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What is the Role for Preoperative Physical Training and Respiratory Kinesitherapy in Obese Surgical Patients?

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Abstract

The role of exercise and physical therapy in the treatment of obesity remains debatable. Those who believe in respiratory kinesitherapy believe that this intervention may prevent or reduce the impact of anesthesia and surgery on the respiratory muscles and on postoperative pulmonary complications. Exercise (especially when combined with diet) has a positive effect on body weight and cardiovascular disease risk factors in overweight and obese patients. If physical fitness can be linked to surgical outcome, then improving fitness by means of physical training as an intervention should theoretically improve postoperative outcome. There is evidence that less fit patients do have a greater risk of complications and death and prehabilitation does improve health-related quality of life and fitness levels. Although there is a paucity of studies on this topic, this chapter will try to address some questions, including “Can preoperative training improve fitness in morbidly obese patients and does this translate to better outcome?” and “What are the key elements of such a preoperative training: modality, frequency, duration, intensity and pattern?”.

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References

  1. Shaw K, Gennat H, O’Rourke P et al (2006) Exercise for overweight or obesity. Cochrane Database Syst Rev (4):CD003817

    Google Scholar 

  2. Bouchard C, Depres JP, Tremblay A (1993) Exercise and obesity. Obes Res 1:133–147

    PubMed  CAS  Google Scholar 

  3. Barnard RJ, Wen SJ (1994) Exercise and diet in the prevention and control of the metabolic syndrome. Sports Med 18:218–228

    Article  PubMed  CAS  Google Scholar 

  4. Katzel LI, Bleecker ER, Colman EG et al (1995) Effects of weight loss vs aerobic exercise training on risk factors for coronary disease in healthy, obese, middle-aged and older men. A randomized controlled trial. JAMA 274:1915–1921

    CAS  Google Scholar 

  5. Pasman WJ, Saris WH, Muls E et al (1999) Effect of exercise training on long-term weight maintenance in weight-reduced men. Metabolism 48:15–21

    Article  PubMed  CAS  Google Scholar 

  6. Wilson RJ, Davies S, Yates D et al (2010) Impaired functional capacity is associated with all-cause mortality after major elective intra-abdominal surgery. Br J Anaesth 105:297–303

    Article  PubMed  CAS  Google Scholar 

  7. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  Google Scholar 

  8. Ditmyer MM, Topp R, Pifer M (2002) Prehabilitation in preparation for orthopaedic surgery. Orthop Nurs 21:43–51

    Article  PubMed  Google Scholar 

  9. Courneya KS (2001) Exercise interventions during cancer treatment: biopsychosocial outcomes. Exerc Sport Sci Rev 29:60–64

    Article  PubMed  CAS  Google Scholar 

  10. Valkenet K, van de Port IG, Dronkers JJ et al (2011) The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil 25:99–111

    Article  PubMed  Google Scholar 

  11. Zavorsky GS (2000) Evidence and possible mechanisms of altered maximum heart rate with endurance training and tapering. Sports Med 29:13–26

    Article  PubMed  CAS  Google Scholar 

  12. Convertino VA (1983) Heart rate and sweat rate responses associated with exercise-induced hypervolemia. Med Sci Sports Exerc 15:77–82

    PubMed  CAS  Google Scholar 

  13. Hulzebos EH, Helders PJ, Favie NJ et al (2006) Preoperative intensive inspiratory muscle training inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA 296:1851–1857

    Article  PubMed  CAS  Google Scholar 

  14. Hulzebos EH, van Meeteren NL, van den Buijs BJ et al (2006) Feasibility of preoperative inspiratory muscle training inspiratory muscle training in patients undergoing coronary artery bypass surgery with a high risk of postoperative pulmonary complications: a randomized controlled pilot study. Clin Rehabil 20:949–959

    Article  PubMed  Google Scholar 

  15. Guimaraes MM, El Dib R, Smith AF et al (2009) Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. Cochrane Database Syst Rev (3):CD006058

    Google Scholar 

  16. Dronkers JJ, Lamberts H, Reutelingsperger IM et al (2010) Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: a randomized controlled pilot study. Clin Rehabil 24:614–622

    Article  PubMed  CAS  Google Scholar 

  17. Barbalho-Moulim MC, Miguel GP, Forti EM et al (2011) Effects of preoperative inspiratory muscle training inspiratory muscle training in obese women undergoing open bariatric surgery: respiratory muscle strength, lung volumes, and diaphragmatic excursion. Clin (Sao Paulo) 66:1721–1727

    Article  Google Scholar 

  18. Jensen C, Tejirian T, Lewis C et al (2008) Postoperative CPAP and BiPAP use can be safely omitted after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 4:512–514

    Article  PubMed  Google Scholar 

  19. McCullough PA, Gallagher MJ, Dejong AT et al (2006) Cardiorespiratory fitness and short-term complications after bariatric surgery. Chest 130:517–525

    Article  PubMed  Google Scholar 

  20. Poirier P, Alpert MA, Fleisher LA et al (2009) Cardiovascular evaluation and management of severely obese patients undergoing surgery: a science advisory from the American Heart Association. Circ 120:86–95

    Article  Google Scholar 

  21. Dolfing JG, Dubois EF, Wolffenbuttel BH et al (2005) Different cycle ergometer outcomes in severely obese men and women without documented cardiopulmonary morbidities before bariatric surgery. Chest 128:256–262

    Article  PubMed  Google Scholar 

  22. Miller WM, Spring TJ, Zalesin KC et al (2011) Lower than predicted resting metabolic rate is associated with severely impaired cardiorespiratory fitness in obese individuals. Obes (Silver Spring) 20(3):505–511

    Google Scholar 

  23. Fornitano LD, Godoy MF (2010) Exercise testing in individuals with morbid obesity. Obes Surg 20:583–588

    Article  PubMed  Google Scholar 

  24. Carli F, Charlebois P, Stein B et al (2010) Randomized clinical trial of prehabilitation in colorectal surgery. Br J Surg 97:1187–1197

    Article  PubMed  CAS  Google Scholar 

  25. Kothmann E, Batterham AM, Owen SJ et al (2009) Effect of short-term exercise training on aerobic fitness in patients with abdominal aortic aneurysms: a pilot study. Br J Anaesth 103:505–510

    Article  PubMed  CAS  Google Scholar 

  26. Still CD, Benotti P, Wood GC et al (2007) Outcomes of preoperative weight loss in high-risk patients undergoing gastric bypass surgery. Arch Surg 142:994–998

    Article  PubMed  Google Scholar 

  27. Huerta S, Dredar S, Hayden E et al (2008) Preoperative weight loss decreases the operative time of gastric bypass at a Veterans Administration hospital. Obes Surg 18:508–512

    Article  PubMed  Google Scholar 

  28. Buchwald H, Avidor Y, Braunwald E et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737

    Article  PubMed  CAS  Google Scholar 

  29. Sjostrom CD, Lissner L, Wedel H et al (1999) Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS intervention study. Obes Res 7:477–484

    PubMed  CAS  Google Scholar 

  30. Ross R, Dagnone D, Jones PJ et al (2000) Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial. Ann Intern Med 133:92–103

    PubMed  CAS  Google Scholar 

  31. Fujioka S, Matsuzawa Y, Tokunaga K et al (1991) Treatment of visceral fat obesity. Int J Obes 15(Suppl 2):59–65

    PubMed  Google Scholar 

  32. Leenen R, van der Kooy K, Deurenberg P et al (1992) Visceral fat accumulation in obese subjects: relation to energy expenditure and response to weight loss. Am J Physiol 263(5 Pt 1):E913–E919

    PubMed  CAS  Google Scholar 

  33. Liu RC, Sabnis AA, Forsyth C et al (2005) The effects of acute preoperative weight loss on laparoscopic Roux-en-Y gastric bypass. Obes Surg 15:1396–1402

    Article  PubMed  Google Scholar 

  34. Becouarn G, Topart P, Ritz P (2010) Weight loss prior to bariatric surgery is not a pre-requisite of excess weight loss outcomes in obese patients. Obes Surg 20:574–577

    Article  PubMed  Google Scholar 

  35. Alami RS, Morton JM, Schuster R et al (2007) Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Surg Obes Relat Dis 3:141–145

    Article  PubMed  Google Scholar 

  36. Caldwell S, Lazo M (2009) Is exercise an effective treatment for NASH? Knowns and unknowns. Ann Hepatol 8(Suppl 1):S60–S66

    PubMed  Google Scholar 

  37. Carey DG, Pliego GJ, Raymond RL (2006) Body composition and metabolic changes following bariatric surgery: effects on fat mass, lean mass and basal metabolic rate: six months to one-year follow-up. Obes Surg 16:1602–1608

    Article  PubMed  Google Scholar 

  38. Poitou Bernert C, Ciangura C, Coupaye M et al (2007) Nutritional deficiency after gastric bypass: diagnosis, prevention and treatment. Diabetes Metab 33:13–24

    Article  PubMed  CAS  Google Scholar 

  39. Stegen S, Derave W, Calders P et al (2011) Physical fitness in morbidly obese patients: effect of gastric bypass surgery and exercise training. Obes Surg 21:61–70

    Article  PubMed  Google Scholar 

  40. Shang E, Hasenberg T (2010) Aerobic endurance training improves weight loss, body composition, and co-morbidities in patients after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 6:260–266

    Article  PubMed  Google Scholar 

  41. Tamboli RA, Hossain HA, Marks PA et al (2010) Body composition and energy metabolism following Roux-en-Y gastric bypass surgery. Obesity (Silver Spring) 18:1718–1724

    Article  CAS  Google Scholar 

  42. Blair SN, Brodney S (1999) Effects of physical inactivity and obesity on morbidity and mortality: current evidence and research issues. Med Sci Sports Exerc 31(Suppl 11):S646–S662

    PubMed  CAS  Google Scholar 

  43. Bellocco R, Jia C, Ye W et al (2010) Effects of physical activity, body mass index, waist-to-hip ratio and waist circumference on total mortality risk in the Swedish National March Cohort. Eur J Epidemiol 25:777–788

    Article  PubMed  Google Scholar 

  44. McMahon MM, Sarr MG, Clark MM et al (2006) Clinical management after bariatric surgery: value of a multidisciplinary approach. Mayo Clin Proc 81(Suppl 10):S34–S45

    PubMed  CAS  Google Scholar 

  45. Mattsson E, Larsson UE, Rossner S (1997) Is walking for exercise too exhausting for obese women? Int J Obes Relat Metab Disord 21:380–386

    Article  PubMed  CAS  Google Scholar 

  46. Saris WH, Blair SN, van Baak MA et al (2003) How much physical activity is enough to prevent unhealthy weight gain? Outcome of the IASO 1st stock conference and consensus statement. Obes Rev 4:101–114

    Article  PubMed  CAS  Google Scholar 

  47. Williams MA, Haskell WL, Ades PA et al (2007) Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation 116:572–584

    Article  PubMed  Google Scholar 

  48. Hatoum IJ, Stein HK, Merrifield BF et al (2009) Capacity for physical activity predicts weight loss after Roux-en-Y gastric bypass. Obesity (Silver Spring) 17:92–99

    Article  Google Scholar 

  49. Bond DS, Phelan S, Wolfe LG et al (2009) Becoming physically active after bariatric surgery is associated with improved weight loss and health-related quality of life. Obesity (Silver Spring) 17:78–83

    Article  Google Scholar 

  50. Silver HJ, Torquati A, Jensen GL et al (2006) Weight, dietary and physical activity behaviors two years after gastric bypass. Obes Surg 16:859–864

    Article  PubMed  Google Scholar 

  51. Vanhecke TE, Franklin BA, Miller WM et al (2009) Cardiorespiratory fitness and sedentary lifestyle in the morbidly obese. Clin Cardiol 32:121–124

    Article  PubMed  Google Scholar 

  52. Sodlerlund A, Fischer A, Johansson T (2009) Physical activity, diet and behaviour modification in the treatment of overweight and obese adults: a systematic review. Perspect Public Health 129:132–142

    Article  PubMed  Google Scholar 

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Correspondence to Luc E. C. De Baerdemaeker .

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De Baerdemaeker, L.E., Rimbaut, S. (2013). What is the Role for Preoperative Physical Training and Respiratory Kinesitherapy in Obese Surgical Patients?. In: Leykin, Y., Brodsky, J. (eds) Controversies in the Anesthetic Management of the Obese Surgical Patient. Springer, Milano. https://doi.org/10.1007/978-88-470-2634-6_11

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  • DOI: https://doi.org/10.1007/978-88-470-2634-6_11

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