Investigation of the Effects of Whole Body Vibration Application on Muscle Functional Level, Physical Fitness and Respiratory Parameters After Bariatric Surgery

Sarcopenic obesity (SO) is the coexistence of obesity characterized by excess fat mass and sarcopenia and is a functional and clinical condition. Sarcopenia, defined as low mass and reduced function of skeletal muscle, has a multifactorial etiology and its prevalence increases with age The development of sarcopenia in obese individuals can occur at any age. Obesity can lead to both muscle mass and functional losses as it causes many conditions that negatively affect muscle mass such as inflammation, insulin resistance, oxidative stress, In addition, individuals with obesity have a high likelihood of non-communicable, chronic diseases that negatively affect muscle metabolism (catabolism and anabolism). Attempts to reduce high amounts of fat lead to losses in skeletal muscle mass. This is especially common after bariatric surgery and long-term unbalanced dietary regimens. However, fat accumulation in the abdominal and thoracic cavity and mediastinal area directly affects the mechanical properties of the lung and chest wall. Increased body fat deposition causes the diaphragm to remain in an upward position, thus limiting its downward movements, increasing pleural pressure, and decreasing functional residual capacity. However, fat accumulation in the abdominal and thoracic cavity and mediastinal area directly affects the mechanical properties of the lung and chest wall. Increased body fat deposition causes the diaphragm to remain in an upward position, thus limiting its downward movements, increasing pleural pressure and decreasing functional residual capacity. This reduction is 22% in obese people and 33% in severely obese people. The most important reason for the decrease in functional residual capacity in obese patients is the decrease in expiratory reserve volume. Expiratory residual volume decreases with increasing body mass index. Respiratory muscle weakness accompanies the picture due to both impaired length-tension relationship and decreased functional mobility of the diaphragm.

Bariatric surgery is a series of surgical methods for the treatment of morbid obesity. This procedure, which has recently gained popularity, is generally considered effective and safe. Bariatric surgery has significant health benefits, such as normalizing blood glucose levels, reducing hyperglycemia, lowering cholesterol and blood pressure, improving diabetes-related micro- and macrovascular complications and obstructive sleep apnea. However, like any other surgical procedure, this procedure has complications, some of which are life-threatening. However, like any other surgical procedure, this procedure has complications, some of which are life-threatening. Often after this surgery, people develop anemia and lose calcium and vitamins, which must be compensated by taking supplements for the rest of their lives. Some of the potentially serious complications of bariatric surgery include macro- and micronutrient deficiencies.

Bariatric surgery also has some adverse effects on the musculoskeletal system. In addition to low-calorie nutrition and surgery-induced malabsorption after surgery, it also causes weight loss through other mechanisms. Bariatric surgery alters the production of bile acids, pancreatic secretions and some hormones. There is an increase in the production of anorexigenic hormones and a decrease in the production of orexigenic hormones. Ghrelin is considered an orexigenic hormone as well as a growth hormone secretagogue and promotes muscle protein anabolism. After bariatric surgery, there is a significant increase in the level of cortisol, which promotes muscle protein catabolism. This is attributed to the hypocaloric diet and post-surgical stress. Bariatric surgery has been proven to reduce not only fat mass but also muscle mass and strength (16-40%). Therefore, implementing tailored exercise programs for people after bariatric surgery may help this population to increase weight loss while maintaining lean mass, bone mass and muscle strength in the long term.

Evidence for various exercise approaches is presented in the literature. With the addition of exercise to the weight loss induced by surgery, adaptations develop in muscle insulin sensitivity that will form the basis for recovery. Capillary density increased angiogenesis, angiogenesis and adaptations that increase insulin and glucose delivery to muscle. Exercise also improves mitochondrial function in skeletal muscle, metabolic flexibility, fat oxidation, and reduces lipotoxic species thought to underlie insulin resistance. Although the physiological mechanism of vibration application has not been clearly explained, it occurs with the activation of the tonic vibration reflex. With whole body vibration (TVV) or local vibration application, the change in muscle length is perceived, increasing the activation of the golgi tendon organ and muscle spindle, which are responsible for transmitting this change to the central nervous system. Ia afferent fibers that form the primary terminations of the muscle spindle, which is sensitive to changes in muscle length, activate the alpha motor neuron through monosynaptic connections, and tonic reflexive contractions occur. Increasing alpha motor neuron activation of the muscle spindle, which becomes more sensitive to tension with vibration application; It has been observed to increase the number of cross bridges established, the amount of motor units, motor unit synchronization, and firing frequency.. The application of vibration is also perceived by the ruffini corpuscles, paccini corpuscles, skin and joint receptors, golgi tendon organ. TVV application can increase the efficiency of the proprioceptive feedback loop. During isometric contractions, proprioceptive pathways are used to generate force. A more efficient proprioceptive feedback loop caused by vibration application may lead to increases in force production. The proposed mechanisms for improvements in body composition (decrease in fat mass, increase in muscle mass) caused by TVV are the same as the proposed mechanisms for improvements after resistance exercise. The additional gravitational loading experienced by individuals when exposed to TVV has been shown to elicit an anabolic response. This is comparable to studies using resistance exercise. Both TVV application and resistance training cause an increase in testosterone and growth hormone levels. Studies have shown that repetitive muscle contractions and changes in the hormonal system caused by vibration application elicit some metabolic responses. This application increases the oxygen uptake of tissues and blood flow of skin and subcutaneous tissues. A decrease in arterial stiffness was observed after application. It also stimulates lipolysis by increasing lipolytic hormones.

The literature on TVV application shows that it significantly improves muscle strength and physical activity of participants performing unloaded exercise . It has also been found to be effective in alleviating conditions such as decreased muscle mass, muscle strength, and bone density, and has similar benefits to resistance training, especially in terms of increasing muscle performance ). Resistance exercises alone or in combination with aerobic exercises prevent the loss of muscle strength associated with bariatric surgery). In particular, resistance training has been shown to increase muscle strength and reduce muscle atrophy in obese individuals who adhere to calorie restriction for weight loss. In a study involving 12 weeks of resistance exercises with 19 participants, a decrease in body weight and waist circumference was observed. There was a significant increase in hand grip strength. Significant improvements were observed in lower and upper extremity muscle strength. People's moderate-to-vigorous physical activity levels increased significantly.

People who have undergone bariatric surgery are recommended to exercise, but the recommended guidelines are not specific to people who have undergone surgery. The American College of Sports Medicine recommends the same amount of physical activity for both individuals who have undergone bariatric surgery and those with obesity. Initiation of exercise interventions after bariatric surgery ranges from 1 to 3 months, depending on the type of exercise. It is observed that resistance exercises are started at the 6th week after surThe aim of this study was to demonstrate the feasibility of whole body vibration application after bariatric surgery.gery and the duration is prolonged in different studies.

Inclusion criteria

• Having undergone bariatric surgery, At least 6 weeks have passed since bariatric surgery, Being between the ages of 18-65, Being diagnosed with obesity and having a BMI>35, There is no obstacle that restricts exercise

Exclusion criteria

• Acute hernia, Thromboembolism, Steroid use, Cardiovascular, neurological, orthopedic disease, Presence of knee or hip prosthesis, History of non-traumatic fracture, Presence of pacemaker, Malignancy, Presence of kidney, liver or thyroid disease, Presence of arrhythmia, Pregnancy status, Presence of kidney stones, Presence of epilepsy, Presence of migraine, Presence of organ failure, Presence of acute infection, History of smoking, Presence of respiratory system disease