Over the long term, people who have undergone bariatric surgery (BS) remain overly sedentary with inadequate physical activity (PA). The purpose of this study was to apply the transtheoretical model (TTM) to (1) explore in-depth how PA is experienced years after BS and (2) identify the barriers to and facilitators of PA involved at each stage of change (SOC).
Seventeen women with a mean age of 32.5 ± 3.3 years and a percentage of total weight loss of 29.6 ± 12.4 were interviewed at a mean of 9.4 ± 3.6 years after BS. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.
The distribution of barriers to and facilitators of PA differed with the SOC. In progressing from the precontemplation and contemplation stages to the preparation stage, the women experienced changes in their decisional balance, supported by processes of self-reevaluation and environmental reevaluation. In shifting from preparation to the action and maintenance stages, they experienced intrinsic motivation and self-liberation processes. The relapse stage was associated with a decrease in self-efficacy to cope with life constraints.
This study presents an in-depth theory-based exploration of the dynamics of long-term engagement in PA after BS in young women, with clinical implications for providing them with better guidance toward a more physically active lifestyle.
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stage of change
Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in swedish obese subjects. N Engl J Med. 2007;357:741–52.
Petroni ML, Caletti MT, Calugi S, et al. Long-term treatment of severe obesity: are lifestyle interventions still an option? Expert Rev Endocrinol Metab. 2017;12:391–400.
Stewart F, Avenell A. Behavioural interventions for severe obesity before and/or after bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2016;26:1203–14.
Herring LY, Stevinson C, Davies MJ, et al. Changes in physical activity behaviour and physical function after bariatric surgery: a systematic review and meta-analysis: physical activity and physical function. Obes Rev. 2016;17:250–61.
Coen PM, Carnero EA, Goodpaster BH. Exercise and bariatric surgery: an effective therapeutic strategy. Exerc Sport Sci Rev. 2018;46:262–70.
Adil MT, Jain V, Rashid F, et al. Meta-analysis of the effect of bariatric surgery on physical function: effect of bariatric surgery on physical function. Br J Surg. 2018;105:1107–18.
Busetto L, Dicker D, Azran C, et al. Practical recommendations of the obesity management task force of the european association for the study of obesity for the post-bariatric surgery medical management. Obes Facts. 2017;10:597–632.
Tettero OM, Aronson T, Wolf RJ, et al. Increase in physical activity after bariatric surgery demonstrates improvement in weight loss and cardiorespiratory fitness. Obes Surg. 2018;28:3950–7.
King WC, Hsu JY, Belle SH, et al. Pre- to postoperative changes in physical activity: report from the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2). Surg Obes Relat Dis. 2012;8:522–32.
Reid RER, Carver TE, Andersen KM, et al. Physical activity and sedentary behavior in bariatric patients long-term post-surgery. Obes Surg. 2015;25:1073–7.
King WC, Chen J-Y, Bond DS, et al. Objective assessment of changes in physical activity and sedentary behavior: pre- through 3 years post-bariatric surgery: presurgery to Postsurgery Changes in Physical Activity. Obes Open Access. 2015;23:1143–50.
Guthold R, Stevens GA, Riley LM, et al. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants. Lancet Glob Health. 2018;6:e1077–86.
Althoff T, Sosič R, Hicks JL, et al. Large-scale physical activity data reveal worldwide activity inequality. Nature. 2017;547:336.
Baruth M, Sharpe PA, Hutto B, et al. Patterns of sedentary behavior in overweight and obese women. Ethn Dis. 2013;23:336–42.
Himpens J, Ramos A, Welbourn R, Dixon J, Kinsman R, Walton P. Fourth IFSO global registry report 2018. IFSO & Dendrite Clinical Systems; 2018.
Zabatiero J, Smith A, Hill K, et al. Do factors related to participation in physical activity change following restrictive bariatric surgery? A qualitative study. Obes Res Clin Pract. 2018;12:307–16.
Dikareva A, Harvey WJ, Cicchillitti MA, et al. Exploring perceptions of barriers, facilitators, and motivators to physical activity among female bariatric patients: implications for physical activity programming. Am J Health Promot. 2016;30:536–44.
Boscatto EC, Duarte MDF d S, Gomes MDA. Stages of behavior change and physical activity barriers in morbid obese subjects. Rev bras cineantropom desempenho hum. 2011;13:329–34.
Peacock JC, Sloan SS, Cripps B. A qualitative analysis of bariatric patients’ post-surgical barriers to exercise. Obes Surg. 2014;24:292–8.
Teixeira PJ, Marques MM. Health behavior change for obesity management. Obes Facts. 2017;10:666–73.
Gourlan M, Bernard P, Bortolon C, et al. Efficacy of theory-based interventions to promote physical activity. A meta-analysis of randomised controlled trials. Health Psychol Rev. 2016;10:50–66.
Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51:390–5.
Marshall SJ, Biddle SJH. The transtheoretical model of behavior change: a meta-analysis of applications to physical activity and exercise. Ann Behav Med. 2001;23:229–46.
Romain AJ, Bernard P, Attalin V, et al. Health-related quality of life and stages of behavioural change for exercise in overweight/obese individuals. Diabetes Metab. 2012;38:352–8.
Marcus BH, Lewis BA. Physical activity and the stages of motivational readiness for change model. Pres Counc Phys Fit Sports Res Dig. 2003;4:1–8.
Waterman AD, Robbins ML, Paiva AL, et al. Kidney patients’ intention to receive a deceased donor transplant: development of stage of change, decisional balance and self-efficacy measures. J Health Psychol. 2010;15:436–45.
Kirk A, MacMillan F, Webster N. Application of the transtheoretical model to physical activity in older adults with type 2 diabetes and/or cardiovascular disease. Psychol Sport Exerc. 2010;11:320–4.
Mastellos N, Gunn LH, Felix LM, Car J, Majeed A. Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Metabolic and Endocrine Disorders Group, editor. Cochrane Database Syst Rev. 2014;
Romain AJ, Bernard P, Hokayem M, et al. Measuring the processes of change from the transtheoretical model for physical activity and exercise in overweight and obese adults. Am J Health Promot. 2016;30:272–8.
Jehl A, Hayotte M, Gugenheim J, et al. Bariatric surgery for subjects under 25 years old: retrospective medico-socio-psychological study. Ann Endocrinol. 2016;77:327–8.
Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982;36:936–42.
Bigard AX, Duforez F, Portero P, et al. Determination of physical activity by questionnaire: validation of Baecke’s self-administered questionnaire. Sci Sport. 1992;7:215–21.
Tehard B, Saris WHM, Astrup A, et al. Comparison of two physical activity questionnaires in obese subjects: the NUGENOB study. Med Sci Sports Exerc. 2005;37:1535–41.
World Health Organization. Global recommendations on physical activity for health. Genève: WHO; 2010.
Marcus BH, Selby VC, Niaura RS, et al. Self-efficacy and the stages of exercise behavior change. Res Q Exerc Sport. 1992;63:60–6.
Cardinal BJ. Construct validity of stages of change for exercise behavior. Am J Health Promot. 1997;12:68–74.
Weed M. Research quality considerations for grounded theory research in sport & exercise psychology. Psychol Sport Exerc. 2009;10:502–10.
Lincoln YS, Guba EG. Establishing trustworthiness. Naturalistic inquiry. Newbury Park, CA: Sage Publications; 1985. p. 289–327.
Smith B, McGannon KR. Developing rigor in qualitative research: problems and opportunities within sport and exercise psychology. Int Rev Sport Exerc Psychol. 2018;11:101–21.
Hart EA, Leary MR, Rejeski WJ. The measurement of social physique anxiety. J Sport Exerc Psychol. 1989;11:94–104.
Zabatiero J, Hill K, Gucciardi DF, et al. Beliefs, barriers and facilitators to physical activity in bariatric surgery candidates. Obes Surg. 2016;26:1097–109.
Bauman AE, Reis RS, Sallis JF, et al. Correlates of physical activity: why are some people physically active and others not? Lancet. 2012;380:258–71.
DuCharme KA, Brawley LR. Predicting the intentions and behavior of exercise initiates using two forms of self-efficacy. J Behav Med. 1995;18:479–97.
Sherwood NE, Jeffery RW. The behavioral determinants of exercise: implications for physical activity interventions. Annu Rev Nutr. 2000;20:21–44.
Engberg E, Alen M, Kukkonen-Harjula K, et al. Life events and change in leisure time physical activity: a systematic review. Sports Med. 2012;42:433–47.
Romain AJ, Horwath C, Bernard P. Prediction of physical activity level using processes of change from the transtheoretical model: experiential, behavioral, or an interaction effect? Am J Health Promot. 2018;32:16–23.
Romain AJ, Chevance G, Caudroit J, et al. The transtheoretical model: description, interests and application in the motivation to physical activity among population with overweight and obesity. Obésité. 2016;11:47–55.
Bellicha A, Ciangura C, Poitou C, et al. Effectiveness of exercise training after bariatric surgery—a systematic literature review and meta-analysis: exercise training and bariatric surgery. Obes Rev. 2018;19:1544–56.
Pouwels S, Wit M, Teijink JAW, et al. Aspects of exercise before or after bariatric surgery: a systematic review. Obes Facts. 2015;8:132–46.
Butryn ML, Arigo D, Raggio GA, et al. Enhancing physical activity promotion in midlife women with technology-based self-monitoring and social connectivity: A pilot study. J Health Psychol. 2016;21:1548–55.
Cotie LM, Prince SA, Elliott CG, et al. The effectiveness of eHealth interventions on physical activity and measures of obesity among working-age women: a systematic review and meta-analysis: eHealth physical activity interventions in women. Obes Rev. 2018;19:1340–58.
The authors would like to thank the participants for their contribution to this research.
M.H. was supported by a PhD grant from the Région Sud Provence-Alpes Côte d’Azur, France, and co-supported by the association “Azur Sport Santé.” This work was supported by the French government, managed by the “Agence Nationale de la Recherche” as part of the UCAJEDI Future Investments project, reference number ANR-15-IDEX-01.
Conflict of Interest
The authors declare that they have no conflict of interest.
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Informed consent was obtained from all individual participants included in the study.
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Hayotte, M., Nègre, V., Gray, L. et al. The transtheoretical model (TTM) to gain insight into young women’s long-term physical activity after bariatric surgery: a qualitative study. OBES SURG 30, 595–602 (2020). https://doi.org/10.1007/s11695-019-04220-9
- Physical activity
- Bariatric surgery
- Stage of change
- Transtheoretical model
- Qualitative analysis