Exercise Enhances the Effect of Bariatric Surgery in Markers of Cardiac Autonomic Function
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Exercise Enhances the Effect of Bariatric Surgery in Markers of Cardiac Autonomic Function Saulo Gil 1 & Tiago Peçanha 1 & Wagner S. Dantas 1,2 & Igor Hisashi Murai 1 & Carlos Alberto Abujabra Merege-Filho 1 & Ana Lúcia de Sá-Pinto 3 & Rosa Maria Rodrigues Pereira 3 & Roberto de Cleva 4 & Marco Aurélio Santo 4 & Diego Augusto Nunes Rezende 1 & John P. Kirwan 2 & Bruno Gualano 1,3 & Hamilton Roschel 1,3 Received: 20 May 2020 / Revised: 8 October 2020 / Accepted: 13 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Bariatric surgery improves cardiovascular health, which might be partly ascribed to beneficial alterations in the autonomic nervous system. However, it is currently unknown whether benefits from surgery on cardiac autonomic regulation in post-bariatric patients can be further improved by adjuvant therapies, namely exercise. We investigated the effects of a 6-month exercise training program on cardiac autonomic responses in women undergoing bariatric surgery. Methods Sixty-two women eligible for bariatric surgery were randomly allocated to either standard of care (control) or an exercise training intervention. At baseline (PRE) and 3 (POST3) and 9 (POST9) months after surgery, we assessed chronotropic response to exercise (CR%; i.e., percentage change in heart rate from rest to peak exercise) and heart rate recovery (HRR30s, HRR60s, and HRR120s; i.e., decay of heart rate at 30, 60, and 120 s post exercise) after a maximal exercise test. Results Between-group absolute changes revealed higher CR% (Δ = 8.56%, CI95% 0.22–19.90, P = 0.04), HRR30s (Δ = 12.98 beat/min, CI95% 4.29–21.67, P = 0.01), HRR60s (Δ = 22.95 beat/min, CI95% 11.72–34.18, P = 0.01), and HRR120s (Δ = 34.54 beat/min, CI95% 19.91–49.17, P < 0.01) in the exercised vs. non-exercised group. Conclusions Our findings demonstrate that exercise training enhanced the benefits of bariatric surgery on cardiac autonomic regulation. These results highlight the relevance of exercise training as a treatment for post-bariatric patients, ensuring optimal cardiovascular outcomes. Keywords Exercise . Cardiac autonomic function . Gastric bypass
Introduction
* Hamilton Roschel [email protected] 1
Applied Physiology & Nutrition Research Group; Laboratory of Assessment and Conditioning in Rheumatology; Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
2
Integrated Physiology and Molecular Medicine Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
3
Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
4
Department of Digestive Surgery, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
Individuals with obesity may show cardiovascular autonomic dysfunction, characterized by increased sympathetic activity to the heart [1] and decreased cardiac parasympathetic activity [2]. These maladaptive responses are associated with metabolic dysfu
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