Physical Exercise in Postoperative Bariatric Surgery Patients

Study Overview
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Brief Summary
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This study aims to determine the effect of two types of exercise training on body composition, cardiopulmonary function and quality of life in people after undergoing bariatric surgery.

Detailed Description
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Three groups will be studied: Control group (CG) Group of moderate intensity continuous aerobic exercise (GMICT) High intensity interval aerobic exercise group (GHIIT) The CG will follow the usual protocol adopted by the hospital San Juan de Dios, Curicó, Chile. The protocol consists in delivering information about relevance of engage in regular physical exercise practice according to the World Health Organization (150 minutes of activity per week moderate physical or at least 75 minutes of intense physical activity), but do not include the patients in a supervised physical exercise program. The GMICT will undergo a physical exercise program in which the aerobic component will be a moderate-intensity continuous exercise training (60% of the heart rate reserve). The GHIIT will undergo the same exercise program of the GMICT, but the aerobic component will be a high-intensity interval exercise training (10 sets of 1 min at 90% of heart rate reserve, with 1 min of rest between sets). All groups will receive a nutritional diet plan prescribed by a specialist bariatric nutritionist blinded to the participants group assignment. At the end of the study, the CG will be invited to enjoy the exercise program showing to be more effective. Outcomes will be assessed at four time points: 1) one week before surgery; 2) 21 days after surgery (baseline before start exercise program); 3) 8 weeks after the beginning of the exercise program; and 4) one week after the end of intervention. Main outcomes are: 1) body composition; 2) heart rate variability; 3) six-minute walk test and 4) quality of life. Secondary outcomes will be: 1) maximal respiratory pressures; 2) flowmeter; 3) dynamometry of upper limb; and 4) squat test in 30 seconds. All procedures will be performed in the Hospital of Curicó, Chile, at the Department of Physical Medicine and Rehabilitation Service.

Official Title
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Effects of Physical Exercise in Postoperative Bariatric Surgery Patients

Conditions
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Bariatric Surgery, Physical Exercise, Morbid Obesity

Intervention / Treatment
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* Other: Physical Exercise
* Other: High-intensity interval training performed at cycle ergometer.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Persons between 18 and 65 years old, both sexes, who have undergone bariatric surgery, with medical authorization to perform physical exercise, that the wound healing process operative is in the final phase, which have been administered with subsequent anti thrombus treatment to surgery, who have no plans to change their place of residence within the current year. Exclusion Criteria: Persons who have had immediate complications after bariatric surgery (dehiscence anastomosis and operative wound dehiscence), presented any comorbidity decompensation after surgery, who are in the process of dialysis or who suffer from neuromotor disease.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomized clinical trial, single blinded.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control Group (CG)<br>The CG will receive the standard indications routinely provided by the hospital which consists in information about practice of regular physical activity according to World Health Organization. A leaflet with illustrations and indications will be provided and will be explained by the principal investigator. | |
| Experimental: Moderate-intensity continuous exercise training group (GMICT)<br>The GMICT will be submitted to a physical exercise program in which the aerobic component will be a moderate-intensity continuous exercise training, performed at 60% of the heart rate reserve, two days a week, for 30 minutes. | Other: Physical Exercise<br>* Moderate-intensity continuous exercise training performed at cycle ergometer.<br>|
| Experimental: High-intensity interval training exercise group (GHIIT)<br>The GHIIT will be will be submitted to a physical exercise program in which the aerobic component will be a high-intensity interval exercise training, performed in a protocol consisted of four one-min sprint at 90% of the heart rate reserve, alternated with one-min rest (at week 1) and progressing until reach 10 bouts of one-min sprint alternated with one-min rest. | Other: High-intensity interval training performed at cycle ergometer.<br>* High-intensity interval training performed at cycle ergometer.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Body fat (%) | To determine the effects of HIIT and MCIT on body composition by measuring percent of body fat using a tetrapolar bioelectrical impedance. | 16 weeks | 
| Muscle mass (Kg) | To determine the effects of HIIT and MCIT on body composition by measuring muscle mass using a tetrapolar bioelectrical impedance. | 16 weeks | 
| Bone mass (Kg) | To determine the effects of HIIT and MCIT on body composition by measuring bone mass using a tetrapolar bioelectrical impedance. | 16 weeks | 
| Heart rate variability | To determine the effects of HIIT and MCIT on cardiac autonomic control in supine and orthostatic positions. | 16 weeks | 
| Six minutes walk test (mts traveled) | To determine the effects of HIIT and MCIT on functional capacity using the six-minute walk test. | 16 weeks | 
| Moorehead-Ardelt Quality of Life Questionnaire (MAQ II) | To determine the effects of HIIT and MCIT on quality of life by the Moorehead-Ardelt Quality of Life Questionnaire. The score of each answer ranges from -0.5 (most unfavorable situation) to +0.5 (most favorable situation). According to the score obtained: -3 to -2.1: very poor; -2 to -1.1: poor; -1 to 1: fair; 1.1 to 2: good; and 2.1 to 3: very good quality of life. | 16 weeks | 
| Bariatric Analysis and Reporting Outcomes System (BAROS Score) | To determine the effects of HIIT and MCIT on quality of life by the Bariatric Analysis and Reporting Outcomes System. Moorehead-Ardelt questionnaire incorporates the percentage of overweight lost or gained after surgery, resolution of comorbidities associated with morbid obesity, need for reoperation and complications. According to the score obtained, it is categorized as: ≤1: failure; > 1 to 3: fair; > 3 to 5: good; > 5 to 7: very good; and > 7 to 9: excellent. | 16 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximal inspiratory and expiratory pressures (cmH2O) | To determine the effects of HIIT and MCIT on the maximal inspiratory and expiratory pressures. | 16 weeks | 
| Flowmeter (L/min) | To determine the effects of HIIT and MCIT on the peak expiratory flow. | 16 weeks | 
| Hand grip strength test (Kg) | To determine the effects of HIIT and MCIT on the maximum prehensile force will be measured. | 16 weeks | 
| 30-sec chair stand test (count) | To determine the effects of HIIT and MCIT on cardiopulmonary function the number of squats in 30 seconds will be counted. | 16 weeks |