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Post-op programmes

Benefits of post-op lifestyle intervention programme

%WL at 3–12-month period was significantly higher in the intervention group than the control group

Patients who undergo a lifestyle intervention programme following bariatric surgery have a greater percentage weight loss (%WL) outcomes were compared with a historical matched control group, as well as improved functional capacity, increased strenuous intensity exercise, increased consumption of fruits and vegetables, reduced consumption of ready meals, and improved “Change in Health” in quality of life (QoL) domain, according to a study by researchers from London, UK. The study, ‘Feasibility and Impact of a Combined Supervised Exercise and Nutritional-Behavioral Intervention following Bariatric Surgery: A Pilot Study.’, published in the Journal of Obesity calls for a large randomised control trial to further investigate such post-surgical programmes.

It has previously been shown that early (3–6-month) post-operative weight loss is the strongest predictor of maximal and two-year post-operative weight loss response. Therefore, the researchers from University College London, University College London Hospitals and The Hatter Institute, London, UK, state that by targeting patients with poor early weight loss following surgery with an early intensive postoperative lifestyle intervention and behavioural support could enhance weight loss outcomes. As a result, they established a pilot study to investigate the feasibility and impact of an eight week combined supervised exercise with nutritional-behavioural intervention following Roux-en-Y gastric bypass and sleeve gastrectomy.

Intervention programme

They devised a programme including a weekly session comprised of a 60-minute exercise training period followed by a 60-minute group discussion on lifestyle education and nutritional-behavioural change sessions. The exercise intensity varied according to individualised functional capacity and increased progressively every week according to the ease of performance and consisted of 15 minutes of warm-up and 30 minutes of workout period followed by 15 minutes of cool-down.

For exercise at home, patients were encouraged to undertake 30 minutes of moderate intensity exercise, combining cardiovascular and resistance training, 5 days a week. The lifestyle education and behaviour change component was divided into two phases, conducted by a physiotherapist, an exercise specialist, a dietitian, and a psychologist. The first four weeks focused on exercise education tackling exercise variety, barriers, and dealing with back and joint problems. The following four weeks focused on nutritional behaviour change, with emphasis on regular eating patterns, portion control, and balanced meals.

Patient’s functional capacity was measured using Six-Minute Walk Test (6MWT), conducted by an exercise specialist. The 6MWT is a self-paced, submaximal assessment of functional capacity used to prescribe appropriate exercise. A questionnaire regarding eating behaviour and food frequency was created and administered to patients and included a list of behaviours associated with better weight loss outcomes, such as regular eating, staged meal progression, eating slowly, not drinking during a meal, self-monitoring, and goal setting.

The post-intervention assessment was undertaken a month after completion of the program. This comprehensive assessment included review of patient’s current medical state, medications, and current physical activity. Body weight, blood pressure, and resting heart rate were recorded. They case-matched the surgical patients with a historical control group who were identified from their electronic database of bariatric surgical patients with 3 and 12-month post-surgery weight data.

Outcomes

Of the eight patients who completed the programme, six patients had undergone SG and two patients had undergone RYGB. The duration after surgery ranged from 3 to 6 months. The mean (±SD) age and BMI before intervention were 44 (±8) years and 38.5 (±7.2) kgm−2, respectively. Two patients had T2DM, two had a diagnosis of polycystic ovarian syndrome, three had treated hypertension, two had controlled asthma, one had fibromyalgia, and one had treated hypothyroidism. The mean (±SD) total %WL at recruitment was 12.9% (±5.4) and 19.6% (±8.5) at the post-intervention assessment. There were no significant differences in characteristics between intervention and the control group.

Two patients attended all the sessions and the other patients attended seven (1), six (1), five (2), four (1), and three sessions (1), respectively. There were significant changes in body weight, BMI, and total %WL observed at approximately 14 weeks after the baseline assessment (p<0.05). With regard to physical activity level (PAL) outcome, none of the patients reported performing any form of strenuous intensity activity prior to intervention. However, after the programme, the mean (±SD) time spent on strenuous activity was 44 (±49) minutes/week (p<0.05). No significant differences were reported for moderate physical activity. Overall, 37.5% of the patients reported that they had been able to fulfil the exercise recommendation for moderate and strenuous intensity per week, respectively, at the end of the programme.

A significant increased distance covered for the 6MWT was observed in all patients (n=5) who attended the post-intervention 6MWT assessment with mean (±SD) increment of +127 (±107) metres (p<0.05). Before the intervention, the baseline mean (±SD) of distance covered was 415 (±149) meters and this was significantly increased to 542 (±81) meters at the post-intervention assessment.

No significant differences were observed between the intervention and control group for %WL at 12 months’ follow-up or ΔBMI at 12 months after surgery. However, %WL at 3–12-month period was significantly higher in the intervention group than the control (12.2+7.5 vs. 5.1+5.4, p=0.027) (Figure 1) with p=0.05 for ΔBMI at 3–12-month period between the intervention and control group.

Figure 1: Comparison of %WL during 3–12-month post-surgery period for each patient with the averaged data from their two case-matched controls

“To our knowledge, this is the first study combining supervised exercise training with a nutritional-behavioural intervention given in a group setting for postoperative bariatric patients”, they write. “Our findings show that a combined supervised exercise with nutritional-behavioural intervention programme offered to post-bariatric patients as early as three months after surgery is feasible and acceptable.”

“Our data suggest that a lifestyle intervention programme that combined exercise training with nutritional-behavioural counselling given in group sessions is feasible and acceptable to post-bariatric surgery patients,” the authors conclude. “This programme significantly improved functional capacity, increased strenuous intensity exercise, increased consumption of fruits and vegetables, but reduced consumption of ready meals and improved “Change in Health” in the QoL domain. These short-term beneficial outcomes have contributed to a greater weight loss at 3–12 month post-surgery period compared to historical controls receiving standard care. A large randomised control study is now warranted to expand upon our findings.”

To access this paper, please click here

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