Functional Training as a Therapeutic Strategy for Obesity: A Narrative Review of Physiological Adaptations, Biomechanical Outcomes, and Translational Implications

Background & Objectives: Obesity is a multifaceted and chronic disease characterized by profound metabolic dysregulation and significant biomechanical impairments, both of which compromise functional capacity and elevate the risk of comorbidities. This narrative review critically examines functional training (FT) as a comprehensive, multidimensional intervention for obesity management, emphasizing its physiological, biomechanical, and translational impacts. It aims to elucidate underlying mechanisms, synthesize current empirical evidence, and highlight clinical implications. Materials & Methods: A thematic synthesis was conducted based on a systematic search of electronic databases up to April 2025. Eligible studies included randomized controlled trials, non-randomized controlled trials, and cohort studies involving adults classified as overweight or obese (BMI ≥ 25). These studies assessed the effects of FT on metabolic parameters, neuromuscular performance, and functional outcomes. The findings were organized into three analytical domains—physiological, biomechanical, and translational—guided by principles from systems physiology and movement science. Results: FT has been shown to elicit marked enhancements in mitochondrial function, insulin sensitivity, and systemic inflammatory modulation (e.g., reductions in IL-6 and TNF-α, increases in adiponectin). From a biomechanical perspective, FT improves gait efficiency, postural stability, joint load distribution, and neuromuscular coordination. In comparison to traditional exercise modalities, FT confers distinct translational benefits, such as fall risk mitigation, injury prevention, and greater applicability in rehabilitation settings—particularly for individuals with sarcopenic obesity, musculoskeletal dysfunction, or cardiovascular comorbidities. Conclusion: FT represents a powerful integrative strategy that bridges metabolic restoration and biomechanical resilience in the context of obesity therapy. Its integration into clinical rehabilitation pathways and public health initiatives is strongly supported by current evidence and should be prioritized. Future investigations should focus on protocol standardization, mechanistic randomized controlled trials, and longitudinal studies across heterogeneous populations to enable widespread clinical adoption