Clinical, functional and systemic effects of whole-body electrical stimulation after bariatric surgery

Abstract

Background: Obesity is a chronic multifactorial disease resulting from many interactions. The success of the pharmacological and non-pharmacological interventions (exercise and diet) are still contradictory in obese patients. Bariatric surgery often becomes a fast and effective intervention in cases of morbid obesity and/or obesity associated with comorbidities. The conventional gastric bypass surgery, associated with dietary restriction in the first weeks, limits the physical activity performance. In this context, whole-body neuromuscular electrical stimulation (WBS), which has been a recent strategy that stimulates simultaneously several and large muscle groups, has become a promising and innovative option to enhance weight loss, improve exercise capacity and peripheral muscle strength, and positively impact on systemic effects.Objectives: To evaluate the functional capacity, the strength parameters and muscular endurance, anti-inflammatory and proinflammatory circulating markers and the autonomic control of heart rate in candidates for bariatric surgery, before and after the surgical intervention, applying the WBS as a strategy to early rehabilitation.Hypothesis: it is speculated that WBS can enhance the performance, muscular strength, and endurance parameters, as well as reduce inflammatory markers, and improve autonomic control of heart rate in these patients compared with controls (sham).Study Design: A randomized, duble blind placebo controlled clinical trial.Methods: Thirty-two obese subjects (BMI > 35 Kg/m2) will be randomized into 2 groups (EENMC=16) and control group (Sham=16)). In the preoperative period, the volunteers will perform several assessments: pulmonary function, maximal and submaximal exercise capacity, blood inflammatory markers, strength and endurance of quadriceps, as well as the autonomic control of heart rate (HR) at rest and during submaximal exercises. In the second day after discharge, the subjects will be evaluated regarding the functional capacity by means of the 6MWT and 2MST, the body composition data and the HR. The patients will be treated by either WBS or sham-US for 30 sessions, five days per week, during 6-consecutive weeks. After this treatment period, all the preoperative assessments will be performed again.Relevance of the study: Considering the reasoning in the academic and clinical role of the neuromuscular electrical stimulation on skeletal muscle conditioning and its value as an aid strategy in exercise performance and muscle strength, this proposal is important since it will expand the use of this new therapeutic strategy (WBS), assessing under controlled conditions, the effects of it in postoperative bariatric surgery patients. (AU)