Morana Claire, Collignon Marie, Nocca David
Centre de Rééducation Spécialisé, 15 avenue du Professeur Grasset, 34090, Montpellier, France.
CHU Montpellier, Département de Chirurgie Digestive, Hôpital St Eloi, 34000, Montpellier, France.
Obes Surg. 2018 Aug;28(8):2321-2326. doi: 10.1007/s11695-018-3154-7.
Beyond obesity-related comorbidities, overweight patients have a high risk of developing osteoarticular pathologies. Moreover, weight loss following bariatric surgery induces a decrease in fat mass but also in muscle mass, thus affecting the physical capacities of these patients. Functional rehabilitation is a solution to correct these imbalances. The aim of this study was to evaluate the effectiveness of a functional rehabilitation program after bariatric surgery.
Twenty-three patients with severe obesity (BMI = 37.9 ± 5.7 kg/m; 41.1 ± 12.9 years) participated in a functional rehabilitation protocol, 2 months after sleeve gastrectomy. Rehabilitation program consisted of 20 sessions of 1h30 (two sessions per week), based on endurance training, muscle strengthening, and proprioception work. An initial and final assessment included bioelectrical impedance measurements, questionnaires, and physical function tests.
All impedance parameters were significantly improved in 20 sessions: % excess weight loss (%EWL) from 27.6 ± 9.1 to 51.1 ± 13.4% and % fat-free mass from 52.7 ± 5.6 to 57.6 ± 6.7%. Waist and hip circumferences were significantly reduced in 20 sessions: from 107.4 ± 13.7 to 94.5 ± 12.6 cm and from 120.5 ± 12.4 to 108.7 ± 11.7 cm, respectively (p < 0.001). Physical function tests were significantly improved between the 1st and the 20th sessions (p < 0.001). The cycloergometer stress test progressed from 77.7 ± 24.1 to 93.6 ± 27.2 W, and the sit-to-stand test from 20 ± 5.2 to 24.8 ± 7.6 flexions in 30 s. The Quality Of Life, Obesity and Dietetics (QOLOD) scale increased by 12.6%.
The functional rehabilitation protocol of 20 sessions significantly improved patients' body composition, functional tests, and quality of life. The standardization of tests and sessions allowed to objectively assess progress.
除肥胖相关合并症外，超重患者发生骨关节疾病的风险也很高。此外，减肥手术后体重减轻不仅会使脂肪量减少，还会使肌肉量减少，从而影响这些患者的身体机能。功能康复是纠正这些失衡的一种解决办法。本研究的目的是评估减肥手术后功能康复计划的有效性。
23例重度肥胖患者（体重指数=37.9±5.7kg/m；41.1±12.9岁）在袖状胃切除术后2个月参加了一项功能康复方案。康复计划包括20节时长1小时30分钟的课程（每周两节），基于耐力训练、肌肉强化和本体感觉训练。初始和最终评估包括生物电阻抗测量、问卷调查和身体功能测试。
在20节课程后，所有阻抗参数均有显著改善：超重减轻百分比（%EWL）从27.6±9.1%提高到51.1±13.4%，去脂体重百分比从52.7±5.6%提高到57.6±6.7%。腰围和臀围在20节课程后显著减小：分别从107.4±13.7厘米减小到94.5±12.6厘米，从120.5±12.4厘米减小到108.7±11.7厘米（p<0.001）。身体功能测试在第1节和第20节课程之间有显著改善（p<0.001）。蹬车测力计应激测试从77.7±24.1瓦提高到93.6±27.2瓦，30秒内从坐立测试的20±5.2次屈伸提高到24.8±7.6次屈伸。生活质量、肥胖与饮食学（QOLOD）量表提高了12.6%。
20节课程的功能康复方案显著改善了患者的身体成分、功能测试和生活质量。测试和课程的标准化使得能够客观地评估进展情况。
