摘要： 背景 隨著肥胖問題日益嚴重，減重代謝術需求量也逐年增加，患者術后仍須維持良好生活習慣以鞏固減重效果。但在相應行為指南已較為成熟的同時，患者行為依從性并不理想，導致術后較高的復胖率?？煽紤]從認知因素這一核心視角出發(fā)采取策略促進患者的飲食與體力活動行為。 目的 系統(tǒng)編碼整合認知因素視角下的減重代謝術后飲食、體力活動行為促進策略。 方法 2022年6月，采用WHITTEMORE和KNAFL的整合性綜述方法，在PubMed、Web of Science、the Cochrane Library、CINAHL英文數(shù)據(jù)庫和中國知網（CNKI）、萬方數(shù)據(jù)知識服務平臺中文數(shù)據(jù)庫中與減重代謝術后飲食與體力活動行為促進策略有關研究，檢索時限為1994年1月至2022年6月。采用2016版"關鍵評估清單"（CASP）進行文獻質量評價，納入符合標準的研究，根據(jù)"體力活動與飲食行為改變技術分類法"（CALO-RE分類法）對策略統(tǒng)一編碼并加以合并。 結果 共納入25篇文獻，包括17篇隨機對照試驗、4篇觀察性研究、4篇綜述。通過編碼，所有策略均被CALO-RE分類法覆蓋，涉及其中的25類策略，主要包括行為情況監(jiān)測、社會支持、目標設定、障礙識別解決等。整合得到的"減重代謝術后飲食與體力活動行為促進策略集"共46條策略。 結論 本研究通過整合性綜述和CALO-RE分類法，系統(tǒng)編碼了適用于減重代謝術后患者的認知因素視角下飲食與體力活動行為促進策略，為術后行為管理提供了技術儲備。減重代謝外科醫(yī)護可在評估患者行為水平和認知因素狀況后，結合實際情況選取合適策略，有效提升患者的行為依從性。未來可在實證研究中進一步驗證并優(yōu)化本策略集。

關鍵詞: 減重代謝術, 體質量保持, 減體質量飲食, 體力活動, 認知因素, 促進策略, 整合性綜述

Abstract:

Background

With the growing problem of obesity, the demand for bariatric surgery has increased these years. Patients still need to maintain good living habits after surgery to consolidate the weight loss effects. While the behavioral guidelines are relatively mature, patient's behavioral compliance is not ideal, resulting in a high rate of postoperative weight regain. In that case, we can depend on strategies to promote dietary and physical activity behaviors in patients from the cognitive perspective.

Objective

To systematically code and merge the dietary and physical activity behavior promotion strategies after bariatric surgery from the cognitive perspective.

Methods

In June 2022, the WHITTEMORE and KNAFL's integrative review methodology was used. Studies written in English related to dietary and physical activity behavior promotion strategies after bariatric surgery were searched in databases of PubMed, Web of Science, the Cochrane Library and CINAHL, and those in Chinese were searched in databases of CNKI and Wanfang Data from January 1994 to June 2022. The 2016 version of the Critical Appraisal Skills Program (CASP) was used to evaluate the quality of the literature. Studies meeting the inclusion criteria were included, and the strategies extracted from which were uniformly coded and merged according to the CALO-RE taxonomy.

Results

A total of 25 studies were included, including 17 randomized controlled trials, 4 observational studies, and 4 reviews. After coding, all strategies were covered by CALO-RE taxonomy, involving 25 kinds, mainly including self-monitoring of behavior, social support, goal setting, identifying barriers/problem resolution, etc. A total of 46 strategies were obtained and used to create a strategy set named "promotion strategies of dietary and physical activity behaviors after bariatric surgery".

Conclusion

Through the application of the integrative review methodology and the guidance of CALO-RE taxonomy, this study systematically coded and merge the dietary and physical activity behavior promotion strategies from the cognitive perspective for applicable to patients after bariatric surgery, providing a reservoir of techniques for postoperative behavioural management. After assessing patients' behavioural levels and cognitive factors, bariatric surgery providers can select appropriate strategies to improve patients' behavioural compliance. This strategy set can be further validated and optimised in future empirical studies.

Key words: Bariatric surgery, Body weight maintenance, Weight reduction diets, Physical activity, Cognitive factors, Promotion stratigies, Integrative review

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