MDNews - Greater Kansas

increased at a greater rate than physica l activit y or weight loss," Herring says. "This may suggest wa lking improves as a result of weight loss, a lthough physica l activit y is likely required for improve- ments to be maintained once the rate of weight loss slows or plateaus." T h e n a t u r e o f t h e l i n k b e t w e e n improved physica l activity and function a nd weight loss a f ter ba riatric surger y rema ins unclea r, but it may be related to the body 's inf lammator y response to shedding pounds, according to Adolfo Z. Ferna ndez, MD, Associate Professor of Surger y at Wa ke Forest Baptist Hea lth in Nor th Ca rolina . " There's a decrease in inf la mmation a nd inf la mmator y ma rkers that tra ns- lates into less a r thritis a nd joint pa in," Dr. Ferna ndez says. "Less pa in tra ns- lates into more activity, which we know helps with joint pa in. Psycholog ica lly, [weight loss] improves the way patients see t hem selves. They a lways tel l us their energ y is better a f ter the weight is off, like they 've gotten a bra nd-new batter y pack a nd have this new energ y a nd wa nt to get out a nd use it." O t h e r r e s e a r c h e r s h a v e n o t e d improvements in physica l function and joint pa in following ba riatric surger y. I n a 2 016 s t udy i n JA M A , a mu lt i- institutiona l tea m of investigators led by resea rchers from the Universit y of Pittsburgh found that about 58 percent of participants experienced less overa ll pain, 77 percent enjoyed better physica l function, a nd 60 percent had improved wa lk times 12 months af ter weight-loss surger y. Approximately 75 percent of patients with severe knee or hip pa in or disabilit y saw improved knee pa in and hip function. Rates of improvement in overa ll pa in a nd physica l f unction declined sig nif ica ntly bet ween yea rs one a nd three a f ter surger y. THE EXERCISE IMPERATIVE T he nex t t a sk for resea rcher s i s t o understa nd more f u l ly why patients are able to be more active after bariatric surger y a nd how to better use exercise to improve outcomes. "Results from current exercise tria ls suggest the importance of structured exerci se a f t er ba r i at r ic s u r ger y t o optimize physica l activ it y, physica l function and fat mass loss, [as well as] preserve fat-free mass," Herring says. "More exercise interventions are needed after surger y. The majority of current exercise inter ventions a re initiated within the early postoperative stages. Physica l activity interventions should a lso be utilized to optimize weight-loss outcomes a ssociated w it h ba r iatr ic surgery and improve patients' physica l function and overall quality of life. Thus, more exercise interventions at the point of weight regain, typica lly experienced 12 to 24 months post-bariatric surgery, could be more benefi cia l and possibly incorporated into routine care." ■ The Long View ADOLFO Z. FERNANDEZ, MD, Associate Professor of Surgery at Wake Forest Baptist Health in North Carolina, thinks obtaining longer-term data is a crucial next step for investigators of physical activity and function in bariatric surgery patients. "The next generation of studies will look at how increased physical activity will change body composition and body function long term," Dr. Fernandez says. "What are we seeing three to fi ve, and then ultimately 10 to 15, years down the road? Are patients maintaining increased activity and improving body composition and fat mass loss? Is fat-free mass increasing? Are they preserving muscle mass and bone mass? As there is less fat mass pressing on the bones, you're going to lose bone mass, but as you start to increase fat-free mass, hopefully that will help preserve bone mass." Dr. Fernandez hopes additional research will demonstrate bariatric surgery confers benefi ts beyond those that are already well-known. "Hopefully, [more research] will further support that what we do with weight- loss surgery not only impacts diabetes, sleep apnea and high blood pressure but also affects physical function and joint disease," he says. "Those areas really have not been researched as much because of the diffi culties of keeping patients in studies for long periods that are focused just on those things." Function after Bariatric Procedures BY THOMAS CROCKER 1 7 M D N E W S . C O M /// M D N E W S G R E AT E R K A N S A S ■ D E C 2 016 /J A N 2 017

• Cover