Development of an Iranian Clinical Guideline on Perioperative Exercise Therapy for Metabolic and Bariatric Surgery: A...

This guidance aims to advance current understanding of the benefits of exercise therapy and to present an exercise protocol for the preoperative and postoperative periods surrounding metabolic and bariatric surgery (MBS).

A panel of experts conducted a comprehensive review of the existing literature in databases such as PubMed, Scopus, and Web of Science to gather evidence. Studies involving exercise interventions before and/or after metabolic and bariatric surgery were included. A three-round Delphi process and the AGREE (Appraisal of Guidelines for Research and Evaluation) Checklist were used to facilitate the development of the practice approach. Selected clinical questions were addressed through a consensus-based protocol, with 94% agreement on the final 16 recommendations.

A total of 16 clinical recommendations were formulated. The benefits of incorporating exercise therapy, as well as the optimal timing and specific protocols for exercise before and after MBS, are highlighted. The recommendations include initiating structured exercise at least three months before surgery and implementing combined aerobic and resistance exercise after surgery. These recommendations emphasize the importance of exercise therapy in improving physical function and metabolic conditions, promoting weight and fat loss, and preventing weight regain.

This guidance draws on the latest scientific evidence. Providing clinicians and patients with obesity with an evidence-based approach to practice could help improve quality of life and reduce the burden on society and patients' families. Candidates for MBS are recommended to initiate a structured exercise program at least three months before surgery and to continue long-term participation in combined aerobic and resistance exercise after MBS to optimize metabolic health and body composition outcomes.