Ventilatory Response at Rest and During Maximal Exercise Testing in Patients with Severe Obesity Before and After Sleeve
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ORIGINAL CONTRIBUTIONS
Ventilatory Response at Rest and During Maximal Exercise Testing in Patients with Severe Obesity Before and After Sleeve Gastrectomy Nicola Borasio 1 & Daniel Neunhaeuserer 1 & Andrea Gasperetti 1 & Claudia Favero 1 & Veronica Baioccato 1 & Marco Bergamin 1 & Luca Busetto 2 & Mirto Foletto 3 & Roberto Vettor 2 & Andrea Ermolao 1 Received: 29 April 2020 / Revised: 18 August 2020 / Accepted: 18 August 2020 # The Author(s) 2020
Abstract Introduction Sleeve gastrectomy (SG) has become a widespread treatment option in patients affected by severe obesity. However, studies investigating the impact of the subsequent weight loss on the ventilatory response at rest and during physical exercise are lacking. Methods This is an observational study on 46 patients with severe obesity (76% females), comparing parameters of ventilatory function 1 month before and 6 months after SG. Patients were first evaluated by resting spirometry and subsequently with an incremental, maximal cardiopulmonary exercise test (CPET) on treadmill. Results The important weight loss of 26.35 ± 6.17% of body weight (BMI from 43.59 ± 5.30 to 32.27 ± 4.84 kg/m2) after SG was associated with a significant improvement in lung volumes and flows during forced expiration at rest, while resting ventilation and tidal volume were reduced (all p ≤ 0.001). CPET revealed decreased ventilation during incremental exercise (p < 0.001), with a less shallow ventilatory pattern shown by a lower increase of breathing frequency (ΔBFrest to AT p = 0.028) and a larger response of tidal volume (ΔTVAT to Peak p < 0.001). Furthermore, a concomitant improvement of the calculated dead space ventilation, VE/ VCO2 slope and peripheral oxygen saturation was shown (all p ≤ 0.002). Additionally, the increased breathing reserve at peak exercise was associated with a lower absolute oxygen consumption but improved exercise capacity and tolerance (all p < 0.001). Conclusion The weight loss induced by SG led to less burdensome restrictive limitations of the respiratory system and to a reduction of ventilation at rest and during exercise, possibly explained by an increased ventilatory efficiency and a decrease in oxygen demands. Keywords Bariatric surgery . Cardiopulmonary exercise test . Spirometry . Lung function . Ventilation
* Daniel Neunhaeuserer [email protected]
Mirto Foletto [email protected]
Nicola Borasio [email protected]
Roberto Vettor [email protected]
Andrea Gasperetti [email protected] Claudia Favero [email protected]
Andrea Ermolao [email protected] 1
Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
2
Department of Medicine, Internal Medicine 3, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
3
Week Surgery, Bariatric Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
Veronica Baioccato [email protected] Marco Bergamin [email protected] Luca Busetto luca.busetto@un
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