ENCOURAGEing Start: A Quasi-experimental Trial on Pre-Op Physical Activity Intervention for Bariatric Surgery Candidates

Abstract

Introduction The American Society for Metabolic and Bariatric Surgery recommends pre- and post-operative physical activity (PA). However, there are no effective standardized PA programs incorporating a behavioral change approach for bariatric surgery patients. A novel pre-operative PA intervention ENCOURAGEing Start was developed and piloted to assist patients in reducing barriers to PA and encouraging positive PA habits. Methods This single arm pilot study recruited patients (n=27, BMI = 47.1 ± 6.2) from the Victoria General Hospital’s Centre for Metabolic and Bariatric Surgery in Winnipeg, Manitoba between September 2017 and May 2018. A time-series quasi-experimental design was used. The 16-week intervention took place at the University of Manitoba’s Active Living Centre. The primary outcome was a six-minute walk test (6MW), a measure of functional ability and predictive of post-surgical weight loss and maintenance. Secondary outcomes included fitness, cardiovascular disease risk and mental health. Outcomes were evaluated at baseline, 8 weeks, and 16 weeks. Results Ten patients completed the intervention. Clinically significant (p≤0.05) differences in the 6MW (457.21 vs 497.58 m, p=0.002), indirect 1RM leg press (283.72 vs 331.60 lb, p<0.001), sit-to-stand (12.78 vs 14.82, p<0.01), and quality of life (181.89 vs 195.96, p=0.028) were identified for completers. Conclusions The ENCOURAGEing Start intervention enhanced markers linked to long-term post-surgery outcomes, including a 10.7% increase in 6MW. This feasible program showed similar effect size to more resource intensive interventions, including those in Canada. A larger study with a minimum of 55 participants should be undertaken to assess the sustainability of these effects.