The transtheoretical model (TTM) to gain insight into young women's long-term physical activity after bariatric surgery: a qualitative study

Background Over the long term, people who have undergone bariatric surgery (BS) remain overly sedentary with inadequate physical activity (PA). The purpose of this study was to apply the transtheoretical model (TTM) to (1) explore in-depth how PA is experienced years after BS and (2) identify the barriers to and facilitators of PA involved at each stage of change (SOC). Methods Seventeen women with a mean age of 32.5 +/- 3.3 years and a percentage of total weight loss of 29.6 +/- 12.4 were interviewed at a mean of 9.4 +/- 3.6 years after BS. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Results The distribution of barriers to and facilitators of PA differed with the SOC. In progressing from the precontemplation and contemplation stages to the preparation stage, the women experienced changes in their decisional balance, supported by processes of self-reevaluation and environmental reevaluation. In shifting from preparation to the action and maintenance stages, they experienced intrinsic motivation and self-liberation processes. The relapse stage was associated with a decrease in self-efficacy to cope with life constraints. Conclusions This study presents an in-depth theory-based exploration of the dynamics of long-term engagement in PA after BS in young women, with clinical implications for providing them with better guidance toward a more physically active lifestyle.