Obesity Surgery

, Volume 27, Issue 8, pp 2026–2033 | Cite as

Effects of a Physical Activity Program on Cardiorespiratory Fitness and Pulmonary Function in Obese Women after Bariatric Surgery: a Pilot Study

  • Tatiana Onofre
  • Renata Carlos
  • Nicole Oliver
  • Amanda Felismino
  • Davi Fialho
  • Renata Corte
  • Eliane Pereira da Silva
  • Eudes Godoy
  • Selma Bruno
Original Contributions

Abstract

Background

In severely obese individuals, reducing body weight induced by bariatric surgery is able to promote a reduction in comorbidities and improve respiratory symptoms. However, cardiorespiratory fitness (CRF) reflected by peak oxygen uptake (VO2peak) may not improve in individuals who remain sedentary post-surgery. The objective of this study was to evaluate the effects of a physical training program on CRF and pulmonary function in obese women after bariatric surgery, and to compare them to a control group.

Methods

Twelve obese female candidates for bariatric surgery were evaluated in the preoperative, 3 months postoperative (3MPO), and 6 months postoperative (6MPO) periods through anthropometry, spirometry, and cardiopulmonary exercise testing (CPX). In the 3MPO period, patients were divided into control group (CG, n = 6) and intervention group (IG, n = 6). CG received only general guidelines while IG underwent a structured and supervised physical training program involving aerobic and resistance exercises, lasting 12 weeks.

Results

All patients had a significant reduction in anthropometric measurements and an increase in lung function after surgery, with no difference between groups. However, only IG presented a significant increase (p < 0.05) in VO2peak and total CPX duration of 5.9 mL/kg/min (23.8%) and 4.9 min (42.9%), respectively.

Conclusions

Applying a physical training program to a group of obese women after 3 months of bariatric surgery could promote a significant increase in CRF only in the trained group, yet also showing that bariatric surgery alone caused an improvement in the lung function of both groups.

Keywords

Bariatric surgery Cardiorespiratory fitness Peak oxygen uptake Physical training Obesity 

References

  1. 1.
    Lorenzo S, Babb TG. Ventilatory responses at peak exercise in endurance-trained obese adults. Chest. 2013;144(4):1330–9.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Gallagher MJ, Franklin BA, Ehrman JK, et al. Comparative impact of morbid obesity vs heart failure on cardiorespiratory fitness. Chest. 2005;127(6):2197–203.CrossRefPubMedGoogle Scholar
  3. 3.
    Crump C, Sundquist J, Winkleby MA, et al. Interactive effects of physical fitness and body mass index on the risk of hypertension. JAMA Intern Med. 2016;176(2):210–6.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Myers J, Prakash M, Froelicher V, et al. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346(11):793–801.CrossRefPubMedGoogle Scholar
  5. 5.
    Hergenroeder AL, Wert DM, Hile ES, et al. Association of body mass index with self-report and performance based measures of balance and mobility. Phys Ther. 2011;91(8):1223–34.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Arena R, Cahalin LP. Evaluation of cardiorespiratory fitness and respiratory muscle function in the obese population. Int J Cardiol. 2014;56(4):457–64.Google Scholar
  7. 7.
    Telford RD. Low physical activity and obesity: causes of chronic disease or simply predictors? Med Sci Sports Exerc. 2007;39(8):1233–40.CrossRefPubMedGoogle Scholar
  8. 8.
    McAuley PA, Artero EG, Sui X, et al. The obesity paradox, cardiorespiratory fitness, and coronary heart disease. Mayo Clin Proc. 2012;87(5):443–51.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Wolfe BM, Kvach E, Eckel RH. Treatment of obesity: weight loss and bariatric surgery. Circ Res. 2016;118(11):1844–55.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefPubMedGoogle Scholar
  11. 11.
    Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.CrossRefPubMedGoogle Scholar
  12. 12.
    de Zwaan M, Lancaster KL, Mitchell JE, et al. Health related quality of life in morbidly obese patients: effect of gastric bypass surgery. Obes Surg. 2002;12(6):773–80.CrossRefPubMedGoogle Scholar
  13. 13.
    Josbeno DA, Kalarchian M, Sparto PJ, et al. Physical activity and physical function in individuals post-bariatric surgery. Obes Surg. 2011;21(8):1243–9.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    King WC, Bond DS. The importance of preoperative and postoperative physical activity counseling in bariatric surgery. Exerc Sport Sci Rev. 2013;41(1):26–35.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Baillot A, Audet M, Baillargeon JP, et al. Impact of physical activity and fitness in class II and III obese individuals: a systematic review. Obes Rev. 2014;15(9):721–39.CrossRefPubMedGoogle Scholar
  16. 16.
    Coen PM, Tanner CJ, Helbling NL, et al. Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity. J Clin Invest. 2015;125(1):248–57.CrossRefPubMedGoogle Scholar
  17. 17.
    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(1):78–83.CrossRefGoogle Scholar
  18. 18.
    Aron-Wisnewsky J, Verger EO, Bounaix C, et al. Nutritional and protein deficiencies in the short term following both gastric bypass and gastric banding. PLoS One. 2016;11(2):e0149588.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Steele T, Cuthbertson DJ, Wilding JPH. Impact of bariatric surgery on physical functioning in obese adults. Obes Rev. 2015;16(3):248–58.CrossRefPubMedGoogle Scholar
  20. 20.
    Castello V, Simões RP, Bassi D, et al. Impact of aerobic exercise training on heart rate variability and functional capacity in obese women after gastric bypass surgery. Obes Surg. 2011;21(11):1739–49.CrossRefPubMedGoogle Scholar
  21. 21.
    Shah M, Snell PG, Rao S, et al. High-volume exercise program in obese bariatric surgery patients: a randomized, controlled trial. Obesity (Silver Spring). 2011;19(9):1826–34.CrossRefGoogle Scholar
  22. 22.
    American Thoracic Society; American College of Chest Physicians. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167(2):211–77.CrossRefGoogle Scholar
  23. 23.
    Wasserman K, Hansen JE, Sue DY. Prova de Esforço: princípios e interpretação. 3th ed. Rio de Janeiro: Revinter; 2005.Google Scholar
  24. 24.
    Wei YF, Tseng WK, Huang CK, et al. Surgically induced weight loss, including reduction in waist circumference, is associated with improved pulmonary function in obese patients. Surg Obes Relat Dis. 2011;7(5):599–604.CrossRefPubMedGoogle Scholar
  25. 25.
    Shin SH, Lee YJ, Heo YS, Park SD, Kwon SW, Woo SI, et al. Beneficial effects of bariatric surgery on cardiac structure and function in obesity. Obes Surg. 2016 Aug 10. [Epub ahead of print].Google Scholar
  26. 26.
    Kelley DE. Skeletal muscle fat oxidation: timing and flexibility are everything. J Clin Invest. 2005;115(7):1699–702.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Toledo FG, 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(4):987–94.CrossRefPubMedGoogle Scholar
  28. 28.
    He J, Watkins S, Kelley DE. Skeletal muscle lipid content and oxidative enzyme activity in relation to muscle fiber type in type 2 diabetes and obesity. Diabetes. 2001;50(4):817–23.CrossRefPubMedGoogle Scholar
  29. 29.
    Toledo FG, Goodpaster BH. The role of weight loss and exercise in correcting skeletal muscle mitochondrial abnormalities in obesity, diabetes and aging. Mol Cell Endocrinol. 2013;379(1–2):30–4.CrossRefPubMedGoogle Scholar
  30. 30.
    Short KR, Vittone JL, Bigelow ML, et al. Impact of aerobic exercise training on age-related changes in insulin sensitivity and muscle oxidative capacity. Diabetes. 2003;52(8):1888–96.CrossRefPubMedGoogle Scholar
  31. 31.
    Phielix E, Meex R, Moonen-Kornips E, et al. Exercise training increases mitochondrial content and ex vivo mitochondrial function similarly in patients with type 2 diabetes and in control individuals. Diabetologia. 2010;53(8):1714–21.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Zalesin KC, Franklin BA, Lillystone MA, et al. Differential loss of fat and lean mass in the morbidly obese after bariatric surgery. Metab Syndr Relat Disord. 2010;8(1):15–20.CrossRefPubMedGoogle Scholar
  33. 33.
    Carey DG, Pliego GJ, Raymond RL. Body composition and metabolic changes following bariatric surgery: effects on fat mass, lean mass and basal metabolic rate: six months to one-year follow-up. Obes Surg. 2006;16(12):1602–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Vaurs C, Diméglio C, Charras L, et al. Determinants of changes in muscle mass after bariatric surgery. Diabetes Metab. 2015;41(5):416–21.CrossRefPubMedGoogle Scholar
  35. 35.
    Bergman RN, Stefanovski D, Buchanan DA, et al. A better index of body adiposity. Obesity (Silver Spring). 2011;19(5):1083–9.CrossRefPubMedCentralGoogle Scholar
  36. 36.
    Laszlo G. Standardisation of lung function testing: helpful guidance from the ATS/ERS task force. Thorax. 2006;61(9):744–6.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Pereira CAC, Sato T, Rodrigues SC. New reference values for forced spirometry in white adults in Brazil. J Bras Pneumol. 2007;33(4):397–406.CrossRefPubMedGoogle Scholar
  38. 38.
    Wasserman K, Whipp BJ, Koyl SN, et al. Anaerobic threshold and respiratory gas exchange during exercise. J Appl Physiol. 1973;35(2):236–43.PubMedGoogle Scholar
  39. 39.
    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(11):3737–50.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    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(1):61–70.CrossRefPubMedGoogle Scholar
  41. 41.
    McCullough PA, Gallagher MJ, Dejong AT, et al. Cardiorespiratory fitness and short-term complications after bariatric surgery. Chest. 2006;130(2):517–25.CrossRefPubMedGoogle Scholar
  42. 42.
    Kavanagh T, Mertens DJ, Hamm LF, et al. Peak oxygen intake and cardiac mortality in women referred for cardiac rehabilitation. J Am Coll Cardiol. 2003;42(12):2139–43.CrossRefPubMedGoogle Scholar
  43. 43.
    Chlif M, Keochkeriana D, Choquet D, et al. Effects of obesity on breathing pattern, ventilatory neural drive and mechanics. Respir Physiol Neurobiol. 2009;168(3):198–202.CrossRefPubMedGoogle Scholar
  44. 44.
    Littleton SW. Impact of obesity on respiratory function. Respirology. 2012;17(1):43–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Sabbahi A, Arena R, Elokda A, Phillips SA. Exercise and hypertension: uncovering the mechanisms of vascular control. Prog Cardiovasc Dis. 2016; pii: S0033–0620(16)30106–2.Google Scholar
  46. 46.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.CrossRefPubMedGoogle Scholar
  48. 48.
    Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012. JAMA Surg. 2014;149(3):275–87.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Tatiana Onofre
    • 1
  • Renata Carlos
    • 1
  • Nicole Oliver
    • 1
  • Amanda Felismino
    • 1
  • Davi Fialho
    • 1
  • Renata Corte
    • 1
  • Eliane Pereira da Silva
    • 2
  • Eudes Godoy
    • 3
  • Selma Bruno
    • 4
  1. 1.Cardiovascular and Metabolic Rehabilitation Laboratory, Postgraduate Physical Therapy ProgramFederal University of Rio Grande do NorteNatalBrazil
  2. 2.Integrated Medicine DepartmentFederal University of Rio Grande do NorteNatalBrazil
  3. 3.Surgery Service for Obesity and Related DiseasesUniversity Hospital Onofre Lopes, Federal University of Rio Grande do NorteNatalBrazil
  4. 4.Physical Therapy Department, Cardiovascular and Metabolic Rehabilitation Laboratory, Federal University of Rio Grande do Norte, Campus UniversitárioNatalBrazil

Personalised recommendations