Sivamainthan Vithiananthan

Pre‐ to Postoperative Physical Activity Changes in Bariatric Surgery Patients: Self Report vs. Objective Measures

Bariatric surgery patients report significant pre‐ to postoperative increases in physical activity (PA). However, it is unclear whether objective measures would corroborate these changes. The present study compared self‐reported and accelerometer‐based estimates of changes in moderate‐to‐vigorous intensity PA (MVPA) from pre‐ (pre‐op) to 6 months postsurgery (post‐op). Twenty bariatric surgery (65% laparoscopic‐adjustable gastric banding, 35% gastric bypass) patients (46.2 ± 9.8 years, 88% female, pre‐op BMI = 50.8 ± 9.7 kg/m2) wore RT3 accelerometers as an objective measure of MVPA and completed the Paffenbarger Physical Activity Questionnaire (PPAQ) as a subjective measure before and 6 months after bariatric surgery. Time (min/week) spent in MVPA was calculated for the PPAQ and RT3 (≥1‐min and ≥10‐min bouts) at pre‐op and post‐op. Self‐reported MVPA increased fivefold from pre‐op to post‐op (44.6 ± 80.8 to 212.3 ± 212.4 min/week; P < 0.005). By contrast, the RT3 showed nonsignificant decreases in MVPA for both ≥1‐min (186.0 ± 169.0 to 151.2 ± 118.3 min/week) and ≥10‐min (41.3 ± 109.3 to 39.8 ± 71.3 min/week) bouts. At pre‐op, the percentage of participants who accumulated ≥150‐min/week of MVPA in bouts ≥10‐min according to the PPAQ and RT3 was identical (10%). However, at post‐op, 55% of participants reported compliance with the recommendation compared to 5% based on RT3 measurement (P = 0.002). Objectively‐measured changes in MVPA from pre‐op to 6 months post‐op appear to be much smaller than self‐reported changes. Further research involving larger samples is needed to confirm these findings and to determine whether self‐report and objective PA measures are differentially associated with surgical weight loss outcomes.

Objective quantification of physical activity in bariatric surgery candidates and normal-weight controls

BACKGROUND Physical activity (PA) is an important component of weight loss programs and should be encouraged for severely obese patients undergoing bariatric surgery. However, few studies have determined the amount and intensity of activities undertaken preoperatively by bariatric surgery patients using objective measures. METHODS Using RT3 tri-axial accelerometers, the present study compared 38 bariatric surgery candidates and 20 normal weight controls on activity counts/hr; the number of minutes daily spent in moderate-to-vigorous intensity PA (MVPA) and vigorous intensity PA; and the level of compliance with national recommendations to accumulate 150 min/wk of MVPA in bouts of > or = 10 minutes. RESULTS Surgery candidates, compared with controls, recorded significantly (P <.01) fewer activity counts/hr (13,799 +/- 3758 counts/hr versus 19,462 +/- 4259 counts/hr) and spent fewer minutes per day engaged in MVPA (26.4 +/- 23.0 min/d versus 52.4 +/- 24.7 min/d) and vigorous PA (1.2 +/- 3.4 min/d vs 11.8 +/- 9.0 min/d). More than two thirds (68%) of the surgery candidates versus 13% of the normal weight controls did not accumulate any MVPA in bouts of > or = 10 minutes and only 4.5% of obese patients met the weekly MVPA recommendation versus 40% of the controls. CONCLUSION The results of our study have shown that bariatric surgery candidates have low PA levels and rarely engage in PA bouts of sufficient duration and intensity to maintain and improve health. Additional research is needed to determine how best to increase PA in bariatric surgery candidates.

Self-reported and objectively measured sedentary behavior in bariatric surgery candidates.

BACKGROUND Sedentary behavior (SB), independent of physical activity, represents a significant health risk. We previously used objective measures to demonstrate that bariatric surgery candidates engage in high levels of SB overall, but supplementing these measures with subjective reports would provide information about time allocated to different forms of SB. The aim of this study was to examine self-reported time spent performing specific types of SB and discrepancy between self-reported and objectively measured estimates of total sedentary time in bariatric surgery candidates. METHODS A total of 52 bariatric surgery candidates (87% female; age = 46.2 ± 9.1 years; body mass index [BMI] = 45.3 ± 6.7) completed the 9-item Sedentary Behavior Questionnaire (SBQ) as a subjective measure of SB and wore the SenseWear Armband (SWA; SenseWear, Pittsburgh, PA) as an objective measure. Paired samples t tests and the intraclass correlation coefficient (ICC) assessed measurement discrepancy. RESULTS Television-viewing was the most frequently performed type of SB (2.7 ± 1.6 hours per day), followed by paper/computer work (1.9 ± 1.8 hours per day), driving/riding in automobile (1.2 ± 1.1 hours per day), and sitting/talking on telephone (1.1 ± 1.2 hours per day). On average, the SBQ and SWA produced similar estimates of daily sedentary time (hours per day) at the group level (9.6 ± 4.8 versus 9.3 ± 1.9; mean difference = -.34 ± 4.6; P = .59), although agreement between the measures at the individual level was poor (mean absolute value of difference = 3.8 ± 2.8 hours per day; ICC = .22; P = .06). CONCLUSION Television-viewing was the single SB in which participants most frequently engaged and thus may be an important modifiable target for reducing total sedentary time in bariatric surgery candidates. The SBQ and SWA can be used similarly to describe SB levels in this patient population at the group level; however, ability of these measures to produce comparable estimates of sedentary time for any individual patient is limited.

Exercise improves quality of life in bariatric surgery candidates: Results from the Bari-Active trial

To examine the impact of a pre‐bariatric surgery physical activity intervention (PAI), designed to increase bout‐related (≥10 min) moderate to vigorous PA (MVPA), on health‐related quality of life (HRQoL).

Physical activity and quality of life in severely obese individuals seeking bariatric surgery or lifestyle intervention

BackgroundGiven that bariatric surgery (BS) and lifestyle intervention (LI) represent two vastly different approaches to treating severe obesity, there is growing interest in whether individuals who seek BS versus LI also differ on weight-related behaviors. In the present study, we compared BS- and LI-seekers on physical activity (PA) and sedentary behaviors (SB), and examined between-group differences in health-related quality of life (HRQoL), while controlling for PA.FindingsA sample of 34 LI-seekers were matched with 34 BS-seekers on gender, age, BMI, and PA monitor-daily wear time (age: 42.1±10.0 years; BMI: 45.6±6.5 kg/m2). PA and SB were assessed over a 7-day period via the SenseWear Armband (SWA). HRQoL was measured using the SF-36, with scores standardized to a population normal distribution (M=50, SD=10). Participants wore the SWA for 13.7±1.6 h/day. BS-seekers did not differ from LI-seekers on average min/d over the wear period spent in SB (641±117.1 vs. 638.4±133.4, p=0.62) or light (136.4±76.1 vs. 145.5±72.5, p=0.59) and moderate-to-vigorous (>1-min bouts=36.4±26.2 vs. 40.2±31.3, p=0.59; ≥10-min bouts=5.7±8.3 vs. 10.2±17.0, p=0.17) PA. BS-seekers reported significantly lower SF-36 physical functioning (42.4±10.9 vs. 49.0±6.8, p=0.004) and physical component summary (43.9±10.1 vs. 48.9±7.0) scores versus LI-seekers. BS-seeker group status was related to lower physical functioning (β=0.30, p=0.009), independent of gender, age, BMI, and daily PA.ConclusionsFindings suggest that seeking BS versus LI is not related to patterns of PA or SB, and that lower subjective physical functioning is not associated with lower overall PA levels in BS-seekers.

Changes in enjoyment, self-efficacy, and motivation during a randomized trial to promote habitual physical activity adoption in bariatric surgery patients

BACKGROUND The Bari-Active trial found that a physical activity (PA) intervention (PAI), versus standard presurgical care control (SC), produced significant increases in daily bout-related moderate-to-vigorous PA (MVPA, in≥10-min bouts) preoperatively. The present study examined whether PAI also produces superior improvements in psychological and/or motivational processes that may be important for PA adoption. OBJECTIVES Compare PAI and SC on baseline to postintervention changes in PA-related enjoyment, self-efficacy, and motivations, and examine whether greater bout-related MVPA changes are associated with greater improvements in these variables. SETTING University hospital, United States. METHODS Participants (87% female; body mass index = 45.0±6.5 kg/m(2)) were randomly assigned to 6 weeks of PAI (n = 40) or SC (n = 35). PAI received weekly counseling sessions to increase daily walking exercise. At baseline and postintervention, both groups completed 7-day objective PA monitoring and questionnaires to evaluate changes in bout-related MVPA and PA enjoyment, self-efficacy, and motivation. RESULTS Retention was 84% at postintervention. Intent-to-treat analyses showed that PAI on average reported more favorable changes than SC in PA enjoyment, self-efficacy, amotivation (i.e., lack of PA motivation), and identified and intrinsic regulations (i.e., more autonomous PA motivations; P<.01). In PAI completers (n = 33), changes in bout-related MVPA and psychological/motivational variables were unrelated. CONCLUSION PAI produced greater improvements in PA-related enjoyment, self-efficacy, and motivations than SC. The lack of association between objectively measured PA changes and psychological/motivational processes highlights the need for future research to identify which processes are most important for PA adoption and maintenance in bariatric surgery patients, and to determine whether the method used to measure PA affects the pattern of association.

Contraceptive use in women undergoing bariatric surgery

INTRODUCTION Contraceptive counselling in women undergoing bariatric surgery is crucial due to increased risk of foetal growth restriction postoperatively. We evaluate if women undergoing bariatric surgery are being counselled about and using contraception. METHODS A 36-question survey was sent electronically to patients at the Miriam Hospital Bariatric Center in Providence, Rhode Island. RESULTS Of the thirty-five women included in our study, 85.7% and 80% reported receiving contraceptive counselling and advice to avoid pregnancy in the 12-24 months following surgery, respectively. Only 65.7% were using contraception. More women using contraception reported receiving counselling (95.7% vs. 66.7%) and knew to avoid pregnancy postoperatively (82.6% vs. 75%) than women not using contraception. Contraceptive use declined over time following surgery. CONCLUSION We have identified an important opportunity for healthcare providers to promote ongoing compliance with contraception for women undergoing bariatric surgery.

Greater Adherence to Recommended Morning Physical Activity is Associated With Greater Total Intervention-Related Physical Activity Changes in Bariatric Surgery Patients

BACKGROUND This study examines whether performance of bout-related physical activity (PA) during morning hours is related to greater overall bout-related PA increases within a preoperative PA intervention for bariatric surgery (BS) patients. METHODS Participants with severe obesity (n = 33; mean age = 45.6 ± 9.6 years; BMI = 45.7 ± 7.0 kg/m2) seeking BS were randomized to and completed 6 weeks of preoperative PA counseling (retention = 82.5%). Participants were encouraged to walk daily at a moderate intensity in bouts ≥ 10 minutes during morning hours to overcome time-related obstacles and establish a PA habit. Timing and amount of bout-related moderate-to-vigorous PA (MVPA) was assessed via objective monitor at pre- and postintervention. RESULTS Greater proportion of bout-related MVPA performed during morning hours (4:00 AM-12:00 PM) at postintervention was associated with larger total increases in bout-related MVPA minutes/day (β = .40, P = .03). At postintervention, a greater proportion of participants whose longest MVPA bouts occurred during morning hours (n = 11) achieved the public health guideline (ie, ≥150 bout-related MVPA minutes/week) versus those whose longest MVPA bouts occurred during nonmorning hours (n = 19; 63.6% vs. 26.3%, P = .04). CONCLUSIONS Intervention-related increases in PA tended to be greatest when PA was performed in the morning. Morning exercise may be a viable strategy for promoting habitual PA in inactive BS patients.