PL-LBA-2145

S. Martinez-Huenchullan¹, J. Enriquez-Schmidt¹, C. Mautner-Molina², M. Kalazich-Rosales², M. Muñoz², F. Fuentes-Leal², M. Monrroy-Uarac¹, M. San Martín-Correa¹, C. Carcamo-Ibaceta³, P. Ehrenfeld⁴

¹Universidad Austral de Chile, Physical Therapy, Valdivia, Chile, ²Clinica Alemana Valdivia, Physical Therapy, Valdivia, Chile, ³Universidad Austral de Chile, Surgery, Valdivia, Chile, ⁴Universidad Austral de Chile, Anatomy, Histology, and Pathology, Valdivia, Chile

Background: Physical exercise programs in candidates to undergo bariatric surgery have been proposed as key for the preparation towards the fast-pacing weight loss after the surgical intervention. A key part of this intervention is the prescription of aerobic exercise to increase cardiorespirory fitness and metabolic function, however, the optimal exercise prescription is far to be elucidated. Moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) are frequently prescribed in people with obesity, nevertheless, no clinical studies are known to compare the metabolic effects that these programs exerts in candidates to undergo bariatric surgery.

Purpose: To compare the metabolic effects of moderate-intensity constant and high-intensity interval training in candidates to undergo bariatric surgery.

Methods: Candidates to undergo batriatric surgery (particularly gastric sleeve) were recluted by agreeing to the following selection criteria: man and woman with body mass indexes (BMI) between 30 and 49 kg/m2, and ages between 18 and 59 years old. As exclusion criteria, people with medical contraindications to perform physical activity, severe functional limitations and/or uncontrolled neuropsychiatric illnesses were not considered. Participants were randomly allocated in one of two groups, MICT and HIIT. MICT was defined as walking/cycling at 50% of heart rate reserve (HRR) for 30 minutes, whereas HIIT consisted in 6 bouts (walking/cycling) at 80% of HRR (2.5 min each) and 6 periods of active rest at 20% of HRR (2.5 min each). Both training programs consisted in 10 sessions performed during a 4 weeks period. Strengthning exercises were performed similarly in both groups to respond to international guidelines. Anthropometric measures (weight, height, waist and hip circumference, fat and muscle mass) and metabolic function markers, such as glycaemia, insulinaemia, HOMA-IR (both fasting and 120 minutes after oral glucose tolerance test), HbA1c, and plasmatic levels of fibroblast growth factor 21 (FGF21) were measured before and after the exercise programs. Parametric variables were compared using paired t-test and non-parametric variables using the Wilcoxon test. For all comparisons, a p value lower than 0.05 was considered statistically significative.

Results: 25 participants completed the exercise trainings and none of them registered any complications during the sessions. At baseline, all variables measured were similar between groups. Participants after MICT (n=14) significantly reduced body weight, BMI, fat mass, and increased muscle mass. Also, reduced insulin levels after the oral glucose tolerance test (p<0.05). In contrast, participants after HIIT (n=11) reduced HbA1C levels and FGF21 plasmatic concentrations (p<0.05). Both programs significantly reduced waist and hip cincumferences (p<0.05).

Conclusions: Both MICT and HIIT exert metabolic benefits in candidates to undergo bariatric surgery, however, these benefits were specific to each program. This might suggest that aerobic exercise intensity could target specific physical and metabolic dysfunctions in people with obesity, particularly in candidates to undergo bariatric surgery. These findings warrant further reasearch.

Implications: Aerobic exercise is frequently recommended as part of the cardiometabolic rehabilitation of people with obesity, however, the intensity at which this intervention is performed could induce specific benefits, which could be relevant at targeting particular dysfunctions in these people.

Funding acknowledgements: National Agency of Research and Development (ANID), FONDECYT de iniciación en investigación, code 11200391

Keywords:
Obesity
Exercise
Insulin resistance

Topics:
Non-communicable diseases (NCDs) & risk factors
Cardiorespiratory
Research methodology, knowledge translation & implementation science

Did this work require ethics approval? Yes

Institution: Servicio de Salud Valdivia

Committee: Comite de Etica Cientifico del Servicio de Salud Valdivia

Ethics number: 350/2020