Assessment of Cardiopulmonary Responses to Treadmill Walking Following Gastric Bypass Surgery

Short-Term Effect of Bariatric Surgery on Cardiorespiratory Response at Submaximal, Ventilatory Threshold, and Maximal Exercise in Women with Severe Obesity

PURPOSE

People with obesity have varying degrees of cardiovascular, pulmonary, and musculoskeletal dysfunction that affect aerobic exercise testing variables. Short time after bariatric surgery, these dysfunctions could affect both peak oxygen consumption ([Formula: see text] O₂ peak), the gold standard for assessing cardiorespiratory fitness (CRF) and aerobic capacity evaluated with ventilatory threshold (VT1). The purpose of this study was to evaluate the short-term effect of bariatric surgery, i.e. before the resumption of physical activity, on submaximal, at VT1 and maximal cardiorespiratory responses in middle-aged women with severe obesity.

MATERIALS AND METHODS

Thirteen middle-aged women with severe obesity (age: 36.7 ± 2.3 years; weight: 110.5 ± 3.6 kg, BMI: 41.8 ± 1.1 kg/m²) awaiting bariatric surgery participated in the study. Four weeks before and 6 to 8 weeks after surgery, body composition was determined by bioelectrical impedance. The participants performed an incremental cycling test to [Formula: see text] O₂ peak.

RESULTS

After bariatric surgery, all body composition parameters were reduced, absolute [Formula: see text] O₂ peak and peak workload decline with a lower VT1. Relative [Formula: see text] O₂ at peak and at VT1 (ml/min/kg or ml/min/kg of FFM) remained unchanged. Ventilation was lower after bariatric surgery during exercise with no change in cardiac response.

CONCLUSION

Our results showed that weight loss alone at short-term after bariatric surgery decreased CRF as seen by a decrease in absolute [Formula: see text] O₂ peak, and peak workload with lower VT1, whereas relative [Formula: see text] O₂ (ml/min/kg or ml/min/kg of FFM) during exercise remained unchanged in women with obesity. Rapid FFM loss affects cardiorespiratory responses at submaximal and maximal.

Effects of bariatric surgery on cardiorespiratory fitness: A systematic review and meta-analysis

Although bariatric surgery (BS) is recognized as an effective strategy for body weight loss, its impact on cardiorespiratory fitness (CRF) is still unclear. We aimed to examine postoperative changes in CRF (VO_2max/peak ) and its relationship with weight loss among adults undergoing BS. We systematically searched the WoS, PubMed, MEDLINE, and Scopus databases. Observational and intervention studies were selected reporting the presurgery and postsurgery CRF, measured by breath-by-breath VO₂ or its estimation. Eleven articles (312 patients) revealed that BS leads to a reduction in absolute VO_2max/peak in the short term (effect size, ES = -0.539; 95%CI = -0.708, -0.369; p < 0.001), and those patients who suffered a more significant decrease in BMI after BS also had a greater loss of absolute VO_2max/peak . However, VO_2max/peak relative to body weight increased after surgery (ES = 0.658; 95%CI = 0.473, 0.842; p < 0.001). An insufficient number of studies were found investigating medium and long-term changes in CRF after BS. This study provides moderate-quality evidence that the weight loss induced by BS can reduce CRF in the short term, which represents a therapeutic target to optimize BS outcomes. More high-quality studies are needed to evaluate the impact of BS on VO_2max/peak in the short, medium, and long term including normalized values for fat-free mass.

Bariatric Surgery in Adults with Obesity: the Impact on Performance, Metabolism, and Health Indices

This systematic review summarizes current evidence on the impact of bariatric surgery (BS) on physical performance, metabolic, and health indices in adults with obesity. This systematic review suggests that BS induced significant reductions in body weight, fat mass, and fat-free mass in individuals with obesity. Additionally, BS may improve many physical fitness and health indicators. Observed improvements manifest during a distinct period of time. To date, studies on BS and performance have been small in number, nonrandomized in design, and not controlled regarding gender distribution and/or post-surgery follow-up. Future studies should further investigate concerns associated with understanding of BS outcomes to improve these outcomes with potential benefits for quality of life, disability, mortality, morbidity, and overall BS success.

Comparison of 12-Week Fitness Protocols Following Bariatric Surgery: Aerobic Exercise Versus Aerobic Exercise and Progressive Resistance

BACKGROUND

Successful bariatric surgery outcomes are better maintained with an exercise program. This pilot study compared the effects on short-term functional capacity and body composition of 2 post-bariatric surgery home-based programs: aerobic exercise alone versus aerobic exercise combined with progressive resistance conditioning.

METHODS

Laboratory measures and self-assessments of post-bariatric surgery patients (BMI ≥ 30 kg/m²) undergoing either aerobic exercise (AE group) or aerobic + progressive-resistance exercise (AEPR group) were compared at postoperative months 1 and 3. Anthropometric characteristic changes were recorded, as well as changes in functional capacity (e.g., 6-min walking test), muscle strength (e.g., hand grip strength test; five-times-sit-to-stand test), and quality of life (i.e., Beck Depression Inventory).

RESULTS

Between July 2018 and March 2019, 35 patients completed the AE (n = 17) or AEPR (n = 18) program. The AEPR group lost statistically significantly more weight (mean 2.2 kg) relative to baseline than the AE group (p < 0.05). The AEPR group achieved significantly greater mean total muscle, liquid, and bone mass; upper-extremity muscle strength; uric acid levels; body fat loss; and performed better on the 6-min walking test (all p < 0.05). In month 3, the AEPR group achieved a greater mean walking distance (p = 0.029) and O₂ saturation related to dyspnea (p = 0.001) than the AE group. Group quality of life scores were comparable.

CONCLUSIONS

In a comparative 12-week post-bariatric surgery study, both aerobic exercise alone and aerobic exercise plus progressive-resistance training were positively correlated with general health improvement. However, the progressive-resistance regimen resulted in significantly greater weight loss, functional capacity, muscle mass, and upper-body strength.

Changes in Physical Activity in Relation to Body Composition, Fitness and Quality of Life after Primary Bariatric Surgery: a Two-Year Follow-Up Study

Purpose

The success of bariatric surgery varies largely, which may relate to variance in adopting a physically active lifestyle. This study aimed to determine whether two-year changes in physical activity (PA) were associated with weight loss, fat-free mass, cardiorespiratory fitness and quality of life up to two years after bariatric surgery.

Materials and Methods

In this retrospective study, 3879 post-bariatric patients were divided into three groups: 1) decreased PA (n = 388), 2) maintained PA (n = 2002) or 3) increased PA (n = 1498). Measurements regarding PA (Baecke questionnaire), body composition (bioelectrical impedance analysis), estimated cardiorespiratory fitness (Åstrand test) and health-related quality of life (RAND-36) were performed preoperatively and two years post-surgery.

Results

Bariatric patients with increased PA had greater excess weight loss (76.3% vs. 73.2% vs. 72.9%, P < 0.001), greater increases in %fat-free mass (Δ14.0% vs. 13.0% vs. 12.8%; P < 0.001), larger improvements in VO₂max (Δ11.8 vs. 10.2 vs. 8.0 ml/kg/min, P < 0.001), and larger increases in health related quality of life subscale scores (P < 0.05) compared to patients with maintained- and decreased PA.

Conclusions

Bariatric patients who managed to induce improvements in habitual physical activity had better body composition, fitness and quality of life at 2 years post-surgery, compared to patients who maintained or even reduced their PA levels. These findings underscore the importance of perioperative-bariatric care programs to change lifestyle and achieve sustainable improvements in PA levels.

Electronic supplementary material

The online version of this article (10.1007/s11695-020-05009-x) contains supplementary material, which is available to authorized users.

Impact of Bariatric Surgery on Women Aerobic Exercise Capacity

RATIONALE

Bariatric surgery has a considerable positive effect on weight loss and on metabolic and cardiovascular risks. It has therefore been extensively used this last decade to overcome obesity. However, the impact of this surgery on exercise capacity remains unclear. The aim of this study is to clarify the impact of a surgically induced weight loss on aerobic exercise capacity (VO₂max) in a specific middle-aged female population.

METHODS

Forty-two women with a body mass index > 40 kg/m² (age, 42 ± 13 years; weight, 117 ± 15 kg) underwent blood analyses and a cardiopulmonary exercise test (CPET) before and 1 year after bariatric surgery. CPET was performed on a cycloergometer. The first ventilatory threshold (VT1) was measured according to the V-slope method.

RESULTS

Absolute VO₂max was reduced by 10% after surgery (2.0 ± 0.4 vs 1.8 ± 0.4 l/min, p < 0.01) or increased when corrected for body weight (18 ± 4 vs 23 ± 4 l/min/kg, p < 0.001) or unchanged when expressed as percentage of predicted values (111 ± 21 vs 105 ± 22, p = 0.06). Weight loss did not affect ventilatory or chronotropic response but increased maximal respiratory exchange ratio (RER) (p < 0.001), decreased maximal O₂pulse (p < 0.05) and VT1 in milliliters per minute (p < 0.01). By multivariable analysis, decreased absolute VO₂max after weight loss was associated with increased maximal RER and reduced maximal O₂pulse (p < 0.05, p < 0.01 respectively), possibly related to a muscular mass limitation.

CONCLUSIONS

Weight loss induced by bariatric surgery may reduce aerobic capacity in women in relation to muscle mass loss.

Associations of Weight Change With Changes in Calf Muscle Characteristics and Functional Decline in Peripheral Artery Disease

Background

Among people with lower extremity peripheral artery disease, obesity is associated with faster functional decline than normal weight. The association of weight loss with functional decline in peripheral artery disease is unknown.

Methods and Results

Adults with an ankle‐brachial index <0.90 were identified from Chicago‐area hospitals in 2002–2004. Weight and 6‐minute walk distance were measured annually. Weight change categories were weight loss or gain (≥5 pounds/year at ≥1 visit) or stable (weight change <5 pounds at each visit). Participants reported whether weight loss was “intentional” or “unintentional.” Calf muscle area was measured with computed tomography every 2 years. Associations of weight change with changes in calf muscle area and 6‐minute walk distance were analyzed using mixed‐effects models and adjusted for age, body mass index, ankle‐brachial index, physical activity, and other confounders. Among 389 participants, mean ankle‐brachial index was 0.63±0.16, mean age was 74.5±7.8, and mean body mass index was 28.1±5.1 kg/m². Over 3.23±1.37 years, muscle area declined more in adults with intentional weight loss versus stable or gain (pair‐wise comparisons, P<0.001). Intentional weight loss was associated with less annual decline in 6‐minute walk distance than weight gain (intentional loss, 3.7 m; stable, –14.0 m; gain, −28.5 m; unintentional loss, −20.8 m; pair‐wise comparison intentional loss versus gain, P=0.003).

Conclusions

Despite a greater loss of calf muscle area, adults with peripheral artery disease who intentionally lost ≥5 pounds experienced less functional decline than those who gained weight. A randomized trial is needed to establish whether benefits of weight loss in peripheral artery disease outweigh potential adverse effects.

See Editorial Kokkinidis et al

The Amount of Weight Loss Six Months after Bariatric Surgery: It Makes a Difference

BACKGROUND

Bariatric surgery, especially Roux-en-Y gastric bypass (RYGB), has become the most frequently used therapy for morbid obesity.

OBJECTIVES

The aim of this study was to examine the effects of surgically induced weight loss on cardiopulmonary function 6 months after the procedure, as well as the effect of such an intervention on well-known risk factors for cardiovascular diseases.

METHODS

This is a cross-sectional study on 66 morbidly obese patients (BMI ≥40 or ≥35 kg/m2 with present comorbidities), comparing their cardiopulmonary function prior to and 6 months after RYGB surgery.

RESULTS

The substantial amount of weight loss (29.80 ± 13.27 kg) after RYGB surgery was associated with significant reduction of comorbidities, especially diabetes and sedentary lifestyle (p = 0.005 and p = 0.002, respectively). Regarding functional capacity, there was significant increase in peak oxygen uptake (VO2 peak, p = 0.003), duration of exercise testing, metabolic equivalents (exercise time and METs, p < 0.001), and in peak O2 pulse. These findings were particularly pronounced in a group of patients who had lost more than 18% of initial weight.

CONCLUSIONS

Reduction of body weight after RYGB surgery is associated with significantly improved cardiorespiratory function 6 months after surgery, especially in patients who lost more than 18% of their initial body weight. In addition, substantial decreases in body weight were also associated with a reduction of cardiovascular risk factors such as diabetes, smoking, hypertriglyceridemia, and sedentary lifestyle.

The Effect of a Muscle Weight-Bearing and Aerobic Exercise Program on the Body Composition, Muscular Strength, Biochemical Markers, and Bone Mass of Obese Patients Who Have Undergone Gastric Bypass Surgery

BACKGROUND

The effect of an exercise program on the body composition, muscular strength (MS), biochemical markers, and bone mineral density (BMD) of individuals undergoing gastric bypass is unclear. We assessed lean mass (LM), MS, bone remodeling markers, and BMD before and after supervised weight-bearing and aerobic exercise training in obese patients who underwent Roux-en-Y gastric bypass (RYGB).

METHODS

This study included 37 obese patients (81.1% women, mean age 38.2 years, mean body mass index 42.4 ± 0.5 kg/m²). Whole body densitometry was used to evaluate pre- and postoperative BMD, total body fat, and LM. Serum calcium, parathyroid hormone, 25-hydroxyvitamin D, and bone remodeling markers were measured. MS was determined through the concentric 10 repetition maximum test. Postoperatively, participants were divided into two groups: the training group, who followed an exercise program (TG, n = 18), and the control group, who did not (CG, n = 19).

RESULTS

After 1 year, the TG showed a lower decrease in total BMD and at the lumbar spine and right hip compared with the CG (p < 0.001). The TG had lower mass reduction and an increase in upper limb LM compared with the CG (both p < 0.05). There was no significant difference between groups in bone markers or calcium metabolism. MS was higher in the TG than the CG (p < 0.05).

CONCLUSION

The supervised exercise program attenuated lumbar spine and right hip BMD loss and improved LM in the arms and overall MS but did not affect bone remodeling.