Background: Weight loss surgery [WLS] is effective at inducing significant weight loss and improving associated complications such as type 2 diabetes. However, weight regain and re-occurrence of these conditions can occur. Consequently there is increasing focus on how to optimise patient outcomes with emerging evidence that those who increase their levels of physical activity [PA] have better clinical and patient-centred outcomes. The aim of this review was to synthesise the evidence for interventions which aim to increase PA in patients who have had WLS and to identify promising behaviour change techniques [BCT].
Methods: Four databases were searched (Medline, CINAHL, Scopus and PsychINFO). Studies published in English, of any design were included if they evaluated a PA intervention, with PA measured at baseline and at least once after WLS. Titles and abstracts were screened by JJ and a 10% random sample by VS. JJ and VS independently screened all full text articles and conducted data extraction. BCTs were coded independently by JJ and WH using the BCT Taxonomy v1.
Results: The search resulted in 3,078 original articles; 42 were selected for full text screening, and seven were included. Two interventions began pre-operatively and five post-operatively; the earliest intervention began 34.6 weeks before surgery and the latest 19.3 (5) months after. Intervention duration ranged between six weeks and three years. All interventions were delivered face-to-face, either on a one-to-one basis, in groups or a combination thereof (n=3, n=2, n=2 respectively), with supervised exercise in five studies. Common BCTs identified were goal setting (behaviour), graded tasks, monitoring behaviour without feedback, instruction on how to do the behaviour and behaviour practice/rehearsal. There was evidence of a positive effect on PA in four of the studies; this included the intervention with the shortest duration, which also had the greatest number of BCTs (n=19).
Conclusion: This review has identified evidence for interventions to increase PA after WLS, and suggests that intervention duration is not critical for effect. However, more research is needed to identify the necessary components of effective interventions, which should be evaluated for their clinical utility.
Keywords: Physical activity, weight loss surgery, behaviour change
12 Sep 2019 - 13 Sep 2019