Efeitos funcionais e sistêmicos do pós-operatório recente de cirurgia bariátrica: treinamento físico com eletroestimulação de corpo inteiro como estratégia de reabilitação precoce
Resumo
Obesity is a chronic inflammation and multifactorial disease associated with comorbidities
and has reached alarming epidemic proportions worldwide. Bariatric surgery (BS) has been
considered the most effective treatment, being Roux-en-Y gastric bypass the most prevalent
approach. The surgical procedure associated with physical inactivity and restrictive
hypocaloric dietary in the postoperative (PO) period decrease weight loss, also followed by
muscle mass loss and, consequently lower functional and aerobic capacity, affecting muscle
quality. In this context, being important to understand the mediate consequences of surgery
as well as to promote early rehabilitation strategies, we proposed the accomplishment of two
studies. The first one, a prospective and observational study, entitled “Impact of bariatric
surgery on submaximal exercise testing in morbid obese patients” aimed to evaluate the
mediate effects of bariatric surgery by means of body composition with bioimpedance and
functional capacity applying the 6-minute walking test (6MWT) before and early after
hospital discharge. Thirty-nine morbid obese who underwent RYGB were included. In our
findings, impairments on aerobic and functional capacity with significant reduction of
distance walked in the 6MWT as well as cardiometabolic and pulmonary variables and
significant decline in all body composition measures, emphasizing the crucial loss of muscle
mass in one week post-BS. Thereafter, due to negative consequences of BS, the study II, a
randomized triple blind controlled trial, entitled “Whole-body electrical stimulation as a
strategy to improve functional capacity and preserver lean mass after bariatric surgery: a
randomized triple-blind controlled trial was developed. Thirty-five obese, aged between 18
and 45 years old, were submitted to RYGB. The preoperative assessments consisted of
maximal and submaximal exercise testing, body composition analysis, blood collection and
quadriceps strength and endurance test. The PO evaluation, performed between two days to
one week after discharge, was carried out with measurements of body composition and
6MWT and after completion of intervention protocol, all preoperative evaluations were
repeated. In the intervention protocol, randomized subjects performed electromyostimulation
group (WB-EMSG, n=17) or control group (ShamG, n=18). The protocol consisted of 10-14
dynamic exercises, with no load, 5 days per week, for a total of 30 sessions. Both groups
wore WB-EMS vests, which only WB-EMSG underwent an electrical stimulation protocol
(Endurance: 85Hz, 350ms, 6s of strain, 4f of rest; Strength: 30Hz, 350ms, 4s of strain, 10
ABSTRACT
seconds of rest, with bipolar electrical pulse). After intervention, subjects were reevaluated
and ShamG performed same protocol with switched off current. The main findings of the
present study were: 1) both intervention protocols demonstrated favorable outcomes on
functional capacity performance but only WB-EMSG reached important amelioration of the
same measures when compared to preoperative baseline, followed by decreased blood
pressure, leg fatigue and dyspnea during recovery; 2) both groups demonstrated similar
improvements in body composition parameters; 3) WB-EMS avoided greater loss of muscle
strength and endurance following the intervention; a significant decline in muscle
performance and important increase in muscle fatigue was only apparent in the ShamG; and
4) WB-EMSG was not superior to exercise training alone in improving biochemical
parameters but did lead to a significant increase in adiponectin. In conclusion, the mediate
PO is associated with reduction of body composition, especially lean mass and impairments
on functional capacity, highlighting the importance of early evaluation and intervention
rehabilitation. Additionally, a 6-week WB-EMS program associated with dynamic exercises
in post-BS patients improved functional capacity, preserved muscle strength and endurance,
with maintenance of muscle fatigue. However, WB-EMS was not able to enhance the effects
of body weight reductions acutely following BS. Our results are important to show the
feasibility of applying early rehabilitation protocols in morbidly obese patients after BS, and
that WB-EMS may potentiate the positive effects of an exercise training program, being well
tolerated and promoting adherence among post-BS patients.
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