目的 探讨基于社会认知理论的运动干预对减重代谢手术后青少年运动行为及相关结局的影响。方法 选取2023年6月至2024年6月南京医科大学第一附属医院减重代谢外科收治的减重代谢手术后4周进入随访管理阶段的青少年肥胖病人共70例，按照随机数字表法分为干预组和对照组，各35例。对照组接受常规术后运动管理，干预组在此基础上接受为期16周的基于社会认知理论的运动干预，围绕认知建构、行为执行与环境支持展开。比较干预前后两组的活动水平、身体成分、心理社会结局。结果 与对照组相比，干预组的高强度活动时间（P=0.027）、步数（P=0.010）、BMI（P=0.037）、多余体重减少百分比（P=0.024）、体肌肉率（P=0.043）、生活质量（P=0.016）以及锻炼行为意向（P=0.038）均显著改善，组间差异有统计学意义，但热量消耗、活动时间、体脂率、运动自我效能方面差异无统计学意义（P>0.05）。结论 基于社会认知理论的运动干预有助于提升减重代谢手术后青少年运动参与水平和心理社会功能，且具备良好的可行性、适应性，可为该人群术后健康行为管理提供理论支持和实践依据。
Abstract
To explore the effects of a social cognitive theory (SCT)-based exercise intervention on physical activity and related outcomes in adolescents after bariatric surgery. Methods A total of 70 adolescent patients who had undergone bariatric metabolic surgery and entered the follow-up management stage for 4 weeks postoperatively at the Department of Bariatric and Metabolic Surgery, the First Affiliated Hospital of Nanjing Medical University, between June 2023 and June 2024, were enrolled. They were randomly assigned to an experimental group (n=35) and a control group (n=35) using a random number table method. The control group received routine postoperative exercise guidance, while the intervention group received an SCT-based 16-week structured program focused on cognitive construction, behavioral execution, and environmental support. Outcomes, including physical activity levels, body composition, and psychosocial measures, were compared before and after the intervention. Results Compared with the control group, the intervention group showed significant improvements after the intervention in duration of moderate-to-vigorous physical activity (P=0.027), step count (P=0.010), BMI (P=0.037), excess weight loss rate (P=0.024), and the improvement in skeletal muscle mass percentage (P=0.043), quality of life (P=0.016), and exercise behavior intention (P=0.038), with statistically significant differences between the groups. However, no significant differences were observed between the groups in calorie expenditure, total activity duration, body fat percentage, or exercise self-efficacy (P>0.05). Conclusion SCT-based exercise interventions are effective in enhancing physical activity participation and psychosocial function in adolescents after bariatric surgery. This approach is feasible and adaptable, offering theoretical and practical support for postoperative behavioral management in this population.
关键词
青少年 /
减重代谢手术 /
运动干预 /
社会认知理论
Key words
adolescents /
metabolic and bariatric surgery /
exercise intervention /
social cognitive theory
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参考文献
［1］ Messiah SE, Xie L, Atem F, et al. Disparity between United States adolescent class Ⅱ and Ⅲ obesity trends and bariatric surgery utilization, 2015-2018 ［J］. Ann Surg, 2022, 276(2): 324-333. DOI: 10.1097/sla.0000000000004493.
［2］ 陈紫来, 王尚鑫, 郭振, 等. 减重代谢手术后复胖影响因素及防治措施的研究进展［J］. 中华实用诊断与治疗杂志, 2024, 38(1): 102-105. DOI: 10.13507/j.issn.1674-3474.2024.01.021.
［3］ 梁辉. 青少年肥胖病人行减重手术适应证及手术方式探讨 ［J］. 中国实用外科杂志, 2020, 40(4): 395-399. DOI: 10.19538/j.cjps.issn1005-2208.2020.04.08.
［4］ Mackey ER, Olson A, Merwin S, et al. Perceived Social support for exercise and weight loss in adolescents undergoing sleeve gastrectomy ［J］. Obes Surg, 2018, 28(2): 421-426. DOI:10.1007/s11695-017-2853-9.
［5］ 中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和代谢病外科专家工作组. 中国肥胖及代谢疾病外科治疗指南（2024版） ［J］. 中国实用外科杂志, 2024, 44(8): 841-849. DOI:10.19538/j.cjps.issn1005-2208.2024.08.01.
［6］ Zhao K, Chen Y, Guo Y, et al. Identifying effective design components in physical activity interventions post-bariatric surgery: A systematic review and Meta-analysis ［J］. Obes Rev, 2025, 26(10): e13951. DOI: 10.1111/obr.13951.
［7］ Tangjittrong S, Udomsawaengsup S, Boonchaya-Anant P. Comparison of body composition variables between post-bariatric surgery patients and non-operative controls ［J］. Clin Med Insights Endocrinol Diabetes, 2023, 16: 11795514231206731. DOI: 10.1177/11795514231206731.
［8］ Javanrouh N, Khalaj A, Guity K, et al. Presence of CC genotype for rs17773430 could affect the percentage of excess weight loss 1 year after bariatric surgery: tehran obesity treatment study（TOTS）［J］. Obes Surg, 2020, 30(2): 537-544. DOI: 10.1007/s11695-019-04211-w.
［9］ Varni JW, Seid M, Kurtin PS. PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations ［J］. Med Care, 2001, 39(8): 800-812. DOI: 10.1097/00005650-200108000-00006.
［10］ Desai AD, Zhou C, Stanford S, et al. Validity and responsiveness of the pediatric quality of life inventory (PedsQL) 4.0 generic core scales in the pediatric inpatient setting ［J］. JAMA Pediatr，2014, 168(12): 1114-1121. DOI: 10.1001/jamapediatrics.2014.1600.
［11］ 戎芷熠, 李富, 付钰赛, 等. 大学生运动自我效能与体力活动水平的关系：基于锻炼行为意向的中介作用及抑郁的调节作用 ［J］. 健康发展与政策研究, 2025, 28(3): 300-306. DOI: 10.12458/HDPR.202411109
［12］ Resnick B, Jenkins LS. testing the reliability and validity of the self-efficacy for exercise scale ［J］. Nurs Res, 2000, 49(3): 154-159. DOI: 10.1097/00006199-200005000-00007.
［13］ 李杨, 刘庚. 代谢减重手术后病人减重效果、体力活动与生活质量的相关性研究 ［J］. 腹腔镜外科杂志, 2021, 26(7): 484-488. DOI: 10.13499/j.cnki.fqjwkzz.2021.07.484.
［14］ Zhu L, Chen Z, Liu J, et al. Energy costs of 37 physical activities in Chinese children and adolescents aged 9-17 years with obesity ［J］. Nutrients, 2024, 16(22): 3966. DOI: 10.3390/nu16223966.
［15］ 李玉珍. 体育学习中的霍桑效应：基于关注的四维度模型 ［J］. 中国教育技术装备, 2020, 23：80-82. DOI：10.3969/j.issn.1671-489X.2020.23.080
［16］ Gil S, Kirwan JP, Murai IH, et al. A randomized clinical trial on the effects of exercise on muscle remodelling following bariatric surgery ［J］. J Cachexia Sarcopenia Muscle, 2021, 12(6): 1440-1455. DOI: 10.1002/jcsm.12815.
［17］ Imhagen A, Karlsson J, Ohlsson-Nevo E, et al. Levels of physical activity, enjoyment, self-efficacy for exercise, and social support before and after metabolic and bariatric surgery: A longitudinal prospective observational study ［J］. Obes Surg, 2023, 33(12): 3899-3906. DOI: 10.1007/s11695-023-06887-7.
［18］ Ling FCM, Khudair M, Ng K, et al. DE-PASS best evidence statement (BESt): Determinants of self-report physical activity and sedentary behaviours in children in settings: A systematic review and Meta-analyses ［J］. PloS One, 2024, 19(11): e0309890. DOI: 10.1371/journal.pone.0309890.
［19］ Zabatiero J, Smith A, Hill K, et al. Do factors related to participation in physical activity change following restrictive bariatric surgery? A qualitative study ［J］. Obes Res Clin Pract, 2018, 12(3): 307-316. DOI: 10.1016/j.orcp.2017.11.001.
［20］ 龙君伟. 论社会认知理论中的建构特征 ［J］. 华东师范大学学报（教育科学版）, 2005, 23(2): 57-62. DOI：10.16382/j.cnki.1000-5560.2005.02.008
［21］ Verswijveren S, Abbott G, Lai SK, et al. Mediators of effects on physical activity and sedentary time in an activity tracker and behavior change intervention for adolescents: Secondary analysis of a cluster randomized controlled trial ［J］. JMIR Mhealth Uhealth, 2022, 10(8): e35261. DOI: 10.2196/35261.
［22］ Sun X, Liu W, Li L, et al. Development of a complex intervention for promoting participation in resistance exercise among community-dwelling frail older adults in china: A multimethod qualitative study ［J］. Innov Aging, 2025, 9(1): igae109. DOI: 10.1093/geroni/igae109.
［23］ Alyafei AA, AlMukhaini SK, Ma Hussein A, et al. The impact of sleeve gastrectomy combined with lifestyle interventions on anthropometric and health outcomes in adults: A systematic review and Meta-analysis ［J］. Cureus, 2025, 17(6): e85587. DOI: 10.7759/cureus.85587.
［24］ Elks W, Rooks A, Schulte S, et al. Resistance training in patients after metabolic and bariatric surgery: Protocol for a systematic review ［J］. JMIR Res Protoc, 2023, 12: e49513. DOI: 10.2196/49513.
［25］ Grief SN, Miranda RL. Weight loss maintenance ［J］. Am Fam Physician, 2010, 82(6): 630-634. PMID: 20842990.
［26］ Wang S, Liu J. Transforming physical fitness and exercise behaviors in adolescent health using a life log sharing model ［J］. Front Public Health, 2025, 13: 1562151. DOI: 10.3389/fpubh.2025.1562151.
［27］ Marc-Hernández A, Ruiz-Tovar J, Aracil A, et al. Effects of a high-intensity exercise program on weight regain and cardio-metabolic profile after 3 years of bariatric surgery: A randomized trial ［J］. Sci Rep, 2020, 10(1): 3123. DOI: 10.1038/s41598-020-60044-z.
［28］ 曹朋, 王冉, 郝艳丽, 等. 青少年、儿童术前焦虑评估量表研究进展［J］. 重庆医学, 2022, 51(21): 3755-3759. DOI：10.3969/j.issn.1671-8348.2022.21.030
［29］ Miller R, Mason SE. Cognitive enhancement therapy: A therapeutic treatment strategy for first-episode schizophrenia patients ［J］. Bull Menninger Clin, 2004, 68(3): 213-230. DOI: 10.1521/bumc.68.3.213.40406.
［30］ Williams MA, Heine PJ, Williamson EM, et al. Active treatment for idiopathic adolescent scoliosis (ACTIvATeS): A feasibility study ［J］. Health Technol Assess, 2015, 19(55): 1-242. DOI:10.3310/hta19550.
［31］ McCullough MB, Cunning A, Klam R, et al. Perceived responsibility for bariatric surgery, eating, and exercise behaviors among adolescent bariatric surgery candidates ［J］. Child Obes, 2024, 20(8): 634-642. DOI: 10.1089/chi.2024.0228.
［32］ 胡启权. 不同强度体育锻炼对提升高校学生心理健康和心理韧性的效果评价［J］. 中国学校卫生, 2019, 40(1): 83-85. DOI: 10.16835/j.cnki.1000-9817.2019.01.022.
［33］ Filipa A, Barton K. Physical therapy rehabilitation of an adolescent preprofessional dancer following os trigonum excision: A case report ［J］. J Orthop Sports Phys Ther, 2018, 48(3): 194-203. DOI: 10.2519/jospt.2018.7508.
