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Effects of a 12-Week Transtheoretical Model–Based Exercise Training Program in Chinese Postoperative Bariatric Patients: a Randomized Controlled Trial

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Abstract

Purpose

This study aims to investigate the effectiveness of the transtheoretical model (TTM)–based exercise training on TTM variables, exercise adherence, and physical function in patients in the early stages after bariatric surgery (BS).

Materials and Methods

We conducted a single-blinded, prospective, randomized controlled trial (RCT) to evaluate the effects of TTM-based exercise training on BS patients immediately after surgery. Participants (n = 120) were randomized into a TTM-based exercise training group (n = 60) and a control group (n = 60). Main outcomes included TTM variables (measured by exercise stages of change (ESCs), exercise self-efficacy (ESE), and decisional balance), exercise adherence, and physical function (determined by the 6-min walk distance (6MWD)). Secondary outcomes were physical activity, anthropometrics, and body composition. We performed all analyses in accordance with the intention-to-treat principle.

Results

Retention rates for the interventions were 91.7% for the intervention group and 90.0% for the control group. Compared with the control group, the 12-week TTM-based intervention significantly helped participants advance through ESCs, demonstrate higher ESE, perceive more benefits and fewer barriers to exercise, and show higher exercise adherence and better physical function afterward (all P < 0.05). However, we observed no statistically significant difference between the two groups in anthropometric parameters or body composition after intervention.

Conclusion

The TTM-based exercise intervention had significant positive effects on the TTM variables, which could further help increase patients’ exercise adherence and physical function immediately after BS.

Trial Registration

This study was retrospectively registered at the Chinese Clinical Trial Registry (website: www.chictr.org.cn, registry number: ChiCTR2000039319).

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Acknowledgements

We would like to thank Guangdong Lu (Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University) for statistical advice. We thank Dongmei Ai (Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital) for administering the exercise assessment and guidance. We thank Donglian Xu (Department of Clinical Nutrition, The First Affiliated Hospital of Nanjing Medical University) for nutrition guidance. We thank LetPub (www.letpub.com) for its linguistic assistance during the revision of this manuscript.

Funding

This research was funded by the project “The exploration of trajectories and intervention program of frailty for gastric cancer survivors based on the health ecology theory (82073407)” (supported by NSFC).

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Author notes

  1. Ziqi Ren and Hanfei Zhu contributed equally to this work.

Authors and Affiliations

  1. School of Nursing, Nanjing Medical University, 818 Tianyuan East Road, Jiangning District, Nanjing, 210029, Jiangsu, China

    Ziqi Ren, Hanfei Zhu, Kang Zhao & Qin Xu

  2. School of Nursing, Fudan University, Shanghai, 200032, China

    Ziqi Ren

  3. Department of Nursing, Jiangsu College of Nursing, Huai’an, 223000, Jiangsu, China

    Tianzi Zhang

  4. Department of Bariatric and Metabolic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China

    Hongxia Hua, Ningli Yang & Hui Liang

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  1. Ziqi Ren
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Contributions

Ziqi Ren contributed to conception, design, acquisition, analysis, and interpretation; drafted and critically revised the manuscript; gave final approval; and took responsibility for the integrity of the data and the accuracy of the data analysis. Hanfei Zhu contributed to conception, design, acquisition, analysis, and interpretation and drafted and critically revised the manuscript. Tianzi Zhang, Hongxia Hua, and Kang Zhao were responsible for the conception, design, participants’ recruitment, data collection, interpretation, and manuscript revision. Ningli Yang and Hui Liang were responsible for participants’ recruitment, data interpretation, and manuscript revision. Qin Xu was responsible for the conception, study design, manuscript drafting, and study supervision.

Corresponding author

Correspondence to Qin Xu.

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Ethics Approval

This study was approved by the ethics committee of the First Affiliated Hospital of Nanjing Medical University (2018-SR-057). All procedures performed in studies involving human participants followed the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Key Points

1. Exercise training for BS patients was conducted immediately after surgery.

2. The TTM-based exercise intervention is effective in motivating BS patients to exercise regularly.

3. The TTM-based exercise intervention following bariatric surgery improves physical function.

4. A structured home-based exercise program for BS patients based on TTM is proposed.

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Ren, Z., Zhu, H., Zhang, T. et al. Effects of a 12-Week Transtheoretical Model–Based Exercise Training Program in Chinese Postoperative Bariatric Patients: a Randomized Controlled Trial. OBES SURG 31, 4436–4451 (2021). https://doi.org/10.1007/s11695-021-05607-3

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  • DOI: https://doi.org/10.1007/s11695-021-05607-3

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