Obesity is a condition that results from an imbalance between caloric input and energy output. It is associated with numerous comorbidities, including cardiovascular disease, diabetes mellitus, obstructive sleep apnea, and osteoarthritis. In turn, these comorbidities may lead to serious health problems, functional limitations, and, in some cases, disability.
Intervention aimed at reducing body weight typically involves a combination of dietary treatment, exercise, and behavior modification. Patients who are morbidly obese often report that they have a poor quality of life, problems with joint pain, decreased mobility, functional limitations, and deconditioning prior to undergoing various types of bariatric surgery.
Operative intervention risks, abdominal incisions, and the complications associated with being on bedrest postoperatively often will exacerbate a patient’s impairments and functional limitations, and may create new deficits. Because physical therapy intervention is directed toward impairments and limitations in movement and function, patients who have bariatric surgery appear to be appropriate candidates for physical therapy examination and intervention both prior to and following surgery.
In addition, many of the comorbidities associated with obesity, such as diabetes, osteoarthritis, and cardiovascular disease, can be positively influenced by physical therapy intervention, making the primary and secondary medical diagnoses appropriate referrals for physical therapy.
Our group has developed a patient group centered exercise program, iExercise, that is led by skilled therapists with assistance from our fitness/yoga partner. Participants have the opportunity to attend 60-minute exercise sessions held one to four times per week.
Prior to entering and exiting the program, each participant has an individualized assessment of their musculoskeletal status with regard to flexibility, strength, endurance, and balance. This enables the exercise-session leaders to screen each participant and tailor exercise sessions to the needs of the individuals in each class.
The iExercise program at iPT uses various types of programming and educational materials to improve musculoskeletal status: low-impact aerobics in sitting and standing for endurance; exercise balls for balance and coordination; resistive bands and free weights for strengthening; self-stretching for flexibility; and slow, controlled movement for posture and body control. Education is provided during class sessions as take-home materials, and we email participants weekly to promote interactive education and communication.