Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity
Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity
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DOI：
10.1172/jci78016
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发表时间：
2015-01-01
影响因子：
15.9
通讯作者：
Goodpaster, Bret H.
中科院分区：
文献类型：
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作者：
Coen, Paul M.;Tanner, Charles J.;Goodpaster, Bret H.
背景Roux-en-Y胃旁路手术（RYGB）可显著减轻肥胖患者的体重，并改善胰岛素敏感性（51）。有规律的运动也可以改善肥胖个体的S-1;然而，目前尚不清楚运动和RYGB手术诱导的体重减轻是否会增加S-1和其他心脏代谢因子。我们对128名最近接受RYGB手术（1-3个月内）的男性和女性进行了一项单盲、前瞻性、随机试验。参与者被随机分为6个月的半监督适度运动方案（EX，n = 66）或健康教育对照（CON; n = 62）干预。测量的主要结果包括Si和葡萄糖有效性（S-G），这是从静脉葡萄糖耐量试验和最小建模确定的。测量的次要结果是心肺适应性（VO 2峰值）和身体成分。使用意向治疗（ITT）和符合方案（PP）方法分析数据，以评估运动干预（>120分钟运动/周）的疗效。119名（93%）参与者完成了干预，CON为95%，EX为91%。两组的体重和脂肪量均显著降低。（时间效应P < 0.001）。干预后两组的S-1均有所改善（ITT：CON vs. EX; +1.64 vs. +2.24 min（-1）/mu U/ml，Delta P = 0.18，时间效应P < 0.001）。PP分析显示，运动产生了比手术更高的附加S_i改善（PP：CON vs. EX; +1.57 vs. +2.69min（-1）/mu U/ml，P = 0.019）。与CON组相比，运动也改善了S-G（ITT：CON vs. EX; +0.0023 vs.+0.0063 min（-1），P = 0.009）。与CON组相比，运动改善了心肺功能（VO 2峰值）。在类似的减肥过程中，与久坐不动的生活方式相比，RYGB手术后的适度运动提供了S-1，S-G和心肺功能的额外改善。
BACKGROUND. Roux-en-Y gastric bypass (RYGB) surgery causes profound weight loss and improves insulin sensitivity (51) in obese patients. Regular exercise can also improves S-1 in obese individuals; however, it is unknown whether exercise and RYGB surgery-induced weight loss would additively improve S-1 and other cardiometabolic factors.METHODS. We conducted a single-blind, prospective, randomized trial with 128 men and women who recently underwent RYGB surgery (within 1-3 months). Participants were randomized to either a 6-month semi-supervised moderate exercise protocol (EX, n = 66) or a health education control (CON; n = 62) intervention. Main outcomes measured included Si and glucose effectiveness (S-G), which were determined from an intravenous glucose tolerance test and minimal modeling. Secondary outcomes measured were cardiorespiratory fitness (VO2 peak) and body composition. Data were analyzed using an intention-to-treat (ITT) and per-protocol (PP) approach to assess the efficacy of the exercise intervention (>120 min of exercise/week).RESULTS. 119 (93%) participants completed the interventions, 95% for CON and 91% for EX. There was a significant decrease in body weight and fat mass for both groups.(P < 0.001 for time effect). S-1 improved in both groups following the intervention (ITT: CON vs. EX; +1.64 vs. +2.24 min(-1)/mu U/ml, P = 0.18 for Delta, P < 0.001 for time effect). A PP analysis revealed that exercise produced an additive S, improvement (PP: CON vs. EX; +1.57 vs. +2.69min(-1)/mu U/ml, P = 0.019) above that of surgery. Exercise also improved S-G (ITT: CON vs. EX; +0.0023 vs. +0.0063 min(-1), P = 0.009) compared with the CON group. Exercise improved cardiorespiratory fitness (VO2 peak) compared with the CON group.CONCLUSION. Moderate exercise following RYGB surgery provides additional improvements in S-1, S-G, and cardiorespiratory fitness compared with a sedentary lifestyle during similar weight loss.