Role of the exercise professional in metabolic and bariatric surgery.

BACKGROUND: Physical activity (PA) is important for the long-term health and weight management of patients who undergo metabolic and bariatric surgery (MBS). However, the roles of exercise professionals in MBS settings have not been systematically determined. OBJECTIVES: To investigate: (1) who are the professionals implementing PA programming in MBS clinical settings; and (2) what patient-centric tasks do they perform? SETTING: Clinical and academic exercise settings worldwide. METHODS: This multimethod study included a scoping review of PA programs in MBS described in the research literature. Data about job tasks were extracted and provided to 10 experts to sort into categories. Cluster analysis was utilized to find the hierarchical structure of tasks. A Delphi process was used to agree on a final model. RESULTS: The majority of PA professionals were exercise physiologists in the USA and physiotherapists or other types of exercise professionals elsewhere. Forty-three tasks were identified, the most reported being supervision of exercise, fitness testing, and exercise prescription. Seven higher-order categories were determined: (1) Exercise-related health assessment, (2) Body composition and physical fitness assessment, (3) Lifestyle physical activity and sedentary behavior assessment, (4) Education, instruction, and prescription, (5) Exercise monitoring, (6) Behavioral counseling and psychosocial support, and (7) Dietary support. The following statements were rated an average of 9.0, classifying them as "imperative": 1) "Pre- and postoperative PA/exercise guidelines for MBS patients are needed", 2) "MBS programs need to include PA/exercise as part of multidisciplinary care". CONCLUSIONS: The expert group reached a consensus on 7 major classifications of job tasks for the exercise professional. It is important for governing medical associations across the world to formally recognize experienced exercise professionals as playing pivotal roles in continuing, multidisciplinary care for MBS patients. These findings also provide evidence-based information in the effort to solidify these positions within the greater context of healthcare.

Role of the exercise professional in metabolic and bariatric surgery.

Background: Physical activity (PA) is important for the long-term health and weight management of patients who undergo metabolic and bariatric surgery (MBS). However, the roles of exercise professionals in MBS settings have not been systematically determined. Objectives: To investigate: (1) who are the professionals implementing PA programming in MBS clinical settings; and (2) what patient-centric tasks do they perform? Setting: Clinical and academic exercise settings worldwide. Methods: This multimethod study included a scoping review of PA programs in MBS described in the research literature. Data about job tasks were extracted and provided to 10 experts to sort into categories. Cluster analysis was utilized to find the hierarchical structure of tasks. A Delphi process was used to agree on a final model. Results: The majority of PA professionals were exercise physiologists in the USA and physiotherapists or other types of exercise professionals elsewhere. Forty-three tasks were identified, the most reported being: supervision of exercise, fitness testing, and exercise prescription. Seven higher-order categories were determined: (1) Exercise-related health assessment, (2) Body composition and physical fitness assessment, (3) Lifestyle physical activity and sedentary behavior assessment, (4) Education, instruction, and prescription, (5) Exercise monitoring, (6) Behavioral counseling and psychosocial support, and (7) Dietary support. The following statements were rated an average of 9.0, classifying them as "imperative": 1) "Pre- and post-operative PA/exercise guidelines for MBS patients are needed", 2) "MBS programs need to include PA/exercise as part of multidisciplinary care". Conclusions: The expert group reached a consensus on 7 major classifications of job tasks for the exercise professional. It is important for governing medical associations across the world to formally recognize experienced exercise professionals as playing pivotal roles in continuing, multidisciplinary care for MBS patients. These findings also provide evidence-based information in the effort to solidify these positions within the greater context of healthcare.

Presenteeism among health care workers: literature review.

Presenteeism is an occupational and psychosocial phenomenon with negative impact on the work environment. In addition to causing losses in productivity losses, it also has implications for the state of health of workers. Therefore, presenteeism is likely to become a serious public health problem. The aim of the present study was to discuss the implications, means for evaluation and impact of presenteeism on the health and work of health care workers. We performed a literature search in database PubMed using keywords presenteeism, absenteeism, nurse presenteeism, physician presenteeism, sickness presenteeism, physician health organization, and working sick. We conclude that adequate assessment, raising the health managers' awareness about the risks and harms associated with this phenomenon, and developing management tools will contribute to reduce the impact of presenteeism. This seems to be the proper path to make this problem more visible and hinder its growth.

O presenteísmo é um fenômeno ocupacional e psicossocial que afeta o ambiente de trabalho, acarretando perdas na produtividade e implicações na condição de saúde dos trabalhadores, com potencial para tornar-se um grave problema de saúde pública. O objetivo deste trabalho foi discorrer sobre implicações, formas de avaliação e repercussões na saúde e na prestação de serviços entre os trabalhadores da saúde. O presente estudo foi realizado mediante busca de artigos do PubMed utilizando palavras-chave como: presenteeism, absenteeism, nurse presenteeism, physician presenteeism, sickness presenteeism, physician health organization e working sick. Concluiu-se que avaliar corretamente o presenteísmo por meio de conscientizar gestores de saúde sobre os riscos e malefícios desse fenômeno e propor ferramentas para manejar essa condição contribuirão para reduzir o seu impacto nos ambientes de trabalho. Esse parece ser o caminho para dar visibilidade a esse problema e evitar o seu crescimento.

Presenteísmo entre trabalhadores da saúde: revisão da literatura / Presenteeism among health care workers: literature review

O presenteísmo é um fenômeno ocupacional e psicossocial que afeta o ambiente de trabalho, acarretando perdas na produtividade e implicações na condição de saúde dos trabalhadores, com potencial para tornar-se um grave problema de saúde pública. O objetivo deste trabalho foi discorrer sobre implicações, formas de avaliação e repercussões na saúde e na prestação de serviços entre os trabalhadores da saúde. O presente estudo foi realizado mediante busca de artigos do PubMed utilizando palavras-chave como: presenteeism, absenteeism, nurse presenteeism, physician presenteeism, sickness presenteeism, physician health organization e working sick. Concluiu-se que avaliar corretamente o presenteísmo por meio de conscientizar gestores de saúde sobre os riscos e malefícios desse fenômeno e propor ferramentas para manejar essa condição contribuirão para reduzir o s

Presenteeism is an occupational and psychosocial phenomenon with negative impact on the work environment. In addition to causing losses in productivity losses, it also has implications for the state of health of workers. Therefore, presenteeism is likely to become a serious public health problem. The aim of the present study was to discuss the implications, means for evaluation and impact of presenteeism on the health and work of health care workers. We performed a literature search in database PubMed using keywords presenteeism, absenteeism, nurse presenteeism, physician presenteeism, sickness presenteeism, physician health organization, and working sick. We conclude that adequate assessment, raising the health managers' awareness about the risks and harms associated with this phenomenon, and developing management tools will contribute to reduce the impact of presenteeism. This seems to be the proper path to make this problem more visible and hinder its growth.

What Is the Best Treatment before Bariatric Surgery? Exercise, Exercise and Group Therapy, or Conventional Waiting: a Randomized Controlled Trial.

OBJECTIVE: This trial's objective was to investigate the effect of an exercise program with and without cognitive-behavioral therapy (CBT), compared by a control group, on weight, functional capacity, and cardiometabolic profile of morbidly obese individuals while waiting for bariatric surgery. MATERIALS AND METHODS: This randomized controlled trial investigated the effect of a 4-month low-intensity exercise program (two weekly sessions of 25 min each) on 66 morbidly obese individuals awaiting bariatric surgery. Participants were randomly divided into three groups: EXER, exercise program; EXER + CBT, exercise program plus support group sessions for lifestyle modification, with a CBT; and CONTROL, routine treatment. They were compared on weight, functional capacity, and cardiometabolic profile. RESULTS: The weight change (Kg) was -7.4 (-9.6 to 5,1); -4,2 (-6,8 to -1.6) and 2.9 (0.4 to 5.3) and the BMI change (kg/m2) was -2.7 (-3.6 to -1.8); -1.4 (-2.4 to -0.4) and 1.1 (0.1 to 2.1) for groups EXER, EXER + CBT, and CONTROL, respectively. Changes were significant when compared to the control group (p < 0.001), but there were no differences between the two intervention arms (p = 0.2). Functional capacity and cardiometabolic parameters significantly improved in the intervention arms and worsened in the control group. The adherence to the exercise program in both groups was above 78 %. CONCLUSION: A 4-month, twice-weekly supervised program of low-intensity physical activity that encourages individuals to adopt a more active lifestyle can positively interfere with weight loss and improvement in functional capacity and cardiometabolic parameters of morbidly obese individuals with and without the aid of support group sessions.

Intervenção nutricional em grupo de funcionários com sobrepeso ou obesidade praticantes de atividade física: um ensaio clínico randomizado / Nutritional intervention in a group of overweight or obese practitioners of physical activity: a randomized clinical trial

Objetivo: Avaliar o impacto da intervenção nutricional em praticantes de atividade física com sobrepeso ou obesidade. Métodos: Ensaio clínico randomizado com adultos praticantes de atividade física com sobrepeso ou obesidade (n=35). Os indivíduos foram divididos em dois grupos: controle (n=15) e intervenção (n=20). Ambos os grupos foram submetidos a um protocolo de exercício misto composto de atividades aeróbicas e com pesos durante três meses. O grupo intervenção recebeu prescrição de dieta individualizada e acompanhamento nutricional. Foram mensurados peso e estatura para cálculo posterior do IMC, circunferência abdominal, circunferência de quadril, percentual de massa magra e percentual de gordura corporal. Resultados: O grupo intervenção reduziu 3 kg de peso ao final do estudo, enquanto o grupo controle, apenas 1 kg (p=0,008). Após três meses, o IMC (p=0,008) e a relação cintura-quadril (p=0,011) foram menores no grupo intervenção. Conclusões: A intervenção nutricional aliada à atividade física promoveu redução no peso, IMC e RCQ em grupo de praticantes de atividade física com sobrepeso ou obesidade.

Aim: To evaluate the impact of nutritional intervention in overweight or obese practitioners of physical activity. Methods: Randomized clinical trial of overweight or obese adult practitioners of physical activity (n=35). The subjects were divided into two groups: control (n=15) and intervention (n=20). Both groups were submitted to a mixed exercise protocol of aerobic activities and weight training during three months. The intervention group was prescribed an individualized diet and nutritional follow-up. Weight and height were measured to calculate later BMI, waist circumference, hip circumference, percentage of lean mass, and percentage of body fat. Results: The intervention group reduced 3 kg at the end of the study, whereas the control group reduced only 1 kg (p=0.008). After three months, both BMI (p=0.008) and waist–hip ratio (WHR) (p=0.011) were reduced in the intervention group. Conclusions: Nutritional intervention combined with physical activity promoted reduction in weight, BMI, and WHR in a group of overweight or obese practitioners of physical activity.

[Impact of a minimum program of supervised exercises in the cardiometabolic risk in patients with morbid obesity]. / Impacto de um programa mínimo de exercícios físicos supervisionados no risco cardiometabólico de pacientes com obesidade mórbida.

OBJECTIVE: The objective aims at evaluating the impact of a minimum program of supervised physical exercise on functional capacity and cardiometabolic risk (CMR) in patients with morbid obesity. MATERIAL AND METHODS: By studying cases with pre and post analyses, we have assessed the variations in weight, functional capacity and in CMR, due to the program of supervised aerobic exercise on a weekly intensity of 30 minutes during a period of 6 months. RESULTS: We have studied 61 subjects, where 34 have only adhered to the intervention. There were significant changes in weight (-5.3 ± 5.3 kg, p < 0.0001), distance in the 6-minute walking test (69.8 ± 48.6 m, p < 0.0001), systolic pressure (-23.8 ± 27.7 mmHg, p < 0.0001), diastolic pressure (-14.4 ± 8.9 mmHg, p < 0.0001) and Framingham Score Risk (-4.4 ± 5.1, p < 0.0001) in the adherent patients. CONCLUSION: The results show that a supervised exercise program of low intensity and frequency might interfere positively on CMR in individuals with morbid obesity.

Impacto de um programa mínimo de exercícios físicos supervisionados no risco cardiometabólico de pacientes com obesidade mórbida / Impact of a minimum program of supervised exercises in the cardiometabolic risk in patients with morbid obesity

OBJETIVO: Avaliar o impacto de um programa mínimo de exercícios físicos supervisionados na capacidade funcional e fatores de risco cardiometabólicos (FRCM) em obesos mórbidos. MATERIAL E MÉTODOS: Estudando uma série de casos com análise tipo pré e pós e amostragem por conveniência, avaliou-se o efeito de um programa semanal de 30 minutos de exercícios aeróbicos supervisionados, durante seis meses, no peso, na capacidade funcional e nos FRCM. RESULTADOS: Estudaram-se 61 indivíduos, dos quais 34 aderiram à intervenção. Nos aderentes, houve modificações em peso (-5,3 ± 5,3 kg, p < 0,0001), teste de caminhada de 6 minutos (69,8 ± 48,6 mts, p < 0,0001), pressão sistólica (-23,8 ± 27,7 mmHg, p < 0,0001), pressão diastólica (-14,4 ± 8,9 mmHg, p < 0 0001), escore de Framingham (-4,4 ± 5,1, p < 0,0001). CONCLUSÃO: Os resultados sugerem que exercícios físicos supervisionados em baixa intensidade e frequência podem interferir positivamente nos FRCM de indivíduos obesos mórbidos.

OBJECTIVE: The objective aims at evaluating the impact of a minimum program of supervised physical exercise on functional capacity and cardiometabolic risk (CMR) in patients with morbid obesity. MATERIAL AND METHODS: By studying cases with pre and post analyses, we have assessed the variations in weight, functional capacity and in CMR, due to the program of supervised aerobic exercise on a weekly intensity of 30 minutes during a period of 6 months. RESULTS: We have studied 61 subjects, where 34 have only adhered to the intervention. There were significant changes in weight (-5.3 ± 5.3 kg, p < 0.0001), distance in the 6-minute walking test (69.8 ± 48.6 m, p < 0.0001), systolic pressure (-23.8 ± 27.7 mmHg, p < 0.0001), diastolic pressure (-14.4 ± 8.9 mmHg, p < 0.0001) and Framingham Score Risk (-4.4 ± 5.1, p < 0.0001) in the adherent patients. CONCLUSION: The results show that a supervised exercise program of low intensity and frequency might interfere positively on CMR in individuals with morbid obesity.