Optimising the Bariatric Patients’ Outcome through Cardiac Rehabilitation Approach

Abstract

Bariatric surgery offers a therapeutic alternative with favourable weight management, cardiovascular, metabolic and functional outcomes. Bariatric individuals often have functional impairments pre-operatively that can be addressed to improve post-operative results and eventual functional independence. Multidisciplinary team offers the best approach to address peri-operative needs and sustainable weight loss thereafter. We exemplified the application of cardiac rehabilitation therapeutic model in managing two bariatric clients with specific bariatric-related challenges. Our approach focuses on adaptive physical activity, sustainable lifestyle changes to promote post-operative weight loss through education and problem solving as well as secondary prevention of cardiovascular disease. Putting emphasis on addressing physical and psychosocial barriers towards physical activity alongside nutritional aspects potentially confers sustained if not better outcomes on weight reduction and functional improvement.

From Prehab to Rehab: The Functional Restoration of a Bariatric Individual

“…The results exemplified that mild and severely disabled bariatric individuals with orthopaedic comorbidities can significantly experience functional improvements independent of the weight loss sustained; with the higher BMI and younger individuals showing the most functional gains. Similarly, Hanapi et al employed an approach based on the cardiac rehabilitation model and resources for inpatient bariatric clients with CVD risk factors and orthopaedic comorbidities [9]. Employing adapted physical activity and exercise prescription, dietary modification, provision of psychological and social support, their approach successfully addressed weight, cardiometabolic profile optimisation prior to bariatric surgical intervention and conferring postoperative improvement in mood, dependency level, perceived physical and mental health during the postoperative phase with sustained functional capacity, endurance and quality of life up to 3 months post operatively.…”

“…Open discussion on equipment use and transfer techniques can lead the way to more serious discussions on dietary habits, adapting lifestyles and long-term functional goals. Education on the importance of physical activity and dietary management to aid weight loss and maintain functional independence helps boost motivation and compliance [9]. Discharge planning should include not just physical preparation of the destination.…”

“…Adapted exercises have been successful to prevent multisystem deconditioning from zero-gravity environment or from prolonged bed rest [20,21]. Hanapi et al demonstrated a 6-weeks bariatric surgery prehabilitation [9] consisting of patient education and prescription of therapeutic exercises, dietary modification and nutritional-behavioural counselling, the use of technological advancement to facilitate early non-weight bearing aerobic and resistance exercises that had successfully prepared the bariatric patients for the demands of the surgery as well as facilitated early post-operative mobilisation that has been purported to reduce post-surgical morbidity [22,23]. This model adapted the principles of cardiac rehabilitation in formulating the evaluation, intervention and outcomes including risk-stratifying the bariatric surgery candidates for cardiovascular risk during exercise participation, quantifying exercise capacity for exercise prescription and addressing CVD risk factors that can complicate anaesthetic and postoperative care.…”

“…Using a cardiac rehabilitation model is effective to cause significant improvement in bariatric individuals' cardio-metabolic profile [31]. Hanapi et al demonstrates the application of cardiac rehabilitation principle for post-bariatric surgery patients which include risk stratification through the use of submaximal exercise stress testing to objectively quantify the patient's cardiovascular capacity for exercise participation, subsequent exercise prescription based on the individuals' physical impairments and cardiovascular functioning, lifestyle modification to manage cardiovascular risk factors and translating the gains of cardiorespiratory and musculoskeletal fitness into more functional activities [9].…”

“…Education on the importance of physical activities to aid weight loss and maintain functional independence helps boost motivation and compliance. This ultimately affects their level of independence, quality of life and self-efficacy [9].…”