Role of the exercise professional in metabolic and bariatric surgery

Expert-based physical activity guidelines for metabolic and bariatric surgery patients: a systematic review of randomized controlled trials

Patients undergoing metabolic and bariatric surgery (MBS) can improve outcomes through a physically active lifestyle. Despite ongoing research, clinical recommendations for physical activity (PA) are not fully developed. For this review, 39 articles representing 24 randomized clinical trials satisfied inclusion criteria. The PA interventions utilized in these trials, the expertise of the multidisciplinary research team, and the general principles of strength and conditioning were considered in the creation of the following 12 PA recommendations: 1) Begin PA intervention pre-MBS; 2) Unless contraindicated, walk short distances the day of the surgery; 3) Progressively increase movement through activities of daily living during the first month postoperatively; 4) Avoid prolonged sitting and adopt lifestyle routines that decrease sedentary time; 5) Slowly progress to 150-300 minutes of accumulated moderate-intensity cardiovascular exercise/week; 6) In addition to walking, gradually increase structured PA through a variety of activities; 7) Delay water exercise until surgical wounds have healed, around 4 weeks postoperatively; 8) Begin full body resistance training (RT) 4-6 weeks post-MBS on 2 noncontinuous d/wk; 9) Delay high-intensity PA and abdominal exercises for 8-12 weeks; 10) Have periodic assessments of strength and cardiovascular fitness to evaluate progress; 11) Continue long-term monitoring with exercise professionals in the context of health; and 12) Consult with a registered dietitian to optimize nutrition alongside changes in PA.

Exploring the acceptability of three time-matched exercise interventions for increasing fitness in women living with obesity: A mixed-methods evaluation of the EXOFFIT study

Background

The EXOFFIT study compared the effectiveness of three time-matched exercise interventions in women with obesity for improving cardiorespiratory fitness. To best inform future research, evaluation of the interventions' acceptability is needed. Previous research has been inconsistent with methods and reporting of acceptability. Thus, the theoretical framework of acceptability (TFA) can be utilized to ensure that all aspects of acceptability are evaluated. No study to date in women with obesity has utilized the TFA in conjunction with quantitative data (i.e., frequencies of themes) to highlight the aspects of interventions that may be most important for participants.

Objective

This study aimed to examine the acceptability of the EXOFFIT program and gain insight into the participants' experience of participation, their perspective on the acceptability of trial procedures and interventions and gather their feedback on program changes.

Methods

A mixed-methods approach was employed. Thirty-eight participants who completed the exercise interventions were interviewed and completed a self-reported exit questionnaire. Interviews were transcribed verbatim and analyzed in three phases: emergent themes were agreed upon, then mapped to the TFA constructs and the frequencies of each construct and theme were presented as counts. Data collected from the exit questionnaire were collated and reported using descriptive statistics.

Results

All seven TFA constructs were identified in the analysis. The EXOFFIT program was found to have a high level of acceptability, with affective attitude, perceived effectiveness and self-efficacy being the most reported constructs. The burden and opportunity costs associated with the program were mainly related to family commitments and support needed to participate. Any negative impact of participation was noted to be outweighed by the perceived benefits.

Conclusions

The results of this study will inform the development of future programs with women with obesity and support the consideration of the TFA constructs from the outset of study design.Clinical Trial Registration Number: ISRCTN13517067.

Early Exercise Through Telerehabilitation After Bariatric Surgery: Is It Feasible?

PURPOSE

The feasibility of early telerehabilitation after bariatric surgery is unknown. The objective of this study was to assess the feasibility and perception of engaging in the online exercise protocol in patients during the first month after bariatric surgery.

MATERIAL AND METHODS

A total of 67 patients, enrolled in a telerehabilitation program following bariatric surgery, completed a survey assessing their perception of the intensity, discomfort, and safety during exercise sessions.

RESULTS

Forty percent of participants began exercising between 5 and 10 days after surgery. Seventy-one percent of patients did not experience discomfort during the first month of exercise, and those who reported discomfort mainly mentioned dizziness and abdominal pain. No significant differences were found in the presence of discomfort among different types of surgeries performed. There was a significant difference in the presence of discomfort between patients who started exercising before and after 15 days of surgery, with less discomfort reported in the group that started after 15 days. Ninety-eight percent of patients felt safe during online exercise sessions. Most participants perceived the intensity of the sessions as moderate. The most frequently mentioned benefits of exercise were increased energy, mood, and feeling more active.

CONCLUSION

Telerehabilitation conducted during the first month after bariatric surgery was feasible and well tolerated by patients, providing a safe alternative for those patients who face difficulties with in-person interventions.