgical, Medical, Molecular Pathology and Critical Area Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3951-2225","authenticated-orcid":false,"given":"Matteo","family":"Pina","sequence":"additional","affiliation":[{"name":"BIOMETRA Department, University of Milan, 20129 Milan, Italy"},{"name":"Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Facchetti","sequence":"additional","affiliation":[{"name":"BIOMETRA Department, University of Milan, 20129 Milan, Italy"},{"name":"Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mara","family":"Malacarne","sequence":"additional","affiliation":[{"name":"BIOMETRA Department, University of Milan, 20129 Milan, Italy"},{"name":"Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Pagani","sequence":"additional","affiliation":[{"name":"Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Nannipieri","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, 56216 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossana","family":"Berta","sequence":"additional","affiliation":[{"name":"Obesity Surgery Division, Pisa University Hospital, 56216 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4845-8988","authenticated-orcid":false,"given":"Daniela","family":"Lucini","sequence":"additional","affiliation":[{"name":"BIOMETRA Department, University of Milan, 20129 Milan, Italy"},{"name":"Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,15]]},"reference":[{"key":"ref_1","first-page":"e596","article-title":"2019 ACC\/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"140","author":"Arnett","year":"2019","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1056\/NEJMoa1614362","article-title":"Health Effects of Overweight and Obesity in 195 Countries over 25 Years: The GBD 2015 Obesity Collaborators","volume":"377","author":"Afshin","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"665","DOI":"10.3389\/fphys.2017.00665","article-title":"The Role of the Autonomic Nervous System in the Pathophysiology of Obesity","volume":"8","author":"Guarino","year":"2017","journal-title":"Front. Physiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5551","DOI":"10.1113\/jphysiol.2009.179432","article-title":"Exercise Protects the Cardiovascular System: Effects beyond Traditional Risk Factors","volume":"587","author":"Joyner","year":"2009","journal-title":"J. Physiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"H244","DOI":"10.1152\/ajpheart.00096.2015","article-title":"Should the Sympathetic Nervous System Be a Target to Improve Cardiometabolic Risk in Obesity?","volume":"309","author":"Lambert","year":"2015","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"865965","DOI":"10.1155\/2013\/865965","article-title":"Obesity-Related Metabolic Syndrome: Mechanisms of Sympathetic Overactivity","volume":"2013","author":"Canale","year":"2013","journal-title":"Int. J. Endocrinol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2037","DOI":"10.1161\/01.CIR.97.20.2037","article-title":"Body Weight Reduction, Sympathetic Nerve Traffic, and Arterial Baroreflex in Obese Normotensive Humans","volume":"97","author":"Grassi","year":"1998","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1136\/heartjnl-2012-302616","article-title":"Altered Cardiovascular Autonomic Regulation in Overweight Children Engaged in Regular Physical Activity","volume":"99","author":"Lucini","year":"2013","journal-title":"Heart"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"57","DOI":"10.2147\/DMSO.S123935","article-title":"Association between Obesity and Heart Rate Variability Indices: An Intuition toward Cardiac Autonomic Alteration-a Risk of CVD","volume":"10","author":"Yadav","year":"2017","journal-title":"Diabetes Metab. Syndr. Obes. Targets Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1007\/s13300-019-00693-0","article-title":"Cardiac Autonomic Neuropathy in Obesity, the Metabolic Syndrome and Prediabetes: A Narrative Review","volume":"10","author":"Williams","year":"2019","journal-title":"Diabetes Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1017\/S1047951118002007","article-title":"Autonomic Responses Induced by Aerobic Submaximal Exercise in Obese and Overweight Adolescents","volume":"29","author":"Santana","year":"2019","journal-title":"Cardiol. Young"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1007\/s11695-020-05053-7","article-title":"Exercise Enhances the Effect of Bariatric Surgery in Markers of Cardiac Autonomic Function","volume":"31","author":"Gil","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.numecd.2008.07.001","article-title":"Heart Rate Behavior during an Exercise Stress Test in Obese Patients","volume":"19","author":"Gondoni","year":"2009","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2246","DOI":"10.1172\/JCI115260","article-title":"Hyperinsulinemia Produces Both Sympathetic Neural Activation and Vasodilation in Normal Humans","volume":"87","author":"Anderson","year":"1991","journal-title":"J. Clin. Investig."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1161\/CIRCRESAHA.116.303604","article-title":"The Sympathetic Nervous System Alterations in Human Hypertension","volume":"116","author":"Grassi","year":"2015","journal-title":"Circ. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1161\/01.HYP.38.3.379","article-title":"Overweight and Sympathetic Overactivity in Black Americans","volume":"38","author":"Abate","year":"2001","journal-title":"Hypertension"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s00592-012-0416-z","article-title":"Exercise Might Improve Cardiovascular Autonomic Regulation in Adolescents with Type 1 Diabetes","volume":"50","author":"Lucini","year":"2013","journal-title":"Acta Diabetol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1067\/mhj.2002.123117","article-title":"Effects of Cardiac Rehabilitation and Exercise Training on Autonomic Regulation in Patients with Coronary Artery Disease","volume":"143","author":"Lucini","year":"2002","journal-title":"Am. Heart J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.clnu.2018.01.006","article-title":"Effects of Weight Changes in the Autonomic Nervous System: A Systematic Review and Meta-Analysis","volume":"38","author":"Costa","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.2337\/dc15-0466","article-title":"Effect of Low-Energy Diets Differing in Fiber, Red Meat, and Coffee Intake on Cardiac Autonomic Function in Obese Individuals with Type 2 Diabetes","volume":"38","author":"Ziegler","year":"2015","journal-title":"Diabetes Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1038\/oby.2001.84","article-title":"Cardiac Parasympathetic Activity Is Increased by Weight Loss in Healthy Obese Women","volume":"9","author":"Rissanen","year":"2001","journal-title":"Obes. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1007\/s00592-020-01645-y","article-title":"A Four-Week Prehabilitation Program in Candidates for Bariatric Surgery Improves Hemodynamic Load, Metabolism and Cardiac Autonomic Regulation","volume":"58","author":"Lucini","year":"2021","journal-title":"Acta Diabetol."},{"key":"ref_23","unstructured":"(2020, August 11). American Society for Metabolic and Bariatric Surgery Estimate of Bariatric Surgery Numbers, 2011\u20132018. Available online: https\/\/asmbs.org\/."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1007\/978-3-319-56246-9_20","article-title":"Evaluating the Homeostasis Assessment Model Insulin Resistance and the Cardiac Autonomic System in Bariatric Surgery Patients: A Meta-Analysis","volume":"988","author":"Geronikolou","year":"2017","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1007\/s11892-014-0540-y","article-title":"Lifestyle Management for Enhancing Outcomes after Bariatric Surgery","volume":"14","author":"Kalarchian","year":"2014","journal-title":"Curr. Diabetes Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3385","DOI":"10.1007\/s11695-019-04112-y","article-title":"Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-Bariatric Surgery Patients: A Practical Guideline","volume":"29","author":"Tabesh","year":"2019","journal-title":"Obes. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1249\/JES.0000000000000253","article-title":"Exercise Is Key to Sustaining Metabolic Gains after Bariatric Surgery","volume":"49","author":"Gualano","year":"2021","journal-title":"Exerc. Sport Sci. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1016\/j.soard.2021.03.022","article-title":"Does Bariatric Surgery Improve Cardiac Autonomic Modulation Assessed by Heart Rate Variability? A Systematic Review","volume":"17","author":"Benjamim","year":"2021","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/j.soard.2014.09.011","article-title":"Improvement of Heart Rate Variability after Decreased Insulin Resistance after Sleeve Gastrectomy for Morbidly Obesity Patients","volume":"11","author":"Wu","year":"2015","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1530\/EJE-13-0506","article-title":"Autonomic Nervous System Activity in Diabetic and Healthy Obese Female Subjects and the Effect of Distinct Weight Loss Strategies","volume":"169","author":"Lips","year":"2013","journal-title":"Eur. J. Endocrinol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1038\/oby.2008.532","article-title":"Independent Evolution of Heart Autonomic Function and Insulin Sensitivity during Weight Loss","volume":"17","author":"Sztajzel","year":"2009","journal-title":"Obesity"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Casellini, C.M., Parson, H.K., Hodges, K., Edwards, J.F., Lieb, D.C., Wohlgemuth, S.D., and Vinik, A.I. (2016). Bariatric Surgery Restores Cardiac and Sudomotor Autonomic C-Fiber Dysfunction towards Normal in Obese Subjects with Type 2 Diabetes. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0154211"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"770690","DOI":"10.3389\/fnins.2021.770690","article-title":"Role of the Autonomic Nervous System in Mechanism of Energy and Glucose Regulation Post Bariatric Surgery","volume":"15","author":"An","year":"2021","journal-title":"Front. Neurosci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"401","DOI":"10.3389\/fphys.2018.00401","article-title":"Autonomic Differentiation Map: A Novel Statistical Tool for Interpretation of Heart Rate Variability","volume":"9","author":"Lucini","year":"2018","journal-title":"Front. Physiol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Oggionni, G., Spataro, A., Pelliccia, A., Malacarne, M., Pagani, M., and Lucini, D. (2019). Left Ventricular Hypertrophy in World Class Elite Athletes Is Associated with Signs of Improved Cardiac Autonomic Regulation. Eur. J. Prev. Cardiol.","DOI":"10.1177\/2047487319830534"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1111\/eci.12730","article-title":"A Composite Autonomic Index as Unitary Metric for Heart Rate Variability: A Proof of Concept","volume":"47","author":"Sala","year":"2017","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"478","DOI":"10.3389\/fphys.2019.00478","article-title":"Cardiac Baroreflex, HRV, and Statistics: An Interdisciplinary Approach in Hypertension","volume":"10","author":"Solaro","year":"2019","journal-title":"Front. Physiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2440","DOI":"10.1056\/NEJMsa1909301","article-title":"Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity","volume":"381","author":"Ward","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_39","first-page":"e00006016","article-title":"Obesity and Public Policies: The Brazilian Government\u2019s Definitions and Strategies","volume":"33","author":"Dias","year":"2017","journal-title":"Cad. Saude Publica"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1159\/000442721","article-title":"European Guidelines for Obesity Management in Adults","volume":"8","author":"Yumuk","year":"2015","journal-title":"Obes. Facts"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1093\/ajcn\/78.6.1141","article-title":"Variability of Measured Resting Metabolic Rate","volume":"78","author":"Haugen","year":"2003","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2673","DOI":"10.1161\/01.CIR.0000039106.89299.AB","article-title":"Impairment in Cardiac Autonomic Regulation Preceding Arterial Hypertension in Humans: Insights from Spectral Analysis of Beat-by-Beat Cardiovascular Variability","volume":"106","author":"Lucini","year":"2002","journal-title":"Circulation"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/S0140-6736(97)11144-8","article-title":"Baroreflex Sensitivity and Heart-Rate Variability in Prediction of Total Cardiac Mortality after Myocardial Infarction","volume":"351","author":"Bigger","year":"1998","journal-title":"Lancet"},{"key":"ref_44","unstructured":"Nardo, M., Saltelli, A., Giovannini, E., Tarantola, S., Saisana, M., and Hoffman, A. (2005). Handbook on Constructing Composite Indicators, OECD Publishing. OECD Statistics Working Papers."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e1798","DOI":"10.2196\/jmir.1798","article-title":"Health Promotion in the Workplace: Assessing Stress and Lifestyle with an Intranet Tool","volume":"13","author":"Lucini","year":"2011","journal-title":"J. Med. Internet Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1161\/01.HYP.0000255034.42285.58","article-title":"Stress Management at the Worksite: Reversal of Symptoms Profile and Cardiovascular Dysregulation","volume":"49","author":"Lucini","year":"2007","journal-title":"Hypertension"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s00592-014-0605-z","article-title":"A Simple Healthy Lifestyle Index as a Proxy of Wellness: A Proof of Concept","volume":"52","author":"Lucini","year":"2015","journal-title":"Acta Diabetol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1161\/CIRCULATIONAHA.109.192703","article-title":"Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction: The American Heart Association\u2019s Strategic Impact Goal through 2020 and beyond","volume":"121","author":"Hong","year":"2010","journal-title":"Circulation"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1249\/01.MSS.0000078924.61453.FB","article-title":"International Physical Activity Questionnaire: 12-Country Reliability and Validity","volume":"35","author":"Craig","year":"2003","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1007\/s40618-017-0746-3","article-title":"Reproducibility and Validity of the Italian Version of the International Physical Activity Questionnaire in Obese and Diabetic Patients","volume":"41","author":"Minetto","year":"2018","journal-title":"J. Endocrinol. Investig."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1038\/s41366-021-01054-3","article-title":"Associations between Body Composition, Fat Distribution and Metabolic Consequences of Excess Adiposity with Severe COVID-19 Outcomes: Observational Study and Mendelian Randomisation Analysis","volume":"46","author":"Gao","year":"2022","journal-title":"Int. J. Obes."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"567312","DOI":"10.3389\/fphys.2020.567312","article-title":"Altered Cardiac Autonomic Regulation in Overweight and Obese Subjects: The Role of Age-and-Gender-Adjusted Statistical Indicators of Heart Rate Variability and Cardiac Baroreflex","volume":"11","author":"Solaro","year":"2021","journal-title":"Front. Physiol."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Calcaterra, V., Palombo, C., Malacarne, M., Pagani, M., Federico, G., Kozakova, M., Zuccotti, G., and Lucini, D. (2021). Interaction between Autonomic Regulation, Adiposity Indexes and Metabolic Profile in Children and Adolescents with Overweight and Obesity. Children, 8.","DOI":"10.3390\/children8080686"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1113\/jphysiol.2011.221036","article-title":"Obesity and Adipokines: Effects on Sympathetic Overactivity","volume":"590","author":"Smith","year":"2012","journal-title":"J. Physiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1038\/nrendo.2012.189","article-title":"The Vagus Nerve and the Inflammatory Reflex\u2014Linking Immunity and Metabolism","volume":"8","author":"Pavlov","year":"2012","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1007\/s00268-021-06394-9","article-title":"Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery after Surgery (ERAS) Society Recommendations: A 2021 Update","volume":"46","author":"Stenberg","year":"2022","journal-title":"World J. Surg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1097\/01.hjh.0000202817.02836.9c","article-title":"Is Reduced Baroreflex Gain a Component of the Metabolic Syndrome? Insights from the LINOSA Study","volume":"24","author":"Lucini","year":"2006","journal-title":"J. Hypertens."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1161\/HYPERTENSIONAHA.114.03183","article-title":"Sympathetic Inhibition after Bariatric Surgery","volume":"64","author":"Mark","year":"2014","journal-title":"Hypertension"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1161\/HYPERTENSIONAHA.113.02988","article-title":"Long-Term Sympathoinhibitory Effects of Surgically Induced Weight Loss in Severe Obese Patients","volume":"64","author":"Seravalle","year":"2014","journal-title":"Hypertension"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1007\/s11695-008-9665-x","article-title":"Gastric Bypass and Cardiac Autonomic Activity: Influence of Gender and Age","volume":"19","author":"MacHado","year":"2009","journal-title":"Obes. Surg."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1016\/S0002-9149(99)00066-1","article-title":"Heart Rate Variability in Obesity and the Effect of Weight Loss","volume":"83","author":"Karason","year":"1999","journal-title":"Am. J. Cardiol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1002\/erv.2392","article-title":"Psychosocial Interventions Pre and Post Bariatric Surgery","volume":"23","author":"Kalarchian","year":"2015","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"2258","DOI":"10.1007\/s11695-017-2633-6","article-title":"Do Bariatric Patients Follow Dietary and Lifestyle Recommendations during the First Postoperative Year?","volume":"27","author":"Keidar","year":"2017","journal-title":"Obes. Surg."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1038\/s41366-020-0585-8","article-title":"Physical Activity Impacts Insulin Sensitivity Post Metabolic Bariatric Surgery in Adolescents with Severe Obesity","volume":"44","author":"Price","year":"2020","journal-title":"Int. J. Obes."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Lucini, D., Malacarne, M., Gatzemeier, W., and Pagani, M. (2020). A Simple Home-Based Lifestyle Intervention Program to Improve Cardiac Autonomic Regulation in Patients with Increased Cardiometabolic Risk. Sustainability, 12.","DOI":"10.3390\/su12187671"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"239","DOI":"10.2165\/00007256-200636030-00005","article-title":"The Role of Diet and Exercise for the Maintenance of Fat-Free Mass and Resting Metabolic Rate during Weight Loss","volume":"36","author":"Stiegler","year":"2006","journal-title":"Sports Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"4347","DOI":"10.1007\/s11695-021-05578-5","article-title":"Evaluation of Resting Energy Expenditure in Subjects with Severe Obesity and Its Evolution after Bariatric Surgery","volume":"31","author":"Fidilio","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1016\/S0140-6736(04)17019-0","article-title":"Association of Psychosocial Risk Factors with Risk of Acute Myocardial Infarction in 11,119 Cases and 13,648 Controls from 52 Countries (the INTERHEART Study): Case-Control Study","volume":"364","author":"Rosengren","year":"2004","journal-title":"Lancet"},{"key":"ref_69","first-page":"60","article-title":"Stress as a Factor Contributing to Obesity in Patients Qualified for Bariatric Surgery\u2014Studies in a Selected Group of Patients (a Pilot Study)","volume":"12","author":"Boniecka","year":"2017","journal-title":"Wideochirurgia I Inne Tech. Maloinwazyjne"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/12\/8\/1317\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:08:53Z","timestamp":1760141333000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/12\/8\/1317"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,15]]},"references-count":69,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["jpm12081317"],"URL":"https:\/\/doi.org\/10.3390\/jpm12081317","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,15]]}}}