| ObjectivesTo understand the current situation of physical activity of patients after bariatric metabolic surgery,to analyze the influencing factors of physical activity of patients after bariatric metabolic surgery on the basis of health promotion model,and to explore the relationship between each influencing factor and physical activity of patients after bariatric metabolic surgery,hoping to draw the attention of medical personnel to the physical activity status of patients,to develop a scientific and specific exercise rehabilitation program suitable for individual patients,and to provide a scientific basis for the postoperative care of patients.MethodsA cross-sectional study design was used in this study.From April 2022 to November 2022,297 patients with weight loss and metabolism after surgery in the general surgery department of two Grade-III Class A general public hospitals in Kunming,Yunnan Province were selected as research objects.The investigation instruments included the General Information Questionnaire,the Hospital Anxiety and Depression Assessment Scale(HADS),the Exercise Benefit/Barrier Perception Scale(EBBS),the Exercise Self-Efficacy Scale(ESES),the Perceptive Social Support Scale(PSSS),Exercise Behavior Stage Change Scale(ESC)and the International Physical Activity Questionnaire Short Volume(IPAQ-S)were investigated.The Epidata3.1software was used to enter the data,and the statistical analysis of the survey data was completed using SPSS 26.0 as well as Amos 26.0 software.The methods of analysis included descriptive statistical analysis,one-way analysis,correlation analysis,multiple linear regression analysis,and fitting structural equation models.Results1.Physical activity status of patients after weight loss and metabolismThe distribution of energy expenditure for one week of physical activity in the patients investigated in this study after bariatric metabolic surgery ranged from 0 to10,290.00 MET-min/week,with a median of 1,611.00 MET-min/week,an interquartile P25 of 893.00 MET-min/week and a P75 of 2,568.50 MET-min/week.The length of activity for the three intensities ranged from 0 to 2700 min,with a median of 420 min,an interquartile P25 of 260 min and a quartile P75 of 715 min.According to the evaluation criteria proposed by the IPAQ,the number of patients who were physically inactive was 45(15.15%),223(75.08%)were moderately physically active and only 29patients(9.77%)were physically active.According to the recommended criteria for physical activity for weight loss and prevention of weight regain guidelines published by the ACSM in 2009,only 130(43.77%)of the 297 patients who had undergone metabolic weight loss achieved the recommended activity level.2.Status quo of anxiety and depression,exercise benefit/ barrier perception,exercise self-efficacy,social support and exercise behavior stage in patients after bariatric metabolic surgeryThe anxiety score of patients after bariatric metabolic surgery ranged from 0 to 15 with a mean score of(4.86 ± 3.50)and the depression score ranged from 0 to 13 with a mean score of(3.93 ± 3.51).According to the evaluation criteria of the HADS,the number of patients with anxiety symptoms was 24(8.08%)and the number of patients with depressive symptoms was 13(4.38%).The perceived exercise benefit/barrier scores of the patients after bariatric metabolic surgery ranged from 98 to 166 with a mean score of(132.73±16.46),among which the mean scores of perceived benefits of motion were(92.06±11.95)points and the mean scores of dyskinesia were(40.67±7.13)points.The exercise self-efficacy score of the patients after weight-loss metabolism was3.89 ～ 100.00,with an average score of(63.20±17.91),indicating that the exercise self-efficacy of the patients was at the medium level.The social support scores of the patients after bariatric metabolic surgery ranged from 18 to 84 with a mean score of(66.58±10.73).According to the grading standard of social support level,206(69.36%)post-MBS patients had high social support,88(29.63%)patients had moderate social support and only 3(1.01%)patients had low social support.Eleven patients(3.70%)were in the pre-intentional phase,89(29.27%)in the intentional phase,78(26.26%)in the preparation phase,113(38.05%)in the action phase and 6(2.02%)in the maintenance phase after bariatric metabolic surgery.3.Factors influencing physical activity in patients after bariatric metabolic surgeryThe results of univariate analysis indicated that age,education,occupation,living conditions,monthly per capita household income,preoperative frequency of physical exercise,preoperative complications,surgical methods,preoperative diet,preoperative BMI,EWL% of patients after bariatric metabolic surgery were statistically significant(P <0.05)in the comparison of energy expenditure for physical activity.Spearman correlation analysis indicated that anxiety and depression were negatively correlated with physical activity after metabolic and bariatric surgery(P<0.01),there was a positive correlation between the perceived impairment of sports benefits,sports self-efficacy,social support and physical activity energy consumption(P< 0.01).The results of multiple linear regression equation indicated that surgical method,preoperative BMI,exercise self-efficacy and social support were the influencing factors for patients’ physical activity,together explaining 62.2% of patients’ physical activity after bariatric metabolic surgery.4.Fitting structural equation model of physical activity in patients after bariatric metabolic surgeryThe results of the fitted structural equation model indicated that exercise self-efficacy and social support can directly influence the physical activity status in patients after bariatric metabolic surgery,while anxiety,depression,perception of exercise benefit/barrier,and social support can indirectly influence physical activity by exercise self-efficacy.Anxiety,depression,and perception of exercise benefit/barrier may also indirectly influence physical activity by social support.In addition,the variables of anxiety,depression,perception of exercise benefit/barrier,exercise self-efficacy,and social support together explained 57.1% of the physical activity of patients after bariatric metabolic surgery.Conclusions1.The physical activity status of patients after bariatric metabolic surgery is not optimistic,with a predominance of lower intensity types of activity.56.23% of patients did not meet the ACSM recommendations for physical activity,and 90.23% of patients were not physically active and needed further improvement.2.The main influencing factors of physical activity after bariatric metabolic surgery included social support,exercise self-efficacy,preoperative BMI and surgical modality,and the related factors were age,education level,occupation,living conditions,household income,preoperative exercise frequency,number of comorbidities,preoperative dieting,EWL%,exercise behavior stage,anxiety,depression and Perception of exercise benefit/barrier.The factors that could be intervened on were anxiety,depression,perception of exercise benefit/barrier,exercise self-efficacy and social support.It suggests that nursing workers should regularly visit patients after bariatric metabolic surgery in the future nursing practice,and judge the patient’s physical activity status in a timely manner,focusing on the elder,low cultural level,high preoperative BMI,many comorbidities,have poor weight loss outcomes,at a low motor behavior stage.The workers should timely evaluate the patient’s anxiety and depression,understand the patient’s perception of the benefit/handicap,know about their confidence in participating in exercise and the social support they would like to receive,and by providing scientific and individual physical activity guidance to improve the physical activity status of patients after weight loss.3.The fit structural equation model constructed by health promotion model has a better explanation for the physical activity status of patients after bariatric metabolic surgery. |
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