SERÉ S, LUIS, JORDI LOPEZ-AYERBE, RAMÓ N COLL, ORIOL RODRIGUEZ, JUAN VILA, XAVIER FORMIGUERA, ANTONIO ALASTRUE, MIGUEL RULL, AND VICENTE VALLE. Increased exercise capacity after surgically induced weight loss in morbid obesity. Obesity. 2006;14:273-279. Objective: To investigate the effects of surgically induced weight loss on exercise capacity in patients with morbid obesity (MO). Research Methods and Procedures:A prospective 1-year follow-up study was carried out, with patients being their own controls. A symptom-limited cardiopulmonary exercise stress test was performed in 31 MO patients (BMI Ͼ 40 kg/m 2 ) before and 1 year after undergoing bariatric surgery. Results: At 1 year after surgery, weight was reduced from 146 Ϯ 33 to 95 Ϯ 19 kg (p Ͻ 0.001), and BMI went from 51 Ϯ 4 to 33 Ϯ 6 kg/m 2 (p Ͻ 0.001). After weight loss, obese patients performed each workload with lower oxygen consumption, heart rate, systolic arterial pressure, and ventilatory volume (p Ͻ 0.001). This reduced energy expenditure allowed them to increase the duration of their effort test from 13.8 Ϯ 3.8 to 21 Ϯ 4.2 minutes (p Ͻ 0.001). Upon finishing the exercise, MO patients before surgery were able to reach only 83% of their age-predicted maximal heart rate, and their respiratory exchange ratio was 0.87 Ϯ 0.06. After weight loss, those values were 90% and 1 Ϯ 0.08, respectively (p Ͻ 0.01). When we compared the peak O 2 pulse corrected by fat free mass before and after surgery, no significant differences between the groups were found. Discussion: After surgically induced weight loss, MO patients markedly improved their exercise capacity. This is due to the fact that they were able to perform the external work with lower energy expenditure and also to increase cardiovascular stress, optimizing the use of cardiac reserve. There were no differences in cardiac function before and after surgery.

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Improvement in self-care behaviour, assessed with the EHFScBS, was achieved with nurse educational intervention in patients without previous heart failure education. However, in our population, this improvement was not obtained in one important aspect such is low salt diet compliance, although punctuation in this item was quite acceptable already initially.

Nurse-guided education has changed self-care behaviour of patients with heart failure in several important aspects, as weight and blood monitoring, and has increased their knowledge and understanding of the disease and treatment. However, these improvements have not been reflected in a better compliance of treatment and sodium restricted diet. Such aspects need more and more work to obtain better results.