Obesity Surgery

, Volume 27, Issue 8, pp 2050–2057 | Cite as

Predictors of Physical Activity After Gastric Bypass—a Prospective Study

  • Irmelin Bergh
  • Ingela Lundin Kvalem
  • Tom Mala
  • Bjørge Herman Hansen
  • Falko F. Sniehotta
Original Contributions

Abstract

Background

Most patients do not meet the recommended level of physical activity after bariatric surgery, and psychological factors underlying postoperative physical activity remain poorly understood. This study aimed at identifying self-regulatory predictors of physical activity after bariatric surgery.

Methods

Questionnaire data including self-regulation variables and the short-version of the International Physical Activity Questionnaire were obtained in a prospective cohort of 230 patients 1 year after Roux-en-Y gastric bypass. The study sample consisted of participants consenting to wear an ActiGraph GT3X+ accelerometer for seven consecutive days, 18–24 months after surgery (n = 120).

Results

A total of 112 participants with complete self-report data provided valid accelerometer data. Mean age was 46.8 years (SD = 9.3), and 81.3% was women. Preoperative and postoperative BMI was 44.8 ± 5.5 and 30.6 ± 5.0 kg/m2, respectively. Total weight loss was 28.9% (SD = 7.5). By objective measures, 17.9% of the participants met the recommended level of moderate-to-vigorous-intensity of physical activity of ≥150 min/week, whereas 80.2% met the recommended level according to self-reported measures. Being single, higher education level, and greater self-regulation predicted objective physical activity in multivariate regression analysis. Greater self-regulation also predicted self-reported physical activity. Weight loss 1 year after surgery was not associated with self-reported or objectively measured physical activity.

Conclusions

Despite large differences between accelerometer-based and subjective estimates of physical activity, the associations of self-regulatory factors and weight loss with postoperative physical activity did not vary depending on mode of measurement. Self-regulation predicted both objective and self-reported physical activity. Targeting patients’ self-regulatory ability may enhance physical activity after gastric bypass.

Keywords

Physical activity Bariatric surgery Gastric bypass Self-regulation Accelerometer Behavior change 

References

  1. 1.
    Coen PM, Goodpaster BH. A role for exercise after bariatric surgery? Diabetes Obes Metab. 2016;18(1):16–23. doi:10.1111/dom.12545.CrossRefPubMedGoogle Scholar
  2. 2.
    Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21(S1):S1–S27.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Helsedirektoratet. Anbefalinger om kosthold, ernæring og fysisk aktivitet. In: Helsedirektoratet, editor. Oslo: Andvord Grafisk AS; 2012Google Scholar
  4. 4.
    O’Donovan G, Blazevich AJ, Boreham C, et al. The ABC of physical activity for health: a consensus statement from the British Association of Sport and Exercise Sciences. J Sports Sci. 2010;28(6):573–91.CrossRefPubMedGoogle Scholar
  5. 5.
    Haskell WL, Lee I-M, Pate RR, et al. Physical activity and public health. Updated recommendations for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116.Google Scholar
  6. 6.
    Reid RE, Carver TE, Andersen KM, et al. Physical activity and sedentary behavior in bariatric patients long-term post-surgery. Obes Surg. 2015;25(6):1073–7. doi:10.1007/s11695-015-1624-8.CrossRefPubMedGoogle Scholar
  7. 7.
    Berglind D, Willmer M, Eriksson U, et al. Longitudinal assessment of physical activity in women undergoing Roux-en-Y gastric bypass. Obes Surg. 2015;5(1):119–25. doi:10.1007/s11695-014-1331-x.CrossRefGoogle Scholar
  8. 8.
    King WC, Hsu JY, Belle SH, Courcoulas AP, Eid GM, Flum DR, et al. Pre- to postoperative changes in physical activity: report from the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2). Surg Obes Relat Dis. 2011;8(5):522-532. doi:10.1016/j.soard.2011.07.018.
  9. 9.
    King WC, Chen JY, Bond DS, et al. Objective assessment of changes in physical activity and sedentary behavior: pre- through 3 years post-bariatric surgery. Obesity. 2015;23(6):1143–50. doi:10.1002/oby.21106.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Wimmelmann CL, Dela F, Mortensen EL. Psychological predictors of weight loss after bariatric surgery: a review of the recent research. Obes Res Clin Pract. 2013;8(4)Google Scholar
  11. 11.
    Galioto R, Gunstad J, Heinberg LJ, et al. Adherence and weight loss outcomes in bariatric surgery: does cognitive function play a role? 2013;23(10), 1703–1710. doi:10.1007/s11695-013-1060-6
  12. 12.
    Parschau L, Barz M, Richert J, et al. Physical activity among adults with obesity: testing the health action process approach. Rehabil Psychol. 2014;59(1):42–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Fishbein M, Ajzen I. Belief, attitude, intention, and behavior: an introduction to theory and research. Reading: Addison-Wesley; 1975.Google Scholar
  14. 14.
    Rhodes RE, Bruijn GJ. How big is the physical activity intention–behaviour gap? A meta-analysis using the action control framework. Br J Health Psychol. 2013;18(2):296–309.CrossRefPubMedGoogle Scholar
  15. 15.
    Hagger MS, Chatzisarantis NL, Biddle SJ. A meta-analytic review of the theories of reasoned action and planned behavior in physical activity: predictive validity and the contribution of additional variables. J Sport Exerc Psychol. 2002;24(1).Google Scholar
  16. 16.
    Bond DS, Thomas GJ, Ryder B, et al. Ecological momentary assessment of the relationship between intention and physical activity behavior in bariatric surgery patients. Int J Behav Med. 2011;1–6.Google Scholar
  17. 17.
    Scholz U, Schüz B, Ziegelmann JP, et al. Beyond behavioural intentions: planning mediates between intentions and physical activity. Br J Health Psychol. 2008;13(3):479–94.CrossRefPubMedGoogle Scholar
  18. 18.
    Reuter T, Ziegelmann JP, Wiedemann AU, et al. Changes in intentions, planning, and self-efficacy predict changes in behaviors. J Health Psychol. 2010;15(6):935–47.CrossRefPubMedGoogle Scholar
  19. 19.
    Conner M, Sandberg T, Norman P. Using action planning to promote exercise behavior. Ann Behav Med. 2010;40(1):65–76.CrossRefPubMedGoogle Scholar
  20. 20.
    Sniehotta FF, Scholz U, Schwarzer R. Action plans and coping plans for physical exercise: a longitudinal intervention study in cardiac rehabilitation. Br J Health Psychol. 2006;11(1):23–37.CrossRefPubMedGoogle Scholar
  21. 21.
    Bergh I, Kvalem IL, Risstad H, et al. Preoperative predictors of adherence to dietary and physical activity recommendations and weight loss one year after surgery. Surg Obes Relat Dis. 2016;12(4):910–8. doi:10.1016/j.soard.2015.11.009.CrossRefPubMedGoogle Scholar
  22. 22.
    Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215.CrossRefPubMedGoogle Scholar
  23. 23.
    Hübner C, Baldofski S, Zenger M, et al. Influences of general self-efficacy and weight bias internalization on physical activity in bariatric surgery candidates. Surg Obes Relat Dis. 2014 (0).Google Scholar
  24. 24.
    Parschau L, Fleig L, Koring M, et al. Positive experience, self-efficacy, and action control predict physical activity changes: a moderated mediation analysis. Br J Health Psychol. 2013;18(2):395–406.CrossRefPubMedGoogle Scholar
  25. 25.
    Sniehotta FF, Nagy G, Scholz U, et al. The role of action control in implementing intentions during the first weeks of behaviour change. Br J Soc Psychol. 2006;45(1):87–106.CrossRefPubMedGoogle Scholar
  26. 26.
    Sniehotta FF, Scholz U, Schwarzer R. Bridging the intention–behaviour gap: planning, self-efficacy, and action control in the adoption and maintenance of physical exercise. Psychol Health. 2005;20(2):143–60.CrossRefGoogle Scholar
  27. 27.
    Hansen BH, Kolle E, Dyrstad SM, et al. Accelerometer-determined physical activity in adults and older people. Med Sci Sports Exerc. 2012;44(2):266.CrossRefPubMedGoogle Scholar
  28. 28.
    Troiano RP, Berrigan D, Dodd KW, et al. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181.CrossRefPubMedGoogle Scholar
  29. 29.
    Craig C, Marshall A, Sjostrom M, et al. International Physical Activity Questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–95. doi:10.1249/01.MSS.0000078924.61453.FB.CrossRefPubMedGoogle Scholar
  30. 30.
    Ainsworth BE, Haskell WL, Herrmann SD, et al. Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;43(8):1575–81.CrossRefPubMedGoogle Scholar
  31. 31.
    IPAQ. Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ). Short and long forms. 2005 [cited 2015 11/19]; Available from: https://sites.google.com/site/theipaq/scoring-protocol.
  32. 32.
    Brethauer SA, Kim J, el Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Obes Surg. 2015;25(4):587–606.CrossRefPubMedGoogle Scholar
  33. 33.
    Renner B, Schwarzer R. Risk and health behaviors documentation of the scales of the research project: “risk appraisal consequences in Korea” (RACK). Berlin: International University Bremen & Freie Universität Berlin; 2005.Google Scholar
  34. 34.
    Sniehotta FF, Schwarzer R, Scholz U, et al. Action planning and coping planning for long-term lifestyle change: theory and assessment. Eur J Soc Psychol. 2005;35(4):565–76.CrossRefGoogle Scholar
  35. 35.
    Bond DS, Jakicic JM, Unick JL, et al. Pre- to postoperative physical activity changes in bariatric surgery patients: self report vs. objective measures. Obesity. 2010;18(12):2395–7.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Berglind D, Willmer M, Tynelius P, et al. Accelerometer-measured versus self-reported physical activity levels and sedentary behavior in women before and 9 months after Roux-en-Y gastric bypass. Obes Surg. 2015:1–8Google Scholar
  37. 37.
    De Souza SAF, Faintuch J, Sant’Anna AF. Effect of weight loss on aerobic capacity in patients with severe obesity before and after bariatric surgery. Obes Surg. 2010;20(7):871–5.CrossRefPubMedGoogle Scholar
  38. 38.
    Wilms B, Ernst B, Thurnheer M, et al. Differential changes in exercise performance after massive weight loss induced by bariatric surgery. Obes Surg. 2012:1–7. EnglishGoogle Scholar
  39. 39.
    Josbeno DA, Kalarchian M, Sparto PJ, et al. Physical activity and physical function in individuals post-bariatric surgery. Obes Surg. 2011;21(8):1243–9.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Kvalem IL, Bergh I, Soest T, et al. A comparison of behavioral and psychological characteristics of patients opting for surgical and conservative treatment for morbid obesity. BMC Obesity. 2016;3(1):1–11.Google Scholar
  41. 41.
    Lutfi R, Torquati A, Sekhar N, et al. Predictors of success after laparoscopic gastric bypass: a multivariate analysis of socioeconomic factors. Surgical Endoscopy And Other Interventional Techniques. 2006;20(6):864–7. EnglishCrossRefPubMedGoogle Scholar
  42. 42.
    Livhits M, Mercado C, Yermilov I, et al. Behavioral factors associated with successful weight loss after gastric bypass. Am Surg. 2011;76(10):1139–42.Google Scholar
  43. 43.
    Homish GG, Leonard KE. Spousal influence on general health behaviors in a community sample. Am J Health Behav. 2008;32(6):754–63.CrossRefPubMedGoogle Scholar
  44. 44.
    Hansen BH, Kolle E, Anderssen SA. Fysisk aktivitetsnivå blant voksne og eldre i Norge. Oppdaterte analyser basert på nye nasjonale anbefalinger i 2014. Oslo: Helsedirektoratet, 2014 IS-2183Google Scholar
  45. 45.
    Bauman A, Bauman R, Reis J, et al. Correlates of physical activity: why are some people physically active and others not? Lancet (London, England). 2012;380(9838):258–71.CrossRefGoogle Scholar
  46. 46.
    Chapman N, Hill K, Taylor S, et al. Patterns of physical activity and sedentary behavior after bariatric surgery: an observational study. Surg Obes Relat Dis. 2014;10(3):524–30.CrossRefPubMedGoogle Scholar
  47. 47.
    King WC, Engel SG, Elder KA, et al. Walking capacity of bariatric surgery candidates. Surg Obes Relat Dis. 2012;8(1):48–59. doi:10.1016/j.soard.2011.07.003.CrossRefPubMedGoogle Scholar
  48. 48.
    Jørgensen T, Andersen LB, Froberg K, et al. Position statement: testing physical condition in a population—how good are the methods? Eur J Sport Sci. 2009;9(5):257–67.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Irmelin Bergh
    • 1
  • Ingela Lundin Kvalem
    • 1
  • Tom Mala
    • 2
  • Bjørge Herman Hansen
    • 3
  • Falko F. Sniehotta
    • 4
  1. 1.Department of PsychologyUniversity of OsloOsloNorway
  2. 2.Center for Morbid Obesity and Bariatric SurgeryOslo University HospitalOsloNorway
  3. 3.Department of Sports MedicineNorwegian School of Sport SciencesOsloNorway
  4. 4.Institute of Health & Society, Fuse—The Centre for Translational Research in Public Health Institute of Health & Society Faculty of Medical SciencesNewcastle UniversityNewcastleUK

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