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Clinical Research

Whole-body electrical stimulation as a strategy to improve functional capacity and preserver lean mass after bariatric surgery: a randomized triple-blind controlled trial

International Journal of Obesity volume 45, pages 1476–1487 (2021)Cite this article

Subjects

Abstract

Background/Objectives

Bariatric surgery (BS) is a successful, long-lasting treatment option for obese. The early postoperative (PO) period is followed by dietary restriction and physical inactivity, leading to declines in muscle mass and functional capacity. Whole-body electromyostimulation (WB-EMS) may be a feasible and potential early rehabilitation strategy post BS. The aim was to evaluate the effects of WB-EMS with exercise training (Fe) on functional capacity, body composition, blood biomarkers, muscle strength, and endurance post BS.

Subjects/Methods

This is a randomized, triple-blind, sham-controlled trial. Thirty-five volunteers underwent a Roux-en-Y gastric bypass and were randomized into a WB-EMS (WB-EMSG) or control group (ShamG). Preoperative evaluations consisted of maximal and submaximal exercise testing, body composition, blood biomarkers, quadriceps strength, and endurance. After discharge, functional capacity and body composition were obtained. Exercise training protocols in both groups consisted of 14 dynamic exercises, 5 days per week, completing 30 sessions. The WB-EMSG also underwent an electrical stimulation protocol (Endurance: 85 Hz, 350 ms, 6 s of strain, 4 f of rest; Strength: 30 Hz, 350 ms, 4 s of strain, 10 seconds of rest, with bipolar electrical pulse). After intervention, subjects were reevaluated.

Results

The protocol started on average 6.7 ± 3.7 days after discharge. Both groups presented with a decline in functional capacity after BS (p < 0.05) and a reduction in all body composition measurements (p < 0.05). The exercise training program led to significant improvements in functional capacity (ShamG – PO: 453.8 ± 66.1 m, Post: 519.2 ± 62.8 m; WB-EMSG- PO: 435.9 ± 74.5, Post: 562.5 ± 66.4 m, p < 0.05), however, only the WB-EMSG demonstrated significant changes of distance walked (interaction time vs group effect, p < 0.05). In addition, adiponectin significantly increased only in the WB-EMSG (p < 0.05). The WB-EMSG was also able to preserve muscle strength, endurance, and fatigue index, while the ShamG demonstrated significant decline (p < 0.05).

Conclusion

WB-EMS + Fe can be an attractive and feasible method following BS to enhance functional capacity and prevent deterioration of muscle function in the early PO.

Clinical trial registration

ReBEC, RBR-99qw5h, on 20 February 2015.

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Fig. 1: Flowchart of a study showing flow of assessments, sample recruitment, and losses.
Fig. 2: Correlations between 6MWT, body composition, and dynamometry measures in WB-EMSG. Results are presented as mean values.

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Acknowledgements

The authors thank all colleagues from the Cardiopulmonary Physiotherapy Laboratory (Department of Physiotherapy), (Federal University of Sao Carlos (UFSCar), Brazil) for their collaboration; the medical gastroenterologists: Guilherme Focchi Haddad and José Michel Haddad for their effort and contribution of recruitment of their eligible patients and all volunteers for their enthusiastic participation. The authors would like to thank all patients for their effort and enthusiastic cooperation throughout the study.

Funding

This study has the financial support of São Paulo State Research Foundation (FAPESP – Grant: 2015/04101−1). A. Borghi-Silva is an Established Investigator (level IB) of the Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil. L.D. André is a doctorate degree of Post-Graduation Program of Coordenação de Aperfeicoamento de Pessoal de Nível Superior (CAPES-PROEX).

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Authors and Affiliations

  1. Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, Brazil

    Larissa Delgado André, Renata Pedrolongo Basso-Vanelli, Paula Angélica Ricci, Luciana Di Thommazo-Luporini, Nivaldo Antonio Parizotto & Audrey Borghi-Silva

  2. Department of Medicine, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, Brazil

    Claudio Ricardo de Oliveira

  3. Gastro Vita (Medical Specialist Centre), Araraquara, São Paulo, Brazil

    Guilherme Focchi Haddad & José Michel Haddad

  4. Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Rua Pedro Ernesto 240, Sao Jose dos Campos-SP, Brazil

    Rodolfo de Vieira

  5. Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA

    Ross Arena

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  1. Larissa Delgado André
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Correspondence to Audrey Borghi-Silva.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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André, L.D., Basso-Vanelli, R.P., Ricci, P.A. et al. Whole-body electrical stimulation as a strategy to improve functional capacity and preserver lean mass after bariatric surgery: a randomized triple-blind controlled trial. Int J Obes 45, 1476–1487 (2021). https://doi.org/10.1038/s41366-021-00812-7

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