In Reply We agree with Dr Soriano-Maldonado and colleagues that future studies would benefit from evaluating whether participation in exercise programs or change in physical activity level following bariatric surgery are associated with changes in pain and physical function. These associations were not examined in the study due to a lack of information regarding participation in exercise programs and objective physical activity data in the full Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) cohort, although the discussion noted that physical activity participation may contribute to changes in pain and function. The associations of function and pain with physical activity level in subsets of the LABS-2 cohort who wore an activity monitor have been examined.1,2 At baseline, perceived and objectively measured walking limitations were associated with less physical activity (ie, fewer steps per day and minutes per week of moderate-to-vigorous intensity physical activity).1 Also, more bodily pain prior to surgery was associated with less physical activity 1 year postsurgery after adjustment for baseline physical activity level and other potential confounders.2 Because observational studies have found most patients only make small changes in objectively measured physical activity following bariatric surgery, with few meeting physical activity guidelines,3,4 a randomized clinical trial may be required to adequately evaluate whether physical activity or exercise provides benefit in pain or physical function following bariatric surgery.
King WC, Chen J, Belle SH. Pain and Physical Function Following Bariatric Surgery—Reply. JAMA. 2016;316(7):771. doi:10.1001/jama.2016.8593