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Activity counselling

Physical activity counselling can improve outcomes

Counselling could increase the physical activity level patients by 50%
Guidelines on how to tailor counselling for patients
Dr Wendy King, co-author of the study

Receiving physical activity counselling before and after bariatric surgery could increase the physical activity level of bariatric surgery patients by about 50% and improve patient outcomes, according to a study published in the journal Exercise and Sports Sciences Review.

"Bariatric surgery is the most effective treatment for severe obesity," said Dr Wendy C King, epidemiologist at the University of Pittsburgh Graduate School of Public Health and lead author of the paper. "However, maintaining the resulting weight loss can be difficult. Providing physical activity counselling is an important way that clinicians can help their patients improve their health and experience long-term success."

To assist surgeons and clinicians, investigators from the Pitt and Warren Alpert Medical School of Brown University, have also provided guidelines on how to tailor counselling for patients so they can safely and effectively increase their physical activity, using proven counselling strategies.

She explained that on their own, bariatric surgery patients are not likely to significantly increase their physical activity following surgery. However, with assistance, motivated patients can increase their activity level to achieve better health than with surgery alone.

King and her co-author, Dr Dale S Bond, an assistant professor of psychiatry and human behaviour at the Warren Alpert Medical School of Brown University, used activity monitors that capture movement and the intensity of physical activity.

They found that without counselling, most bariatric surgery patients are insufficiently active prior to surgery and, without support, fail to substantially increase their physical activity after surgery. This is despite significant weight loss and improvements in their physical function.

However, brief pre-operative counselling about physical activity can increase patients’ participation in moderate-intensity physical activity to levels that are close to national recommendations. The researchers say that the preoperative period may serve as a “powerful” teachable moment for helping patients change their physical activity behaviours.

"Because of patients' health-related barriers to physical activity, clinicians may be inclined to hold off on advising their patients to become more physically active until after the surgery helps them lose weight," said King. "However, the US Department of Health and Human Services' guidelines indicate that it is safe and beneficial for people with chronic medical conditions, such as obesity and diabetes, to be physically active according to their abilities."

Currently, 22% of patients of bariatric surgical centres accredited by the American College of Surgeons Bariatric Surgery Center Network report having received postoperative exercise counselling.

King and Bond are members on the joint committee of the American College of Sports Medicine's and the American Society for Metabolic and Bariatric Surgery, which is developing the first evidence-based preoperative or postoperative physical activity guidelines for bariatric surgery patients.

The strategies, known as the "Five As”, include:

  • Assess: Determine the patient's physical activity knowledge, experiences and preferences, as well as his or her ability to safely increase their physical activity level.
  • Advise: Educate the patient on the benefits of regular physical activity and help the patient develop realistic expectations and address safety concerns.
  • Agree: Work with the patient to set specific physical activity goals and develop a written exercise contract to reinforce a lifelong commitment to exercise.
  • Assist: Provide printed materials, online resources, tools (such as pedometers and physical activity diaries) and a list of community resources that support physical activity.
  • Arrange: Follow-up with the patient to reinforce the physical activity goals and answer questions, as well as schedule an in-person appointment to discuss the goals and make any necessary revisions.

These guidelines are supported by preliminary findings from the on-going Bari-Active trial conducted by Bond.

Recent studies also show that bariatric surgery patients' postoperative physical activity levels can be increased when the patients are enrolled in exercise programs with a personal trainer or other structured support.

The research was funded by the National Institutes of Health.

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