Effects of Exercise Training in Individuals Undergoing Bariatric Surgery
Condition: Obesity
MeSH terms: Obesity
Study type: Interventional

Summary: 
      The subject of the research; Effects of exercise training on cardiometabolic risk factors and
      functional capacity in individuals undergoing bariatric surgery.

      Purpose of the research; Cardiometabolic risk factors, body composition, muscle strength and
      endurance, posture, foot sense, physical exercise capacity, balance, pain, exercise benefits
      - barriers, exercise self-efficacy, exercise beliefs, to evaluate the effects on body esteem,
      body image and quality of life.

      Method of Research:

      Post-surgical interventions are important in individuals who have undergone bariatric
      surgery. Intervention programs that include exercise, encourage the change in the lifestyle
      of individuals, effectively and accurately reduce post-surgical obesity. Functional Exercise
      Training, which can also be used for obesity treatment, consists of stretching, aerobics,
      strengthening and balance training. Therefore, it has a positive effect on body systems. In
      addition, Home Exercise Training can be used within the scope of obesity treatment. Exercise
      is one of the alternative methods by providing the adaptation of the individual to the
      exercise. Socio-demographic and physical characteristics of individuals will be recorded.
      Laboratory tests will be ordered for cardiometabolic risk factors. Body composition will be
      determined by Tanita brand body analysis monitor (MC-780MA). Posture will be evaluated by
      photogrammetry technique. Muscle strength assessment will be evaluated by leg, back and hand
      dynamometer instrument, muscle endurance tests, sensory assessment by foot sense assessment,
      physical capacity with physical exercise capacity tests, balance static and dynamic balance
      tests and pain questionnaire. Exercise benefits-barriers will be assessed by Exercise
      Benefits Barriers Scale, exercise self-efficacy by Exercise Self-Efficacy Scale. Exercise
      beliefs will also be questioned with a questionnaire. Self-esteem will be evaluated for all
      groups before and after treatment. The self respect will be evaluated by using the Rosenberg
      Self-Esteem Scale, body image with the Body Image Scale, with the quality of life using the
      Obesity-Specific Quality of Life Scale.The training will be carried out 3 days a week for 8
      weeks, approximately 1 hour. Sufficient number of assessments and exercises will be used for
      individuals to become familiar with the equipment and training protocol.
    

Detailed description: 
      Obesity is defined as abnormal or excessive fat accumulation in the body to the extent that
      it disrupts health. The prevalence of obesity is increasing day by day in developed and
      developing countries. While 600 million of the world population were obese in 2014, this
      situation reached 700 million in 2015, and when the trend continues in the same way, it is
      thought that more than 3 billion people will have overweight or obesity in 2030. Therefore,
      the worldwide prevalence of morbid obesity will increase rapidly. Obesity is a risk factor
      especially for cardiovascular disease and causes an increase in mortality and morbidity with
      the central accumulation of adipose tissues. It affects the muscle, liver, subcutaneous and
      intra-abdominal regions, especially due to intraabdominal and / or visceral fat. As a result,
      cardiometabolic complications occur, as it causes physical inactivity, muscle strength and
      endurance are affected, posture is affected, physical performance is affected, self-esteem,
      body image, health-related quality of life and exercise avoidance occur. It has been reported
      that approximately 91% of obese individuals complain of musculoskeletal pain, 69% of them
      have back pain and 58% have knee pain.

      When the literature is examined, it is seen that conservative therapies such as nutrition,
      exercise and drug management are used intensively in the treatment of obesity, more invasive
      methods are more prominent today and bariatric surgery is preferred by many people. Studies
      emphasize that non-surgical methods fail to achieve permanent success compared to surgical
      methods. Obese individuals undergoing bariatric surgery have reported a large diet history
      that failed to stop weight gain, starting in adolescence. It has been reported that obese
      individuals experience higher levels of symptoms such as stress, anxiety, depression, food
      cravings and psychological effects such as lower self-esteem compared to normal weight
      individuals, and this situation continuously increases weight gain. For this reason,
      bariatric surgery has become increasingly common in the fight for effective weight loss. The
      postoperative process in which exercise and lifestyle changes are adopted after bariatric
      surgery is important. With the prominence of bariatric surgery in the studies performed, if
      weight loss management is not planned well after surgery, weight gain and complications occur
      after surgery, and it is seen that the effect of the surgery performed decreases. Weight
      recovery in this population also increases the likelihood of the return of obesity-related
      comorbidities. Insufficient physical activity and inadequate nutritional support after
      surgery cause sarcopenia. Therefore, it is an important anabolic stimulant for the prevention
      of muscle protein synthesis and sarcopenia formation, together with adequate nutritional
      support, together with early physical activity after surgery.

      Increasing physical activity, exercise and lifestyle changes are important in maintaining the
      weight given during the postoperative period, reducing muscle loss and increasing fat
      burning. The purposes of exercise training given in the post-surgery period in obese
      individuals are to increase body fat mass loss, protect muscle mass, and improve physical and
      mental health. Although there are studies in which exercise training is important following
      bariatric surgery, there is insufficient evidence regarding the interventions of different
      exercise protocols. Finding the best exercise protocols, increasing body fat mass loss and
      preserving muscle mass is important as part of the post-surgical guideline. Studies have
      reported that physical exercise is a positive predictor of outcome after bariatric surgery.
      Intervention programs that include exercise are reported to effectively reduce obesity and
      comorbidity by encouraging individuals to change their lifestyle after such surgery. Studies
      have shown that exercise is considered an effective mediator for correcting insulin
      resistance, effectively reduces indicators of obesity such as body mass index (BMI) and body
      fat percentage, and reduced risk factors for cardiovascular diseases. Therefore, the main
      purpose of the study is to evaluate the effects of exercise training on cardiometabolic risk
      factors and functional capacity in individuals who have undergone bariatric surgery. There is
      no such exercise protocol study conducted in Cyprus. The investigators are of the opinion
      that the research is an interesting study in this respect.

      Functional Exercise Training is a type of exercise that includes training for stretching,
      aerobics, strengthening and balance. Studies on obese individuals have reported a positive
      effect on body composition, functional capacity and quality of life.

      Home Exercise Training, on the other hand, is one of the alternative methods of exercise that
      maximizes the sustainability of behavioral change by providing adaptation to exercise
      throughout life. It is an option that will increase an individual's physical activity
      compliance.

      Evidence regarding the effectiveness of Functional Exercise Training and Home Exercise
      Training in Individuals Undergoing Bariatric Surgery is insufficient and it is necessary to
      know and clarify the differences create. It is necessary to clarify whether individuals
      continue the exercise in their daily lives and whether the continuity of the effects of the
      exercise should be addressed. In this context, the content and effects of the exercise
      programs to be applied to individuals who have undergone bariatric surgery are important in
      Cyprus for future multifactorial situations and may guide individuals.
    

Intervention name(s): Functional Exercise Training Group; Home Exercise Training Group
Intervention type(s): Other; Other
Intervention description(s): Training will start with Stretching Training and end with stretching training. Stretching exercises targeting actively applied shoulder girdle, chest, neck, trunk, hip, front and back leg and ankle muscle groups will be given. Afterwards, it will be continued with Aerobic Exercise Training. The training will be given on the treadmill "Treadmill Technogym". Afterwards, it will be continued with Strengthening Training. Strength training will consist of a strengthening program that includes the lower extremity, upper extremity, trunk and core region. Elastic bands will be used in the training. Then, balance training will be given at the end.; Training will start with Stretching Training and end with stretching training. Stretching exercises targeting actively applied shoulder girdle, chest, neck, trunk, hip, front and back leg and ankle muscle groups will be given. Afterwards, it will be continued with Aerobic Exercise Training. They will walk at least 30 minutes, 3 days a week for 8 weeks at outdoor. Afterwards, it will be continued with Strengthening Training. Strength training will consist of a strengthening program that includes the lower extremity, upper extremity, trunk and core region. Elastic bands will be used in the training. Then, balance training will be given at the end.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Bariatrics; Obesity; Bariatric Surgery