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Bariatric Surgery

Psychological determinants of exercise adherence in individuals with severe obesity awaiting bariatric surgery: what strategies can physical therapists adopt in prehabilitation programs? A scoping review

International Journal of Obesity volume 49, pages 1704–1716 (2025)Cite this article

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Abstract

Bariatric surgery is recognized for its efficacy in addressing the physical and psychological challenges of severe obesity. Pre-surgical rehabilitation plays a pivotal role in enhancing treatment success. By examining modifiable psychological processes linked to exercise adherence, treatment outcomes for surgery candidates can be improved. The objective of this scoping review was to identify psychological factors influencing adherence to physical exercise in individuals with obesity awaiting bariatric surgery and to assess physical therapy interventions that could instigate lasting behavioral changes in surgical candidates within rehabilitation programs. Following the JBI protocol, various databases were scrutinized, including EMBASE, Scopus, Web of Science, PubMed, Cochrane Library, PEDro, PsyINFO, LILACS, and grey literature sources such as Google Scholar. Studies encompassing individuals with obesity of both sexes, aged over 18, enrolled in perioperative intervention programs were considered. The review encompassed 7 relevant studies. Key psychological constructs associated with exercise adherence included quality of life, pleasure, motivation, self-efficacy, self-monitoring, goal setting, and information seeking. Interventions employed cognitive behavioral therapy, group or individual physical activity counseling, and digital technologies to optimize exercise adherence. In conclusion, bariatric rehabilitation programs should embrace physical activity counseling with a multi-theoretical approach, tailored to the unique needs and perspectives of surgical candidates. The integration of remote digital technologies preoperatively could serve as an effective strategy to provide support and guidance for behavioral changes.

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The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgments

To the Santa Catarina State University Postgraduate Monitoring Scholarship Program (PROMOP/UDESC).

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Authors and Affiliations

  1. Center for Health and Sports Sciences (CEFID). Santa Catarina State University (UDESC), Florianópolis, Santa Catarina, Brazil

    Ananda Quaresma Nascimento, Darlan Laurício Matte, Amanda Farias e Farias, Karina Abreu & Alexandro Andrade

  2. State University of Londrina (UEL), Londrina, Paraná, Brazil

    Diego Bessa Dantas

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Contributions

AQN and DBD were responsible for designing the review protocol, selecting potentially eligible studies and writing the manuscript. AFF and KA were responsible for extracting and analyzing data, interpreting results and writing the manuscript. DLM and AA were responsible for reviewing, analyzing and giving feedback on the manuscript.

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Correspondence to Ananda Quaresma Nascimento.

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The authors declare no competing interests.

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This study is a scoping review that did not involve human participants, animals, or identifiable images. Therefore, ethical approval and informed consent were not required. All methods were carried out in accordance with the PRISMA-ScR.

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Nascimento, A.Q., Matte, D.L., Dantas, D.B. et al. Psychological determinants of exercise adherence in individuals with severe obesity awaiting bariatric surgery: what strategies can physical therapists adopt in prehabilitation programs? A scoping review. Int J Obes 49, 1704–1716 (2025). https://doi.org/10.1038/s41366-025-01830-5

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