Muscle Strength in Severe Obese Patients in the Postoperative of Bariatric Surgery

NCT ID: NCT04129801

Last Updated: 2019-10-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

132 participants

Study Classification

OBSERVATIONAL

Study Start Date

2017-05-05

Study Completion Date

2019-05-08

Brief Summary

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Excessive fat mass (FM) contributes to changes in the strength and endurance of skeletal muscles. Mid-thigh muscle mass is approximately 2.5 times that of fat mass, but individuals who are obese have increased intra- (fat within muscle cells) and intermuscular fat (fat between muscle cells), establishing a negative influence on strength generation capacity and functional independence. The functional capacity of a skeletal muscle can be assessed based on the muscle's ability to produce strength. The relevance of this study is to identify/analyze the changes in segmental body composition (BC) which might better determine the association between fat free mass (FFM) of the lower limbs and maximum voluntary contraction (MVC), 36 months after bariatric surgery. This study was elaborated and will be performed at the Clinical Hospital in the Medical School of the University of Sao Paulo (HCFMUSP). The patients involved will receive the Informed Consent Form. The sample, consists of 155 adults selected at the ambulatory of the Bariatric and Metabolic Surgery Unit of the Department of Gastroenterology of HCFMUSP in the periods: preoperative, 6 and 36 months after surgery. Patients of both sexes, above 18 years of age, will undergo bariatric surgery performed at the institution. Adult patients over 60 years old, undergoing revision surgery and other surgical techniques will be excluded. Anthropometric variables will be obtained on the same day as the evaluation of BC by trained evaluators. The BC will be measured by In Body 230. BMI (kg/m2) shall be determined by dividing body weight (kg) by height (m) squared. Evaluation of Body Composition and Muscle Strength will be held between 8:00 am and 10:00 am in the Laboratory of Exercise and Movement Studies at the Institute of Orthopedics and Traumatology of FMUSP. BC measurements as FM (% and kg), FFM (% and kg), will be obtained by the indirect noninvasive method of electrical bioimpedance. The dynamometer will be used to evaluate muscle strength extension (Ext) and flexion (Flex) MVC torques for both legs will be carried. The MVC assessed variables should be absolute Ext and Flex torques (Nm), Ext and Flex torques relative to the body weight (Nm/Bw) and Ext and Flex torques relative to FFM (Nm/FFM).

Detailed Description

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Anthropometric Assessment Anthropometric variables will be obtained on the same day as the evaluation of BC by trained evaluators. The body weight (kg) will be measured by In Body 230, 2.0, (Biospace Seoul, Korea). The patient should be in the orthostatic position, facing the display, in the center of the scale, barefoot, in light clothes. The height measurement (m) will be performed in a stadiometer coupled to the scale W 300, Class III, with a maximum capacity of 2m. The patient will be kept with his back to the meter, with the feet united, in an erect position, looking at horizon and arms extended to the side of the body. The reading will be made in the nearest centimeter when the horizontal rod of the vertical bar of the stature scale rests against the individual's head. BMI (kg/m2) will be determined by dividing body weight (kg) by height (m) squared.

Bioimpedance Body composition will be determined by bioelectrical impedance analysis (BIA) under constant conditions (with subjects appropriately hydrated and at the same time of day).The body composition analyzer (InBody230, Biospace Co., Gangnam-gu, Seoul, South Korea) was a segmental impedance device that uses a tetrapolar 8-point tactile electrode system, and the measured weight range was 10 to 250 kg. Impedance measurements were performed by utilizing 2 different frequencies (20 and 100 kHz) at each segment (the right arm, left arm, trunk, right leg, and left leg). The participant will be positioned in orthostatic position on a platform with lower electrodes for the feet and two brackets (the upper electrodes) gripped on hands. Data output was calculated in percentages (%) and included FM, FFM, trunk FFM, and appendicular FFM (the sum of the FFM values for the right arm, left arm, right leg, and left leg).

Isokinetic dynamometer The muscular strength evaluation will be performed on the isokinetic dynamometer, Biodex ® Multi-joint System 3 (Biodex Medical Systems Inc, Shirley, New York, USA). The dynamometer is calibrated thirty minutes before the start of the tests.

Participants are positioned for evaluation in the concentric / concentric mode of knee joint extension and flexion movements. Individuals remain seated with their hip at 90º of flexion, affixed to the chair with chest X-belts, a strap around the pelvic girdle, a strap over the distal third of the thigh and one at the distal third of the assessed leg, way to free the movements of the ankle.

All participants are instructed to perform four movements with submaximal force to familiarize themselves with the equipment. The test is performed first on the dominant limb and later on the non-dominant limb. The assessed limb is positioned with the lateral femoral condyle (axis of the knee joint movement) aligned to the mechanical axis of the dynamometer. The member that is not being evaluated will be aligned with the other member. The volunteers are instructed to perform two sets of 4 uninterrupted repetitions of knee extension and flexion with interval of 60 seconds. Throughout the period of the test, standardized and constant verbal encouragement is performed to obtain as much force as possible during contractions.

The tests are performed with concentric movements of flexion and extension of the knee, starting from 90º of flexion and reaching 20º of extension, with correction of the force of gravity.

The angular velocity used will be 60 degrees per second (60º / s).

The variables that will be obtained through the evaluation of muscular strength are:

Torque Peak (Nm): is the maximum force reached in each of the repetitions in which the test was performed. The peak torque represents the largest muscle contraction in the arc of movement and corresponds to the highest point of the force x distance curve.

Peak torque relative to body weight (Nm / kg): maximum force corrected for body weight, the result being expressed in percent newton-kilogram.

Conditions

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Severe Obesity

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Prospective analysis

Bioimpedance The BC measurements as FM (% and kg), FFM (% and kg), will be obtained by the indirect noninvasive method of electrical bioimpedance (BIA) 230, 2.0, (Biospace Seoul, Korea). Those evaluated will be standing and positioned on the platform electrodes, barefoot and with their arms extended with their hands on the two supports (electrodes).

Evaluation of Muscle Strength was used The Biodex Multi-joint System 3 dynamometer (Biodex Medical Systems, Inc., Shirley, New York, USA) to measure isokinetic extension (Ext) and flexion (Flex) MVC torques for both legs.

Isokinetic Dynamometer

Intervention Type OTHER

Participants then executed two series of four uninterrupted repetitions of Ext and Flex of both legs, first with the dominant member and subsequently with the non-dominant member, at an angular velocity of 60o/s, with a 60-second interval between series.

Bioimpedance

Intervention Type OTHER

Bioimpedance The BC measurements as FM (% and kg), FFM (% and kg), will be obtained by the indirect noninvasive method of electrical bioimpedance (BIA) 230, 2.0, (Biospace Seoul, Korea). Those evaluated will be standing and positioned on the platform electrodes, barefoot and with their arms extended with their hands on the two supports (electrodes).

Interventions

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Isokinetic Dynamometer

Participants then executed two series of four uninterrupted repetitions of Ext and Flex of both legs, first with the dominant member and subsequently with the non-dominant member, at an angular velocity of 60o/s, with a 60-second interval between series.

Intervention Type OTHER

Bioimpedance

Bioimpedance The BC measurements as FM (% and kg), FFM (% and kg), will be obtained by the indirect noninvasive method of electrical bioimpedance (BIA) 230, 2.0, (Biospace Seoul, Korea). Those evaluated will be standing and positioned on the platform electrodes, barefoot and with their arms extended with their hands on the two supports (electrodes).

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Body mass index (BMI) between 40 and 60 kg/m2.

Exclusion Criteria

* Functional disability
* Treatment with steroid medication for any reason.
* Use of artificial devices such as an orthosis or a prosthesis.
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Sao Paulo General Hospital

OTHER

Sponsor Role lead

Responsible Party

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Roberto de Cleva

Principal investigador

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Roberto de Cleva, MD Phd

Role: STUDY_CHAIR

Clinical Hospital of University of Sao Paulo Medical School

Alexandre Gadducci, MsC

Role: PRINCIPAL_INVESTIGATOR

University of Sao Paulo Medical School

Locations

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Hospital das Clinicas da Faculdade de Medicina da USP

São Paulo, , Brazil

Site Status

Countries

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Brazil

References

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Pereira-Lancha LO, Campos-Ferraz PL, Lancha AH Jr. Obesity: considerations about etiology, metabolism, and the use of experimental models. Diabetes Metab Syndr Obes. 2012;5:75-87. doi: 10.2147/DMSO.S25026. Epub 2012 Apr 10.

Reference Type BACKGROUND
PMID: 22570558 (View on PubMed)

Okoro CA, Hootman JM, Strine TW, Balluz LS, Mokdad AH. Disability, arthritis, and body weight among adults 45 years and older. Obes Res. 2004 May;12(5):854-61. doi: 10.1038/oby.2004.103.

Reference Type BACKGROUND
PMID: 15166307 (View on PubMed)

Syed IY, Davis BL. Obesity and osteoarthritis of the knee: hypotheses concerning the relationship between ground reaction forces and quadriceps fatigue in long-duration walking. Med Hypotheses. 2000 Feb;54(2):182-5. doi: 10.1054/mehy.1999.0013.

Reference Type BACKGROUND
PMID: 10790748 (View on PubMed)

Anandacoomarasamy A, Fransen M, March L. Obesity and the musculoskeletal system. Curr Opin Rheumatol. 2009 Jan;21(1):71-7. doi: 10.1097/bor.0b013e32831bc0d7.

Reference Type BACKGROUND
PMID: 19093327 (View on PubMed)

Hulens M, Vansant G, Claessens AL, Lysens R, Muls E. Predictors of 6-minute walk test results in lean, obese and morbidly obese women. Scand J Med Sci Sports. 2003 Apr;13(2):98-105. doi: 10.1034/j.1600-0838.2003.10273.x.

Reference Type BACKGROUND
PMID: 12641641 (View on PubMed)

Brown M, Sinacore DR, Host HH. The relationship of strength to function in the older adult. J Gerontol A Biol Sci Med Sci. 1995 Nov;50 Spec No:55-9. doi: 10.1093/gerona/50a.special_issue.55.

Reference Type BACKGROUND
PMID: 7493219 (View on PubMed)

Wolfson L, Judge J, Whipple R, King M. Strength is a major factor in balance, gait, and the occurrence of falls. J Gerontol A Biol Sci Med Sci. 1995 Nov;50 Spec No:64-7. doi: 10.1093/gerona/50a.special_issue.64.

Reference Type BACKGROUND
PMID: 7493221 (View on PubMed)

Moxley Scarborough D, Krebs DE, Harris BA. Quadriceps muscle strength and dynamic stability in elderly persons. Gait Posture. 1999 Sep;10(1):10-20. doi: 10.1016/s0966-6362(99)00018-1.

Reference Type BACKGROUND
PMID: 10469937 (View on PubMed)

Skelton DA, Kennedy J, Rutherford OM. Explosive power and asymmetry in leg muscle function in frequent fallers and non-fallers aged over 65. Age Ageing. 2002 Mar;31(2):119-25. doi: 10.1093/ageing/31.2.119.

Reference Type BACKGROUND
PMID: 11937474 (View on PubMed)

Capodaglio P, Vismara L, Menegoni F, Baccalaro G, Galli M, Grugni G. Strength characterization of knee flexor and extensor muscles in Prader-Willi and obese patients. BMC Musculoskelet Disord. 2009 May 6;10:47. doi: 10.1186/1471-2474-10-47.

Reference Type BACKGROUND
PMID: 19419559 (View on PubMed)

Nocera J, Buford TW, Manini TM, Naugle K, Leeuwenburgh C, Pahor M, Perri MG, Anton SD. The impact of behavioral intervention on obesity mediated declines in mobility function: implications for longevity. J Aging Res. 2011;2011:392510. doi: 10.4061/2011/392510. Epub 2011 Oct 16.

Reference Type BACKGROUND
PMID: 22013527 (View on PubMed)

Wakeling JM, Liphardt AM, Nigg BM. Muscle activity reduces soft-tissue resonance at heel-strike during walking. J Biomech. 2003 Dec;36(12):1761-9. doi: 10.1016/s0021-9290(03)00216-1.

Reference Type BACKGROUND
PMID: 14614930 (View on PubMed)

Taylor WR, Heller MO, Bergmann G, Duda GN. Tibio-femoral loading during human gait and stair climbing. J Orthop Res. 2004 May;22(3):625-32. doi: 10.1016/j.orthres.2003.09.003.

Reference Type BACKGROUND
PMID: 15099644 (View on PubMed)

Gaines JM, Talbot LA. Isokinetic strength testing in research and practice. Biol Res Nurs. 1999 Jul;1(1):57-64. doi: 10.1177/109980049900100108.

Reference Type BACKGROUND
PMID: 11225298 (View on PubMed)

Gleeson NP, Mercer TH. The utility of isokinetic dynamometry in the assessment of human muscle function. Sports Med. 1996 Jan;21(1):18-34. doi: 10.2165/00007256-199621010-00003.

Reference Type BACKGROUND
PMID: 8771283 (View on PubMed)

O'Shea K, Kenny P, Donovan J, Condon F, McElwain JP. Outcomes following quadriceps tendon ruptures. Injury. 2002 Apr;33(3):257-60. doi: 10.1016/s0020-1383(01)00110-3.

Reference Type BACKGROUND
PMID: 12084643 (View on PubMed)

Jaric S. Muscle strength testing: use of normalisation for body size. Sports Med. 2002;32(10):615-31. doi: 10.2165/00007256-200232100-00002.

Reference Type BACKGROUND
PMID: 12141882 (View on PubMed)

Jaric S. Role of body size in the relation between muscle strength and movement performance. Exerc Sport Sci Rev. 2003 Jan;31(1):8-12. doi: 10.1097/00003677-200301000-00003.

Reference Type BACKGROUND
PMID: 12562164 (View on PubMed)

De Ste Croix M, Deighan M, Armstrong N. Assessment and interpretation of isokinetic muscle strength during growth and maturation. Sports Med. 2003;33(10):727-43. doi: 10.2165/00007256-200333100-00002.

Reference Type BACKGROUND
PMID: 12895130 (View on PubMed)

Handrigan G, Hue O, Simoneau M, Corbeil P, Marceau P, Marceau S, Tremblay A, Teasdale N. Weight loss and muscular strength affect static balance control. Int J Obes (Lond). 2010 May;34(5):936-42. doi: 10.1038/ijo.2009.300. Epub 2010 Jan 26.

Reference Type BACKGROUND
PMID: 20101249 (View on PubMed)

Paolillo FR, Milan JC, Bueno Pde G, Paolillo AR, Borghi-Silva A, Parizotto NA, Arena R, Kurachi C, Bagnato VS. Effects of excess body mass on strength and fatigability of quadriceps in postmenopausal women. Menopause. 2012 May;19(5):556-61. doi: 10.1097/gme.0b013e3182364e80.

Reference Type BACKGROUND
PMID: 22089183 (View on PubMed)

Koenig SM. Pulmonary complications of obesity. Am J Med Sci. 2001 Apr;321(4):249-79. doi: 10.1097/00000441-200104000-00006.

Reference Type BACKGROUND
PMID: 11307867 (View on PubMed)

Hulens M, Vansant G, Lysens R, Claessens AL, Muls E, Brumagne S. Study of differences in peripheral muscle strength of lean versus obese women: an allometric approach. Int J Obes Relat Metab Disord. 2001 May;25(5):676-81. doi: 10.1038/sj.ijo.0801560.

Reference Type BACKGROUND
PMID: 11360150 (View on PubMed)

Maffiuletti NA, Jubeau M, Munzinger U, Bizzini M, Agosti F, De Col A, Lafortuna CL, Sartorio A. Differences in quadriceps muscle strength and fatigue between lean and obese subjects. Eur J Appl Physiol. 2007 Sep;101(1):51-9. doi: 10.1007/s00421-007-0471-2. Epub 2007 May 3.

Reference Type BACKGROUND
PMID: 17476522 (View on PubMed)

Gadducci AV, de Cleva R, de Faria Santarem GC, Silva PRS, Greve JMD, Santo MA. Muscle strength and body composition in severe obesity. Clinics (Sao Paulo). 2017 May;72(5):272-275. doi: 10.6061/clinics/2017(05)03.

Reference Type BACKGROUND
PMID: 28591338 (View on PubMed)

Rolland Y, Lauwers-Cances V, Pahor M, Fillaux J, Grandjean H, Vellas B. Muscle strength in obese elderly women: effect of recreational physical activity in a cross-sectional study. Am J Clin Nutr. 2004 Apr;79(4):552-7. doi: 10.1093/ajcn/79.4.552.

Reference Type BACKGROUND
PMID: 15051596 (View on PubMed)

Hulens M, Vansant G, Lysens R, Claessens AL, Muls E. Assessment of isokinetic muscle strength in women who are obese. J Orthop Sports Phys Ther. 2002 Jul;32(7):347-56. doi: 10.2519/jospt.2002.32.7.347.

Reference Type BACKGROUND
PMID: 12113469 (View on PubMed)

Karelis AD, Chamberland G, Aubertin-Leheudre M, Duval C; Ecological mobility in Aging and Parkinson (EMAP) group. Validation of a portable bioelectrical impedance analyzer for the assessment of body composition. Appl Physiol Nutr Metab. 2013 Jan;38(1):27-32. doi: 10.1139/apnm-2012-0129. Epub 2013 Jan 1.

Reference Type BACKGROUND
PMID: 23368825 (View on PubMed)

Calmels PM, Nellen M, van der Borne I, Jourdin P, Minaire P. Concentric and eccentric isokinetic assessment of flexor-extensor torque ratios at the hip, knee, and ankle in a sample population of healthy subjects. Arch Phys Med Rehabil. 1997 Nov;78(11):1224-30. doi: 10.1016/s0003-9993(97)90336-1.

Reference Type BACKGROUND
PMID: 9365353 (View on PubMed)

Gadducci AV, de Cleva R, Cardia L, Estabile P, Silva PRS, Greve JMD, Santo MA. Muscle Strength of Lower Limbs as a Postoperative Predictor in Bariatric Surgery. J Musculoskelet Neuronal Interact. 2024 Mar 1;24(1):31-37.

Reference Type DERIVED
PMID: 38427366 (View on PubMed)

Other Identifiers

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01038912.6.0000.0068

Identifier Type: -

Identifier Source: org_study_id

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