Physical Activity Associates with Muscle Insulin Sensitivity Postbariatric Surgery

Anna M Savolainen, Anna Karmi, Heidi Immonen, Minna Soinio, Virva Saunavaara, Tam Pham, Paulina Salminen, Mika Helmiö, Jari Ovaska, Eliisa Löyttyniemi, Marja A Heiskanen, Terho Lehtimäki, Andrea Mari, Pirjo Nuutila, Jarna C Hannukainen, Anna M Savolainen, Anna Karmi, Heidi Immonen, Minna Soinio, Virva Saunavaara, Tam Pham, Paulina Salminen, Mika Helmiö, Jari Ovaska, Eliisa Löyttyniemi, Marja A Heiskanen, Terho Lehtimäki, Andrea Mari, Pirjo Nuutila, Jarna C Hannukainen

Abstract

Purpose: Bariatric surgery is considered as an effective therapeutic strategy for weight loss in severe obesity. Remission of type 2 diabetes is often achieved after the surgery. We investigated whether increase in self-reported habitual physical activity associates with improved skeletal muscle insulin sensitivity and reduction of fat depots after bariatric surgery.

Methods: We assessed self-reported habitual physical activity using Baecke questionnaire in 18 diabetic and 28 nondiabetic patients with morbid obesity (median age, 46 yr; body mass index, 42.0 kg·m) before and 6 months after bariatric surgery operation. Insulin-stimulated femoral muscle glucose uptake was measured using fluorodeoxyglucose positron emission tomography method during hyperinsulinemia. In addition, abdominal subcutaneous and visceral fat masses were quantified using magnetic resonance imaging and liver fat content using magnetic resonance spectroscopy. Also, serum proinflammatory cytokines were measured.

Results: Patients lost on average 22.9% of weight during the follow-up period of 6 months (P < 0.001). Self-reported habitual physical activity level increased (P = 0.017). Improvement in skeletal muscle insulin sensitivity was observed only in those patients who reported increase in their physical activity postoperatively (P = 0.018). The increase in self-reported physical activity associated with the loss of visceral fat mass (P = 0.029). Postoperative self-reported physical activity correlated also positively with postoperative hepatic insulin clearance (P = 0.02) and tended to correlate negatively with liver fat content (P = 0.076). Postoperative self-reported physical activity also correlated negatively with serum TNFα, methyl-accepting chemotaxis protein and interleukin 6 levels.

Conclusions: Self-reported physical activity is associated with reversal of skeletal muscle insulin resistance after bariatric surgery as well as with the loss of visceral fat content and improved postoperative metabolism in bariatric surgery patients.

Trial registration: Clinicaltrials.gov, NCT00793143 (SLEEVEPASS), NCT01373892 (SLEEVEPET2).

Figures

FIGURE 1
FIGURE 1
Study flowchart.
FIGURE 2
FIGURE 2
A, Baecke physical activity indices in healthy participants (white bars) and in patients pre (gray bars) and post (black bars) bariatric surgery. Data expressed as mean (+SD). Preoperative vs postoperative sport index (P = 0.0096) and total index (P = 0.0168) increased significantly. **P ≤ 0.01, ***P ≤ 0.001. Patients compared to healthy. #P ≤ 0.05, ###P ≤ 0.001. Preoperative vs postoperative values. B, Most frequently played sports according to Baecke physical activity questionnaire (item 9) before and after bariatric surgery in patients. †Strength training either at gym or at home, ‡Swimming, aqua jogging or aqua gymnastics.
FIGURE 3
FIGURE 3
A, Preoperative total physical activity index correlated with higher rate of insulin-stimulated skeletal muscle glucose uptake in bariatric surgery patients (r = 0.415, P = 0.049, logarithm transformed glucose uptake values). B, Only patients who had increase in the total physical activity index postoperatively had increase in the rate of insulin-stimulated skeletal muscle glucose uptake 6 months after bariatric surgery. ***P ≤ 0.001. Paired t test for preoperative (white bars) vs postoperative (black bars) glucose uptake values with logarithm transformation. #P ≤ 0.05. Increase in the physical activity index vs no increase postoperatively. C, Change in the total physical activity index correlated with the loss of visceral fat mass (r = −0.349, P = 0.029) 6 months after bariatric surgery.
FIGURE 4
FIGURE 4
Correlations between total physical activity index and serum proinflammatory cytokines TNF α, MCP and IL6 prebariatric and postbariatric surgery.

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