Efficacy of systemic integral neurorehabilitation on cognitive function and functional capacity in women with severe obesity: A systematic review protocol

Systemic neuro-integral rehabilitation in severe obesity

Abstract

Background: Severe obesity is a multisystemic chronic disease associated with significant neurocognitive impairments, including deficits in executive functions, memory, and attention. Traditional weight loss interventions often overlook these neurological and psychosocial barriers. Systemic Neuro-Integral Rehabilitation, combining cognitive training, functional neurorehabilitation, and Cognitive-Behavioral Therapy (CBT), emerges as a holistic approach to bridge this gap. This protocol outlines a systematic review to evaluate the efficacy of these multidisciplinary interventions in women with severe obesity. Methods: This review will follow the PRISMA guidelines and is registered in PROSPERO (CRD420261356828). A systematic search will be conducted in MEDLINE (via PubMed), Scopus, and Web of Science for Randomized Controlled Trials (RCTs) involving women with severe obesity (BMI 40 kg/m² or 35 kg/m² with comorbidities). Interventions of interest include cognitive and functional neurorehabilitation compared to conventional exercise or nutritional education. Two independent reviewers will perform study selection, data extraction, and risk of bias assessment using the Cochrane RoB 2 tool. Data will be synthesized through a narrative approach and, if feasible, a meta-analysis using random-effects models. Results: The review aims to demonstrate that integrated neurofunctional interventions lead to superior improvements in executive functions, working memory, and functional capacity compared to isolated treatments. Additionally, improvements in mental health (anxiety, depression, and body image) and autonomic regulation (heart rate variability) are anticipated. Conclusion: By synthesizing evidence on neurocentric approaches, this review seeks to provide a foundation for new clinical guidelines that prioritize cognitive health as a pillar for long-term therapeutic success and autonomy in women with severe obesity.