Effects of Exercise Training after Bariatric Surgery on Cardiopulmonary Function in Patients with Type 2 Diabetes Mellitus and Obesity: a Randomized Controlled Trial

doi:10.12114/j.issn.1007-9572.2024.0529

Chinese General Practice ›› 2025, Vol. 28 ›› Issue (21): 2611-2617.DOI: 10.12114/j.issn.1007-9572.2024.0529

Special Issue: 内分泌代谢性疾病最新文章合辑；运动相关研究最新文章合辑；肥胖/减重最新文章合辑

• Original Research • Previous Articles Next Articles

Effects of Exercise Training after Bariatric Surgery on Cardiopulmonary Function in Patients with Type 2 Diabetes Mellitus and Obesity: a Randomized Controlled Trial

1. Clinical College of Nanjing University of Chinese Medicine, Nanjing 210008, China
2. Department of Rehabilitation, School of Acupuncture-Moxibustion and Tuina & School of Health Preservation and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing 210023, China
3. Department of Cardiology, Taikang Xianlin Drum Tower Hospital, Nanjing 210008, China
4. Jiangsu Health Development Research Center, Nanjing 210029, China
5. Department of Ultrasound, Nanjing Drum Tower Hospital, Nanjing 210008, China

Received:2024-07-10 Revised:2024-11-10 Published:2025-07-20 Online:2025-06-05
Contact: LI Xinyan, ZHANG Ning

减重代谢手术后运动训练对2型糖尿病合并肥胖患者心肺功能的影响：一项随机对照试验

1．210008　江苏省南京市，南京中医药大学鼓楼临床医学院
2．210023　江苏省南京市，南京中医药大学针灸推拿学院·养生康复学院康复医学系
3．210008　江苏省南京市，南京泰康仙林鼓楼医院心内科
4．210029　江苏省南京市，江苏省卫生健康发展研究中心
5．210008　江苏省南京市，南京鼓楼医院超声医学科

通讯作者: 李新艳, 张宁
作者简介:
作者贡献：
金彦、李新艳、张宁进行文章的构思与设计，结果的分析与解释，对文章整体负责，监督管理；金彦、王璐璐进行研究的实施与可行性分析；杨洋、郑清婉进行数据收集；金彦、杨洋进行数据整理、统计学处理，撰写及修订论文；李新艳、张宁负责文章的质量控制及审校。
基金资助:
江苏省卫生健康发展研究中心开放课题(JSHD2021001); 中国康复医学会科技发展项目(KFKT-2024-009); 江苏省基础研究专项资金项目(BK20241907); 国家自然科学基金资助项目(82302847)

Abstract

Abstract:

Background

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.

Objective

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

Methods

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.

Results

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) .

Conclusion

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.

Key words: Exercise training, Cardiopulmonary exercise test, Bariatric surgery, Diabetes mellitus, Obesity, Nanjing, Mixed measures ANOVA

摘要： 背景 2型糖尿病（T2DM）合并肥胖是一个日益严重的全球公共卫生问题，患者常伴有胰岛素抵抗、代谢异常及慢性炎症及心肺功能受损。尽管减重代谢手术可在降低BMI的同时缓解糖尿病、高血压等症状，但术后心肺功能降低影响患者的运动能力及生活质量。运动干预被广泛认为能改善心肺功能，但术后有氧与抗阻训练对患者心肺功能的影响尚不明确。目的探索减重代谢手术后运动训练对T2DM合并肥胖症患者心肺功能的影响。方法选取2022年南京鼓楼医院接诊的60例T2DM合并肥胖待行减重代谢手术患者为研究对象，使用随机数字表法分为运动组（30例）和对照组（30例）。术后4周为恢复期，期间鼓励适当运动。术后4周后运动组和对照组均行心肺运动试验评估心肺功能以定制运动处方。对照组每日运动满足日常体力活动，运动组在对照组的基础上加入80%无氧阈值指导的中等强度有氧训练和抗阻训练项目，两组均训练12周。训练12周后检测两组的形态学指标、心肺功能指标及血生化指标。结果对照组有1例受试者因个人原因无法继续配合研究。运动组共有4例受试者未能完成研究，其中3例因未达到实际要求的运动量、1例因个人原因退出研究，最终完成试验者55例（运动组26例，对照组29例）。混合测量方差分析显示，组别与时间对腹围、胆固醇存在交互作用（P_交互<0.05）；组别分别对腹围、餐后2 h血糖、胆固醇主效应显著（P_组间<0.05）；组别与时间对峰值摄氧量、千克峰值摄氧量、峰值代谢当量、峰值功率、无氧阈下功率、千克峰值功率、峰值每分通气量、无氧阈摄氧量、无氧阈摄氧量占峰值摄氧量百分比、峰值氧脉搏、静息收缩压存在交互作用（P_交互<0.05）。术后4周，运动组峰值呼吸商、峰值功率、无氧阈下功率、峰值每分通气量、二氧化碳通气当量斜率、无氧阈摄氧量与术前相比，差异有统计学意义（P<0.05）。术后4周，对照组峰值摄氧量、峰值代谢当量、无氧阈下功率、峰值每分通气量、二氧化碳通气当量斜率、无氧阈摄氧量与术前相比，差异有统计学意义（P<0.05）。训练12周后，运动组体腹围、空腹血糖、餐后2 h血糖、糖化血红蛋白、胆固醇、峰值摄氧量、无氧阈下功率、千克峰值功率、峰值每分通气量、无氧阈摄氧量、千克无氧阈摄氧量、无氧阈摄氧量占峰值摄氧量百分比与对照组比较，差异有统计学意义（P<0.05）。结论减重术后4周，T2DM合并肥胖患者心肺功能降低；术后12周的运动训练能够减少患者的腹围，改善血糖、血脂水平，改善心肺功能。

关键词: 运动训练, 心肺运动试验, 减重代谢手术, 糖尿病, 肥胖症, 南京, 混合测量方差分析

CLC Number:

R 165

JIN Yan,YANG Yang,WANG Lulu, et al. Effects of Exercise Training after Bariatric Surgery on Cardiopulmonary Function in Patients with Type 2 Diabetes Mellitus and Obesity: a Randomized Controlled Trial[J]. Chinese General Practice, 2025, 28(21): 2611-2617. DOI: 10.12114/j.issn.1007-9572.2024.0529.
金彦,杨洋,王璐璐等. 减重代谢手术后运动训练对2型糖尿病合并肥胖患者心肺功能的影响：一项随机对照试验[J]. 中国全科医学, 2025, 28(21): 2611-2617. DOI: 10.12114/j.issn.1007-9572.2024.0529.

Figures/Tables 3

References 22

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组别	例数	年龄（岁）	性别（男/女）	身高（cm）	体质量（kg）
对照组	30	29.2±8.3	8/22	167.2±5.5	93.6±12.4
运动组	30	30.9±8.1	7/23	165.5±7.9	92.6±12.5
t（χ²）值		0.791	0.089^a	-0.937	-0.294
P值		0.432	0.766	0.353	0.770

组别	例数	年龄（岁）	性别（男/女）	身高（cm）	体质量（kg）
对照组	30	29.2±8.3	8/22	167.2±5.5	93.6±12.4
运动组	30	30.9±8.1	7/23	165.5±7.9	92.6±12.5
t（χ²）值		0.791	0.089^a	-0.937	-0.294
P值		0.432	0.766	0.353	0.770

组别	例数	BMI（kg/m²）			腹围（cm）			空腹血糖（mmol/L）
组别	例数	术前	术后4周	训练12周后	术前	术后4周	训练12周后	术前	术后4周	训练12周后
对照组	30	33.5±3.9	31.9±1.6	30.8±3.7	109.4±3.0	100.8±2.6	96.9±2.4	8.84±3.09	8.04±0.33^a	6.22±0.19^ab
运动组	30	33.9±4.4	30.6±6.5^a	27.0±2.0^ab	109.0±8.1	101.4±4.9^a	89.7±2.8^abc	9.23±2.45	7.67±0.70^ac	5.61±0.77^abc
F值		F_交互=0.740，F_组间=0.790，F_时间=10.961			F_交互=13.045，F_组间=10.228，F_时间=185.126			F_交互=0.670，F_组间=0.284，F_时间=24.587
P值		P_交互=0.479，P_组间=0.378，P_时间<0.001			P_交互<0.001，P_组间=0.002，P_时间<0.001			P_交互=0.515，P_组间=0.598，P_时间<0.001
组别	餐后2 h血糖（mmol/L）			糖化血红蛋白（%）			三酰甘油（mmol/L）
组别	术前	术后4周	训练12周后	术前	术后4周	训练12周后	术前	术后4周	训练12周后
对照组	14.39±4.63	13.45±0.52^a	12.87±0.27^ab	8.42±2.03	8.25±0.44	8.12±0.21	2.39±0.30	1.88±0.13^a	1.92±0.30^a
运动组	14.63±4.21	13.91±0.76^ac	12.12±0.37 ^abc	8.51±1.91	8.25±0.47	7.27±0.34^abc	2.39±1.67	1.96±0.48^a	1.72±0.32^ab
F值	F_交互=0.717，F_组间=3 115.478，F_时间=7.102			F_交互=1.965，F_组间=1.426，F_时间=4.566			F_交互=1.822，F_组间=2.142，F_时间=16.859
P值	P_交互=0.491，P_组间<0.001，P_时间=0.001			P_交互=0.147，P_组间=0.240，P_时间=0.013			P_交互=0.177，P_组间=0.162，P_时间<0.001
组别	胆固醇（mmol/L）			高密度脂蛋白胆固醇（mmol/L）			低密度脂蛋白胆固醇（mmol/L）
组别	术前	术后4周	训练12周后	术前	术后4周	训练12周后	术前	术后4周	训练12周后
对照组	7.54±0.52	6.97±0.40^a	6.67±0.50^a	1.06±0.22	1.12±0.12	1.15±0.15	2.75±0.55	2.65±0.27	2.67±0.43
运动组	7.46±1.14	6.82±0.35^a	5.89±0.20^abc	1.05±0.28	1.01±0.17^c	1.40±0.37^ab	2.93±0.94	2.80±0.35	2.36±0.78^ab
F值	F_交互=4.299，F_组间=6.178，F_时间=3.938			F_交互=1.105，F_组间=0.577，F_时间=7.118			F_交互=0.090，F_组间=1.49，F_时间=0.127
P值	P_交互=0.019，P_组间=0.020，P_时间=0.026			P_交互=0.344，P_组间=0.459，P_时间=0.003			P_交互=0.914，P_组间=0.241，P_时间=0.881

组别	例数	BMI（kg/m²）			腹围（cm）			空腹血糖（mmol/L）
组别	例数	术前	术后4周	训练12周后	术前	术后4周	训练12周后	术前	术后4周	训练12周后
对照组	30	33.5±3.9	31.9±1.6	30.8±3.7	109.4±3.0	100.8±2.6	96.9±2.4	8.84±3.09	8.04±0.33^a	6.22±0.19^ab
运动组	30	33.9±4.4	30.6±6.5^a	27.0±2.0^ab	109.0±8.1	101.4±4.9^a	89.7±2.8^abc	9.23±2.45	7.67±0.70^ac	5.61±0.77^abc
F值		F_交互=0.740，F_组间=0.790，F_时间=10.961			F_交互=13.045，F_组间=10.228，F_时间=185.126			F_交互=0.670，F_组间=0.284，F_时间=24.587
P值		P_交互=0.479，P_组间=0.378，P_时间<0.001			P_交互<0.001，P_组间=0.002，P_时间<0.001			P_交互=0.515，P_组间=0.598，P_时间<0.001
组别	餐后2 h血糖（mmol/L）			糖化血红蛋白（%）			三酰甘油（mmol/L）
组别	术前	术后4周	训练12周后	术前	术后4周	训练12周后	术前	术后4周	训练12周后
对照组	14.39±4.63	13.45±0.52^a	12.87±0.27^ab	8.42±2.03	8.25±0.44	8.12±0.21	2.39±0.30	1.88±0.13^a	1.92±0.30^a
运动组	14.63±4.21	13.91±0.76^ac	12.12±0.37 ^abc	8.51±1.91	8.25±0.47	7.27±0.34^abc	2.39±1.67	1.96±0.48^a	1.72±0.32^ab
F值	F_交互=0.717，F_组间=3 115.478，F_时间=7.102			F_交互=1.965，F_组间=1.426，F_时间=4.566			F_交互=1.822，F_组间=2.142，F_时间=16.859
P值	P_交互=0.491，P_组间<0.001，P_时间=0.001			P_交互=0.147，P_组间=0.240，P_时间=0.013			P_交互=0.177，P_组间=0.162，P_时间<0.001
组别	胆固醇（mmol/L）			高密度脂蛋白胆固醇（mmol/L）			低密度脂蛋白胆固醇（mmol/L）
组别	术前	术后4周	训练12周后	术前	术后4周	训练12周后	术前	术后4周	训练12周后
对照组	7.54±0.52	6.97±0.40^a	6.67±0.50^a	1.06±0.22	1.12±0.12	1.15±0.15	2.75±0.55	2.65±0.27	2.67±0.43
运动组	7.46±1.14	6.82±0.35^a	5.89±0.20^abc	1.05±0.28	1.01±0.17^c	1.40±0.37^ab	2.93±0.94	2.80±0.35	2.36±0.78^ab
F值	F_交互=4.299，F_组间=6.178，F_时间=3.938			F_交互=1.105，F_组间=0.577，F_时间=7.118			F_交互=0.090，F_组间=1.49，F_时间=0.127
P值	P_交互=0.019，P_组间=0.020，P_时间=0.026			P_交互=0.344，P_组间=0.459，P_时间=0.003			P_交互=0.914，P_组间=0.241，P_时间=0.881

组别	例数	峰值呼吸商			峰值摄氧量（L/min）			千克峰值摄氧量（mL·kg^-1·min^-1）			峰值代谢当量（METs）
组别	例数	术前	术后4周	训练12周后	术前	术后4周	训练12周后	术前	术后4周	训练12周后	术前	术后4周	训练12周后
对照组	30	1.09±0.08	1.06±0.08	1.10±0.08	1.77±0.33	1.63±0.25^a	1.51±0.35^ab	17.90±3.46	15.38±2.96^a	16.6±1.14^ab	5.47±0.89	4.80±0.84^a	5.10±0.90^b
运动组	30	1.07±0.08	1.00±0.02^ac	1.08±0.09^b	1.54±0.34^c	1.52±0.27	1.57±0.48	17.0±3.05	16.54±2.04	19.59±3.91^abc	5.26±0.84	5.01±0.84	6.05±1.15^abc
F值		F_交互=2.626，F_组间=4.308，F_时间=10.065			F_交互=6.709，F_组间=0.973，F_时间=2.541			F_交互=52.849，F_组间=34.181，F_时间=8.252			F_交互=6.597，F_组间=37.120，F_时间=7.299
P值		P_交互=0.077，P_组间=0.043，P_时间<0.001			P_交互=0.002，P_组间=0.328，P_时间=0.084			P_交互<0.001，P_组间<0.001，P_时间<0.001			P_交互=0.002，P_组间<0.001，P_时间=0.001
组别	峰值功率（watts）			无氧阈下功率（watts）			千克峰值功率（watts/kg）			峰值每分通气量（L/min）
组别	术前	术后4周	训练12周后	术前	术后4周	训练12周后	术前	术后4周	训练12周后	术前	术后4周	训练12周后
对照组	136.95±34.49	132.60±29.87	126.75±30.31	71.62±16.63	61.31±2.22^a	72.50±19.30^b	1.50±0.36	1.49±0.33	1.47±0.27	49.45±14.38	35.34±2.13^a	45.61±14.56^b
运动组	126.00±36.30	114.73±33.05^c	134.86±31.95^ab	72.10±24.66	60.08±2.77^a	87.64±29.41^abc	1.39±0.33	1.40±0.40	1.65±0.28^abc	48.81±13.16	37.59±12.60^a	49.36±9.57^bc
F值	F_交互=7.355，F_组间=0.307，F_时间=2.733			F_交互=4.020，F_组间=2.678，F_时间=25.518			F_交互=4.990，F_组间=0.055，F_时间=3.320			F_交互=4.754，F_组间=4.355，F_时间=18.866
P值	P_交互=0.001，P_组间=0.582，P_时间=0.070			P_交互=0.021，P_组间=0.108，P_时间<0.001			P_交互=0.008，P_组间=0.816，P_时间=0.040			P_交互=0.011，P_组间=0.042，P_时间<0.001
组别	二氧化碳通气当量斜率			无氧阈摄氧量（L/min）			千克无氧阈摄氧量（mL·kg^-1·min^-1）			无氧阈摄氧量占峰值摄氧量百分比
组别	术前	术后4周	训练12周后	术前	术后4周	训练12周后	术前	术后4周	训练12周后	术前	术后4周	训练12周后
对照组	28.15±2.99	31.50±1.27^a	27.26±3.01^b	1.09±0.24	0.99±0.22	1.05±0.22	10.71±1.55	11.69±0.97	13.35±1.66^a	0.62±0.18	0.61±0.21	0.70±0.22
运动组	26.73±2.22	30.58±1.29^ac	27.82±3.73^ab	1.11±0.39	0.97±0.16^a	1.38±0.28^abc	11.24±2.68	12.27±2.86	17.68±1.25^ac	0.72±0.37^c	0.64±0.19	0.88±0.12^c
F值	F_交互=0.783，F_组间=0.447，F_时间=42.332			F_交互=47.591，F_组间=1.270，F_时间=9.153			F_交互=0.904，F_组间=27.689，F_时间=6.398			F_交互=22.146，F_组间=2.160，F_时间=9.944
P值	P_交互=0.460，P_组间=0.506，P_时间<0.001			P_交互<0.001，P_组间=0.265，P_时间<0.001			P_交互=0.408，P_组间<0.001，P_时间=0.002			P_交互<0.001，P_组间=0.148，P_时间<0.001
组别	峰值氧脉搏（mL/次）			静息心率（次/min）			峰值心率（次/min）			无氧阈心率（次/min）
组别	术前	术后4周	训练12周后	术前	术后4周	训练12周后	术前	术后4周	训练12周后	术前	术后4周	训练12周后
对照组	12.19±2.14	12.41±2.15	10.70±2.56	90.71±10.39	98.52±6.07	86.35±12.70	146.71±15.25	154.24±6.55^a	141.95±12.43^b	124.81±9.44	129.10±5.92	118.45±9.22^b
运动组	10.62±2.09^c	11.16±1.58^c	12.18±4.25^aba	89.62±8.49	96.81±3.69^a	85.86±11.78^b	154.00±16.50	165.69±4.30^ac	146.27±15.56^b	119.43±14.26	131.88±4.76^a	118.41±11.17^b
F值	F_交互=6.771，F_组间=1.294，F_时间=0.812			F_交互=0.286，F_组间=2.144，F_时间=7.386			F_交互=1.447，F_组间=15.97，F_时间=20.431			F_交互=1.952，F_组间=0.566，F_时间=16.346
P值	P_交互=0.002，P_组间=0.260，P_时间=0.447			P_交互=0.752，P_组间=0.149，P_时间=0.001			P_交互=0.240，P_组间<0.001，P_时间<0.001			P_交互=0.147，P_组间=0.455，P_时间<0.001
组别	静息收缩压（mmHg）			静息舒张压（mmHg）			峰值运动收缩压（mmHg）			峰值运动舒张压（mmHg）
组别	术前	术后4周	训练12周后	术前	术后4周	训练12周后	术前	术后4周	训练12周后	术前	术后4周	训练12周后
对照组	124±17	119±8	119±17	81±10	79±6	83±14	184±26	180±16	171±27	88±19	87±10	92±14
运动组	121±23	129±14^ac	119±10^b	85±15	84±14	79±7	187±27	186±19^a	165±22^b	90±22	87±18	80±11
F值	F_交互=5.878，F_组间=0.001，F_时间=7.252			F_交互=1.612，F_组间=0.642，F_时间=0.950			F_交互=2.453，F_组间=0.420，F_时间=5.448			F_交互=1.839，F_组间=1.578，F_时间=0.749
P值	P_交互=0.004，P_组间=0.972，P_时间=0.001			P_交互=0.205，P_组间=0.427，P_时间=0.391			P_交互=0.094，P_组间=0.522，P_时间=0.007			P_交互=0.167，P_组间=0.218，P_时间=0.477

Effects of Exercise Training after Bariatric Surgery on Cardiopulmonary Function in Patients with Type 2 Diabetes Mellitus and Obesity: a Randomized Controlled Trial

减重代谢手术后运动训练对2型糖尿病合并肥胖患者心肺功能的影响：一项随机对照试验

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