Abstract
Background
This study seeks to assess the effect of inspiratory muscle training (IMT) on pulmonary function, respiratory muscle strength, and endurance in morbidly obese patients submitted to bariatric surgery.
Methods
Thirty patients were randomly assigned to sham muscular training, or to IMT with a threshold device (40% of maximum inspiratory pressure, MIP), for 30 min/day, from the 2nd until 30th postoperative (PO) day. All of them were submitted to a standard respiratory kinesiotherapy and early deambulation protocol. Data on spirometry, maximum static respiratory pressures, and respiratory muscle endurance were collected on the PO days 2, 7, 14, and 30 in a blinded matter.
Results
IMT enabled increases in PO MIP and endurance, and an earlier recovery of the spirometry parameters FEV1, PEF, and FEF25–75%. Comparing to preoperative values, MIP was increased by 13% at the 30th PO day in the trained group, whereas control group had a reduction of 8%, with higher values for the IMT group (30th PO, IMT—130.6 ± 22.9 cmH2O; controls—112.9 ± 25.1 cmH2O; p < 0.05). Muscular endurance at the 30th PO day was increased in the trained group comparing to preoperative value (61.5 ± 39.6 s vs 114.9 ± 55.2 s; p < 0.05), a finding not observed in the control group (81.7 ± 44.3 vs 95.2 ± 42.0 s).
Conclusions
IMT improves inspiratory muscle strength and endurance and accounts for an earlier recovery of pulmonary airflows in morbidly obese patients submitted to bariatric surgery.
Similar content being viewed by others
References
World Health Organization. The world health report 2006: working together for health. Geneva: 2006. Disponível em: <http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/> access April 20, 2009.
Mcclean KM, Kee F, Young IS, et al. Obesity and the lung: epidemiology. Thorax. 2008;63(7):649–54.
Surgeman HJ. Pulmonary function in morbid obesity. Gastroenterol Clin North Am. 1987;16(2):225–37.
Siafakas NM, Mitrouska I, Bouros D, et al. Surgery and the respiratory muscles. Thorax. 1999;54(5):458–65.
Dumont L, Mattys M, Mardirosoff C, et al. Changes in pulmonary mechanics during laparoscopic gastroplasty in morbidly obese patients. Acta Anaesthesiol Scand. 1997;41(3):408–13.
Pelosi P, Croci M, Ravagnan I, et al. Total respiratory system, lung and chest wall mechanics in sedated–paralyzed postoperative morbidly obese patients. Chest. 1996;109(1):144–51.
Christensen EF, Schultz P, Jensen OV, et al. Postoperative pulmonary complications and lung function in high-risk patients: a comparasion of three physiotherapy regiments after upper abdominal surgery in general anesthesia. Acta Anaesthesiol Scand. 1991;35(2):97–104.
Fagevik Olsen M, Hahn I, Nordgren S, et al. Randomized controlled trial of prophylactic chest physiotherapy in major abdominal surgery. Br J Surg. 1997;84(11):1535–8.
Fagevik Olsen M, Josefson K, Lonroth H. Chest physiotherapy does not improve the outcome in laparoscopic fundoplication and vertical-banded gastroplsty. Surg Endosc. 1999;13(3):260–3.
Lawrence VA, Cornell JE, Smetana GW. Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144(8):596–608.
Pasquina P, Tramer MR, Phil D, et al. Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery. Chest. 2006;130(6):1887–99.
Dronkers J, Veldman A, Hoberg E, et al. Prevention of pulmonary complications after upper abdominal surgery by preoperative intensive inspiratory muscle training: a randomized controlled pilot study. Clin Rehabil. 2008;22(2):134–42.
Capella JF, Capella RF. An assessment of vertical banded gastroplasty–Roux-en-Y gastric bypass for the treatment of morbid obesity. Am J Surg. 2001;183(2):117–23.
Gastaldi AC, Magalhães CMB, Baraúna MA, et al. Benefits of postoperative respiratory kinesiotherapy following laparoscopic cholecystectomy. Rev Bras Fisioter. 2008;12(2):100–6.
Black LF, Hyatt RE. Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis. 1969;99(5):696–702.
Enright PL, Kronmal RA, Manolio TA, et al. Respiratory muscle strength in the elderly. Correlates and reference values. Am J Respir Crit Care Med. 1994;149(2):430–8.
Bellemare F, Grassino A. Effect of pressure and timing of contraction on human diaphragm fatigue. J Appl Physiol. 1982;53(5):1990–5.
Ramonatxo M, Boulard P, Prefaut C. Validation of noninvasive tension–time index of inspiratory muscles. J Appl Physiol. 1995;78(2):646–53.
American Thoracic Society. Official statement. Standardization of spirometry: update. Am J Respir Crit Care. 1994;152(3):1107–36.
Knudson RJ, Lebowitz MD, Holberg CJ, et al. Changes in the normal maximal expiratory flow-volume curve with growth and aging. Am Rev Respir Dis. 1983;127(6):725–34.
Putensen-Himmer G, Putensen C, Lammer H, et al. Comparison of postoperative respiratory function after laparoscopy for cholecystectomy. Anaesth. 1992;77(4):675–80.
Ebeo CT, Benotti PN, Byrd RA. The effect of bi-level positive airway pressure on postoperative pulmonary function following gastric surgery for obesity. Respir Med. 2002;96(9):672–6.
Paisani DM, Chiavegato LD, Faresin SM. Lung volumes, lung capacities and respiratory muscle strength following gastroplasty. J Bras Pneumol. 2005;31(2):125–32.
Lisboa C, Muñoz V, Beroiza T, et al. Inspiratory muscle training in chronic airflow limitation: comparison of two different training loads with a threshold device. Eur Respir J. 1994;7(7):1266–74.
Gosselink R, Wagenaar RC, Decramer M. Reliability of a commercially available threshold loading device in healthy subjects and in patients with chronic obstructive pulmonary disease. Thorax. 1996;51(6):601–5.
Shoemaker MJ, Donker S, Lapoe A. Inspiratory muscle training in patients with chronic obstructive pulmonary disease: the state of the evidence. Cardiopulm Phys Ther J. 2009;20(3):5–15.
Chlif M, Keochkerian D, Mourlhon C, et al. Noninvasive assessment of the tension–time index of inspiratory muscles at rest in obese male subjects. Int J Obes. 2005;29(12):1478–83.
Chumillas S, Ponce JL, Delgado F, et al. Prevention of postoperative pulmonary complications through respiratory rehabilitation: a controlled clinical study. Arch Phys Med Rehabil. 1998;79(1):5–9.
Lindner K, Lotz Pahnefeld F. Continuous positive airway pressure effect on functional residual capacity, vital capacity and its subdivisions. Chest. 1987;92(1):66–70.
Manzano RM, Carvalho CR, Saraiva-Romanholo BM, et al. Chest physiotherapy during immediate postoperative period among patients undergoing upper abdominal surgery: randomized clinical trial. São Paulo Med J. 2008;126(5):269–73.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Casali, C.C.C., Pereira, A.P.M., Martinez, J.A.B. et al. Effects of Inspiratory Muscle Training on Muscular and Pulmonary Function After Bariatric Surgery in Obese Patients. OBES SURG 21, 1389–1394 (2011). https://doi.org/10.1007/s11695-010-0349-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-010-0349-y