Bariatric surgery has proved to be an effective treatment in patients suffering from morbid obesity, with more than 50% excess weight loss at ten years. However, the variability in patients’ outcomes is significant, with several factors being related to the maintenance of weight loss and the resolution of comorbidities. It has been suggested that physical activity has a substantial impact on the prognosis of morbidly obese operated patients, by improving physiological and psychological health. More specifically, active patients enjoy an improved quality of life and lean towards maintaining the long-term surgical benefits. By contrast, inactivity induces loss of muscle mass and development of abdominal adiposity, which may stimulate insulin resistance, atherosclerosis, and tumorigenesis.
The reason why many patients who undergo bariatric surgery limit physical exercise is multiple: some attribute it to a lack of time, others to physical limitations, but in the majority this is due to a lack of motivation. The role of the physician is to help the patient overcome barriers and promote activity, with a particular focus on making them part of the decision-making process and increasing their motivation. The design of individualized programs, recording daily tasks and realistic objectives, being mindful of diet and physical limitations, learning about the benefits of exercise, and dealing with the lack of energy are some of the necessary steps.
In addition to the importance that physical activity has for treated obese patients, exercise training has been shown to be of utmost relevance in the preoperatory population. Prehabilitation encompasses the concept of optimizing the pre-surgical patient, by promoting exercise, nutritional supplementation, and anxiety management. Several trials have reported a decreased rate of postoperative complications after prehabilitation, suggesting that it should be performed in the majority of patients who undergo major abdominal surgery.
In this video, Dr. Cristina Aquino discusses the role of physical activity before and after bariatric surgery. Dr. Tracy Martinez moderates the session in which Drs. Dale S. Bond, Scott Jamieson, and Marcos Morales also participate.