Die Rolle der körperlichen Aktivität im Kontext der bariatrischen Chirurgie

Zusammenfassung

Die Prävalenz der Adipositas steigt seit mehreren Jahrzehnten. Damit einhergehend steigt die Anzahl der jährlich durchgeführten bariatrischen Operationen sukzessive an. Die deutsche S3-Leitlinie „Chirurgie der Adipositas und metabolischer Erkrankungen“ empfiehlt präoperativ für die meisten Patienten eine multimodale Therapie, die auch eine Bewegungstherapie beinhaltet. Eine solche strukturell verankerte Bewegungstherapie findet sich in den Empfehlungen zur Nachsorge nicht. Eine alleinige Bewegungstherapie führt präoperativ in aller Regel nicht zu signifikanten Gewichtsreduktion. Dies ist jedoch bei einem Teil der Patienten möglich in Kombination mit einer Ernährungs- und/oder Verhaltenstherapie. Durch eine Bewegungstherapie kann jedoch eine über den Zeitpunkt der Operation hinausreichende, erhöhte körperliche Aktivität erreicht werden, die sich positive auf einen möglichen Weight Regain auswirkt. Für den Einfluss einer Bewegungstherapie nach einem bariatrischen Eingriff auf den Gewichtsverlust ist die Datenlage widersprüchlich. Allerdings wirkt sie sich ebenso wie die präoperative Bewegungstherapie positiv auf einen Weight Regain aus. Darüber hinaus scheint ein positiver Einfluss auf die Knochendichte und somit auf das nach bariatrischen Operationen erhöhte Frakturrisiko zu bestehen.

Abstract

Obesity is a growing worldwide pandemic. Subsequently, the number of bariatric procedures performed is constanly increasing. The German guideline for bariatric and metabolic surgery recommends a multimodale therapy including an exercise program prior to surgery for most patients. Such a recommendation for a structured exercise program is missing in the follow up period. Exercise programs alone do not lead to significant weight loss. But combined with diet therapy and/or behavioural therapy significant weight loss can be achieved. Exercise programs result in an increased level of physical activity, which is maintained beyond the procedure and therefore may prevent a weight regain. Available data for postoperative exercise programs is inconsistent. However, there is a positive effect on weight regain. Furthermore, people undergoing postoperative exercise programs showed a lower decrease in bone mineral densitiy, thus reducing the elevated risk of fracture in postbariatric patient.

Schlüsselwörter

Adipositas - bariatrische Chirurgie - körperliche Aktivität - Gewichtsreduktion

Key words

obesity - bariatric surgery - physical activity - weight reduction

Publication History

Article published online:
03 March 2023

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