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      Exploring the socio-ecological factors behind the (in)active lifestyles of Spanish post-bariatric surgery patients

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          ABSTRACT

          Purpose: Physical activity (PA) is considered essential for the treatment of morbid obesity and the optimization of bariatric surgery outcomes. The objective of this article was to identify the facilitators and barriers that bariatric patients perceived to do PA one year after finishing a PA programme for the promotion of a long-term active lifestyle. This objective was addressed from a socio-ecological and qualitative perspective.

          Methods: Nine patients (eight women and one man), aged between 31 and 59 years, participated in semi-structured interviews directly following the PA programme and one year after it. A content analysis was carried out to analyze the qualitative data.

          Results: Weight loss, improvement of physical fitness, perceived competence, and enjoyment were the main facilitators of PA. Complexes related to skin folds, osteoarthritis, perceived unfavourable weather conditions, lack of social support and economic resources, long workdays, lack of specific PA programmes, and other passive leisure preferences were the main barriers to participate in PA.

          Conclusions: Results highlight the important interplay between personal, social environmental, and physical environmental factors to explain (in)active behaviours of bariatric patients. The findings of this article could be useful for future research and interventions aimed at promoting PA in bariatric patients.

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          Most cited references35

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          Self-determination theory: A macrotheory of human motivation, development, and health.

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            The relative influence of individual, social and physical environment determinants of physical activity.

            Environmental determinants of health are receiving growing attention in the literature, although there is little empirical research in this area. The Study on Environmental and Individual Determinants of Physical Activity (known as the SEID project) was a social ecological project that examined the relative influence of individual, social environmental and physical environmental determinants of recreational physical activity. It involved a community survey of 1803 healthy workers and home-makers aged 18-59 years living in a 408 km2 area of metropolitan Perth, Western Australia. Physical environmental determinants were mainly conceptualised as spatial access to popular recreational facilities. Overall, 59% of respondents exercised as recommended. Recreational facilities located near home were used by more respondents than facilities located elsewhere. The most frequently used facilities were informal: the streets (45.6%); public open space (28.8%) and the beach (22.7%). The physical environment's directs the influence on exercising as recommended was found to be secondary to individual and social environmental determinants. Nevertheless, accessible facilities determined whether or not they were used and in this way, support and enhance the achievement of recommended levels of physical activity behaviour by providing opportunities. The results suggest that access to a supportive physical environment is necessary, but may be insufficient to increase recommended levels of physical activity in the community. Complementary strategies are required that aim to influence individual and social environmental factors. Given the popularity of walking in the community, it is recommended that greater emphasis be placed on creating streetscapes that enhance walking for recreation and transport.
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              A randomized controlled trial to evaluate self-determination theory for exercise adherence and weight control: rationale and intervention description

              Background Research on the motivational model proposed by Self-Determination Theory (SDT) provides theoretically sound insights into reasons why people adopt and maintain exercise and other health behaviors, and allows for a meaningful analysis of the motivational processes involved in behavioral self-regulation. Although obesity is notoriously difficult to reverse and its recidivism is high, adopting and maintaining a physically active lifestyle is arguably the most effective strategy to counteract it in the long-term. The purposes of this study are twofold: i) to describe a 3-year randomized controlled trial (RCT) aimed at testing a novel obesity treatment program based on SDT, and ii) to present the rationale behind SDT's utility in facilitating and explaining health behavior change, especially physical activity/exercise, during obesity treatment. Methods Study design, recruitment, inclusion criteria, measurements, and a detailed description of the intervention (general format, goals for the participants, intervention curriculum, and main SDT strategies) are presented. The intervention consists of a 1-year group behavioral program for overweight and moderately obese women, aged 25 to 50 (and pre-menopausal), recruited from the community at large through media advertisement. Participants in the intervention group meet weekly or bi-weekly with a multidisciplinary intervention team (30 2 h sessions in total), and go through a program covering most topics considered critical for successful weight control. These topics and especially their delivery were adapted to comply with SDT and Motivational Interviewing guidelines. Comparison group receive a general health education curriculum. After the program, all subjects are follow-up for a period of 2 years. Discussion Results from this RCT will contribute to a better understanding of how motivational characteristics, particularly those related to physical activity/exercise behavioral self-regulation, influence treatment success, while exploring the utility of Self-Determination Theory for promoting health behavior change in the context of obesity. Trial Registration Clinical Trials Gov. Identifier NCT00513084
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                Author and article information

                Journal
                Int J Qual Stud Health Well-being
                Int J Qual Stud Health Well-being
                ZQHW
                zqhw20
                International Journal of Qualitative Studies on Health and Well-being
                Taylor & Francis
                1748-2623
                1748-2631
                2019
                12 June 2019
                : 14
                : 1
                : 1626180
                Affiliations
                [a ]Department of Sport Sciences, Sport Research Centre, Miguel Hernández University , Elche, Spain
                [b ]Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University , Cardiff, UK
                [c ]Department of Mental Health, Hospital Universitario del Vinalopó , Elche, Spain
                Author notes
                CONTACT Vicente J. Beltrán-Carrillo vbeltran@ 123456umh.es Department of Sport Sciences, Sport Research Centre, Miguel Hernández University of Elche , Avenida de la Universidad s/n, 03202Elche, Alicante, Spain
                Author information
                http://orcid.org/0000-0001-8794-5901
                http://orcid.org/0000-0003-0033-2374
                http://orcid.org/0000-0002-3781-568X
                http://orcid.org/0000-0002-8584-3992
                http://orcid.org/0000-0001-5854-6354
                Article
                1626180
                10.1080/17482631.2019.1626180
                6566659
                31187702
                009d87cf-fae3-4062-9e04-5574574df5fa
                © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 May 2019
                Page count
                Tables: 3, References: 44, Pages: 11
                Funding
                Funded by: Fundación MAPFRE 10.13039/501100003350
                Award ID: UEM2.11X
                Funded by: Escuela de Estudios Universitarios Real Madrid-Universidad Europea de Madrid
                Award ID: UEM2.11X
                This study was supported by the Fundación MAPFRE and the Escuela de Estudios Universitarios Real Madrid-Universidad Europea de Madrid (UEM2.11X).
                Categories
                Empirical Studies

                Health & Social care
                physical activity,exercise,obesity,environment,barriers,facilitators
                Health & Social care
                physical activity, exercise, obesity, environment, barriers, facilitators

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