The Role of Physical Activity in Optimizing Bariatric Surgery Outcomes

Abstract

Habitual physical activity (PA) is associated with numerous health benefits, is a major component of behavioral treatments for obesity, and is a key strategy for improving long-term weight loss maintenance. These findings, along with preliminary research in the field of bariatric surgery, suggest that habitual PA plays a significant role in improving weight loss and other outcomes of bariatric surgery. Recent studies employing objective assessment of PA indicate that most patients do not perform habitual PA preoperatively nor make significant positive changes in PA behaviors postoperatively. In addition, a recent study suggests that while many postoperative patients intend to perform PA on most days of the week, they rarely fulfill these intentions. Given the significant barriers to adoption and maintenance of habitual PA, preoperative and postoperative counseling should be provided, ideally within a multidisciplinary patient care approach. The five As (assess, advise, agree, assist, and arrange) provide a useful organizational framework for effective PA counseling. In the current absence of specific PA guidelines for bariatric surgery patients, patients should be encouraged to gradually progress to performing at least 30 min of aerobic exercise at a moderate intensity on at least 5 days of the week, consistent with PA guidelines for Americans. Greater amounts of PA may be needed to enhance weight loss and prevent significant weight regain. However, PA prescriptions should be individualized to address differences in health status, disease risk factors, physical capacity, personal goals, and exercise preferences.

Appendix: Online Resources

The National Physical Activity Plan by Centers for Disease Control and Prevention: http://www.cdc.gov/physicalactivity/index.html

• A comprehensive set of policies, programs, and initiatives aimed at increasing physical activity in all segments of the American population. There are sections aimed at health professionals as well as the general public, and specifically for older adults.

Physical Activity Guidelines for Americans by US Department of Health and Human Services: http://www.health.gov/paguidelines/

• In 2008, the federal government issued these evidence-based guidelines, described in detail and more briefly, along with material for individuals (i.e., “Be Active Your Way”).

Be Active Your Way: A Guide for Adults by US Department of Health and Human Services: http://www.health.gov/paguidelines/adultguide/activeguide.aspx

• Sections include: getting started, making physical activity part of your life, keeping it up, stepping it up, and being active for life, which includes a physical activity diary. In addition to the guide information is summarized in a shorter fact sheet.

Get Active by US Department of Health and Human Services: http://www.healthfinder.gov/prevention/ViewTopic.aspx?topicID=22&cnt=1&areaID=0

• This site offers a background section, “The Basics,” which provides educational information on physical activity and a “Take Action” section, which provides advice on how to be more active, tailored to individual’s current physical activity level.

Get Moving by American Heart Association: http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/Physical-Activity_UCM_001080_SubHomePage.jsp

• Physical activity and inactivity information and advice on how to start an exercise program.

The Health Care Providers Action Guide by Exercise is Medicine: http://exerciseismedicine.org/physicians.htm

• A thorough exercise guide for health-care providers that includes information on providing prescriptions and referrals and assessment tools that can be used with patients.

The Public Action Guide by Exercise is Medicine: http://exerciseismedicine.org/documents/PublicActionGuide_HR.pdf

• A thorough exercise guide for individuals that includes a pre-exercise health assessment, a barrier to exercise assessment, an exercise time finder, and other motivational tools.

Walking, A Step in the Right Direction, by the Weight-control Information Network: http://win.niddk.nih.gov/publications/walking.htm

• An online brochure that describes how to create and follow a walking plan. Sections include: walking for your health, know before you go, start walking now, walking safely, stretch it out, and step right this way.

Walking Guide by the American Heart Association: http://www.startwalkingnow.org/home.jsp

• This walking guide includes a quiz that can be used to get a personalized walking plan, an activity tracker, and information on walking clubs and walking paths throughout the country.

Walking Works by BlueCross BlueShield Association: http://www.bcbs.com/why-bcbs/walkingworks/

• This walking guide provides information on how to start a walking program and a walking log.

Tips for Increasing Physical Activity by US Department of Agriculture: http://www.choosemyplate.gov/physical-activity/increase-physical-activity.html

• Tips for increasing physical activity at home, at work, and at play. The Website www.choosemyplate.gov also has sections on physical activity, its importance, how much is needed, and how many calories are used.

Tips for Family Fitness Fun in Shape Up America by Health Weight for Life: http://www.shapeup.org/children/tips_index.html

• Provides several handouts in English and Spanish, on tips for being more active with your family. The Website www.shapeup.org also has health messages on the importance of maintaining a healthy weight and increasing physical activity.

Workout descriptions in Get Fit and Moving by American Council on Exercise: http://www.acefitness.org/getfit/default.aspx

• Descriptions of various types of workouts (high/thigh, core, total body, at home, lunch time) are provided. This site may be more helpful for postoperative patients who have some exercise experience.

Exercise While Traveling by American College of Sports Medicine: http://www.acsm.org/docs/current-comments/exercisewhiletraveling.pdf

• Ideas for how to stick with an exercise routine even when traveling.

Public Information from the American College of Sports Medicine: http://www.acsm.org/access-public-information/search-by-topic

• Provides publications, audiotapes, and videotapes on physical fitness and weight loss for health professionals and the general public.

When to see a physician before exercising by American College of Sports Medicine: http://www.acsm.org/docs/current-comments/whentoseeadoctortemp.pdf

• Describes a risk stratification scheme physicians can use to determine which patients need to undergo exercise testing before initiating a new exercise program.

Patient-Centered Assessment and Counseling for Exercise (PACE) program: http://rtips.cancer.gov/rtips/programDetails.do?programId=199774

• Information on PACE, an individually adapted health behavior change intervention to increase physical activity of patients, suitable for implementation in a physician’s office.

Energy Expenditure in Different Modes of Exercise by American College of Sports Medicine: http://www.acsm.org/docs/current-comments/energyexpendindifferentexmodes.pdf

• Describes energy expenditure from different modes of exercise as well as several other factors that should be considered when selecting an exercise mode.

Exercise for Persons with Cardiovascular Disease by American College of Sports Medicine: http://www.acsm.org/docs/current-comments/exercise-for-persons-with-cardiovascular-disease.pdf

• Describes how exercise in an integral component of a comprehensive approach to treating heart disease, while describing risks of exercise relevant to patients with cardiovascular disease, as well as compliance issues and behavioral strategies to help patients meet their exercise goals.

Resistance Training and Injury Prevention by American College of Sports Medicine: http://www.acsm.org/docs/current-comments/rtandip.pdf

• Describes the effect resistance training has on the bone, connective tissue, and muscle and advocates for patients to see an exercise physiologist or sports trainer to develop a safe and effective program.