How valuable is cardiopulmonary exercise testing in patients with severe obesity undergoing bariatric surgery?
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How valuable is cardiopulmonary exercise testing in patients with severe obesity undergoing bariatric surgery? Leila Itani1 · Dana El Masri1 · Dima Kreidieh1 · Hana Tannir1 · Marwan El Ghoch1 Received: 21 January 2020 / Accepted: 22 January 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Cardiorespiratory fitness (CRF) refers to the ability of the circulatory and respiratory systems to supply oxygen to skeletal muscles during sustained physical activity [1]. Low levels of CRF are associated with a higher risk of cardiovascular disease and all-cause mortality, to an extent that this risk exceeds that due to smoking, diabetes and hypertension [2]. Exercise capacity (EC) is the maximum amount of physical exertion that an individual can sustain [3]. Poor EC is a more powerful predictor of mortality than other established cardiovascular disease risk factors [4]. Hence, the American Heart Association (AHA) recommends that patients with chronic conditions undergo regular assessments of CRF and EC via cardiopulmonary exercise testing, which is considered to be the gold-standard tool for this purpose [5]. As a chronic disease, obesity is a growing health problem worldwide [6], associated with medical [7] and psychosocial comorbidities [8] and an increase in the rate of mortality [7]. Its prevalence over the last three decades has increased, to the extent that it has doubled in more than 70 countries and continuously increased in most others in both adolescents and adults [9]. Moreover, the most worrisome data, which concern the approximate tripling of obesity in youth and young adults, come from developing and middle-income countries, since the early onset of obesity is * Marwan El Ghoch [email protected]; [email protected] Leila Itani [email protected] Dana El Masri [email protected] Dima Kreidieh [email protected] Hana Tannir [email protected] 1
Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Riad El Solh, P.O. Box 11‑5020, Beirut, Lebanon
likely to translate into a high cumulative incidence of cardiovascular and metabolic diseases as well as a higher risk of mortality during adulthood, accounting for four million deaths globally, with more than two thirds of deaths related to obesity due to cardiovascular diseases [9]. This scenario has prompted international societies and associations dealing with obesity to recommend a wide range of weight loss interventions [10]. Lifestyle modification programmes, on their own or in combination with anti-obesity drugs, are considered a cornerstone and a key element of weight management for patients with obesity; however, weight regain is common in these patients, regardless of the type of intervention, with the majority of patients returning to their baseline weight with three to 5 years of follow-up [11]. On the other hand, bariatric surgery seems to be the most effective treatment for severe obesity compared with nonsurgical interventions, in terms of weight loss and improvements in obes
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