Longitudinal associations between self-regulation and physical activity behavior following metabolic bariatric surgery; an exploratory study

C Sundgot-Borgen; S Baardstu; D S Bond; F F Sniehotta; I Bergh; T Mala; Ø Rø; I L Kvalem

doi:10.1186/s12966-025-01739-2

Longitudinal associations between self-regulation and physical activity behavior following metabolic bariatric surgery; an exploratory study

Int J Behav Nutr Phys Act. 2025 Apr 8;22(1):40. doi: 10.1186/s12966-025-01739-2.

Authors

C Sundgot-Borgen^{1

2}, S Baardstu³, D S Bond⁴, F F Sniehotta⁵, I Bergh⁶, T Mala^{7

8}, Ø Rø^{9

10}, I L Kvalem¹¹

Affiliations

¹ Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, 4956, Nydalen, Oslo, 0424, Norway. christine.sundgot-borgen@psykologi.uio.no.
² Department of Psychology, University of Oslo, 1094, Blindern, Oslo, 0317, Norway. christine.sundgot-borgen@psykologi.uio.no.
³ Department of Childhood and Families, the Norwegian Institute of Public Health, 222, Skøyen, Oslo, 0213, Norway.
⁴ Center for Obesity Research, Innovation and Education, Digestive Health Institute, Hartford Healthcare, Hartford, CT, 06102, USA.
⁵ Centre for Preventive Medicine and Digital Health, Division Public Health, Preventive and Social Medicine, Medical Faculty Mannheim, Heidelberg University, Röntgenstraße 7, D- 68167, Mannheim, Germany.
⁶ Nudgelab, Konghellegata 10, 0570, Oslo, Norway.
⁷ Center for Morbid Obesity and Bariatric Surgery, Oslo University Hospital, 4950, Nydalen, 0424, Norway.
⁸ Institute of Clinical Medicine, University of Oslo, 1171, Blindern, Oslo, 0318, Norway.
⁹ Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, 4956, Nydalen, Oslo, 0424, Norway.
¹⁰ Institute of Clinical Medicine, University of Oslo, 1039, Blindern, Oslo, 0315, Norway.
¹¹ Department of Psychology, University of Oslo, 1094, Blindern, Oslo, 0317, Norway.

Abstract

Background: Low adherence to moderate-to-vigorous physical activity (MVPA) recommendations among patients undergoing metabolic bariatric surgery (MBS) is common. However, understanding of psychosocial factors that contribute to low adherence levels is limited. Self-regulation plays a key role in MVPA adherence. Still, the longitudinal and bidirectional associations between self-regulation and MVPA in the MBS patient population remains unexplored. This study aimed to investigate how self-regulatory processes of action- and coping planning, and action control, developed over a 1-5-year post-surgery period, and explore longitudinally the direct, indirect, and bidirectional associations between this development in self-regulation and MVPA assessed at 1- and 5-years after surgery.

Methods: Participants from the Oslo Bariatric Surgery Study (OBSS) completed MVPA-specific self-regulation questionnaires at 1-, 3-, and 5-years post-surgery and wore ActiGraph monitors for seven days at 1- and 5-years to assess daily MVPA. Second-order latent growth curve modeling examined changes in the three self-regulation constructs, followed by path analysis to explore direct, indirect, and bidirectional associations between baseline levels and changes in self-regulation, and MVPA at 1- and 5-years post-surgery.

Results: A total of 205 (82.8%), 195 (64.6%), and 79 (26.2%) male and females (77%) participated at 1-, 3-, and 5-years after surgery, respectively. Action- and coping- planning decreased with.52 and.30 sd, respectively, over 1-5 years post-surgery. This indicates a moderate effect size. Action control remained relatively stable. Indirect and bidirectional path analyses showed that only higher levels of action control at 1-year were indirectly associated with higher MVPA at 5-years through their impact on MVPA at 1-year, whereas there were no indications of bidirectional associations from MVPA levels at 1-year to changes in any of the self-regulation constructs over time.

Conclusions: After MBS, patients exhibited low self-regulation 1-year post-surgery, and many participants faced growing difficulties in self-regulating over time. Self-regulation at 1-year was positively linked to MVPA, with action control only, being associated with MVPA at 5-years. However, no bidirectional associations from MVPA to self-regulation were found. These findings suggest further research is needed to test interventions targeting action control to improve MVPA adherence and optimize surgical outcomes and overall health after MBS.

Keywords: Exercise; Lifestyle; Metabolic bariatric surgery; Physical activity; Self-regulation.

MeSH terms

Adaptation, Psychological
Adult
Bariatric Surgery* / psychology
Exercise* / psychology
Female
Health Behavior
Humans
Longitudinal Studies
Male
Middle Aged
Norway
Self-Control* / psychology
Surveys and Questionnaires

Grants and funding

2020061/Helse Sør-Øst RHF