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Introduction <p>Severe obesity is associated with autonomic nervous system dysfunction and impaired functional capacity, both independent predictors of perioperative complications and mortality. Heart rate variability (HRV) and functional tests are noninvasive, accessible tools for assessing these conditions. This study aimed to characterize autonomic modulation and functional capacity in bariatric surgery candidates and, innovatively, explore their interrelationship – a critical gap in preoperative risk assessment.</p> Methods <p>This cross-sectional study enrolled 100 individuals (age 41.7 ± 9.8 years; body mass index [BMI] 46.9 ± 7.4&#xa0;kg/m<sup>2</sup>; 78% women) awaiting metabolic bariatric surgery. HRV was assessed at rest using validated time- and frequency-domain indices. Functional capacity was measured via handgrip strength (HGS), sit-to-stand test, and 6-minute walk test (6MWT). Spearman correlations (ρ) and linear regression models examined associations between domains.</p> Results <p>Participants exhibited a high-vulnerability phenotype: profound autonomic dysfunction (SDNN: 22.2 ± 10.6 ms; LF/HF ratio: 2.8 ± 2.9) and severely impaired functional capacity (6MWT: 404.5 ± 102.0&#xa0;m, 20% below predicted; HGS: 35.2 ± 10.6&#xa0;kg). Critically, 6MWT performance correlated significantly with HRV indices (SDNN: <i>p</i> = 0.314, <i>p</i> = 0.001; RMSSD: ρ = 0.206, <i>p</i> = 0.039), and HRV parameters predicted up to 8% of variance in cardiorespiratory fitness (R<sup>2</sup> = 0.08, <i>p</i> = 0.003), suggesting shared pathophysiology.</p> Conclusion <p>Bariatric surgery candidates demonstrate coexisting autonomic and functional deficits that are physiologically interconnected. Integrated preoperative assessment of these domains enables more accurate risk stratification and targeted prehabilitation strategies. These findings support a paradigm shift toward multidimensional preoperative evaluation to optimize surgical safety and outcomes.</p>

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Autonomic Dysfunction and Functional Impairment in Candidates for Metabolic Bariatric Surgery: A High Vulnerability Profile

  • 期刊论文

  • 发表日期：

    2026年1月5日

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  • Rodrigo Montenegro Wanderley,
  • Paulo Adriano Schwingel,
  • Ivyne Oliveira Araújo Wanderley,
  • Igor Henriques Fortunato,
  • Fabiano Ferreira de Lima,
  • Rinaldo Silvino dos Santos,
  • Thaiana Marcelino Lima,
  • Laila Barbosa de Santana,
  • Augusto Batista da Silva,
  • Vitor Rafael Ferraz Ferreira,
  • Aline de Freitas Brito

摘要

Introduction

Severe obesity is associated with autonomic nervous system dysfunction and impaired functional capacity, both independent predictors of perioperative complications and mortality. Heart rate variability (HRV) and functional tests are noninvasive, accessible tools for assessing these conditions. This study aimed to characterize autonomic modulation and functional capacity in bariatric surgery candidates and, innovatively, explore their interrelationship – a critical gap in preoperative risk assessment.

Methods

This cross-sectional study enrolled 100 individuals (age 41.7 ± 9.8 years; body mass index [BMI] 46.9 ± 7.4 kg/m2; 78% women) awaiting metabolic bariatric surgery. HRV was assessed at rest using validated time- and frequency-domain indices. Functional capacity was measured via handgrip strength (HGS), sit-to-stand test, and 6-minute walk test (6MWT). Spearman correlations (ρ) and linear regression models examined associations between domains.

Results

Participants exhibited a high-vulnerability phenotype: profound autonomic dysfunction (SDNN: 22.2 ± 10.6 ms; LF/HF ratio: 2.8 ± 2.9) and severely impaired functional capacity (6MWT: 404.5 ± 102.0 m, 20% below predicted; HGS: 35.2 ± 10.6 kg). Critically, 6MWT performance correlated significantly with HRV indices (SDNN: p = 0.314, p = 0.001; RMSSD: ρ = 0.206, p = 0.039), and HRV parameters predicted up to 8% of variance in cardiorespiratory fitness (R2 = 0.08, p = 0.003), suggesting shared pathophysiology.

Conclusion

Bariatric surgery candidates demonstrate coexisting autonomic and functional deficits that are physiologically interconnected. Integrated preoperative assessment of these domains enables more accurate risk stratification and targeted prehabilitation strategies. These findings support a paradigm shift toward multidimensional preoperative evaluation to optimize surgical safety and outcomes.