Commiseration about kids and phone calls led to a fast friendship between Mandy Schey and Shawn Zierke, both graduate students in the University of Iowa College of Public Health. That connection eventually sparked an idea for a new fitness program designed for patients receiving weight loss surgery at the UI.

Although the program Schey developed has been in place just a short time, it’s “brought a new dynamic to our clinic,” says Judy Swift, a nurse with the Bariatric Surgery Clinic at the UI Hospitals and Clinics.

It all started last year, when Zierke sat next to Schey in class and began their acquaintance with an apology.

“I told her, ‘I’m sorry if my phone rings, I have five kids,’” recalls Zierke. “And Mandy’s like, ‘What are you talking about? I have three kids. My phone’s going to ring.’ And it was Mandy’s phone that buzzed the whole time.”

That mom moment forged an instant bond between the two women, who are both pursuing Master of Public Health (MPH) degrees. Zierke is a student in the MPH in Policy program and Schey, who worked as a physical therapist before returning to school, is set to graduate this May with an MPH degree in community and behavioral health.

As a capstone experience for the degree, students complete a 200-contact-hour practicum project in a public health setting. Schey had lined up a practicum for the spring 2013 semester, but hit an unexpected bump when the plans fell through.

"Then Shawn had an idea,” says Schey.

Zierke was aware that the UI’s Bariatric Surgery Clinic didn’t have a physical fitness program for patients, and suggested that Schey might be able to fill this gap.

“I decided to talk to the surgeons and dietitian there to see what the situation was, and they were very excited about the idea of including a physical activity component,” says Schey, who then centered her practicum around the development of a fitness intervention for the clinic’s patients.

“The reason I suggested [the practicum idea] to her was that I had gastric bypass surgery 7 ½ years ago in Maryland,” says Zierke, adding that the clinic where she had the surgery recommended exercise but provided no physical activity program.

“I lost 118 pounds, but all I did was have the surgery,” says Zierke. “I didn’t change anything other than how my diet had to change as a limitation of my altered anatomy. So, of course, after the initial weight loss, things start to creep back. I gained back 60 pounds.”

To achieve long-term weight loss, diet and exercise must be addressed in tandem, Schey says. She saw an opening where a fitness component could be introduced at the UI clinic during bariatric patients’ pre-surgery visits.

“In order to be a candidate for bariatric surgery and for insurance reasons, patients need to come six times within six months to talk to the dietitian,” Schey explains. “So they’re coming every month, and that’s a perfect opportunity for them to get some kind of fitness program as well.”

Working with clinical dietitian Amy Lukas as her practicum preceptor, Schey set out to increase awareness among the surgical staff of the importance of offering and following up on the fitness component to their patient care plan. She also designed, demonstrated, and facilitated customized fitness plans for each patient.

To do this, Schey met with pre-operative patients to assess their level of physical fitness, ability to exercise, availability of fitness equipment at home, and any other barriers and opportunities for activity.

“Some of our patients can’t work out 30 minutes a day due to their weight or joint pain,” says Swift, the bariatric nurse coordinator. “But Mandy came up with a plan for every instance. She assigned individualized exercises that can be done in a chair, for example. She’d demonstrate how to do it and have the patient show it back to her. You could see the ‘aha’ moment in people’s faces when they’d get it.”

Schey also tackled the logistics to enable pre-operative bariatric patients to be referred to the UI Cardiac Rehabilitation Clinic (CHAMPS) for a physical assessment and stress test.

“I connected the bariatric clinic to CHAMPS, and we worked out that almost every patient can get a fitness evaluation from CHAMPS paid for by their insurance because they are obese,” says Schey .

CHAMPS has exercise equipment at locations in the UI Hospitals and Clinics as well as Iowa River Landing. Schey also coordinated an initiative that allows patients with qualifying insurance to visit CHAMPS for six monthly follow-up sessions at a low cost. Patients can use the fitness equipment and work with a coordinator there to develop an exercise plan and assess their progress.

Schey also created handouts with pictures depicting simple exercises and an exercise log for patients to bring back to their monthly appointments. Patients need to show that they can lose some amount of weight prior to surgery in order to demonstrate that they can be compliant with dietary requirements after surgery, Schey says.

“We’re looking for some sort of documentation of improvement. With the log, it’s measurable,” says Swift. “Before, [improvement in exercise] was just discussion.”

“Mandy’s had a major impact on our program,” adds Lukas.

In addition to forming the direct relationship between the bariatric surgery clinic and CHAMPS, Schey put out feelers to other areas within the hospital, opening up new lines of communication among programs with the potential to work with bariatric patients.

As a result, Swift is currently exploring the possibility of having physical therapy students complete a rotation with pre- and post-operative bariatric patients.

“These patients have such specific needs, and as the population grows in weight, they will be representative of the kinds of people they will see in practice,” Swift says.

Plus, working with bariatric patients is rewarding, Schey says. “It’s an incredible population to work with. They want to make a change.”

As for Zierke, she found new motivation to lose the weight she had gained back.

“I finally decided to start exercising and make it a priority,” says Zierke, who credits Schey with helping her stick to her plan. “A big part of it is having someone say, ‘Here, do these exercises. Look, you’re stronger than you think you are. You can do this.’ I had to make my own fitness goals, but it helps having someone cross that barrier of the unknown with you.”