Abstract
ObjectiveExamine if adding aerobic exercise to standard medical care (EX+SC) prior to bariatric surgery improves metabolic health in relation to surgical outcomes.MethodsFourteen bariatric patients (age: 42.3±2.5y, BMI: 45.1±2.5 kg/m2) met inclusion criteria and were match-paired to pre-operative SC (n = 7) or EX+SC (n = 7; walking 30min/d, 5d/wk, 65–85% HRpeak) for 30d. A 120min mixed meal tolerance test was performed pre- and post-intervention (~2d prior to surgery) to assess insulin sensitivity (Matsuda Index) and metabolic flexibility (indirect calorimetry). Aerobic fitness (VO2peak), body composition (BodPod), and adipokines (adiponectin, leptin) were also measured. Omental adipose tissue was collected during surgery to quantify gene expression of adiponectin and leptin, and operating time and length of hospital stay were recorded. ANOVA and Cohen’s d effect size (ES) was used to test group differences.ResultsSC tended to increase percent body fat (P = 0.06) after the intervention compared to EX+SC. Although SC and EX+SC tended to raise insulin sensitivity (P = 0.11), EX+SC enhanced metabolic flexibility (P = 0.01, ES = 1.55), reduced total adiponectin (P = 0.01, ES = 1.54) with no change in HMW adiponectin and decreased the length of hospital stay (P = 0.05) compared to SC. Albeit not statistically significant, EX+SC increased VO2peak 2.9% compared to a 5.9% decrease with SC (P = 0.24, ES = 0.91). This increased fitness correlated to shorter operating time (r = -0.57, P = 0.03) and length of stay (r = -0.58, P = 0.03). Less omental total adiponectin (r = 0.52, P = 0.09) and leptin (r = 0.58, P = 0.05) expression correlated with shorter operating time, and low leptin expression was linked to shorter length of stay (r = 0.70, P = 0.01), and low leptin expression was linked to shorter length of stay (r = 0.70, P = 0.01).ConclusionAdding pre-operative aerobic exercise to standard care may improve surgical outcomes through a fitness and adipose tissue derived mechanism.
Highlights
Bariatric surgery is an effective treatment for reducing obesity [1, 2] and related co-morbidities such as adipose tissue derived inflammation [1,2,3,4,5,6] and insulin insensitivity [1,2,3,4,5,6]
exercise to standard medical care (SC) (EX+SC) increased VO2peak 2.9% compared to a 5.9% decrease with SC (P = 0.24, effect size (ES) = 0.91)
Less omental total adiponectin (r = 0.52, P = 0.09) and leptin (r = 0.58, P = 0.05) expression correlated with shorter operating time, and low leptin expression was linked to shorter length
Summary
Bariatric surgery is an effective treatment for reducing obesity [1, 2] and related co-morbidities such as adipose tissue derived inflammation [1,2,3,4,5,6] and insulin insensitivity [1,2,3,4,5,6]. Low calorie diets (LCD) are standard medical practice prior to bariatric surgery and typically consist of meal replacement shakes for breakfast and lunch along with sensible snacks and a lean protein, high fiber dinner [11,12,13] These 2–4 week pre-operative LCD reduce liver size prior to surgery and often coincide with lower surgical complication rates and improved surgical outcomes [11,12,13,14,15]. Cardiorespiratory fitness impacts surgery outcomes, as a peak oxygen uptake (VO2peak) greater than 15.8 ml/kg/min at the time of bariatric surgery is related to shorter operating time and fewer surgical complications [16] The latter is supported by a prospective pre-operative exercise training study that showed that exercise prior to surgery induces greater weight loss and quality of life [17, 18] compared to standard medical care (SC). We anticipated that these changes in metabolic health would correlate with improved bariatric surgery outcomes
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