title: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, Rhode Island. Electronic address: dbond@lifespan.org.
authors.forename: Dale S
authors.initials: DS
authors.lastname: Bond
authors.affiliation: Department of Surgery, Alpert Medical School of Brown University/The Miriam Hospital, Providence, Rhode Island.
authors.forename: Sivamainthan
authors.initials: S
authors.lastname: Vithiananthan
authors.affiliation: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, Rhode Island.
authors.forename: J Graham
authors.initials: JG
authors.lastname: Thomas
authors.affiliation: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, Rhode Island.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Trautvetter
authors.affiliation: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, Rhode Island.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Unick
authors.affiliation: Department of Physical Activity and Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: John M
authors.initials: JM
authors.lastname: Jakicic
authors.affiliation: Department of Surgery, Roger Williams Hospital, Providence, Rhode Island.
authors.forename: Dieter
authors.initials: D
authors.lastname: Pohl
authors.affiliation: Department of Surgery, Alpert Medical School of Brown University/The Miriam Hospital, Providence, Rhode Island.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Ryder
authors.affiliation: Department of Surgery, Alpert Medical School of Brown University/The Miriam Hospital, Providence, Rhode Island.
authors.forename: G Dean
authors.initials: GD
authors.lastname: Roye
authors.affiliation: Department of Surgery, Cedars-Sinai Medicine, Los Angeles, California.
authors.forename: Harry C
authors.initials: HC
authors.lastname: Sax
authors.affiliation: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, Rhode Island.
authors.forename: Rena R
authors.initials: RR
authors.lastname: Wing
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods; D006801:Humans; D057194:Intention to Treat Analysis; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009043:Motor Activity; D009765:Obesity / Q000628:therapy*; D009767:Obesity, Morbid / Q000523:psychology / Q000628:therapy; D057234:Preoperative Period; D016138:Walking; D055815:Young Adult
keywords: Bariatric; Behavior; Intervention; Objective measurement; Physical activity; Randomized controlled trial; Severe obesity