# Moderate-Intensity Constant and High-Intensity Interval Training Confer Differential Metabolic Benefits in Skeletal Muscle, White Adipose Tissue, and Liver of Candidates to Undergo Bariatric Surgery

PMID: 38892984
Journal: Journal of Clinical Medicine
Published: 2024
Authors: Ruíz-Uribe M, Enríquez-Schmidt J, Monrroy-Uarac M, Mautner-Molina C, Kalazich-Rosales M, Muñoz M, Fuentes-Leal F, Cárcamo-Ibaceta C, Fazakerley DJ, Larance M, Ehrenfeld P, Martínez-Huenchullán S

## Question

Do short preoperative HIIT and MICT programs produce different metabolic marker changes in skeletal muscle, subcutaneous adipose tissue, and liver among bariatric surgery candidates?

## Summary

In adults awaiting bariatric surgery, 4 weeks of supervised HIIT or moderate continuous training before surgery produced different tissue-marker patterns. HIIT was linked to higher subcutaneous adipose adiponectin and lower liver collagen/AMPK/PGC-1alpha markers than MICT, but the study was small and lacked pre-training tissue samples.

## Population

- Adults selected for sleeve gastrectomy who completed preoperative exercise and accepted tissue extraction
- Sample size: 17
- Age: 18-60 years eligible; group means not extracted here
- Sex: Mostly women; exact distribution not extracted here
- Fitness level: Candidates for bariatric surgery with severe obesity
- Health status: Obesity requiring bariatric surgery; excluded exercise contraindications and uncontrolled neuropsychiatric illness

## Methodology

- Randomized controlled preoperative exercise trial
- 4 weeks
- Supervised hospital/clinical exercise before sleeve gastrectomy with tissue samples at surgery
- Randomized and controlled study design.

## Protocol

- Preoperative HIIT plus resistance training.
- Modality: Treadmill walking or cycling plus strengthening.
- Work intervals: 2.5 min.
- Recovery: 2.5 min active rest.
- Sets or repetitions: 6 intervals plus strengthening exercises.
- Intensity: 80% HRR and/or Borg modified RPE 7-8/10; recovery 20% HRR and/or RPE 1-2/10.
- Session duration: 30 min aerobic interval component plus common strengthening program.
- Frequency: 2-3 sessions/week.
- Program length: 4 weeks; 10 sessions.
- Progression: Exercise speed, incline, or load adjusted by physiotherapist to maintain target HRR/RPE.
- MICT plus resistance training.
- Modality: Treadmill walking or cycling plus same strengthening program.
- Work intervals: Continuous 30 min.
- Sets or repetitions: Continuous aerobic exercise plus same strengthening exercises.
- Intensity: 50% HRR and/or Borg modified RPE 4-5/10.
- Session duration: 30 min aerobic component plus common strengthening program.
- Frequency: 2-3 sessions/week.
- Program length: 4 weeks; 10 sessions.
- Progression: Adjusted to maintain target HRR/RPE.

## Outcomes

### Adipose adiponectin
Status: improved
Subcutaneous adipose adiponectin was higher after HIIT than MICT.

HIIT 1.9 +/- 0.69 vs MICT 1.1 +/- 0.48 fold, p < 0.05

### Liver markers
Status: improved
HIIT showed lower liver phospho-AMPK/AMPK, PGC-1alpha, and collagen 1 than MICT.

Phospho-AMPK/AMPK 0.52 +/- 0.22 vs 1.0 +/- 0.37; PGC-1alpha 0.69 +/- 0.15 vs 1.0 +/- 0.18; collagen 1 0.59 +/- 0.28 vs 1.0 +/- 0.26; all p < 0.05

### Muscle PGC-1alpha
Status: worse/safety concern
Skeletal muscle PGC-1alpha was higher after MICT than HIIT.

MICT 1.1 +/- 0.27 vs HIIT 0.7 +/- 0.4 fold, p < 0.05

### Clinical markers
Status: mixed
MICT showed small body-weight/composition changes, while HIIT reduced waist/hip circumference and HbA1c slightly.

Article reports significant within-group changes but small sample and limited between-group clinical separation

## Practical Insights

- Short preoperative HIIT may affect tissue markers differently from moderate continuous training.
- The clinical consumer relevance is limited because tissue samples were collected during surgery.
- Interval walking/cycling can be adapted for severe-obesity clinical settings with professional supervision.

## Limitations

- Very small completer sample
- No untrained control group
- No pre-exercise tissue samples
- Mostly women, creating possible sex bias
- Clinical bariatric population limits generalizability

## Safety And Adherence

- Participants were screened for exercise contraindications and supervised by a physiotherapist.
- The extracted text did not report specific adverse-event counts.

## Original Sources

- [PubMed](https://pubmed.ncbi.nlm.nih.gov/38892984/) (pubmed)
- [DOI](https://doi.org/10.3390/jcm13113273) (doi)
- [PMC full text](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11172953/) (full text)

## Agent Guidance

Preserve the paper-level scope of this note. Do not generalize beyond the population, protocol, measured outcomes, and limitations above.