Prebariatric Surgery Physical Exercise Training in Telehealth
Condition: Obesity
Study type: Interventional

Summary: 
      The aim of our study is to evaluate the feasibility of a supervised training session using
      telehealth in the "Clinique medico-chirurgicale du traitement de l'obésité de Sherbrooke"
      (CMCTO) and its impact on health, physical fitness, quality of life and satisfaction of
      subjects. 6 subjects awaiting bariatric surgery will be recruited. In addition to usual care,
      subjects will perform additional sessions of supervised endurance and resistance exercise
      training. Subjects will be instructed to perform two supervised exercise sessions per week
      with telehealth plus one without supervision during 12 weeks. The following outcomes will be
      assessed before and after the telePreSET, then 12 months after bariatric surgery: 1- physical
      fitness (6MWT, maximal strength, symptom-limited cardiac exercise test); 2-health related
      quality of life (Laval questionnaire); 3-weight, height, body composition (bioelectrical
      impedance scale); 4-comorbidities and metabolic parameters (files and blood samples);
      5-exercise beliefs (Physical Exercise Belief questionnaire); 6-physical activity
      (GPAQuestionnaire and actimeter). The feasibility will be assessed with a satisfaction
      questionnaire concerning physical activity management, dropout and compliance rates, as well
      as the number of injuries and accidents. The results of this research will give us
      preliminary data for future projects in order to improve support of bariatric surgery
      candidates to assure optimal results for their health. Also, we will contribute to the
      advancement of scientific knowledge, absent in the current literature in this population.
    

Detailed description: 
      Background: Obesity class II and III increased most rapidly over the past 25 years in Canada
      and USA. This alarming situation has significantly increased the number of bariatric
      surgeries performed in North America (101,645 surgeries in 2011). Indeed, bariatric surgery
      has demonstrated its long-term efficacy in maintaining significant weight loss and in
      lowering mortality, while reducing the health-care costs of obesity. Unfortunately, bariatric
      surgery does not always present optimal results in terms of weight loss and resolution of
      comorbidities, and may be the cause of perioperative complications. The effectiveness of
      bariatric surgery and the number of perioperative complications are influenced by various
      factors such as initial weight or physical fitness/activity. For this reasons, various
      experts recommend regular physical activity in order to optimize the results of bariatric
      surgery and to decrease perioperative morbidity. However, no interventional studies including
      pre-surgery exercise training is available in the literature. Preliminary results showed that
      a supervised Pre-Surgical Exercise Training (PreSET) is feasible and improved physical
      fitness and quality of life and decreased embarrassment during exercise (Baillot et al.
      2013). However, 71.3 % (n = 57) of patients who refused to participate in PreSET explain
      their refusal because of their schedule, reduced mobility or distance from the hospital.
      Telehealth is growing and often used for the rehabilitation of cardiac and pulmonary
      patients. Indeed, it allows to provide equal access to care for people who are geographically
      remote and are physically and economically disadvantaged. Studies showed that telehealth
      improve the quality of health care, and may be as effective as face to face meetings to
      improve the health of patients. The recent decrease in costs related to the equipment makes
      this intervention modality more accessible. However, no study is available in subjects
      awaiting bariatric surgery.

      Hypothesis and Objectives: Investigators hypothesize that a Telehealth Pre-Surgical Exercise
      Training (telePreSET) is feasible and will improve the health, physical fitness, quality of
      life, compliance and satisfaction of subjects. The aim of our study is to evaluate the
      feasibility in the "Clinique medico-chirurgicale du traitement de l'obésité de Sherbrooke"
      (CMCTO) of the telePreSET and its impact on health, physical fitness, quality of life and
      satisfaction of subjects.

      Method: 6 subjects awaiting bariatric surgery will be recruited. In addition to usual care,
      subjects will perform before bariatric surgery additional sessions of supervised endurance
      and resistance exercise training. Subjects will be instructed to perform two supervised
      exercise sessions per week with telehealth plus one without supervision during 12 weeks. The
      following outcomes will be assessed in the different groups before and after the telePreSET,
      then 12 months after bariatric surgery: 1- physical fitness (6MWT, maximal strength,
      symptom-limited cardiac exercise test); 2-health related quality of life (Laval
      questionnaire); 3-weight, height, body composition (bioelectrical impedance scale);
      4-comorbidities and metabolic parameters (files and blood samples); 5-exercise beliefs
      (Physical Exercise Belief questionnaire); 6-physical activity (GPA Questionnaire and
      actimeter). The feasibility will be assessed with a satisfaction questionnaire concerning PA
      management, dropout and compliance rates, as well as the number of injuries and accidents.

      Issue: The results of this research will give us preliminary data for future projects in
      order to improve support for bariatric surgery candidates to assure optimal results for their
      health. Also, we will contribute to the advancement of scientific knowledge, absent in the
      current literature in this population.
    

Intervention name(s): Telehealth supervised exercise training
Intervention type(s): Behavioral
Intervention description(s): Endurance and strength training (3x/week during 12 weeks)
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Severely obese; Bariatric surgery; Physical activity; Physical fitness; Telehealth; Quality of life