Physical activity prescription before bariatric surgery: Feasibility, health impacts, and practical implications
Obesity is a challenging health problem. For people with morbid obesity who cannot lose weight, using conventional weight loss methods, they may resort to bariatric surgery. However, despite increasing evidence that physical activity (PA) can reduce weight and improve postsurgical outcomes, most preoperative obese patients are inactive. Therefore, the aim of the present paper was to review the evidence for the feasibility and beneficial health impact of prebariatric surgery PA program for obese patients and to discuss the practical implications of PA counseling and exercise prescription to healthcare providers. A systematic electronic search was conducted utilizing keywords related to PA, exercise, and prebariatric surgery using MEDLINE databases. The findings of this review indicated that a presurgical intervention targeting PA among obese patients awaiting bariatric surgery is feasible and has the potential to increase patient's engagement in PA postoperatively. In addition, higher levels of preoperative PA or physical fitness were associated with lower postsurgical complications and a shorter length of stay in hospital. There is also evidence to support that higher levels of preoperative PA may improve weight loss outcomes following laparoscopic surgery. Research showed that the daily time spent being sedentary among obese patients was quite excessive. In adult population, the available evidence demonstrates a dose response relationship between the amount of moderate to vigorous intensity PA and reduced weight loss and increased health benefits. It is recommended that healthcare providers to increase their use of the five A's (Assess, Advise, Agree, Assist, and Arrange) counseling model when counseling obese patients about PA and weight loss. Finally, the future studies must seek to make PA more effective and compliant for obese patients and focus on identifying major barriers that are preventing most patients from assuming active lifestyles.