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Energy, Attentiveness, and Fatigue After Bariatric Surgery and Associations with Daily Physical Activity and Weight Loss: an Ecological Momentary Assessment Study

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Abstract

Purpose

Energy and fatigue are thought to improve after bariatric surgery. Such improvements could be related to weight loss and/or increased engagement in day-to-day health behaviors, such as moderate-to-vigorous physical activity (MVPA). This study used ecological momentary assessment (EMA) to evaluate several aspects of energy/fatigue in real-time in patients’ natural environment during the first year after surgery and assessed the associations of percent total weight loss (%TWL) and daily MVPA with daily energy/fatigue levels.

Methods

Patients (n = 71) undergoing Roux-en-Y gastric bypass or sleeve gastrectomy rated their energy, alertness and attentiveness (averaged to create an “attentiveness” rating), and tiredness and sleepiness (averaged to create a “fatigue” rating) via smartphone-based EMA at 4 semi-random times daily for 10 days at pre-surgery and 3-, 6-, and 12 months post-surgery. Daily MVPA minutes were assessed via accelerometry. Weight was measured in clinic.

Results

Energy ratings initially increased from pre- to post-surgery, before leveling off/decreasing by 12 months (p < 0.001). Attentiveness and fatigue ratings did not change over time. %TWL was unrelated to any ratings, while MVPA related to both energy and attentiveness but not fatigue. Participants reported more energy on days with more total MVPA min (p = 0.03) and greater attentiveness on days with more total (p < 0.001) and bouted (p = 0.02) MVPA.

Conclusions

While more research is needed to confirm causality, results suggest that greater daily MVPA is associated with increased daily energy and attentiveness among bariatric surgery patients, independent of %TWL. Findings add to growing evidence of MVPA’s potential benefits beyond energy expenditure in the context of bariatric surgery.

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References

  1. Lavrusheva O. The concept of vitality. Review of the vitality-related research domain. New Ideas Psychol. 2020;56:100752.

    Article  Google Scholar 

  2. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;473–83.

  3. Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. J Clin Epidemiol. 2010;63(11):1179–94.

    Article  Google Scholar 

  4. Swain MG. Fatigue in chronic disease. Clin Sci. 2000;99(1):1–8.

    Article  CAS  Google Scholar 

  5. Van Nunen AM, Wouters EJ, Vingerhoets AJ, Hox JJ, Geenen R. The health-related quality of life of obese persons seeking or not seeking surgical or non-surgical treatment: a meta-analysis. Obes Surg. 2007;17(10):1357–66.

    Article  Google Scholar 

  6. Gletsu-Miller N, Shevni N, Manatunga A, Lin E, Musselman D. A multidimensional analysis of the longitudinal effects of roux en y gastric bypass on fatigue: an association with visceral obesity. Physiol Behav. 2019;209:112612.

    Article  CAS  Google Scholar 

  7. Anandacoomarasamy A, Caterson ID, Leibman S, Smith GS, Sambrook PN, Fransen M, et al. Influence of BMI on health-related quality of life: comparison between an obese adult cohort and age-matched population norms. Obesity. 2009;17(11):2114–8.

    Article  Google Scholar 

  8. Driscoll S, Gregory DM, Fardy JM, Twells LK. Long-term health-related quality of life in bariatric surgery patients: a systematic review and meta-analysis. Obesity. 2016;24(1):60–70.

    Article  Google Scholar 

  9. Kolotkin RL, Andersen JR. A systematic review of reviews: exploring the relationship between obesity, weight loss and health-related quality of life. Clin Obes. 2017;7(5):273–89.

    Article  CAS  Google Scholar 

  10. Schmier JK, Halpern MT. Patient recall and recall bias of health state and health status. Expert Rev Pharmacoecon Outcomes Res. 2004;4(2):159–63.

    Article  Google Scholar 

  11. Smyth JM, Stone AA. Ecological momentary assessment research in behavioral medicine. J Happiness Stud. 2003;4(1):35–52.

    Article  Google Scholar 

  12. Sarwer DB, Wadden TA, Moore RH, Eisenberg MH, Raper SE, Williams NN. Changes in quality of life and body image after gastric bypass surgery. Surg Obes Relat Dis. 2010;6(6):608–14.

    Article  Google Scholar 

  13. Swencionis C, Wylie-Rosett J, Lent MR, Ginsberg M, Cimino C, Wassertheil-Smoller S, et al. Weight change, psychological well-being, and vitality in adults participating in a cognitive–behavioral weight loss program. Health Psychol. 2013;32(4):439.

    Article  Google Scholar 

  14. Strain G, Kolotkin R, Dakin G, Gagner M, Inabnet W, Christos P, et al. The effects of weight loss after bariatric surgery on health-related quality of life and depression. Nutr Diabetes. 2014;4(9):e132.

  15. Kroes M, Osei-Assibey G, Baker-Searle R, Huang J. Impact of weight change on quality of life in adults with overweight/obesity in the United States: a systematic review. Curr Med Res Opin. 2016;32(3):485–508.

    Article  Google Scholar 

  16. Nuijten MA, Tettero OM, Wolf RJ, Bakker EA, Eijsvogels TM, Monpellier VM, et al. Changes in physical activity in relation to body composition, fitness and quality of life after primary bariatric surgery: a two-year follow-up study. Obes Surg. 2021;31(3):1120–8.

    Article  Google Scholar 

  17. Sellberg F, Possmark S, Willmer M, Tynelius P, Persson M, Berglind D. Meeting physical activity recommendations is associated with health-related quality of life in women before and after Roux-en-Y gastric bypass surgery. Qual Life Res. 2019;28(6):1497–507.

    Article  Google Scholar 

  18. Bond DS, Thomas JG, King WC, Vithiananthan S, Trautvetter J, Unick JL, et al. Exercise improves quality of life in bariatric surgery candidates: results from the Bari-Active trial. Obesity. 2015;23(3):536–42.

    Article  Google Scholar 

  19. Bond DS, Phelan S, Wolfe LG, Evans RK, Meador JG, Kellum JM, et al. Becoming physically active after bariatric surgery is associated with improved weight loss and health-related quality of life. Obesity. 2009;17(1):78–83.

    Article  Google Scholar 

  20. King WC, Hinerman AS, White GE, Courcoulas AP, Belle SH. Associations between physical activity and changes in depressive symptoms and health-related quality of life across 7 years following Roux-en-Y gastric bypass surgery: a multicenter prospective cohort study. Ann Surg. 2020.

  21. Puetz TW, O’Connor PJ, Dishman RK. Effects of chronic exercise on feelings of energy and fatigue: a quantitative synthesis. Psychol Bull. 2006;132(6):866.

    Article  Google Scholar 

  22. Loy BD, O’Connor PJ, Dishman RK. The effect of a single bout of exercise on energy and fatigue states: a systematic review and meta-analysis. Fatigue. 2013;1(4):223–42.

    Google Scholar 

  23. Bize R, Johnson JA, Plotnikoff RC. Physical activity level and health-related quality of life in the general adult population: a systematic review. Prev Med. 2007;45(6):401–15.

    Article  Google Scholar 

  24. Dennett AM, Peiris CL, Shields N, Prendergast LA, Taylor NF. Moderate-intensity exercise reduces fatigue and improves mobility in cancer survivors: a systematic review and meta-regression. J Physiother. 2016;62(2):68–82.

    Article  Google Scholar 

  25. Fitzpatrick SL, Appel LJ, Bray B, Brooks N, Stevens VJ. Predictors of long-term adherence to multiple health behavior recommendations for weight management. Health Educ Behav. 2018;45(6):997–1007.

    Article  Google Scholar 

  26. Goldstein SP, Thomas JG, Vithiananthan S, Blackburn GA, Jones DB, Webster J, et al. Multi-sensor ecological momentary assessment of behavioral and psychosocial predictors of weight loss following bariatric surgery: study protocol for a multicenter prospective longitudinal evaluation. BMC Obesity. 2018;5(1):1–2.

    Article  CAS  Google Scholar 

  27. Watson D, Clark LA. The PANAS-X: Manual for the positive and negative affect schedule-expanded form. Unpublished manuscript. Iowa City: University of Iowa; 1994.

  28. Smets EM, Garssen B, Bonke BD, De Haes JC. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 1995;39(3):315–25.

  29. Cole RJ, Kripke DF, Gruen W, Mullaney DJ, Gillin JC. Automatic sleep/wake identification from wrist activity. Sleep. 1992;15(5):461–9.

    Article  CAS  Google Scholar 

  30. Tudor-Locke C, Barreira TV, Schuna JM Jr, Mire EF, Katzmarzyk PT. Fully automated waist-worn accelerometer algorithm for detecting children’s sleep-period time separate from 24-h physical activity or sedentary behaviors. Appl Physiol Nutr Metab. 2013;39(1):53–7.

    Article  Google Scholar 

  31. Kamada M, Shiroma EJ, Harris TB, Lee I-M. Comparison of physical activity assessed using hip-and wrist-worn accelerometers. Gait Posture. 2016;44:23–8.

    Article  Google Scholar 

  32. Wennman H, Pietilä A, Rissanen H, Valkeinen H, Partonen T, Mäki-Opas T, et al. Gender, age and socioeconomic variation in 24-hour physical activity by wrist-worn accelerometers: The FinHealth 2017 Survey. Sci Rep. 2019;9(1):1–9.

    Article  CAS  Google Scholar 

  33. Bond DS, Thomas JG, Jones DB, Schumacher LM, Webster J, Evans EW, et al. Ecological momentary assessment of gastrointestinal symptoms and risky eating behaviors in Roux-en-Y gastric bypass and sleeve gastrectomy patients. Surg Obes Relat Dis. 2021;17(3):475–83.

    Article  Google Scholar 

  34. R Core Team. R: a language and environment for statistical computing. 3.6.0 ed. R Foundation for Statistical Computing, Vienna, Austria; 2021. http://www.R-project.org/.

  35. Bates D, Mächler M, Bolker B, Walker S. Fitting linear mixed-effects models using lme4. J Stat Softw. 2015;67(1), 1–48.

  36. Kuznetsova A, Brockhoff PB, Christensen RH. lmerTest package: tests in linear mixed effects models. J Stat Softw. 2017;82(1):1–26.

  37. Loy BD, Cameron MH, O’Connor PJ. Perceived fatigue and energy are independent unipolar states: supporting evidence. Med Hypotheses. 2018;113:46–51.

    Article  Google Scholar 

  38. Alosco ML, Galioto R, Spitznagel MB, Strain G, Devlin M, Cohen R, et al. Cognitive function after bariatric surgery: evidence for improvement 3 years after surgery. Am J Surg. 2014;207(6):870–6.

    Article  Google Scholar 

  39. Handley JD, Williams DM, Caplin S, Stephens JW, Barry J. Changes in cognitive function following bariatric surgery: a systematic review. Obes Surg. 2016;26(10):2530–7.

    Article  Google Scholar 

  40. Fernandes M, de Sousa A, Medeiros AR, Del Rosso S, Stults-Kolehmainen M, Boullosa DA. The influence of exercise and physical fitness status on attention: a systematic review. Int Rev Sport Exerc Psychol. 2019;12(1):202–34.

    Article  Google Scholar 

  41. Basso JC, Suzuki WA. The effects of acute exercise on mood, cognition, neurophysiology, and neurochemical pathways: a review. Brain Plast. 2017;2(2):127–52.

    Article  Google Scholar 

  42. Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, et al. The physical activity guidelines for Americans. JAMA. 2018;320(19):2020–8.

    Article  Google Scholar 

  43. Zhang Y, Wang W, Yang C, Shen J, Shi M, Wang B. Improvement in nocturnal hypoxemia in obese patients with obstructive sleep apnea after bariatric surgery: a meta-analysis. Obes Surg. 2019;29(2):601–8.

    Article  Google Scholar 

  44. Arterburn DE, Telem DA, Kushner RF, Courcoulas AP. Benefits and risks of bariatric surgery in adults: A review. JAMA. 2020;324(9):879–87.

    Article  Google Scholar 

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Funding

This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK108579) and the National Heart, Lung, and Blood Institute (T32 HL076134; principal investigator: Rena Wing; recipients: Leah Schumacher and Hallie Espel-Huynh).

Author information

Authors and Affiliations

  1. Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital, Weight Control and Diabetes Research Center, 196 Richmond St., Providence, RI, 02903, USA

    Leah M. Schumacher, Hallie M. Espel-Huynh, J. Graham Thomas & Dale S. Bond

  2. Cambridge Health Alliance, Cambridge, MA, 02139, USA

    Sivamainthan Vithiananthan

  3. Department of Surgery, Beth Israel Deaconess Medical Center, Harvard School of Medicine, Boston, MA, 02215, USA

    Daniel B. Jones

Authors
  1. Leah M. Schumacher
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  2. Hallie M. Espel-Huynh
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  5. Daniel B. Jones
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  6. Dale S. Bond
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Corresponding author

Correspondence to Leah M. Schumacher.

Ethics declarations

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with 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 was obtained from all individual participants included in the study.

Conflict of interest

Drs. Schumacher, Espel-Huynh, Thomas, Vithiananthan, Jones, and Bond have received grant funding from the NIH. Dr. Thomas reports board membership, consultancy, and stock ownership for Lumme Heatlh Inc.

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Key Points

• Energy increased after surgery while attentiveness and fatigue did not improve.

• Patients reported more energy on days they accrued more total MVPA minutes.

• Patients reported greater attentiveness on days with more total and bouted MVPA.

• Percent total weight loss was unrelated to perceived energy, attentiveness, and fatigue.

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Schumacher, L.M., Espel-Huynh, H.M., Thomas, J.G. et al. Energy, Attentiveness, and Fatigue After Bariatric Surgery and Associations with Daily Physical Activity and Weight Loss: an Ecological Momentary Assessment Study. OBES SURG 31, 4893–4900 (2021). https://doi.org/10.1007/s11695-021-05662-w

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  • DOI: https://doi.org/10.1007/s11695-021-05662-w

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