Type 2 diabetes mellitus (T2DM) combined with obesity is an increasingly concerned severe global public health issue. Patients typically experience insulin resistance, metabolic abnormalities, chronic inflammation, and impaired cardiopulmonary function. Bariatric surgery can reduce the BMI, and alleviate diabetic and hypertensive symptoms. However, postoperative cardiopulmonary function decline negatively influences the motor function and quality of life. Postoperative intervention of rehabilitation is an established way to improve the cardiopulmonary function, although the effect of postoperative aerobic and resistance training on the cardiopulmonary function of T2DM patients combined with obesity remains unclear.

To explore the effects of exercise training after bariatric surgery on cardiopulmonary function in T2DM patients combined with obesity.

Sixty T2DM patients combined with obesity admitted at the Nanjing Drum Tower Hospital in 2022, who were treated with an elective bariatric surgery were selected as study subjects. They were randomly divided into the exercise group (n=30) and control group (n=30) using a random number table method. A recovery period was defined as the first 4 weeks postoperatively, during which patients were encouraged to engage in physical activities at a moderate intensity. After 4 weeks, cardiopulmonary exercise tests were conducted in both the exercise group and the control group to assess cardiopulmonary function and tailor exercise prescriptions. The control group was instructed to perform daily activities that met general physical activity recommendations, while the exercise group was additionally given to moderate-intensity aerobic and resistance training at 80% of the anaerobic threshold. Both groups were intervened for 12 weeks. After 12 weeks of training, the morphological parameters, cardiopulmonary function indicators, and blood biochemical markers of the two groups were assessed.

One patient in the control group was unable to continue with the study due to personal reasons. In the exercise group, 4 subjects were unable to complete the study, with 3 failing to meet the required exercise volume and 1 withdrew for personal reasons. Ultimately, 55 patients completed the trial, including 26 in the exercise group and 29 in the control group. The mixed ANOVA showed an interaction between group and time for abdominal circumference and cholesterol (P_intercation<0.05) . The main effects of the group were significant for abdominal circumference, postprandial 2-hour blood glucose, and cholesterol (P_group<0.05) . There was a significant interaction between group and time in the peak oxygen uptake, peak oxygen uptake in kg, peak METs (among of energy used during any activity) , peak work rate, anaerobic threshold (AT) power (power@AT) , peak work rate in kg, peak ventilatory equivalent (VE) , anaerobic threshold oxygen uptake (VO₂) , VO₂@AT/peakVO₂, peak O₂ pulse, and resting systolic blood pressure (SBP) (P_intercation<0.05) . In the exercise group, there were significant differences in the peak respiratory exchange ratio (RER) , peak watts, power@AT, peak VE, VE/VCO₂ slope, and anaerobic threshold oxygen uptake before and 4 weeks after surgery (P<0.05) . In the control group, there were significant differences in peak oxygen uptake, peak METs, power@AT, peak VE, VE/VCO₂ slope, and anaerobic threshold oxygen uptake before and 4 weeks after surgery (P<0.05) . After 12 weeks of training, there were significant differences in abdominal circumference, fasting blood glucose, postprandial 2-hour blood glucose, hemoglobin A_1C (HbA_1c) , cholesterol, peak oxygen uptake, power@AT, peak work rate, peak VE, anaerobic threshold oxygen uptake, anaerobic threshold oxygen uptake in kg and VO₂@AT/peakVO₂ between groups (P<0.05) .

Cardiopulmonary function decreases in T2DM patients combined with obesity at four weeks after bariatric surgery. Twelve weeks of exercise training post-surgery can reduce waist circumference, improve blood glucose and lipid levels, and enhance cardiopulmonary function.