Department of Research & Evaluation News

Bariatric surgery has recently emerged as the most successful treatment for severe obesity. The different surgical procedures — gastric bypass, adjustable gastric band and sleeve gastrectomy — cause weight loss by restricting the amount of food the stomach can hold, decreasing absorption of nutrients or a combination of both.

One of the referral criteria for bariatric surgery is that patients have made multiple yet unsuccessful attempts at weight loss and maintenance. Observational studies have shown that one of the most important predictors of weight loss following the surgery is increases in self-reported physical activity. However, it can be challenging for patients to adopt and maintain an active lifestyle after surgery when they have had difficulty being active previously.

A recent Kaiser Permanente study, published in Obesity Surgery, examined the effectiveness of an exercise program adapted for bariatric patients to help them maintain an active lifestyle after surgery. The research team found that patients who took part in the exercise program experienced significant improvements in key areas such as functional strength, mobility and flexibility when compared to patients who received usual care consisting of regular post-operative health care visits as well as weight and laboratory monitoring.

We asked the study’s lead author, Karen J. Coleman, PhD, Kaiser Permanente Southern California, Department of Research & Evaluation, to discuss the significance of her research and what health care clinicians and patients who have undergone bariatric surgery should keep in mind as they embark on an exercise program.

Q: What prompted you to undertake this study?

A: We know that exercise helps maintain weight loss and that it is important for post-bariatric patients to adopt a more active lifestyle, but little research has been done regarding what types of exercise programs are tolerated well by these patients and what exercises are best for improvements in daily functioning. The program we designed and evaluated in our study was focused on all aspects of physical fitness, with special attention to exercise-limiting conditions, such as arthritis, which are common in severely obese patients having bariatric surgery.

Q: Can you elaborate on the limitations that bariatric surgery patients have that make exercising difficult?

A: Patients who have undergone bariatric surgery may have conditions that limit their ability to exercise, balance and maintain energy. These conditions include arthritis, excess skin on legs and arms, low blood sugar due to metabolic changes and nerve damage from diabetes.

Q: What are the key takeaways of the study?

A: Based upon our findings, it may be unreasonable to expect post-bariatric patients to maintain the public health recommendations of 150 minutes per week of moderate-to-vigorous physical activity (or 10,000 steps per day). Although exercise program participants in our study experienced small but significant changes in all aspects of fitness, this can be difficult to maintain without ongoing counseling and support.  Instead, it may be more reasonable to prescribe exercise for 3 to 4 days a week for 30 to 60 minutes with a social support and monitoring component to improve adherence. Above all else, exercise programs for post-bariatric patients should include:

• Individualized exercise target
• Broadening of aerobic prescriptions from the traditional focus on walking, and
• Inclusion of circuit-based exercise programs with supervised, individualized exercise modification and an emphasis on strength, flexibility, mobility and improved functional status.

Q: What programs does Kaiser Permanente have for post-bariatric patients?

A: As an integrated health care organization, we know that exercise helps maintain weight loss and that it is important for post-bariatric patients to adopt a more active lifestyle and positive well-being. One way we help our patients accomplish this is by collaborating with the Positive Choice Integrative Center, a unique center within Kaiser Permanente in San Diego, which focuses on the promotion of emotional and physical wellness for members.

Q: What advice would you give to patients who have had bariatric surgery?

A: If your health care provider has not spoken to you about your lifestyle following surgery, you should take a proactive approach and bring it up on your own. Beyond regular post-operative care, such as routine laboratory testing and weight assessment, exercise programs are important in creating a plan that helps to keep the weight off and maintain a healthy lifestyle for years to come.