1. Aspects of Exercise before or after Bariatric Surgery Pouwels, S; Wit, M; Teijink, JA; Nienhuijs, SW Monday 13th of July15:10-15:40

2. CONFLICT OF INTEREST Sjaak Pouwels I declare that I have no potential conflict of interest

3. Welcome Sjaak Pouwels, MD Resident and PhD student Catharina Hospital Obesity Centre Eindhoven, Netherlands

4. YOU DESERVE A RIBBON The surprised lady in front of me looked at me in total disbelief: “I’m sorry??” “Yes, I believe you deserve a ribbon; It’s quite something what you’ve pulled off: you lost almost 100 pounds.!” (Van Hout et al. 2015)

5. 5 (Un)realistic expectations?

6. We have some work to do! -Obesity = big problem -Associated with various diseases; Diabetes, Hypertension, dyslipidemia, OSAS -Bariatric surgery only treatment with longstanding effect 6

7. Perioperative Exercise -A reduction of 1.5 kg was contributed to exercise (Cochrane review Shaw et al. 2006) -Physical training in obese patients  4% Excess Weight Loss (%EWL) (Livhits et al. 2010) -Reduction of 3.6 kg related to exercise (Egberts et al. 2012) 7

8. What do we have to do? -The positive relationship between exercise seems evident 8 But what do we have to do? And when?

9. Materials and Methods (1) P: Obese patients with a BMI ≥ 30 kg/m 2 I: Exercise training C: Regular care (no specific exercise training) O: Improvement of anthropometric variables, physical fitness and cardiovascular risk factors 9

10. Types of exercise programs 10

11. Exercise before surgery Significant improvement of anthropometric variables (Baillot et al. 2013, Funderburk et al. 2010, Marcon et al. 2011) Significant improvement of cardiovascular risk factors and inflammation: -Blood pressure (Funderburk et al. 2010, Marcon et al. 2011) -Glucose, insulin and blood lipid profile (Marcon et al. 2011, Hickey et al. 1999) 11

12. Exercise before surgery (2) Significant improvement of physical fitness and functional capacity: -The six-minute walk test distance increased (Funderburk et al. 2010, Marcon et al. 2011, Baillot et al. 2013) 12

13. Exercise after surgery Significant improvement of anthropometric variables (Castello-Simoes et al. 2013, Stegen et al. 2011, Berggren et al. 2008, Shah et al. 2011) No significant changes in cardiovascular risk and inflammation Significant increase in fatty-acid oxidation (Berggren et al. 2008) Prevention of a decrease in muscle strength by an exercise program (Stegen et al. 2011) 13

14. Challenges in clinical practice -Supervision (by whom?) -Timing around surgery -What do we have to do 14

15. Conclusion -Exercise is good for everyone -Even for a (future) bariatric patient population -In current literature  Wide range of exercise programs and peri-operative timing 15

16. Thank you for your attention Exercise Is Good For Everyone! 16