Bari-Active: a randomized controlled trial of a preoperative intervention to increase physical activity in bariatric surgery patients

Abstract

Background: Habitual physical activity (PA) may help to optimize bariatric surgery outcomes; however, objective PA measures show that most patients have low PA preoperatively and make only modest PA changes postoperatively. Patients require additional support to adopt habitual PA. The objective of this study was to test the efficacy of a preoperative PA intervention (PAI) versus standard presurgical care (SC) for increasing daily moderate-to-vigorous PA (MVPA) in bariatric surgery patients.

Methods: Outcomes analysis included 75 participants (86.7% women; 46.0±8.9 years; body mass index [BMI]=45.0±6.5 kg/m2) who were randomly assigned preoperatively to 6 weeks of PAI (n=40) or SC (n=35). PAI received weekly individual face-to-face sessions with tailored instruction in behavioral strategies (e.g., self-monitoring, goal-setting) to increase home-based walking exercise. The primary outcome, pre- to postintervention change in daily bout-related (≥10 min bouts) and total (≥1 min bouts) MVPA minutes, was assessed objectively via a multisensor monitor worn for 7 days at baseline- and postintervention.

Results: Retention was 84% at the postintervention primary endpoint. In intent-to-treat analyses with baseline value carried forward for missing data and adjusted for baseline MVPA, PAI achieved a mean increase of 16.6±20.6 min/d in bout-related MVPA (baseline: 4.4±5.5 to postintervention: 21.0±21.4 min/d) compared to no change (-0.3±12.7 min/d; baseline: 7.9±16.6 to postintervention: 7.6±11.5 min/d) for SC (P=.001). Similarly, PAI achieved a mean increase of 21.0±26.9 min/d in total MVPA (baseline: 30.9±21.2 to postintervention: 51.9±30.0 min/d), whereas SC demonstrated no change (-0.1±16.3 min/d; baseline: 33.7±33.2 to postintervention: 33.6±28.5 minutes/d) (P=.001).

Conclusion: With behavioral intervention, patients can significantly increase MVPA before bariatric surgery compared to SC. Future studies should determine whether preoperative increases in PA can be maintained postoperatively and contribute to improved surgical outcomes.

Trial registration: ClinicalTrials.gov NCT00962325.

Keywords: Bariatric; Behavior; Intervention; Objective measurement; Physical activity; Randomized controlled trial; Severe obesity.

Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

CONSORT flow diagram includes data on surgeon referrals, patient enrollment, allocation to intervention and control groups, assessment at post-intervention follow-up, and primary analysis.

Figure 2

Daily Moderate-to-Vigorous Physical Activity (MVPA) in the Physical Activity Intervention (PAI) and Standard Surgical Care Control (SC) Conditions at Baseline and Post-Intervention Follow-up Note. For comparison of PAI and SC in baseline to post-intervention follow-up changes in daily minutes of bout-related and total MVPA adjusting for baseline values and objective monitor wear time, * P = 0.001