ENCOURAGEing Start: A Quasi-Experimental Trial on Pre-Op Physical Activity Intervention for Bariatric Surgery Candidates

INTRODUCTION: The American Society for Metabolic and Bariatric Surgery recommends pre- and post-operative physical activity. However, there are no surgery-specific physical activity guidelines or standardized programs tailored for individuals preparing for metabolic and bariatric surgery, including programs that integrate structured behavior change approaches. A novel pre-operative physical activity intervention, ENCOURAGEing Start, was developed and piloted to assist patients in reducing barriers to physical activity and encouraging positive physical activity habits. METHODS: This single arm pilot study recruited patients (n = 27, BMI = 47.1 ± 6.2 kg/m²) from the Victoria General Hospital's Centre for Metabolic and Bariatric Surgery in Winnipeg, Manitoba between September 2017 and May 2018. A time-series quasi-experimental design was used. The 16-week intervention took place at the University of Manitoba's Active Living Centre. The primary outcome was a six-minute walk test, a measure of functional ability and predictive of post-surgical weight loss and maintenance. Secondary outcomes included fitness, cardiovascular disease risk, and mental health. Outcomes were evaluated at baseline, 8 weeks, and 16 weeks. RESULTS: Ten patients completed the intervention. Statistically significant (p ≤ 0.05) differences in the six-minute walk test (457.21 vs. 497.58 m, p = 0.002), indirect 1RM leg press (128.7 vs. 150.4 kg, p < 0.001), 30 second chair stand test (12.78 vs. 14.82 repetitions, p < 0.01), and Laval quality of life (181.89/308 vs. 195.96/308, p = 0.028) were identified for completers. CONCLUSIONS: The ENCOURAGEing Start intervention enhanced markers linked to long-term post-surgery outcomes, including a 10.7% improvement in the six-minute walk test. This feasible program showed a similar effect size to more resource intensive interventions, including those in Canada. A larger study with a minimum of 55 participants should be undertaken to assess the sustainability of these effects.