Effect of inspiratory muscle training on patients undergoing bariatric surgery: a systematic review
DOI:
https://doi.org/10.1590/1809-2950/16901723042016Keywords:
Breathing Exercises, Bariatric Surgery, Clinical Trial, ReviewAbstract
Studies have shown that among the various techniques that involve chest physical therapy, the inspiratory muscle training (IMT) is essential in the recovery of lung function and in preventing respiratory complications. However, the effect of IMT on patients undergoing bariatric surgery is still inconclusive. The aim of this study was to systematically review randomized and controlled trials that assessed the effect of IMT compared with sham IMT, standard physical therapy (breathing exercises and early ambulation) or no intervention in the lung function on patients undergoing bariatric surgery. The search was conducted in PubMed/MEDLINE, Cochrane, TRIP, PEDro and Scopus databases with no publication year or language limits, following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. From 2,184 potentially eligible studies, two studies were included. Bias risk criteria were adapted and divided into nine main areas using the Cochrane Handbook. This review included 62 participants, being 30 allocated to receive Threshold® IMT device, but in different periods: preoperative and postoperative. IMT promoted increased maximal inspiratory pressure (MIP) in relation to standard physical therapy, but no significant differences were found in maximal expiratory pressure (MEP). The studies showed low and unclear bias risk. IMT seems to be the most effective treatment in comparison with standard physical therapy alone in pre- or postoperative period. However, there is no solid evidence for clinical decision-making.Downloads
References
Stothard KJ, Tennant PWG, Bell R, Rankin J. Maternal
overweight and obesity and the risk of congenital anomalies.
JAMA. 2015;301(6):636-50.
Güngör NK. Overweight and Obesity in Children
and Adolescents. J Clin Res Pediatr Endocrinol.
;6(3):129-43.
World Health Organization. 10 facts on obesity. 2016.
Jung UJ, Choi M. Obesity and its metabolic complications:
the role of adipokines and the relationship between
obesity, inflammation, insulin resistance, dyslipidemia and
nonalcoholic fatty liver disease. Int J Mol Sci. 2014;15:6184-223.
Chrostowska M, Zyndler A, Hoffmann M, Narkiewicz K.
Impact of obesity on cardiovascular health. Best Pract Res
Clin Endocrinol Metab. 2013;27:147-56.
Malhotra A, White DP. Obstructive sleep apnoea. Lancet.
;360:237-45.
The Global BMI Mortality Colaboration. Body-mass index and
all-cause mortality: individual-participant-data meta-analysis
of 239 prospective studies in. Lancet. 2016;388:776-86.
Sturm RÃ. Increases in morbid obesity in the USA: 2000 –
J R Inst public Heal. 2007;121:492-6.
Jones RL, Nzekwu M-MU. The effects of body mass index on
lung volumes. Chest. 2006;130:827-33.
Mafort TT, Rufino R, Costa CH, Lopes AJ. Obesity: systemic
and pulmonary complications, biochemical abnormalities,
and impairment of lung function. Multidiscip Respir Med.
;11(28):1-11.
Fisioter Pesqui. 2016;23(4):448-457
Melo LC, Silva MAM, Calles AC do N. Obesity and lung
function : a systematic review. Einstein. 2014;12(1):120-5.
Paisani DDEM, Chiavegato LD, Faresin SM. Volumes,
capacidades pulmonares e força muscular respiratória
no pós-operatório de gastroplastia. J Bras Pneumol.
;31(2):125-32.
Weiner P, Waizman J, Weiner M, Rabner M, Magadle R, Zamir
D. Influence of excessive weight loss after gastroplasty for
morbid obesity on respiratory muscle performance. Thorax.
;53:39-42.
Costa D, Barbalho MC, Miguel GPS, Forti EMP, Azevedo
JLMC. The impact of obesity on pulmonary function in adult
women. Clinics. 2008;63(6):719-24.
Porhomayon J, Papadakos P, Singh A, Nader ND. Alteration
in respiratory physiology in obesity for anesthesia-critical
care physician. HSR Proc Intensive Care Cardiovasc Anesth.
;3(2):109-18.
Albuquerque CG De, Andrade FMD, Rocha MA de A, et al.
Determining respiratory system resistance and reactance by
impulse oscillometry in obese individuals. J Bras Pneumol.
;41(5):422-6.
Castello V, Simões RP, Bassi D, Mendes RG, Borghi-silva A.
Força muscular respiratória é marcantemente reduzida
em mulheres obesas mórbidas. Arq Médicos ABC.
;32(2):74-7.
Casali CCC, Pereira APM, Martinez BJA, Celso H, Souza
HCD, Gastaldi AC. Effects of Inspiratory Muscle Training on
Muscular and Pulmonary Function After Bariatric Surgery in
Obese Patients. Obes Surg. 2011;21:1389-94.
Salome CM, King GG, Berend N. Physiology of obesity and
effects on lung function. J Appl Physiol. 2010;108:206-11.
Sant Anna J M, Oliveira JEP, Carneiro JRI, et al. Força
muscular respiratória de mulheres obesas mórbidas e
eutróficas Respiratory muscle strength in morbidly obese
and eutrophic women. Fisioter Pesqui. 2011;18(17):122-6.
Colquitt J, Pickett K, Loveman E, Frampton G. Surgery for
weight loss in adults (Review). Cochrane Database Syst Rev.
;(8):1-243. DOI: 10.1002/14651858.CD003641.pub4.
Madura JA, DiBaise JK. Quick fix or long-term cure? pros and
cons of bariatric surgery. F1000 Reports Med. 2012;4:19.
Blouw EL, Rudolph AD, Narr BJ, Sarr MG. The frequency of
respiratory failure in patients with morbid obesity undergoing
gastric bypass. AANA J. 2003;71(1):45-50.
Dall’Ago P, Chiappa GRS, Guths H, Stein R, Ribeiro JP.
Inspiratory Muscle Training in Patients With Heart Failure
and Inspiratory Muscle Weakness. J Am Coll Cardiol.
;47(4):757-763.
Bosnak-Guclu M, Arikan H, Savci S, Inal-ince D. Effects of
inspiratory muscle training in patients with heart failure *.
Respir Med. 2011;105:1671-81.
Barbalho-Moulim MC, Miguel GPS, Forti EMP, Campos F do A,
Costa D. Effects of preoperative inspiratory muscle training in
obese women undergoing open bariatric surgery: respiratory
muscle strength, lung volumes, and diaphragmatic excursion.
Clinics. 2011;66(10):1721-7.
Lloréns J, Rovira L, Ballester M, Moreno J, Hernández-Lafore
J. Preoperative inspiratory muscular training to prevent
postoperative hypoxemia in morbidly obese patients
undergoing laparoscopic bariatric surgery: a randomized
clinical trial. Obes Surg. 2015;2(6)5:1003-9.
Katsura M, Kuriyama A, Takeshima T, Fukuhara S, Ta F.
Preoperative inspiratory muscle training for postoperative
pulmonary complications in adults undergoing cardiac and
major abdominal surgery ( Review ). 2015;(10):1-84.
Mans CM, Reeve JC, Elkins MR. Postoperative outcomes
following preoperative inspiratory muscle training in
patients undergoing cardiothoracic or upper abdominal
surgery: a systematic review and meta analysis. Clin Rehabil.
;29(5):426-38.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred
Reporting Items for Systematic Reviews and Meta-Analyses:
The PRISMA Statment. Ann Intern Med. 2009;151(4):264-9.
Higgins JPT, Green S. Cochrane Handbook for Systematic
Reviews of Interventions Version 5.1.0 [updated March 2011].
Cochrane Collab. 2011.
Collet F, Mallart A, Bervar JF, et al. Physiologic correlates
of dyspnea in patients with morbid obesity. Int J Obes.
;31:700-6.
Chlif M, Keochkerian D, Choquet D, Vaidie A, Ahmaidi S. Effects
of obesity on breathing pattern , ventilatory neural drive and
mechanics. Respir Physiol Neurobiol. 2009;168:198-202.
Peixoto-Souza FS, Gallo-Silva B, Echevarria LB, Silva MAA,
Pessoti E, Pazzianotto-forti EM. Fisioterapia respiratória
associada à pressão positiva nas vias aéreas na evolução
pós-operatória da cirurgia bariátrica. Fisioter Pesqui.
;19(3):204-9.
Tzani P, Chetta A, Olivieri D. Patient assessment and
prevention of pulmonary side-effects in surgery. Curr Opin
Anesthesiol. 2011;24:2-7.
McConnell AK, Romer LM. Respiratory Muscle Training in
Healthy Humans: Resolving the Controversy. Int J Sport Med.
;25:284-93.
Sturdy G, Hillman D, Green D, Jenkins S, Cecins N, Eastwood
P. Based Respiratory Muscle Training in COPD*. Chest.
;123(1):142-50.
Hill K, Jenkins SC, Philippe DL, et al. High-intensity inspiratory
muscle training in COPD. Eur Respir J. 2006;27(6):1119-28.
Moritani, Toshio & DeVries HA. 1979 Moritani.pdf. Am J Phys
Med. 1979;58(3).
Hiikkinen K, Komi P V, Alan M, Kauhanen H. Applied Physiology
EMG, muscle fibre and force production characteristics
during a 1 year training period in elite weight-lifters. Eur J
Appl Physiol. 1987;56:419-27.
George RB, Weill H. Fluoroscopy. J Am Med Assoc.
;217(2):171-6.
Ahmad S, Nagle A, Mccarthy RJ, Fitzgerald PC, Sullivan
JT, Prystowsky J. Postoperative hypoxemia in morbidly
obese patients with and without obstructive sleep apnea
undergoing laparoscopic bariatric surgery. Anesthesia
Analgesia. 2008;107(1):138-143.
Downs SH, Black N. The feasibility of creating a checklist
for the assessment of the methodological quality both of
randomised and non-randomised studies of health care
interventions. J Epidemiol Community Heal. 1998;52:377-84.
De Nardi et al. IMT in patients undergoing bariatric surgery: systematic review
Jadad AR, Moore RA, Carroll D, et al. Assessing the Quality of
Reports of Randomized Clinical Trials: Is Blinding Necessary?
Elsevier Sci. 1996;17:1-12.
Viswanathan M, Ansari M, Berkman N, Chang S, Hartling
L, et al. Assessing the risk of bias of individual studies in
systematic reviews of health care interventions.In: Methods
Guide for Effectiveness and Comparative Effectiveness
Reviews. Rockville: Agency Healthc Res Qual Methods Guid
Comp Eff Rev. 2012
Downloads
Published
Issue
Section
License
Copyright (c) 2016 Fisioterapia e Pesquisa
![Creative Commons License](http://i.creativecommons.org/l/by-sa/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.