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Yanovski SZ, Yanovski JA. Approach to Obesity Treatment in Primary Care: A Review. JAMA Intern Med 2024; 184:818-829. [PMID: 38466272 DOI: 10.1001/jamainternmed.2023.8526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Importance More than 40% of US adults have obesity, which increases the risks for multiple chronic diseases and premature mortality. Historically, nonsurgical interventions often have not led to sufficient weight loss and maintenance to improve health, but highly effective antiobesity medications (AOMs) have recently become available, and additional effective therapeutics are under development. Given that most medical care for adults with obesity is delivered in primary care settings, guidance for integrating weight-management approaches is needed. Observations Lifestyle interventions can lead to a mean weight loss of 2% to 9% of initial weight at 1 year and increase the likelihood of weight loss of 5% or more, but weight regain over time is common even with continued treatment. Adjunctive treatments, including AOMs and surgical approaches, can lead to larger, more sustained weight loss and improvements in numerous obesity-associated medical conditions. Highly effective AOMs, including nutrient-stimulated hormone-based therapies, induce mean weight loss of 15% or more. Barriers to intervention, including access to care, have a disproportionate influence on populations most affected by obesity and its consequences. Conclusions and Relevance Primary care clinicians play a vital role in the assessment, management, and support of patients with obesity. With careful clinical assessment and shared decision-making, a flexible treatment plan can be developed that reflects evidence of treatment efficacy, patient preference, and feasibility of implementation. Adjunctive therapies to lifestyle interventions, including more effective pharmacotherapeutics for obesity, offer hope to patients and the potential for considerable improvements in health and quality of life.
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Affiliation(s)
- Susan Z Yanovski
- Office of Obesity Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jack A Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Imhagen A, Karlsson J, Ohlsson-Nevo E, Stenberg E, Jansson S, Hagberg L. Levels of Physical Activity, Enjoyment, Self-Efficacy for Exercise, and Social Support Before and After Metabolic and Bariatric Surgery: a Longitudinal Prospective Observational Study. Obes Surg 2023; 33:3899-3906. [PMID: 37837533 PMCID: PMC10687134 DOI: 10.1007/s11695-023-06887-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Physical activity (PA) after metabolic and bariatric surgery (MBS) can influence weight loss, health status, and quality of life. Known mediators to participate in PA are enjoyment, self-efficacy, and social support. Little is known about PA behavior in MBS individuals. The aim of this study was to explore levels of PA and the PA mediators enjoyment, self-efficacy, and social support before and after MBS and to investigate changes over time. METHODS Adults scheduled to undergo MBS were recruited from a Swedish university hospital. Accelerometer-measured and self-reported PA, body weight, and PA mediators were collected at baseline and at 12 to 18 months post-surgery. RESULTS Among 90 individuals included, 50 completed the follow-up assessment and had valid accelerometer data. Sedentary time (minutes/day) was unchanged, but sedentary time as percentage of wear time decreased significantly from 67.2% to 64.5% (p<0.05). Time spent in light PA and total PA increased significantly from 259.3 to 288.7 min/day (p < 0.05) and from 270.5 to 303.5 min/day (p < 0.01), respectively. Step counts increased significantly from 6013 to 7460 steps/day (p < 0.01). There was a significant increase in self-reported PA, enjoyment, self-efficacy for exercise, and positive social support from family. The increase in PA mediators did not lead to a significant change in time spent in moderate to vigorous PA. CONCLUSION The increase in PA-mediators was not associated with an increase in moderate to vigorous PA, but the strengthened PA mediators suggest potential for an increase in moderate to vigorous PA in patients undergoing MBS.
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Affiliation(s)
- Annika Imhagen
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE-701 82, Örebro, Sweden.
| | - Jan Karlsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE-701 82, Örebro, Sweden
| | - Emma Ohlsson-Nevo
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE-701 82, Örebro, Sweden
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-701 82, Örebro, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-701 82, Örebro, Sweden
- School of Medical Sciences, Örebro University, SE-701 82, Örebro, Sweden
| | - Stefan Jansson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE-701 82, Örebro, Sweden
| | - Lars Hagberg
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE-701 82, Örebro, Sweden
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Valenzuela PL, Carrera-Bastos P, Castillo-García A, Lieberman DE, Santos-Lozano A, Lucia A. Obesity and the risk of cardiometabolic diseases. Nat Rev Cardiol 2023; 20:475-494. [PMID: 36927772 DOI: 10.1038/s41569-023-00847-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 03/18/2023]
Abstract
The prevalence of obesity has reached pandemic proportions, and now approximately 25% of adults in Westernized countries have obesity. Recognized as a major health concern, obesity is associated with multiple comorbidities, particularly cardiometabolic disorders. In this Review, we present obesity as an evolutionarily novel condition, summarize the epidemiological evidence on its detrimental cardiometabolic consequences and discuss the major mechanisms involved in the association between obesity and the risk of cardiometabolic diseases. We also examine the role of potential moderators of this association, with evidence for and against the so-called 'metabolically healthy obesity phenotype', the 'fatness but fitness' paradox or the 'obesity paradox'. Although maintenance of optimal cardiometabolic status should be a primary goal in individuals with obesity, losing body weight and, particularly, excess visceral adiposity seems to be necessary to minimize the risk of cardiometabolic diseases.
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Affiliation(s)
- Pedro L Valenzuela
- Physical Activity and Health Research Group (PaHerg), Research Institute of Hospital 12 de Octubre ("i + 12"), Madrid, Spain.
- Department of Systems Biology, University of Alcalá, Alcalá de Henares, Spain.
| | - Pedro Carrera-Bastos
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | | | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Alejandro Santos-Lozano
- Physical Activity and Health Research Group (PaHerg), Research Institute of Hospital 12 de Octubre ("i + 12"), Madrid, Spain
- Department of Health Sciences, European University Miguel de Cervantes, Valladolid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain.
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.
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4
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Bischoff SC, Ockenga J, Eshraghian A, Barazzoni R, Busetto L, Campmans-Kuijpers M, Cardinale V, Chermesh I, Kani HT, Khannoussi W, Lacaze L, Léon-Sanz M, Mendive JM, Müller MW, Tacke F, Thorell A, Vranesic Bender D, Weimann A, Cuerda C. Practical guideline on obesity care in patients with gastrointestinal and liver diseases - Joint ESPEN/UEG guideline. Clin Nutr 2023; 42:987-1024. [PMID: 37146466 DOI: 10.1016/j.clnu.2023.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Patients with chronic gastrointestinal disease such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, gastroesophageal reflux disease (GERD), pancreatitis, and chronic liver disease (CLD) often suffer from obesity because of coincidence (IBD, IBS, celiac disease) or related pathophysiology (GERD, pancreatitis and CLD). It is unclear if such patients need a particular diagnostic and treatment that differs from the needs of lean gastrointestinal patients. The present guideline addresses this question according to current knowledge and evidence. OBJECTIVE The present practical guideline is intended for clinicians and practitioners in general medicine, gastroenterology, surgery and other obesity management, including dietitians and focuses on obesity care in patients with chronic gastrointestinal diseases. METHODS The present practical guideline is the shortened version of a previously published scientific guideline developed according to the standard operating procedure for ESPEN guidelines. The content has been re-structured and transformed into flow-charts that allow a quick navigation through the text. RESULTS In 100 recommendations (3× A, 33× B, 24 × 0, 40× GPP, all with a consensus grade of 90% or more) care of gastrointestinal patients with obesity - including sarcopenic obesity - is addressed in a multidisciplinary way. A particular emphasis is on CLD, especially metabolic associated liver disease, since such diseases are closely related to obesity, whereas liver cirrhosis is rather associated with sarcopenic obesity. A special chapter is dedicated to obesity care in patients undergoing bariatric surgery. The guideline focuses on adults, not on children, for whom data are scarce. Whether some of the recommendations apply to children must be left to the judgment of the experienced pediatrician. CONCLUSION The present practical guideline offers in a condensed way evidence-based advice how to care for patients with chronic gastrointestinal diseases and concomitant obesity, an increasingly frequent constellation in clinical practice.
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Affiliation(s)
- Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - Johann Ockenga
- Medizinische Klinik II, Klinikum Bremen-Mitte, Bremen FRG, Bremen, Germany.
| | - Ahad Eshraghian
- Department of Gastroenterology and Hepatology, Avicenna Hospital, Shiraz, Iran.
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
| | - Luca Busetto
- Department of Medicine, University of Padova, Padova, Italy.
| | - Marjo Campmans-Kuijpers
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, the Netherlands.
| | - Vincenzo Cardinale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.
| | - Irit Chermesh
- Department of Gastroenterology, Rambam Health Care Campus, Affiliated with Technion-Israel Institute of Technology, Haifa, Israel.
| | - Haluk Tarik Kani
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey.
| | - Wafaa Khannoussi
- Hepato-Gastroenterology Department, Mohammed VI University Hospital, Oujda, Morocco; and Laboratoire de Recherche des Maladies Digestives (LARMAD), Mohammed the First University, Oujda, Morocco.
| | - Laurence Lacaze
- Department of General Surgery, Mantes-la-Jolie Hospital, Mantes-la-Jolie, France.
| | - Miguel Léon-Sanz
- Department of Endocrinology and Nutrition, University Hospital Doce de Octubre, Medical School, University Complutense, Madrid, Spain.
| | - Juan M Mendive
- La Mina Primary Care Academic Health Centre, Catalan Institute of Health (ICS), University of Barcelona, Barcelona, Spain.
| | - Michael W Müller
- Department of General and Visceral Surgery, Regionale Kliniken Holding, Kliniken Ludwigsburg-Bietigheim gGmbH, Krankenhaus Bietigheim, Bietigheim-Bissingen, Germany.
| | - Frank Tacke
- Department of Hepatology & Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany.
| | - Anders Thorell
- Department of Clinical Science, Danderyds Hospital, Karolinska Institutet & Department of Surgery, Ersta Hospital, Stockholm, Sweden.
| | - Darija Vranesic Bender
- Unit of Clinical Nutrition, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany.
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Mahmoud AM, da Silva ALG, André LD, Hwang CL, Severin R, Sanchez-Johnsen L, Borghi-Silva A, Elokda A, Arena R, Phillips SA. Effects of Exercise Mode on Improving Cardiovascular Function and Cardiorespiratory Fitness After Bariatric Surgery: A Narrative Review. Am J Phys Med Rehabil 2022; 101:1056-1065. [PMID: 35034058 PMCID: PMC9279514 DOI: 10.1097/phm.0000000000001946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
ABSTRACT Obesity affects 600 million people globally and increases the risk of developing cardiovascular disease, stroke, diabetes, and cancer. Bariatric surgery is an increasingly popular therapeutic intervention for morbid obesity to induce rapid weight loss and reduce obesity-related comorbidities. However, some bariatric surgery patients, after what is considered a successful surgical procedure, continue to manifest obesity-related health issues, including weight gain, reduced physical function, persistent elevations in blood pressure, and reduced cardiorespiratory fitness. Cardiorespiratory fitness is a strong predictor of mortality and several health outcomes and could be improved by an appropriate exercise prescription after bariatric surgery. This review provides a broad overview of exercise training for patients after bariatric surgery and discusses cardiorespiratory fitness and other potential physiological adaptations in response to exercise training.
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Affiliation(s)
- Abeer M. Mahmoud
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Andréa Lúcia Gonçalves da Silva
- Department of Physical Education and Health, Physiotherapy‘ Course at University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Larissa Delgado André
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
- Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Chueh-Lung Hwang
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Richard Severin
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
- Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Lisa Sanchez-Johnsen
- Departments of Surgery, Psychiatry, and Psychology, College of Medicine, University of Illinois at Chicago (UIC), Chicago, IL, USA
- Department of Family Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in Physical Exercise, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Ahmed Elokda
- Department of Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, FL
| | - Ross Arena
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
- Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
| | - Shane A. Phillips
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
- Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL, USA
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6
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Bischoff SC, Barazzoni R, Busetto L, Campmans-Kuijpers M, Cardinale V, Chermesh I, Eshraghian A, Kani HT, Khannoussi W, Lacaze L, Léon-Sanz M, Mendive JM, Müller MW, Ockenga J, Tacke F, Thorell A, Vranesic Bender D, Weimann A, Cuerda C. European guideline on obesity care in patients with gastrointestinal and liver diseases - Joint ESPEN/UEG guideline. Clin Nutr 2022; 41:2364-2405. [PMID: 35970666 DOI: 10.1016/j.clnu.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with chronic gastrointestinal (GI) disease such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, gastroesophageal reflux disease (GERD), pancreatitis, and chronic liver disease (CLD) often suffer from obesity because of coincidence (IBD, IBS, celiac disease) or related pathophysiology (GERD, pancreatitis and CLD). It is unclear if such patients need a particular diagnostic and treatment that differs from the needs of lean GI patients. The present guideline addresses this question according to current knowledge and evidence. OBJECTIVE The objective of the guideline is to give advice to all professionals working in the field of gastroenterology care including physicians, surgeons, dietitians and others how to handle patients with GI disease and obesity. METHODS The present guideline was developed according to the standard operating procedure for ESPEN guidelines, following the Scottish Intercollegiate Guidelines Network (SIGN) grading system (A, B, 0, and good practice point (GPP)). The procedure included an online voting (Delphi) and a final consensus conference. RESULTS In 100 recommendations (3x A, 33x B, 24x 0, 40x GPP, all with a consensus grade of 90% or more) care of GI patients with obesity - including sarcopenic obesity - is addressed in a multidisciplinary way. A particular emphasis is on CLD, especially fatty liver disease, since such diseases are closely related to obesity, whereas liver cirrhosis is rather associated with sarcopenic obesity. A special chapter is dedicated to obesity care in patients undergoing bariatric surgery. The guideline focuses on adults, not on children, for whom data are scarce. Whether some of the recommendations apply to children must be left to the judgment of the experienced pediatrician. CONCLUSION The present guideline offers for the first time evidence-based advice how to care for patients with chronic GI diseases and concomitant obesity, an increasingly frequent constellation in clinical practice.
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Affiliation(s)
- Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
| | - Luca Busetto
- Department of Medicine, University of Padova, Padova, Italy.
| | - Marjo Campmans-Kuijpers
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, the Netherlands.
| | - Vincenzo Cardinale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.
| | - Irit Chermesh
- Department of Gastroenterology, Rambam Health Care Campus, Affiliated with Technion-Israel Institute of Technology, Haifa, Israel.
| | - Ahad Eshraghian
- Department of Gastroenterology and Hepatology, Avicenna Hospital, Shiraz, Iran.
| | - Haluk Tarik Kani
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey.
| | - Wafaa Khannoussi
- Hepato-Gastroenterology Department, Mohammed VI University Hospital, Oujda, Morocco; Laboratoire de Recherche des Maladies Digestives (LARMAD), Mohammed the First University, Oujda, Morocco.
| | - Laurence Lacaze
- Department of General Surgery, Mantes-la-Jolie Hospital, Mantes-la-Jolie, France; Department of Clinical Nutrition, Paul-Brousse-Hospital, Villejuif, France.
| | - Miguel Léon-Sanz
- Department of Endocrinology and Nutrition, University Hospital Doce de Octubre, Medical School, University Complutense, Madrid, Spain.
| | - Juan M Mendive
- La Mina Primary Care Academic Health Centre, Catalan Institute of Health (ICS), University of Barcelona, Barcelona, Spain.
| | - Michael W Müller
- Department of General and Visceral Surgery, Regionale Kliniken Holding, Kliniken Ludwigsburg-Bietigheim GGmbH, Krankenhaus Bietigheim, Bietigheim-Bissingen, Germany.
| | - Johann Ockenga
- Medizinische Klinik II, Klinikum Bremen-Mitte, Bremen FRG, Bremen, Germany.
| | - Frank Tacke
- Department of Hepatology & Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany.
| | - Anders Thorell
- Department of Clinical Science, Danderyds Hospital, Karolinska Institutet & Department of Surgery, Ersta Hospital, Stockholm, Sweden.
| | - Darija Vranesic Bender
- Unit of Clinical Nutrition, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany.
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Vieira FT, de Oliveira GS, Gonçalves VSS, Neri SGR, de Carvalho KMB, Dutra ES. Effect of physical exercise on muscle strength in adults following bariatric surgery: A systematic review and meta-analysis of different muscle strength assessment tests. PLoS One 2022; 17:e0269699. [PMID: 35687555 PMCID: PMC9187088 DOI: 10.1371/journal.pone.0269699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/25/2022] [Indexed: 11/18/2022] Open
Abstract
Individuals following bariatric surgery are considered at high risk for the development of sarcopenic obesity (excess fat mass, low muscle mass and low physical function), and exercise may play an important role in its prevention and treatment. We systematically reviewed 5 scientific databases (Embase, Medline, Scopus, SPORTDiscus, and Web of Science) and 2 grey literature databases (ProQuest and Google Scholar) for clinical trials that evaluated the effect of exercise on muscle strength in adults following bariatric surgery and conducted a separate meta-analysis for studies that used different muscle strength tests. Random-effect models, restricted maximum likelihood method and Hedges’ g were used. The review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42020152142). Fifteen studies were included (638 patients), none had a low risk of bias, and all were included in at least 1 of the 5 meta-analyses (repetition maximum [lower and upper limbs], sit-to-stand, dynamometer, and handgrip tests). Exercise interventions improved both upper (effect size, 0.71; 95% CI, 0.41–1.01; I2 = 0%) and lower (effect size, 1.37; 95% CI, 0.84–1.91; I2 = 46.14) limb muscle strength, as measured by repetition maximum tests. Results were similar for the sit-to-stand (effect size, 0.60; 95% CI, 0.20–1.01; I2 = 68.89%) and dynamometer (effect size, 0.46; 95% CI, 0.06–0.87; I2 = 31.03%), but not for the handgrip test (effect size, 0.11; 95% CI, -0.42–0.63; I2 = 73.27%). However, the certainty level of the meta-analyses was very low. Exercise with a resistance training component performed post bariatric surgery may improve muscle strength, which is related to sarcopenic obesity, functional capacity, and mortality risk, therefore should be included in the follow-up.
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Affiliation(s)
- Flávio Teixeira Vieira
- Graduate Program in Human Nutrition of the University of Brasilia, Brasilia, Brazil
- * E-mail:
| | | | | | - Silvia G. R. Neri
- Graduate Program in Physical Education of the University of Brasilia, Brasilia, Brazil
| | | | - Eliane Said Dutra
- Graduate Program in Human Nutrition of the University of Brasilia, Brasilia, Brazil
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James JD, Hardeman W, Goodall M, Eborall H, Sprung VS, Bonnett LJ, Wilding JP. A systematic review of interventions to increase physical activity and reduce sedentary behaviour following bariatric surgery. Physiotherapy 2022; 115:1-17. [PMID: 35091180 PMCID: PMC9153984 DOI: 10.1016/j.physio.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 12/23/2022]
Abstract
Background Objectives Eligibility Study appraisal and synthesis methods Results Limitations Conclusion and implications of key findings Systematic review registration number
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9
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Gasmi A, Boukhmis B, Bjørklund G, Elkhidir IH, Semenova Y, Dosa A, Piscopo S, Temitope AH, Noor S, Costea DO. Physical activity and obesity spectrum disorders in post-bariatric surgery patients: A systematic review and Meta-analysis. Crit Rev Food Sci Nutr 2022; 63:8161-8172. [PMID: 35442131 DOI: 10.1080/10408398.2022.2056868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This systematic review and meta-analysis is based on randomized controlled trials evaluating the effect of physical activity on weight loss in adults undergoing bariatric surgery. The study compared certain biomarkers for individuals with and without physical activity after bariatric surgery. Secondary, the study identified potential successful interventions for the target population. METHOD PubMed, Embase, OVID, CINAHL, and Cochrane Library were searched from January 2000 to December 2020. Intervention studies on the effect of physical activity in adults after bariatric surgery were selected, included, and analyzed following the PRISMA guidelines. The primary outcome was weight loss followed by selected biomarkers. RESULTS Two independent reviewers extracted data and conducted quality assessments. Of the 11 studies included, six reported BMI, two reported fat-free mass, three reported fat mass, two reported waist-hip ratio, and two reported waist circumference. Six studies measuring change from baseline BMI reported a significant intervention effect: SMD = -0.93 (-1.65;-0.20) with high heterogeneity of included trials (I2 = 72%). There was no significant difference between control and intervention groups for other outcomes. CONCLUSION BMI as a measure of physical activity positively impacts the target population. Large-scale studies with better criteria and a longer evaluation follow-up may finalize pronounced outcomes.
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Affiliation(s)
- Amin Gasmi
- Société Francophone de Nutrithérapie et de Nutrigénétique Appliquée, Villeurbanne, France
| | | | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Mo i Rana, Norway
| | - Ibrahim H Elkhidir
- Department of Pathology, Faculty of Medicine, University of Khartoum, Sudan
| | - Yuliya Semenova
- Semey Medical University, Semey, Kazakhstan
- CONEM Kazakhstan Environmental Health and Safety Research Group, Semey Medical University, Semey, Kazakhstan
| | - Alexandru Dosa
- Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania
| | - Salva Piscopo
- Société Francophone de Nutrithérapie et de Nutrigénétique Appliquée, Villeurbanne, France
| | | | - Sadaf Noor
- Federal University of Technology, Akure, Nigeria
- Institute of Molecular Biology and Biotechnology, Bahauddin Zakariya University Multan, Pakistan
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Boppre G, Diniz-Sousa F, Veras L, Oliveira J, Fonseca H. Does Exercise Improve the Cardiometabolic Risk Profile of Patients with Obesity After Bariatric Surgery? A Systematic Review and Meta-analysis of Randomized Controlled Trials. Obes Surg 2022; 32:2056-2068. [PMID: 35332396 DOI: 10.1007/s11695-022-06023-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 01/06/2023]
Abstract
We aimed to determine the effects of different exercise types, duration, and onset after bariatric surgery (BS) on cardiometabolic risk factors (CMRFs). A systematic search was conducted up to July 2021. Eleven studies were identified (n = 618 participants). Overall, exercise induced reductions in systolic blood pressure (SBP; - 5.33 mmHg; 95%CI - 8.99, -1.66; p < 0.01). Combined exercises elicited reductions on SBP (- 7.18 mmHg; 95%CI - 12.42, - 1.94; p < 0.01) and triglycerides (- 17.56 mg/dL; 95%CI - 34.15, - 0.96; p = 0.04). SBP reductions were also observed on interventions starting > 6 months post-BS (- 7.71 mmHg; 95%CI - 13.12, - 2.31; p < 0.01), and on > 12-week protocols (- 5.78 mmHg; 95%CI - 9.91, - 1.66; p < 0.01). Overall exercise and particularly aerobic plus resistance protocols were an effective therapy to reduce CMRFs post-BS. Benefits were also observed with interventions starting > 6 months post-BS and with > 12-week duration. Trial registration: CRD42020161175 .
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Affiliation(s)
- Giorjines Boppre
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal. .,Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal.
| | - Florêncio Diniz-Sousa
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
| | - Lucas Veras
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
| | - José Oliveira
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
| | - Hélder Fonseca
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
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11
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Hardy K, Kwok K, Bouchard DR, Bharti N, Gamey D, Vergis A. Impact of a Preoperative Exercise Program on General Fitness in Patients Awaiting Bariatric Surgery: A Pilot Randomized Trial. Cureus 2022; 14:e22566. [PMID: 35355537 PMCID: PMC8957355 DOI: 10.7759/cureus.22566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background Evidence supports the association between exercise and outcomes following bariatric surgery. However, there is a lack of knowledge regarding the short-term benefits of preoperative exercise. Objectives The objective of this pilot study was to evaluate the feasibility and functional benefits of a 12-week preoperative exercise program in patients awaiting bariatric surgery. The primary aim was the six-minute walk test (6MWT). The secondary aim of this study included anthropometric measures, strength, and quality of life. Methods A total of 54 patients were enrolled in this pilot randomized controlled study. Of them, 29 patients received standard multidisciplinary preoperative care, while 25 patients participated in a 12-week supervised exercise program in addition to standard preoperative care consisting of strength and aerobic exercises three times per week in a fitness facility. The primary outcome was improvement in 6MWT. Secondary outcomes included other functional outcomes, quality of life, and anthropometric measures. Results Average attendance for the intervention group was 27.2 (75.6%) of 36 sessions. There was a mean improvement of 27 ± 10 meters in the intervention group compared with a reduction of 5 ± 10 meters in the control group (p = 0.003). Patients in the intervention group had significant improvement in all self-reported quality-of-life domains, particularly in the variables related to symptoms, hygiene, and emotions. Conclusions A 12-week preoperative exercise intervention was feasible and showed association with a statistically significant improvement in 6MWT and quality-of-life measures in patients awaiting bariatric surgery. The results of this study will inform sample size calculations and recruitment planning for a future study that will assess the longer-term benefits of a pre-surgical fitness intervention.
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12
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Boppre G, Diniz‐Sousa F, Veras L, Oliveira J, Fonseca H. Can exercise promote additional benefits on body composition in patients with obesity after bariatric surgery? A systematic review and meta-analysis of randomized controlled trials. Obes Sci Pract 2022; 8:112-123. [PMID: 35127127 PMCID: PMC8804945 DOI: 10.1002/osp4.542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/04/2021] [Accepted: 06/15/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Bariatric surgery is the most effective treatment for patients with severe obesity, but success rates vary substantially. Exercise is recommended after bariatric surgery to reduce weight regain but the effectiveness remains undetermined on weight loss due to conflicting results. It is also unclear what should be the optimal exercise prescription for these patients. A systematic review and meta-analysis of randomized controlled trials on the effects of exercise on body weight (BW), anthropometric measures, and body composition after bariatric surgery was performed. METHODS PubMed/MEDLINE®, EBSCO®, Web of Science® and Scopus® databases were searched to identify studies evaluating exercise effectiveness. RESULTS The analysis comprised 10 studies (n = 487 participants). Exercise favored BW (-2.51kg; p = 0.02), waist circumference (-4.14cm; p = 0.04) and body mass index (-0.84kg·m-2; p = 0.02) reduction but no improvements in body composition. Combined exercise interventions were the most effective in reducing BW (-5.50kg; p < 0.01) and body mass index (-1.86kg·m-2; p < 0.01). Interventions starting >6-months after bariatric surgery were more successful in reducing BW (-5.02kg; p < 0.01) and body mass index (-1.62kg·m-2; p < 0.01). CONCLUSION Exercise, combined exercise regimens and interventions starting >6-months after bariatric surgery were effective in promoting BW, waist circumference and body mass index reduction. Exercise following bariatric surgery does not seem to favor body composition improvements.
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Affiliation(s)
- Giorjines Boppre
- Research Center in Physical ActivityHealth and Leisure (CIAFEL)Faculty of SportUniversity of PortoPortoPortugal
- Laboratory for Integrative and Translational Research in Population Health (ITR)PortoPortugal
| | - Florêncio Diniz‐Sousa
- Research Center in Physical ActivityHealth and Leisure (CIAFEL)Faculty of SportUniversity of PortoPortoPortugal
- Laboratory for Integrative and Translational Research in Population Health (ITR)PortoPortugal
| | - Lucas Veras
- Research Center in Physical ActivityHealth and Leisure (CIAFEL)Faculty of SportUniversity of PortoPortoPortugal
- Laboratory for Integrative and Translational Research in Population Health (ITR)PortoPortugal
| | - José Oliveira
- Research Center in Physical ActivityHealth and Leisure (CIAFEL)Faculty of SportUniversity of PortoPortoPortugal
- Laboratory for Integrative and Translational Research in Population Health (ITR)PortoPortugal
| | - Hélder Fonseca
- Research Center in Physical ActivityHealth and Leisure (CIAFEL)Faculty of SportUniversity of PortoPortoPortugal
- Laboratory for Integrative and Translational Research in Population Health (ITR)PortoPortugal
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13
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Zhao K, Xu X, Zhu H, Ren Z, Zhang T, Yang N, Zhu S, Xu Q. Trajectory Analysis and Predictors of the Percentage of Body Fat Among Chinese Sleeve Gastrectomy Patients. Diabetes Metab Syndr Obes 2021; 14:4959-4970. [PMID: 35002268 PMCID: PMC8721014 DOI: 10.2147/dmso.s347032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/17/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The weight loss in Chinese patients after sleeve gastrectomy is different, and the differences can be evaluated through the trajectories of the percentage of body fat (BF%). Patients' baseline psychosocial factors may be associated with these trajectories. MATERIALS AND METHODS We selected 267 patients who received sleeve gastrectomy for the first time. The BF% at baseline and 1, 3, 6, 12 months after surgery and baseline psychosocial variables were retrospectively collected. The trajectory model was established according to BF% based on the growth mixture model. The baseline psychosocial variables were compared among different trajectory classes. RESULTS Four types of trajectory classes were obtained. The differences in preoperative dietary self-efficacy, exercise self-efficacy, depression, social support, working status, alcohol consumption, and gender among the classes were statistically significant. The pairwise comparison of the above variables revealed that the differences of gender, dietary self-efficacy and exercise self-efficacy among classes were highly effective. CONCLUSION Female gender, low dietary self-efficacy and low exercise self-efficacy were predictors for poor BF% trajectory in sleeve gastrectomy patients. Health professionals can early identify patients who are most likely to lose weight in a not-ideal manner based on the above predictors.
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Affiliation(s)
- Kang Zhao
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Xinyi Xu
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
- Faculty of Health, The Queensland University of Technology, Brisbane, Queensland, Australia
| | - Hanfei Zhu
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Ziqi Ren
- School of Nursing, Fudan University, Shanghai, People’s Republic of China
| | - Tianzi Zhang
- Department of Nursing, Jiangsu College of Nursing, Huai’an, Jiangsu, People’s Republic of China
| | - Ningli Yang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Shuqin Zhu
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
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James J, Hardeman W, Eborall H, Goodall M, Wilding J. PARIS: protocol for a prospective single arm, theory-based, group-based feasibility intervention study to increase Physical Activity and reduce sedentary behaviouR after barIatric Surgery. BMJ Open 2021; 11:e051638. [PMID: 34937717 PMCID: PMC8704967 DOI: 10.1136/bmjopen-2021-051638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Increased physical activity and reduced sedentary behaviour can encourage favourable outcomes after bariatric surgery. However, there is a lack of evidence as to how to support patients with behaviour change. The aim of this study is to assess the feasibility of a physiotherapist led, online group-based behaviour change intervention to increase physical activity and reduce sedentary behaviour following bariatric surgery. METHODS AND ANALYSIS Single arm feasibility study of a theory and evidence-based group behaviour change intervention based on the Behaviour Change Wheel and Theoretical Domains Framework using behaviour change techniques from the Behaviour Change Technique Taxonomy v1. The intervention has eight objectives and specifies behaviour change techniques that will be used to address each of these. Groups of up to eight participants who have had surgery within the previous 5 years will meet weekly over 6 weeks for up to 1½ hours. Groups will be held online led by a physiotherapist and supported by an intervention handbook. Feasibility study outcomes include: rate of recruitment, retention, intervention fidelity, participant engagement and acceptability. Secondary outcomes include: physical activity, sedentary behaviour, body composition, self-reported health status and will be analysed descriptively. Change in these outcomes will be used to calculate the sample size for a future evaluation study. Qualitative interviews will explore participants' views of the intervention including its acceptability. Data will be analysed according to the constant comparative approach of grounded theory. ETHICS AND DISSEMINATION This study has National Health Service Research Ethics Committee approval; Haydock 20/NW/0472. All participants will provide informed consent and can withdraw at any point. Findings will be disseminated through peer-reviewed journals, conference and clinical service presentations. TRIAL REGISTRATION NUMBER ISRCTN31524689.
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Affiliation(s)
- Jennifer James
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Helen Eborall
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mark Goodall
- Primary care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - John Wilding
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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15
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Assessment of Cardiorespiratory and Metabolic Responses in Women with Obesity After Surgically Induced Weight Loss: Results from a Pilot Study. Obes Surg 2021; 32:318-324. [PMID: 34780025 DOI: 10.1007/s11695-021-05782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Bariatric surgery is effective in controlling severe obesity. However, studies investigating the impact of surgically induced weight loss on cardiorespiratory and metabolic responses during maximal effort are controversial. The aim of this study was to assess cardiorespiratory and metabolic responses in women with obesity after bariatric surgery. MATERIALS AND METHODS We performed a secondary analysis on data from a pilot study with women with obesity submitted to bariatric surgery and who did not participate in a controlled physical training program. Anthropometry, pulmonary function (spirometry), and cardiorespiratory fitness (cardiopulmonary exercise testing [CPX]) were assessed before and after bariatric surgery. RESULTS Thirty-four women were included (38.7 ± 9.6 years, body mass index = 44.1 ± 6.3 kg/m2). Postoperative assessment was conducted 9.4 ± 2.7 months after surgery. After surgery, we observed a reduction in all anthropometric measurements (mean loss of 28.6 kg, p < 0.001), and improvement in spirometry values (p < 0.001). Relative VO2peak (mL/kg/min) increased slightly (Δ = 1.7; p = 0.06); however, absolute VO2peak (L/min) reduced significantly (Δ = - 0.398; p < 0.001). We also observed an increase of 1.3 min (p < 0.001) in CPX duration, a reduction of 11.3 bpm (p < 0.001) in resting heart rate, and a decrease of systolic (p = 0.02) and diastolic (p < 0.001) blood pressures at peak effort. CONCLUSION Surgically induced weight loss without exercise training improved cardiac reserve, ventilatory response, blood pressure, and resting heart rate. Cardiorespiratory fitness reflected by relative VO2peak increased slightly, despite increased tolerance to CPX.
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16
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Ren Z, Zhu H, Zhang T, Hua H, Zhao K, Yang N, Liang H, Xu Q. Effects of a 12-Week Transtheoretical Model-Based Exercise Training Program in Chinese Postoperative Bariatric Patients: a Randomized Controlled Trial. Obes Surg 2021; 31:4436-4451. [PMID: 34373988 DOI: 10.1007/s11695-021-05607-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/11/2021] [Accepted: 07/16/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aims to investigate the effectiveness of the transtheoretical model (TTM)-based exercise training on TTM variables, exercise adherence, and physical function in patients in the early stages after bariatric surgery (BS). MATERIALS AND METHODS We conducted a single-blinded, prospective, randomized controlled trial (RCT) to evaluate the effects of TTM-based exercise training on BS patients immediately after surgery. Participants (n = 120) were randomized into a TTM-based exercise training group (n = 60) and a control group (n = 60). Main outcomes included TTM variables (measured by exercise stages of change (ESCs), exercise self-efficacy (ESE), and decisional balance), exercise adherence, and physical function (determined by the 6-min walk distance (6MWD)). Secondary outcomes were physical activity, anthropometrics, and body composition. We performed all analyses in accordance with the intention-to-treat principle. RESULTS Retention rates for the interventions were 91.7% for the intervention group and 90.0% for the control group. Compared with the control group, the 12-week TTM-based intervention significantly helped participants advance through ESCs, demonstrate higher ESE, perceive more benefits and fewer barriers to exercise, and show higher exercise adherence and better physical function afterward (all P < 0.05). However, we observed no statistically significant difference between the two groups in anthropometric parameters or body composition after intervention. CONCLUSION The TTM-based exercise intervention had significant positive effects on the TTM variables, which could further help increase patients' exercise adherence and physical function immediately after BS. TRIAL REGISTRATION This study was retrospectively registered at the Chinese Clinical Trial Registry (website: www.chictr.org.cn , registry number: ChiCTR2000039319).
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Affiliation(s)
- Ziqi Ren
- School of Nursing, Nanjing Medical University, 818 Tianyuan East Road, Jiangning District, Nanjing, 210029, Jiangsu, China.,School of Nursing, Fudan University, Shanghai, 200032, China
| | - Hanfei Zhu
- School of Nursing, Nanjing Medical University, 818 Tianyuan East Road, Jiangning District, Nanjing, 210029, Jiangsu, China
| | - Tianzi Zhang
- Department of Nursing, Jiangsu College of Nursing, Huai'an, 223000, Jiangsu, China
| | - Hongxia Hua
- Department of Bariatric and Metabolic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Kang Zhao
- School of Nursing, Nanjing Medical University, 818 Tianyuan East Road, Jiangning District, Nanjing, 210029, Jiangsu, China
| | - Ningli Yang
- Department of Bariatric and Metabolic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Hui Liang
- Department of Bariatric and Metabolic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, 818 Tianyuan East Road, Jiangning District, Nanjing, 210029, Jiangsu, China.
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Bellicha A, van Baak MA, Battista F, Beaulieu K, Blundell JE, Busetto L, Carraça EV, Dicker D, Encantado J, Ermolao A, Farpour-Lambert N, Pramono A, Woodward E, Oppert JM. Effect of exercise training before and after bariatric surgery: A systematic review and meta-analysis. Obes Rev 2021; 22 Suppl 4:e13296. [PMID: 34080281 PMCID: PMC8365633 DOI: 10.1111/obr.13296] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 12/21/2022]
Abstract
We aimed to assess the effectiveness of exercise training programs in adults with severe obesity undergoing bariatric surgery. A systematic search of controlled trials published up to October 2019 that assigned participants to either a preoperative or postoperative exercise training group or a nonexercise group was performed. Meta-analyses were conducted using random-effects models. Twenty-two training programs were assessed (18 performed after bariatric surgery). The effect of preoperative exercise training on postsurgery outcomes was reported in only one study. Compared with the control condition without exercise, postoperative exercise training led to higher weight loss (N = 14, mean difference [95% CI] = -1.8 [-3.2; -0.4] kg, P = 0.01), fat loss (N = 9, P = 0.01), increase in VO2 max (N = 8, P < 0.0001), and increase in muscle strength (N = 9, P < 0.0001). No significant effect was found on lean body mass (N = 11). Preliminary evidence suggests a beneficial effect of postoperative exercise training on bone mineral density (N = 3, P < 0.001) and weight maintenance after the end of the intervention (N = 2, P < 0.001) but no significant effect on quality of life (N = 2), habitual physical activity (N = 2), or cardiometabolic outcomes (N < 4). In conclusion, exercise training performed after bariatric surgery improves physical fitness and leads to a small additional weight and fat loss and may prevent bone loss and weight regain after bariatric surgery.
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Affiliation(s)
- Alice Bellicha
- INSERM, Nutrition and Obesities: Systemic Approaches, NutriOmics, Sorbonne University, Paris, France.,UFR SESS-STAPS, University Paris-Est Créteil, Créteil, France
| | - Marleen A van Baak
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Human Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Francesca Battista
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padua, Italy
| | - Kristine Beaulieu
- Appetite Control and Energy Balance Group (ACEB), School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - John E Blundell
- Appetite Control and Energy Balance Group (ACEB), School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Luca Busetto
- Obesity Management Task Force (OMTF), European Association for the Study of obesity (EASO), London, UK.,Department of Medicine, University of Padova, Padova, Italy
| | - Eliana V Carraça
- CIDEFES, Faculdade de Educação Física e Desport, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal
| | - Dror Dicker
- Obesity Management Task Force (OMTF), European Association for the Study of obesity (EASO), London, UK.,Department of Internal Medicine, Hasharon Hospital, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jorge Encantado
- APPsyCI - Applied Psychology Research Center Capabilities & Inclusion, ISPA - University Institute, Lisbon, Portugal
| | - Andrea Ermolao
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padua, Italy
| | - Nathalie Farpour-Lambert
- Obesity Management Task Force (OMTF), European Association for the Study of obesity (EASO), London, UK.,Obesity Prevention and Care Program Contrepoids, Service of Endocrinology, Diabetology, Nutrition and Patient Education, Department of Internal Medicine, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Adriyan Pramono
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Human Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Euan Woodward
- Obesity Management Task Force (OMTF), European Association for the Study of obesity (EASO), London, UK
| | - Jean-Michel Oppert
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Department of Nutrition, Institute of Cardiometabolism and Nutrition, Sorbonne University, Paris, France
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Hansen D, Decroix L, Devos Y, Nocca D, Cornelissen V, Dillemans B, Lannoo M. Towards Optimized Care After Bariatric Surgery by Physical Activity and Exercise Intervention: a Review. Obes Surg 2021; 30:1118-1125. [PMID: 31912467 DOI: 10.1007/s11695-020-04390-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although there is growing evidence on the importance of physical activity and exercise intervention after bariatric surgery, it remains to be clarified as to why and how post-operative exercise intervention should be implemented. In this narrative and practically oriented review, it is explained why exercise interventions and physical activity are important after bariatric surgery, how to prescribe exercise and monitor physical activity and how and when physical fitness, muscle strength, fat (-free) mass and bone mineral density could be assessed during follow-up. It is suggested that the inclusion of physical activity and exercise training in the clinical follow-up trajectory could be of great benefit to bariatric surgery patients, since it leads to greater improvements in body composition, bone mineral density, muscle strength and physical fitness.
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Affiliation(s)
- Dominique Hansen
- Faculty of Rehabilitation Sciences, REVAL - Rehabilitation Research Center, Hasselt University, Agoralaan, Building A, Diepenbeek, 3590, Hasselt, Belgium. .,Hasselt University, BIOMED, Hasselt, Belgium. .,Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.
| | - Lieselot Decroix
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yves Devos
- Fitness als Medicijn®-Medisch Fitness Centrum, Ternat, Belgium
| | - David Nocca
- Department of Surgery, Université de Montpellier, Montpellier, France
| | | | - Bruno Dillemans
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Brugge, Belgium
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Vetrovsky T, Fortova T, Conesa-Ros E, Steffl M, Heczkova J, Belohlavek J, Courel-Ibáñez J. Increased Cardiopulmonary Fitness Is Associated with a Greater Reduction in Depression among People Who Underwent Bariatric Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052508. [PMID: 33802552 PMCID: PMC7967516 DOI: 10.3390/ijerph18052508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 11/26/2022]
Abstract
The aim of this study was to determine the effect of changes in cardiopulmonary fitness on the mental health of patients with severe obesity who underwent gastric bypass surgery (prior to and 1, 3, and 6 months after surgery). Study participants were recruited from among patients of a regional hospital in Czechia who underwent gastric bypass surgery between April 2018 and October 2019. They were eligible if they (a) were between 18 and 65 years old, (b) provided written informed consent, and (c) were able to walk independently. Twenty-six patients (age 45.4 ± 9.0 years, body mass index 45.1 ± 7.4 kg·m−2, body fat 43.8 ± 4.8%) were included in the analysis. The key finding revealed that the greater the increase in cardiopulmonary fitness (i.e., longer distance walked in the six-minute walk test, 6MWT), the better the improvement in depression score among patients who underwent bariatric surgery. In particular, increments of 10 m in the 6MWT lead to the improvement of 0.5 points on the depression subscale of the Hospital Anxiety and Depression Scale (HADS) questionnaire. As the main implication, these results suggest that patients should participate in exercise training programs to increase their fitness status for optimal physical and mental outcomes of bariatric surgery.
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Affiliation(s)
- Tomas Vetrovsky
- Institute of Nursing Theory and Practice, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic; (T.V.); (T.F.); (J.H.)
- Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic;
| | - Tereza Fortova
- Institute of Nursing Theory and Practice, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic; (T.V.); (T.F.); (J.H.)
- Hospital Jablonec nad Nisou, 466 01 Jablonec nad Nisou, Czech Republic
| | - Elena Conesa-Ros
- Human Performance and Sports Science Laboratory, Faculty of Sport Sciences, University of Murcia, 30720 Murcia, Spain;
| | - Michal Steffl
- Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic;
| | - Jana Heczkova
- Institute of Nursing Theory and Practice, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic; (T.V.); (T.F.); (J.H.)
| | - Jan Belohlavek
- 2nd Department of Internal Medicine, Cardiovascular Medicine, General University Hospital, 128 08 Prague, Czech Republic;
- 1st Faculty of Medicine, Charles University in Prague, 128 00 Prague, Czech Republic
| | - Javier Courel-Ibáñez
- Human Performance and Sports Science Laboratory, Faculty of Sport Sciences, University of Murcia, 30720 Murcia, Spain;
- Correspondence:
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Lamarca F, Vieira FT, Lima RM, Nakano EY, da Costa THM, Pizato N, Dutra ES, de Carvalho KMB. Effects of Resistance Training With or Without Protein Supplementation on Body Composition and Resting Energy Expenditure in Patients 2-7 Years PostRoux-en-Y Gastric Bypass: a Controlled Clinical Trial. Obes Surg 2021; 31:1635-1646. [PMID: 33409971 DOI: 10.1007/s11695-020-05172-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Resistance training (RT) and adequate protein intake are recommended as strategies to preserve fat-free mass (FFM) and resting metabolic demand after bariatric surgery. However, the effect of both interventions combined in the late postoperative period is unclear. This study investigated the effects of RT, isolated and combined with protein supplementation, on body composition and resting energy expenditure (REE) in the late postoperative period of Roux-en-Y gastric bypass (RYGB). METHODS This controlled trial involved patients who were 2-7 years postRYGB. Participants were partially matched on body mass index (BMI), age, sex, and years after surgery, and divided into four groups, placebo maltodextrin (control [CON]; n = 17), whey protein supplementation (PRO; n = 18), RT combined with placebo (RTP; n = 13), and RT combined with whey protein supplementation (RTP + PRO; n = 15)-considering the participants who completed the protocol. REE was measured by indirect calorimetry and body composition by multifrequency electrical bioimpedance. RESULTS Participant characteristics (40.3 ± 8.3 years old; average BMI 29.7 ± 5.3 kg/m2; 88.9% females) were similar among groups. The RTP+PRO group showed an increase of 1.46 ± 1.02 kg in FFM and 0.91 ± 0.64 kg in skeletal muscle mass (SMM), which was greater than the equivalent values in the CON group (- 0.24 ± 1.64 kg, p = 0.006 and - 0.08 ± 0.96 kg, p = 0.008, respectively). There was no significant time-by-group interaction for absolute or relative REE. CONCLUSION Combined RT and adequate protein intake via supplementation can increase FFM and SMM in the late postoperative period without changing REE. These associated strategies were effective in improving muscle-related parameters and potentially in improving the patients' physical function.
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Affiliation(s)
- Fernando Lamarca
- Graduate Program in Human Nutrition, University of Brasília, 70910-900, Asa Norte, Brasília, Federal District, Brazil.,Department of Applied Nutrition, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flávio Teixeira Vieira
- Graduate Program in Human Nutrition, University of Brasília, 70910-900, Asa Norte, Brasília, Federal District, Brazil
| | - Ricardo Moreno Lima
- Graduate Program in Physical Education, University of Brasília, Brasília, Brazil
| | | | - Teresa Helena Macedo da Costa
- Graduate Program in Human Nutrition, University of Brasília, 70910-900, Asa Norte, Brasília, Federal District, Brazil
| | - Nathalia Pizato
- Graduate Program in Human Nutrition, University of Brasília, 70910-900, Asa Norte, Brasília, Federal District, Brazil
| | - Eliane Said Dutra
- Graduate Program in Human Nutrition, University of Brasília, 70910-900, Asa Norte, Brasília, Federal District, Brazil
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21
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Haghighat N, Kazemi A, Asbaghi O, Jafarian F, Moeinvaziri N, Hosseini B, Amini M. Long-term effect of bariatric surgery on body composition in patients with morbid obesity: A systematic review and meta-analysis. Clin Nutr 2020; 40:1755-1766. [PMID: 33097305 DOI: 10.1016/j.clnu.2020.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 12/12/2022]
Abstract
We performed a meta-analysis to provide quantitative estimates of fat mass (FM) and fat-free mass (FFM) changes in patients following bariatric surgery over 1 year. A systematic search of PubMed, SCOPUS and Web of Science databases was conducted; the pooled weighted mean difference (WMD) and 95% confidence intervals (CI) were calculated using a random-effects model. Thirty-four studies including Roux en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) biliopancreatic diversion (BPD) and gastric banding (GB) were analyzed. RYGB decreased in body FM (-28.99 kg [31.21, -26.77]) or FM% (-12.73% [-15.14, -10.32]) or FFM (-9.97 kg [-10.93, -9.03]), which were greater than SG and GB. Moreover, the FFM% in RYGB group (11.72% [7.33, 16.11]) was more than SG (5.7% [4.44, 6.95]) and GB (8.1% [6.15, 10.05]) groups. Bariatric surgeries, especially RYGB, might be effective for a decrease in FM and maintenance of FFM in patients with morbid obesity in over 1 year.
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Affiliation(s)
- Neda Haghighat
- Laparascopy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Asma Kazemi
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Asbaghi
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fateme Jafarian
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nader Moeinvaziri
- Laparascopy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Hosseini
- Laparascopy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Amini
- Laparascopy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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22
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Changes in Physical Activity in Relation to Body Composition, Fitness and Quality of Life after Primary Bariatric Surgery: a Two-Year Follow-Up Study. Obes Surg 2020; 31:1120-1128. [PMID: 33331984 PMCID: PMC8249277 DOI: 10.1007/s11695-020-05009-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 12/11/2022]
Abstract
Purpose The success of bariatric surgery varies largely, which may relate to variance in adopting a physically active lifestyle. This study aimed to determine whether two-year changes in physical activity (PA) were associated with weight loss, fat-free mass, cardiorespiratory fitness and quality of life up to two years after bariatric surgery. Materials and Methods In this retrospective study, 3879 post-bariatric patients were divided into three groups: 1) decreased PA (n = 388), 2) maintained PA (n = 2002) or 3) increased PA (n = 1498). Measurements regarding PA (Baecke questionnaire), body composition (bioelectrical impedance analysis), estimated cardiorespiratory fitness (Åstrand test) and health-related quality of life (RAND-36) were performed preoperatively and two years post-surgery. Results Bariatric patients with increased PA had greater excess weight loss (76.3% vs. 73.2% vs. 72.9%, P < 0.001), greater increases in %fat-free mass (Δ14.0% vs. 13.0% vs. 12.8%; P < 0.001), larger improvements in VO2max (Δ11.8 vs. 10.2 vs. 8.0 ml/kg/min, P < 0.001), and larger increases in health related quality of life subscale scores (P < 0.05) compared to patients with maintained- and decreased PA. Conclusions Bariatric patients who managed to induce improvements in habitual physical activity had better body composition, fitness and quality of life at 2 years post-surgery, compared to patients who maintained or even reduced their PA levels. These findings underscore the importance of perioperative-bariatric care programs to change lifestyle and achieve sustainable improvements in PA levels. Electronic supplementary material The online version of this article (10.1007/s11695-020-05009-x) contains supplementary material, which is available to authorized users.
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23
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Bonn SE, Hult M, Spetz K, Löf M, Andersson E, Wiren M, Trolle Lagerros Y. App Technology to Support Physical Activity and Intake of Vitamins and Minerals After Bariatric Surgery (the PromMera Study): Protocol of a Randomized Controlled Clinical Trial. JMIR Res Protoc 2020; 9:e19624. [PMID: 32795990 PMCID: PMC7455871 DOI: 10.2196/19624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 01/24/2023] Open
Abstract
Background To optimize postoperative outcomes after bariatric surgery, lifestyle changes including increased physical activity are needed. Micronutrient deficiency after surgery is also common and daily supplementation is recommended. Objective The aim of the PromMera study is to evaluate the effects of a 12-week smartphone app intervention on promotion of physical activity (primary outcome) and adherence to postsurgery vitamin and mineral supplementation, as well as on other lifestyle factors and overall health in patients undergoing bariatric surgery. Methods The PromMera study is a two-arm, randomized controlled trial comprising patients undergoing bariatric surgery. Participants are randomized postsurgery 1:1 to either the intervention group (ie, use of the PromMera app for 12 weeks) or the control group receiving only standard care. Clinical and lifestyle variables are assessed pre- and postsurgery after 18 weeks (postintervention assessment), 6 months, 1 year, and 2 years. Assessments include body composition using Tanita or BOD POD analyzers, muscle function using handgrip, biomarkers in blood, and an extensive questionnaire on lifestyle factors. Physical activity is objectively measured using the ActiGraph wGT3X-BT triaxial accelerometer. Results A total of 154 participants have been enrolled in the study. The last study participant was recruited in May 2019. Data collection will be complete in May 2021. Conclusions Implementing lifestyle changes are crucial after bariatric surgery and new ways to reach patients and support such changes are needed. An app-based intervention is easily delivered at any time and can be a key factor in the adoption of healthier behavioral patterns in this rapidly growing group of patients. Trial Registration ClinicalTrials.gov NCT03480464; https://clinicaltrials.gov/ct2/show/NCT03480464 International Registered Report Identifier (IRRID) DERR1-10.2196/19624
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Affiliation(s)
- Stephanie Erika Bonn
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Mari Hult
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.,Division of Upper Abdominal Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Spetz
- Department of Surgery, Linköping University, Norrköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Ellen Andersson
- Department of Surgery, Linköping University, Norrköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden
| | - Mikael Wiren
- Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.,Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
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24
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Morales-Marroquin E, Kohl HW, Knell G, de la Cruz-Muñoz N, Messiah SE. Resistance Training in Post-Metabolic and Bariatric Surgery Patients: a Systematic Review. Obes Surg 2020; 30:4071-4080. [PMID: 32671727 DOI: 10.1007/s11695-020-04837-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 12/24/2022]
Abstract
Resistance exercise guidelines exist for obesity but not for post-metabolic and bariatric surgery (MBS) patients. Therefore, the main goal of the present study is to provide evidence to support resistance exercise guidelines for this population. A secondary goal is to evaluate the available evidence to identify gaps for future research. Nine studies evaluating the effect of resistance exercise post-MBS on strength and body composition were included. Resistance training consistently prevented strength loss and when performed by younger population (~ 35 years) also prevented lean mass loss. Combined exercise, but not strength training independently, was found to promote body fat mass loss. Resistance training should be added to post-MBS exercise programs. Sufficiently powered studies using higher volume resistance training with supportive protein consumption and diverse populations are needed.
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Affiliation(s)
- Elisa Morales-Marroquin
- School of Public Health, Department of Epidemiology, Human Genetics & Environmental Sciences, University of Texas Health Science Center at Houston, Dallas, TX, USA. .,Center for Pediatric Population Health, Children's Health System of Texas, and School of Public Health University of Texas Health, Dallas, TX, USA.
| | - Harold W Kohl
- School of Public Health, Department of Epidemiology, Human Genetics & Environmental Sciences, University of Texas Health Science Center at Houston, Dallas, TX, USA.,Department of Kinesiology, University of Texas, Austin, TX, USA
| | - Gregory Knell
- School of Public Health, Department of Epidemiology, Human Genetics & Environmental Sciences, University of Texas Health Science Center at Houston, Dallas, TX, USA.,Center for Pediatric Population Health, Children's Health System of Texas, and School of Public Health University of Texas Health, Dallas, TX, USA.,Institute for Orthopaedics and Sports Medicine, Children's Health Andrews, Plano, TX, USA
| | | | - Sarah E Messiah
- School of Public Health, Department of Epidemiology, Human Genetics & Environmental Sciences, University of Texas Health Science Center at Houston, Dallas, TX, USA.,Center for Pediatric Population Health, Children's Health System of Texas, and School of Public Health University of Texas Health, Dallas, TX, USA
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25
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Impact of a 12-Week Randomized Exercise Training Program on Lipid Profile in Severely Obese Patients Following Bariatric Surgery. Obes Surg 2020; 30:3030-3036. [DOI: 10.1007/s11695-020-04647-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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26
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Possmark S, Sellberg F, Willmer M, Tynelius P, Persson M, Berglind D. Accelerometer-measured versus self-reported physical activity levels in women before and up to 48 months after Roux-en-Y Gastric Bypass. BMC Surg 2020; 20:39. [PMID: 32103734 PMCID: PMC7045736 DOI: 10.1186/s12893-020-00699-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 02/14/2020] [Indexed: 01/07/2023] Open
Abstract
Background Roux-en-Y Gastric Bypass (RYGB) patients overestimate their time spent in moderate-to-vigorous physical activity (MVPA) to a greater extent post-surgery than pre-surgery. However, there is no data on discrepancy between self-reported and accelerometer-measured MVPA beyond nine months post-RYGB. The aim was to investigate how the duration of MVPA (main outcome) differs when comparing a self-administered questionnaire to accelerometer-data from pre-surgery and up to 48 months post-RYGB. Methods Twenty-six (38%) RYGB-treated women with complete data from the original cohort (N = 69) were included. Participants were recruited from five Swedish hospitals. Mean pre-surgery BMI was 38.9 (standard deviation (SD) = 3.4) kg/m2 and mean age 39.9 (SD = 6.5) years. MVPA was subjectively measured by a self-administered questionnaire and objectively measured by the ActiGraph GT3X+ accelerometer at 3 months pre-RYGB and 9- and 48 months post-RYGB. Means and SD were calculated at 3 months pre- and 9- and 48 months post-RYGB. We calculated the P-values of the differences with Wilcoxon Signed-Rank test. For correlations between the self-administered questionnaire and the accelerometers, Spearman’s rank correlation was used. Results Participants significantly overestimated (i.e. self-reported more time spent in MVPA compared to accelerometry) their MVPA in a higher degree post- compared to pre-RYGB surgery. Compared to pre-surgery, self-reported MVPA increased with 46.9 and 36.5% from pre- to 9- and 48 months, respectively, whereas changes were a 6.1% increase and 3.5% decrease with accelerometers. Correlations between self-reported and accelerometer-measured MVPA-assessments were poor at all measurement points (r = 0.21–0.42) and only significant at 48 months post-RYGB (P = 0.032). Conclusions The discrepancy between self-reported and objectively assessed MVPA within the same individual is greater up to 48 months post-RYGB compared to before surgery. To help bariatric patients understand and hopefully increase their physical activity behaviors post-surgery, objective measures of physical activity should be used.
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Affiliation(s)
- Sofie Possmark
- Department of Global Public Health, Karolinska Institutet, K9, Social Medicine, 171 77, Stockholm, Sweden.
| | - Fanny Sellberg
- Department of Global Public Health, Karolinska Institutet, K9, Social Medicine, 171 77, Stockholm, Sweden
| | - Mikaela Willmer
- Department of Health and Caring Sciences, University of Gävle, 801 76, Gävle, Sweden
| | - Per Tynelius
- Department of Global Public Health, Karolinska Institutet, K9, Social Medicine, 171 77, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 45436, 104 31, Stockholm, Sweden
| | | | - Daniel Berglind
- Department of Global Public Health, Karolinska Institutet, K9, Social Medicine, 171 77, Stockholm, Sweden
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27
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Moore JM, Haemer MA, Fox CK. Lifestyle and pharmacologic management before and after bariatric surgery. Semin Pediatr Surg 2020; 29:150889. [PMID: 32238284 PMCID: PMC8456424 DOI: 10.1016/j.sempedsurg.2020.150889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
As metabolic and bariatric surgery (MBS) increasingly becomes a treatment of choice for adolescents with severe obesity, there is a need to understand how to deliver pre- and postoperative care in ways that maximize long-term safety and efficacy. This article describes major pre- and postoperative goals, lifestyle modification targets, and, when necessary, pharmacologic management strategies for adolescents undergoing MBS. Three categories of evidence were used-studies of pre- and postoperative interventions and factors influencing MBS outcomes in adolescents, studies of pre- and postoperative associations and interventions in adults, and studies of non-surgical weight management applicable to adolescents pursuing MBS. Finally, priority areas for future research within this topic are identified.
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Affiliation(s)
- Jaime M Moore
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States.
| | - Matthew A Haemer
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Claudia K Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, University of Minnesota Medical School, Minneapolis, MN 55455, United States
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28
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Atlantis E, Langford K, Piya M, Ho V, Skelsey K, Rickards L, Edwards S, Kormas N. Physical capacity outcomes in patients with severe obesity after 12 months of physician-led multidisciplinary team care: A case series from a public hospital clinical obesity service. Clin Obes 2019; 9:e12337. [PMID: 31475476 DOI: 10.1111/cob.12337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/20/2019] [Accepted: 08/14/2019] [Indexed: 01/21/2023]
Abstract
Impaired physical capacity is common in people with severe levels of obesity. We aimed to investigate changes in physical capacity outcomes in patients with severe obesity following 12 months of physician-led multidisciplinary care from a "real world" Australian public hospital setting using a case series study design. We extracted data from medical records for all of the eligible patients referred to our clinical obesity service from 2010 to 2015 (69 of 239). We found significant (P < .05) pre-test/post-test (mean ± SD) improvements in the 6-minute walk test (6MWT) (339 ± 120 to 417 ± 112 m); 30-second sit-to-stand test (11 ± 4 to 15 ± 6 counts) and sit-and-reach test (-12 ± 13 to -8 ± 15 cm). Using linear mixed-effects models adjusting for repeated measurements over time (baseline vs 12 months) and testing for potential predictors, we found: mean 6MWT was associated with 12-month time period (56 m), body mass index (BMI, -3 m), no walking aid over 12 months (106 m) and no opioid analgesics (75 m); mean sit-to-stand was associated with 12-month time period (3 counts), age at referral (-0.2 counts), BMI (-0.2 counts), and diabetes (3 counts); and mean sit-and-reach was associated with 12-month time period (5 cm), female gender (5 cm) and total medications (-0.9 cm). Using causal mediation analysis, our results show that total exercise classes partially mediates change in walking capacity among those with cardiovascular disease. Our study shows that significant and clinically important improvements in physical capacity outcomes in patients with severe obesity can be achieved following 12 months of intensive specialist obesity services, such as ours.
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Affiliation(s)
- Evan Atlantis
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
- School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kiri Langford
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Milan Piya
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Vincent Ho
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Kathryn Skelsey
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Lachlan Rickards
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
| | - Suzanne Edwards
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nic Kormas
- Campbelltown and Camden Hospitals, Campbelltown, New South Wales, Australia
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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29
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Lamarca F, Melendez-Araújo MS, Porto de Toledo I, Dutra ES, de Carvalho KMB. Relative Energy Expenditure Decreases during the First Year after Bariatric Surgery: A Systematic Review and Meta-Analysis. Obes Surg 2019; 29:2648-2659. [DOI: 10.1007/s11695-019-03934-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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