What is the role for preoperative physical training and respiratory kinesitherapy in obese surgical patients?

Abstract

The role of exercise and physical therapy in the treatment of obesity remains debatable. Those who believe in respiratory kinesitherapy believe that this intervention may prevent or reduce the impact of anesthesia and surgery on the respiratory muscles and on postoperative pulmonary complications. Exercise (especially when combined with diet) has a positive effect on body weight and cardiovascular disease risk factors in overweight and obese patients. If physical fitness can be linked to surgical outcome, then improving fitness by means of physical training as an intervention should theoretically improve postoperative outcome. There is evidence that less fit patients do have a greater risk of complications and death and prehabilitation does improve health-related quality of life and fitness levels. Although there is a paucity of studies on this topic, this chapter will try to address some questions, including Can preoperative training improve fitness in morbidly obese patients and does this translate to better outcome? and What are the key elements of such a preoperative training: modality, frequency, duration, intensity and pattern?.