Effects of Inspiratory Exercise With Linear and Nonlinear Load on Respiratory Variables Post-Bariatric Surgery.

BACKGROUND: Obesity leads to changes in respiratory function, causing reduced lung volumes and mechanical disadvantage of the respiratory muscles. We sought to evaluate the effect of breathing exercises using devices that impose linear and nonlinear load on reversing diaphragm dysfunction and the prevalence of atelectasis after bariatric surgery. METHODS: This was a blind randomized clinical trial. Preoperatively, we assessed the subjects' maximum inspiratory pressure by measuring nasal inspiratory pressure and respiratory muscle endurance with an incremental test based on sustained maximum inspiratory pressure (sustained PImax) and the prevalence of atelectasis by chest radiograph. Subjects were then randomized into 2 groups: a linear load pressure group and nonlinear load pressure group; both groups received conventional respiratory physiotherapy. Subjects were reassessed on the second day after bariatric surgery. RESULTS: We included 40 morbidly obese women (body mass index > 40 kg/m2), age 25-55 years, who underwent bariatric surgery by laparotomy. The groups were homogeneous with respect to age (P = .11), body mass (P = .12), height (P = .75), body mass index (P = .75), nasal inspiratory pressure (P = .48), sustained PImax (P = .89), and absence of atelectasis at baseline. In the reassessment, both groups showed significant reduction in nasal inspiratory pressure (P < .001) and maintenance of sustained PImax (linear load pressure P = .51; nonlinear load pressure P = .055). The prevalence of atelectasis was 15% for linear load pressure and 25% for nonlinear load pressure, with no significant difference between groups (P = .69). CONCLUSION: Both groups were able to maintain respiratory muscle endurance after bariatric surgery. In addition, the treatment contributed to controlling atelectasis so that it did not cause clinical repercussions to the subjects. (ClinicalTrials.gov registration NCT02298517).

Changes in Physical Activities and Body Composition after Roux-Y Gastric Bypass Surgery.

PURPOSE: Given the importance of physical activities for health outcomes, it is still unclear whether bariatric surgery per se and the standard care after surgery would result in an increase of physical activity level. This study aimed to determine physical activities preoperatively and at 6 and 12 months postoperatively among female patients who underwent bariatric surgery, and to investigate its relationship with body composition changes. MATERIAL AND METHODS: Thirty-four women who had Roux-Y gastric bypass (RYGB) surgery completed the study. Physical activity was measured objectively for 7 consecutive days by using an ActiGraph GT3X+ accelerometer. Body composition was estimated by using multifrequency bioimpedance analysis. RESULTS: The percentage of time spent in moderate-to-vigorous physical activity (MVPA) changed significantly from preoperatively to 6 months postoperatively; however, no difference was observed at 12 months. No significant changes were detected for other physical activity variables. Multivariable regression analysis suggested that the percentage of time spent in sedentary activity was associated with fat-free mass loss at 6 months (ß = - 0.323; 95% CI = - 0.649 to 0.003) and 12 months (ß = - 0.510; 95% CI = - 0.867 to - 0.154) postoperatively. CONCLUSION: The overall MVPA increased at 6 months post-RYGB surgery; however, this change was not maintained at 12 months. Despite the considerable body mass loss postoperatively, most of the subjects were classified as being physically inactive and did not change their sedentary behavior. These findings indicate that female patients undergoing bariatric surgery should be encouraged to increase their physical activity level.

Efeitos da pressão positiva nas vias aéreas no antes, durante e depois da cirurgia bariátrica: estudo randomizado e cego / Effects of positive pressure on respiratory tract in bariatric surgery pre-, intra- and postoperative: a randomized and blinded study / Efectos de la presión positiva en las vías aéreas en pre, intra y postoperatorio de la cirugía bariátrica: estudio randomizado y cego

A obesidade é, por si, um fator de risco independente para o surgimento de complicações respiratórias pós-operatórias. O objetivo do estudo foi investigar os efeitos da aplicação de pressão positiva antes, durante e depois do procedimento cirúrgico − em obesos submetidos à cirurgia bariátrica, sobre os volumes e capacidades pulmonares e a mobilidade toracoabdominal. Foram estudados 40 indivíduos com índice de massa corporal entre 40 e 55 kg/m2 e idade entre 25 e 55 anos, submetidos a avaliação pré e pós-operatória e alocados nos grupos: Gpré: tratamento com pressão positiva nas vias aéreas antes da cirurgia; Gpós: pressão positiva nas vias aéreas após a cirurgia; Gintra: pressão positiva nas vias aéreas durante a cirurgia; Gcontrole: fisioterapia convencional conforme rotina hospitalar. Foram avaliadas cirtometria toracoabdominal em três níveis e ventilometria: frequência respiratória, volume corrente, volume minuto e capacidade vital. Os resultados indicaram que, na análise intragrupo, houve aumento significativo da frequência respiratória e queda da capacidade vital para todos os grupos no pós-operatório. O volume corrente apresentou queda significativa somente no Gintra. Não houve diferença significativa nos três níveis de mobilidade toracoabdominal no Gpré. Concluiu-se que a utilização da pressão positiva no pós-operatório de cirurgia bariátrica não promove a manutenção da frequência respiratória e capacidade vital nos seus valores pré-operatórios. Entretanto, quando utilizada no pré-operatório, contribuiu para a manutenção do volume minuto, do volume corrente e da mobilidade toracoabdominal nos três níveis.

Obesity itself is an independent risk factor for the development of postoperative respiratory complications. The objective of the study was to investigate the effects of positive pressure application before, during and after the surgical procedure - in obese patients undergoing bariatric surgery, on lung volumes and capacities and thoracoabdominal mobility. 40 individuals with a Body Mass Index between 40 and 55 kg/m2 and between 25 and 55 years old were studied, submitted to pre- and postoperative evaluation and allocated to the groups: Gpré: treatment with positive airway pressure before surgery, Gpós: positive airway pressure after surgery. Gintra: positive airway pressure during surgery; Gcontrole: conventional physiotherapy according to hospital routine. Thoracoabdominal cirtometry at three levels, and ventilometry: respiratory rate, tidal volume, minute volume and vital capacity were evaluated. The results indicated that in the intragroup analysis there was a significant increase in respiratory rate and drop in vital capacity for all groups in the postoperative period. Tidal volume showed significant decrease only in Gintra. There was no significant difference in the three levels of thoracoabdominal mobility in the Gpré. It was possible to conclude that the use of positive pressure in the postoperative of bariatric surgery does not foster the maintenance of respiratory frequency and vital capacity in its preoperative values. However, when used in the preoperative, contributed to the maintenance of minute volume, tidal volume and thoracoabdominal mobility in the three levels.

La obesidad es, por sí, un factor de riesgo independiente para el surgimiento de complicaciones respiratorias postoperatorias El objetivo del estudio fue investigar los efectos de la aplicación de presión positiva antes, durante y después del procedimiento quirúrgico − en obesos sometidos a la cirugía bariátrica, sobre los volúmenes y capacidades pulmonares y la movilidad toracoabdominal. Fueron estudiados 40 individuos con Índice de Masa Corporal entre 40 y 55 kg/m2 y edad entre 25 y 55 años, sometidos a evaluación pre y postoperatoria y asignados en los grupos: Gpré: tratamiento con presión positiva de la vía aérea antes de la cirugía, Gpós: presión positiva de la vía aérea después de la cirugía. Gintra: Presión positiva de la vía aérea durante la cirugía. Gcontrole: fisioterapia convencional según rutina hospitalaria. Fueron evaluados: cirtometría toracoabdominal en tres niveles, y ventilometría: frecuencia respiratoria, volumen corriente, volumen minuto y capacidad vital. Los resultados indicaron que en el análisis intragrupo hubo aumento significativo de la frecuencia respiratoria y caída de la capacidad vital para todos los grupos en el postoperatorio. No hubo diferencia significativa en los tres niveles de movilidad toracoabdominal en el Gpré. Concluyóse que la utilización de la presión positiva en el postoperatorio de la cirugía bariátrica no promueve la manutención de la frecuencia respiratoria y capacidad vital en sus valores preoperatorios. Todavía cuando utilizada en el preoperatorio, contribuyó al mantenimiento del volumen minuto, del volumen corriente y de la movilidad toracoabdominal en los tres niveles.

Food aversions in women during the 2 years after Roux-en-Y gastric bypass.

The anatomical and physiological changes of the gastrointestinal tract after Roux-en-Y gastric bypass lead to changes in dietary patterns and their effects are still little known. Hence, the objective of this work was to characterize the prevalence, the associated factors and the list of food aversions with the effect of surgery on the body weight of women in the first two years after Roux-en-Y gastric bypass. A total of 141 women were studied. Their food aversions were assessed with a short food frequency questionnaire (FFQ-S) containing 26 items before and 6, 12 and 24 months after surgery. The FFQ-S was filled out during individual interviews and referenced in the medical records. The association between total aversion score and body weight variables and general characteristics of the group was analyzed. Variation of food aversions over time was assessed for 26 foods individually and grouped. Of all the studied variables, a weak but significant negative correlation (rs = -0.1944; p = 0.0208) was found between total aversion score and shorter postoperative period and a weak but significant positive correlation was found between total aversion score and percentage of weight regained (rs = -0.1759; p = 0.0369). Food aversions were more common in the first six months after surgery, especially to red meats, rice, chicken, eggs, pasta, milk and others. Food aversions in the early postoperative period are associated with weight variations in the first two years after surgery and subside significantly over time, probably because of a physiological and cognitive adaptation of the individual to the surgical procedure.