Physical Activity After Surgery for Severe Obesity: The Role of Exercise Cognitions

Wouters, Eveline; Larsen, Junilla K.; Zijlstra, Hanna; Ramshorst, Bert van; Geenen, Rinie

doi:10.1007/s11695-010-0276-y

Cited by 57 publications

(40 citation statements)

References 38 publications

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“…Of the 22 participants who did not strictly adhere to the intervention, 13 reported reasons for noncompliance, while 9 did not. It has been well documented that bariatric surgery patients have psychosocial barriers to exercise, including low self efficacy and exercise motivation, and social stigma (39,40). The aim of this study was not to determine psychosocial barriers to exercise, and while we didn't measure these factors, it is likely that they contributed to noncompliance in these 9 participants.…”

Section: Discussionmentioning

confidence: 97%

“…A 50% dextrose bolus (0.3 g/kg body mass) was administered after fasting samples were collected, and insulin (0.025 U/kg body mass) was then injected at minute 20. Blood samples were collected in EDTA tubes at minutes 2,3,4,5,6,8,10,12,14,16,19,22,23,24,25,27,30,40,50,60,70,80,90,100,120,140,160, and 180. Plasma samples were stored at −80°C until later analyses.…”

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confidence: 99%

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Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity

Coen¹,

Tanner²,

Helbling³

et al. 2014

J. Clin. Invest.

125

199

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nondiabetic patients following RYGB surgery are typically quite modest compared with the presurgery condition (3). Moreover, there appear to be 2 discrete periods of improvement. The first is immediately after surgery, at which time hepatic, but not peripheral, S I improves in response to acute energy restriction (4-6), while greater, protracted weight loss appears to be more strongly associated with improved peripheral S I (7,8). Even with significant weight loss 1 year following RYBG surgery, peripheral S I is still low compared with that of lean metabolically healthy individuals (3,5,6,9).Exercise is considered a cornerstone for obesity treatment, and while it is not generally viewed to cause substantial body weight reduction (10), it can potently improve peripheral S I and glucose control (11-13) and can reduce the risk of T2D and cardiovascular disease (14,15). There is general consensus that even a single session of moderate intensity exercise can induce an improvement in S I (16). There is also evidence that exercise can BACKGROUND. Roux-en-Y gastric bypass (RYGB) surgery causes profound weight loss and improves insulin sensitivity (S I ) in obese patients. Regular exercise can also improve S I in obese individuals; however, it is unknown whether exercise and RYGB surgery-induced weight loss would additively improve S I and other cardiometabolic factors. METHODS.We conducted a single-blind, prospective, randomized trial with 128 men and women who recently underwent RYGB surgery (within 1-3 months). Participants were randomized to either a 6-month semi-supervised moderate exercise protocol (EX, n = 66) or a health education control (CON; n = 62) intervention. Main outcomes measured included S I and glucose effectiveness (S G ), which were determined from an intravenous glucose tolerance test and minimal modeling. Secondary outcomes measured were cardiorespiratory fitness (VO 2 peak) and body composition. Data were analyzed using an intention-to-treat (ITT) and per-protocol (PP) approach to assess the efficacy of the exercise intervention (>120 min of exercise/week).RESULTS. 119 (93%) participants completed the interventions, 95% for CON and 91% for EX. There was a significant decrease in body weight and fat mass for both groups (P < 0.001 for time effect). S I improved in both groups following the intervention (ITT: CON vs. EX; +1.64 vs. +2.24 min -1 /μU/ml, P = 0.18 for Δ, P < 0.001 for time effect). A PP analysis revealed that exercise produced an additive S I improvement (PP: CON vs. EX; +1.57 vs. +2.69 min

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Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity

Coen¹,

Tanner²,

Helbling³

et al. 2014

J. Clin. Invest.

125

199

View full text Add to dashboard Cite

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“…Dados da literatura mostram que após a realização do procedimento cirúrgico, há um aumento na prática de atividade física. 12 No entanto, em nosso estudo, a maioria dos pacientes (82,9%) relatou ser sedentário ou praticar irregularmente exercícios físicos. Não está totalmente esclarecido porque alguns pacientes mantêm-se sedentários e outros não, no entanto, uma das teorias é sobre falta de conhecimento específico sobre os benefícios do exercício físico para a saúde humana.…”

Section: Discussionunclassified

“…Não está totalmente esclarecido porque alguns pacientes mantêm-se sedentários e outros não, no entanto, uma das teorias é sobre falta de conhecimento específico sobre os benefícios do exercício físico para a saúde humana. Wouters e colaboradores 12 suge-rem que a segmentação do conhecimento sobre o exercício antes e após a cirurgia pode levar a uma melhora relevante na aderência à atividade física. Muitas vezes os pacientes acreditam que a cirurgia bariátrica representa a "cura" da obesidade e se posicionam de maneira passiva, não considerando necessário e importante adotar outras medidas comportamentais.…”

Section: Discussionunclassified

“…5,9,10 Fatores como IMC prévio alto e sedentarismo também estão relacionados com taxa de reganho crescente e perda de excesso de peso cada vez menor. 5,12 As limitações deste estudo estão relacionadas com o relato não comprovado de algumas variáveis analisadas, já que estes pacientes foram acompanhados no período pré-cirúrgico e submetidos à cirurgia em outras unidades médicas.…”

Section: Discussionunclassified

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Taxas de reganho ponderal em pacientes bariátricos acompanhados na Policlínica Piquet Carneiro

Garroni

Bacellar

Lima

et al. 2014

Revista Hospital Universitário Pedro Ernesto

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ResumoA obesidade é uma doença com alta prevalência em nosso meio e o tratamento cirúrgico pode promover redução da morbimortalidade cardiovascular. Apesar do maior conhecimento sobre as técnicas cirúrgicas empregadas e manejo clínico destes pacientes, ainda observam-se altas taxas de reganho ponderal. O objetivo deste estudo é avaliar a taxa de reganho (TxR) ponderal dos pacientes bariátricos atendidos em consulta de primeira vez na Policlínica Piquet Carneiro. Foram recrutados 35 pacientes (29 mulheres e 6 homens; 39,3 ± 9,10 anos) submetidos à cirurgia bariátrica entre abril e setembro de 2013. O índice de massa corporal (IMC = peso/altura 2 ) foi calculado e, com base no relato do peso pré-cirúrgico e do peso mínimo alcançado após a cirurgia, foram calculados respectivamente, o IMC pré-cirúrgico e o IMC mínimo. A TxR foi calculada [(peso atual -peso mínimo relatado) x 100/(peso pré-operatório relatado -peso mínimo relatado)]. Os pacientes foram divididos conforme o tempo decorrido da cirurgia, primeiramente em dois grupos: ≤ 1 ano (G ≤ 1) e > 1 ano (G > 1). Posteriormente, estes foram reagrupados em outros dois novos grupos: < 2 anos (G < 2) e ≥ 2 anos (G ≥ 2) e ainda em < 5 anos (G < 5) e ≥ 5 anos (G ≥ 5). Dos 35 pacientes recrutados, 94,3% (n = 33) relataram a realização de gastroplastia redutora com reconstrução em Y de Roux. O IMC pré-cirúrgico relatado era de 50,5 ± 8,92 kg/m 2 . Em relação ao tempo decorrido da cirurgia, observamos que 22,8% (n = 8) da amostra havia realizado a cirurgia em até um ano, 40% (n = 14) em menos de dois anos e 74,3% (n = 26) em menos de cinco anos. O IMC mínimo alcançado foi de 30,7 ± 6,6 kg/m 2 . O percentual de pacientes que apresentavam reganho ponderal foi de 71,4% (n = 25) e o IMC atual era de 34,2 ± 6,89 kg/m 2 . O grupo G ≤ 1 apresentou uma TxR inferior ao G > 1 (3,8 ± 3,1 vs. 20,6 ± 4,1%; p < 0,05). Tal fato se acentua após o segundo ano da cirurgia (2,6 ± 1,8 vs. 26,2 ± 4,6%; P < 0,001); tornando-se ainda mais relevante após cinco anos da cirurgia (10,1 ± 3,0 vs. 35,9 ± 7,2%; p < 0,001). Conclui-se que o reganho ponderal já esteve presente no primeiro ano do pós-operatório, entretanto torna-se mais relevante em função do tempo decorrido da cirurgia.Descritores: Obesidade; Cirurgia bariátrica; Ganho de peso; Prognóstico. AbstractObesity is a disease with high prevalence in our country and surgical treatment may reduce cardiovascular morbimortality. Despite increased knowledge about surgical techniques and clinical management of these patients, we still observe high rates of weight regain. The aim of this study is to evaluate the rate of weight regain (TxR) of bariatric patients seen in a medical set for the first time at the Policlínica Piquet Carneiro for outpatients care. We recruited between April and September, 2013, 35 patients (29 females and 6 males; 39.3 ± 9.10 years) who have undergone bariatric surgery. The body mass index (BMI -weight in kg/height 2 ) was calculated and, based on the reported pre-surgical weight and minimum weight achieved after surgery, w...

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Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by american association of clinical endocrinologists, The obesity society, and american society for metabolic & bariatric surgery*

Mechanick

Youdim

Jones

et al. 2013

Obesity

1,082

372

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The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.

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Physical Activity After Surgery for Severe Obesity: The Role of Exercise Cognitions

Cited by 57 publications

References 38 publications

Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity

Clinical trial demonstrates exercise following bariatric surgery improves insulin sensitivity

Taxas de reganho ponderal em pacientes bariátricos acompanhados na Policlínica Piquet Carneiro

Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by american association of clinical endocrinologists, The obesity society, and american society for metabolic & bariatric surgery*

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