Patients' views and experiences of live supervised tele-exercise classes following bariatric surgery during the COVID-19 pandemic: The BARI-LIFESTYLE qualitative study.

Friedrich C Jassil,Adrian Brown,Rachel L Batterham,Helen Kingett,Gemma Montagut‐Pino,Amy Kirk,Jacqueline Doyle,Kusuma Chaiyasoot,Neville Lewis,Kalpana Devalia,Rebecca Richards,Alisia Carnemolla,Chetan Parmar

doi:10.1111/cob.12499

Abstract

SummaryThe BARI‐LIFESTYLE trial is a randomized controlled trial evaluating the efficacy of a post‐surgery nutritional and behavioural tele‐counselling, and supervised exercise programme to maximize the health benefits of bariatric surgery. Due to the coronavirus disease 2019 (COVID‐19) pandemic, the in‐person supervised exercise component had to be converted to remote tele‐exercise. However, patients' acceptability of this method of exercise provision is unknown. Between 3 and 6 months following bariatric surgery, 13 adults participated in weekly, structured, 60‐min supervised exercise classes delivered via Zoom by a trained exercise therapist. A total of 12 participants (n = 8 female), with a mean age of 46.3 (range 33–63) years, who had undergone either sleeve gastrectomy (n = 8) or Roux‐en‐Y gastric bypass (n = 4) surgery, participated in one‐to‐one semi‐structured interviews following the tele‐exercise classes. Interviews were audio‐recorded, transcribed verbatim and analysed using thematic analysis. Participants described how the tele‐exercise classes helped them to cope with the changes to their lives brought about by the COVID‐19 pandemic. Participants found the tele‐exercise schedule, content and intensity to be acceptable, and were satisfied with the privacy, security and safety of the technology and classes. Professional supervision and guidance from an exercise therapist were described as central to the tele‐exercise provision. Importantly, participation in the tele‐exercise provided physical, emotional and social benefits. Few participants reported barriers to participation. Overall, the tele‐exercise classes were deemed acceptable and compared favourably to in‐person exercise classes.

Highlights

In March 2020, the UK government imposed a nationwide lockdown to contain the spread of the coronavirus disease 2019 (COVID-19),[13] which we know had a negative impact on mental health and health-related behaviours such as physical activity, especially for people living with obesity.[14]
Most participants described how the COVID-19 pandemic had negatively impacted many aspects of their daily routines, which made it challenging to adhere to the post-bariatric surgery lifestyle recommendations
Participants described how tele-exercise classes helped them to cope with the changes to their lives due to the COVID-19 pandemic including how it helped them in adhering to the lifestyle change required post-surgery

Summary

Introduction

Bariatric surgery is currently the most effective treatment option for people living with severe obesity[1]; approximately 20%–33% of patients experience poor weight loss outcomes and weight regain over the long term.[2,3,4] Exercise provides additional health benefits after bariatric surgery[5] but the majority of patients do not meet the recommended level of physical activity and studies suggest that more than 60% of their waking time is spent in sedentary behaviour.[6,7,8,9,10] Post-bariatric exercise services help patients to adopt and/or maintain exercise behaviours access to these is limited.[11]. In order to maintain the integrity of BARI-LIFESTYLE, the supervised exercise component was modified to be delivered remotely via Zoom, a cloudbased video conferencing service (referred to hereafter as tele-exercise).[15] With the advancement in digital communication technology, health systems worldwide are looking to integrate online delivery of services to improve the overall efficiency and effectiveness of care.[16] The acceptability of such technology for patients is essential for the successful implementation and uptake of such services. The use of telehealth to deliver exercise programmes in patients pre- and postbariatric surgery is scarce.[17] In view of this, the present study sought to: (1) explore experiences and views of patients who have undergone bariatric surgery on supervised tele-exercise classes, (2) identify the barriers to, and limitations of such classes, and (3) identify points of intervention that could be targeted to optimize the delivery and safety of, and adherence to, a future tele-exercise programme

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Discussion

Conclusion