Physical and Psychological Effects of Home-Based vs Face-to-Face Prehabilitation in Individuals With Severe Obesity Awaiting Bariatric and Metabolic Surgery: Protocol for a Randomized Controlled Trial

Abstract Background Obesity is a growing public health issue associated with comorbidities and substantial medical costs. Although bariatric and metabolic surgery (BMS) is often recommended for individuals with severe obesity, prehabilitation may optimize their physical and psychological status. However, face-to-face delivery can limit accessibility, and evidence on home-based approaches remains scarce. Objective This study protocol aims to compare the effectiveness of a home-based prehabilitation program with a face-to-face prehabilitation program on physical and psychological variables in individuals with severe obesity awaiting BMS. Methods This is a study protocol for a randomized, controlled, parallel-group trial. To ensure ecological validity, recruitment will be stratified to target 50% low-income and 20% rural participants. Participants with grade III obesity and an indication for BMS will be allocated via block randomization to 3 groups (1:1:1): a face-to-face group, a home-based group, and a control group. The intervention will last 7 weeks (1 week of familiarization plus 6 weeks of training) and will include 12 combined aerobic and resistance exercise sessions and 3 health education sessions. The primary outcome will be the total score of the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes include the HADS subscales (HADS-A and HADS-D), sleep quality, mood states, self-efficacy, quality of life, and functional performance (6-minute walk test, handgrip strength, and 5-repetition sit-to-stand test). Results This study was funded in August 2025 by the Research Support Program of the Santa Catarina State University. Recruitment is scheduled to begin in April 2026. The intervention phase is expected to be completed in September 2026, followed by data analysis between October and November 2026. Results are expected to be published in mid-2027. Conclusions This trial will provide evidence on the comparative effectiveness of home-based and face-to-face prehabilitation for individuals with severe obesity. The findings can be used to support the implementation of feasible, accessible, equitable, and cost-effective preoperative care models.