Question

You are working at a bariatric center and a patient comes to you for pre-operative exercise counseling. Your role is to assess and counsel/ prescribe patients on exercise prior and post-surgery. With this, each patient must participate in at least 8 weeks of an exercise program prior to surgery.

Patient Profile: the patient is 48 years old, weight is 345 pounds; BMI= 57 kg/m2. She had a recent oral glucose tolerance test result of 285 mg/dl, TC= 290 mg/dl; TG= 560 mg/dl; HDL = 19 mg/dl. She also has sleep apnea and is developing arthritis in both knees. She takes 120 units of Lantus (basal insulin); 25 units Humalog (rapid insulin) per 3 meals; 80 mg of Zocor; 100mg Atenolol; 1500 mg Niaspan and Valsartan 160 mg twice daily.

Her goal with the laparoscopic adjustable gastric banding surgery is to lose 200 pounds and discontinue all her medications. She is getting the surgery so she does not have to try another diet and fail. She also hates to exercise so having this surgery will help her avoid exercising to lose weight. However, she realizes that she has to comply with your 8 week program to get the surgery.

Using the FITT principle, what would your exercise plan look like? Do we need to be concerned with the medications regarding exercise induced responses?

Answer 1

Patient is 48 yrs old. She is overweight. Her glucose level and cholesterol level is increased. She also has sleep apnea and is developing arthritis in both kness.

Her goal with the laproscopic adjustable gastric banding surgery is to lose 200 pounds and discontinue all her medications,which she has been taking for a while.

Gastric bypass and other weight loss surgeries known collectively as bariatric surgery - involve making changes to your digestive system to help you loss weight. Bariatric surgery is done when diet and exercise haven't worked or when you have a serious health problems because of your weight.you must have to undergo an 8 weeks exercise program based on FIIT principle prior to surgery.

The FIIT principles are an exercise prescription to help participants understand how long and how hard they should exercise. FIIT stands for frequency, intensity, time and type. FIIT principle can help you get the results you want from a workout in a timely manner with limited risk of burning out or getting hurt.

Overload and progression are two basic principles of FIIT. Overload refers to the amount of load or resistance, providing a greater stress or load, on the body that it is normally accustomed to in order to increase fitness. Progression is the way in which an individual should increase the load.

8 weeks preoperative exercise program consist of activities such as slow walking, slow bike riding(less than 10miles/ hour), dancing, stretching, weight lifting - light workout.

Frequency-.. Do some type of physical activity every day.

Intensity -.. Choose an activity that is at least moderate in intensity,and also try to add a few more vigorous activities over the week. But in this case since the patient is having arthritis and diabetic mellitus, we will avoid vigorous exercise.

Time-.. Plan on a total time of atleast 60 minutes of activity each day. This can be done all at once or added together over several shorter 10 to 15 minutes blocks of activity.

Type-.. Type of activity can include a variety team sports, individual sports, recreational activities, family activities, active hobbies, and walking or bicycling. Most important thing is to choose something fun.

Medications is also carried out along with exercise. The point to be noted is that patient should monitor her blood sugar level periodically before taking insulin. The sugar level can be vary due to the systematic exercise.