Exercise Therapy

“Play an active part in the treatment of your condition”

Prior to meeting with the Exercise Therapist, the patient will normally have seen their physician and undergone a full family history and physical exam as well as some diagnostic tests such as fasting blood sugar, lipid profile (total cholesterol, LDL and HDL cholesterol, triglycerides), and thyroid hormone levels (TSH, free T4). Other tests may also be conducted in some cases such as nonalcoholic fatty liver, renal function, and testosterone levels as well as testing for deficiencies in certain vitamins and minerals. If patient exhibits signs of cardiac abnormalities such as palpitations or has a cardiac condition or high blood pressure then an ECG may be required as well.

Clinical Exercise Testing

Clinical exercise testing will be conducted in order to collect baseline information on the patient and assess their functional capacity as well as help in establishing the exercise prescription.

  • Resting blood pressure
  • Resting heart rate
  • Waist-to-hip ratio (or waist circumference)
  • Body composition (% fat, % lean muscle, fat free mass)
  • Cardiorespiratory capacity (VO2max)
  • Muscular endurance
  • Muscular strength
  • Flexibility (if required) 

Pre-bariatric surgery Exercise Therapy

It is one thing having weight loss surgery and it is quite another being as ready as you can be physically for that surgery. Studies have shown that preparing by engaging in exercise before bariatric surgery helps you recover quicker and improves overall success in the future (1). The road to a more physically active life begins before surgery and must become part of a regular routine or habit.

(1) The exercise therapist’s role is to put you on the right track and help guide you in the right direction so that you engage in the much needed exercise safely and effectively.

Before surgery, your exercise therapist will help you:

  • Recover quicker from surgery by starting with you before surgery
  • Will test and measure where you stand before surgery regarding your health and fitness level
  • Start understanding which exercises will help you most
  • Begin to engage in exercise regularly

(1) Toussi, R., Fujioka, K., Coleman, K.J.  Pre- and post-surgery behavioral compliance, patient health, and post-bariatric surgical weight lossObesity, May 2009; 17:(5): 996-1002

Post-bariatric surgery Exercise Therapy

Now that you’ve been through it, it’s time to look forward and take charge of your health by making sure you continue to engage in what will, in part, preserve and enhance your health, physical activity. The evidence is quite clear. Patients that engage in physical activity after bariatric surgery lose more weight and keep it off longer (2) and have do better outcomes overall.

The exercise therapist will continue to show you which types of exercises will help you most and what you can do to continue to challenge yourself as get more fit. She or he will also help you identify what is preventing you from engaging in the physical activity you need and what you can do to overcome these. They will follow-up with you to help you stay on track!

After your surgery, your exercise therapist will help you:

  • continue to engage in exercise regularly and make it a routine part of your new life 
  • monitor how well you are doing
  • follow-up to see if you are having any difficulties engaging in exercise regularly and help you overcome these
  • help you keep the weight off

(2) Egberts, K., Brown, WA., Brennan, L., et al. Does exercise improve weight loss after bariatric surgery?A systematic review. Obesity Surgery, 2012:335-341

Exercise Therapy as part of treatment plan for weight reduction for obese patients

After performing a clinical exercise test, the exercise therapist is specifically trained to deliver evidence-based guidelines for exercise to chronic patients including obese patients. She or he will show you what exercise is best for you according to your health and fitness level and your medical condition.

The exercise therapist will also address issues of behavior change as well as lifestyle issues that may affect your health and medical condition such as stress level and sleep.

Working with other health professionals in a comprehensive, patient-centered approach, the exercise therapist will work with you on a one-on-one basis show you how exercise will be part of the medicine you need and in what doses you need to take medicines.

Note that in the National Weight Control Registry (NWCR), over 90% of the successful subjects combined exercise therapy with diet therapy (3).

(3) Klem, M.L, Wing, R.R., McGuire, M.T., Seagle, , H.M., Hill, J.O. A descriptive study of individuals successful at long term maintenance of substantial weight loss.American Journal of Clinical Nutrition, 1997; 66:239-246

Health Benefits of a 10% Weight Loss(4)

Blood Pressure

Decline of about 10mmHg in systolic and diastolic BP in patients with hypertension (equivalent to most BP medications)

Diabetes

Decline of up to 50% in fasting glucose for newly diagnosed patients

Prediabetes

  • >30% decline in fasting or 2hinsulins
  • >30% increase in insulin sensitivity
  • 40 to 60% decline in the incidence of diabetes

Lipids

  • 10% decline in total cholesterol
  • 15% decline in LDL cholesterol
  • 30% decline in triglycerides
  • 8% increase in HDL cholesterol

Mortality

  • >20% decline in all-cause mortality
  • >30% decline in deaths related to diabetes
  • >40% decline in deaths related to obesity

(4) Haslam, D., Satter, N., Lean, M. ABC of Obesity. Obesity – time to wake up. British Medical Journal (BMJ), 2006; 333:640-642

Haig Balekian, MSc, CSCS

Haig Balekian, MSc, CSCS

Managing Director at Health Matters FZ-LLC, Dubai, UAE

 

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