Effects of Inspiratory Muscle Training on Muscular and Pulmonary Function After Bariatric Surgery in Obese Patients

Abstract

IMT improves inspiratory muscle strength and endurance and accounts for an earlier recovery of pulmonary airflows in morbidly obese patients submitted to bariatric surgery.

Efeito do treinamento muscular inspiratório em pacientes submetidos à cirurgia bariátrica: uma revisão sistemática

“…Both included studies were published in English in 2011, and were developed in Brazil. This review included 62 participants, of which 30 were allocated to receive Threshold ® IMT device, but at different periods, preoperative 26 and postoperative 18 . The IMT group was compared with standard physiotherapy.…”

“…Spirometry parameters evaluated in both studies were forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV 1 ). Moreover, different outcomes were investigated as diaphragmatic excursion 26 and respiratory muscle endurance 18 . Different protocols of IMT were used in the included studies.…”

“…In one study, the IMT was performed for 2-4 weeks prior to surgery, consisting of a daily session with duration of 25 min, six times a week (two sessions supervised and four unsupervised) 26 . In the other study 18 , the training was conducted from the 2 nd postoperative day to the 30 th day, involving two training sessions of 20 min each during the period of hospitalization and 30 min once a day in the physical therapy clinic after discharge.…”

“…Despite the greater governmental and public health attention over the last decades on dietary and exercise interventions, the proportion of obese population has increased every year 8 . Morbid or severe obese patients frequently develop alterations in body mechanisms, especially in the respiratory system, including interference in the respiratory function, decreased pulmonary volumes and capacities [9][10][11][12][13] mechanical compression of the diaphragm, lungs and of the chest cavity 14 , reduced compliance and increased pulmonary resistance 10,15,16 besides reduced respiratory muscle strength 10,17,18 . Thus, due to chest and abdomen fat excess, the morbid obesity has effects on lung function, which leads to a mechanical disadvantage and influences the strength of respiratory muscles 17 .…”

“…Randomized controlled trials have shown the effects of IMT on the inspiratory muscle strength and endurance in several diseases and demonstrated that this technique provides improvement in the peak oxygen consumption, quality of life and dyspnea 24,25 , and also reduces postoperative atelectasis, pneumonia and length of hospital stay 28 . Moreover, the use of IMT in patients undergoing bariatric surgery has been investigated in recent studies 18,26,27 , but the real effect of IMT in this population profile is still inconclusive. A recent systematic review observed postoperative outcomes following preoperative IMT in patients undergoing cardiothoracic or upper abdominal surgery and demonstrated that preoperative IMT significantly improves respiratory function in the early postoperative period, halving the risk of pulmonary complications 29 .…”