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Fernández-Alonso M, Bejarano G, Creel DB, Kohl HW, Messiah SE, Altieri MS, Papasavas P, Horn C, Marroquin E. Expert-based physical activity guidelines for metabolic and bariatric surgery patients: a systematic review of randomized controlled trials. Surg Obes Relat Dis 2025; 21:606-614. [PMID: 39709279 DOI: 10.1016/j.soard.2024.11.005] [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] [Received: 03/03/2024] [Revised: 09/24/2024] [Accepted: 11/02/2024] [Indexed: 12/23/2024]
Abstract
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.
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Affiliation(s)
- Melissa Fernández-Alonso
- Department of Nutritional Sciences, College of Science and Engineering, Texas Christian University, Fort Worth, Texas
| | - Geronimo Bejarano
- Department of Health Services, Policy & Practice, Brown University, Providence, Rhode Island
| | - David B Creel
- Department of Endocinology, Cleveland Clinic, Cleveland, Ohio
| | - Harold W Kohl
- School of Public Health and Department of Kinesiology and Health Education, University of Texas Health Science Center - Houston, Houston, Texas; Michael and Susan Dell Center for Healthy Living, Austin, Texas; Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas
| | - Sarah E Messiah
- Department of Epidemiology, Peter O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, Children's Health System of Texas, Dallas, TX, Center for Child and Adolescent Population Health, Peter O'Donnell School of Public Health, UT Southwestern Medical Center and Children's Health System of Texas, Dallas, TX
| | - Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pavlos Papasavas
- Department of Medical Sciences, Frank H. Netter MD School of Medicine, Hartford, Connecticut
| | - Carah Horn
- Nursing Department, Bayfront Health Weight Loss and Bariatric Surgery Institute, St. Petersburg, Florida
| | - Elisa Marroquin
- Department of Nutritional Sciences, College of Science and Engineering, Texas Christian University, Fort Worth, Texas.
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Niezgoda N, Chomiuk T, Mamcarz A, Śliż D. Physical Activity before and After Bariatric Surgery. Metab Syndr Relat Disord 2025; 23:1-12. [PMID: 39361501 DOI: 10.1089/met.2024.0174] [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: 10/05/2024] Open
Abstract
Lifestyle changes including reduced calorie intake and increased physical activity (PA) improve the prognosis associated with bariatric surgery (BS) and metabolic indices. Early implementation of exercise leads to improved physical performance, better glycemic control and lipid profile, reduces the risks associated with anesthesia, and accelerates recovery from surgery. Undertaking systematic exercise after BS is associated with a better quality of life, improves insulin sensitivity, results in additional weight loss, reduces adverse effects on bone mass, and results in better body composition. The aim of this review was to summarize recommendations for physical activity in patients undergoing BS and to highlight the key role of physical activity in this patient group.
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Affiliation(s)
- Natalia Niezgoda
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Tomasz Chomiuk
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Daniel Śliż
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Poland
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3
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Vosadi E, Hashemi Fard ES, Mirakhori Z, Borjian Fard M. The Impact of Exercise Training on Psychological Outcomes, Body Composition, and Quality of Life in Overweight or Obese Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Biol Res Nurs 2025:10998004241313332. [PMID: 39792027 DOI: 10.1177/10998004241313332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
Abstract
Background: Overweight and obesity are associated with adverse psychological outcomes, compromised body composition, and reduced quality of life (QoL). While exercise training has been proposed as an effective intervention, its impact on these outcomes remains unclear. Objective: This systematic review and meta-analysis evaluated the effects of exercise training on psychological outcomes, body composition, and QoL in overweight or obese adults. Methods: A systematic review and meta-analysis were performed through July 2024, utilizing multiple databases. Random-effects models were used to calculate standardized mean differences (SMDs) or mean differences (MDs), with corresponding 95% confidence intervals (CIs). Results: Thirty-one trials involving 2779 participants were included. Exercise training significantly improved mental health (SMD: 0.25, 95% CI: 0.11, 0.39, p = .0003), depression (SMD: -0.52, 95% CI: -0.86, -0.18, p = .003), mood (SMD: 7.55, 95% CI: 10.78, 4.31, p < .00001), waist circumference (MD: -2.77 cm, 95% CI: -4.60, -0.94, p = .003), and lean body mass (MD: 1.16 kg, 95% CI: 0.62, 1.69, p < .0001). Improvements were also observed in various QoL domains, including social functioning (p = .004), physical functioning (p < .00001), vitality (p = .003), general health (p = .001), and environmental quality (p < .00001). However, some psychological, body composition, and QoL variables did not show significant effects. Conclusion: Exercise training positively impacts psychological outcomes, body composition, and multiple QoL domains in overweight and obese adults. These findings highlight the importance of exercise in lifestyle interventions. Further research is needed to determine long-term and consistent effects.
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Affiliation(s)
- Elham Vosadi
- Department of Physical Education and Sport Sciences, Faculty of Physical Education, Shahrood University of Technology, Shahrood, Iran
| | - Elahe Sadat Hashemi Fard
- Department of Physical Education and Sport Sciences, Faculty of Physical Education, Shahrood University of Technology, Shahrood, Iran
| | - Zahra Mirakhori
- Department of Physical Education, Amirkabir University of Tehran, Tehran, Iran
| | - Mahboobeh Borjian Fard
- Department of Exercise Physiology, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran
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Maqueda-Martínez MDLÁ, Ferrer-Márquez M, García-Redondo M, Rubio-Gil F, Reina-Duarte Á, Granero-Molina J, Correa-Casado M, Chica-Pérez A. Effectiveness of a Nurse-Led Telecare Programme in the Postoperative Follow-Up of Bariatric Surgery Patients: A Quasi-Experimental Study. Healthcare (Basel) 2024; 12:2448. [PMID: 39685070 DOI: 10.3390/healthcare12232448] [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: 10/24/2024] [Revised: 12/03/2024] [Accepted: 12/04/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND/OBJECTIVES Obesity is a growing public health challenge due to its high prevalence and associated comorbidities. Bariatric surgery is the most effective treatment for achieving sustained weight reduction when more conservative treatments have failed. This study evaluates the impact of a nurse-led telecare follow-up programme in the immediate postoperative period for patients who have undergone bariatric surgery. METHODS A quasi-experimental study was carried out in two hospitals in southern Spain. We included 161 patients who met the inclusion criteria: a body mass index (BMI) ≥ 40 kg/m2 or a BMI ≥ 35 kg/m2 with associated comorbidities, and the failure of non-surgical treatments. Patients were divided into two groups: the intervention group (IG), which received follow-up telephone calls from a specialised nurse during the first 30 days post-surgery, and the control group (CG), which received standard care. The nurse, who was available 24 h a day, answered questions and dealt with queries over the phone or referred patients to the emergency department if necessary. Several variables were recorded, including the number of telephone consultations, reasons for consultation, number of emergency visits, readmissions, and surgical reinterventions. RESULTS AND CONCLUSIONS The IG showed a significant reduction in ED visits (4.9% vs. 30% in CG), and consultations were mainly related to diet and drainage. The nurse telecare intervention significantly improved postoperative recovery by reducing complications and optimising the safety and quality of postoperative care. These results reinforce the importance of personalised follow-up in improving clinical outcomes in bariatric patients.
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Affiliation(s)
| | - Manuel Ferrer-Márquez
- Bariatric Surgery Department, Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, 04009 Almería, Spain
| | - Manuel García-Redondo
- Bariatric Surgery Department, Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, 04009 Almería, Spain
| | - Francisco Rubio-Gil
- Bariatric Surgery Department, Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, 04009 Almería, Spain
| | - Ángel Reina-Duarte
- Bariatric Surgery Department, Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, 04009 Almería, Spain
| | - José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almería, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago 7500000, Chile
| | - Matías Correa-Casado
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almería, Spain
| | - Anabel Chica-Pérez
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almería, Spain
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Ghannadi S, Selk-Ghaffari M, Ejtahed HS, Khalaji K, Hoseini Tavassol Z, Pourgharib Shahi MH, Hasani-Ranjbar S. Evaluation of the Effect of the Pre-Operative Exercise Training on Weight Loss, Quality of Life, and Cardiopulmonary Parameter in Bariatric Metabolic Surgery: A Systematic Review and Meta-Analysis. Obes Surg 2024; 34:2670-2684. [PMID: 38856886 DOI: 10.1007/s11695-024-07333-y] [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] [Received: 11/06/2023] [Revised: 05/25/2024] [Accepted: 05/29/2024] [Indexed: 06/11/2024]
Abstract
The purpose of this study is to assess the impact of pre-surgery exercise training on cardiopulmonary fitness. Ten articles (six RCTs and four non-RCTs) involving 281 individuals were finally included in the synthesis. Regarding the effect on VO2 peak, overall standardized mean differences were 0.71 (95% CI, 0.31 to 1.11, n = 103) with heterogeneity (I2 = 0%, P = 0.49). For 6MWT, overall weighted mean differences (distance in meters) were 31.87 (95% CI, 27.84 to 35.89, n = 100) with heterogeneity (I2 = 0%, P = 0.96). Engaging in pre-bariatric metabolic surgery exercise training might improve anthropometric parameters and cardiopulmonary fitness with no significant changes in components of quality of life. However, considering high levels of heterogeneity, the results should be generalized cautiously.
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Affiliation(s)
- Shima Ghannadi
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Selk-Ghaffari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanieh-Sadat Ejtahed
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Khalaji
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Osteoporosis Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Hoseini Tavassol
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shirin Hasani-Ranjbar
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Stults-Kolehmainen MA, Bond DS, Richardson LA, Herring LY, Mulone B, Garber CE, Morton J, Ghiassi S, Duffy AJ, Balk E, Abolt CJ, Howard MC, Ash GI, Williamson S, Marcon ER, De Los Santos M, Bond S, Huehls J, Alowaish O, Heyman NB, Gualano B. Role of the exercise professional in metabolic and bariatric surgery. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.20.23288698. [PMID: 37645986 PMCID: PMC10462198 DOI: 10.1101/2023.04.20.23288698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Physical activity (PA) is important for the long-term health and weight management of patients who undergo metabolic and bariatric surgery (MBS). However, the roles of exercise professionals in MBS settings have not been systematically determined. Objectives To investigate: (1) who are the professionals implementing PA programming in MBS clinical settings; and (2) what patient-centric tasks do they perform? Setting Clinical and academic exercise settings worldwide. Methods This multimethod study included a scoping review of PA programs in MBS described in the research literature. Data about job tasks were extracted and provided to 10 experts to sort into categories. Cluster analysis was utilized to find the hierarchical structure of tasks. A Delphi process was used to agree on a final model. Results The majority of PA professionals were exercise physiologists in the USA and physiotherapists or other types of exercise professionals elsewhere. Forty-three tasks were identified, the most reported being: supervision of exercise, fitness testing, and exercise prescription. Seven higher-order categories were determined: (1) Exercise-related health assessment, (2) Body composition and physical fitness assessment, (3) Lifestyle physical activity and sedentary behavior assessment, (4) Education, instruction, and prescription, (5) Exercise monitoring, (6) Behavioral counseling and psychosocial support, and (7) Dietary support. The following statements were rated an average of 9.0, classifying them as "imperative": 1) "Pre- and post-operative PA/exercise guidelines for MBS patients are needed", 2) "MBS programs need to include PA/exercise as part of multidisciplinary care". Conclusions The expert group reached a consensus on 7 major classifications of job tasks for the exercise professional. It is important for governing medical associations across the world to formally recognize experienced exercise professionals as playing pivotal roles in continuing, multidisciplinary care for MBS patients. These findings also provide evidence-based information in the effort to solidify these positions within the greater context of healthcare.
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Affiliation(s)
- Matthew A. Stults-Kolehmainen
- Center for Weight Management, Division of Digestive Health, Yale New Haven Hospital, New Haven, CT, United States
- Department of Biobehavioral Sciences, Teachers College – Columbia University, New York, NY, United States
| | - Dale S. Bond
- Departments of Surgery and Research, Hartford Hospital/HealthCare, Hartford, CT, United States
| | | | - Louisa Y. Herring
- University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, England, United Kingdom
- NIHR Leicester Biomedical Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester, England, United Kingdom
| | - Bethany Mulone
- Center for Weight Management, Division of Digestive Health, Yale New Haven Hospital, New Haven, CT, United States
| | - Carol Ewing Garber
- Department of Biobehavioral Sciences, Teachers College – Columbia University, New York, NY, United States
| | - John Morton
- Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Saber Ghiassi
- Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Andrew J. Duffy
- Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Ethan Balk
- Center for Weight Management, Division of Digestive Health, Yale New Haven Hospital, New Haven, CT, United States
- Department of Nutrition and Food Studies, New York University, New York, NY, United States
| | - Charles J. Abolt
- Earth and Environmental Sciences Division, Los Alamos National Laboratory, Los Alamos, NM, United States
| | - Matt C. Howard
- Department of Marketing & Quantitative Methods, University of South Alabama, Mobile, AL, United States
| | - Garrett I. Ash
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT, United States
- Center for Pain, Research, Informatics, Medical Comorbidities and Education Center (PRIME), VA Connecticut Healthcare System, West Haven, CT, United States
| | - Susannah Williamson
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD, United States
- Army Educational Outreach Program, Rochester Institute of Technology, United States
| | - Emilian Rejane Marcon
- Department of Bariatric Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Melissa De Los Santos
- Department of Biobehavioral Sciences, Teachers College – Columbia University, New York, NY, United States
| | - Samantha Bond
- College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Janet Huehls
- UMass Memorial Weight Center, UMASS Memorial Medical Center, Worchester, MA, United States
| | - Osama Alowaish
- Department of Biobehavioral Sciences, Teachers College – Columbia University, New York, NY, United States
| | - Nina Brojan Heyman
- Department of Biobehavioral Sciences, Teachers College – Columbia University, New York, NY, United States
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group, School of Medicine, University of São Paulo, São Paulo, Brazil
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Tabesh MR, Eghtesadi M, Abolhasani M, Maleklou F, Ejtehadi F, Alizadeh Z. Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: An Updated Comprehensive Practical Guideline. Obes Surg 2023; 33:2557-2572. [PMID: 37389806 DOI: 10.1007/s11695-023-06703-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/18/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
Only in the USA, 315 billion dollars are spent annually on the medical cost of obesity in adult patients. Till now, bariatric surgery is the most effective method for treating obesity and can play an essential role in reducing the direct and indirect costs of obesity treatment. Nonetheless, there are few comprehensive guidelines which include nutrition, physical activity, and supplements, before and after surgery. The purpose of the present narrative review is to provide an updated and comprehensive practical guideline to help multidisciplinary teams. The core keywords include nutrition, diet, physical activity, exercise, supplements, macronutrients, micronutrients, weight reduction, bariatric surgery, Roux-en-Y Gastric Bypass, Sleeve Gastrostomy, Laparoscopic Adjustable Gastric Banding, and Biliopancreatic diversion with duodenal switch which were searched in databases including PubMed/Medline, Cochrane, and some other sources such as Google Scholar. We answered questions in five important areas: (a) nutritional strategies before bariatric surgery, (b) nutrition after bariatric surgery, (c) physical activity before and after bariatric surgery, (d) weight regain after bariatric surgery, and (e) micronutrient assessments and recommendations before and after bariatric surgery. Some new items were added in this updated guideline including "weight regain" and "pregnancy after bariatric surgery." Other fields were updated based on new evidence and guidelines.
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Affiliation(s)
| | - Maryam Eghtesadi
- Sports and Exercise Medicine Department, Tehran University of Medical Sciences, No. 7, Ale-ahmad Highway, Tehran, 14395-578, Iran
| | - Maryam Abolhasani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Maleklou
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ejtehadi
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Alizadeh
- Sports and Exercise Medicine Department, Tehran University of Medical Sciences, No. 7, Ale-ahmad Highway, Tehran, 14395-578, Iran.
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Pritchard MW, Lewis SR, Robinson A, Gibson SV, Chuter A, Copeland RJ, Lawson E, Smith AF. Effectiveness of the perioperative encounter in promoting regular exercise and physical activity: a systematic review and meta-analysis. EClinicalMedicine 2023; 57:101806. [PMID: 36816345 PMCID: PMC9929685 DOI: 10.1016/j.eclinm.2022.101806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 02/10/2023] Open
Abstract
Background Low levels of physical activity (PA) are associated with poorer health outcomes. The perioperative encounter (extending from initial contact in primary care to beyond discharge from hospital) is potentially a good time to intervene, but data regarding the effectiveness of interventions are scarce. To address this, we systematically reviewed existing literature to evaluate the effectiveness of interventions applied perioperatively to facilitate PA in the medium to long-term (at least six months after the intervention). Methods In this systematic review and meta-analysis, we searched Central Register of Controlled Trials (CENTRAL, Cochrane Library), MEDLINE, CINAHL, Embase, PsycInfo, and SPORTDiscus from database inception to October 22nd 2020, with an updated search done on August 4th 2022. We searched clinical trials registers, and conducted forward- and backward-citation searches. We included randomised controlled trials and quasi-randomised trials comparing PA interventions with usual care, or another PA intervention, in adults who were scheduled for, or had recently undergone, surgery. We included trials which reported our primary outcomes: amount of PA or whether participants were engaged in PA at least six months after the intervention. A random effects meta-analysis was used to pool data across studies as risk ratios (RR), or standardised mean differences (SMDs), which we interpreted using Cohen. We used the Cochrane risk of bias tool and used GRADE to assess the certainty of the evidence. This study is registered with PROSPERO, CRD42019139008. Findings We found 57 trials including 8548 adults and compared 71 interventions facilitating PA. Most interventions were started postoperatively and included multiple components. Compared with usual care, interventions may slightly increase the number of minutes of PA per day or week (SMD 0.17, 95% CI 0.09-0.26; 14 studies, 2172 participants; I2 = 0%), and people's engagement in PA at the study's end (RR 1.19, 95% CI 0.96-1.47; 9 studies, 882 participants; I2 = 25%); this was moderate-certainty evidence. Some studies compared two different types of interventions but it was often not feasible to combine data in analysis. The effect estimates generally indicated little difference between intervention designs and we judged all the evidence for these comparisons to be very low certainty. Thirty-six studies (63%) had low risk of selection bias for sequence generation, 27 studies (47%) had low risk of bias for allocation concealment, and 56 studies (98%) had a high risk of performance bias. For detection bias for PA outcomes, we judged 30 studies (53%) that used subjective measurement tools to have a high risk of detection bias. Interpretation Interventions delivered in the perioperative setting, aimed at enhancing PA in the medium to long-term, may have overall benefit. However, because of imprecision in some of the findings, we could not rule out the possibility of no change in PA. Funding National Institute for Health Research Health Services and Delivery Research programme (NIHR127879).
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Affiliation(s)
- Michael W. Pritchard
- Lancaster Patient Safety Research Unit, Royal Lancaster Infirmary, Lancaster, UK
| | - Sharon R. Lewis
- Bone and Joint Health, School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
| | - Amy Robinson
- Lancaster Patient Safety Research Unit, Royal Lancaster Infirmary, Lancaster, UK
| | | | | | - Robert J. Copeland
- The Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Euan Lawson
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Andrew F. Smith
- Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK
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9
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Cigrovski Berkovic M, Bilic-Curcic I, Mrzljak A, Canecki Varzic S, Cigrovski V. Prehabilitation of overweight and obese patients with dysglycemia awaiting bariatric surgery: Predicting the success of obesity treatment. World J Diabetes 2022; 13:1096-1105. [PMID: 36578866 PMCID: PMC9791574 DOI: 10.4239/wjd.v13.i12.1096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/09/2022] [Accepted: 11/02/2022] [Indexed: 12/15/2022] Open
Abstract
Bariatric surgery offers the best health results in overweight and obese patients but is not a risk and/or complication-free treatment. In cases with additional hyperglycemia, the burden of surgery can be even higher and alter both short-term and long-term outcomes. Although bariatric surgery offers glycemic improvements and in the case of early onset diabetes disease remission, weight loss results are lower than for obese patients without diabetes. Different multimodal programs, usually including interventions related to patients' performance, nutritional and psychological status as well as currently available pharmacotherapy before the surgery itself might considerably improve the immediate and late postoperative course. However, there are still no clear guidelines addressing the prehabilitation of obese patients with dysglycemia undergoing bariatric surgery and therefore no unique protocols to improve patients' health. In this minireview, we summarize the current knowledge on prehabilitation before bariatric surgery procedures in patients with obesity and dysglycemia.
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Affiliation(s)
- Maja Cigrovski Berkovic
- Department of Endocrinology, Diabetes and Clinical Pharmacology, Clinical Hospital Dubrava, Zagreb 10000, Croatia
- Faculty of Kinesiology, University of Zagreb, Zagreb 10000, Croatia
| | - Ines Bilic-Curcic
- Faculty of Medicine University of Osijek, Osijek 31000, Croatia
- Department of Endocrinology and Diabetes, Clinical Hospital Centre Osijek, Osijek 31000, Croatia
| | - Anna Mrzljak
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Silvija Canecki Varzic
- Faculty of Medicine University of Osijek, Osijek 31000, Croatia
- Department of Endocrinology and Diabetes, Clinical Hospital Centre Osijek, Osijek 31000, Croatia
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10
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Herrera-Santelices A, Argüello-Florencio G, Westphal G, Nardo Junior N, Zamunér AR. Effects of Supervised Physical Exercise as Prehabilitation on Body Composition, Functional Capacity and Quality of Life in Bariatric Surgery Candidates: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11175091. [PMID: 36079027 PMCID: PMC9457213 DOI: 10.3390/jcm11175091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/19/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Prehabilitation is a strategy used aiming to reduce the risk factors and complications of surgery procedures, but there is no consensus on the effectiveness of supervised physical exercise and its optimal prescription during this phase. Objectives: To determine the effects of exercise prehabilitation on body composition, functional capacity and quality of life in candidates for bariatric surgery. Search methods: A search was conducted in PubMed, Web of Science, SciELO, Scopus, MEDLINE and CINAHL. Selection criteria: Only randomized clinical trials that examined the effectiveness of supervised physical exercise were included. The main outcomes were body composition, functional capacity, quality of life and surgical outcomes. Data collection and analysis: Two researchers independently selected the literature, extracted the data and evaluated the risk of bias. A third researcher was consulted when a consensus was not reached. The risk of bias was assessed by the tool recommended by the Cochrane Collaboration, the quality of the evidence by GRADE, and to analyze the effects of prehabilitation on the primary objectives, RevMan software, version 5.3 was used. Main results: The search resulted in 4550 articles, of which 22 met the eligibility criteria, leaving 5 articles selected for this review. One article was assessed as a high bias risk and four as an uncertain risk, which included 139 candidates for bariatric surgery. Most of the studies evaluated the body composition, functional capacity and quality of life; none reported surgical outcomes. Conclusions: Supervised physical exercise has positive effects on the body composition, functional capacity and quality of life; there was no evidence for surgical outcomes, which opens up a field of study for future research of this population.
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Affiliation(s)
- Andrea Herrera-Santelices
- Facultad de Ciencias de la Salud, Universidad Católica de Maule, Talca 3480112, Chile
- Servicio de Medicina Física y Rehabilitación, Hospital San Juan de Dios, Curicó 3343005, Chile
| | - Graciela Argüello-Florencio
- Department of Health Sciences, Nutrition and Dietetics Career, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Greice Westphal
- Multidisciplinary Center of Obesity Studies, Department of Physical Education, Sate University of Maringa, Maringá 87020-900, Brazil
| | - Nelson Nardo Junior
- Multidisciplinary Center of Obesity Studies, Department of Physical Education, Sate University of Maringa, Maringá 87020-900, Brazil
| | - Antonio Roberto Zamunér
- Laboratory of Clinical Research in Kinesiology, Department of Kinesiology, Universidad Católica del Maule, Talca 3480112, Chile
- Correspondence: ; Tel.: +56-71-2203100
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11
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Tokgoz G, Arman N. Effects of Exercise in Subjects with Morbid Obesity Awaiting Bariatric Surgery: A Systematic Review. Bariatr Surg Pract Patient Care 2022. [DOI: 10.1089/bari.2022.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gulfidan Tokgoz
- Department of Physiotherapy and Rehabilitation, Institute of Graduates Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nilay Arman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
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12
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Tokgoz G, Arman N, Seyit H, Karabulut M. Effects of pre-surgical aerobic dance-based exercise on lower extremity in people with morbid obesity awaiting bariatric surgery: Randomized controlled study. Clin Obes 2022; 12:e12529. [PMID: 35611581 DOI: 10.1111/cob.12529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/23/2022] [Accepted: 05/01/2022] [Indexed: 11/29/2022]
Abstract
To investigate what are the effects of pre-surgical aerobic dance-based exercise programme (PSADBE) and physical activity counselling (PAC) programme on lower extremity functions after surgery in people with morbid obesity awaiting bariatric surgery (PMOABS). This study was a single-blind, randomized controlled study. Groups were divided into Group I (PSADBE and PAC) and Group II (PAC). Both groups received PAC, Group I completed the PSADBE programme accompanied by music for 60 min/2 days/8 weeks. Thirty-four PMOABS were included in the study. The 6-Minute Walking Test, as primary outcomes, and The Stair Climbing Up-Down Test for evaluating functional capacity, Biodex Isokinetic Test and Exercise System® for evaluating muscle strength were used. Besides, muscle endurance, physical activity (PA) level, fatigue and quality of life (QoL) were also assessed. All measurements were repeated three times; pre-treatment, post-treatment and the fifth-month post-surgery. After 8 weeks, significant changes were found in functional capacity, muscle strength and endurance, PA level, fatigue and QoL in both groups (p < .05). Comparing the groups, the changes in functional capacity, muscle strength and endurance, PA and fatigue scores after treatment and the fifth-month post-surgery were statistically superior in Group I (p < .05). Adding an 8-week PSADBE programme to PAC is an effective treatment option for improving postoperative functional capacity, muscle strength and endurance, PA level and fatigue in PMOABS.
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Affiliation(s)
- Gulfidan Tokgoz
- Department of Physiotherapy and Rehabilitation, Institute of Graduates Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nilay Arman
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hakan Seyit
- Faculty of Medicine, Department of General Surgery, Bakirkoy Dr. Sadi Konuk Health Practice & Research Center, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Karabulut
- Faculty of Medicine, Department of General Surgery, Bakirkoy Dr. Sadi Konuk Health Practice & Research Center, University of Health Sciences, Istanbul, Turkey
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13
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Jabbour G, Ibrahim R, Bragazzi N. Preoperative Physical Activity Level and Exercise Prescription in Adults With Obesity: The Effect on Post-Bariatric Surgery Outcomes. Front Physiol 2022; 13:869998. [PMID: 35874538 PMCID: PMC9301048 DOI: 10.3389/fphys.2022.869998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/16/2022] [Indexed: 01/06/2023] Open
Abstract
This systematic review summarizes current evidence on the relation between preoperative physical activity (PA) levels with bariatric surgery (BS) outcomes and on the beneficial role of preoperative exercise/PA program among BS candidates. This systematic review suggests that candidate patients accumulating the preoperative PA level improved several BS outcomes. These improvements were reported mainly for anthropometric and cardiometabolic parameters and physical function. Observed improvements manifested during a distinct period of time in response to a wide variety of exercise programs. Evidence on the preoperative PA level as well as on preoperative exercise implementation on BS outcomes is advocated despite the small number of participants and lack of control. Thus, further studies are required to explore the most effective and suitable form of exercise prescription prior to BS while considering physical and psychological limitations of obese patients.
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Affiliation(s)
- Georges Jabbour
- Physical Education Department, College of Education, Qatar University, Doha, Qatar
- *Correspondence: Georges Jabbour, ,
| | - Rony Ibrahim
- Physical Education Department, College of Education, Qatar University, Doha, Qatar
| | - Nicola Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
- Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Genoa, Italy
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14
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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: 0.7] [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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Smith NA, Martin G, Marginson B. Preoperative assessment and prehabilitation in patients with obesity undergoing non-bariatric surgery: A systematic review. J Clin Anesth 2022; 78:110676. [DOI: 10.1016/j.jclinane.2022.110676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/08/2022] [Accepted: 01/31/2022] [Indexed: 11/17/2022]
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Lodewijks Y, van der Ven R, Nienhuijs S. A broad focus on additional programmes prior to bariatric surgery: A systematic review. Clin Obes 2022; 12:e12518. [PMID: 35289099 DOI: 10.1111/cob.12518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/14/2022] [Accepted: 02/26/2022] [Indexed: 12/15/2022]
Abstract
Additional preoperative programmes may be beneficial for candidates who seek bariatric surgery, but there is no consensus on the optimal preparation. This systematic review aimed to summarize the effects of a preoperative programme on weight loss. A literature search was performed for Embase, Cinahl, PubMed and Cochrane Library. Studies on preoperative exercise, behaviour and/or diet programmes administered in adult patients in a bariatric trajectory measuring weight loss were included. Initial results yielded 2148 titles, 70 of which were thoroughly analysed and 37 articles were included, comprising 10 333 patients. Eleven out of 37 studies included postoperative weight loss as an outcome in interventions focused on diet (n = 5), behaviour (n = 2), exercise (n = 2) and a combination of interventions (n = 2). Only one study (9%) which administered exercise as a preoperative programme showed a significant effect on postoperative weight loss. In total, 33 studies included preoperative weight loss as an outcome, which was significant in 64% of the cases. It is difficult to draw conclusions from the investigated data as it was extremely heterogeneous concerning the intensity, duration and administration of a programme. Nevertheless, it seems that a preoperative weight loss programme seems beneficial in terms of preoperative weight loss, postoperative physical activity and improved mental health postinterventional. The use of a core outcome set is recommended for future studies.
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Affiliation(s)
- Yentl Lodewijks
- Department of Obesity Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Roos van der Ven
- Department of Obesity Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Simon Nienhuijs
- Department of Obesity Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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17
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Baillot A, St-Pierre M, Lapointe J, Bernard P, Bond D, Romain AJ, Garneau PY, Biertho L, Tchernof A, Blackburn P, Langlois MF, Brunet J. Acceptability and feasibility of the TELEhealth BARIatric behavioural intervention to increase physical ACTIVity (TELE-BariACTIV): A single-case experimental study protocol (Preprint). JMIR Res Protoc 2022; 11:e39633. [PMID: 36173668 PMCID: PMC9562082 DOI: 10.2196/39633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background Regular physical activity (PA) is recommended to optimize weight and health outcomes in patients who have undergone metabolic and bariatric surgery (MBS). However, >70% of patients have low PA levels before MBS that persist after MBS. Although behavioral interventions delivered face-to-face have shown promise for increasing PA among patients who have undergone MBS, many may experience barriers, preventing enrollment into and adherence to such interventions. Delivering PA behavior change interventions via telehealth to patients who have undergone MBS may be an effective strategy to increase accessibility and reach, as well as adherence. Objective This paper reports the protocol for a study that aims to assess the feasibility and acceptability of the protocol or methods and the Telehealth Bariatric Behavioral Intervention (TELE-BariACTIV). The intervention is designed to increase moderate-to-vigorous intensity PA (MVPA) in patients awaiting bariatric surgery and is guided by a multitheory approach and a patient perspective. Another objective is to estimate the effect of the TELE-BariACTIV intervention on presurgical MVPA to determine the appropriate sample size for a multicenter trial. Methods This study is a multicenter trial using a repeated (ABAB’A) single-case experimental design. The A phases are observational phases without intervention (A1=pre-MBS phase; A2=length personalized according to the MBS date; A3=7 months post-MBS phase). The B phases are interventional phases with PA counseling (B1=6 weekly pre-MBS sessions; B2=3 monthly sessions starting 3 months after MBS). The target sample size is set to 12. Participants are inactive adults awaiting sleeve gastrectomy who have access to a computer with internet and an interface with a camera. The participants are randomly allocated to a 1- or 2-week baseline period (A1). Protocol and intervention feasibility and acceptability (primary outcomes) will be assessed by recording missing data, refusal, recruitment, retention, attendance, and attrition rates, as well as via web-based acceptability questionnaires and semistructured interviews. Data collected via accelerometry (7-14 days) on 8 occasions and via questionnaires on 10 occasions will be analyzed to estimate the effect of the intervention on MVPA. Generalization measures assessing the quality of life, anxiety and depressive symptoms, and theory-based constructs (ie, motivational regulations for PA, self-efficacy to overcome barriers to PA, basic psychological needs satisfaction and frustration, PA enjoyment, and social support for PA; secondary outcomes for a future large-scale trial) will be completed via web-based questionnaires on 6-10 occasions. The institutional review board provided ethics approval for the study in June 2021. Results Recruitment began in September 2021, and all the participants were enrolled (n=12). Data collection is expected to end in fall 2023, depending on the MBS date of the recruited participants. Conclusions The TELE-BariACTIV intervention has the potential for implementation across multiple settings owing to its collaborative construction that can be offered remotely. International Registered Report Identifier (IRRID) DERR1-10.2196/39633
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Affiliation(s)
- Aurélie Baillot
- Nursing Department, Université du Québec en Outaouais, Gatineau, QC, Canada
- Institut du savoir de l'hôpital Montfort-recherche, Ottawa, ON, Canada
- Centre de Recherche en Médecine Psychosociale, Centre Intégré de Santé et Services Sociaux de l'Outaouais, Gatineau, QC, Canada
| | - Maxime St-Pierre
- Basic Science Department, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | - Josyanne Lapointe
- Department of Physical Activity Sciences, Université du Québec à Montréal, Montréal, QC, Canada
- Montreal Mental Health University Institute Research Centre, Montreal, QC, Canada
| | - Paquito Bernard
- Department of Physical Activity Sciences, Université du Québec à Montréal, Montréal, QC, Canada
- Montreal Mental Health University Institute Research Centre, Montreal, QC, Canada
| | - Dale Bond
- Department of Surgery, Hartford Hospital/HealthCare, Hartford, CT, United States
| | - Ahmed Jérôme Romain
- Montreal Mental Health University Institute Research Centre, Montreal, QC, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Pierre Y Garneau
- Department of Surgery, Université de Montréal, Montréal, QC, Canada
| | - Laurent Biertho
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada
| | - André Tchernof
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada
| | - Patricia Blackburn
- Division of Kinesiology, Department of Health Sciences, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | - Marie-France Langlois
- CHUS Research Center and Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jennifer Brunet
- Institut du savoir de l'hôpital Montfort-recherche, Ottawa, ON, Canada
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
- Cancer Therapeutic Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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18
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Schurmans G, Caty G, Reychler G. Is the Peri-Bariatric Surgery Exercise Program Effective in Adults with Obesity: a Systematic Review. Obes Surg 2022; 32:512-535. [PMID: 34981321 DOI: 10.1007/s11695-021-05693-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/25/2021] [Accepted: 08/29/2021] [Indexed: 11/30/2022]
Abstract
The number of people with obesity continues to increase. Bariatric surgery is the most effective treatment for severe obesity. However, this surgery also has disadvantages, such as an increased risk of excessive loss of fat-free mass, lean body mass, and muscle mass compared to other weight loss interventions. PubMed and Cochrane Library database including articles in English, Dutch, French, and German were used. From the 3609 retrieved references, 20 articles were selected. Compared with the control group, physical exercise improved body mass index (5 of 13 articles), weight loss (7 of 17 articles), functional capacity (2 of 5 articles), muscle strength (1 of 1 article), fat-free mass (3 of 5 articles), cardiorespiratory endurance (4 of 6 articles), and quality of life (2 of 4 articles) in obese patients undergoing BS. Current data is suggestive of positive effects of exercise on body mass index, weight loss, functional capacity, muscle strength, fat-free mass, cardiorespiratory endurance, and quality of life in obese patients undergoing bariatric surgery. However, our conclusions are limited because of the heterogeneity of programs and short studies. Further research is needed to determine the most effective physical exercise program in peri-bariatric surgery.
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Affiliation(s)
- Gaëlle Schurmans
- Institut de Recherche Expérimentale et Clinique (IREC), Groupe de Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, 1200, Brussels, Belgium.
| | - Gilles Caty
- Service de Médecine Physique, Centre Hospitalier Wallonie Picarde (CHWAPI), Avenue Delmée 9, 7500, Tournai, Belgium
| | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Groupe de Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, 1200, Brussels, Belgium.,Service de Pneumologie, Cliniques Universitaires Saint-Luc, 1200, Brussels, Belgium.,Cliniques Universitaires Saint-Luc, Secteur de kinésithérapie, 1200, Brussels, Belgium
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19
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Durey BJ, Fritche D, Martin DS, Best LMJ. The Effect of Pre-operative Exercise Intervention on Patient Outcomes Following Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2022; 32:160-169. [PMID: 34671929 DOI: 10.1007/s11695-021-05743-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 09/26/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
This systematic review aimed to assess the effect of a pre-operative exercise intervention on short- and long-term health and clinical outcomes for adult patients undergoing bariatric surgery (BS). We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), SPORTDiscus and reference lists of relevant papers, through March 2021. Five randomised controlled trials were included (n = 199 patients). Modest increases in cardiorespiratory fitness (VO2max) were found at both pre-operative (0.73 mL kg-1 min-1, P ≤ 0.001) and maximum follow-up time points (0.98 mL kg-1 min-1, P ≤ 0.04). There was no significant effect of an exercise intervention on percentage total weight loss (%TWL). Pre-operative exercise can induce significant short- and long-term improvements in fitness in individuals with obesity. There is insufficient evidence to determine whether pre-operative training impacts other post-operative clinical outcomes.
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Affiliation(s)
- Belinda J Durey
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
- UCL Division of Surgery and Interventional Science, University College London, London, WC1E 6BT, UK.
| | - Dominic Fritche
- Medical School, University College London, London, WC1E 6BT, UK
| | - Daniel S Martin
- UCL Division of Surgery and Interventional Science, Royal Free Hospital, Pond St, London, NW3 2PS, UK
- Intensive Care Unit, University Hospitals Plymouth, Derriford Road, Plymouth, Devon, PL6 8DH, UK
- Peninsula Medical School, University of Plymouth, John Bull Building, Tamar Science Park, Plymouth, PL6 8BU, UK
| | - Lawrence M J Best
- Medical School, University College London, London, WC1E 6BT, UK
- Northern Care Alliance NHS Group, Mayo Building, Salford Royal, Stott Lane, Salford, M68HD, UK
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Sasaki A, Yokote K, Naitoh T, Fujikura J, Hayashi K, Hirota Y, Inagaki N, Ishigaki Y, Kasama K, Kikkawa E, Koyama H, Masuzaki H, Miyatsuka T, Nozaki T, Ogawa W, Ohta M, Okazumi S, Shimabukuro M, Shimomura I, Nishizawa H, Saiki A, Seki Y, Shojima N, Tsujino M, Ugi S, Watada H, Yamauchi T, Yamaguchi T, Ueki K, Kadowaki T, Tatsuno I. Metabolic surgery in treatment of obese Japanese patients with type 2 diabetes: a joint consensus statement from the Japanese Society for Treatment of Obesity, the Japan Diabetes Society, and the Japan Society for the Study of Obesity. Diabetol Int 2021; 13:1-30. [PMID: 34777929 PMCID: PMC8574153 DOI: 10.1007/s13340-021-00551-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Indexed: 12/20/2022]
Abstract
Bariatric surgery has been shown to have a variety of metabolically beneficial effects for patients with type 2 diabetes (T2D), and is now also called metabolic surgery. At the 2nd Diabetes Surgery Summit held in 2015 in London, the indication for bariatric and metabolic surgery was included in the “algorithm for patients with type T2D”. With this background, the Japanese Society for Treatment of Obesity (JSTO), the Japan Diabetes Society (JDS) and the Japan Society for the Study of Obesity (JASSO) have formed a joint committee to develop a consensus statement regarding bariatric and metabolic surgery for the treatment of Japanese patients with T2D. Eventually, the consensus statement was announced at the joint meeting of the 38th Annual Meeting of JSTO and the 41st Annual Meeting of JASSO convened in Toyama on March 21, 2021. In preparing the consensus statement, we used Japanese data as much as possible as scientific evidence to consider the indication criteria, and set two types of recommendation grades, “recommendation” and “consideration”, for items for which recommendations are possible. We hope that this statement will be helpful in providing evidence-based high-quality care through bariatric and metabolic surgery for the treatment of obese Japanese patients with T2D.
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Affiliation(s)
- Akira Sasaki
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695 Japan
| | - Koutaro Yokote
- Department of Endocrinology Hematology, and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junji Fujikura
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Karin Hayashi
- Department of Neuropsychiatry, Toho University Sakura Medical Center, Sakura, Chiba Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasushi Ishigaki
- Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University, Yahaba, Japan
| | - Kazunori Kasama
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Eri Kikkawa
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Hidenori Koyama
- Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo College of Medicine, Nishinomiya, Hyogo Japan
| | - Hiroaki Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Department of Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takeshi Miyatsuka
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takehiro Nozaki
- Clinical Trial Center, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masayuki Ohta
- Global Oita Medical Advanced Research Center for Health, Oita University, Oita, Japan
| | - Shinichi Okazumi
- Department of Surgery, Toho University Sakura Medical Center, Sakura, Chiba Japan
| | - Michio Shimabukuro
- Department of Diabetes, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hitoshi Nishizawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Atsuhito Saiki
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Yosuke Seki
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Nobuhiro Shojima
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Motoyoshi Tsujino
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Satoshi Ugi
- Division of Endocrinology and Metabolism, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Hiroaki Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Yamaguchi
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Koujiro Ueki
- Department of Molecular Diabetic Medicine, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Ichiro Tatsuno
- Chiba Prefectural University of Health Sciences, Chiba, Japan
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Gilbertson NM, Eichner NZM, Gaitán JM, Khurshid M, Rexrode EA, Kranz S, Hallowell PT, Malin SK. Effect of presurgical aerobic exercise on cardiometabolic health 30 days after bariatric surgery. Physiol Rep 2021; 9:e15039. [PMID: 34713979 PMCID: PMC8554771 DOI: 10.14814/phy2.15039] [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] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/24/2022] Open
Abstract
We evaluated the effect of preoperative standard medical care (SC) vs. unsupervised aerobic exercise combined with SC (EX + SC) on cardiometabolic health and quality of life (QoL) 30 days after bariatric surgery. Bariatric patients (n = 14, age: 42.3 ± 2.5 years, body mass index: 45.1 ± 2.5 kg/m2 ) were match-paired to presurgical SC (n = 7) or EX + SC (n = 7; walking 30 min/day, 5 day/week, 65-85% HRpeak ) for 30 days. Body composition, peak cardiorespiratory fitness (VO2 peak), QoL, inflammation (adiponectin, leptin, cytokeratin-18), and a 120 min mixed meal tolerance test was performed to assess aortic waveforms (augmentation index, AIx@75), insulin sensitivity, and glucose total area under the curve (tAUC) at the time of surgery (post-intervention) and 30 days post-surgery. EX + SC had significantly higher high molecular weight (HMW) adiponectin (p = 0.01) and ratio of HMW to total adiponectin (p = 0.04) than SC at 30 days post-surgery, although they significantly (p = 0.006; ES = 1.86) decreased total time spent in moderate to vigorous physical activity (MVPA). SC had a significantly greater increase in VO2 peak (p = 0.02; ES = 1.54) and decrease in 120 min AIx@75 (p = 0.02; ES = 1.78) than EX + SC during the post-surgical period. The increase in MVPA was associated with a reduction in cytokeratin-18 (r = -0.67, p = 0.02). Increased VO2 peak was associated with increased activity/mobility QoL domain (r = 0.52, p = 0.05) and decreased 120 min AIx@75 (r = -0.61, p = 0.03) from surgery to post-surgery. Preoperative EX + SC did not maintain more favorable cardiometabolic health 30 days post-operation in this pilot study. However, changes in MVPA appear important for QoL and should be considered in future work.
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Affiliation(s)
| | | | - Julian M. Gaitán
- Department of KinesiologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Mahnoor Khurshid
- Department of KinesiologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | | | - Sibylle Kranz
- Department of KinesiologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | | | - Steven K. Malin
- Department of Kinesiology and HealthRutgers UniversityNew BrunswickNew JerseyUSA
- Division of Endocrinology, Metabolism and NutritionRutgers UniversityNew BrunswickNew JerseyUSA
- New Jersey Institute for Food, Nutrition and HealthRutgers UniversityNew BrunswickNew JerseyUSA
- Institute of Translational Medicine and ScienceRutgers UniversityNew BrunswickNew JerseyUSA
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22
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Wagnild JM, Akowuah E, Maier RH, Hancock HC, Kasim A. Impact of prehabilitation on objectively measured physical activity levels in elective surgery patients: a systematic review. BMJ Open 2021; 11:e049202. [PMID: 34493516 PMCID: PMC8424868 DOI: 10.1136/bmjopen-2021-049202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To systematically review the impact of prehabilitation on objectively measured physical activity (PA) levels in elective surgery patients. DATA SOURCES Articles published in Web of Science Core Collections, PubMed, Embase (Ovid), CINAHL (EBSCOHost), PsycInfo (EBSCOHost) and CENTRAL through August 2020. STUDY SELECTION Studies that met the following criteria: (1) written in English, (2) quantitatively described the effect(s) of a PA intervention among elective surgery patients prior to surgery and (3) used and reported objective measures of PA in the study. DATA EXTRACTION AND SYNTHESIS Participant characteristics, intervention details, PA measurement, and clinical and health-related outcomes were extracted. Risk of bias was assessed following the revised Cochrane risk of bias tool. Meta-analysis was not possible due to heterogeneity, therefore narrative synthesis was used. RESULTS 6533 unique articles were identified in the search; 21 articles (based on 15 trials) were included in the review. There was little evidence to suggest that prehabilitation is associated with increases in objectively measured PA, but this may be due to insufficient statistical power as most (n=8) trials included in the review were small feasibility/pilot studies. Where studies tested associations between objectively measured PA during the intervention period and health-related outcomes, significant beneficial associations were reported. Limitations in the evidence base precluded any assessment via meta-regression of the association between objectively measured PA and clinical or health-related outcomes. CONCLUSIONS Additional large-scale studies are needed, with clear and consistent reporting of objective measures including accelerometry variables and outcome variables, to improve our understanding of the impact of changes in PA prior to surgery on surgical and health-related outcomes. PROSPERO REGISTRATION NUMBER CRD42019151475.
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Affiliation(s)
| | - Enoch Akowuah
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Rebecca H Maier
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Helen C Hancock
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
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23
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García-Delgado Y, López-Madrazo-Hernández MJ, Alvarado-Martel D, Miranda-Calderín G, Ugarte-Lopetegui A, González-Medina RA, Hernández-Lázaro A, Zamora G, Pérez-Martín N, Sánchez-Hernández RM, Ibarra-González A, Bengoa-Dolón M, Mendoza-Vega CT, Appelvik-González SM, Caballero-Díaz Y, Hernández-Hernández JR, Wägner AM. Prehabilitation for Bariatric Surgery: A Randomized, Controlled Trial Protocol and Pilot Study. Nutrients 2021; 13:2903. [PMID: 34578781 PMCID: PMC8465022 DOI: 10.3390/nu13092903] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/13/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022] Open
Abstract
Bariatric surgery is the most efficacious treatment for obesity, though it is not free from complications. Preoperative conditioning has proved beneficial in various clinical contexts, but the evidence is scarce on the role of prehabilitation in bariatric surgery. We describe the protocol and pilot study of a randomized (ratio 1:1), parallel, controlled trial assessing the effect of a physical conditioning and respiratory muscle training programme, added to a standard 8-week group intervention based on therapeutical education and cognitive-behavioural therapy, in patients awaiting bariatric surgery. The primary outcome is preoperative weight-loss. Secondary outcomes include associated comorbidity, eating behaviour, physical activity, quality of life, and short-term postoperative complications. A pilot sample of 15 participants has been randomized to the intervention or control groups and their baseline features and results are described. Only 5 patients completed the group programme and returned for assessment. Measures to improve adherence will be implemented and once the COVID-19 pandemic allows, the clinical trial will start. This is the first randomized, clinical trial assessing the effect of physical and respiratory prehabilitation, added to standard group education and cognitive-behavioural intervention in obese patients on the waiting list for bariatric surgery. Clinical Trial Registration: NCT0404636.
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Affiliation(s)
- Yaiza García-Delgado
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (M.J.L.-M.-H.); (N.P.-M.); (R.M.S.-H.); (A.I.-G.)
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35001 Las Palmas, Spain; (D.A.-M.); (G.Z.)
| | - María José López-Madrazo-Hernández
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (M.J.L.-M.-H.); (N.P.-M.); (R.M.S.-H.); (A.I.-G.)
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35001 Las Palmas, Spain; (D.A.-M.); (G.Z.)
| | - Dácil Alvarado-Martel
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35001 Las Palmas, Spain; (D.A.-M.); (G.Z.)
| | - Guillermo Miranda-Calderín
- Department of Rehabilitation and Physical Medicine, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (G.M.-C.); (A.U.-L.); (C.T.M.-V.); (S.M.A.-G.)
| | - Arantza Ugarte-Lopetegui
- Department of Rehabilitation and Physical Medicine, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (G.M.-C.); (A.U.-L.); (C.T.M.-V.); (S.M.A.-G.)
| | - Raúl Alberto González-Medina
- Internal Medicine Nursing 8th North Wing, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain;
| | - Alba Hernández-Lázaro
- Department of Endocrinology and Nutrition, Hospital Universitario Dr. Negrín, 35010 Gran Canaria, Spain;
| | - Garlene Zamora
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35001 Las Palmas, Spain; (D.A.-M.); (G.Z.)
| | - Nuria Pérez-Martín
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (M.J.L.-M.-H.); (N.P.-M.); (R.M.S.-H.); (A.I.-G.)
| | - Rosa María Sánchez-Hernández
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (M.J.L.-M.-H.); (N.P.-M.); (R.M.S.-H.); (A.I.-G.)
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35001 Las Palmas, Spain; (D.A.-M.); (G.Z.)
| | - Adriana Ibarra-González
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (M.J.L.-M.-H.); (N.P.-M.); (R.M.S.-H.); (A.I.-G.)
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35001 Las Palmas, Spain; (D.A.-M.); (G.Z.)
| | - Mónica Bengoa-Dolón
- Department of Pneumology, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain;
| | - Carmen Teresa Mendoza-Vega
- Department of Rehabilitation and Physical Medicine, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (G.M.-C.); (A.U.-L.); (C.T.M.-V.); (S.M.A.-G.)
| | - Svein Mikael Appelvik-González
- Department of Rehabilitation and Physical Medicine, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (G.M.-C.); (A.U.-L.); (C.T.M.-V.); (S.M.A.-G.)
| | - Yurena Caballero-Díaz
- Department of General and Digestive Surgery, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (Y.C.-D.); (J.R.H.-H.)
| | - Juan Ramón Hernández-Hernández
- Department of General and Digestive Surgery, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (Y.C.-D.); (J.R.H.-H.)
| | - Ana María Wägner
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Gran Canaria, Spain; (M.J.L.-M.-H.); (N.P.-M.); (R.M.S.-H.); (A.I.-G.)
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35001 Las Palmas, Spain; (D.A.-M.); (G.Z.)
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24
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Kolen AM, Romeijn MM, Holthuijsen DDB, Janssen L, Greve JWM, Leclercq WKG, van Dielen FMH. Current preoperative strategies applied in the Dutch bariatric centers: A national survey. Clin Obes 2021; 11:e12461. [PMID: 34028197 PMCID: PMC8365720 DOI: 10.1111/cob.12461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/30/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022]
Abstract
There is no consensus about the optimal management of patients undergoing bariatric surgery. This study aimed to identify current weight loss goals prior to bariatric surgery, as well as aimed to explore preoperative strategies related to diet, nutritional supplements and physical activity. An online survey was distributed among bariatric surgeons and dietitians in all 18 Dutch bariatric centers. This survey included the following four domains: weight loss, diet, nutritional supplements and physical activity. For the analyses one answer per center was used, either the most common answer or the answer given by the most expert responder. All 18 centers reported at least one response. Preoperative weight loss was requested in 28% of the centers, whereas 61% desired a stable weight or weight loss, and 11% had no requests. A preoperative diet was routinely recommended in 78% of the centers and on indication (ie, depending on baseline weight and/or comorbidity status) in 22%. The most frequently prescribed diet was a low-energy diet (800-1500 kcal/day) in 44% of the centers. Nutritional supplements were recommended in 78% of the centers. Physical activity with low intensity was recommended in 83% of the centers, while physical exercise training with mid- to high-intensity was recommended in 72%. Inconsistent responses within centers were observed in 56% of the questions. The current bariatric practice within the Netherlands shows high variability and inconsistencies in preoperative management. Consensus-building and standardization of strategies should be promoted in the future.
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Affiliation(s)
- Aniek M. Kolen
- Department of SurgeryMáxima Medical CenterVeldhovenThe Netherlands
- Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Marleen M. Romeijn
- Department of SurgeryMáxima Medical CenterVeldhovenThe Netherlands
- Research School NUTRIM, Department of SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Daniëlle D. B. Holthuijsen
- Department of SurgeryMáxima Medical CenterVeldhovenThe Netherlands
- Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Loes Janssen
- Department of SurgeryMáxima Medical CenterVeldhovenThe Netherlands
| | - Jan Willem M. Greve
- Research School NUTRIM, Department of SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
- Department of SurgeryZuyderland Medical CenterHeerlenThe Netherlands
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25
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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: 44] [Impact Index Per Article: 11.0] [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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26
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Baillot A, Chenail S, Barros Polita N, Simoneau M, Libourel M, Nazon E, Riesco E, Bond DS, Romain AJ. Physical activity motives, barriers, and preferences in people with obesity: A systematic review. PLoS One 2021; 16:e0253114. [PMID: 34161372 PMCID: PMC8221526 DOI: 10.1371/journal.pone.0253114] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 05/30/2021] [Indexed: 12/28/2022] Open
Abstract
Background Although the benefits of physical activity (PA) are well known, physical inactivity is highly prevalent among people with obesity. The objective of this systematic review was to i) appraise knowledge on PA motives, barriers, and preferences in individuals with obesity, and ii) quantify the most frequently reported PA motives, barriers and preferences in this population. Methods Six databases (Pubmed, CINAHL, Psyarticle, SportDiscus, Web of science and Proquest) were searched by independent reviewers to identify relevant quantitative or qualitative articles reporting PA motives, barriers or preferences in adults with body mass index ≥ 30 kg/m2 (last searched in June 2020). Risk of bias for each study was assessed by two independent reviewers with the Mixed Methods Appraisal Tool (MMAT). Results From 5,899 papers identified, a total of 27 studies, 14 quantitative, 10 qualitative and 3 mixed studies were included. About 30% of studies have a MMAT score below 50% (k = 8). The three most reported PA motives in people with obesity were weight management, energy/physical fitness, and social support. The three most common PA barriers were lack of self-discipline/motivation, pain or physical discomfort, and lack of time. Based on the only 4 studies available, walking seems to be the preferred mode of PA in people with obesity. Conclusions Weight management, lack of motivation and pain are key PA motives and barriers in people with obesity, and should be addressed in future interventions to facilitate PA initiation and maintenance. Further research is needed to investigate the PA preferences of people with obesity.
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Affiliation(s)
- Aurélie Baillot
- Department of Nursing, University of Québec en Outaouais, Gatineau, QC, Canada
- Institut du savoir Montfort-Recherche, Ottawa, ON, Canada
- Centre de recherche du Centre Intégré de Santé et Services Sociaux de l’Outaouais, Gatineau, QC, Canada
- * E-mail:
| | | | - Naiara Barros Polita
- Department of Nursing, State University of Northern Paraná, Bandeirantes, PR, Brazil
| | - Mylène Simoneau
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Mathilde Libourel
- Faculty of Physical Activity Sciences, University of Sherbrooke and Research Center on Aging, CIUSSS de l’Estrie–CHUS, Sherbrooke, QC, Canada
- Institut des Sciences et Industries du vivant et de l’environnement, AgroParisTech, Paris, France
| | - Evy Nazon
- Department of Nursing, University of Québec en Outaouais, Gatineau, QC, Canada
| | - Eléonor Riesco
- Faculty of Physical Activity Sciences, University of Sherbrooke and Research Center on Aging, CIUSSS de l’Estrie–CHUS, Sherbrooke, QC, Canada
| | - Dale S. Bond
- Department of Psychiatry and Human Behavior, Weight Control and Diabetes Research Center, The Miriam Hospital/Brown Alpert Medical School, Providence, RI, United States of America
| | - Ahmed J. Romain
- Faculty of Medicine, School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
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27
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Sherf-Dagan S, Sinai T, Goldenshluger A, Globus I, Kessler Y, Schweiger C, Ben-Porat T. Nutritional Assessment and Preparation for Adult Bariatric Surgery Candidates: Clinical Practice. Adv Nutr 2021; 12:1020-1031. [PMID: 33040143 PMCID: PMC8262552 DOI: 10.1093/advances/nmaa121] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/25/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
Bariatric surgery (BS) has proven to be highly efficacious in the treatment of obesity and its comorbidities. However, careful patient selection is critical for its success. Thus, patients should undergo medical, behavioral, and nutritional assessment by a multidisciplinary team. From the nutritional point of view, BS candidates should undergo nutritional assessment, preparation, and education by a registered dietitian in the preoperative period. Currently, detailed specified and comprehensive information on these topics is lacking. The present narrative review aimed to summarize the available literature concerning both the preoperative nutritional assessment components and the preoperative nutritional preparation and education components of patients planning to undergo BS. Current literature indicates that proper management before BS should include a comprehensive nutritional assessment, in which it is advisable to perform a clinical interview to assess patients' medical background, weight management history, eating patterns and pathologies, oral health, physical activity habits, nutritional status, supplementation usage, BS knowledge, surgery expectations and anthropometric measurements. Nutritional preparation and educational strategies should include an individualized preoperative weight-loss nutrition program, improvement of glycemic control, micronutrients deficiencies correction, eating and lifestyle habits adaptation, physical activity initiation, and strengthening knowledge on obesity and BS. At this stage, more well-designed intervention and long-term cohort studies are needed in order to formulate uniform evidence-based nutritional guidelines for patients who plan to undergo BS, including populations at higher nutritional risk. Moreover, postoperative outcomes of presurgical nutritional intervention programs should be studied.
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Affiliation(s)
- Shiri Sherf-Dagan
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel
| | - Tali Sinai
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
- School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Ariela Goldenshluger
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, and Sylvan Adams Sports Institute, Tel-Aviv University, Tel Aviv, Israel
| | | | - Yafit Kessler
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - Chaya Schweiger
- Nutrition Service, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel
| | - Tair Ben-Porat
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Ein-Kerem Campus, Jerusalem, Israel
- Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel
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28
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Naran V, Namous N, Eddy VJ, Le Guen CL, Sarwer DB, Soans RS. The effects of the COVID-19 pandemic on patients with obesity undergoing bariatric care. Surg Obes Relat Dis 2021; 17:1714-1720. [PMID: 34187742 PMCID: PMC8154188 DOI: 10.1016/j.soard.2021.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 11/16/2022]
Abstract
Background Patients with obesity are at increased risk of developing severe COVID-19. The pandemic has caused delays in preoperative preparation, progression, and completion of bariatric surgeries. Objectives The aim of this study was to evaluate the impact of COVID-19 restrictions on bariatric surgery patients and assess their concern of COVID-19 as they continue the preoperative process. Setting Philadelphia, Pennsylvania Methods A questionnaire was administered to patients to assess the impact of COVID-19 on their weight loss goals, physical activity, and diet. Time points assessed were initial bariatric consultation (T1), as well as the beginning (T2), and the end (T3) of lockdown restrictions in the region. Results Seventy-four participants were invited and 50 completed the survey, for a response rate of 67.6%. The average age of participants was 44.1 years. Two-thirds of patients reported significant concern that COVID-19 would affect their weight loss goals. Patients reported significant improvements in their diet from T1 to T2 (P < .01). However, at T3, some patients returned to behaviors held at T1, with snacking behaviors significantly increasing between T2 and T3 (P < .01). Physical activity decreased in 60% of patients between T2 to T3. The vast majority (90%) wanted to have their surgery as soon as possible; 56% reported low levels of concern for COVID-19 infection. Conclusion Bariatric patients were highly motivated to proceed with bariatric surgery despite the risks imposed by the pandemic.
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Affiliation(s)
- Vineet Naran
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Nadia Namous
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Vikram J Eddy
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Claire L Le Guen
- Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - David B Sarwer
- College of Public Health, Temple University, Philadelphia, Pennsylvaia
| | - Rohit S Soans
- Department of Minimally Invasive and Bariatric Surgery, Temple University Hospital, Philadelphia, Pennsylvania.
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29
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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: 26] [Impact Index Per Article: 6.5] [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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30
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Arman N, Tokgoz G, Seyit H, Karabulut M. The effects of core stabilization exercise program in obese people awaiting bariatric surgery: A randomized controlled study. Complement Ther Clin Pract 2021; 43:101342. [PMID: 33684639 DOI: 10.1016/j.ctcp.2021.101342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was the effects of the core stabilization exercise program (CSEP) and physical activity counseling on functional capacity, physical fitness, physical activity, fatigue and quality of life (QoL) in obese people awaiting bariatric surgery. METHODS Twenty-one patients were divided into two groups: an exercise group (n = 10) and a control group (n = 11). Both groups received physical activity counseling, but the exercise group also performed an 8-week CSEP. Functional capacity, physical fitness, physical activity, fatigue and QoL were assessed at baseline and after 8 weeks. RESULTS After eight weeks, results showed significant improvements in all parameters except for body composition for the exercise group, comparing to the control group (effect size = 0.40-0.87, p < 0.05). CONCLUSIONS Implementing an 8-week adding CSEP to physical activity counseling provided significant improvements in functional capacity, physical fitness, physical activity, fatigue and QoL compared to physical activity counseling in obese people awaiting bariatric surgery.
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Affiliation(s)
- Nilay Arman
- Istanbul University-Cerrahpasa, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Gulfidan Tokgoz
- Istanbul University-Cerrahpasa, Institute of Graduates Studies, Physiotherapy and Rehabilitation Master's Program, Istanbul, Turkey
| | - Hakan Seyit
- University of Health Sciences, Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Health Practice & Research Center, Department of General Surgery, Istanbul, Turkey
| | - Mehmet Karabulut
- University of Health Sciences, Faculty of Medicine, Bakirkoy Dr. Sadi Konuk Health Practice & Research Center, Department of General Surgery, Istanbul, Turkey
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31
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Fagevik Olsén M, Wiklund M, Sandberg E, Lundqvist S, Dean E. Long-term effects of physical activity prescription after bariatric surgery: A randomized controlled trial. Physiother Theory Pract 2021; 38:1591-1601. [PMID: 33576284 DOI: 10.1080/09593985.2021.1885087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This study examined the effects of physical activity prescription (PAP) in patients after gastric bypass surgery. Patients' physical activity (PA) levels and outcomes were followed over their first postoperative year. METHODS Patients slated for bariatric surgery were randomized to a control group (n = 64) (basic information about postoperative PA) or an intervention group (n = 57) (also received physical therapist-prescribed PAP). Outcome measures were self-reported PA/exercise and sedentary time; and weight, waist circumference, blood pressure, and blood lipids; recorded pre-operatively and at 2, 6, and 12 months postoperatively. Follow-ups were conducted by nurses/dieticians. Trial registration: "Research and Development in Sweden" number 107371. RESULTS There were no differences between the groups except for higher level of PA (579 vs. 182 minutes/week) six months after surgery (p = .046) and a larger decrease in cholesterol (-24 vs. -8%) after a year (p = .017) in the intervention group. Patients in both groups lost considerable weight, had reduced waist circumference, and increased PA (p < .001). CONCLUSION Although marked differences between groups were not observed over one year, the intervention group increased its PA 6-months postoperatively, but not at other time points. Whether long-term outcomes of PAP use are more robust with physical therapist participation across follow-ups warrants study.
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Affiliation(s)
- Monika Fagevik Olsén
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Wiklund
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erica Sandberg
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Lundqvist
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centrum För Fysisk Aktivitet Göteborg, Gothenburg, Sweden
| | - Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Hodkinson A, Kontopantelis E, Adeniji C, van Marwijk H, McMillan B, Bower P, Panagioti M. Notice of Retraction. Hodkinson et al. Accelerometer- and Pedometer-Based Physical Activity Interventions Among Adults With Cardiometabolic Conditions: A Systematic Review and Meta-analysis. JAMA Netw Open. 2019;2(10):e1912895. JAMA Netw Open 2020; 3:e2032700. [PMID: 33337497 DOI: 10.1001/jamanetworkopen.2020.32700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alexander Hodkinson
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Evangelos Kontopantelis
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Charles Adeniji
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, United Kingdom
| | - Brian McMillan
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
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33
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Swierz MJ, Storman D, Jasinska KW, Storman M, Staskiewicz W, Gorecka M, Skuza A, Tobola P, Bala MM. Systematic review and meta-analysis of perioperative behavioral lifestyle and nutritional interventions in bariatric surgery: a call for better research and reporting. Surg Obes Relat Dis 2020; 16:2088-2104. [PMID: 33036943 DOI: 10.1016/j.soard.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/02/2020] [Accepted: 08/07/2020] [Indexed: 01/08/2023]
Abstract
Bariatric surgery is considered the most effective treatment for people with morbid obesity, and certain interventions could enhance its long-term results. We searched MEDLINE, Embase, Web of Science, CENTRAL, and trial registers up to January 1, 2020. Randomized controlled trials, where behavioral lifestyle or nutritional interventions were provided perioperatively were included. Primary outcome was weight change. Two reviewers independently performed each stage of the review. Altogether 6652 references were screened. 31 studies were included for qualitative synthesis and 22 studies for quantitative synthesis. Interventions varied greatly, thus limiting possibility of synthesizing all results. Six groups of interventions were discerned, and we used standardized mean differences for synthesis. Low to very-low certainty evidence suggests that physical activity, nonvitamin nutritional interventions, vitamins, psychotherapy, and counseling but not combined interventions might bring some benefit regarding short-term postsurgery follow-ups (up to 12 mo), but the estimates varied and results were not statistically significant, except for 12 months follow-ups regarding counseling. Psychotherapy and counseling, but not vitamins and combined interventions, may provide some benefit at longer follow-ups (over 12 mo), but the certainty of evidence was low to very-low and statistically significant results were observed in comparisons including data from single studies with small sample sizes only. Included studies expressed an outcome "weight change" using 20 different measures. Misreporting of data and huge variety of outcomes do not benefit systematic analyses and may possibly lead to confusion of both researchers and readers. We suggest that authors follow a predefined set of outcomes when reporting the results of their studies. The initiative to produce "core outcome set" for clinical trials in bariatric surgery trials is currently underway.
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Affiliation(s)
- Mateusz J Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna W Jasinska
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Monika Storman
- Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Staskiewicz
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Gorecka
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Skuza
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Paulina Tobola
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland.
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34
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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: 1.0] [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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35
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Marshall S, Mackay H, Matthews C, Maimone IR, Isenring E. Does intensive multidisciplinary intervention for adults who elect bariatric surgery improve post-operative weight loss, co-morbidities, and quality of life? A systematic review and meta-analysis. Obes Rev 2020; 21:e13012. [PMID: 32196906 DOI: 10.1111/obr.13012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/30/2020] [Accepted: 02/08/2020] [Indexed: 12/14/2022]
Abstract
This systematic review and meta-analysis of intervention studies aims to evaluate the effect of preoperative and/or post-operative support for adults who elect bariatric surgery delivered by a multidisciplinary team (MDT) on post-operative body composition, mental health, co-morbidities, quality of life, and side effects. Six electronic databases were searched. Revman and GRADE were used to assess confidence in pooled effects. Included interventions (N = 1533 participants in total) focused on lifestyle counselling (n = 4 studies), psychology (n = 4 studies), or exercise (n = 10 studies); comparator groups were less intensive usual care. Intensive MDT interventions increased post-operative weight loss (SMD: -0.94; 95% CI: -1.27 to -0.61) if delivered post-operatively. Preoperative and post-operative intensive interventions improved symptoms of depression and anxiety, quality of life, diastolic blood pressure, and resting heart rate but not lipids or glycaemic measures. Whilst usual MDT care is important preoperatively, this review conditionally recommends intensive MDT interventions for enhanced post-operative weight loss if delivered in the post-operative period, led by any health professional, based on moderate evidence. This review also conditionally recommends preoperative and/or post-operative lifestyle, nutrition, or psychology counselling and/or physical activity for improved mental and physical health. Further randomized controlled trials are required, which aim to specifically evaluate the best use of MDT resources.
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Affiliation(s)
- Skye Marshall
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,Nutrition & Dietetics, Mater Health Services, South Brisbane, Queensland, Australia
| | - Hannah Mackay
- Weightloss Solutions Australia, Gold Coast, Queensland, Australia
| | - Charlene Matthews
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | | | - Elizabeth Isenring
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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36
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Tabesh MR, Maleklou F, Ejtehadi F, Alizadeh Z. Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: a Practical Guideline. Obes Surg 2020; 29:3385-3400. [PMID: 31367987 DOI: 10.1007/s11695-019-04112-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
According to ASMBS, the rate of bariatric surgery increased from 158,000 in 2011 to 196,000 in 2015. Nevertheless, this growth in invasive techniques does not eliminate unhealthy habits, so lifestyle modification such as healthy nutrition and correct physical activity programs may improve surgical results. The objective of the present narrative review was to categorize the guidelines related to nutrition, physical activity, and supplement prescription before and after bariatric surgery. The main key words including nutrition, diet, physical activity, exercise, supplements, macronutrients, micronutrients, weight reduction, bariatric surgery, Roux-en-Y gastric bypass, sleeve gastrostomy, laparoscopic adjustable gastric banding, and biliopancreatic diversion with duodenal switch were searched in databases including PubMed/Medline, Cochrane, and some other sources such as Google scholar. The recommendations are classified based on the type of surgery. The indications for surgery and the type of bariatric surgery are not included in this review. This review helps medical teams, including bariatric surgeons, nutritionists, and sports medicine specialists, with proper management before and after bariatric surgery.
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Affiliation(s)
| | - Faezeh Maleklou
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ejtehadi
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Alizadeh
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, No. 7, Ale-ahmad Highway, Opposite of the Shariati Hospital, Tehran, 14395-578, Iran.
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37
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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: 0.2] [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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38
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Hodkinson A, Kontopantelis E, Adeniji C, van Marwijk H, McMillan B, Bower P, Panagioti M. Accelerometer- and Pedometer-Based Physical Activity Interventions Among Adults With Cardiometabolic Conditions: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e1912895. [PMID: 31596494 PMCID: PMC6802237 DOI: 10.1001/jamanetworkopen.2019.12895] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/19/2019] [Indexed: 01/15/2023] Open
Abstract
Importance Accelerometers and pedometers are accessible technologies that could have a role in encouraging physical activity (PA) in line with current recommendations. However, there is no solid evidence of their association with PA in participants with 1 or more cardiometabolic conditions such as diabetes, prediabetes, obesity, and cardiovascular disease. Objectives To assess the association of accelerometer- and pedometer-based interventions with increased activity and other improved health outcomes in adults with cardiometabolic conditions and to examine characteristics of the studies that could influence the association of both interventions in improving PA. Data Sources Records from MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health, and PsycINFO were searched from inception until August 2018 with no language restriction. Study Selection Randomized clinical trials or cluster randomized clinical trials evaluating the use of wearable technology devices such as pedometers and accelerometers as motivating and monitoring tools for increasing PA were included. After removing duplicates, the searches retrieved 5762 references. Following abstract and title screening of 1439 references and full-text screening of 107 studies, 36 studies met inclusion criteria. Data Extraction and Synthesis Mean difference in PA was assessed by random-effects meta-analysis. Where the scale was different across studies, the standardized mean difference was used instead. Heterogeneity was quantified using the I2 statistic and explored using mixed-effects metaregression. This study was registered with PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures The primary outcome was objectively measured PA in the short to medium term (postintervention to 8 months' follow-up). Results Thirty-six randomized clinical trials (20 using accelerometers and 16 using pedometers) involving 5208 participants were eligible for review. Meta-analysis involving 32 of these trials (4856 participants) showed medium improvements in PA: accelerometers and pedometers combined vs comparator showed a small significant increase in PA overall (standardized mean difference, 0.39 [95% CI, 0.28-0.51]; I2 = 60% [95% CI, 41%-73%]) in studies of short to medium follow-up over a mean (SD) of 32 (28.6) weeks. Multivariable metaregression showed improved association with PA for complex interventions that involved face-to-face consultation sessions with facilitators (β = 0.36; 95% CI, 0.17-0.55; P < .001) and pedometer-based interventions (β = 0.30; 95% CI, 0.08-0.52; P = .002). Conclusions and Relevance In this study, complex accelerometer- and pedometer-based interventions led to significant small to medium improvements in PA levels of people with cardiometabolic conditions. However, longer-term trials are needed to assess their performance over time. This study found no evidence that simple self-monitored interventions using either pedometers or accelerometers are associated with improvements in PA.
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Affiliation(s)
- Alexander Hodkinson
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Evangelos Kontopantelis
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Charles Adeniji
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, United Kingdom
| | - Brian McMillan
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
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Preoperative exercise as a predictor of weight loss in adolescents and young adults following sleeve gastrectomy: a cohort study. Surg Obes Relat Dis 2019; 15:1051-1057. [PMID: 31130404 DOI: 10.1016/j.soard.2019.03.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/12/2019] [Accepted: 03/17/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Preoperative exercise is associated with weight loss following bariatric surgery in adults, but this relationship in adolescents and young adults (AYA) is not well studied. OBJECTIVES The present study examined AYA-reported preoperative exercise and demographic factors and their prediction of percent excess body mass index (BMI) loss at 6 and 12 months following sleeve gastrectomy. SETTING The setting for recruitment and surgeries was in a children's hospital in the United States. METHODS Participants were 173 AYA aged 12-21 years (mean age, 16.5 [SD, 2.0] yr; mean preoperative BMI, 50 [SD, 8.5] kg/m2). Demographic characteristics including age, sex, ethnicity, and preoperative BMI were extracted from the medical record. Preoperatively, adolescents self-reported on exercise using 5 items from the Center for Disease Control's Youth Risk Behavior Surveillance Survey. The study evaluated the association of self-reported preoperative exercise in total and obtained a threshold of higher exercise to weight loss at 6 and 12 months after surgery. RESULTS More preoperative exercise was associated with greater weight loss at 12 months. Grouping participants by those who reported exercising at high levels (≥5 hr/wk) compared with those who reported <5 hr/wk, high levels of exercise predicted greater weight loss at 6 and marginally at 12 months postoperatively. Lower preoperative BMI was a significant predictor of weight loss in all analyses. CONCLUSIONS Preoperative exercise may predict and contribute to weight loss in AYA and could be a target for pre- and postoperative intervention to improve outcomes. The importance of lower preoperative BMI for maximizing postoperative weight loss was also supported.
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Effects of a Combined High-Intensity Interval Training and Resistance Training Program in Patients Awaiting Bariatric Surgery: A Pilot Study. Sports (Basel) 2019; 7:sports7030072. [PMID: 30934623 PMCID: PMC6473567 DOI: 10.3390/sports7030072] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 01/10/2023] Open
Abstract
Bariatric surgery (BS) is considered the most effective treatment for morbid obesity. Preoperative body weight is directly associated with a higher surgical morbimortality and physical activity could be effective in the preparation of patients. The aim of this study is to determine the effects of a six-month exercise training program (ETP), combining high-intensity interval training (HIIT) and resistance training in patients awaiting BS. Six candidates awaiting BS (38.78 ± 1.18 kg·m−2; 38.17 ± 12.06 years) were distributed into two groups: the ETP group (experimental group (EG), n = 3) and a control group (CG, n = 3). Anthropometrical and blood pressure (BP), cardiorespiratory fitness and maximal strength were registered before and after the ETP. The EG participated in 93.25% of the sessions, showing reductions in body mass index (BMI) compared to the CG (34.61 ± 1.56 vs. 39.75 ± 0.65, p = 0.006, ANOVA). The inferential analysis showed larger effects on BMI, excess body weight percentage and fat mass, in addition to small to moderate effects in BP and the anthropometric measurements. Peak oxygen uptake normalized to fat-free mass showed likely positive effects with a probability of >95–99%. A six-month ETP seems to be a positive tool to improve body composition, cardiometabolic health, and fitness level in patients awaiting BS, but a larger sample size is needed to confirm these findings.
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Coen PM, Carnero EA, Goodpaster BH. Exercise and Bariatric Surgery: An Effective Therapeutic Strategy. Exerc Sport Sci Rev 2018; 46:262-270. [PMID: 30052546 PMCID: PMC6147093 DOI: 10.1249/jes.0000000000000168] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Exercise is a clinically effective adjunct therapy with the potential to promote long-term weight loss maintenance for bariatric surgery patients. The long-term efficacy of bariatric surgery is not entirely clear, and weight regain and diabetes relapse are problems for some patients. Exercise is a feasible and clinically effective adjunct therapy for bariatric surgery patients. We hypothesize that exercise is also a critical factor for long-term weight loss maintenance and lasting remission of type 2 diabetes.
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Affiliation(s)
- Paul M Coen
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital.,Sanford Burnham Prebys Medical Discovery Institute at Lake Nona, Orlando, FL
| | - Elvis A Carnero
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital
| | - Bret H Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital.,Sanford Burnham Prebys Medical Discovery Institute at Lake Nona, Orlando, FL
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