Comparing minimally supervised home-based and closely supervised gym-based exercise programs in weight reduction and insulin resistance after bariatric surgery: A randomized clinical trial

Abstract

Background: Effectiveness of various exercise protocols in weight reduction after bariatric surgery has not been sufficiently explored in the literature. Thus, in the present study, we aimed at comparing the effect of minimally supervised home-based and closely supervised gym-based exercise programs on weight reduction and insulin resistance after bariatric surgery. Methods: Females undergoing gastric bypass surgery were invited to participate in an exercise program and were randomly allocated into 2 groups using a random number generator in Excel. They were either offered a minimally supervised home-based (MSHB) or closely supervised gym-based (CSGB) exercise program. The CSGB protocol constitutes 2 weekly training sessions under ACSM guidelines. In the MSHB protocol, the participants received a notebook containing a list of recommended aerobic and resistance exercises, a log to record their activity, and a schedule of follow-up phone calls and clinic visits. Both groups received a pedometer. We measured their weight, BMI, lipid profile, FBS, and insulin level at baseline and at 20 weeks after the exercises, the results of which were compared using t test or Mann-Whitney U test at the end of the study. All the processes were observed by 1 senior resident in sport medicine. Results: A total of 80 patients were recruited who were all able to complete our study (MSHB= 38 and CSGB= 42). The baseline comparison revealed that the 2 groups were similar. The mean change (reduction) in BMI was slightly better in CSGB (8.61 95% CI 7.76–9.45) compared with the MSHB (5.18 95% CI 3.91–6.46); p< 0.01. However, the 2 groups did not have a statistically significant difference in the amount of change in the other factors including FBS and Homa.ir. Conclusion: As we expected a non-inferiority result, our results showed that both MSHB and CSGB exercise methods are somewhat equally effective in improving lipid profile and insulin resistance in the 2 groups, but a slightly better effect on BMI was observed in CSGB group. With considerably lower costs of minimally supervised home- based exercise programs, both methods should be considered when there is lack of adequate funding.

Does Lifestyle Intervention After Gastric Bypass Surgery Prevent Weight Regain? A Randomized Clinical Trial

“…Despite some weight regain, the proportion of participants with metabolic risk factors remained unchanged in both groups. Several RCTs have aimed at improving weight loss postsurgery [7][8][9][10][11][34][35][36]. The majority of these RCTs have described no differences in weight loss between intervention groups (that received counselling in dietary habits, physical activity, and/or cognitive therapy) and control groups [9,11,34,35].…”

“…One study found a short-time moderately greater total weight loss in the dietary counselling group that was not maintained beyond the intervention [8]. Some studies show beneficial effect of lifestyle intervention on weight loss start prior to or shortly after surgery [7,10,36] and include only Hispanic Americans [10] or only females [7,36]. Kaviani et al found better weight loss with a closely supervised 20wk exercise programme compared with a minimally supervised exercise programme [36].…”

“…Some studies show beneficial effect of lifestyle intervention on weight loss start prior to or shortly after surgery [7,10,36] and include only Hispanic Americans [10] or only females [7,36]. Kaviani et al found better weight loss with a closely supervised 20wk exercise programme compared with a minimally supervised exercise programme [36]. Improved weight loss is also observed in non-randomized lifestyle intervention studies that selectively target patients with weight regain post-surgery [12][13][14][15].…”

Factors Related to Weight Loss Maintenance in the Medium–Long Term after Bariatric Surgery: A Review

“…Increased physical activity has been associated with greater weight loss after bariatric surgery [ 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 ]. Furthermore, close supervision and monitoring of exercise programs support greater weight loss compared to minimally supervised programs [ 85 ]. Egberts et al [ 78 ] in a systematic review of observational studies (on 3852 patients) found a relationship between increased physical exercise (measured by physical activity questionnaires) and weight loss after bariatric surgery (LAGB and RYBG).…”

Are Perceived Barriers to Exercise and Level of Interest in Fitness Programs Different Between Preoperative and Postoperative Bariatric Surgery Groups?

“…Bariatric clinics can assist patients in increasing their physical workouts by providing them with visual home exercise routines (DVDs or internet uploaded files) [9]. Home-, outside-, or gym-based physical exercise have been shown to have similar beneficial results on weight loss [10]. Even though all the benefits of exercise are communicated to all pre-and post-operative bariatric surgery patients, there are studies that show non-adherence to physical workout routines by the majority (more than 60%) of patients following bariatric surgery [11].…”