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

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.