Department of Kinesiology, University of Virginia, Charlottesville, Virginia, United States of America.
Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, Virginia, United States of America.
PLoS One. 2020 Oct 2;15(10):e0239130. doi: 10.1371/journal.pone.0239130. eCollection 2020.
Examine if adding aerobic exercise to standard medical care (EX+SC) prior to bariatric surgery improves metabolic health in relation to surgical outcomes.
Fourteen 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.
SC 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).
Adding pre-operative aerobic exercise to standard care may improve surgical outcomes through a fitness and adipose tissue derived mechanism.
研究减重手术前增加有氧运动（EX+SC）是否比单纯标准医疗（SC）更能改善代谢健康与手术结果的关系。
14 名符合纳入标准的肥胖患者（年龄：42.3±2.5 岁，BMI：45.1±2.5kg/m2）被匹配为术前 SC（n=7）或 EX+SC（n=7；每天步行 30 分钟，每周 5 天，65-85%HRpeak）组，进行 30 天的干预。在干预前（约手术前 2 天）和干预后进行 120 分钟混合餐耐量试验，以评估胰岛素敏感性（Matsuda 指数）和代谢灵活性（间接测热法）。还测量了有氧运动能力（VO2peak）、身体成分（BodPod）和脂肪因子（脂联素、瘦素）。在手术期间收集网膜脂肪组织，以定量测定脂联素和瘦素的基因表达，并记录手术时间和住院时间。采用方差分析和 Cohen's d 效应量（ES）来检验组间差异。
与 EX+SC 相比，SC 组在干预后体脂百分比有增加的趋势（P=0.06）。尽管 SC 和 EX+SC 均有增加胰岛素敏感性的趋势（P=0.11），但 EX+SC 提高了代谢灵活性（P=0.01，ES=1.55），降低了总脂联素（P=0.01，ES=1.54），而高相对分子质量脂联素没有变化，并缩短了住院时间（P=0.05）。尽管没有统计学意义，但与 SC 组相比，EX+SC 组的 VO2peak 增加了 2.9%（P=0.24，ES=0.91），而 SC 组则下降了 5.9%。这种适应性的增加与手术时间的缩短相关（r=-0.57，P=0.03）和住院时间的缩短相关（r=-0.58，P=0.03）。网膜组织中总脂联素（r=0.52，P=0.09）和瘦素（r=0.58，P=0.05）表达的减少与手术时间的缩短相关，而低瘦素表达与住院时间的缩短相关（r=0.70，P=0.01）。
在标准治疗的基础上增加术前有氧运动可能通过提高健康水平和脂肪组织衍生的机制来改善手术结果。
