LAUSR

Dear Editor, In the past years, obesity has been a major contributor to a variety of diseases, and secondly, a recent population based study performed by Ng et al. [1] showed that the obesity epidemic has reached epidemic proportions. Dietary and exercise interventions have gained increasing public health and governmental attention. However, bariatric surgery is the only treatment option with long-term significant weight loss and remission of comorbidities. Exercise interventions prior to bariatric surgery seem interesting because of their effect on physical activity and quality of life and can be a valuable addition to standard lifestyle interventions [2–4]. The BariActive trial from Bond et al. [4] showed that physical exercise interventions in the 6 weeks prior to bariatric surgery have a significant effect on physical capacity compared to the standard care group. These results were supported by a randomized controlled trial by Marcon et al. [3] that showed a 4month, twice-weekly supervised program of low-intensity physical exercise can be valuable in the perioperative bariatric care. Also, small-sample randomized controlled trials by Coleman et al. [5] and Baillot et al. [6] showed that perioperative exercise interventions can be beneficial for bariatric patients in adopting a more active lifestyle and can interfere positively with weight loss and improvement in functional capacity and cardio-metabolic parameters. There was no difference in patients attending these interventions with or without the aid of support group sessions according to both studies [5, 6]. These studies provide us with very promising results in terms of lifestyle change and increase in exercise capacity; however, implementing these programs seems to be very difficult. In current literature, there is no consensus on what type of exercise programs (either strength, endurance training, or both) is most effective. To adequately assess the effect of physical exercise interventions in obese individuals, an indepth analysis or the perioperative timing and type of exercise is needed. A recent systematic review [2] showed that there are different effects of the timing of exercise and the type of exercise. Preoperative exercise interventions showed a significant decrease in cardiovascular risk factors, whereas postoperative interventions did not. Mainly, this result can be contributed to the effect of the bariatric surgical intervention on cardiovascular risk factors and anthropometric variables [2]. Secondly, they summarized their results and recommended an exercise intervention that lasts for a median of 12 weeks, had an intensity of median 65% peak heart rate/VO2 max, and at least partially supervised [2]. It is well known that exercise has significant positive results on weight loss and other anthropometric variables. However, it seems difficult to determine which type of exercise is beneficial, because of a lack of standardized exercise regimens and uniformity in outcome variables. Therefore, there is increasing need for large-sample randomized studies to assess the additive value, type of exercise, and perioperative * Sjaak Pouwels [email protected]