临床试验表明，减肥手术后进行运动可提高胰岛素敏感性。
Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity.
作者信息
Coen Paul M, Tanner Charles J, Helbling Nicole L, Dubis Gabriel S, Hames Kazanna C, Xie Hui, Eid George M, Stefanovic-Racic Maja, Toledo Frederico G S, Jakicic John M, Houmard Joseph A, Goodpaster Bret H
出版信息
J Clin Invest. 2015 Jan;125(1):248-57. doi: 10.1172/JCI78016. Epub 2014 Dec 1.
BACKGROUND
Roux-en-Y gastric bypass (RYGB) surgery causes profound weight loss and improves insulin sensitivity (S(I)) in obese patients. Regular exercise can also improve S(I) in obese individuals; however, it is unknown whether exercise and RYGB surgery-induced weight loss would additively improve S(I) and other cardiometabolic factors.
METHODS
We conducted a single-blind, prospective, randomized trial with 128 men and women who recently underwent RYGB surgery (within 1-3 months). Participants were randomized to either a 6-month semi-supervised moderate exercise protocol (EX, n = 66) or a health education control (CON; n = 62) intervention. Main outcomes measured included S(I) and glucose effectiveness (S(G)), which were determined from an intravenous glucose tolerance test and minimal modeling. Secondary outcomes measured were cardiorespiratory fitness (VO2 peak) and body composition. Data were analyzed using an intention-to-treat (ITT) and per-protocol (PP) approach to assess the efficacy of the exercise intervention (>120 min of exercise/week).
RESULTS
119 (93%) participants completed the interventions, 95% for CON and 91% for EX. There was a significant decrease in body weight and fat mass for both groups (P < 0.001 for time effect). S(I) improved in both groups following the intervention (ITT: CON vs. EX; +1.64 vs. +2.24 min⁻¹/μU/ml, P = 0.18 for Δ, P < 0.001 for time effect). A PP analysis revealed that exercise produced an additive S(I) improvement (PP: CON vs. EX; +1.57 vs. +2.69 min⁻¹/μU/ml, P = 0.019) above that of surgery. Exercise also improved S(G) (ITT: CON vs. EX; +0.0023 vs. +0.0063 min⁻¹, P = 0.009) compared with the CON group. Exercise improved cardiorespiratory fitness (VO2 peak) compared with the CON group.
CONCLUSION
Moderate exercise following RYGB surgery provides additional improvements in S(I), S(G), and cardiorespiratory fitness compared with a sedentary lifestyle during similar weight loss.
TRIAL REGISTRATION
clinicaltrials.gov identifier: NCT00692367.
FUNDING
This study was funded by the NIH/National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK078192) and an NIH/National Center for Research Resources/Clinical and Translational Science Award (UL1 RR024153).
背景
Roux-en-Y胃旁路术（RYGB）可使肥胖患者显著减重并改善胰岛素敏感性（S(I)）。规律运动也可改善肥胖个体的S(I)；然而，运动和RYGB手术引起的体重减轻是否会叠加改善S(I)及其他心脏代谢因素尚不清楚。
方法
我们对128名近期（1 - 3个月内）接受RYGB手术的男性和女性进行了一项单盲、前瞻性随机试验。参与者被随机分为6个月的半监督适度运动方案组（EX，n = 66）或健康教育对照组（CON；n = 62）。主要测量指标包括S(I)和葡萄糖效能（S(G)），通过静脉葡萄糖耐量试验和最小模型法测定。次要测量指标为心肺适能（VO2峰值）和身体成分。采用意向性分析（ITT）和符合方案分析（PP）方法分析数据，以评估运动干预（每周运动>120分钟）的疗效。
结果
119名（93%）参与者完成了干预，CON组为95%，EX组为91%。两组体重和脂肪量均显著下降（时间效应P < 0.001）。干预后两组S(I)均有所改善（ITT：CON组与EX组；+1.64 vs. +2.24 min⁻¹/μU/ml，Δ的P = 0.18，时间效应P < 0.001）。PP分析显示，运动使S(I)在手术改善的基础上进一步提高（PP：CON组与EX组；+1.57 vs. +2.69 min⁻¹/μU/ml，P = 0.019）。与CON组相比，运动还改善了S(G)（ITT：CON组与EX组；+0.0023 vs. +0.0063 min⁻¹，P = 0.009）。与CON组相比，运动改善了心肺适能（VO2峰值）。
结论
与类似体重减轻期间的久坐生活方式相比，RYGB手术后进行适度运动可在S(I)、S(G)和心肺适能方面带来额外改善。
试验注册
clinicaltrials.gov标识符：NCT00692367。
资助
本研究由美国国立卫生研究院/国立糖尿病、消化和肾脏疾病研究所（R01 DK078192）以及美国国立卫生研究院/国家研究资源中心/临床和转化科学奖（UL1 RR024153）资助。
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