title: The lived experiences of being physically active when morbidly obese: A qualitative systematic review.
abstract: The aim is to identify facilitators and barriers for physical activity (PA) experienced by morbidly obese adults in the Western world. Inactivity and a sedentary lifestyle have become a major challenge for health and well-being, particularly among persons with morbid obesity. Lifestyle changes may lead to long-term changes in activity level, if facilitators and barriers are approached in a holistic way by professionals. To develop lifestyle interventions, the perspective and experiences of this group of patients are essential for success. The methodology of the systematic review followed the seven-step procedure of the Joanna Briggs Institute and was published in a protocol. Six databases were searched using keywords and index terms. Manual searches were performed in reference lists and in cited citations up until March 2015. The selected studies underwent quality appraisal in the Joanna Briggs-Qualitative Assessment and Review Instrument. Data from primary studies were extracted and were subjected to a hermeneutic text interpretation and a data-driven coding in a five-step procedure focusing on meaning and constant targeted comparison through which they were categorized and subjected into a meta-synthesis. Eight papers were included for the systematic review, representing the experiences of PA among 212 participants. One main theme developed from the meta-data analysis: "Identity" with the three subthemes: "considering weight," "being able to," and "belonging with others." The theme and subthemes were merged into a meta-synthesis: "Homecoming: a change in identity." The experiences of either suffering or well-being during PA affected the identity of adults with morbid obesity either by challenging or motivating them. A change in identity may be needed to feel a sense of "homecoming" when active.
authors.affiliation: Department of Lifestyle Rehabilitation, Horsens Regional Hospital, Brædstrup, Denmark.|Department of Research, Horsens Regional Hospital, Denmark; Betoft@horsens.rm.dk.
authors.forename: Bente Skovsby
authors.initials: BS
authors.lastname: Toft
authors.affiliation: Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark.|Danish Centre of Systematic Reviews: An Affiliate Centre of the Joanna Briggs Institute, Aalborg, Denmark.
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Uhrenfeldt
mesh_terms: D001290:Attitude; D015444:Exercise; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D009042:Motivation; D009767:Obesity, Morbid / Q000523:psychology*; D020377:Self Efficacy; D013315:Stress, Psychological
keywords: Physical activity; body image; identity; interpersonal relations; morbid obesity; qualitative research; self-efficacy