Impact of Physical Training Programs on Physical Fitness in People With Class II and III Obesity: A Systematic Review and Meta-Analysis.

BACKGROUND: Physical training, regardless of the presence of concurrent weight loss, provides numerous health benefits for individuals who are overweight and obese and have or are at risk for cardiovascular disease. PURPOSE: The purpose of this review was to identify different types of physical training programs (aerobic, resistance, or combined), with or without counseling/diet modifications, and their impact on physical fitness in individuals who have class II and III obesity. DATA SOURCES: Medline and Medline In-Process, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, Web of Science, LILACS, CINAHL, SPORTDiscus, PEDro, and PubMed were searched up to June 2017. STUDY SELECTION: This review had the following inclusion criteria: body mass index of ≥35 kg/m2 and age 18 years or older; supervised physical training program; randomized controlled trial; physical fitness outcome (muscular strength, muscular endurance, cardiovascular endurance, and/or flexibility); in English or Portuguese; and available full-text article. DATA EXTRACTION: Three reviewers independently extracted data, assessed study risk of bias using the Cochrane tool, and discussed disagreements until consensus was reached. DATA SYNTHESIS: Of the 9460 identified articles, 26 were included and 8 were used in a meta-analysis. The meta-analysis showed improvements in walking speed and maximal oxygen uptake but not knee extension strength in the intervention groups. The Cochrane risk-of-bias score indicated that the majority of the data were from randomized controlled trials with a low or unclear risk of bias. LIMITATIONS: The large variability of outcomes and interventions made comparisons difficult. CONCLUSIONS: A combination of aerobic exercise and resistance exercise, in addition to diet modifications, may improve cardiovascular and muscular endurance in individuals with class II and III obesity. However, conclusions must be interpreted with caution because of the heterogeneity in interventions and outcome measures among the studies and an unclear risk of bias in several studies.

Bilevel positive airway pressure in two moments after bariatric surgery.

OBJECTIVE: To investigate the use of Bilevel Positive Airway Pressure (BiPAP) in morbidly obese individuals in two moments following bariatric surgery (Roux-en-Y gastric bypass): post-anesthetic recovery (PAR) and first postoperative day (1PO). DESIGN: Randomized and blinded clinical trial. METHODS: We studied 40 morbidly obese individuals aged between 25 and 55 years who underwent pulmonary function test and chest X-ray preoperatively, and on the day of discharge (2nd day after surgery). They were randomly allocated into two groups: PAR-G (BiPAP in PAR for one hour), and 1PO-G (BIPAP for one hour on the 1PO). RESULTS: In the PAR-G and 1PO-G, respectively there were significant reductions in slow vital capacity (SVC) (p=0.0007 vs. p<0.0001), inspiratory reserve volume (IRV) (p=0.0016 vs. p=0.0026), and forced vital capacity (FVC) (p=0.0013 vs. p<0.0001) and expiratory reserve volume (ERV) was maintained only for the PAR-G (p=0.4446 vs. p=0.0191). Comparing the groups, the SVC (p=0.0027) and FVC (p=0.0028) showed a significant difference between the treatments, while the PAR-G showed smaller declines in these capacities. The prevalence of atelectasis was 10% for the PAR-G and 30% for the 1PO-G (p=0.0027). CONCLUSION: Thus, the use of BiPAP in PAR can promote restoration of ERV and contribute to the reduction of atelectasis.

AIRWAY POSITIVE PRESSURE VS. EXERCISES WITH INSPIRATORY LOADING FOCUSED ON PULMONARY AND RESPIRATORY MUSCULAR FUNCTIONS IN THE POSTOPERATIVE PERIOD OF BARIATRIC SURGERY.

BACKGROUND: Bariatric surgery can trigger postoperative pulmonary complications due to factors inherent to the procedure, mainly due to diaphragmatic dysfunction. AIM: To evaluate and compare the effects of two levels of positive pressure and exercises with inspiratory load on lung function, inspiratory muscle strength and respiratory muscle resistance, and the prevalence of atelectasis after gastroplasty. METHODS: Clinical, randomized and blind trial, with subjects submitted to bariatric surgery, allocated to two groups: positive pressure group, who received positive pressure at two levels during one hour and conventional respiratory physiotherapy and inspiratory load group, who performed exercises with load linear inspiratory pressure, six sets of 15 repetitions, in addition to conventional respiratory physiotherapy, both of which were applied twice in the immediate postoperative period and three times a day on the first postoperative day. Spirometry was performed for pulmonary function analysis, nasal inspiratory pressure for inspiratory muscle strength and incremental test of respiratory muscle resistance for sustained maximal inspiratory pressure, both preoperatively and on hospital discharge on the second postoperative day. RESULTS: There was no significant difference (p> 0.05) in the expiratory reserve volume and in the tidal volume in the pre and postoperative periods when compared intra and intergroup. There was no significant difference (p>0.05) in the nasal inspiratory pressure and the maximal inspiratory pressure maintained in the inspiratory load group in the intragroup evaluation, but with a significant difference (p<0.05) compared to the positive pressure group. The prevalence of atelectasis was 5% in both groups with no significant difference (p>0.05) between them. CONCLUSION: Both groups, associated with conventional respiratory physiotherapy, preserved expiratory reserve volume and tidal volume and had a low atelectasis rate. The inspiratory loading group still maintained inspiratory muscle strength and resistance of respiratory muscles.

Accuracy of total energy expenditure predictive equations after a massive weight loss induced by bariatric surgery.

BACKGROUND AND AIMS: Predictive equations remain the clinical tool of choice to estimate the energy expenditure, however, poor accuracy has been found when applied in patients with severe obesity. The aim of this study was to test the accuracy of the total energy expenditure (TEE) those obtained by predictive equations of resting energy expenditure (REE) times individual estimates of metabolic equivalents (MET), taking as reference the TEE measured by doubly labeled water (DLW), before, six and twelve months after bariatric surgery. SUBJECTS AND METHODS: Twenty class III obese women (age: 29.4 ± 5.1 years; BMI: 44.9 ± 2.5 kg/m2), approved for Roux-en-Y gastric bypass participated in this study. TEE and body composition was measured after administration of a fixed dose of DLW. Predictive equations of REE were selected: Dietary Reference Intake (DRI), World Health Organization, Oxford, Harris-Benedict, Mifflin, De Lorenzo, Lazzer and Muller and their collaborators. The MET values were obtained individually by triaxial accelerometer. RESULTS: The patients showed 65% of excess weight loss. The body fat mass decreased 17% after 1 year of surgery. TEE (2930 ± 525 kcal.day-1) decreased by 20% (p < 0.05) by the sixth postoperative month (2319 ± 430 kcal.day-1), increasing 10% by the twelfth month (2538 ± 336 kcal.day-1). The Harris and Benedict (accuracy: 65%) and DRI equations (accuracy: 60%) yielded better results in the prediction of TEE values at pre-surgery. In the sixth month after surgery, only the equation of Harris and Benedict kept accuracy above 50%. At twelve months post-surgery, only the equation of Lazzer et al. considering body composition showed better prediction (accuracy: 50%) in this period. CONCLUSION: None of the prediction equations tested was accurate for estimating TEE for the 3 periods evaluated; however, while there are no reports of specific equations for class III obese women, the Harris and Benedict x MET and DRI equations, can describe the TEE with acceptable accuracy. After surgery, the best equation to be used will depend if the patient has been treated for weight loss and in which post-treatment period it is used. Registration of clinical trial as an observational study in Brazilian Clinical Trials Registry: RBR-8k5jsj. Universal Trial Number: U1111-1206-0858.

Association of 5-HT2C (rs3813929) and UCP3 (rs1800849) gene polymorphisms with type 2 diabetes in obese women candidates for bariatric surgery.

OBJECTIVE: Obesity can cause systemic arterial hypertension (SAH) and type 2 diabetes mellitus (DM2) factor that is also influenced by genetic variability. The present study aims to investigate the association between gene polymorphisms related with obesity on the prevalence of SAH and DM2 in the preoperative period and 1 year after Roux-en-Y gastric bypass surgery. SUBJECTS AND METHODS: In total, 351 obese women in a Brazilian cohort completed the study. The clinical diagnosis of SAH and DM2 was monitored from medical records. Twelve gene polymorphisms (rs26802; rs572169; rs7799039; rs1137101; rs3813929; rs659366; rs660339; rs1800849; rs7498665; rs35874116; rs9701796; and rs9939609) were determined using real-time polymerase chain reaction and TaqMan assay. RESULTS: In the preoperative period, prevalence of SAH and DM2 was 57% and 22%, respectively. One year postoperatively, 86.8% subjects had remission of DM2 and 99.5% had control of SAH. Subjects with T allele from the serotonin receptor gene (5-HT2C, rs3813929) had five times greater chance of DM2, and the CC genotype from uncoupling protein 3 gene (UCP3, rs1800849) had three times greater chance in the preoperative period. CONCLUSION: These findings indicate that polymorphisms rs3813929 and rs1800849 from 5-HT2C and UCP3 genes were related to DM2 prevalence among the Brazilian obese women candidates for bariatric surgery.

Micronutrient supplementation in gastric bypass surgery: prospective study on inflammation and iron metabolism in premenopausal women.

BACKGROUND: Low-grade chronic inflammation in morbid obesity is associated with impaired iron metabolism. Bariatric surgery is effective in weight loss; however, it can induce specific nutritional deficiencies, such as iron, especially in premenopausal women. Alternatively, after surgery, there is an improvement in systemic inflammation, raising questions concerning the dosages of micronutrient supplementation. OBJECTIVES: This study aimed to assess the effect of two micronutrient supplementation schemes before and 6 months after a Roux-en-Y gastric bypass (RYGB) surgery on inflammation and iron metabolism in premenopausal women. METHODS: This prospective study included 45 premenopausal women (aged 20-45 years; body mass index [BMI] ≥ 35 kg/m2) divided into two supplementation schemes: group 1 (n = 34): daily supplemental dose of 1 RDA 30 days before surgery and 2 RDAs during the six months following surgery; and group 2 (n = 11): daily supplementation of 1 RDA during the 6 months postsurgery. Anthropometry, dietary intake, inflammation, and iron metabolism were monitored. RESULTS: Evident reductions in BMI, high-sensitivity C-reactive protein, and ferritin levels for both groups occurred 6 months after surgery. Additionally, anemia was 9% in both groups after surgery. However, group 1 exhibited an increased transferrin saturation index and reduced transferrin levels. Multivariate regression analysis suggested serum iron, hepcidin, and iron intake determined ferritin values before and after RYGB surgery. CONCLUSION: Six months after RYGB, systemic inflammation was reduced in both supplementation schemes. However, supplementation of 1 RDA before and 2 RDAs after surgery resulted in better improvements on iron metabolism.

Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery.

BACKGROUND AND OBJECTIVE: To observe the prevalence of atelectasis in patients undergoing bariatric surgery and the influence of the body mass index (BMI), gender and age on the prevalence of atelectasis. METHOD: Retrospective study of 407 patients and reports on chest X-rays carried out before and after bariatric surgery over a period of 14 months. Only patients who underwent bariatric surgery by laparotomy were included. RESULTS: There was an overall prevalence of 37.84% of atelectasis, with the highest prevalence in the lung bases and with greater prevalence in women (RR=1.48). There was a ratio of 30% for the influence of age for individuals under the age of 36, and of 45% for those older than 36 (RR=0.68). There was no significant influence of BMI on the prevalence of atelectasis. CONCLUSION: The prevalence of atelectasis in bariatric surgery is 37% and the main risk factors are being female and aged over 36 years.

[Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery]. / Análise da prevalência de atelectasia em pacientes submetidos à cirurgia bariátrica.

BACKGROUND AND OBJECTIVE: To observe the prevalence of atelectasis in patients undergoing bariatric surgery and the influence of the body mass index (BMI), gender and age on the prevalence of atelectasis. METHOD: Retrospective study of 407 patients and reports on chest X-rays carried out before and after bariatric surgery over a period of 14 months. Only patients who underwent bariatric surgery by laparotomy were included. RESULTS: There was an overall prevalence of 37.84% of atelectasis, with the highest prevalence in the lung bases and with greater prevalence in women (RR=1.48). There was a ratio of 30% for the influence of age for individuals under the age of 36, and of 45% for those older than 36 (RR=0.68). There was no significant influence of BMI on the prevalence of atelectasis. CONCLUSION: The prevalence of atelectasis in bariatric surgery is 37% and the main risk factors are being female and aged over 36 years.

Gene polymorphisms as a predictor of body weight loss after Roux-en-Y gastric bypass surgery among obese women.

This study aimed to investigate the association between twelve gene polymorphisms and body weight loss, 12 months after Roux-en-Y gastric bypass (RYGB) surgery. Three hundred and fifty-one obese women participated in this study. The statistical software WEKA was used to identify which gene polymorphisms were potential predictors of postoperative percentage of excess weight loss (%EWL). Our results indicate that the only gene polymorphism that predicted %EWL was rs3813929, which is related to the serotonin receptor gene (5-HT2C). Therefore, the 5-HT2C gene polymorphism rs3813929 (more specifically, the TT genotype) predicted greater %EWL 12 months after RYGB surgery among female patients.

[Use of positive pressure in pre and intraoperative of bariatric surgery and its effect on the time of extubation]. / Utilização da pressão positiva no pré e no intraoperatório de cirurgia bariátrica e seus efeitos sobre o tempo de extubação.

BACKGROUND AND OBJECTIVE: to investigate the influence of intraoperative and preoperative airway positive pressure in the time of extubation in patients undergoing bariatric surgery. METHOD: Randomized clinical trial, in which 40 individuals with a body mass index between 40 and 55kg/m(2), age between 25 and 55 years, nonsmokers, underwent bariatric surgery type Roux-en-Y gastric bypass by laparotomy and with normal preoperative pulmonary function were randomized into the following groups: G-pre (n = 10): individuals who received treatment with noninvasive positive pressure before surgery for one hour, G-intra (n = 10): individuals who received positive end-expiratory pressure of 10cm H2O throughout the surgical procedure and G-control (n = 20): not received any pre or intraoperative intervention. Following were recorded: time between induction of anesthesia and extubation, between the end of anesthesia and extubation, duration of mechanical ventilation, and time between extubation and discharge from the Post-Anesthetic Recovery. RESULTS: there was no statistical difference between groups. However, when applied to the Cohen coefficient, the use of positive end-expiratory pressure of 10cm H2O during surgery showed a large effect on the time between the end of anesthesia and extubation. About this same time, the treatment performed preoperatively showed moderate effect. CONCLUSION: The use of positive end-expiratory pressure of 10cm H2O in the intraoperative and positive pressure preoperatively, influenced the time of extubation of patients undergoing bariatric surgery.

Application of positive airway pressure in restoring pulmonary function and thoracic mobility in the postoperative period of bariatric surgery: a randomized clinical trial.

OBJECTIVE: To evaluate whether the application of bilevel positive airway pressure in the postoperative period of bariatric surgery might be more effective in restoring lung volume and capacity and thoracic mobility than the separate application of expiratory and inspiratory positive pressure. METHOD: Sixty morbidly obese adult subjects who were hospitalized for bariatric surgery and met the predefined inclusion criteria were evaluated. The pulmonary function and thoracic mobility were preoperatively assessed by spirometry and cirtometry and reevaluated on the 1st postoperative day. After preoperative evaluation, the subjects were randomized and allocated into groups: EPAP Group (n=20), IPPB Group (n=20) and BIPAP Group (n=20), then received the corresponding intervention: positive expiratory pressure (EPAP), inspiratory positive pressure breathing (IPPB) or bilevel inspiratory positive airway pressure (BIPAP), in 6 sets of 15 breaths or 30 minutes twice a day in the immediate postoperative period and on the 1st postoperative day, in addition to conventional physical therapy. RESULTS: There was a significant postoperative reduction in spirometric variables (p<0.05), regardless of the technique used, with no significant difference among the techniques (p>0.05). Thoracic mobility was preserved only in group BIPAP (p>0.05), but no significant difference was found in the comparison among groups (p>0.05). CONCLUSION: The application of positive pressure does not seem to be effective in restoring lung function after bariatric surgery, but the use of bilevel positive pressure can preserve thoracic mobility, although this technique was not superior to the other techniques.

Bilevel positive airway pressure in two moments after bariatric surgery

SUMMARY OBJECTIVE To investigate the use of Bilevel Positive Airway Pressure (BiPAP) in morbidly obese individuals in two moments following bariatric surgery (Roux-en-Y gastric bypass): post-anesthetic recovery (PAR) and first postoperative day (1PO). DESIGN Randomized and blinded clinical trial. METHODS We studied 40 morbidly obese individuals aged between 25 and 55 years who underwent pulmonary function test and chest X-ray preoperatively, and on the day of discharge (2nd day after surgery). They were randomly allocated into two groups: PAR-G (BiPAP in PAR for one hour), and 1PO-G (BIPAP for one hour on the 1PO). RESULTS In the PAR-G and 1PO-G, respectively there were significant reductions in slow vital capacity (SVC) (p=0.0007 vs. p<0.0001), inspiratory reserve volume (IRV) (p=0.0016 vs. p=0.0026), and forced vital capacity (FVC) (p=0.0013 vs. p<0.0001) and expiratory reserve volume (ERV) was maintained only for the PAR-G (p=0.4446 vs. p=0.0191). Comparing the groups, the SVC (p=0.0027) and FVC (p=0.0028) showed a significant difference between the treatments, while the PAR-G showed smaller declines in these capacities. The prevalence of atelectasis was 10% for the PAR-G and 30% for the 1PO-G (p=0.0027). CONCLUSION Thus, the use of BiPAP in PAR can promote restoration of ERV and contribute to the reduction of atelectasis.

RESUMO OBJETIVO Investigar o uso da pressão positiva em dois níveis nas vias aéreas (BiPAP) em obesos mórbidos em dois momentos após a cirurgia bariátrica (bypass gástrico em Y-de-Roux): recuperação pós-anestésica (RPA) e primeiro dia de pós-operatório (1PO). DESENHO Ensaio clínico randomizado e cego. MÉTODO Foram estudados 40 obesos mórbidos, com idade entre 25 e 55 anos, submetidos à prova de função pulmonar e radiografia de tórax no pré-operatório e no dia da alta (segundo dia de pós-operatório). Eles foram alocados aleatoriamente em dois grupos: G-RPA (BiPAP na RPA por uma hora) e G-1PO (BiPAP por uma hora no 1PO). RESULTADOS No G-RPA e G-1PO, respectivamente, houve reduções significativas na capacidade vital lenta (CVL) (p=0,0007 vs p<0,0001), volume de reserva inspiratório (VRI) (p=0,0016 vs p=0,0026) e capacidade vital forçada (CVF) (p=0,0013 vs p<0,0001). O volume de reserva expiratório (VRE) foi mantido apenas para o G-RPA (p=0,4446 vs p=0,0191). Comparando os grupos, a CVL (p=0,0027) e a CVF (p=0,0028) apresentaram diferenças significativas entre os tratamentos e o G-RPA apresentou menores declínios nessas capacidades. A prevalência de atelectasia foi de 10% para o G-RPA e 30% para o 1PO-G (p=0,0027). CONCLUSÃO O uso de BiPAP na RPA pode promover uma restauração do VRE e contribuir para a redução de atelectasias.

Ferritin in hypertensive and diabetic women before and after bariatric surgery.

UNLABELLED: In addition to its important role as marker of iron stores, serum ferritin is a marker of systemic inflammation, and obesity has been associated with chronic inflammation. OBJECTIVE: To verify, six months after surgery, the effect of bariatric surgery on the serum ferritin of women who were hypertensive, diabetic, or comorbidity free before surgery. SAMPLE AND METHODS: This retrospective study included 200 women aged 20 to 45 years, with a body mass index (BMI) equal to or greater than 35 kg/m2, submitted to Roux-en-Y gastric bypass (RYGB). Seventy of these women were hypertensive, forty had type 2 diabetes (T2D), and ninety were comorbidity free (CF). They were assessed before and six months after surgery. Anthropometric, laboratory (serum ferritin and hemoglobin), and comorbidity- related data were collected from their medical records. RESULTS: Before surgery, women with comorbidities were older, the hypertensives had higher BMI, and the diabetics had higher serum ferritin levels than the CF women. The study comorbidities had resolved in 68% of the hypertensive women and 86% of the diabetic women six months after RYGB. Also at this time, the serum ferritin of hypertensive women decreased from 110.1±86.3 to 88.7±80.5 ng/dL and of diabetic women, from 164.8±133.4 to 101.2±97.7 ng/dL (p0.05). CONCLUSION: High ferritin in premenopausal obese women was associated with the main obesity-related comorbidities, and these comorbidities determined the reduction of serum ferritin after bariatric surgery.

Además de importante marcador de las reservas de hierro, la ferritina sérica es un marcador de la inflamación sistémica, mientras que la obesidad se ha asociado con la inflamación crónica. Objetivo: Identificar, después de 6 meses, el efecto de la cirugía bariátrica sobre los niveles de ferritina sérica en hipertensos, diabéticos o sin estas comorbilidades preoperatorias mujeres. Pacientes y métodos: Los autores realizaron un estudio retrospectivo de 200 mujeres sometidas a bypass gástrico en Y de Roux (BGYR), con edades comprendidas entre 20 y 45 años, con un índice de masa corporal (IMC) superior a 35 kg/m2, con hipertensión arterial (HA, n = 70), la diabetes mellitus tipo 2 (DM2, n = 40) y sin comorbilidades (SC, n = 90) fueron evaluados antes y 6 meses después de BGYR. Antropométricas, de laboratorio (ferritina sérica y hemoglobina) y la información de comorbilidad se recogió de la historia clínica electrónica. Resultados: Antes de la cirugía, las mujeres con comorbilidades eran mayores, tenían mayores hipertensos IMC, niveles más altos de ferritina diabéticos en relación con el grupo SC. La resolución de las comorbilidades después de 6 meses de DGYR ocurrió en el 68 % de las mujeres con hipertensión y el 86 % de los diabéticos. 6 meses después de la cirugía, se observó una disminución de la ferritina sérica en mujeres con comorbilidades de 110,1 ± 86,3 a 88,7 ± 80,5 ng/dl en el grupo con hipertensión y 164,8 ± 133,4 a 101 2 ± 97,7 ng/dl en DM2 (p < 0,05) y la hemoglobina, excepto en los pacientes diabéticos (p > 0,05). Conclusión: El aumento de la ferritina en mujeres obesas en el periodo de premenopausia se relacionan con las principales comorbilidades de la obesidad, y la presencia de estas comorbilidades fue fundamental en la reducción de la ferritina sérica después de la cirugía bariátrica.

Lipoabdominoplastia em âncora / Anchor lipoabdominoplasty

A obesidade mórbida se caracteriza por acúmulo de tecido adiposo que se distribui de maneira heterogênea em todo o organismo, tendo a gastroplastia como o mais recente método de tratamento cirúrgico. Após perda considerável de peso, o doente apresenta sobras cutâneas, sob essas sobras acumulam-se secreções que favorecem a instalação de infecções cutâneas que podem ser minimizadas com a execução de dermolipectomias. Os autores descrevem a técnica de lipoabdominoplastia em âncora, adaptando os princípios de descolamento reduzido do retalho, lipoaspiração de abdome e flancos, e preservação da fáscia de Scarpa infraumbilical associado à marcação pré-cirúrgica em "Fleur-de-Lis". A técnica foi realizada em 17 pacientes em pós-operatório tardio de gastroplastia, entre janeiro de 2018 e junho de 2019, com idade entre 35 a 66 anos, sendo 16 pacientes do sexo feminino e 1 do sexo masculino. Todos os pacientes foram operados com exames pré-operatórios dentro da normalidade, condições clínicas satisfatórias e IMC<30. Na presente série de casos, um paciente apresentou epidermólise de coto umbilical; todos os pacientes apresentaram edema e equimoses, e um paciente apresentou seroma no 13º dia de pós-operatório. Hematoma, necrose, infecção, deiscência de ferida operatória ou eventos tromboembólicos não foram observados em nenhum paciente. A técnica demostrou ser segura e eficaz no tratamento de pacientes com excedente cutâneo abdominal, com melhora do contorno corporal, porém há necessidade de maior tempo de acompanhamento pós-operatório e maior número de casos operados para melhor mensurar os resultados, bem como a incidência de complicações.

Morbid obesity is characterized by the accumulation of adipose tissues distributed heterogeneously throughout the body, and gastroplasty is the latest method of surgical treatment. After considerable weight loss, patients present with excess skin under which secretions accumulate, increasing susceptibility for skin infections, which can be minimized with dermolipectomy. Herein, we describe the anchor lipoabdominoplasty technique, adapting the principles of reduced flap detachment, abdominal and flank liposuctions, and preservation of the infraumbilical Scarpa's fascia associated with the preoperative fleurde- lis marking. The technique was used for seventeen patients, including sixteen women and one man, with late postoperative gastroplasty, aged 35­66 years in the period from January 2018 to June 2019. The patients presented with normal preoperative testing, satisfactory clinical conditions, and body mass index scores less than 30 kg/m2. In the present case series, one patient had umbilical cord remnant epidermolysis; all patients had edema and ecchymosis; and one patient had seroma on postoperative day 13. Hematoma, necrosis, infection, wound dehiscence, or thromboembolic events were not observed in any patient. The technique is safe and effective in the treatment of patients with abdominal excess skin, improving their body contour. However, longer postoperative follow-up periods and more cases are necessary to better measure the results and incidence of complications.

Treinamento físico aquático melhora capacidade funcional e aptidão física em mulheres com obesidade graus II e III / Aquatic physical training improves functional capacity and physical fitness in grades II and III obese women / El entrenamiento físico acuático mejora la capacidad funcional y la aptitud física en mujeres con grados de obesidad II y III

Resumo O objetivo foi verificar o efeito de um treinamento físico aquático (TFA) na aptidão física e capacidade funcional de obesas graus II e III. Foram estudadas 14 mulheres com 34,2 ± 8,3 anos e índice de massa corporal (IMC) de 44,76 ± 10,08 kg/m2 que fizeram TFA de 12 semanas. Foram avaliados o IMC e as medidas de circunferências, capacidade aeróbia e funcional pelos testes: degrau seis minutos; sentar e levantar e sentar e alcançar, antes e após o TFA. Evidenciou-se redução significativa na massa corporal, IMC e circunferência da cintura, assim como aumento (p < 0,05) na força de membros inferiores, flexibilidade e capacidade aeróbia e funcional. Concluiu-se que o TFA proposto melhorou a aptidão física e a capacidade funcional de obesas graus II e III.

Abstract The objective was to investigate the effect of an aquatic physical training (APT) on physical fitness and functional capacity of grades II and III obese women. The study included 14 women aged 34.2 ± 8.3 years and body mass index (BMI) of 44.76 ± 10.08 kg/m2 who underwent APT for 12 weeks. BMI and measures of circumferences, aerobic and functional capacity were evaluated by means of tests: six-minute step; sit-to-stand; and sit-and-reach, before and after the APT. There was a significant reduction in body mass, BMI and waist circumference as well as an increase (p < 0.05) in lower limb strength, flexibility and aerobic and functional capacity. The proposed APT improved the physical fitness and the functional capacity of grades II and III obese women.

Resumen El objetivo fue comprobar el efecto de un entrenamiento físico acuático (EFA) en la aptitud física y la capacidad funcional de mujeres obesas de los grados II y III. Se estudiaron 14 mujeres con edad de 34,2±8,3 años e índice de masa corporal (IMC) de 44,76±10,08 kg/m2 que realizaron entrenamiento físico acuático de 12 semanas. Se evaluaron el IMC y las medidas de perímetros, capacidad aeróbica y funcional de las pruebas: simulador de escalera durante 6 minutos; sentarse y levantarse, y sentarse y estirarse, antes y después del entrenamiento físico acuático. Se evidenció una reducción importante de la masa corporal, IMC y perímetro de la cintura, así como aumento (p< 0,05) de la fuerza de miembros inferiores, flexibilidad y capacidad aeróbica y funcional. Se concluye que el entrenamiento físico acuático propuesto mejoró la aptitud física y la capacidad funcional de mujeres obesas de los grados II y III.

Inspiratory loading exercises on respiratory muscle function in post-operative gastroplasty patients: a randomized clinical trial / Exercícios com carga inspiratória na função muscular respiratória no pós-operatório de gastroplastia: um ensaio clínico randomizado / Ejercicios con carga inspiratoria en la función muscular respiratoria en el postoperatorio de gastroplastia: un ensayo clínico aleatorizado

Abstract Introduction: The gastroplasty post-operative period can alter respiratory mechanics and predispose patients to respiratory complications. Objective: The objective was to evaluate the effects of exercises with inspiratory load on respiratory muscle function and on the prevalence of atelectasis after gastroplasty. Method: 40 participants were randomly allocated into two groups: Control Group (CG), its members underwent conventional respiratory physical therapy (CRP) and the Inspiratory Load Group (ILG), its members performed exercises with linear inspiratory pressure load, with 40% of the maximum inspiratory pressure (MIP), associated with CRP. Therapy procedures were conducted twice during the immediate post-operative period and thrice on the first post-operative day. In addition to evaluating the MIP, the nasal inspiratory pressure (NIP) and the sustained maximum inspiratory pressure (SMIP) were evaluated before and after treatment. Analysis of variance followed by the Bonferroni correction were applied considering a 5% significance level (p < 0.05). Results: There was no significant difference in NIP and SMIP values when the pre- and post-operative periods were compared for the ILG; however, these values were significantly lower for the CG, also with intergroup differences in NIP values. Atelectasis prevalence was 5% for ILG and 15% for CG, with no intergroup difference. Conclusion: The inspiratory muscle strength and resistance of the respiratory muscles were maintained in the group that performed exercises with inspiratory load associated with CRP, with a low rate of atelectasis after gastroplasty.

Resumo Introdução: O pós-operatório de gastroplastia pode alterar a mecânica respiratória e predispor a complicações respiratórias. Objetivo: Avaliar os efeitos de exercícios com carga inspiratória na função muscular respiratória e na prevalência de atelectasias após gastroplastia. Método: 40 voluntárias foram alocadas randomicamente em: Grupo Controle (GC), que recebeu Fisioterapia Respiratória Convencional (FRC) e Grupo Carga Inspiratória (GCI), que executou exercícios com carga inspiratória linear pressórica com 40% da pressão inspiratória máxima (PImáx), associados à FRC. Os tratamentos foram realizados duas vezes no pós-operatório imediato e três vezes no primeiro dia pós-operatório. Além da PImáx, foram avaliadas a pressão inspiratória nasal (PIN) e a pressão inspiratória máxima sustentada (PImáxS) antes e após o tratamento. Foi realizada análise de variância seguida de ajuste de Bonferroni, e o nível de significância estatística foi de 5% (p < 0,05). Resultados: Não houve diferença significativa nos valores de PIN e na PImáxS no GCI quando comparados o pré e pós-operatório, diferentemente do GC, no qual esses valores foram significativamente menores além de diferença entre os grupos no valor de PIN. A prevalência de atelectasias foi de 5% para GCI e 15% para GC, sem diferenças intergrupos. Conclusão: Houve manutenção da força muscular inspiratória e da resistência dos músculos respiratórios no grupo que realizou exercícios com carga inspiratória, associado a FRC com baixo índice de atelectasias após gastroplastia.

Resumen Introducción: El postoperatorio de gastroplastia puede alterar la mecánica respiratoria y predisponer a complicaciones respiratorias. Objetivo: Evaluar los efectos de ejercicios con carga inspiratoria en la función muscular respiratoria y en la prevalencia de atelectasias después de la gastroplastia. Método: 40 voluntarias fueron asignadas en: Grupo Control (GC), que recibió Fisioterapia Respiratoria Convencional (FRC) y Grupo Carga Inspiratoria (GCI), que ejecutó ejercicios con carga inspiratoria, realizados con carga lineal inspiratoria con un 40% de la presión inspiratoria máxima (PIM) asociados a la FRC. Ambos tratamientos se realizaron dos veces en el postoperatorio inmediato y tres veces en el primer día postoperatorio. Además de la PIM, se evaluaron la presión inspiratoria nasal (PIN) y la presión inspiratoria máxima sostenida (PImáxS) antes y después del tratamiento. Se realizó el análisis de varianza seguida de ajuste de Bonferroni. Se adoptó nivel de significancia estadística del 5% (p < 0,05). Resultados: No hubo diferencia significativa en los valores de PIN y en la PImáxS en el GCI cuando se compararon en el pre y en postoperatorio, a diferencia del GC, en el cual estos valores fueron significativamente menores más allá de diferencia entre los grupos en el valor de PIN. La prevalencia de atelectasias fue de 5% para GCI y 15% para GC, sin diferencia entre grupos. Conclusión: Hubo mantenimiento de la fuerza muscular inspiratoria y de la resistencia de los músculos respiratorios en el grupo que realizó ejercicios con carga inspiratoria, asociados a la FRC, con bajo índice de atelectasias tras gastroplastia.

Lung age in women with morbid obesity.

OBJECTIVE: To investigate the influence of morbid obesity on the lung age in women and to correlate with body mass, body mass index (BMI), and ventilatory variables. METHODS: This was a cross-sectional study with 72 morbidly obese women and a control group consisting of 37 normal weight women. The subjects performed a pulmonary function test to determine lung age, and the results were correlated to anthropometric variables and lung volumes. RESULTS: The morbidly obese group had significantly higher lung age (50.1±6.8 years) than the control group (38.8±11.4 years). There was no difference in chronological age between groups. There was a significant positive correlation among chronological age, body mass, BMI, and lung age (r=0.3647, 0.4182, and 0.3743, respectively). There was a negative correlation among forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, expiratory reserve volume (ERV), and lung age (r=-0.7565, -0.8769, --0.2723, and -0.2417, respectively). CONCLUSION: Lung age is increased in morbidly obese women and is associated with increased body mass and BMI.

Airway positive pressure vs. exercises with inspiratory loading focused on pulmonary and respiratory muscular functions in the postoperative period of bariatric surgery / Pressão positiva nas vias aéreas versus exercícios com carga inspiratória na função pulmonar e na função muscular respiratória no pós-operatório de cirurgia bariátrica

ABSTRACT Background: Bariatric surgery can trigger postoperative pulmonary complications due to factors inherent to the procedure, mainly due to diaphragmatic dysfunction. Aim: To evaluate and compare the effects of two levels of positive pressure and exercises with inspiratory load on lung function, inspiratory muscle strength and respiratory muscle resistance, and the prevalence of atelectasis after gastroplasty. Methods: Clinical, randomized and blind trial, with subjects submitted to bariatric surgery, allocated to two groups: positive pressure group, who received positive pressure at two levels during one hour and conventional respiratory physiotherapy and inspiratory load group, who performed exercises with load linear inspiratory pressure, six sets of 15 repetitions, in addition to conventional respiratory physiotherapy, both of which were applied twice in the immediate postoperative period and three times a day on the first postoperative day. Spirometry was performed for pulmonary function analysis, nasal inspiratory pressure for inspiratory muscle strength and incremental test of respiratory muscle resistance for sustained maximal inspiratory pressure, both preoperatively and on hospital discharge on the second postoperative day. Results: There was no significant difference (p> 0.05) in the expiratory reserve volume and in the tidal volume in the pre and postoperative periods when compared intra and intergroup. There was no significant difference (p>0.05) in the nasal inspiratory pressure and the maximal inspiratory pressure maintained in the inspiratory load group in the intragroup evaluation, but with a significant difference (p<0.05) compared to the positive pressure group. The prevalence of atelectasis was 5% in both groups with no significant difference (p>0.05) between them. Conclusion: Both groups, associated with conventional respiratory physiotherapy, preserved expiratory reserve volume and tidal volume and had a low atelectasis rate. The inspiratory loading group still maintained inspiratory muscle strength and resistance of respiratory muscles.

RESUMO Racional : A cirurgia bariátrica pode desencadear complicações pulmonares no pós-operatório devido a fatores inerentes ao procedimento, sobretudo pela disfunção diafragmática. Objetivo : Avaliar e comparar os efeitos da aplicação de dois níveis de pressão positiva e dos exercícios com carga inspiratória na função pulmonar, força muscular inspiratória e resistência muscular respiratória e na prevalência de atelectasia após gastroplastia. Métodos : Ensaio clínico, randomizado e cego, com sujeitos submetidos à cirurgia bariátrica, alocados em dois grupos: grupo pressão positiva, que recebeu pressão positiva em dois níveis, durante uma hora e fisioterapia respiratória convencional e grupo carga inspiratória, que realizou exercícios com carga linear pressórica inspiratória, seis séries de 15 repetições, além da fisioterapia respiratória convencional, sendo ambos aplicados duas vezes no pós-operatório imediato e três vezes ao dia no primeiro dia de pós-operatório. Foram realizados espirometria para análise da função pulmonar, pressão inspiratória nasal para força muscular inspiratória e teste incremental de resistência muscular respiratória para pressão inspiratória máxima sustentada, no pré-operatório e no dia da alta hospitalar, no segundo dia de pós-operatório. Resultados : Não houve diferença significativa (p>0,05) no volume de reserva expiratório e no volume corrente no pré e no pós-operatório quando comparados intra e intergrupo. Não houve diferença significativa (p>0,05) na pressão inspiratória nasal e na pressão inspiratória máxima sustentada no grupo carga inspiratória na avaliação intragrupo, mas com diferença significativa (p<0,05) comparada ao grupo pressão positiva. A prevalência de atelectasias foi de 5% em ambos os grupos sem diferença significativa (p>0,05) entre eles. Conclusão : Ambos os grupos, associados à fisioterapia respiratória convencional, preservaram o volume de reserva expiratório e o volume corrente e apresentaram baixo índice de atelectasias. O grupo carga inspiratória ainda manteve a força muscular inspiratória e a resistência dos músculos respiratórios.

The under-reporting of energy intake influences the dietary pattern reported by obese women in the waiting list for bariatric surgery / A subnotificação do consumo energético influencia os resultados de padrão alimentar relatado por mulheres obesas na fila de espera para cirurgia bariátrica

ABSTRACT Objective To verify the interference of the energy intake under-reporting in the determination of the dietary patterns and nutrient intakes reported by obese women in the waiting list for bariatric surgery. Methods The study included 412 women aged 20 to 45 years with a body mass index ranging from 35 to 60kg/m2 who were on waiting list for bariatric surgery. Data from three reported food intake and physical activity, body weight, and height were used for estimating the reported energy intake, physical activity level, and resting energy expenditure. Subsequently, it was checked the biological plausibility of the reported energy intakes, classifying all participants as plausible reporters or under-reporters. Exploratory factor analysis was used to determine the participants' dietary patterns. The Mann-Whitney test assessed the reported energy and nutrient intakes between plausible reporters and under-reporters groups. The Z-test assessed the variables of plausible reporters or under-reporters in relation to all participants of the study. Results Six dietary patterns were determined for all participants of study. After excluding information from under-reporting women, only two dietary patterns remained similar to those of all participants, while three other dietary patterns presented different conformations from food subgroups to plausible reporters. The reported energy intake did not present difference for the subgroups of fruits, leaf vegetables and vegetables. However, the energetic value reported for the other food subgroups was higher for the plausible reporters. Conclusion The under-reporting of energy intake influenced the determination of dietary patterns of obese women waiting for bariatric surgery.

RESUMO Objetivo Esta pesquisa buscou verificar a interferência da subnotificação do consumo energético na determinação do padrão alimentar e consumo de nutrientes, relatados por mulheres obesas na fila de espera para cirurgia bariátrica. Métodos Participaram do estudo 412 mulheres com idade entre 20 e 45 anos e índice de massa corporal entre 35 e 60 kg/m2, que aguardavam na fila de espera de cirurgia bariátrica. Foram utilizadas informações de três registros do consumo alimentar, da atividade física de 24 horas e do peso corporal e altura, para estimativa da Ingestão Energética Relatada, Nível de Atividade Física e Gasto Energético de Repouso das participantes e subsequente verificação da plausibilidade biológica do consumo energético. As mulheres foram agrupadas em notificadoras plausíveis e subnotificadoras. A análise fatorial exploratória foi utilizada para classificar os padrões alimentares. Os valores relatados de energia e nutrientes entre os grupos de notificadoras plausíveis e subnotificadoras foram avaliados por meio do teste de Mann-Whitney. O Teste de hipótese Z avaliou as variáveis das notificadoras plausíveis ou subnotificadoras em relação a todas as participantes do estudo. Resultados Seis padrões alimentares foram determinados para todas as participantes do estudo. Após excluir as informações das mulheres subnotificadoras, apenas dois padrões alimentares mantiveram-se similares aos de todas as participantes, ao passo que outros três padrões alimentares apresentaram diferentes conformações de subgrupos alimentares para as notificadoras plausíveis. A ingestão energética relatada não apresentou diferença para os subgrupos das frutas, hortaliças e legumes. Porém, o valor energético relatado para os demais subgrupos alimentares foi maior para as notificadoras plausíveis. Conclusão A subnotificação do consumo energético influenciou a determinação de padrões alimentares de mulheres obesas na lista de espera para cirurgia bariátrica.

Behavior of respiratory muscle strength in morbidly obese women by using different predictive equations.

BACKGROUND: Studies on the behavior of respiratory muscle strength (RMS) in morbidly obese patients have found conflicting results. OBJECTIVES: To evaluate RMS in morbidly obese women and to compare the results by using different predictive equations. METHOD: This is a cross-sectional study that recruited 30 morbidly obese women and a control group of 30 normal-weight women. The subjects underwent anthropometric and maximal respiratory pressure measurement. Visual inspection of the Bland-Altman plots was performed to evaluate the correlation between the different equations, with a p value lower than 0.05 considered as statistically significant. RESULTS: The obese women showed a significant increase in maximal inspiratory pressure (MIP) values (-87.83±21.40 cmH(2)O) compared with normal-weight women (-72±15.23 cmH(2)O) and a significant reduction of MIP (-87.83±21.40 cmH(2)O) according to the values predicted by the EHarik equation (-130.71±11.98 cmH(2)O). Regarding the obtained maximal expiratory pressure (MEP), there were no between-group differences (p>0.05), and no agreeement was observed between obtained and predicted values of MEP and the ENeder and ECosta equations. CONCLUSIONS: Inspiratory muscle strength was greater in the morbidly obese subjects. The most appropriate equation for calculating the predicted MIP values for the morbidly obese seems to be Harik-Khan equation. There seem to be similarities between the respiratory muscle strength behavior of morbidly obese and normal-weight women, however, these findings are still inconclusive.