Marcela Barbalho-Moulim

Effects of preoperative inspiratory muscle training in obese women undergoing open bariatric surgery: respiratory muscle strength, lung volumes, and diaphragmatic excursion

OBJECTIVE: To determine whether preoperative inspiratory muscle training is able to attenuate the impact of surgical trauma on the respiratory muscle strength, in the lung volumes, and diaphragmatic excursion in obese women undergoing open bariatric surgery. DESIGN: Randomized controlled trial. SETTING: Meridional Hospital, Cariacica/ES, Brazil. SUBJECTS: Thirty-two obese women undergoing elective open bariatric surgery were randomly assigned to receive preoperative inspiratory muscle training (inspiratory muscle training group) or usual care (control group). MAIN MEASURES: Respiratory muscle strength (maximal static respiratory pressure – maximal inspiratory pressure and maximal expiratory pressure), lung volumes, and diaphragmatic excursion. RESULTS: After training, there was a significant increase only in the maximal inspiratory pressure in the inspiratory muscle training group. The maximal expiratory pressure, the lung volumes and the diaphragmatic excursion did not show any significant change with training. In the postoperative period there was a significant decrease in maximal inspiratory pressure in both the groups. However, there was a decrease of 28% in the inspiratory muscle training group, whereas it was 47% in the control group. The decrease in maximal expiratory pressure and in lung volumes in the postoperative period was similar between the groups. There was a significant reduction in the measures of diaphragmatic excursion in both the groups. CONCLUSION: The preoperative inspiratory muscle training increased the inspiratory muscle strength (maximal inspiratory pressure) and attenuated the negative postoperative effects of open bariatric surgery in obese women for this variable, though not influencing the lung volumes and the diaphragmatic excursion.

Effects of chest physiotherapy on the respiratory function of postoperative gastroplasty patients

INTRODUCTION: Bariatric surgery has become increasingly more recommended for the treatment of morbidly obese individuals for whom it is possible to identify co-morbidities other than alterations in pulmonary function. The objective of this study was to evaluate the effects of conventional chest physiotherapy (CCP) and of conventional physiotherapy associated with transcutaneous electrical diaphragmatic stimulation (CCP+TEDS) on pulmonary function and respiratory muscle strength in patients who have undergone Roux-en-Y gastric bypass. METHODS: In total, 44 female patients with an average age of 37 ± 7.3 years and an average body mass index (BMI) of 47.4 ± 6.5 K/m² were selected as candidates for Roux-en-Y gastric bypass laparoscopy. They were evaluated for pulmonary volume and flow using spirometry and maximum respiratory pressure through manovacuometry during the preoperative period and on the fifteenth and thirtieth postoperative days. RESULTS: No differences were detected between CCP and CCP+TEDS, and both factors contributed to the maintenance of pulmonary flow and volume as well as inhalation muscle strength. Exhalation muscle strength was not maintained in the CCP group at fifteen or thirty days postoperative, but it was maintained in patients treated with conventional chest physiotherapy + transcutaneous electric diaphragmatic stimulation. DISCUSSION: These results suggest that both conventional chest physiotherapy and conventional chest physiotherapy + transcutaneous electric diaphragmatic stimulation prevent the reduction of pulmonary function during the Roux-en-Y gastric bypass postoperative period, and that transcutaneous electric diaphragmatic stimulation also contributes to expiratory muscle strength.

Estudo dos volumes pulmonares e da mobilidade toracoabdominal de portadoras de obesidade mórbida, submetidas à cirurgia bariátrica, tratadas com duas diferentes técnicas de fisioterapia

OBJECTIVE: To compare the effects of conventional respiratory physical therapy (CRP) and CRP associated with transcutaneous electrical diaphragmatic stimulation (TEDS) on the pulmonary volumes and the thoracoabdominal mobility of patients undergoing bariatric surgery. METHODS: This randomized prospective study evaluated 44 female candidates for bariatric surgery (age 37.4±8.1 years; body mass index 47.4±6.1 kg/m2), before surgery and 15 and 30 days after surgery. The candidates were evaluated with regard to measurements of inspiratory reserve volume (IRV), expiratory reserve volume (ERV), inspiratory capacity (IC) and thoracoabdominal mobility, by means of spirometry and cirtometry, respectively. CRP consisted of diaphragmatic respiratory exercises, deep fractionated inspiration and respiratory exercises associated with upper limb movement. One set of 10 repetitions of each exercise was carried out twice daily while hospitalized. For TEDS, two electrodes were placed on the parasternal region, next to the xiphoid process, and another two between the sixth and seventh intercostal spaces, bilaterally on the anterior axillary lines. Friedmans test was used to compare repeated measures within groups, and the Mann-Whitney test for comparisons between groups. P values <0.05 were taken to be statistically significant. RESULTS: The IRV, ERV and thoracoabdominal mobility measurements increased significantly in the CRP+TEDS group. In contrast, the IC measurements decreased significantly both in the CRP and in the CRP+TEDS groups. CONCLUSION: The obese women who underwent bariatric surgery and received postoperative CRP+TEDS presented greater gains in some of the pulmonary volumes and improvements in the amplitude of respiratory movements.

Pulmonary Function after Weight Loss in Obese Women Undergoing Roux-en-Y Gastric Bypass: One-Year Followup

Introduction. Obesity is a condition that causes damage to the respiratory function. However, studies have demonstrated that weight loss due to bariatric surgery has resulted in a huge improvement on some lung volumes, but controversy still persists regarding the behavior of the respiratory muscle strength and IRV (inspiratory reserve volume). Objective. To evaluate the effect of weight loss, after 1 year of the Roux-en-Y gastric bypass surgery (RYGB), on the lung volumes and the respiratory muscle strength in obese women. Methods. 24 obese women candidates were recruited for RYGB. Lung volumes (spirometry) and respiratory muscle strength were evaluated in preoperative period and one year after surgery. Results. There was a significant increase in some lung volumes. However, when examining the components of the VC (vital capacity) separately, an increase in ERV (expiratory reserve volume) and reduction of IRV were observed. Moreover, a statistically significant reduction in the values of respiratory muscle strength was recorded: MIP (maximal inspiratory pressure) and MEP (maximal expiratory pressure). Conclusion. Weight loss induced by bariatric surgery provides an increase in some lung volumes of obese women, but reduction in IRV. Additionally, there was also a reduction in the respiratory muscle strength.

Comportamento da força muscular respiratória de obesas mórbidas por diferentes equações preditivas

BACKGROUND: Studies on the behavior of respiratory muscle strength (RMS) in morbidly obese patients have found conflicting results. OBJECTIVES: To evaluate RMS in morbidly obese women and to compare the results by using different predictive equations. METHOD: This is a cross-sectional study that recruited 30 morbidly obese women and a control group of 30 normal-weight women. The subjects underwent anthropometric and maximal respiratory pressure measurement. Visual inspection of the Bland-Altman plots was performed to evaluate the correlation between the different equations, with a p value lower than 0.05 considered as statistically significant. RESULTS: The obese women showed a significant increase in maximal inspiratory pressure (MIP) values (-87.83±21.40 cmH2O) compared with normal-weight women (-72±15.23 cmH2O) and a significant reduction of MIP (-87.83±21.40 cmH2O) according to the values predicted by the EHarik equation (-130.71±11.98 cmH2O). Regarding the obtained maximal expiratory pressure (MEP), there were no between-group differences (p>0.05), and no agreeement was observed between obtained and predicted values of MEP and the ENeder and ECosta equations. CONCLUSIONS: Inspiratory muscle strength was greater in the morbidly obese subjects. The most appropriate equation for calculating the predicted MIP values for the morbidly obese seems to be Harik-Khan equation. There seem to be similarities between the respiratory muscle strength behavior of morbidly obese and normal-weight women, however, these findings are still inconclusive.

Lung age in women with morbid obesity

OBJECTIVE To investigate the influence of morbid obesity on the lung age in women and to correlate with body mass, body mass index (BMI), and ventilatory variables. METHODS This was a cross-sectional study with 72 morbidly obese women and a control group consisting of 37 normal weight women. The subjects performed a pulmonary function test to determine lung age, and the results were correlated to anthropometric variables and lung volumes. RESULTS The morbidly obese group had significantly higher lung age (50.1±6.8 years) than the control group (38.8±11.4 years). There was no difference in chronological age between groups. There was a significant positive correlation among chronological age, body mass, BMI, and lung age (r=0.3647, 0.4182, and 0.3743, respectively). There was a negative correlation among forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, expiratory reserve volume (ERV), and lung age (r=-0.7565, -0.8769, --0.2723, and -0.2417, respectively). CONCLUSION Lung age is increased in morbidly obese women and is associated with increased body mass and BMI.

Comparação entre inspirometria de incentivo e pressão positiva expiratória na função pulmonar após cirurgia bariátrica

The aim of this study was to compare the effect of expiratory positive airway pressure (EPAP) and flow-oriented incentive spirometry on pulmonary function after laparoscopic Roux-en-Y gastric bypass surgery. Twenty-eight non-smoking women, with no lung disease and body mass index of 35 to 50 kg/m2, undergoing laparoscopic gastric bypass surgery (hospitalized for two days) were assessed by spirometry, thoracoabdominal cirtometry and as to diaphragmatic motion prior to, and on the second post-operative day. Before surgery patients were divided into two groups, SG - spirometer group (n=13), and EG - EPAP group (n=15). Motor physical therapy was standardized for both groups; respiratory therapy (both modalities) started on the day of surgery, in 15-minute sessions. Post-operative results showed similar reduction, in both groups, in the values of vital capacity, forced vital capacity, maximum voluntary ventilation, and inspiratory reserve volume. No changes were found in tidal volume values in SG, neither in expiratory reserve volume in EG. Diaphragmatic and thoracoabdominal motion were less harmed in SG. After bariatric surgery thus incentive spirometry had better effect in maintaining tidal volume, as well as on diaphragmatic and thoracoabdominal motion; while EPAP proved more efficient in re-establishing expiratory reserve volume in the postoperative period.

Improvement in lung function and functional capacity in morbidly obese women subjected to bariatric surgery

OBJECTIVE: To determine whether weight loss in women with morbid obesity subjected to bariatric surgery alters lung function, respiratory muscle strength, functional capacity and the level of habitual physical activity and to investigate the relationship between these variables and changes in both body composition and anthropometrics. METHODS: Twenty-four women with morbid obesity were evaluated with regard to lung function, respiratory muscle strength, functional capacity, body composition, anthropometrics and the level of habitual physical activity two weeks prior to and six months after bariatric surgery. RESULTS: Regarding lung function, mean increases of 160 mL in slow vital capacity, 550 mL in expiratory reserve volume, 290 mL in forced vital capacity and 250 mL in forced expiratory volume in the first second as well as a mean reduction of 490 mL in inspiratory capacity were found. Respiratory muscle strength increased by a mean of 10 cmH2O of maximum inspiratory pressure, and a 72-meter longer distance on the Incremental Shuttle Walk Test demonstrated that functional capacity also improved. Significant changes also occurred in anthropometric variables and body composition but not in the level of physical activity detected using the Baecke questionnaire, indicating that the participants remained sedentary. Moreover, correlations were found between the percentages of lean and fat mass and both inspiratory and expiratory reserve volumes. CONCLUSION: The present data suggest that changes in body composition and anthropometric variables exerted a direct influence on functional capacity and lung function in the women analyzed but exerted no influence on sedentarism, even after accentuated weight loss following bariatric surgery.

Reproducibility of the incremental shuttle walk test for women with morbid obesity.

Abstract Objective: The incremental shuttle walk test (ISWT) is a valuable tool for the assessment of functional capacity. However, few studies have used the ISWT in individuals with obesity or have determined its reproducibility in this population. Purpose: The aim of the present study was to evaluate the reproducibility of the ISWT in women with morbid obesity. Methods: Twenty-three women with a body mass index >40 kg/m2 (mean age: 39.1 ± 7.7) performed the ISWT twice on the same day. Results: The mean distance traveled was 313.3 ± 100.2 m on the first test and 322.5 ± 98.9 on the second test, with no significant difference between tests. The intraclass correlation coefficient (0.91) indicated excellent reproducibility. Reliability determined through Bland–Altman analysis revealed a small mean difference between tests (−9.2 m). Conclusion: The practice of repeating the ISWT appears to be unnecessary for women with morbid obesity, as demonstrated by the excellent reproducibility of the test.