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Post-surgery treatment

Benefits of post-bariatric Aqua Club

The biokinetic exercise class we offer post-bariatric patients at the Charing Cross Hospital Sports Club Swimming Pool has a few names. Carel LeRoux (Imperial NHS) calls it an exercise clinic in order to emphasize the clinical aspect.


I like to call it the Aqua Club, in order to emphasize the community and play up the unique benefits of the belonging to a club to a patient group who may previously have only perceived themselves as belonging to the “fat club”.


During the classes, George Marais (Biokineticist) focuses on increasing his patients' functionality. George has explained that functionality is achieved by focusing on six general movement patterns (squat, bend, lunge, twist, push and pull) and improving the biomotor abilities (strength, endurance, flexibility, balance and co-ordination) in these movement patterns. 


The water provides a safe environment for orthopaedic considerations and by exercising in the water patients can increase or decrease the intensity easily to suit their own levels of fitness. The exercise also challenges the aerobic and anaerobic energy.


From my perspective as group leader for BOSPA London (British Obesity Surgery Patient Association) and as a psychotherapist, patients who have had bariatric surgery are being given two very valuable tools to work with hope, and not being hungry. What the surgery does not offer is the slightest clue about how to achieve a change towards a healthier lifestyle.


Most obese patients have not been able to move much – sometimes for twenty years or more – because of their weight, knee problems, back problems, breathing difficulties, depression, shame, or hopelessness. They need to reconnect with their bodies and learn how they want to use them, safely.


These bodies have often been a source of pain and embarrasment and changing this allows patients to achieve the most difficult aspect of weight loss and healthy living, which is long-term maintenance – an important aspect to consider if one is to avoid the need for repeat surgery at more expense to the NHS further down the line.


If a healthy lifestyle could not be achieved prior to surgery, the Aqua Club is undoubtedly a first step towards acquiring the necessary physical mobility, stamina, motivation, confidence and self-esteem required to move towards more independent steps.


The super obese cannot be expected to go to public pools. They don’t.


I believe that the Aqua Club offers great benefit to patients at relatively little cost to the NHS.


The benefits to patients are:


• Patients are unlikely to cause themselves damage exercising in water so that the exercise clinic provides safety.


• The Aqua Club is relatively private at 8.30pm allowing patients the dignity of not being stared at or shamed in any way.


• George Marais is a sensitive teacher, he steps up the work and supports people as they progress towards increased functionality and mobility. We have one member who had to be practically carried into and helped out of the pool. She now manages mostly by herself.


• Patients gain increased stamina, muscle tone and energy. Over time, most are able and have the desire and motivation to move on to other forms of exercise. Two patients are having cycling lessons. One is having swimming lessons. Six have joined the walking club that I have started on Sunday afternoons. Three have started Zumba classes. Several have moved on to join gyms.


• Exposing themselves semi-naked – for the first time in twenty-five years in some cases – in the company of others who do not judge them, allows people to become more comfortable with their bodies and improves confidence and body image for both women and men. Some of our members are dating for the first time in a very long time.


• Depression and isolation are other possible aspects of the lives of the obese. The exercise clinic counters depression and offers social contact. A number of members have become good friends. 


• Playing in water is something most of us enjoyed as children. Patients remember the pleasure of enjoying exercise as well as the unusual experience of not feeling their heaviness in the water. Another added bonus of exercising in water is that patients do not get too hot whilst exercising, which can be a serious disincentive.


• Last, but not least, the Aqua Club is fun as we very often sing along to music. We are learning “Dancing Queen” at the moment! Much giggling goes on as we exercise.


I have been actively attending the Charing Cross/BOSPA Aqua Club since its inception in June 2010. I wanted to lead by example and inspire as well as observe. Patients really appreciate the class and look forward to coming. One told me, “I was apprehensive at first but it has become the highlight of my week”.


I believe Charing Cross Hospital is leading the way nationally and possibly internationally in offering this important aspect of post-bariatric care, that I hope in time will be taken up widely.


The impressive boost to the wellbeing of patients that this Exercise Clinic offers in so many ways acts as an essential “bridge” between the surgery and independent steps towards a healthy lifestyle.


I would like to think that an Exercise Clinic/ Aqua Club will become part of the aftercare of every bariatric patient. Speaking of independent steps, a few of us, all Aqua Club members, are walking a half marathon in May for breast cancer. This could not have happened without this Exercise Clinic.