- Why Should You Exercise After Bariatric Surgery?
- How Should I Exercise After Bariatric Surgery?
- My Exercise Schedule After Bariatric Surgery
- Bariatric Surgery and Exercise Can Help You Lose Weight
- Exercises You SHOULD Be Doing After Weight Loss Surgery
- Types of Exercise
- How Beneficial is Exercise After Surgery?
- 1-6 Months Post-Op – Exercises You Should Do
- 6-12 Months Post-Op – Exercises You Should Do
- 1 Year and Beyond – Exercises You Should Do
- How to Easily Get in an Exercise Routine
- Exercises to Avoid After Bariatric Surgery
- 9 Great Exercises to Do Getting In or Out of Bed
- Exercise Before and After Weight-Loss Surgery
- After gastric bypass surgery, are there specific exercise precautions I should take?
- 23 Feb What can exercise give you – that bariatric surgery alone cannot?
- Weight loss through bariatric surgery doesn’t equal fitness.
- A real life example: Tracy’s* story
- The measurable, and immeasurable benefits of exercise
- So, where do you begin?
- Supervised exercise following bariatric surgery in morbid obese adults: CERT-based exercise study protocol of the EFIBAR randomised controlled trial
- 6 Exercises to Stay Fit after Roux-en-Y Gastric Bypass Surgery
- 1. Sitting Exercises
- 2. Walking
- 3. Cycling
- 4. Water Aerobics
- 5. Squats and Lunges
- 6. Yoga
- MOVEMENT AND EXERCISE AFTER BARIATRIC SURGERY
- Tips for Exercise after Bariatric Surgery
- Ease Into Physical Activity
- Enjoy the Great Outdoors in Sydney
- Don’t Forget Strength Training
- Join a Fitness Group
- Keep Your Bariatric Surgeon in the Loop
Why Should You Exercise After Bariatric Surgery?
Bariatric surgery is a powerful weight-loss tool, but it i’s not a miracle cure. To experience the best life after bariatric surgery, you wi’ll need to commit to a healthy diet and a consistent bariatric exercise regime so you can maximize your weight loss and feel better than ever.
The good news is that exercising after weight loss surgery comes with a lot of benefits.
Bariatric Exercise Benefit #1: The Right Kind of Weight Loss
Exercise can help you lose more weight and keep it off after surgery. According to a meta-analysis of studies on the subject by the National Institutes of Health, weight loss surgery patients who exercised saw their Body Mass Index (BMI) drop 4.2% more than those who did not.
But when you’re losing weight, it’s also important to lose the right kind of weight. Exercise helps you burn fat while keeping your lean muscle.
Christopher Still, director of the Geisinger Obesity Institute, talks about why exercise after weight loss surgery is so important.
“When we lose weight rapidly, we lose muscle,” Dr. Still says. “Exercise is a safe and effective way of maintaining lean body mass, which maintains metabolism and will facilitate weight loss.”
When you lose weight, your body will naturally eliminate both fat and muscle. It’s important to exercise after bariatric surgery so you can preserve your lean muscle. That way, you’ll keep enough muscle to stay healthy.
Ready to lose weight and keep it off with safe, powerful bariatric surgery?
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Exercise Benefit #2: Helps You Feel Amazing
Exercise can also help you have more energy and feel better. Many of our patients say they don’t just want to lose weight; they want to be able to hike, or run 5ks, or play with their grandchildren. If that’s your goal, exercising regularly after weight loss surgery can help you get there.
Regular exercise can strengthen your heart and bones, improve your blood sugar, enhance your immune system so you’re less likely to get sick, and make it easier to do everyday activities like shopping. There is also evidence that exercise can enhance your mental function and health. In his book Spark, John Ratey, MD describes the impact that exercise has on increasing academic performance and mental function, and on resolving depression and anxiety.
Exercise Benefit #3: Mental Health
Exercise produces endorphins that help you combat anxiety and depression. The time after your surgery can be tough for many patients. Lots of people look down on you if you suffer from obesity, and that can leave emotional scars. Some people feel alone after surgery, because so many Americans think (wrongly) that bariatric surgery is the “easy way out.” .At the BMCC we have strong support groups to help you handle your emotions after surgery, and many of our patients report that these support groups feel like a second family.
At the BMCC we have strong support groups to help you handle your emotions after surgery, and many of our patients report that these support groups feel like a second family. EBut exercise can also help you feel better. Exercising after bariatric surgery can help you deal with stress, anxiety, and depression. Exercise creates more blood flow to the brain, breaks the brain’s downward spirals into depression and anxiety, and produces endorphins that help to regulate and improve your mood. According to John Ratay, MD daily exercise has been shown to be as effective at treating depression and anxiety as the medications prescribed by your doctor. Exercise also enhances your brain’s function, your IQ, and prevents age related decline.
How Should I Exercise After Bariatric Surgery?
At the BMCC, you’ll consult with your surgeon and your weight loss team to come up with a post-bariatric surgery exercise plan that’s custom-tailored to you. Our whole team will work with you so that you can lose weight, keep it off, and reclaim your health.
After surgery, there are three key areas you should focus on when it comes to exercise.
• Strength training
Let’s go through each of these together.
Cardio: Burning Calories and Giving You More Energy
Regular cardio aerobic exercise (or “cardio”) has a lot of benefits. It can give you more energy and help you sleep better. Our bodies are made to move, and getting your blood pumping in a good way can boost your metabolism and energy levels. It can also help you work through anxiety and sleep better.
Cardio also produces endorphins, which can increase your confidence. It strengthens your heart and lungs, increases bone density (which is important to ward off arthritis), and also boosts your mental sharpness and ability to focus.
What are some great cardio bariatric exercises? Early after surgery, walking is recommended as it decreases complications and improves your recovery. Eventually, water workouts and swimming can be very good low impact options. Running or hiking a beautiful Colorado trail are very invigorating outdoor options.
Here’s a breakdownan example of how many calories you’ll burn for some typical bariatric workouts (of note your individual calorie burn may vary depending on weight and body composition among other factors):
Strength Training: Keeping Your Lean Muscle Mass
Strength training is important to help you maintain your lean muscle mass. By maintaining your muscle mass you are also maintaining your body’s calorie burning engine. It also helps keep your bones strong. Strength training is also great for toning and for building muscle so that you can be more active and enjoy life more.
When it comes to strength training, it i’s important to start slow. Start with 1-5 pound weights, and then increase weight once you can do 3 sets of 15-20 reps. If you feel sharp pain, don’t try to push through it; stop and try a different exercise.
Lunges, squats, and lifting weights are all great bariatric exercises for strength training. Sit-ups, crunches or other core exercises can also be an excellent toning exercise after bariatric surgery and can produce greater core strength to prevent future injuries.
Flexibility: Preventing Injuries
Flexibility training is important to help you avoid injuring yourself. If you feel sore or tight after your bariatric workout, flexibility training can help. It can also help you avoid straining yourself when you’re running or lifting weights.
What’s a great flexibility workout? Stretching.
When you’re stretching, it’s important to be careful. Take each stretch slowly and hold it for ten seconds–don’t bounce up and down. Go far enough that you feel a burn, but pull back if you feel sharp pain.
Warmups and Cooldowns: Vital for Exercise After Bariatric Surgery
It’s important to warmup before each bariatric workout, and to cooldown after. Warming up helps get your blood flowing and your heart pumping, and loosens your muscles. This can help you get the most out of your workout, and also prevents injuries.
You should warm up for 5-10 minutes by doing light stretching, light jogging or walking, or jumping jacks. Make sure to keep it easy, rather than push yourself.
After your bariatric workout, you should spend 5-10 minutes cooling down. Cooling down will slowly bring down your heart rate and breathing, which will prevent dizziness. Cooling down also lets your body get rid of the lactic acid that it creates during a tough workout, which can be bad for your muscles.
What are some good bariatric cooldown exercises? Walking and stretching. Aim to slowly take your heart rate back down from exercise pace to resting pace.
My Exercise Schedule After Bariatric Surgery
When should you start exercising after weight loss surgery, and how far should you push yourself? This schedule should help you.
Right After Surgery: Take It Slow
It’s important to start gentle, slow walks the day after surgery. Remember: your body is still recovering, so it’s important to listen to your body and your medical team. Don’t walk for more than 15 minutes at a time.
After your initial appointment at the BMCC, you’ll meet with our exercise physiologists to assess your barriers to activity and develop an individualized, safe plan to regain activity without causing further damage to your back, joints, and the rest of your body. After surgery, you will start off walking around 20 minutes per day and gradually progress over the next 6-8 weeks toward your custom fitness goals, which will include cardio and resistance. However, you should generally avoid anything harder than walking until 6 weeks after surgery.
2-4 Weeks After Weight Loss Surgery: Light Exercise
Now that your body’s healing, you can start low-impact bariatric exercises. Leg lifts, hamstring stretches, shoulder rolls, and arm rotations can be great ways to build strength and flexibility. You can also start going on longer walks, or walking more quickly.
Exercising 1-2 Months After Weight Loss Surgery: Cardio
As your body continues to heal and strengthen, it’s important to build to moderate cardio workouts. Cycling and water workouts are both great exercises after bariatric surgery that are easier on your joints than running. You should start aiming to work out 5 days a week, for 30 minutes per day and build from there.
At any point if you experience chest pain or tightness while exercising it is important to stop immediately and call a doctor.
It’s still important to listen to your body. When you’re doing cardio, don’t sprint; you should be able to talk comfortably while working out. But, if you can sing while you’re doing any bariatric exercise, you may not be pushing yourself hard enough.
Exercising 6 Weeks After Weight Loss Surgery: Strength Training
At this point, it’s important to start adding strength training to your workout routine at least 2 days per week.
Squats and lunges are great bariatric exercises. So is lifting weights. Bear But please keep in mind, that it’s important to only respect your body’s injury go exercise up to your pain thresholdlimit for exercise. You want to until you feel a burn, but s. Stop if you feel sharp pain. For your safety you must also stop immediately if you begin to feel chest pressure, nausea, or extreme shortness of breath.
At this point, you should be doing cardio training regularly 5 days a week, between half an hour and an hour each time. Aim to add at least two of your strength training bariatric workouts per week. However, don’t target the same muscle groups back to back.
As you progress, you’ll need to keep pushing yourself physically. That’s because your body will adapt to exercises, so the same bariatric exercise won’t burn as many calories as it did three months ago.
Vitamin and Mineral Supplements
After weight loss surgery, you will need to take daily vitamin and mineral supplements in order to avoid malnutrition. The good news is that these supplements can also help you build healthy bones and muscle, and even give you more energy because you’re fortifying your body with nutrients that it craves.
Sticking to your vitamin and mineral supplement regime can help you maximize the effectiveness of your exercise after bariatric surgery.
Bariatric Surgery and Exercise Can Help You Lose Weight
You have’ve probably tried exercise before. But after bariatric surgery, diet and exercise are much more effective at helping you lose weight, keep it off, and reclaim your health.
After bariatric surgery, you’ll work with our expert team every step of the way to make an exercise plan that’s right for you.
Losing weight is challenging and takes intentional commitment. But living with obesity is harder. With commitment and dedication, you can do this because you deserve the better life that is waiting for you. We believe in you and will be with you every step of the way.
Exercises You SHOULD Be Doing After Weight Loss Surgery
Exercise after bariatric surgery is one of the top three components to weight loss success.
In fact, exercise should begin immediately after returning home from surgery.
Most patients will have to ease into exercising after weight loss surgery. Even just starting by walking a few minutes a day is a great way to get into healthy exercise habits.
Remember – exercise does not mean only running. It means to be physically active. Whether that’s dancing, walking, weights, or yoga, there are hundreds of different exercises that patients can incorporate into their daily routine.
Types of Exercise
- Light Exercise: Walking or elliptical
- Weights: Free weights, lifting, yoga
- Interval Training: Crossfit, personal trainers, boot camp
How Beneficial is Exercise After Surgery?
Well, it’s HUGE! But why?
- Not only do studies suggest that exercise after bariatric surgery will increase your weight loss, but it will also help to assuage depression and lift your mood.
- Studies also show that exercise also helps the healing process and helps to minimize post-bariatric surgery complications.
Some patients may be required to undergo a mild exercise regimen before bariatric surgery. Exercise prior to surgery will help patients become qualified candidates. In some cases, bariatric surgeons require a full year of mild exercise before the surgery date.
Simple tasks could be necessary for morbidly obese patients before weight loss surgery:
- Walking (Walk for 10 to 20 minutes per day)
Immediately following bariatric surgery (gastric sleeve, gastric bypass, duodenal switch, or mini gastric bypass) during your healing and recovery process, patients are at increased risks of complications. Most surgeons recommend that patients begin a lite exercise regimen after two or three weeks of your surgery date.
1-6 Months Post-Op – Exercises You Should Do
Starting the regimen, most doctors will tell patients to start slowly. Most recommend simple exercises including walking in the very beginning.
Starting out at one to two days per week and increasing from there is a good step. Patient’s goals should be to work to 30-minute exercises for three to five days a week.
Yoga can help patients increase flexibility, tone body, improve metabolism, and circulate blood flow which improves healing and long-term weight loss.
Walking is a good place to start, and patients can increase to “speed walking,” in the later months. It’s something everyone can do to maintain a healthy weight and get out of the house.
Swimming can be very physically demanding, so we recommend intermittent lite-swimming. It’s a great way to increase the heart rate and proven to reduce stress in many past patients.
Dancing can be fun and also help you meet your cardio goals. Improves bones, balance, heart, and muscle strength.
5. Resistance Training
Resistance Training using light weights contribute to strengthening your body. Patients may find free weights, machines, or even resistance bands helpful to improve strength.
6-12 Months Post-Op – Exercises You Should Do
After six months, you should be able to endure 45-minute exercise sessions 3 to 5 times per week. This stage will be spent investing more time with resistance training, helping to increase your core muscles (abdominal, lower back, upper back), your leg muscles and upper-body muscles.
Patients should feel free to try more challenging exercises. Patients can include workouts like kickboxing or aerobics in their repertoire.
1 Year and Beyond – Exercises You Should Do
Making past one year deserves a big congratulation! Getting to this point means you’ve probably shredded a significant portion of your excess weight. Some patients may have even lost 100 pounds or more.
Now that you’re halfway there, it’s time to try more intense exercises to keep the fat coming off.
- Interval training on the treadmill: walking then running, or walking than jogging, and doing it in varying intervals will keep increasing your metabolic rate to burn more fat.
- Incorporate more activity-based exercises into their routine: Hiking, running, swimming, biking are all novel ways that will help you to continue to your weight loss goals.
How to Easily Get in an Exercise Routine
Exercise is essential to maintain long-term weight loss. That being said, it needs to become habitual and some sort of routine should be followed.
Create a steady exercise routine to build a strong heart and bones. Make sure you consume enough calories to support your exercise. Build muscle by exercising on a regular basis.
Keep in mind, the purpose of physical activity is to increase your heart rate, so cultivating does not check..1
- Find a friend to motivate one another
- Join a local gym or club
- Walk further by using stairs or parking further away
- Do things you love and become more active with those hobbies, sports, or activities
- Take your dog on a walk or to the park
- Find clothes you feel good in
Exercises to Avoid After Bariatric Surgery
Bariatric surgery is considered one of the best ways to lose weight when diet and exercise have failed. But bariatric surgery is not a substitute for diet and exercise. Once you’ve completed your surgery, you will need to start eating healthy and exercising regularly in order to help the weight loss occur.
However, bariatric surgery is surgery. Although it’s usually minimally invasive surgery, there are some risks and recovery that you need to keep in mind.
Recovery Following Bariatric Surgery
Recovering from bariatric surgery involves a liquid diet. For the first day, most patients will have a hard time even consuming ice and water. Eventually, they can move onto juice, broth, and fat-free milk. By the end of the first week, or shortly thereafter, they’ll be allowed yogurt, soft fruits, lean meat, and fish.
These types of extreme dietary restrictions speak to how delicate the body is following this surgery, and it could make exercise a bit more challenging. You’ll also have wounds that need to heal. While these wounds are not likely to be significant, you still need your body to heal. That is why in the earlier stages of recovery and weight loss, you may want to stay away from some exercises and speak to your doctor often about which exercises are best for you.
Exercise During the First Two Months
Unless your surgeon says otherwise, the only type of exercise you should be doing during the first two months following your bariatric surgery is walking. As your body is still weak and adapting to this major change, it’s important that you not push yourself. Take it slow at first. Try walking 10 minutes at a time. You can always do it again later in the day if you feel like more.
Although you are recovering, you should be walking right away. Indeed, your surgeon may tell you to start walking regularly the day you come home from surgery or within a few days. Walking increases blood flow around your body which helps you heal, and decreases the risk of complications from surgery.
The only other exercise that may be acceptable is water aerobics because of how low-impact it is. Even with this option, it’s important you stop once you feel that your body is being pushed too far, and talk to your surgeon to see if the water may interact with recovery.
During these first three months, abdominal exercises must be completely avoided. You need to let your incisions heal and reduce pressure on your stomach while it is still sensitive.
Exercise During the Third Month
By the second month, some patients begin feeling more comfortable and want to start lifting weights or jogging. But it is recommended that you first discuss this with your surgeon or your doctor, to ensure that your body is ready.
It’s important to remember that your sense of balance and coordination may be in flux. You’ve lost a lot of weight in a very short amount of time. If you haven’t been walking a lot already, don’t begin jogging or sign up for an aerobics class simply because it’s been three months. Get used to how it feels.
But right around the end of the 3 rd month, you should be able to start picking up your exercise routine and do both aerobic (running) and anaerobic (muscle) workouts.
Exercise During Months Four to Six
After 4 months there are rarely any bariatric surgery-related complications. After speaking with your doctor, you should be able to enjoy a wide range of exercises, including:
- Kettlebell routines
- Weight Training
It’s important that you find types of exercise you truly enjoy. This may take a while. No exercise routine is going to pay off if you quit because you’re not having fun, which is why even something as simple as walking can have significant effects if the patient does it on a regular basis for years to come.
Following bariatric surgery, exercise is just as important as eating fewer calories. Working out regularly will help you keep the weight off and build valuable muscle. It will also restore your sense of coordination, improve your physical health, and provide you with the weight loss and fitness goals you wanted.
If you are considering bariatric surgery, and want affordable options, feel free to contact us today at 1-855-768-7247
9 Great Exercises to Do Getting In or Out of Bed
When you are struggling with obesity or are highly overweight, it can be difficult to know just where to start in terms of exercise. It is important not to overdo it when first getting started on being physically active in order to avoid injury or overexertion.
Simple small steps that lead to further progress over time can be a great way to get your body used to be more active and many of them can be done without even leaving the house!
Since we all get in and out of bed every day, why not fit your exercise routine in with something that you do on such a regular basis? Here are 9 great exercises that you can do at home, possibly with no equipment, that will help to improve your overall health and well-being.
1. Bedside Crunches
This exercise is quite simple and is done before you even get out of bed. Simply follow these steps:
- Sit with your legs hanging off the side of the bed
- Lay back with your hands on the back of your head (you can place pillows under your lower back for support if this helps)
- Sit up and bring your elbows toward your knees and your ribs toward your hips
- Do a set of, as many repetitions as you can, up to 30 reps before moving to the next exercise
Note: You should feel your muscles contracting as you do this and you can either allow yourself to rest before each crunch or maintain constant resistance by keeping your back slightly above the bed when you go back down on each repetition.
If using your bed for this exercise cannot be done easily, simply find a clear spot on the ground and do some standard crunches.
2. Lateral Leg Lift
This is a great exercise for sculpting your legs and thighs that can be done with or without a resistance band. Here are the steps:
- Find a soft area of the ground such as the carpet or a yoga mat
- Lay on your side and bring your lower hand up to support your head with your elbow rested on the ground
- Bend your lower leg at a 90-degree angle and rest your upper hand on the ground near your shoulder
- Lift your upper leg to the side, keeping it straight, and point your toes and knee slightly outward
- Do this exercise for up to 20 reps on each leg
Note: This exercise can be done with a resistance band designed to wrap around your upper legs if you feel additional resistance is needed.
3. Bedside Squats
This exercise is great for your lower back, upper legs & glutes. Simply follow these steps:
- Stand about 5 inches from the side of the bed with your feet a shoulder width apart
- From there, squat until your butt just barely touches the mattress and then return to standing position
- Do this for a set of up to 25 reps before moving onto the next exercise
Note: You can rest your hands on your quads and use them to aid in the sitting and standing process if needed. Doing so will provide additional support as you build up strength in your legs. You can also temporarily sit on the bed for a moment before going back into a standing position as you build up strength in your legs.
4. Doorknob Squat
If you have a good strong door with a dependable doorknob, this exercise can serve as a great additional way to work those legs! Here are the steps:
- Open the door and stand facing its side with your legs a shoulder width apart
- Grab a hold of the doorknob on each side of the door with the appropriate hand
- Make sure that you can go into a squat that keeps your knees on your toes and with your back still straight as you go down
- Go down into a squat to where your thighs are parallel to the ground and then back into standing position
- Repeat this motion for up to 20 reps
5. Calf Raises
This is a great way to work your calves that also requires no equipment. Here are some steps to doing this exercise:
- Stand upright, holding onto the frame of a doorway for support if needed for stability, feet placed firmly on the ground a shoulder width apart
- Push the heels of your feet upward, keeping your toes and balls of your feet on the ground so that you feel your calves tense up
- Then lower your feet back to almost being flat on the ground
- Repeat this motion for up to 30 reps
6. Counter or Chair Pushups
Pushups are a great way to work out your chest and biceps that can be done in a variety of ways to build up strength. Here are some steps to getting started in this exercise:
- Walk up to a counter or a chair that can serve as a stable surface area for your hands
- Place your hands on the counter or chair and lean into them, keeping your body straight
- Go into a pushup at a steady pace and then push back out to starting position
- This exercise can be done for up to 25 reps
Note: As you build up strength, you can move into standard pushups over time.
7. Tricep Pushups:
Now that you’ve done standard pushups to target the chest, it’s time to move into a variation of pushups that targets your triceps. This helps to tighten up your arms and give them a good shape. Here are the steps:
- Get on your hands and knees with your feet crossed over each other in the air so that the top of one is rested against the back of the ankle on the other
- Your arms should be a shoulder-width apart directly under the shoulders
- Go down into a pushup with your hands almost touching your shoulders as you bring your chest to the ground
- Push back up into upright position
- Repeat this for up to 20 reps
8. Towel Curls
To really focus in on those biceps, you can always grab a towel to help you out. Here are the steps:
- Create a sling with a towel and hook it under one of your feet (this can be done in a standing or lying position)
- Keeping your knee slightly bent, keep your hands grasped around the ends of the towel
- Curl your arms while using your leg to provide desired resistance
- Pause briefly at the top of the motion before extending your arms again
- Repeat this for up to 20 reps
Note: Your upper arms should not move out of position during this exercise. Focus on bringing your hands (palms facing your chest) toward your shoulders.
You can change this up into hammer curls by bringing your hands toward your shoulders with thumbs facing your chest and palms facing each other.
Now it’s time to work on your core and overall body strength. Here are the steps:
- On a yoga mat or comfortable carpet, lay on your stomach
- Place your elbows below your shoulder at a shoulder-width apart place your hands out with the palms facing down into the ground
- Keep your feet close to or directly touching each other and lift yourself onto your toes, hands, and elbows
- Hold this position for up to 1 minute
Are the at home bodyweight exercises that you enjoy doing and find effective? If so, share them in the comments below.
9 Great Exercises to Do Getting In or Out of Bed
Gastric Sleeve Surgery Post-Operative Guidelines
Yoga and Bariatric Surgery
Gastric Sleeve Patient Turn Bodybuilder
Exercise Before and After Weight-Loss Surgery
Days after Holli Dunayer-Shalvoy’s gastric bypass surgery in 2005, she ventured out onto the beachside boardwalk near her Long Beach, New York, home. Her first walks were short, but each day they got a little bit longer. Now, three years after her surgery and more than 120 pounds lighter, Dunayer-Shalvoy runs four miles every morning.
“You hear the doctors say, ‘You have to exercise,'” Dunayer-Shalvoy says. “I think it’s not a given that you’re going to do that. That is where you separate people and their will to succeed. I wanted it. I was hungry for a different life.”
Exercise Is Crucial for Weight-Loss Success
Exercise after gastric bypass surgery is critical for effective weight loss, says Christopher Still, DO, director of the Geisinger Obesity Institute in Danville, Pennsylvania, and a member of the Integrated Health program of the American Society for Metabolic and Bariatric Surgery (ASMBS).
“When we lose weight rapidly, we lose muscle,” Dr. Still says. “Muscle gauges and controls our metabolism. Exercise is a safe and effective way of maintaining lean body mass, which maintains metabolism and will facilitate weight loss.”
A recent study reported in the journal Obesity found that of 190 patients who underwent bariatric surgery, 68 percent said that they became physically active in the year after the procedure — “active” defined as at least 200 minutes per week of walking or other moderate or vigorous exercise. The exercisers lost an average of 13.2 more pounds than inactive patients and also suffered from less depression and anxiety and had higher scores in general health./p>
Exercise also shortens recovery time for bariatric surgery patients and reduces the risk of postsurgical complications. In addition, physical activity improves mood and reduces stress, according to the ASMBS. “People who choose to put an emphasis on exercise lose more weight and have an easier time with weight maintenance,” Still says.
Kristine Salmon, an exercise physiologist with the Banner Good Samaritan Bariatric Center in Phoenix, offers the following example of a typical exercise program recommended to bariatric surgery patient:
6–12 Months Before Surgery
Patients who start an exercise regimen before surgery are twice as likely as those who don’t to have an easy time adjusting to exercising after surgery, according to a Harris survey conducted for ASMBS. But exercise is almost always difficult for people who carry a lot of extra weight. For this reason, starting slow is imperative. If you are morbidly obese and are contemplating an exercise regimen, you should have a cardiac evaluation by your internist. The goal, says Salmon, should be 20 to 30 minutes of physical activity three days a week. Some sample exercises:
- Walking for 10 minutes, twice a day.
- Marching in place for 20 minutes while sitting in a chair (especially effective for people with back problems).
1–6 Months After Surgery
You should resume an exercise regimen two to three weeks after bariatric surgery. The goal is to increase range of motion so you can take off your shoes, for example, and pick things up off the ground. Strength-training exercises are also important because as you lose weight you will lose muscle. You should work toward 30 minutes of continuous exercise three to five days per week by the time six months have passed. Sample exercises during this stage:
- Walking, biking, or swimming exercises for aerobic fitness.
- Resistance training with dumbbells, weight bands, or gym machines to build muscle mass.
6–12 Months After Surgery
A year after gastric bypass, you should be able to perform 45 minutes of exercise at least four times a week. Salmon recommends varying workouts so your body is constantly challenged. Strengthening the stomach muscles is also important because it helps improve your posture, which will change as you lose more weight. Some sample exercises:
- Yoga, dancing, aerobics, or kickboxing for 45 minutes four times a week.
- Resistance training using dumbbells while sitting on a balance ball, which helps to strengthen the abdominal muscles.
1 Year–Plus After Surgery (Long-term Maintenance)
Now that more than a year has passed since surgery, you’ve probably lost more than 100 pounds. Such a drastic change can leave many patients thinking that they no longer need to exercise, but “we tell patients that exercise is not an option, it’s a must,” Salmon says. At this stage the recommendation is the same as that for the general population: 45 minutes of exercise at least four days per week. Sample exercises:
- Interval training on a treadmill, varying speed and incline, for 45 minutes.
- Hiking, running, or bicycling — take your exercise outdoors and be proud of your new body and how good it feels to be physically fit.
Learn more in the Everyday Health Diet and Nutrition Center.
After gastric bypass surgery, are there specific exercise precautions I should take?
One of the underlying premises of almost all gastric bypass surgery programs is that gastric bypass patients can experience a wide range of benefits from exercising on a regular basis. Without question, exercise can play a critical role helping gastric bypass patients achieve long-term success in their efforts to fully recover from surgery and engage in a “normal” routine of activities. However, certain exercise training considerations and precautions exist for these individuals.
Benefits of Exercise Training for Gastric Bypass Surgery Patients
- Helps preserve lean body mass
- Aids in maintenance of weight loss
- Helps maintain muscle strength and endurance
- Helps develop and maintain muscle tone
- Promotes joint stability
- Enhances bone strength and integrity
- Improves ability to perform activities of daily living (ADL)
- Promotes improved skin elasticity
- Boosts immune system
- Elevates mood
- Enhances self esteem and confidence
- Reduces stress and anxiety
- Improves overall health, well-being, and mental outlook
Within the first 30 days after gastric bypass surgery, patients are typically very sore and uncomfortable. During that time, bariatric surgeons may prescribe a simple walking program for their patients. In most instances, patients are encouraged to walk at least three times a day for 5 to 10 minutes at a time, gradually increasing the duration of each walking bout as tolerated. Other forms of exercise are generally not recommended during this period. In fact, resistance training is contraindicated during at this time.
Depending on the fitness level of the patient, bariatric surgeons may approve of other types of exercise activities to be undertaken, beyond walking, at some point between 30 – 90 days after surgery. Aquatic activities tend to be a popular choice, since most exercise movements are more easily performed in water and the level of stress on the body’s joints is minimal. To the degree that they can tolerate them, patients can also engage in other low-impact, aerobic exercise activities. Regardless of what activities are part of a person’s exercise regimen, all aerobic workouts should stay at an exercise intensity level where speaking is comfortable (Zone 1 of the ACE Integrated Fitness Training Model for Cardiorespiratory Training).
As a rule, strength training exercise usually isn’t included in a gastric bypass surgery patient’s exercise program until about 120 days after the procedure to ensure that the body has been given sufficient time to heal. Furthermore, exercises targeting the abdominal and lower back regions are typically not recommended until at least six months after surgery. In addition, high-intensity and near-maximal load resistance training is normally precluded until almost a year post-surgery. Finally, caution should be taken when performing exercises that require a significant degree of balance and coordination (e.g., squats, lunges, step-ups). Because of the patient’s rapidly changing body weight following a bariatric procedure, which alter the body’s center of balance, these types of exercises are not recommended during the first six months after surgery.
A well-designed and supervised exercise program is an essential component of a successful gastric bypass surgery program. As such, it is recommended that you work with your bariatric surgeon and a properly-trained fitness professional to develop a program that addresses your unique needs. By creating a program based on your personal preferences and abilities, the likelihood that you will experience long-term success in your pursuit of healthy active lifestyle will be greatly enhanced. For more detailed information on exercise and gastric bypass surgery, view the article from ACE Certified News magazine “How Fitness Professionals Can Help Gastric Bypass Patients Make the Transition to Healthier Lifestyles”
23 Feb What can exercise give you – that bariatric surgery alone cannot?
Posted at 10:19h in Weight Loss by Exercise Right
The decision to undertake bariatric surgery is not one that people take lightly. The Australian Institute of Health and Welfare has reported that the rising number of weight-loss procedures being completed is not actually proportional to the rise in obesity rates – instead, the increase has been linked to more publicity, accessibility, safety and reported successes as a result of surgery.
There is a growing body of research that bariatric surgery has the highest effectiveness and long-term impact on clinically severe obesity. Following surgery, dietary intake is closely monitored and guided by dietitians. But what about exercise? With weight coming off rapidly after surgery, is it that important to get moving? The main thing to remember is this:
Weight loss through bariatric surgery doesn’t equal fitness.
When people try conservative weight loss methods, it’s highly likely that they incorporate regular exercise. Exercise alone is not always a significant contributor to weight loss, but it works wonderfully alongside a healthy diet. When even just a few kilograms are lost this way, there is a noticable improvement in physical fitness and function, if the exercise is consistent and purposeful.
What might fitness mean to you? Everyone has a different level of capacity which would be required to go about their day to day lives. If your body mass is interfering with your daily activities, it is important to note that underneath the excess weight are muscles, which require movement to gain strength and also require strength to provide you with movement.
Biologically speaking, our bodies were made to move. Specific, and even gentle exercise can reverse the spiral of immobility and disuse, and if that wasn’t motivation enough, patients who undertake exercise following bariatric surgery lose 4% more from their BMI than those who don’t. That could mean the difference between clothing sizes, fitting comfortably into seatbelts and chairs, or simply going about your day with ease.
A real life example: Tracy’s* story
I had the pleasure of working with Tracy (*name has been changed) in the lead up to her Roux-en-Y Gastric Bypass surgery. Her main goal was to tone up the muscles under the skin, and assist with her required weight loss prior to surgery. We started with one exercise session per week, and this quickly led to two, as she began to enjoy the feeling of meaningful movement once more.
Our exercise was especially tailored to consider her medical and physical background, taking extra care not to cause overuse injuries. Even prior to surgery, Tracy had exceeded her expected weight loss, increased all weights and walking distances in the gym, and reduced some of her Type 2 Diabetes medication. As soon as Tracy had the all clear to return to exercise, she continued her excellent efforts with exercise. It had become a positive habit, and a big part of her life.
What stood out to me the most was Tracy’s experience after surgery. The nurses were shocked that she was able to help herself out of bed and walk around with her IV drip! She was the only one on the ward able to move herself in this way and practically ‘bounced back’ from the procedure. 4 months on, Tracy has lost 32.5kg and 40cm has been reduced from her waist.
Functonally, Tracy reports how easy it is now to get in and out of the car, she can walk faster (particularly up hills), and she can go down stairs with a new level of mobility. I am still seeing Tracy – but she now requires no assistance to complete her exercise program!
The measurable, and immeasurable benefits of exercise
One study of interest has proven that large-scale weight loss through bariatric surgery alone leads to a in a decrease in muscle strength and no improvement in aerobic capacity. In contrast, those patients whom undertook surgery and an exercise program increased the strength of most major muscle groups, improved aerobic (heart-related) fitness and boosted their functional capacity.
Other well known benefits of exercise include:
- Increased management of bloog sugar and type 2 diabetes
- Reduced blood pressure
- Correction of high cholesterol
- Prevention and management of heart disease
- Addressing musculoskeletal aches and pains, including arthritis
- Increased energy
- Peaceful sleep
- Increased mood, less depression and anxiety
- Overally feeling a sense of control over health and wellbeing
Do any of those appeal to you? Perhaps they all do! If so, read on…
So, where do you begin?
When a particular level of weight has been reached, and surgery becomes an option, it is highly likely that an individual has tried exercise before. And perhaps it didn’t ‘work’, in relation to the scales, for a number of reasons. The truth that I would like everyone to know is: that is okay.
In the lead up to, or following surgery, working with an Accredited Exercise Physiologist no longer becomes purely about weight loss but about other factors: function, sleep, energy, self-esteem, habit forming. If we can make exercise a habit prior to surgery, we know that it will be easier to continue losing weight after the initial benefits of the surgery.
In my exercise physiology appointments, I take a full history, undertake an assessment, and then we discuss goals, barriers, facilitators and devise a plan that fits exactly into your life. I liase with your other practitioners and report back to your GP regarding your progress. I see it as my responsibility to empower you, and ensure that you are guided to make the right decisions – especially when nobody is around.
If you are ready to make a life-changing decision to lose weight through surgical means, why not value-add to your experience with exercise? If you commit to surgery, you might as well commit to making a healthy habit of exercise to add strength and mobility to your new figure. You never know the positive power of movement on the body and mind until you try it.
Jennifer Smallridge is an Accredited Exercise Physiologist who works in private practice, aged care and as an academic lecturer.
AIHW 2010, ‘Weight Loss Surgery in Australia’, http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442472773
ASCM 2011, ‘Exercise and Bariatric Surgery’, http://certification.acsm.org/files/file/CNews22_3pp4_webready.pdf#page=11
Endocrine Society 2013, ‘Long-Term Impact of Bariatric Surgery on Body Weight, Comorbidities, and Nutritional Status’,
http://press.endocrine.org/doi/full/10.1210/jc.2006-0557 – sthash.XW8flN11.dpuf
Supervised exercise following bariatric surgery in morbid obese adults: CERT-based exercise study protocol of the EFIBAR randomised controlled trial
Briefly, a total of 80 BS patients will be enrolled in the EFIBAR Randomized Control Trial (RCT) (ClinicalTrials.gov ID: NCT03497546), following recruitment from a public hospital and a private clinic in Almería, southern Spain. Participants will be randomised either to a normal care Control Group (n = 40), involving nutritional status monitoring and diet/physical activity counselling following international guidelines , or an Exercise Group (n = 40), who will additionally undertake a 16-week supervised concurrent (strength and aerobic) exercise programme (three sessions/week, 60 min/session) starting 7 to 14 days after surgery, with the final aim of evaluating the effects on weight loss (primary outcome), body composition, cardiometabolic risk, physical fitness and quality of life (secondary outcomes). Recruitment of participants started in May 2018 and it may extend till December 2020.
Sample size calculations indicate that, assuming an alpha error of 0.05 and a power of 80%, a total of 66 patients (n = 33 patients per group) will be needed to detect an effect (between group difference) of at least 0.7 standard deviations in the main outcome (% total weight loss, %TWL). Anticipating a potential lost to follow-up of up to 20%, a total of 80 patients will be recruited. Additionally, we will aim at maximizing the adherence and minimizing lost to follow-up, which could in fact increase the power to detect the main effect.
The rationale of the exercise programme implemented in EFIBAR will be described following the CERT criteria recommendations for detailing the 16 items (Table 1). The structure that was followed to describe the exercise programme is presented in the Fig. 1.
Table 1 CERT checklist from EFIBAR study exercise programme Fig. 1
Graphical abstract of the detailed exercise programme of the EFIBAR Study
Exercise programme rationale
With the overall aim of making this exercise programme transferable to society, the exercise level in EFIBAR is based on the physical activity recommendations for adults proposed by the World Health Organization , together with the American College of Sports Medicine’s position stand on progression models in strength and aerobic training for healthy adults. Since there is limited information regarding the ideal exercise model for morbidly obese adults, we will combine strength and aerobic training (i.e., a concurrent training protocol), as previous findings in obese adults displayed important benefits when both strength and aerobic exercise are implemented in the same session . A question that often arises is whether aerobic or strength training should be performed first within any particular training session. It has been suggested that performing aerobic exercise prior to strength training could result in impaired strength training performance (e.g., strength exercises technique), and unfavourable responses to strength (decrease in force production) when strength training is conducted with moderate to high loads in the general population . Moreover, in a previous study conducted in obese men, concurrent strength prior to aerobic training generated a greater effect in reducing body fat compared to aerobic prior to strength training . However, further research is still needed to know which order (i.e., strength prior to aerobic or vice versa) produces greater benefits in BS patients.
The length of the intervention period is 16 weeks based on a previous large scale RCT , where substantial physiological adaptations occurred within the first 3 to 6 months of exercise. We also considered the increased logistical and participation burdens, which indeed might lead to poorer adherence, as well as the cost of running a highly controlled laboratory-based study for a longer period. In addition to the exercise programme, all participants (both control and exercise groups) will undergo routine visits to the clinic during medical discharge and also for follow-up visits (months 1, 3, 6, 9 and 12). In these examinations, lifestyle-specific instructions (Item 10), including dietary and physical activity recommendations, will be provided as indicated in the perioperative clinical practice guidelines by the American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery .
Exercise programme characteristics
The exercise programme will be carried out in a fitness room at the University of Almería (400 m2), which is equipped with aerobic and strength training areas. The mean temperature registered in Almería from www.aemet.es averaged 19° during 2018. The training programme will be free for participants (Item 12). The detailed description of the exercise equipment (Item 1) used in the training programme is shown in Additional file 1: Table S1. Two Personal Trainers (PT) with BSc degrees in Sport Sciences, and at least 2 years of experience as personal trainers, will be in charge of all sessions (Item 2). The PTs will receive a written standardised programme and weekly instruction by the study group training coordinators. Finally, the exercise programme will be developed individually (i.e., personal training sessions) (Item 3) and always supervised with a ratio of one-to-one (1,1, personal trainer, participant) (Item 4), unless participants report schedule unavailability; if this is the case, some sessions will be permitted to include two patients per PT.
The prescription of the exercise programme will try to meet the recommendations proposed by current guidelines for aerobic and strength training in healthy adult populations . The total exercise training volume will be 180 min/week. The doses will be composed of 48 sessions (1 h/session) over 16 weeks (3 times/week). A full description of the training periodization (Item 13) is shown in Table 2.
It is estimated that 150 min/week of moderate intensity, i.e., ≈3–5.9 metabolic equivalent (MET, 1 MET = 3.5 ml O2/kg/min) aerobic physical activity is equivalent to 1000 kcal/week; this is associated with lower rates of cardiovascular disease and premature mortality in healthy adults . Moreover, an energy expenditure of 1000 kcal/week can also be achieved with ≈75 min/week of vigorous intensity (≥6 METs) aerobic exercise. Thus, the proposed weekly volume of 180 min/week of concurrent training is likely to elicit ≈1200 kcal/week. PTs will continuously monitor heart rate using a Polar Electro V-800 (Kempele, Finland) in all sessions of the intervention programme.
Although physical activity recommendations suggest undertaking physical activity most or preferably all days of the week, there was concern that exercising more than 3 days per week would be an excessive burden and might have undesirable effects on participants’ adherence and motivation to complete the exercise intervention programme. Studies on exercise frequency show little differences for 3 or more days per week provided the weekly dose of exercise is attained . Participants in the EFIBAR study will perform the exercise programme 3 days per week (preferably on Mondays, Wednesdays and Fridays). If the participant misses one training session, the participant will be rescheduled for a different day of the week to recover the session, provided the necessary between-session resting time is achieved (a minimum of 24 h). A previous study of morbidly obese women found that three sessions per week improved cardiac parameters, such as variability and heart rate kinetic . At the end of each training week, the PTs will remind participants of their appointments for the following week’s training sessions to increase attendance.
Sessions structure and exercises
The main structure of the physical exercise sessions will be: 1) warm up; 2) compensatory training; 3) strength training; 4) aerobic training; and 5) cool down. A detailed description of the exercises used in the EFIBAR RCT (Item 8) is shown in Additional file 2: Table S2. Briefly, the warm up comprises 5 min of low intensity aerobic activity (treadmill) at 50 to 65% of heart rate reserve (HRR). Compensatory training includes core stability and stabiliser muscle exercises prior to strength training. Strength training will comprise a whole body exercise routine involving major upper and lower body muscle groups progressed through three phases after a familiarisation phase. Then, aerobic training will be conducted on a treadmill. Finally, participants will perform a cool down including static and dynamic stretching exercises.
In compensatory training, from week 3 until the end of the programme, participants will perform nine core stability and stabiliser muscle exercises, in order to minimise risk of injury and, hopefully, increase adherence (page 30 to 59 of Additional file 2: Table S2). All exercises will be modified such that they can be performed at three levels of difficulty: basic (Level A), intermediate (Level B) and advanced (Level C). All participants will begin at the basic level (Item 15). These exercises will be carefully progressed in level of difficulty (Item 7a and 7b). In general, Level A will be carried out from week 3, Level B from week 5, and Level C from week 11. A certain degree of individualization will also be permitted, as each participant will progress through the different exercise levels (i.e., A, B or C) according to their individual adaptation; when the participant successfully complete all sets/repetitions of the prescribed exercises in a level (see Additional files 2 and 3) over more than three consecutive sessions (i.e., over 1 week), they will be able to progress to the next level. Our PTs will modify all exercises based on the participant’s response to the exercise (Item 14a and 14b). The progression and order has been carefully structured, as presented in Additional file 2: Table S2. The proposed exercises allow for good activation of the central area of the body (e.g., abdominal area) with low pressure in the spinal structures (e.g., bird dog, side plank or modified crunch), as recommended in previous studies .
For strength training, the exercises will progress in intensity based on the participant’s response to the exercise during the four main phases (Item 7a and 7b): familiarisation (weeks 1 to 4), phase 1 (weeks 5 to 8), phase 2 (weeks 9 to 10) and phase 3 (weeks 11 to 16). Participants will go through a familiarisation period during the first 4 weeks of the exercise program before including external loads. Since participants may present some movement limitations due to discomfort during the first weeks after surgery , we will prescribe exercises that allow participants to learn movement patterns (from week 1) and weight-bearing and strength training with elastic bands (from week 3) of the different main movements (e.g., squat, horizontal pull, vertical push); this will provide participants with the appropriate technique for the main exercises. In this phase, participants will learn seven movement pattern exercises, which constitute the basis of movement, such as diaphragmatic or abdominal breathing, dissociation and mobility of the hip or stabilization of the shoulders or the wrist. These seven exercises can be performed whenever the PT feels they are necessary over the 16 weeks in order to remind the patients of the basic movement patterns. During the first 4 weeks, participants will perform two sets of 5 to 7 repetitions of each movement pattern exercise. The resting time between series of these exercises will be adjusted to the patients’ perceptions. Moreover, they will be asked to perform the exercises at progressively increasing speeds. It will be recommended that they do not perform trunk and hip flexion exercises until week 2 or 3 to avoid discomfort in the area of the surgical intervention (see the example of the hip flexion exercises 2 and 6 of movement pattern exercises in Additional file 2: Table S2). Likewise, in order to minimise trunk flexion during the first 2 to 3 weeks, we will avoid upward facing positions by proposing foot variants (see exercises 1 and 2 of the movement patterns exercises). Given the participants’ degree of obesity, the order of the exercises was carefully designed to improve the flow of the sessions (i.e., reducing the number of transitions from lying to standing positions). Thus, the seven proposed exercises will be performed in the order detailed in Additional file 2: Table S2.
From phase 1 (week 5) onwards, all participants will perform exercises with external loads, including six main exercises performed in the following order: 1) squat; 2) seated lat pull-down; 3) bench press; 4) seated low row; 5) push press with dumbbells; and 6) deadlift. The training progression from one exercise to another will be done vertically (e.g., exercise 1 – rest – exercise 2). A detailed description of each exercise is presented in Additional file 2: Table S2, according to previous training recommendations (Item 14a and 14b). Participants will be instructed to exercise through the full range of motion and to avoid the Valsalva manoeuvre. Finally, it should be noted that previous studies used similar strength training modalities in BS populations, such as stack-weight equipment, free weights, body weight or resistive bands, in order to maintain high levels of enjoyment, engagement, and most importantly, adherence .
The aerobic training part will be conducted on a treadmill after strength training. Previous findings recommend that obese individuals can briskly walk or even run, provided they follow conservative transitions and progression, schedule rest days and heed onset of pain symptoms . For progression to running, intensity or mileage increases should be slow and consistent to prevent musculoskeletal injury. Moreover, a study by Vincent et al. indicated that patients who have undergone bariatric surgery and are now lean can also run, but special foci, such as hydration and energy replacement, must be considered. All these considerations will be taken into account in the EFIBAR RCT.
Finally, participants will perform a cool down, including 5 min of static and dynamic stretching exercises in order to promote training adherence.
Doses: training load/intensity
Several public health institutions clearly indicate that moderate intensity physical activity is beneficial for health in deconditioned persons , yet additional benefits have been observed for vigorous compared to moderate intensity exercise . An intensity of at least 60% HRR is sufficient to produce clinically significant physiological adaptations in sedentary individuals . We are aware that our participants might not be immediately capable of exercising at their required volume and intensity dose; therefore, there will be a gradual progression to the assigned exercise dose. The training loads in the EFIBAR RCT will range from ≈50 to 75% of one repetition maximum (1 RM) for strength training, and from 65 to 85% HRR for aerobic training. Moreover, the Borg Rating of Perceived Exertion (RPE) scale will also be used to monitor the intensity of aerobic training (intensity values from 6 to 9, where the scale is 1–10) and the OMNI-resistance scale (intensity values from 5 to 8, where the scale is 1–10) will be used for strength training .
An intensity equivalent to 40–50% of 1 RM may be beneficial for improving muscle strength in sedentary persons beginning a strength training programme, whereas 60–70% of 1 RM is recommended for novice to intermediate exercisers to improve strength . The main strength training phase (i.e., from weeks 5 to 16) will have an intensity progressing from 24 to 10 RM (≈50 to 75% of 1RM), quantified by perceived exertion (CE) as in previous studies (i.e., the maximum number of repetitions which participants could perform with a given load). In week 5, participants will perform one set of 12 repetitions of strength training, lifting a load with which the participant could perform a maximum of 24 repetitions, whereas participants will finish the programme (week 16) performing three sets of 6 repetitions using the load corresponding to 10 maximum repetitions. CE will be readjusted twice during the exercise programme: at the beginning of phase 1 (session 13) and during phase 3 (session 31).
As the load (i.e., % RM) is not the only variable that determines strength training intensity, we will control other variables such as movement speed during both concentric and eccentric phases, recovery time and range of motion; therefore, we assume that different loads (i.e., ≈50% RM vs. 75% RM) will constitute different training intensities . The cadence for the strength exercises is fixed at 1:2 (concentric: eccentric phases), performing the concentric phase with the maximum velocity possible . On the other hand, it is well known that different configurations of the strength training stimulus can elicit different physiological responses (e.g., muscle damage, metabolic stress) . Taking into account that it is not known which kind of strength training stimulus is best for this population, we will vary the type of stimuli across the three different strength training phases. From weeks 5 to 8, we will conduct strength training based on metabolic stress (i.e., <load and > volume), from weeks 9 to 11 it will be based on metabolic stress/mechanical tension and muscle damage, and from week 12 to the end of the intervention we will conduct a programme based on mechanical tension and muscle damage stress (i.e., >load and < volume), following previous strength training recommendations . For strength training with elastic bands (weeks 3 and 4), the intensity will be controlled by the Thera-Band RPE scale (range 2 to 6, easy to somewhat hard) . Rest periods between sets were intentionally minimised to 30 to 60 s to achieve the proposed intensity .
Aerobic training intensity will be controlled based on heart rate reserve (HRR). HRR will be calculated from the maximum real heart rate (HRmax) achieved during the maximum treadmill test, which will be performed at baseline as part of the pre-surgery evaluations. The Karvonen formula ( + resting heart rate) will be used to calculate the individual exercise intensity. Resting heart rate will be taken from the heart rate variability (HRV) assessment included in the pre-surgery evaluations, as this test requires 10 min of sitting rest. Five training zones will be used: Zone 1 < 55–69%; Zone 2: 70–79%; Zone 3: 80–84%; Zone 4: 85–89%; and Zone 5: > 90%. Heart rate monitors will be programmed according to the percentage of the participants individual HRRmax. In order to adjust the individual exercise intensity throughout the programme, the HRR will be estimated using the Karvonen formula in weeks 12 and 36. In addition, prior to the beginning of each exercise session, participants will wear a Polar heart rate monitor (V-800) and rest in a seated position for 5 min, after which time their heart rate will be recorded to ensure that they are not beginning with a heart rate in high training zones .
Participants will start with a dose of 15 min/session of aerobic training with ≤65% HRR during weeks 1 to 4 (familiarisation phase). From this point onwards, they will start a gradual increase in exercise volume and intensity. The volume will increase to 20 min/session from 65 to 70% of HRR during weeks 5 to 8 (phase 1). The volume in phase 2 will be maintained (20 min/session), but with an increase of 5% in intensity (i.e., until 75% of HRR). The first week of phase 3 will have the same volume as phase 2 (20 min/session), but from weeks 12 to 16 it will be increased by 5 min (i.e., until 25 min/session) with intensity from 75 to 85% of HRR. We will estimate intensity (% of HRR) by monitoring all sessions with Polar heart rate monitors. Moreover, the CR-10 Borg scale (values ranging from 0 to 10) will be used to evaluate perceived exertion during the aerobic part (range between 7 to 9 corresponding to 75 to 85% of HRR) and after that in order to control the final intensity in this part.
Whenever the aerobic target intensity (% of HRR) is not reached by means of speed increase (without running), the inclination of the treadmill will be increased. A previous study conducted in moderately obese adults (mean BMI 33.4 kg/m2) demonstrated that walking at slower speeds and on moderate inclines lowered the net muscle moments of the joints of the lower extremities . Furthermore, following recommendations from this study, in the EFIBAR RCT, the treadmill inclination will be increased by a maximum of 1° every 2 weeks, and the final inclination will not exceed 6° to minimise the risk of the onset of chronic tibia pain .
Adherence to the exercise programme will be measured throughout the whole intervention period using a comprehensive tally sheet to be completed daily by the PT during and after each training session. The detailed tally sheet is shown in Additional file 3: Table S3. It describes measurement and reporting of adherence to the exercise programme (Item 5), the type and number of adverse events that occur during exercise (Item 11), the adherence and fidelity to the programme (Item 16a and 16b). Moreover, extra physical activity and/or exercise performed (Item 9) will be register as it has been recommended . Briefly, training attendance will be defined as the number of sessions attended divided the number of sessions prescribed (n = 48). Performing at least 80% of all planned training sessions will be considered a successful attendance rate. Additionally, self-efficacy and intention to be physically active will be measured at baseline (pre-surgery), post-intervention (4 months after surgery) and at 1-year follow-up examinations, due to their associations with adherence to the exercise programmes . For self-efficacy, we will use a modification of the McAuley’s Exercise Self Efficacy Scale , whereas for measuring the intention to be physically active, we will adopt the question used by González-Cutre et al. . During each training session, other variables related to adherence to the exercise programme will be collected, such as punctuality, extra physical activity, compliant attitude, and the Rate of Perceived Exertion for aerobic and strength training (Borg Scale RPE: 0–10 and ONMI resistance scale: 0–10, respectively). Heart rate (using a Polar V800 pulsometer) will be registered immediately after each part of the training session. Mood through Feeling Scale, Exercise-Induced Acute Onset Exhaustion by HPHEE scale and the Rate of Perceived Exertion by Borg Scale (RPE 0–10) will be also measured before and after training sessions. All of these variables are presented in Additional file 3: Table S3. Another adherence strategy designed to maintain motivation throughout the intervention consists of WhatsApp motivational messages and videos (Item 6), which will be sent to programme participants; participants will receive WhatsApp messages every Friday and videos every month. The 16 motivational messages and four videos are shown in Table 2.
Table 2 Training periodization (Item 13)
6 Exercises to Stay Fit after Roux-en-Y Gastric Bypass Surgery
After successfully undergoing Roux-en-Y gastric bypass surgery in Perth, you are now ready to begin a new chapter. This new chapter is characterized by a healthy diet, regular exercises, and workout. Sticking to healthy living not only keeps your weight in check but also helps improve your overall health. Your exercise routine will depend on your fitness level prior to weight loss surgery. Post Roux-en-Y surgery, your trainer will introduce you to a variety of exercises that you need to perform regularly. Gradually they will add challenging exercises to your exercise routine to help improve your strength and stamina. This blog post lists six exercises you must follow post bariatric surgery regardless of the time that has passed.
1. Sitting Exercises
In the first couple weeks after surgery you should only focus on your recovery and only perform some low impact sitting exercises, such as arm rotations, leg lifts, and shoulder rolls. These exercises are not too strenuous and can be performed at anytime of the day. Practice them regularly to relax your shoulder, legs, and arms muscles.
Related Blog: 5 Tips to Keep Your Exercise Regime on Track
Once your body is comfortable with simple sitting exercises, include walking in your exercise routine. After surgery, start off by walking only for 10 minutes and slowly increase the time to 30 minutes. Walking is one of the easiest way to stay fit. It helps build stamina, making it an ideal activity not only for bariatric patients but also for normal people. Instead of treating it as an exercise, make walking a part of your life.
Riding a bike is another excellent exercise for weight loss surgery patients, but should only be performed after you have built some strength and stamina. One month after surgery is the ideal time to start cycling. Start by exploring the neighborhood on a bicycle for about 30 minutes every day, 5 times in a week. The biggest benefit of cycling is that it is easy on the joints.
4. Water Aerobics
Along with cycling you can also start some water aerobics or swimming. Water aerobics are effective and have the lowest injury rates. You may either join a gym that offers water aerobics classes or choose to swim a few laps daily in your swimming pool.
5. Squats and Lunges
After improving your stamina, it is time to improve your strength. Strength training is essential to maintain weight after bariatric surgery for strength exercises help burn more calories, improve balance, and build muscle. Consult your bariatric surgeon, and if you get a go ahead, begin strength training at least thrice a week. Start with squats and lunges for both are effective low impact strength training exercises that help build and strengthen leg muscles. Strong legs will enable you to complete longer endurance exercises without much efforts.
Related Blog: Step-By-Step Exercise Regimen: Pre and Post Gastric Bypass Surgery
Another excellent strength training exercise is yoga. Infact, yoga is a mix of strength training and relaxation. Practicing yoga everyday the first thing in the morning can have a calming effect on you and improve our mood. The best part about incorporating yoga in your workout routine is that you can do it in the privacy of your own home. Just purchase a yoga DVD or watch YouTube videos and follow the instructor. You may also find fitness centers in your area that offer yoga classes.
Final Few Words
A healthy life post Roux-en-Y Gastric Bypass Surgery depends on how you change your lifestyle. A balanced diet and daily workout go a long way in maintaining your weight and overall fitness. That said, do not rush your lifestyle changes. Start out slow and let your body get accustomed to the changes. Bariatric surgeons at Perth Surgical & Bariatrics also assist patients by preparing their workout routines and diet plans to make sure they’re on the right path to recovery. If you face any challenges post Roux-en-Y Bypass surgery, feel free to get in touch with our bariatric surgeons by filling out our appointment form or simply call 0865581901.
MOVEMENT AND EXERCISE AFTER BARIATRIC SURGERY
Exercise plays a major role in your weight loss journey. Complications of obesity such as back and joint pain may have limited your movement for some time. Adopting a movement plan in the early stages after bariatric surgery is beneficial, enabling your strength and tone to develop as you lose weight. As your recovery continues, exercise at greater levels can be a liberating component to your overall health and wellbeing, as well as serve to enhance your weight loss outcomes.
Exercise can help build strength in your body and increase health and vitality. Obesity is a risk factor for diabetes, heart disease and a host of other complications. Exercise is an effective way to improve your overall health and wellbeing.
And last, but by no means least, exercise can release endorphins, and help you to feel good. The changes exercising can make to mental strength, body image and overall positivity cannot be understated. This is why exercise perfectly complements weight loss surgery.
Tips for Exercise after Bariatric Surgery
Written by Advanced Surgicare on July 6, 2017
Exercise is an essential component of your post-weight-loss surgery regimen. Once your doctor has cleared you to resume (or begin) exercise, you will need to maintain a fitness regimen in order to stay healthy and maintain your weight loss results. To help you begin, Campbelltown bariatric surgeon Dr. V. Kuzinkovas would like to share some important exercise tips to keep in mind.
Ease Into Physical Activity
It’s better to be safe than sorry when it comes to exercising following your bariatric surgery. Before running miles, try walking first. As days go by, you can add more distance and time to your walks and eventually transition into running. Or, try walking on a flat surface first and gradually build up your endurance by incorporating hills and picking up your speed. If anything feels too strenuous, slow down to a more comfortable pace.
Enjoy the Great Outdoors in Sydney
With scenic beaches and magnificent hiking trails and parks, Sydney is filled with opportunities to get a good workout while enjoying the great outdoors. If you’re a fan of the gym, try one of Sydney’s outdoor gyms, all equipped with modern fitness equipment. Don’t be afraid to mix it up: try out a new park, hiking trail or beach to work out at every few days.
Don’t Forget Strength Training
Strength training is a great way not only to build muscle tone but also to burn fat. It is a good idea to consult or work with a professional fitness trainer who can teach and train you to achieve the proper form. Keep in mind that strength training after your weight loss surgery is not recommended until your doctor clears you to do so.
Join a Fitness Group
Some people find motivation in exercising with individuals who have similar fitness goals. If you are one of these people, try joining one of the many fitness and exercise groups in your area. Try searching Facebook or MeetUp to find a group that fits your interests and schedule.
Keep Your Bariatric Surgeon in the Loop
If you have questions about what exercises to incorporate, or if you have concerns, don’t hesitate to contact your bariatric surgeon or physician. Consult with your doctor first before starting a new exercise.
If you would like to learn more exercise tips after weight loss surgery or about bariatric surgery itself – please contact Dr. Kuzinkovas at Advanced Surgicare by calling 1300 551 533 today.