Download PDF
Int J Sports Med 2022; 43(09): 818-824
DOI: 10.1055/a-1766-5803
Clinical Sciences

Effects of a Multicomponent Exercise Training Program on Balance Following Bariatric Surgery

Florêncio Diniz-Sousa 
1   Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
2   Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
,
Tiago Granja
1   Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
2   Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
,
Giorjines Boppre 
1   Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
2   Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
,
Lucas Veras 
1   Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
2   Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
,
Vítor Devezas 
3   General Surgery Department, São João Medical Center, Porto, Portugal
,
Hugo Santos-Sousa 
3   General Surgery Department, São João Medical Center, Porto, Portugal
,
John Preto
2   Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
3   General Surgery Department, São João Medical Center, Porto, Portugal
,
Leandro Machado 
4   Center of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Porto, Portugal
5   Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Porto, Portugal
,
Joao Paulo Vilas Boas 
4   Center of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Porto, Portugal
5   Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Porto, Portugal
,
Jose Oliveira 
1   Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
2   Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
,
Hélder Fonseca 
1   Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
2   Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Patients who undergo bariatric surgery (BS) have an increased risk of falls. Our aim was to determine if a multicomponent exercise intervention after BS improves balance. Eighty-four patients with obesity enrolled for BS were recruited and 1 month after BS randomly allocated to a control (CG; standard medical care) or exercise group (EG; exercise plus standard medical care) consisting of a supervised multicomponent training program (3d/week; 75 min/session; 5 months). Anthropometry, lower limb muscle strength (isokinetic dynamometer), vitamin D (ELISA) and balance in bipedal stance (force platform) were assessed pre-BS, 1 month and 6 months post-BS. One month post-BS, significant balance improvements were observed, namely in antero-posterior center of gravity (CoG) displacement and velocity, and medio-lateral and total CoG velocity. Between 1- and 6-months post-BS, improvements in balance were observed only in the EG, with a significant treatment effect on CoG displacement area and antero-posterior CoG displacement. No significant differences were observed between EG and CG over time in any of the anthropometric, muscle strength, and vitamin D variables assayed. In conclusion, a multicomponent exercise intervention program improves some balance parameters in patients with severe obesity following BS and therefore should be part of post-BS follow-up care as a potential strategy to reduce falls and associated injuries.

Key words

weight loss surgery - postural control - force platform - physical exercise

Supplementary Material



Publication History

Received: 30 July 2021

Accepted: 19 January 2022

Article published online:
13 April 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Picot J, Jones J, Colquitt JL. et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess 2009; 13: 1-190 215–357, iii-iv
    CrossrefPubMedSearch in Google Scholar
  • 2 Zhang Q, Chen Y, Li J. et al. A meta-analysis of the effects of bariatric surgery on fracture risk. Obes Rev 2018; 19: 728-736
    CrossrefPubMedSearch in Google Scholar
  • 3 Schafer AL, Kazakia GJ, Vittinghoff E. et al. Effects of gastric bypass surgery on bone mass and microarchitecture occur early and particularly impact postmenopausal women. J Bone Miner Res 2018; 33: 975-986
    CrossrefPubMedSearch in Google Scholar
  • 4 Berarducci A, Haines K, Murr MM. Incidence of bone loss, falls, and fractures after Roux-en-Y gastric bypass for morbid obesity. Appl Nurs Res 2009; 22: 35-41
    CrossrefPubMedSearch in Google Scholar
  • 5 Skalska A, Wizner B, Piotrowicz K. et al. The prevalence of falls and their relation to visual and hearing impairments among a nation-wide cohort of older Poles. Exp Gerontol 2013; 48: 140-146
    CrossrefPubMedSearch in Google Scholar
  • 6 Carlsson LMS, Sjoholm K, Ahlin S. et al. Long-term incidence of serious fall-related injuries after bariatric surgery in Swedish obese subjects. Int J Obes (Lond) 2019; 43: 933-937
    CrossrefPubMedSearch in Google Scholar
  • 7 Terroso M, Rosa N, Torres Marques A. et al. Physical consequences of falls in the elderly: a literature review from 1995 to 2010. Eur Rev Aging Phys Act 2014; 11: 51-59
    CrossrefPubMedSearch in Google Scholar
  • 8 Heinrich S, Rapp K, Rissmann U. et al. Cost of falls in old age: a systematic review. Osteoporos Int 2010; 21: 891-902
    CrossrefPubMedSearch in Google Scholar
  • 9 Ganz DA, Bao Y, Shekelle PG. et al. Will my patient fall?. JAMA 2007; 297: 77-86
    CrossrefPubMedSearch in Google Scholar
  • 10 Hita-Contreras F, Martinez-Amat A, Lomas-Vega R. et al. Relationship of body mass index and body fat distribution with postural balance and risk of falls in Spanish postmenopausal women. Menopause 2013; 20: 202-208
    CrossrefPubMedSearch in Google Scholar
  • 11 Hue O, Simoneau M, Marcotte J. et al. Body weight is a strong predictor of postural stability. Gait Posture 2007; 26: 32-38
    CrossrefPubMedSearch in Google Scholar
  • 12 Benetti FA, Bacha IL, Garrido Junior AB. et al. Analyses of balance and flexibility of obese patients undergoing bariatric surgery. Clinics (Sao Paulo) 2016; 71: 78-81
    CrossrefPubMedSearch in Google Scholar
  • 13 Neunhaeuserer D, Gasperetti A, Savalla F. et al. Functional evaluation in obese patients before and after sleeve gastrectomy. Obes Surg 2017; 27: 3230-3239
    CrossrefPubMedSearch in Google Scholar
  • 14 Maffiuletti NA, Agosti F, Proietti M. et al. Postural instability of extremely obese individuals improves after a body weight reduction program entailing specific balance training. J Endocrinol Invest 2005; 28: 2-7
    CrossrefPubMedSearch in Google Scholar
  • 15 Horlings CG, van Engelen BG, Allum JH. et al. A weak balance: the contribution of muscle weakness to postural instability and falls. Nat Clin Pract Neurol 2008; 4: 504-515
    CrossrefPubMedSearch in Google Scholar
  • 16 Sartorio A, Lafortuna CL, Conte G. et al. Changes in motor control and muscle performance after a short-term body mass reduction program in obese subjects. J Endocrinol Invest 2001; 24: 393-398
    CrossrefPubMedSearch in Google Scholar
  • 17 Fernandes MR, Barreto WDRJ. Association between physical activity and vitamin D: A narrative literature review. Rev Assoc Med Bras (1992) 2017; 63: 550-556
    CrossrefPubMedSearch in Google Scholar
  • 18 Cangussu LM, Nahas-Neto J, Orsatti CL. et al. Effect of isolated vitamin D supplementation on the rate of falls and postural balance in postmenopausal women fallers: a randomized, double-blind, placebo-controlled trial. Menopause 2016; 23: 267-274
    CrossrefPubMedSearch in Google Scholar
  • 19 Diniz-Sousa F, Veras L, Boppre G. et al. The effect of an exercise intervention program on bone health after bariatric surgery: a randomized controlled trial. J Bone Miner Res 2021; 36(3): 489-499
    CrossrefPubMedSearch in Google Scholar
  • 20 Low DC, Walsh GS, Arkesteijn M. Effectiveness of exercise interventions to improve postural control in older adults: a systematic review and meta-analyses of centre of pressure measurements. Sports Med 2017; 47: 101-112
    CrossrefPubMedSearch in Google Scholar
  • 21 Feys J. Nonparametric tests for the interaction in two-way factorial designs using R. R J 2016; 8: 367-378
    CrossrefPubMedSearch in Google Scholar
  • 22 Handrigan G, Hue O, Simoneau M. et al. Weight loss and muscular strength affect static balance control. Int J Obes (Lond) 2010; 34: 936-942
    CrossrefPubMedSearch in Google Scholar
  • 23 Teasdale N, Hue O, Marcotte J. et al. Reducing weight increases postural stability in obese and morbid obese men. Int J Obes (Lond) 2007; 31: 153-160
    CrossrefPubMedSearch in Google Scholar
  • 24 Macht R, George J, Ameli O. et al. Factors associated with bariatric postoperative emergency department visits. Surg Obes Relat Dis 2016; 12: 1826-1831
    CrossrefPubMedSearch in Google Scholar
  • 25 Rubio MA, Moreno C. [Nutritional implications of bariatric surgery on the gastrointestinal tract]. Nutr Hosp 2007; 22: 124-134
    PubMedSearch in Google Scholar
  • 26 Morales J, Ubasart C, Solana-Tramunt M. et al. Effects of rapid weight loss on balance and reaction time in elite judo athletes. Int J Sports Physiol Perform 2018; 1-7
    CrossrefPubMedSearch in Google Scholar
  • 27 Lion A, Bosser G, Gauchard GC. et al. Exercise and dehydration: a possible role of inner ear in balance control disorder. J Electromyogr Kinesiol 2010; 20: 1196-1202
    CrossrefPubMedSearch in Google Scholar
  • 28 van Beek AP, Emous M, Laville M. et al. Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management. Obes Rev 2017; 18: 68-85
    CrossrefPubMedSearch in Google Scholar
  • 29 Bird ML, El Haber N, Batchelor F. et al. Vitamin D and parathyroid hormone are associated with gait instability and poor balance performance in mid-age to older aged women. Gait Posture 2018; 59: 71-75
    CrossrefPubMedSearch in Google Scholar
  • 30 Koundourakis NE, Avgoustinaki PD, Malliaraki N. et al. Muscular effects of vitamin D in young athletes and non-athletes and in the elderly. Hormones (Athens) 2016; 15: 471-488
    CrossrefPubMedSearch in Google Scholar
  • 31 Lapszo J, Giovanis V, Prusik K. et al. Balance control contributors – the relationships between leg strength and balance control ability in seniors. Acta Bioeng Biomech 2012; 14: 3-8
    CrossrefPubMedSearch in Google Scholar
  • 32 Liu J, Wang XQ, Zheng JJ. et al. Effects of tai chi versus proprioception exercise program on neuromuscular function of the ankle in elderly people: a randomized controlled trial. Evid Based Complement Alternat Med 2012; 2012: 265486
    CrossrefPubMedSearch in Google Scholar
  • 33 Donath L, Kurz E, Roth R. et al. Different ankle muscle coordination patterns and co-activation during quiet stance between young adults and seniors do not change after a bout of high intensity training. BMC Geriatr 2015; 15: 19
    CrossrefPubMedSearch in Google Scholar
  • 34 Yelnik A, Bonan I. Clinical tools for assessing balance disorders. Neurophysiol Clin 2008; 38: 439-445
    CrossrefPubMedSearch in Google Scholar
  • 35 Coen PM, Tanner CJ, Helbling NL. et al. Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity. J Clin Invest 2015; 125: 248-257
    CrossrefPubMedSearch in Google Scholar
  • 36 Campanha-Versiani L, Pereira DAG, Ribeiro-Samora GA. et al. The effect of a muscle weight-bearing and aerobic exercise program on the body composition, muscular strength, biochemical markers, and bone mass of obese patients who have undergone gastric bypass surgery. Obes Surg 2017; 27: 2129-2137
    CrossrefPubMedSearch in Google Scholar