Effects of Exercise Mode on Improving Cardiovascular Function and Cardiorespiratory Fitness After Bariatric Surgery: A Narrative Review.

ABSTRACT: Obesity affects 600 million people globally and increases the risk of developing cardiovascular disease, stroke, diabetes, and cancer. Bariatric surgery is an increasingly popular therapeutic intervention for morbid obesity to induce rapid weight loss and reduce obesity-related comorbidities. However, some bariatric surgery patients, after what is considered a successful surgical procedure, continue to manifest obesity-related health issues, including weight gain, reduced physical function, persistent elevations in blood pressure, and reduced cardiorespiratory fitness. Cardiorespiratory fitness is a strong predictor of mortality and several health outcomes and could be improved by an appropriate exercise prescription after bariatric surgery. This review provides a broad overview of exercise training for patients after bariatric surgery and discusses cardiorespiratory fitness and other potential physiological adaptations in response to exercise training.

Responses of different functional tests in candidates for bariatric surgery and the association with body composition, metabolic and lipid profile.

Individuals with obesity can have metabolic disorders and may develop impairments that affect the ability to exercise. The maximal incremental cardiopulmonary exercise test is widely used to assess functional capacity. However, submaximal tests such as the two-minute step test (2MST) and the six-minute walk test (6MWT) also allow this assessment. We propose to analyze whether body composition, metabolic and lipid profile influence the maximal and submaximal performance, and investigate these variables in response to different functional tests. Forty-four individuals with obesity, aged 18-50 years, underwent analysis of body composition, metabolic and lipid profile, incremental treadmill test (ITMT), 6MWT, and 2MST. One-way ANOVA, Pearson or Spearman correlation, and Stepwise multiple linear regression analysis were performed. ITMT induced a greater metabolic, ventilatory, cardiovascular, and perceived exertion demand when compared to the 6MWT and 2MST (p < 0.05). In addition, 2MST elicited a higher chronotropic (HR) and metabolic (V̇O2) demand when compared to the 6MWT (p < 0.05). Significant correlations were found between tests and body composition, metabolic and lipid profile. Fat mass and low-density lipoprotein can explain 30% of the V̇O2 variance in the ITMT; and fat mass, glucose, and performance in the 2MST can explain 42% of the variance of the distance walked in the ITMT. Obesity and its metabolic impairments are capable of influencing responses to exercise. ITMT generated greater demand due to the high stress imposed, however, 2MST demanded greater metabolic and chronotropic demand when compared to the 6MWT.

Whole-body electrical stimulation as a strategy to improve functional capacity and preserver lean mass after bariatric surgery: a randomized triple-blind controlled trial.

BACKGROUND/OBJECTIVES: Bariatric surgery (BS) is a successful, long-lasting treatment option for obese. The early postoperative (PO) period is followed by dietary restriction and physical inactivity, leading to declines in muscle mass and functional capacity. Whole-body electromyostimulation (WB-EMS) may be a feasible and potential early rehabilitation strategy post BS. The aim was to evaluate the effects of WB-EMS with exercise training (Fe) on functional capacity, body composition, blood biomarkers, muscle strength, and endurance post BS. SUBJECTS/METHODS: This is a randomized, triple-blind, sham-controlled trial. Thirty-five volunteers underwent a Roux-en-Y gastric bypass and were randomized into a WB-EMS (WB-EMSG) or control group (ShamG). Preoperative evaluations consisted of maximal and submaximal exercise testing, body composition, blood biomarkers, quadriceps strength, and endurance. After discharge, functional capacity and body composition were obtained. Exercise training protocols in both groups consisted of 14 dynamic exercises, 5 days per week, completing 30 sessions. The WB-EMSG also underwent an electrical stimulation protocol (Endurance: 85 Hz, 350 ms, 6 s of strain, 4 f of rest; Strength: 30 Hz, 350 ms, 4 s of strain, 10 seconds of rest, with bipolar electrical pulse). After intervention, subjects were reevaluated. RESULTS: The protocol started on average 6.7 ± 3.7 days after discharge. Both groups presented with a decline in functional capacity after BS (p < 0.05) and a reduction in all body composition measurements (p < 0.05). The exercise training program led to significant improvements in functional capacity (ShamG - PO: 453.8 ± 66.1 m, Post: 519.2 ± 62.8 m; WB-EMSG- PO: 435.9 ± 74.5, Post: 562.5 ± 66.4 m, p < 0.05), however, only the WB-EMSG demonstrated significant changes of distance walked (interaction time vs group effect, p < 0.05). In addition, adiponectin significantly increased only in the WB-EMSG (p < 0.05). The WB-EMSG was also able to preserve muscle strength, endurance, and fatigue index, while the ShamG demonstrated significant decline (p < 0.05). CONCLUSION: WB-EMS + Fe can be an attractive and feasible method following BS to enhance functional capacity and prevent deterioration of muscle function in the early PO. CLINICAL TRIAL REGISTRATION: ReBEC, RBR-99qw5h, on 20 February 2015.

Effects of Whole-Body Electromyostimulation Associated with Dynamic Exercise on Functional Capacity and Heart Rate Variability After Bariatric Surgery: a Randomized, Double-Blind, and Sham-Controlled Trial.

PURPOSE: Bariatric surgery is the most effective treatment for morbid obesity. In association with dietary restrictions, the ability to exercise in the immediate post-surgical phase is limited. In this context, whole-body electromyostimulation (WB-EMS), strategy that stimulates various muscle groups, in conjunction with physical exercise, holds promise for improving functional capacity, and cardiac autonomic control, following surgery. The purpose of this study was to analyze whether a rehabilitation program consisting of WB-EMS with 30 exercise training sessions following bariatric surgery significantly improves functional capacity, body mass and heart rate variability (HRV). METHODS: Randomized, double-blind, and sham-controlled trial. Twenty obesity patients were randomized into the WB-EMS (n = 10) and sham (n = 10) groups. On average, 7 days after surgery, individuals underwent a six-minute walk test (6MWT), HRV, and body composition analysis at rest. The next day, patients initiated an exercise training protocol, five times per week, over 6 weeks. Walking distance changes (post-pre = ΔWD) obtained by 6MWT and HRV indices were determined following the intervention. RESULTS: Only WB-EMSG significantly increased WD and body mass index (BMI) after the intervention (p = 0.002) and ΔWD was significantly higher in this group when compared with sham (p = 0.04). Moreover, both groups demonstrated an improvement in key measures of HRV after the intervention. CONCLUSION: An exercise training intervention initiated shortly after bariatric surgery improved functional capacity and cardiac autonomic tone. Improvements in functional capacity and BMI following exercise training were greater with the addition of WB-EMS but did not promote additional improvements in HRV beyond that realized with exercise training alone.