Prehabilitation for Bariatric Surgery: A Randomized, Controlled Trial Protocol and Pilot Study

Yaiza García-Delgado, María José López-Madrazo-Hernández, Dácil Alvarado-Martel, Guillermo Miranda-Calderín, Arantza Ugarte-Lopetegui, Raúl Alberto González-Medina, Alba Hernández-Lázaro, Garlene Zamora, Nuria Pérez-Martín, Rosa María Sánchez-Hernández, Adriana Ibarra-González, Mónica Bengoa-Dolón, Carmen Teresa Mendoza-Vega, Svein Mikael Appelvik-González, Yurena Caballero-Díaz, Juan Ramón Hernández-Hernández, Ana María Wägner, Yaiza García-Delgado, María José López-Madrazo-Hernández, Dácil Alvarado-Martel, Guillermo Miranda-Calderín, Arantza Ugarte-Lopetegui, Raúl Alberto González-Medina, Alba Hernández-Lázaro, Garlene Zamora, Nuria Pérez-Martín, Rosa María Sánchez-Hernández, Adriana Ibarra-González, Mónica Bengoa-Dolón, Carmen Teresa Mendoza-Vega, Svein Mikael Appelvik-González, Yurena Caballero-Díaz, Juan Ramón Hernández-Hernández, Ana María Wägner

Abstract

Bariatric surgery is the most efficacious treatment for obesity, though it is not free from complications. Preoperative conditioning has proved beneficial in various clinical contexts, but the evidence is scarce on the role of prehabilitation in bariatric surgery. We describe the protocol and pilot study of a randomized (ratio 1:1), parallel, controlled trial assessing the effect of a physical conditioning and respiratory muscle training programme, added to a standard 8-week group intervention based on therapeutical education and cognitive-behavioural therapy, in patients awaiting bariatric surgery. The primary outcome is preoperative weight-loss. Secondary outcomes include associated comorbidity, eating behaviour, physical activity, quality of life, and short-term postoperative complications. A pilot sample of 15 participants has been randomized to the intervention or control groups and their baseline features and results are described. Only 5 patients completed the group programme and returned for assessment. Measures to improve adherence will be implemented and once the COVID-19 pandemic allows, the clinical trial will start. This is the first randomized, clinical trial assessing the effect of physical and respiratory prehabilitation, added to standard group education and cognitive-behavioural intervention in obese patients on the waiting list for bariatric surgery. Clinical Trial Registration: NCT0404636.

Keywords: bariatric surgery; obesity; prehabilitation; preoperative exercise; respiratory training.

Conflict of interest statement

The authors declare no conflict of interest related to the contents of the manuscript. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Incentive spirometry device, which provides visual cues to the patients that the desired flow or volume has been achieved.
Figure 3
Figure 3
Inspiratory valve used in the training programme.

References

    1. Bailly L., Schiavo L., Sebastianelli L., Fabre R., Morisot A., Pradier C., Iannelli A. Preventive effect of bariatric surgery on type 2 diabetes onset in morbidly obese inpatients: A national French survey between 2008 and 2016 on 328,509 morbidly obese patients. Surg. Obes. Relat. Dis. 2019;15:478–487. doi: 10.1016/j.soard.2018.12.028.
    1. Jakobsen G.S., Småstuen M.C., Sandbu R., Nordstrand N., Hofsø D., Lindberg M., Hertel J.K., Hjelmesæth J. Association of bariatric surgery vs medical obesity treatment with long-term medical complications and obesity-related comorbidities. JAMA J. Am. Med. Assoc. 2018;319:291–301. doi: 10.1001/jama.2017.21055.
    1. Lee G.K., Cha Y.M. Cardiovascular benefits of bariatric surgery. Trends Cardiovasc. Med. 2016;26:280–289. doi: 10.1016/j.tcm.2015.07.006.
    1. Madsen L.R., Baggesen L.M., Richelsen B., Thomsen R.W. Effect of Roux-en-Y gastric bypass surgery on diabetes remission and complications in individuals with type 2 diabetes: A Danish population-based matched cohort study. Diabetologia. 2019;62:611–620. doi: 10.1007/s00125-019-4816-2.
    1. Schauer P.R., Bhatt D.L., Kirwan J.P., Wolski K., Aminian A., Brethauer S.A., Navaneethan S.D., Singh R.P., Pothier C.E., Nissen S.E., et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes—5-Year Outcomes. N. Engl. J. Med. 2017;376:641–651. doi: 10.1056/NEJMoa1600869.
    1. Van Nieuwenhove Y., Dambrauskas Z., Campillo-Soto A., Van Dielen F., Wiezer R., Janssen I., Kramer M., Thorell A. Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass: A randomized multicenter study. Arch. Surg. 2011;146:1300–1305. doi: 10.1001/archsurg.2011.273.
    1. Schauer P.R., Nor Hanipah Z., Rubino F. Metabolic surgery for treating type 2 diabetes mellitus: Now supported by the world’s leading diabetes organizations. Clevel. Clin. J. Med. 2017;84:S47–S56. doi: 10.3949/ccjm.84.s1.06.
    1. Sjöström L., Narbro K., Sjöström D., Karason K., Bo L., Wedel H., Lystig T., Sullivan M., Bouchard C., Carlsson B., et al. Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. N. Engl. J. Med. 2007;357:741–752. doi: 10.1056/NEJMoa066254.
    1. Schauer P.R., Bhatt D.L., Kirwan J.P., Wolski K., Brethauer S.A., Navaneethan S.D., Aminian A., Pothier C.E., Kim E.S.H., Nissen S.E., et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes—3-Year Outcomes. N. Engl. J. Med. 2014;370:2002–2013. doi: 10.1056/NEJMoa1401329.
    1. Mingrone G., Panunzi S., De Gaetano A., Guidone C., Iaconelli A., Leccesi L., Nanni G., Pomp A., Castagneto M., Ghirlanda G., et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N. Engl. J. Med. 2012;366:1577–1585. doi: 10.1056/NEJMoa1200111.
    1. Schiavon C.A., Ikeoka D., Santucci E.V., Santos R.N., Damiani L.P., Bueno P.T., Oliveira J.D., Torreglosa C.R., Bersch-Ferreira A.C., Miranda T.A., et al. Effects of bariatric surgery versus medical therapy on the 24-hour ambulatory blood pressure and the prevalence of resistant hypertension: The GATEWAY randomized clinical trial. Hypertension. 2019;73:571–577. doi: 10.1161/HYPERTENSIONAHA.118.12290.
    1. Kwok C.S., Pradhan A., Khan M.A., Anderson S.G., Keavney B.D., Myint P.K., Mamas M.A., Loke Y.K. Bariatric surgery and its impact on cardiovascular disease and mortality: A systematic review and meta-analysis. Int. J. Cardiol. 2014;173:20–28. doi: 10.1016/j.ijcard.2014.02.026.
    1. Mechanick J.I., Youdim A., Jones D.B., Garvey T., Hurley D.L., McMahon M., Heinberg L.J., Kushner R., Adams T.D., Shikora S., et al. 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 Sociaty fo. Obesity. 2013;21:S1–S27. doi: 10.1002/oby.20461.
    1. Anderin C., Gustafsson U.O., Heijbel N., Thorell A. Weight Loss before Bariatric Surgery and Postoperative Complications: Data from the Scandinavian Obesity Registry (SOReg) Ann. Surg. 2015;261:909–913. doi: 10.1097/SLA.0000000000000839.
    1. Cassie S., Menezes C., Birch D.W., Shi X., Karmali S. Effect of preoperative weight loss in bariatric surgical patients: A systematic review. Surg. Obes. Relat. Dis. 2011;7:760–767. doi: 10.1016/j.soard.2011.08.011.
    1. Colles S.L., Dixon J.B., Marks P., Strauss B.J., O’Brien P.E. Preoperative weight loss with a very-low-energy diet: Quantitation of changes in liver and abdominal fat by serial imaging. Am. J. Clin. Nutr. 2006;84:304–311. doi: 10.1093/ajcn/84.2.304.
    1. Edholm D., Kullberg J., Haenni A., Karlsson F.A., Ahlström A., Hedberg J., Ahlström H., Sundbom M. Preoperative 4-week low-calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese. Obes. Surg. 2011;21:345–350. doi: 10.1007/s11695-010-0337-2.
    1. Roman M., Monaghan A., Serraino G.F., Miller D., Pathak S., Lai F., Zaccardi F., Ghanchi A., Khunti K., Davies M.J., et al. Meta-analysis of the influence of lifestyle changes for preoperative weight loss on surgical outcomes. Br. J. Surg. 2019;106:181–189. doi: 10.1002/bjs.11001.
    1. Sinha A., Jayaraman L., Punhani D., Chowbey P. Enhanced Recovery after Bariatric Surgery in the Severely Obese, Morbidly Obese, Super-Morbidly Obese and Super-Super Morbidly Obese Using Evidence-Based Clinical Pathways: A Comparative Study. Obes. Surg. 2017;27:560–568. doi: 10.1007/s11695-016-2366-y.
    1. Livhits M., Mercado C., Yermilov I., Parikh J.A., Dutson E., Mehran A., Ko C.Y., Gibbons M.M. Does weight loss immediately before bariatric surgery improve outcomes: A systematic review. Surg. Obes. Relat. Dis. 2009;5:713–721. doi: 10.1016/j.soard.2009.08.014.
    1. Gerber P., Anderin C., Gustafsson U.O., Thorell A. Weight loss before gastric bypass and postoperative weight change: Data from the Scandinavian Obesity Registry (SOReg) Surg. Obes. Relat. Dis. 2016;12:556–562. doi: 10.1016/j.soard.2015.08.519.
    1. Thorell A., MacCormick A.D., Awad S., Reynolds N., Roulin D., Demartines N., Vignaud M., Alvarez A., Singh P.M., Lobo D.N. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J. Surg. 2016;40:2065–2083. doi: 10.1007/s00268-016-3492-3.
    1. Dronkers J.J., Lamberts H., Reutelingsperger I.M.M.D., Naber R.H., Dronkers-Landman C.M., Veldman A., Van Meeteren N.L.U. Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: A randomized controlled pilot study. Clin. Rehabil. 2010;24:614–622. doi: 10.1177/0269215509358941.
    1. Coats V., Maltais F., Simard S., Fréchette É., Tremblay L., Ribeiro F., Saey D. Feasibility and effectiveness of a home-based exercise training program before lung resection surgery. Can. Respir. J. 2013;20:10–17. doi: 10.1155/2013/291059.
    1. Gillis C., Li C., Lee L., Awasthi R., Augustin B., Gamsa A., Liberman A.S., Stein B., Charlebois P., Feldman L.S., et al. Prehabilitation versus Rehabilitation. A randomized control trial in patients undergoing colorectal resection cancer. Anesthesiology. 2014;121:937–947. doi: 10.1097/ALN.0000000000000393.
    1. Li C., Carli F., Lee L., Charlebois P., Stein B., Liberman A.S., Kaneva P., Augustin B., Wongyingsinn M., Gamsa A., et al. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: A pilot study. Surg. Endosc. 2013;27:1072–1082. doi: 10.1007/s00464-012-2560-5.
    1. Jensen B.T., Petersen A.K., Jensen J.B., Laustsen S., Borre M. Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: A prospective randomized controlled trial. Scand. J. Urol. 2015;49:133–141. doi: 10.3109/21681805.2014.967810.
    1. Carli F., Zavorsky G.S. Optimizing functional exercise capacity in the elderly surgical population. Curr. Opin. Clin. Nutr. Metab. Care. 2005;8:23–32. doi: 10.1097/00075197-200501000-00005.
    1. Topp R., Swank A.M., Quesada P.M., Nyland J., Malkani A. The Effect of Prehabilitation Exercise on Strength and Functioning After Total Knee Arthroplasty. PM R. 2009;1:729–735. doi: 10.1016/j.pmrj.2009.06.003.
    1. West M.A., Loughney L., Lythgoe D., Barben C.P., Sripadam R., Kemp G.J., Grocott M.P.W., Jack S. Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: A blinded interventional pilot study. Br. J. Anaesth. 2015;114:244–251. doi: 10.1093/bja/aeu318.
    1. Dunne D.F.J., Jack S., Jones R.P., Jones L., Lythgoe D.T., Malik H.Z., Poston G.J., Palmer D.H., Fenwick S.W. Randomized clinical trial of prehabilitation before planned liver resection. Br. J. Surg. 2016;103:504–512. doi: 10.1002/bjs.10096.
    1. Minnella E.M., Bousquet-Dion G., Awasthi R., Scheede-Bergdahl C., Carli F. Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: A five-year research experience. Acta Oncol. 2017;56:295–300. doi: 10.1080/0284186X.2016.1268268.
    1. Sebio García R., Yáñez-Brage M.I., Giménez Moolhuyzen E., Salorio Riobo M., Lista Paz A., Borro Mate J.M. Preoperative exercise training prevents functional decline after lung resection surgery: A randomized, single-blind controlled trial. Clin. Rehabil. 2017;31:1057–1067. doi: 10.1177/0269215516684179.
    1. Chen B.P., Awasthi R., Sweet S.N., Minnella E.M., Bergdahl A., Santa Mina D., Carli F., Scheede-Bergdahl C. Four-week prehabilitation program is sufficient to modify exercise behaviors and improve preoperative functional walking capacity in patients with colorectal cancer. Support. Care Cancer. 2017;25:33–40. doi: 10.1007/s00520-016-3379-8.
    1. Huang G.H., Ismail H., Murnane A., Kim P., Riedel B. Structured exercise program prior to major cancer surgery improves cardiopulmonary fitness: A retrospective cohort study. Support. Care Cancer. 2016;24:2277–2285. doi: 10.1007/s00520-015-3028-7.
    1. Carli F., Charlebois P., Stein B., Feldman L., Zavorsky G., Kim D.J., Scott S., Mayo N.E. Randomized clinical trial of prehabilitation in colorectal surgery. Br. J. Surg. 2010;97:1187–1197. doi: 10.1002/bjs.7102.
    1. Gillis C., Fenton T.R., Sajobi T.T., Minnella E.M., Awasthi R., Loiselle S.È., Liberman A.S., Stein B., Charlebois P., Carli F. Trimodal prehabilitation for colorectal surgery attenuates post-surgical losses in lean body mass: A pooled analysis of randomized controlled trials. Clin. Nutr. 2019;38:1053–1060. doi: 10.1016/j.clnu.2018.06.982.
    1. Lyons N.B., Bernardi K., Olavarria O.A., Dhanani N., Shah P., Holihan J.L., Ko T.C., Kao L.S., Liang M.K. Prehabilitation among Patients Undergoing Non-Bariatric Abdominal Surgery: A Systematic Review. J. Am. Coll. Surg. 2020;231:480–489. doi: 10.1016/j.jamcollsurg.2020.06.024.
    1. Waldburger R., Wilms B., Ernst B., Thurnheer M., Schultes B. Cardio-respiratory fitness is independently associated with cardio-metabolic risk markers in severely obese women. Exp. Clin. Endocrinol. Diabetes. 2014;122:190–194. doi: 10.1055/s-0034-1367006.
    1. McCullough P.A., Gallagher M.J., DeJong A.T., Sandberg K.R., Trivax J.E., Alexander D., Kasturi G., Jafri S.M.A., Krause K.R., Chengelis D.L., et al. Cardiorespiratory fitness and short-term complications after bariatric surgery. Chest. 2006;130:517–525. doi: 10.1378/chest.130.2.517.
    1. Busetto L., Dicker D., Azran C., Batterham R.L., Farpour-Lambert N., Fried M., Hjelmesæth J., Kinzl J., Leitner D.R., Makaronidis J.M., et al. Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management. Obes. Facts. 2017;10:597–632. doi: 10.1159/000481825.
    1. Casali C.C.C., Pereira A.P.M., Martinez J.A.B., De Souza H.C.D., Gastaldi A.C. Effects of inspiratory muscle training on muscular and pulmonary function after bariatric surgery in obese patients. Obes. Surg. 2011;21:1389–1394. doi: 10.1007/s11695-010-0349-y.
    1. Pazzianotto-Forti E.M., Munno C.M.d.C., Merino D.F.B., da Rocha M.R.S., de Mori T.A., Rasera I., Jr. Effects of inspiratory exercise with linear and nonlinear load on respiratory variables post-bariatric surgery. Respir. Care. 2019;64:1516–1522. doi: 10.4187/respcare.05841.
    1. Carver T.E., Mayo N., Andersen R.E., Zavorsky G.S. Pilot investigation to evaluate changes in exercise capacity following a prehabilitation intervention among seriously obese patients awaiting bariatric surgery. Can. J. Diabetes. 2011;35:149. doi: 10.1016/S1499-2671(11)52045-3.
    1. Lecube A., Monereo S., Rubio M.Á., Martínez-de-Icaya P., Martí A., Salvador J., Masmiquel L., Goday A., Bellido D., Lurbe E., et al. Prevención, diagnóstico y tratamiento de la obesidad. Posicionamiento de la Sociedad Española para el Estudio de la Obesidad de 2016. Endocrinol. Diabetes Nutr. 2017;64:15–22. doi: 10.1016/j.endonu.2016.07.002.
    1. Dronkers J., Veldman A., Hoberg E., van der Waal C., van Meeteren N. Prevention of pulmonary complications after upper abdominal surgery by preoperative intensive inspiratory muscle training: A randomized controlled pilot study. Clin. Rehabil. 2008;22:134–142. doi: 10.1177/0269215507081574.
    1. Riddle M.C., Bakris G., Blonde L., Boulton A.J.M., D’Alessio D., Greene E.L., Hood K.K., Hu F.B., Kahn S.E., Kaul S., et al. Classification and diagnosis of diabetes: Standards of medical care in diabetes. Diabetes Care. 2019;42:S13–S28. doi: 10.2337/dc19-S002.
    1. Kotler D.P., Burastero S., Wang J., Pierson R.N. Prediction of body cell mass, fat-free mass, and total body water with bioelectrical impedance analysis: Effects of race, sex, and disease. Am. J. Clin. Nutr. 1996;64 doi: 10.1093/ajcn/64.3.489S.
    1. Hernandez G., Garin O., Pardo Y., Vilagut G., Pont À., Suárez M., Neira M., Rajmil L., Gorostiza I., Ramallo-Fariña Y., et al. Validity of the EQ–5D–5L and reference norms for the Spanish population. Qual. Life Res. 2018;27:2337–2348. doi: 10.1007/s11136-018-1877-5.
    1. Martínez-González M.Á., Corella D., Salas-salvadó J., Ros E., Covas M.I., Fiol M., Wärnberg J., Arós F., Ruíz-Gutiérrez V., Lamuela-Raventós R.M., et al. Cohort profile: Design and methods of the PREDIMED study. Int. J. Epidemiol. 2012;41:377–385. doi: 10.1093/ije/dyq250.
    1. Garner D.M., Elosua P., López-Jáuregui A., Sánchez-Sánchez F. EDI-Inventario de Trastornos de la Conducta Alimentaria-3. Editions Tea; Madrid, Spain:
    1. Schröder H., Fitó M., Estruch R., Martínez-González M.A., Corella D., Salas-Salvadó J., Lamuela-Raventós R., Ros E., Salaverría I., Fiol M., et al. A Short screener is valid for assessing mediterranean diet adherence among older spanish men and women. J. Nutr. 2011;141:1140–1145. doi: 10.3945/jn.110.135566.
    1. Stern A.F. The Hospital Anxiety and Depression Scale. Occup. Med. 2014;64:393–394. doi: 10.1093/occmed/kqu024.
    1. Carmen Terol-Cantero M., Cabrera-Perona V., Martín-Aragón M. Revisión de estudios de la Escala de Ansiedad y Depresión Hospitalaria (HAD) en muestras españolas. Ann. Psychol. 2015;31:494–503. doi: 10.6018/analesps.31.2.172701.
    1. Crapo R.O., Casaburi R., Coates A.L., Enright P.L., MacIntyre N.R., McKay R.T., Johnson D., Wanger J.S., Zeballos R.J. American Thoracic Society ATS Statement: Guidelines for the Six-Minute Walk Test. Am. J. Respir. Crit. Care Med. 2002;166:111–117. doi: 10.1164/rccm.166/1/111.
    1. Enright P.L., Sherrill D.L. Reference equations for the six-minute walk in healthy adults. Am. J. Respir. Crit. Care Med. 1998;158:1384–1387. doi: 10.1164/ajrccm.158.5.9710086.
    1. MacDermid J., Solomon G., Valdes K., Therapists of ASHT . ASHT Clinical Assessment Recommendations. 3rd ed. ASHT; Mount Laurel, NJ, USA: 2015.
    1. Graham B.L., Brusasco V., Burgos F., Cooper B.G., Jensen R., Kendrick A., Macintyre N.R., Thompson B.R., Wanger J. 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur. Respir. J. 2017;49:1–31. doi: 10.1183/13993003.00016-2016.
    1. Garcia-Rio F., Calle M., Burgos F., Casan P., del Campo F., Galdiz J.B., Giner J., Gonzalez-Mangado N., Ortega F., Puente Maestu L. Espirometria. Arch. Bronconeumol. 2013;49:388–401. doi: 10.1016/j.arbres.2013.04.001.
    1. American Academy of Sleep Disorders . International Classification of Sleep Disorders (ICSD-3) American Academy of Sleep Disorders; Darien, IL, USA: 2014.
    1. Kapur V.K., Auckley D.H., Chowdhuri S., Kuhlmann D.C., Mehra R., Ramar K., Harrod C.G. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: An American academy of sleep medicine clinical practice guideline. J. Clin. Sleep Med. 2017;13:479–504. doi: 10.5664/jcsm.6506.
    1. Mantilla Toloza S.C., Gómez-Conesa A. El Cuestionario Internacional de Actividad Física. Un instrumento adecuado en el seguimiento de la actividad física poblacional. Rev. Iberoam. Fisioter. Kinesiol. 2007;10:48–52. doi: 10.1016/S1138-6045(07)73665-1.
    1. Dindo D., Demartines N., Clavien P.A. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg. 2004;240:205–213. doi: 10.1097/.
    1. Marcon E.R., Baglioni S., Bittencourt L., Lopes C.L.N., Neumann C.R., Trindade M.R.M. What Is the Best Treatment before Bariatric Surgery? Exercise, Exercise and Group Therapy, or Conventional Waiting: A Randomized Controlled Trial. Obes. Surg. 2017;27:763–773. doi: 10.1007/s11695-016-2365-z.
    1. Hennis P.J., Meale P.M., Hurst R.A., O’Doherty A.F., Otto J., Kuper M., Harper N., Sufi P.A., Heath D., Montgomery H.E., et al. Cardiopulmonary exercise testing predicts postoperative outcome in patients undergoing gastric bypass surgery. Br. J. Anaesth. 2012;109:566–571. doi: 10.1093/bja/aes225.
    1. Baillot A., Mampuya W.M., Dionne I.J., Comeau E., Méziat-Burdin A., Langlois M.F. Impacts of Supervised Exercise Training in Addition to Interdisciplinary Lifestyle Management in Subjects Awaiting Bariatric Surgery: A Randomized Controlled Study. Obes. Surg. 2016;26:2602–2610. doi: 10.1007/s11695-016-2153-9.
    1. Baillot A., Vallée C.A., Mampuya W.M., Dionne I.J., Comeau E., Méziat-Burdin A., Langlois M.F. Effects of a Pre-surgery Supervised Exercise Training 1 Year After Bariatric Surgery: A Randomized Controlled Study. Obes. Surg. 2018;28:955–962. doi: 10.1007/s11695-017-2943-8.
    1. Marc-Hernández A., Ruiz-Tovar J., Aracil A., Guillén S., Moya-Ramón M. Impact of Exercise on Body Composition and Cardiometabolic Risk Factors in Patients Awaiting Bariatric Surgery. Obes. Surg. 2019;29:3891–3900. doi: 10.1007/s11695-019-04088-9.
    1. Bond D.S., Thomas J.G., Vithiananthan S., Unick J., Webster J., Roye G.D., Ryder B.A., Sax H.C. Intervention-related increases in preoperative physical activity are maintained 6-months after Bariatric surgery: Results from the bari-active trial. Int. J. Obes. 2017;41:467–470. doi: 10.1038/ijo.2016.237.
    1. Bond D.S., Thomas G., Vithiananthan S., Webster J., Unick J., Ryder B., Pohl D. Changes in enjoyment, self-efficacy, and motivation during a randomized trial to promote habitual physical activity adoption in bariatric surgery patients. Surg. Obes. Relat. Dis. 2016;12:1072–1079. doi: 10.1016/j.soard.2016.02.009.
    1. Camolas J., Santos O., Moreira P., do Carmo I. INDIVIDUO: Results from a patient-centered lifestyle intervention for obesity surgery candidates. Obes. Res. Clin. Pract. 2017;11:475–488. doi: 10.1016/j.orcp.2016.08.003.
    1. Kalarchian M.A., Marcus M.D., Courcoulas A.P., Cheng Y., Levine M.D. Preoperative lifestyle intervention in bariatric surgery: Initial results from a randomized, controlled trial. Obesity. 2013;21:254–260. doi: 10.1002/oby.20069.
    1. Kalarchian M.A., Marcus M.D., Courcoulas A.P., Cheng Y., Levine M.D. Preoperative lifestyle intervention in bariatric surgery: A randomized clinical trial. Surg. Obes. Relat. Dis. 2016;12:180–187. doi: 10.1016/j.soard.2015.05.004.
    1. Lier H., Biringer E., Stubhaug B., Tangen T. The impact of preoperative counseling on postoperative treatment adherence in bariatric surgery patients: A randomized controlled trial. Patient Educ. Couns. 2012;87:336–342. doi: 10.1016/j.pec.2011.09.014.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다