肥胖人群减重代谢术后运动康复方案的构建研究
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摘要
背景减重代谢手术是目前国际上有效的治疗病态肥胖的方法,但代谢术后并非所有患者均取得最佳的减重疗效,运动康复作为减重代谢术后康复和生活方式管理的重要组成部分,对于改善患者术后减重结局意义重大,但目前我国尚缺乏科学规范的代谢术后患者运动康复相关指南或共识来指导临床实践。目的构建适合我国肥胖人群减重代谢术后的运动康复方案。方法系统检索国内外减重代谢术后运动康复相关文献,检索时间为建库至2017-12-28,对筛选后的文献进行质量评价并提炼内容,制定减重代谢术后运动康复方案的初稿。于2018年1—2月采用德尔菲法,通过16名专家进行2轮专家函询,修订并最终确定肥胖人群减重代谢术后运动康复方案。结果 2轮专家函询的问卷回收率分别为88.9%(16/18)和100.0%(16/16),专家权威系数为0.90。肯德尔协调系数(Kendall's W)分别为0.343和0.453(P<0.01),最终形成的运动康复方案包括筛查与评估、运动处方制定、随访与教育3项一级指标,二级指标10项,三级指标48项。结论基于文献研究和德尔菲法构建的运动康复方案具有一定的科学性和实用性,可用于指导肥胖人群减重代谢术后的运动康复。
Background For severe obese people,bariatric surgery is the most effective choice,but not all patients can achieve satisfied weight loss after the surgery.As an important component of postoperative rehabilitation and lifestyle management,exercise rehabilitation is of great significance in improving postoperative weight loss related outcomes.However,in China,there is lack of a scientific and standardized exercise rehabilitation guideline or consensus to guide clinical practice.Objective To construct a scientific and practical exercise rehabilitation program suitable for Chinese obese population after bariatric surgery.Methods We systematically searched the articles about exercise rehabilitation after bariatric surgery from the establishment of the database to 28 December,2017,and extracted useful contents from the eligible ones after a quality assessment,then formulated an initial version of the exercise rehabilitation program for Chinese obese people after bariatric surgery.After this,we conducted two rounds of Delphi consultation among 16 experts from January to Febnary 2018,and according to the results,we revised the initial version,and developed the final version.Results The response rates for the first,and second consultations were 88.9%(16/18)and 100.0%(16/16),respectively,and the authority coefficient of experts was 0.90.Kendall's coefficients of concordance in the first,and second consultations were 0.343 and 0.453 respectively(P<0.01). The final program includes 3 primary indicators(screening and assessment,exercise prescription formulation,follow-up and education),10 secondary indicators and 48 tertiary indicators.Conclusion Our exercise rehabilitation program conducted on the basis of literature review and Delphi consultation is scientific and practical,which may be useful in guiding the exercise rehabilitation of patients after bariatric surgery.
Background For severe obese people,bariatric surgery is the most effective choice,but not all patients can achieve satisfied weight loss after the surgery.As an important component of postoperative rehabilitation and lifestyle management,exercise rehabilitation is of great significance in improving postoperative weight loss related outcomes.However,in China,there is lack of a scientific and standardized exercise rehabilitation guideline or consensus to guide clinical practice.Objective To construct a scientific and practical exercise rehabilitation program suitable for Chinese obese population after bariatric surgery.Methods We systematically searched the articles about exercise rehabilitation after bariatric surgery from the establishment of the database to 28 December,2017,and extracted useful contents from the eligible ones after a quality assessment,then formulated an initial version of the exercise rehabilitation program for Chinese obese people after bariatric surgery.After this,we conducted two rounds of Delphi consultation among 16 experts from January to Febnary 2018,and according to the results,we revised the initial version,and developed the final version.Results The response rates for the first,and second consultations were 88.9%(16/18)and 100.0%(16/16),respectively,and the authority coefficient of experts was 0.90.Kendall's coefficients of concordance in the first,and second consultations were 0.343 and 0.453 respectively(P<0.01). The final program includes 3 primary indicators(screening and assessment,exercise prescription formulation,follow-up and education),10 secondary indicators and 48 tertiary indicators.Conclusion Our exercise rehabilitation program conducted on the basis of literature review and Delphi consultation is scientific and practical,which may be useful in guiding the exercise rehabilitation of patients after bariatric surgery.
引文
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[2]ANGRISANI L,SANTONICOLA A,IOVINO P,et al.Bariatric surgery worldwide 2013[J].Obes Surg,2015,25(10):1822-1832.DOI:10.1007/s11695-015-1657-z.
[3]张刘兆,孙陡,张长乐.3种常见消化道重建方式对非肥胖型2型糖尿病患者疗效的Meta分析[J].安徽医学,2017,38(5):612-618.DOI:10.3969/j.issn.1000-0399.2017.05.011.ZHANG L Z,SUN D,ZHANG C L.Meta-analysis of three common digestive tract reconstruction methods in the treatment of non-obese type 2 diabetes mellitus[J].Anhui Medical Journal,2017,38(5):612-618.DOI:10.3969/j.issn.1000-0399.2017.05.011.
[4]COURCOULAS A P,CHRISTIAN N J,BELLE S H,et al.Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity[J].JAMA,2013,310(22):2416-2425.DOI:10.1001/jama.2013.280928.
[5]RUDOLPH A,HILBERT A.Post-operative behavioural management in bariatric surgery:a systematic review and meta-analysis of randomized controlled trials[J].Obes Rev,2013,14(4):292-302.DOI:10.1111/obr.12013.
[6]HASSANNEJAD A,KHALAJ A,MANSOURNIA M A,et al.The effect of aerobic or aerobic-strength exercise on body composition and functional capacity in patients with BMI≥35 after bariatric surgery:a randomized control trial[J].Obes Surg,2017,(3):1-10.DOI:10.1007/s11695-017-2717-3.
[7]CASTELLO-SIM?ES V,POLAQUINI S R,BELTRAME T,et al.Effects of aerobic exercise training on variability and heart rate kinetic during submaximal exercise after gastric bypass surgery:a randomized controlled trial[J].Disabil Rehabil,2013,35(4):334-342.DOI:10.3109/09638288.2012.694575.
[8]HERRING L Y,STEVINSON C,CARTER P,et al.The effects of supervised exercise training 12-24 months after bariatric surgery on physical function and body composition:a randomised controlled trial[J].Int J Obes(Lond),2017,41(6):909-916.DOI:10.1038/ijo.2017.60.
[9]JASSIL F C,MANNING S,LEWIS N,et al.Feasibility and impact of a combined supervised exercise and nutritional-behavioral intervention following bariatric surgery:a pilot study[J].JObes,2015,2015:1-12.DOI:10.1155/2015/693829.
[10]PEACOCK J C,ZIZZI S J.Survey of bariatric surgical patients'experiences with behavioral and psychological services[J].Surg Obes Relat Dis,2012,8(6):777-783.DOI:10.1016/j.soard.2011.11.015.
[11]韦当,王聪尧,肖晓娟,等.指南研究与评价(AGREEⅡ)工具实例解读[J].中国循证儿科杂志,2013,8(4):316-319.DOI:10.3969/j.issn.1673-5501.2013.04.017.WEI D,WANG W Y,XIAO X J,et al.Interpretation of guideline research and evaluation(AGREEⅡ)tools[J].Chinese Journal of Evidenced Based Pediatric,2013,8(4):316-319.DOI:10.3969/j.issn.1673-5501.2013.04.017.
[12]胡雁.循证护理学[M].北京:人民卫生出版社,2012:69-93.HUI Y.Evidenced based nursing[M].Beijing:People's Medical Publishing House,2012:69-93.
[13]伍琳,孙艳杰.德尔菲法简介及在护理学中的应用现状[J].护理研究,2015,29(10):3599-3601.DOI:10.3969/j.issn.1009-6493.2015.29.006.WU L,SUN Y J.Delphi method introduction and its application status quo in nursing science[J].Chinese Nursing Research,2015,29(10):3599-3601.DOI:10.3969/j.issn.1009-6493.2015.29.006.
[14]MECHANICK J I,ADRIENNE Y.Clinical practice guidelines for the perioperative nutritional,metabolic,and nonsurgical support of the bariatric surgery patient:2013 update:cosponsored by American Association of Clinical Endocrinologists,the Obesity Society,and American Society Metabolic&Bariatric Surgery[J].Surgery for Obesity&Related Diseases,2013,9(2):159-191.DOI:10.1016/j.soard.2012.12.010.
[15]LIVHITS M,MERCADO C,YERMILOV I,et al.Exercise following bariatric surgery:systematic review[J].Obes Surg,2010,20(5):657-665.DOI:10.1007/s11695-010-0096-0.
[16]EGBERTS K,BROWN W A,BRENNAN L,et al.Does exercise improve weight loss after bariatric surgery?A systematic review[J].Obes Surg,2012,22(2):335-341.DOI:10.1007/s11695-011-0544-5.
[17]POUWELS S,WIT M,TEIJINK J A,et al.Aspects of exercise before or after bariatric surgery:a systematic review[J].Obes Facts,2015,8(2):132-146.DOI:10.1159/000381201.
[18]COEN P M,TANNER C J,HELBLING N L,et al.Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity[J].J Clin Invest,2015,125(1):248-257.DOI:10.1172/JCI78016.
[19]DANIELS P,BURNS R D,BRUSSEAU T A,et al.Effect of a randomised 12-week resistance training programme on muscular strength,cross-sectional area and muscle quality in women having undergone Roux-en-Y gastric bypass[J].J Sports Sci,2018,36(5):529-535.DOI:10.1080/02640414.2017.1322217.
[20]MUNDBJERG L H,STOLBERG C R,CECERE S,et al.Supervised physical training improves weight loss after Rouxen-Y gastric bypass surgery:a randomized controlled trial[J].Obesity(Silver Spring),2018,26(5):828-837.DOI:10.1002/oby.22143.
[21]HASSANNEJAD A,KHALAJ A,MANSOURNIA M A,et al.The effect of aerobic or aerobic-strength exercise on body composition and functional capacity in patients with BMI≥35 after bariatric surgery:a randomized control trial[J].Obes Surg,2017,27(11):2792-2801.DOI:10.1007/s11695-017-2717-3.
[22]SHAH M,SNELL P G,RAO S,et al.High-volume exercise program in obese bariatric surgery patients:a randomized,controlled trial[J].Obesity(Silver Spring),2011,19(9):1826-1834.DOI:10.1038/oby.2011.172.
[23]CASTELLO V,SIM?ES R P,BASSI D,et al.Impact of aerobic exercise training on heart rate variability and functional capacity in obese women after gastric bypass surgery[J].Obes Surg,2011,21(11):1739-1749.DOI:10.1007/s11695-010-0319-4.
[24]COLEMAN K J,CAPAROSA S L,NICHOLS J F,et al.Understanding the capacity for exercise in post-bariatric patients[J].Obes Surg,2017,27(1):51-58.DOI:10.1007/s11695-016-2240-y.
[25]CREEL D B,SCHUH L M,REED C A,et al.A randomized trial comparing two interventions to increase physical activity among patients undergoing bariatric surgery:physical activity and bariatric surgery[J].Obesity(Silver Spring),2016,24(8):1660-1668.DOI:10.1002/oby.21548.
[26]EDWARD S,HASENBERG T.Aerobic endurance training improves weight loss,body composition,and co-morbidities in patients after laparoscopic Roux-en-gastric bypass[J].Surgery for Obesity&Related Diseases,2010,6(3):260-266.DOI:10.1016/j.soard.2010.01.006.
[27]CAMPANHA-VERSIANI L,PEREIRA D,RIBEIRO-SAMORAG A,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[J].Obes Surg,2017,27(11):1-9.DOI:10.1007/s11695-017-2618-5.
[28]HUCK C J.Effects of supervised resistance training on fitness and functional strength in patients succeeding bariatric surgery[J].Journal of Strength&Conditioning Research,2015,29(3):589-595.DOI:10.1519/jsc.0000000000000667.
[29]STEGEN S,DERAVE W,CALDERS P,et al.Physical fitness in morbidly obese patients:effect of gastric bypass surgery and exercise training[J].Obes Surg,2011,21(1):61-70.DOI:10.1007/s11695-009-0045-y.
[30]ONOFRE T,CARLOS R,OLIVER N,et al.Effects of a physical activity program on cardiorespiratory fitness and pulmonary function in obese women after bariatric surgery:a pilot study[J].Obes Surg,2017,27(8):2026-2033.DOI:10.1007/s11695-017-2584-y.
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