Multicomponent Online Intervention Improves Sarcopenia-Related Traits Following Long-Term Metabolic Bariatric Surgery: A Randomized Clinical Trial

INTRODUCTION: Telemedicine provides outcomes comparable to in-person follow-up after Metabolic Bariatric Surgery (MBS), but evidence on multicomponent online interventions in the late postoperative period remains scarce. This study evaluated the effects of a supervised online multicomponent program on sarcopenia risk and related components in adults 2-7 years after MBS. METHODS: In this randomized controlled trial, participants were assigned to either the multicomponent online group (n = 79) or control group (n = 60). The intervention combined nutritional counseling, delivered through synchronous group sessions and pre-recorded videos addressing behavioral strategies; and supervised exercise training including aerobic and resistance components. Assessments included body composition, phase angle, handgrip strength, sit-to-stand test, functional performance, resting energy expenditure, and biochemical analyses. Sarcopenia risk was assessed based on phase angle. Analyses used generalized estimating equations (intention-to-treat, p < 0.05). RESULTS: After 12 weeks, the multicomponent online group (mean age 40.1 ± 7.5 years; BMI 29.6 ± 5.1 kg/m²; 3.9 ± 1.7 years post-surgery), compared with controls (mean age 40.6 ± 8.1 years; BMI 29.2 ± 5.0 kg/m²; 3.9 ± 1.6 years post-surgery) showed improvements in phase angle (β = 0.15; 95% CI: 0.02; 0.29; p = 0.025), handgrip strength/body weight (β = 0.03; 95% CI: 0.001; 0.06; p = 0.043), sit-to-stand time test (β = - 1.22; 95% CI: - 2.30; - 0.14; p = 0.027). Regarding biochemical outcomes, C-reactive protein and HOMA-β levels decreased, while serum creatinine and glucose increased within clinical reference ranges (p < 0.05). Compared to controls, the intervention group had a significantly lower likelihood of sarcopenia risk after 12 weeks (OR = 0.41; 95% CI: 0.19; 0.87; p = 0.020). CONCLUSION: A supervised online multicomponent intervention improved muscle strength and lowered sarcopenia risk after MBS, highlighting the potential of remote multicomponent strategies as a feasible approach to preserve muscle health and prevent sarcopenia in long-term bariatric care.