The Effect of Supervised Exercise on Physical Fitness and Energy Expenditure in Post Bariatric Surgery Patients

Inclusion criteria

• RYGB or GB surgery patients who are at least 12 weeks post surgery
• BMI of 40 or more
• age 18-70years
• sedentary lifestyle (energy expenditure of <35 kcal/kg/day measured by 7-day physical activity recall and no regular moderate physical activity exceeding 20 min/day within the previous 3 months)
• willingness to alter physical activity in accordance with the intervention programs
• English or Spanish speaking.

Exclusion criteria

• body weight > 180 kg
• cardiovascular disease
• pulmonary disease
• uncontrolled hypertension (resting DBP >100 or SBP >180 mm of Hg)
• visual or hearing impairment
• functional limitations (difficulty walking one-quarter mile or climbing 10 stairs)
• abnormal ECG on VO2max test ( >1 mm ST segment depression at < 5 METS or with symptoms such as atrial fibrillation, complex ventricular arrhythmias and 3rd degree atrioventricular block)
• known liver disease due to causes other than nonalcoholic steatohepatitis (liver transaminases > 2.5 times the upper limits of normal [SGPT>105 U/L, SGPT>120 U/L] or total bilirubin >1.5 mg/dL)
• hematocrit of less than 30%
• current alcohol abuse (>7 drinks or 210 g/wk for women and >14 drinks or 420 g/wk for men)
• recreational drug abuse
• current use of any drugs capable of inducing weight loss (e.g., orlistat, sibutramine, topiramate, etc.)
• major neuro-psychiatric illnesses impeding competence or compliance
• pregnancy and lactation
• chronic renal insufficiency (serum creatinine > 2 mg/dL)
• untreated thyroid disorders such as hypothyroidism and hyperthyroidism; and 17) bariatric surgical complications including anastomotic leak, wound complications, thrombotic disorders, intestinal obstruction, stomal complications, GI bleeding, recurrent severe abdominal pain, bilious vomiting.