Abstract
Background
Although sleeve gastrectomy (SG) has become an important treatment option in severe obesity, cardiorespiratory and muscle function after SG has not adequately been investigated.
Methods
This is an observational study in 26 obese patients (BMI 45.2 ± 5.8 kg/m2), comparing physical function before and after 6 months from SG. All available patients listed for SG were here included. Incremental cardiopulmonary exercise tests, standardized strength tests, and balance analysis were performed.
Results
The substantial weight loss (−33.4 ± 11.0 kg) after SG led to increased peak work capacity (metabolic equivalents, METs) and relative peak oxygen uptake (VO2peak/kg) (both p < 0.001). However, the absolute VO2peak, oxygen pulse (VO2/heart rate (HR)), and the oxygen uptake efficiency slope (OUES) significantly declined after SG (all p < 0.001). Furthermore, HR/VO2-slope significantly worsened after SG (p < 0.001), whereas the HR reserve and HR recovery improved (all p ≤ 0.01). Parameters of ventilatory efficiency were not affected by SG. The time-constant (Tau τ) of the fundamental component of VO2-kinetics, reflecting oxygen metabolism in skeletal muscles, was found to be significantly worsened after SG (p < 0.05). Finally, muscle strength and balance parameters were not much affected by SG.
Conclusions
The ventilatory and cardiac function do not appear negatively affected by SG; thus, we hypothesize that the decrease in aerobic capacity could be due to alterations in peripheral muscles. This might in part be due to a loss of muscle mass, although our patients’ muscle strength did not decrease. Pilot results from VO2-kinetics analysis seem to support the hypothesis of a deterioration of oxidative muscle metabolism after SG.
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References
Steele T, Cuthbertson DJ, Wilding JPH. Impact of bariatric surgery on physical functioning in obese adults. Obes rev. 2015;16:248–58.
Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999-2008. Jama. 2010;303:235–41.
Flegal KM, Graubard BI, Williamson DF, et al. Cause-specific excess deaths associated with underweight, overweight, and obesity. Jama. 2007;298:2028–37.
Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934.
King WC, Chen J-Y, Belle SH, et al. Change in pain and physical function following bariatric surgery for severe obesity. Jama. 2016;315:1362–71.
Frühbeck G. Bariatric and metabolic surgery: a shift in eligibility and success criteria. Nat Publ gr. Nature Publishing Group. 2015;11:465–77.
Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg. 2014;24:437–55.
Switzer NJ, Prasad S, Debru E, et al. Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review of long-term outcomes. Obes Surg. 2016;26:1616–21.
Myers J, Prakash M, Froelicher V, et al. Exercise capacity and mortality among men referred for exercise testing. N Engl J med. 2002;346:793–801.
Ciangura C, Bouillot J-L, Lloret-Linares C, et al. Dynamics of change in total and regional body composition after gastric bypass in obese patients. Obesity (Silver Spring). Nature Publishing Group. 2010;18:760–5.
Browning MG, Franco RL, Herrick JE, et al. Assessment of cardiopulmonary responses to treadmill walking following gastric bypass surgery. Obes Surg. 2017;27:96–101.
Kanoupakis E, Michaloudis D, Fraidakis O, et al. Left ventricular function and cardiopulmonary performance following surgical treatment of morbid obesity. Obes Surg. 2001;11:552–8.
Seres L, Lopez-Ayerbe J, Coll R, et al. Increased exercise capacity after surgically induced weight loss in morbid obesity. Obes (Silver Spring). 2006;14:273–9.
DeSouza S, Faintuch J, Sant’Anna A. Effect of weight loss on aerobic capacity in patients with severe obesity before and after bariatric surgery. Obes Surg. 2010;20:871–5.
Wasmund SL, Yanowitz FG, Adams TD, et al. Improved heart rate recovery after marked weight loss induced by gastric bypass surgery: 2 year follow up in the Utah obesity study. Hear Rhythm. 2011;8:84–90.
Sun XG, Hansen JE, Stringer WW. Oxygen uptake efficiency plateau best predicts early death in heart failure. Chest. 2012;141:1284–94.
Salvadego D, Lazzer S, Busti C, et al. Gas exchange kinetics in obese adolescents. Inferences on exercise tolerance and prescription. Am J Physiol Regul Integr Comp Physiol. 2010;299:R1298–305.
Grassi B, Poole D, Richardson R, et al. Muscle O2 uptake kinetics in humans: implications for metabolic control. J Appl Physiol. 1996;80:988–98.
Brzycki M. Strength testing—predicting a one-rep max from reps to fatigue. JOPERD. 1993;64:88–90.
Bergamin M, Gobbo S, Zanotto T, et al. Influence of age on postural sway during different dual-task conditions. Front Aging Neurosci. 2014;6:1–7.
World Health Organization. Global physical activity surveillance: the Global Physical Activity Questionnaire. [Internet]. [cited 2017 Feb 20]. Available from: http://www.who.int/chp/steps/GPAQ/en/
Vargas CB, Picolli F, Dani C, et al. Functioning of obese individuals in pre- and postoperative periods of bariatric surgery. Obes Surg. 2013;23:1590–5.
Miller G, Nicklas B, You T, et al. Physical function improvements after laparoscopic Roux-en-Y gastric bypass surgery. Surg Obes Relat dis. 2009;5:530–7.
Buys R, Coeckelberghs E, Vanhees L, et al. The oxygen uptake efficiency slope in 1411 Caucasian healthy men and women aged 20-60 years: reference values. Eur J Prev Cardiol. 2015;22:356–63.
Chen-Tournoux A, Khan AM, Baggish AL, et al. Effect of weight loss after weight loss surgery on plasma N-terminal pro-B-type natriuretic peptide levels. Am J Cardiol. 2010;106:1450–5.
Kardassis D, Bech-Hanssen O, Schönander M, et al. Impact of body composition, fat distribution and sustained weight loss on cardiac function in obesity. Int J Cardiol. Elsevier Ireland Ltd. 2012;159:128–33.
Sun XG, Hansen JE, Stringer WW, et al. Oxygen uptake efficiency plateau: physiology and reference values. Eur J Appl Physiol. 2012;112:919–28.
Refsum H, Holter P, Løvig T, et al. Pulmonary function and energy expenditure after marked weight loss in obese women: observations before and one year after gastric banding. Int J Obes. 1990;14:175–83.
Grassi B. Oxygen uptake kinetics: why are they so slow? And what do they tell us? J Physiol Pharmacol. 2006;57:53–65.
Aghamohammadzadeh R, Greenstein AS, Yadav R, et al. Effects of bariatric surgery on human small artery function: evidence for reduction in perivascular adipocyte inflammation, and the restoration of normal anticontractile activity despite persistent obesity. J am Coll Cardiol. 2013;62:128–35.
Coen PM, Menshikova EV, Distefano G, et al. Exercise and weight loss improve muscle mitochondrial respiration, lipid partitioning, and insulin sensitivity after gastric bypass surgery. Diabetes. 2015;64:3737–50.
Rabøl R, Svendsen PF, Skovbro M, et al. Reduced skeletal muscle mitochondrial respiration and improved glucose metabolism in nondiabetic obese women during a very low calorie dietary intervention leading to rapid weight loss. Metabolism. Elsevier Inc. 2009;58:1145–52.
Toledo FGS, Menshikova EV, Azuma K, et al. Mitochondrial capacity in skeletal muscle is not stimulated by weight loss despite increases in insulin action and decreases in intramyocellular lipid content. Diabetes. 2008;57:987–94.
Vijgen GHEJ, Bouvy ND, Hoeks J, et al. Impaired skeletal muscle mitochondrial function in morbidly obese patients is normalized one year after bariatric surgery. Surg Obes Relat dis. 2013;9:936–41.
Stegen S, Derave W, Calders P, et al. Physical fitness in morbidly obese patients: Effect of gastric bypass surgery and exercise training. Obes Surg. 2011;21:61–70.
Otto M, Kautt S, Kremer M, et al. Handgrip strength as a predictor for post bariatric body composition. Obes Surg. 2014;24:2082–8.
Hue O, Berrigan F, Simoneau M, et al. Muscle force and force control after weight loss in obese and morbidly obese men. Obes Surg. 2008;18:1112–8.
Lyytinen T, Liikavainio T, Pääkkönen M, et al. Physical function and properties of quadriceps femoris muscle after bariatric surgery and subsequent weight loss. J Musculoskelet Neuronal Interact. 2013;13:329–38.
Handrigan G, Hue O, Simoneau M, et al. Weight loss and muscular strength affect static balance control. Int J Obes. Nature Publishing Group. 2010;34:936–42.
Egberts K, Brown WA, Brennan L, et al. Does exercise improve weight loss after bariatric surgery? A systematic review. Obes Surg. 2012;22:335–41.
Bond DS, Phelan S, Wolfe LG, et al. Becoming physically active after bariatric surgery is associated with improved weight loss and health-related quality of life. Obesity (Silver Spring). 2009;17:78–83.
Acknowledgements
The authors thank the Nursing staff of the Sports and Exercise Medicine Division and, in particular, Claudia Dainese for her substantial contribution. Thanks also to Fausto Roman and Barbara Vendramin for their valuable support.
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Informed consent was obtained from all individual participants included in the study.
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Neunhaeuserer, D., Gasperetti, A., Savalla, F. et al. Functional Evaluation in Obese Patients Before and After Sleeve Gastrectomy. OBES SURG 27, 3230–3239 (2017). https://doi.org/10.1007/s11695-017-2763-x
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DOI: https://doi.org/10.1007/s11695-017-2763-x