Effect of Weight Reduction on Constipation
Effect of Weight Reduction on Constipation
In total, 125 women aged between 20 and 40 years were recruited in this study. Participants
 were considered eligible when they met the inclusion criteria of being diagnosed with
 functional constipation, as defined by the Rome Foundation. The study was a randomized
 controlled trial carried out at Cairo University Hospital.Patients whose BMI exceeded 30
 kg/m2 were included. In addition, they fulfilled the ROM criteria of constipation.
In total, 125 women aged between 20 and 40 years were recruited in this study. Participants
 were considered eligible when they met the inclusion criteria of being diagnosed with
 functional constipation, as defined by the Rome Foundation. The study was a randomized
 controlled trial carried out at Cairo University Hospital.

 Patients whose BMI exceeded 30 kg/m2 were included. In addition, they fulfilled the ROM
 criteria of constipation, as follows: (1) Suffered from any 2 or more of the following
 symptoms in the past 12 weeks (not necessarily consecutive), with the onset of symptoms at
 least 6 months prior to diagnosis: a) straining during at least 25% of defecations, b) lumpy
 or hard stools in at least 25% of defecations, c) sensation of incomplete evacuation for at
 least 25% of defecations, d) sensation of anorectal obstruction/blockage for at least 25% of
 defecations, e) requirement of manual maneuvers to facilitate at least 25% of defecations
 (e.g., digital evacuation, support of the pelvic floor muscles), and f) fewer than 3
 defecations per week; (2) Loose stools rarely occurred without the use of laxatives; (3)
 Insufficient criteria for irritable bowel syndrome; and (4) Women were sedentary (less than 1
 hour/week of physical activity), with no evidence of participation in diet control/weight
 reduction programs within the last 6 months.

 Patients with metabolic, endocrine, and neurologic constipation; current or past smokers;
 those with any orthopedic limitation; and those with congenital megacolon,
 pseudo-obstruction, and anorectal disorders were excluded from the study. Patients suffering
 from constipation due to drugs, disabled patients, and those who had undergone any abdominal
 surgery during the intervention or those who failed to complete the study protocol were also
 excluded. All participants provided a written informed consent before enrolling in the study.

 Study design and intervention:

 Participants were randomly divided into 2 groups. Group A included 62 women who were
 following a suggested protocol of physical activity and a low caloric diet in addition to the
 routine standard care for constipation. The low caloric diet allowed 1000-1200 kcal/day,
 divided as follows: 50%-60% carbohydrates, 20% protein, <30% total fat, and 18 g of fiber
 /1000 Kcal. The diet plans were revised every 2 weeks and the diet was modified while
 ensuring that it was within the allowed caloric value, in addition to the routine standard
 care for constipation. Group B included 63 patients who received only the standard medical
 care for constipation and a low caloric diet as in Group A. Patients in both groups followed
 their program for 12 weeks.

 Exercise intervention for Group (A) Each woman in Group A participated in the exercise
 training program for 12 weeks, 3 times per week, with each exercise session lasting for 60
 minutes. The participants were instructed not to eat for 3 hours before the exercise session.

 The exercise training program was in the form of walking on a treadmill without tightly
 grasping the rails, because this action seemed to reduce the workload during any stage of the
 exercise. To overcome this issue, the participants were asked to remove their hands from the
 rails, close their fists, and place only 1 finger on the rails to maintain balance once they
 were accustomed to walking on the treadmill.

 The exercise session was started by a 10-minute warm-up, which involved walking without any
 resistance or inclination on the walkway of the treadmill, followed by 40 minutes of walking
 with 15 degrees of inclination and a speed adjusted to reach 20%-40% of the target heart rate
 (THR) in the first 6 weeks of the study; the speed was increased to reach 40%-60% THR in the
 next 6 weeks of the study. The session ended by 10 minutes of recovery period, in which the
 intensity of the exercise was reduced to the level of the warm-up.

 The assessment procedures performed before and after 12 weeks of intervention consisted of
 the following:

 1. The Patient Assessment of Constipation - Symptom (PAC-SYM) is a reliable and valid 16,
 17 tool to measure the patient's perspective of constipation symptoms in terms of the
 frequency and severity. It is a 12-item self-reported measure, which is divided into 3
 manifestation subscales (i.e. abdominal, rectal, and stool). Items are scored on a
 4-point Likert scale, with a score of 4 demonstrating the worst symptom severity 18, 19.

 2. The Patient Assessment of Constipation Quality of Life (PAC-QOL) is a comprehensive
 measure of the constipation burden on the patient's quality of life (QoL) in terms of
 functions, activities, and well-being. It is considered a valid and reproducible tool
 with high internal consistency 20.

 3. The Short Form-36 (SF-36) is well validated, reliable, does not require more time or
 effort to be completed, and has been presented in several international studies 21- 23.
 It is a 36-item questionnaire that measures the QoL across 8 scales (domains), which are
 based on both physical and emotional aspects. The 8 domains of SF36 are concerned with
 the following: physical functioning, role limitations owing to physical health or
 emotional problems, energy/fatigue, emotional wellbeing, social functioning, pain, and
 general health. In addition, a single item is included to identify any perceived change
 in health, making the SF-36 a useful indicator for change in QoL over time and
 treatment. The scores of the SF-36TM physical component summary and SF-36TM mental
 component summary are calculated by simply calculating the mean score of all of the
 physically and emotionally relevant items 23- 25.

 Descriptive statistics were calculated as the mean and standard deviation. Inferential
 statistics evaluated the changes in constipation symptoms, QoL questionnaires, and BMI using
 unpaired t-test between the 2 groups, while paired t-test was used to measure the changes
 within a group. Pearson correlation coefficient was used to measure the strength and
 direction of the relationship between BMI and PAC-SYM scores, and between BMI and QoL. All
 data were analyzed using SPSS version 18.0 (SPSS, Chicago, IL, USA), with statistical
 significance set at p ≤ 0.05.
Inclusion Criteria:

 Patients whose BMI exceeded 30 kg/m2 were included.

 In addition, they fulfilled the ROM criteria of constipation, as follows:

 1. Suffered from any 2 or more of the following symptoms in the past 12 weeks (not
 necessarily consecutive), with the onset of symptoms at least 6 months prior to
 diagnosis:

 1. straining during at least 25% of defecations,

 2. lumpy or hard stools in at least 25% of defecations,

 3. sensation of incomplete evacuation for at least 25% of defecations,

 4. sensation of anorectal obstruction/blockage for at least 25% of defecations,

 5. requirement of manual maneuvers to facilitate at least 25% of defecations (e.g.,
 digital evacuation, support of the pelvic floor muscles), and

 6. fewer than 3 defecations per week;

 2. Loose stools rarely occurred without the use of laxatives;

 3. Insufficient criteria for irritable bowel syndrome; and

 4. Women were sedentary (less than 1 hour/week of physical activity), with no evidence of
 participation in diet control/weight reduction programs within the last 6 months.

 Exclusion Criteria:

 -  Patients with metabolic, endocrine, and neurologic constipation;

 -  current or past smokers;

 -  those with any orthopedic limitation; and

 -  those with congenital megacolon, pseudo-obstruction, and anorectal disorders were
 excluded from the study.

 Patients suffering from constipation due to drugs, disabled patients, and those who had
 undergone any abdominal surgery during the intervention or those who failed to complete the
 study protocol were also excluded.