Impact of a 12-week supervised exercise program on weight loss trajectory, daily physical activity levels and sedentary behaviors after bariatric surgery

Background The evidence suggests that physical activity (PA) following bariatric surgery can enhance weight loss and other metabolic outcomes. However, most individuals with severe obesity are insufficiently active, and without support, fail to make substantial increases in their daily PA levels postoperatively. Purpose The aim of this study was to investigate the effectiveness of a 12-week supervised exercise program on daily PA levels, sedentary time, and on maintenance of the weight loss trajectory following bariatric surgery. Methods Fifty-nine individuals with severe obesity (body mass index [BMI] ≥40 or ≥35 kg/m2 with comorbidities) eligible for bariatric surgery were randomly assigned (1:2) to either standard of care (CG, n=19) or a 12-week supervised exercise program (ExG, n=40). Daily PA levels and sedentary time were assessed using an armband accelerometer worn over a 3-day period (2 week-day and 1 weekend day). Body weight, body fat and fat-free mass were assessed using bioelectrical impedance balance. The exercise training program (60 min, 3 times per week for 12 weeks) started 3 months after the bariatric surgery and was supervised by a certified clinical exercise physiologist. Daily PA levels, sedentary time and anthropometric measurements were obtained preoperatively, and at 3, 6 and 12 months after bariatric surgery. Results Age of participants was 42±12 years, BMI was 46±6 kg/m2, and 76% were women. Before the exercise training program, PA parameters (daily PA levels, sedentary time and moderate to vigorous intensity PA [MVPA] were comparable between groups. Following the exercise training program, the ExG showed a significant reduction in sedentary time (753±113 to 721±88 min/day), an increase in daily PA levels (4544±1863 to 5853±3101 steps/day) and in MVPA levels (18.8±25.1 to 30.5±38.1 min/day). Further increase in daily MVPA levels were observed at the 12 months follow-up visit (p=0.05). In the standard of care group, changes in PA parameters were also comparable to those in the ExG. All anthropometric measurements indicate statistically significant changes postoperatively, after the intervention and up to 12 months follow-up (p<0.001) without showing any difference between groups. Anthropometric changes up to 12 months follow-up show, respectively for CG and ExG, a total weight loss of 37.8±9.3% and 38.4±10.3%, a body fat reduction of 60.4±13.7% and 61.9±15.2% and fat-free mass loss of 16.6±5.4% and 15.1±7.9%. Conclusion This study shows that bariatric surgery candidates have low PA levels and rarely engage in MVPA. We found no additional effect to the standard of care treatment of a postoperative 12-week supervised exercise training program on weight loss trajectory, daily PA levels and sedentary behaviors. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research (CIHR)Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval (IUCPQ - UL)

Supervised Exercise Immediately After Bariatric Surgery: the Study Protocol of the EFIBAR Randomized Controlled Trial

Background Previous studies have investigated weight loss caused by exercise following bariatric surgery. However, in most cases, the training program is poorly reported; the exercise type, volume, and intensity are briefly mentioned; and the sample size, selection criteria, and follow-up time vary greatly across studies. Purpose The EFIBAR study aims to investigate over 1 year the effects of a 16-week supervised exercise program, initiated immediately after bariatric surgery, on weight loss (primary outcome), body composition, cardiometabolic risk, physical fitness, and quality of life in patients with severe/extreme obesity. Material and Methods The EFIBAR study is a parallel-group, superiority, randomized controlled trial (RCT), comprising 80 surgery patients. Half of the participants, randomly selected, perform a 16-week supervised exercise program, including both strength and aerobic training, starting immediately after the surgery (7–14 days). For each participant, all primary and secondary outcomes are measured at three different time points: (i) before the surgery, (ii) after the intervention (≈4 months), and (iii) 1 year after the surgery. Conclusion The EFIBAR study will provide new insights into the multidimensional benefits of exercise in adults with severe/extreme obesity following bariatric surgery. Trial Registration EFIBAR randomized controlled trial was prospectively registered at Clinicaltrials.gov (NCT03497546) on April 13, 2018. Graphical abstract

Effects of a Targeted Exercise Program on Inter-Leg Asymmetries in Patients with Patellofemoral Pain

Patellofemoral pain (PFP) is often associated with impaired muscle strength, flexibility, and stability. It has been suggested that inter-leg asymmetries have an important role in increasing the risk of musculoskeletal injuries, including PFP. Thus, the aim of this study was to identify significant asymmetries and determine the effects of a symmetry targeted exercise program in patients with PFP. Eighteen patients aged 13 to 54 years (24.17 ± 12.52 years) with PFP participated in this study. Strength, flexibility and stability outcomes of the trunk, hip, knee and ankle muscles were assessed. A single-group pretest–posttest design was used to assess changes in inter-leg and agonist–antagonist asymmetries resulting from the 8-week period of the supervised exercise program. Results indicated a significant improvement in inter-leg symmetry regarding bilateral stance in a semi-squat position (p = 0.020, d = 0.61, df = 17) and ankle plantarflexion (p = 0.003, d = 0.32, df = 17) and ankle dorsiflexion strength (p < 0.001, d = 0.46, df = 17). In addition, the ratio of ankle dorsiflexion/plantarflexion (p = 0.036, d = 1.14, df = 17) and hip extension/flexion (p = 0.031, d = 0.94, df = 16) changed significantly during the intervention period. To our knowledge, this was the first study to evaluate inter-leg asymmetries resulting from a period of a supervised exercise program. The results indicate that an exercise program focusing on individual asymmetries may influence specific deficits and contribute to better rehabilitation outcomes.

EFFECT OF KINESIOTAPING ON PAIN, RANGE OF MOTION, PHYSICAL PERFORMANCE AND FUNCTIONAL DISABILITY IN PATIENTS WITH KNEE OSTEOARTHRITIS- A RANDOMIZED CONTROL TRIAL

Aim of Study: The aim of the study was to conduct a randomized control study to check the efciency of kinesiotaping in Knee Osteoarthritis patients. Material and Method: 30 subjects both male and female with unilateral / bilateral knee osteoarthritis were included in the study as per inclusion and exclusion criteria. Awritten informed consent was signed by the subjects in their own language. The subjects were assigned into two groups, Group (A) Experimental Group (n=15): received treatment with kinesiotaping and supervised exercise program. Group (B) Control Group (n=15): received treatment with supervised exercise program only. Outcomes were measured by Numerical Pain Rating Scale (NPRS), modied Western Ontario and McMaster universities OA index (m. WOMAC), Timed Up and Go test (TUG) and Goniometer. Appropriate statistical tool was applied. Result: The result showed that there was signicant (p<0.05) improvement in NPRS, m.WOMAC, TUG and ROM in both groups A & B after 6 weeks of treatment. But when compared between group A & B; group A showed signicant (p<0.05) improvement as compared to group B. Conclusion: The Kinesiotaping along with supervised exercise program showed statistically signicant improvement in reducing pain, functional disability increasing range of motion and physical performance as compared to the Supervised exercise program alone. Thus, Kinesiotaping along with supervised exercise program was more effective as compared to the supervised exercise program alone.

374 Cognitive Behavioral Therapy with Exercise in Adults with Insomnia and Short Sleep: Daytime Function Outcomes from a Pilot Study

Introduction Cognitive behavioral therapy for insomnia (CBT-I) is efficacious, but there is mixed evidence as to whether improvement is blunted in adults with insomnia and short sleep duration. Exercise training can reduce physiologic hyperarousal and may increase homeostatic sleep drive, which could potentiate CBT-I treatment effects. This pilot study explored changes in self-reported outcomes from a CBT-I intervention augmented by exercise training in a sample of adults with insomnia and objective short sleep duration. Methods Eight adults (50% female, 62.5% white) with insomnia disorder and short sleep duration (mean actigraphic TST &lt;6.5 hr) completed a 12-week single-arm trial. Participants self-administered the online “Sleep Healthy Using the Internet” (SHUT-I) CBT-I program with additional staff guidance while completing a supervised exercise program (EX; 150 min/wk of moderate-intensity aerobic exercise and 2 days/wk of strength training). Participants completed assessments of self-reported sleep and daytime function pre- and post-intervention, including the Insomnia Severity Index (ISI), Flinders Fatigue Scale (FFS), Ford Insomnia Response to Stress Test (FIRST), Perceived Stress Scale (PSS), and Epworth Sleepiness Scale (ESS). Differences between timepoints were analyzed using paired t-tests and Cohen’s d effect size calculations. Results Insomnia severity significantly decreased after the intervention (ISI: p&lt;0.001, d=2.99), with 75% reporting post-intervention ISI ≤ 7. Likewise, fatigue significantly decreased after the intervention (FFS: p=0.032, d=0.95). Symptoms of stress-related sleep reactivity and stress were also reduced (FIRST: p=0.012, d=1.19; PSS: p=0.014, d=1.14). Though nonsignificant, large reductions in sleepiness were additionally observed (ESS: p=0.058, d=0.80). Conclusion In this pilot trial among patients with insomnia and short sleep duration, online CBT-I plus a supervised exercise program resulted in a significant reduction in insomnia severity. The intervention also produced large and meaningful reductions in fatigue and stress, which are common daytime impairments in patients with insomnia. Future research should attempt to disentangle the independent contributions of CBT-I and exercise on outcomes in this population. Support (if any) NIH: K23HL118318