Purpose Ways to motivate and support patients in being physically active after bariatric surgery are needed. This trial was aimed at evaluating the effect of using a smartphone application targeting physical activity during 12 weeks on moderate-to-vigorous physical activity (MVPA, primary outcome) and secondary outcomes of inactivity, light physical activity (LPA), body mass index (BMI), and percent total weight loss (%TWL) after bariatric surgery.Materials and Methods Data from a randomized controlled trial comprising 146 patients (79.5% women) undergoing bariatric surgery was analyzed. Mean age and BMI pre-surgery were 40.9 years and 40.5 kg/m(2), respectively. Participants were randomized 1:1 to an intervention or a control group. Physical activity and body weight were objectively measured at baseline pre-surgery and post-surgery follow-ups after 6 weeks (weight only), 18 weeks, 6 months, and 1 year. Linear mixed models were fitted to assess longitudinal differences in outcomes between the groups.Results A significant effect of the intervention (group-by-time interaction 16.2, 95% CI 3.5 to 28.9) was seen for MVPA at 18 weeks; the intervention group had increased their MVPA since baseline, while the control group had decreased their MVPA. The control group had lowered their BMI approximately 1 kg/m(2) more than the intervention group at follow-up after 18 weeks and 12 months, yet, mean BMI did not differ between the groups. No intervention effect was seen on inactivity, LPA, or %TWL.ConclusionOur results indicate that use of a smartphone application targeting physical activity may have the potential to promote short-term MVPA post bariatric surgery.

Background 

Poor adherence to the lifelong vitamin and mineral supplementation post bariatric surgery is common and can be a challenge for healthcare professionals to recognize. There are several questionnaires for self-reporting of adherence to chronic medication, but none has been evaluated for assessment of adherence to vitamin and mineral supplementation post bariatric surgery.

Aim: 

To assess the accuracy of the 5-item Medication Adherence Report Scale (MARS-5) in measuring adherence to vitamin and mineral supplementation post bariatric surgery. 

Method: 

We validated the psychometric properties of MARS-5 for vitamin and mineral supplementation in two cohorts: one at 1 year post bariatric surgery (n=120) and one at 2 years post-surgery (n=211). The validity was compared to pharmacy refill data for vitamin B12 and combined Calcium/vitamin D as reference.

Results: 

Correlation analyzes demonstrated that the MARS-5 demonstrated acceptable validity compared to objectively measured adherence rate from pharmacy refill data calculated as continuous, multiple-interval measures of medication availability/gaps (coefficient ranged from 0.49 to 0.54). Internal reliability (Cronbach's α) was high: 0.81 and 0.95, respectively.  A ceiling effect was seen, where one out of three scored max in MARS-5.

Conclusion: 

MARS-5 demonstrated acceptable, but not optimal, psychometric properties for assessment of adherence to vitamin and mineral supplementation post bariatric surgery. We encourage further validation of other questionnaires for assessing adherence of vitamin and mineral supplementation post bariatric surgery.

Objective This trial evaluated a smartphone applications effectiveness in improving adherence to vitamin and mineral supplementation postoperatively. Methods This study was a randomized controlled trial comprising 140 patients undergoing bariatric surgery (gastric bypass or sleeve gastrectomy). Participants were randomized 1:1 to the 12-week intervention, using the smartphone application PromMera, or to standard care. The primary end point was adherence to vitamin and mineral supplementation. Results Initiation rate and overall adherence to supplementation were high in both groups. Change in objectively measured adherence rate from before the intervention to 1 year post surgery, measured with pharmacy refill data, did not differ between groups for vitamin B-12 (-9.6% [SD = 27%] vs. -9.3% [SD = 30%]; p = 0.48) or calcium/vitamin D (-12.3% [SD = 29%] vs. -11.5% [SD = 32%]; p = 0.44). A modest effect on the secondary end point (subjectively measured adherence, using the Medication Adherence Report Scale-5) was seen immediately after the intervention (intervention group 0.00 [SD = 1.3] vs. control group -1.2 [SD = 3.5]; p = 0.021), but this effect did not persist 1 year post surgery. No differences were detected in the prevalence of biochemical deficiencies. Conclusions The use of the smartphone application PromMera did not obtain a lasting improvement in adherence to vitamin and mineral supplementation 1 year post bariatric surgery.

Introduction:  Previous studies suggest insufficient adherence to vitamin and mineral supplementation after bariatric surgery. 

Objective: This trial evaluated a smartphone application’s effectiveness in improving adherence to vitamin and mineral supplementation postoperatively. 

Methods: A two-arm, randomized controlled trial comprising 140 patients undergoing bariatric surgery (gastric bypass or sleeve gastrectomy). Participants were randomized 1:1 post-surgery to 12-week intervention, using the smartphone application PromMera, or standard care. The PromMera application was designed to promote vitamin and mineral use and physical activity after bariatric surgery. The primary end point was adherence to vitamin and mineral supplementation, objectively assessed with pharmacy claim data the first-year post-surgery. Additional endpoints were adherence subjectively assessed with change in MARS-5 score, measured pre-intervention, and at 18 weeks and one year post surgery and development of nutritional deficiencies one-year post-surgery.

Results: Initiation rate and overall adherence to supplementation were high in both groups. Change in objectively measured adherence rate from before intervention to 1 year post surgery, measured with pharmacy refill data, did not differ between groups for vitamin B12  (-9.6% [SD 27%] vs. -9.3% [SD 30%]; p=0.48) or calcium/vitamin D (-12.3% [SD 29%] vs. -11.5% [SD 32%]; p=0.44). A modest effect on the secondary end point (subjectively measured adherence, using the Medication Adherence Report Scale-5 [MARS-5]) was seen immediately after the intervention (intervention group 0.00 [SD 1.3] vs. control group -1.2 [SD 3.5]; p=0.021), but this effect did not persist 1 year post surgery. No differences were detected in the prevalence of biochemical deficiencies.

Conclusions The use of the smartphone application PromMera did not obtain a lasting improvement in adherence to vitamin and mineral supplementation one year post bariatric surgery.

Introduction:  Previous studies suggest insufficient adherence to vitamin and mineral supplementation after bariatric surgery. 

Objective: This trial evaluated a smartphone application’s effectiveness in improving adherence to vitamin and mineral supplementation postoperatively. 

Methods: A two-arm, randomized controlled trial comprising 140 patients undergoing bariatric surgery (gastric bypass or sleeve gastrectomy). Participants were randomized 1:1 post-surgery to 12-week intervention, using the smartphone application PromMera, or standard care. The PromMera application was designed to promote vitamin and mineral use and physical activity after bariatric surgery. The primary end point was adherence to vitamin and mineral supplementation, objectively assessed with pharmacy claim data the first-year post-surgery. Additional endpoints were adherence subjectively assessed with change in MARS-5 score, measured pre-intervention, and at 18 weeks and one year post surgery and development of nutritional deficiencies one-year post-surgery.

Results: Initiation rate and overall adherence to supplementation were high in both groups. Change in objectively measured adherence rate from before intervention to 1 year post surgery, measured with pharmacy refill data, did not differ between groups for vitamin B12  (-9.6% [SD 27%] vs. -9.3% [SD 30%]; p=0.48) or calcium/vitamin D (-12.3% [SD 29%] vs. -11.5% [SD 32%]; p=0.44). A modest effect on the secondary end point (subjectively measured adherence, using the Medication Adherence Report Scale-5 [MARS-5]) was seen immediately after the intervention (intervention group 0.00 [SD 1.3] vs. control group -1.2 [SD 3.5]; p=0.021), but this effect did not persist 1 year post surgery. No differences were detected in the prevalence of biochemical deficiencies.

Conclusions The use of the smartphone application PromMera did not obtain a lasting improvement in adherence to vitamin and mineral supplementation one year post bariatric surgery.

Background: Lifelong vitamin and mineral supplementation is recommended after bariatric surgery to prevent nutritional deficiencies, but it is not clear to which extent patients adhere to the recommended medication. The aim of this study was to assess adherence to supplementation. Additionally, we assessed predictors of low adherence and biochemical deficiencies.Methods: 263 adults were followed two years post bariatric surgery (89.4 % Roux-en-Y gastric bypass, 10.6 % sleeve gastrectomy) regarding adherence to calcium-vitamin D, vitamin B12 and iron. Pharmacy refill data was used to objectively capture adherence-rate. Predictors of low adherence were assessed via questionnaires and medical records. Blood sampling was performed preoperatively, and 1-and 2-years post-surgery.Results: About 60 % of the study participants had high adherence-rate (>= 80 %) two years post-surgery, but a significant proportion had discontinued the intended lifelong supplementation: 15 % for calcium-vitamin D and 12 % for B12. Biochemical deficiencies were uncommon two years after surgery, both in adherent and non -persistent subjects, except for a 10 % prevalence of anemia. Younger age, experience of side effects, mental health problems and no regular use of medication before surgery, were factors associated with low adherence.Conclusion: Substantial variation existed in adherence to supplementation regimens after bariatric surgery during the first two years after bariatric surgery, but biochemical deficiencies were rare. The results indicate need for tailored follow-up and strategies to support long-term persistence.

Background: To optimize postoperative outcomes after bariatric surgery, lifestyle changes including increased physical activity are needed. Micronutrient deficiency after surgery is also common and daily supplementation is recommended. Objective: The aim of the PromMera study is to evaluate the effects of a 12-week smartphone app intervention on promotion of physical activity (primary outcome) and adherence to postsurgery vitamin and mineral supplementation, as well as on other lifestyle factors and overall health in patients undergoing bariatric surgery. Methods: The PromMera study is a two-arm, randomized controlled trial comprising patients undergoing bariatric surgery. Participants are randomized postsurgery 1:1 to either the intervention group (ie, use of the PromMera app for 12 weeks) or the control group receiving only standard care. Clinical and lifestyle variables are assessed pre- and postsurgery after 18 weeks (postintervention assessment), 6 months, 1 year, and 2 years. Assessments include body composition using Tanita or BOD POD analyzers, muscle function using handgrip, biomarkers in blood, and an extensive questionnaire on lifestyle factors. Physical activity is objectively measured using the ActiGraph wGT3X-BT triaxial accelerometer. Results: A total of 154 participants have been enrolled in the study. The last study participant was recruited in May 2019. Data collection will be complete in May 2021. Conclusions: Implementing lifestyle changes are crucial after bariatric surgery and new ways to reach patients and support such changes are needed. An app-based intervention is easily delivered at any time and can be a key factor in the adoption of healthier behavioral patterns in this rapidly growing group of patients.