Table 4.

Unique Physical and Psychological Barriers to Engaging in and Maintaining Regular Physical Activity among Severely Obese Bariatric Surgery Patients

Barrier	Reason	Possible Solutions
Lack of confidence to go to a fitness facility or try group exercise classes	-no experience using equipment -too heavy to use equipment (machines may have max weight of 350 pounds) -embarrassed to exercise in front of others -unable to keep pace with others -fear that fitness instructor will not empathize or understand their physical limitations	-sign up for a gym orientation or work with a fitness specialist -select activities that do not require equipment -determine alternative locations to exercise, including home -make modifications to exercises as needed; try classes aimed at beginners or older adults -arrive early to introduce yourself to the instructor before class and explain any relevant limitations
Excessive fatigue	-low cardiorespiratory fitness -poor sleep quality	-start out performing low-intensity PA and gradually increase to moderate intensity as energy and fitness improve -break up daily PA goals into shorter more frequent bouts of exercise -start PA earlier in the day when energy level is better
Activity-indeced pain or impaired mobility	-osteoarthritis of hip, knee or foot -chronic back pain -neuropathy -cannot meet PA goals by walking or doing other common modes of PA	-seek exercise classes specifically designed for individuals with arthritis or other limitations -try pool-based exercise options -participate in physical therapy as needed
Fear of harming self (e.g., injury, heart attack)	-impaired balance (due to obesity or shift in center of gravity with weight loss) -history of activity-related injuries -misinterpretation of normal side effects of exercising (e.g., muscle soreness, fatigue, side ache, breathing hard)	-gradually increase PA to lower risk -use talk test to guide PA intensity which will minimize sense of breathlessness -learn differences between normal side effects of exercising vs. signs to stop an activity and possibly seek medical attention
Frustration with exercise guidelines	-achieving at least 150 min of exercise/week may sound intimidating or unrealistic -a “brisk” walk or walking 2.5 mph may sound unreasonable	-focus on short-term goals that are reasonable for current fitness level -break up daily PA goals into manageable bouts -use your heart rate or the talk/sing test to determine an appropriate walking speed or exercise intensity