Individuals who have undergone any type of bariatric surgery often have anxieties about beginning or resuming an exercise program. Here we address many of the common concerns as well as offer suggestions on the best and safest ways to get started.
What Is Bariatric Surgery?
Bariatric surgery –the medical term for surgical procedures used to manage obesity and obesity-related conditions–can involve alteration of gut hormones, rerouting/reduction of stomach size, lessening of nutrient (fat and caloric) absorption, or a combination thereof. Each of these changes to the digestive tract promote significant weight reduction.
The choice to undergo bariatric surgery typically comes after unsuccessful attempts at diet and exercise, or in the face of serious obesity-related health problems. While bariatric surgery can offer many benefits, the patient must assume responsibility for making permanent healthy dietary changes and including daily exercise to help ensure long-term success.
Advance Preparation Paves the Way
Any serious surgical procedure – knee replacement, transplants, or gastric sleeve – usually involves some degree of post-operative rehab therapy. Medical experts as well as seasoned personal trainers will often suggest “prehabbing”, or gentle physical training in advance of a procedure. Such practices help to prepare the body for the arduous surgery and healing process to come, and can also improve recovery time. Coming into surgery already focused on exercise eases the transition into a healthier, more dynamic lifestyle, both physically and psychologically.
The American Society for Metabolic and Bariatric Surgery suggests patients engage in light exercise 3-4x/week for up to 12 months prior to surgery. The often seemingly insurmountable challenges most individuals face involve mobility limitations due to their body size. Jennifer Gooding, Aquatics Therapy and Wellness Supervisor at Daniel Drake Center, explains that any kind of movement, no matter how small, beats a sedentary lifestyle. “Take baby steps, set reachable goals, track your activity and give yourself credit for any improvements,” she says. “The stronger patients are going into surgery, the easier surgery, recovery and resuming exercise will be.”
Consider movements that easily work around mobility limitations in an effort to simply move more:
- Try gently cleaning the house, choosing a parking space further away from the entrance to the mall, or using the stairs whenever possible (even if holding a handrail)
- Light aerobic exercises such as water-walking, or anything that focuses on movement and duration rather than intensity, work particularly well
- Chair yoga movements prove an ideal option for individuals with serious mobility/joint issues
The Days Immediately Following Surgery
After any form of weight-loss surgery, a patient’s entire digestive system needs a considerable amount of recovery and healing. To facilitate this, he generally cannot consume solids for at least the first 2 days. A liquid diet ensues, followed by extremely soft foods (pudding, gelatin, slightly runny oatmeal or Cream of Wheat), and finally slowly progressing to regular food choices. While the limits on quantity and types of foods/liquids vary from patient to patient, the quantity will look considerably less than that to which one consumed prior to the procedure.
As one readies himself to begin engaging in a gentle exercise program, he must pay close attention to calorie consumption in an effort to protect the new digestive tract while also ensuring enough calories for the workout itself. The bariatric surgeon can recommend how many calories a patient needs each day, finding a prudent number based upon one’s particular goals.
Training Timeline Suggestions
Internists, surgeons and personal trainers always suggest starting a new workout very slowly, to avoid damaging incisions and/or slowing recovery time. In addition, muscles that have lain dormant for quite some time need a period of adjustment, or “awakening”. Walking around the house or the backyard helps build stamina and re-engage muscles. Here we present merely a rough outline of getting started (every surgeon has his own preferences):
1 Month Post-Op
For the first full week after surgery, aim for walking 5-10 minutes/day. Gradually work up to 15-20 minutes during the second week. By weeks three and four, a 30-minute gentle walk should feel comfortable. If that seems too taxing, try breaking this up into 3 walks of 10 minutes each, spaced throughout the day.
As the patient works at incorporating more movement into activities of daily life, warming up and cooling down take on even more importance before and after exercise.
Warming up prior to working out facilitates blood flow, warms the muscle tissues and encourages the heart to begin pumping more aggressively. These movements should last 5-10 minutes prior to beginning a training regimen to help with injury prevention. Walking, marching in place, overhead arm lifts or arm circles can suffice.
Cooling down post-exercise often gets neglected, either because the patient does not wish to take the time after he already feels fatigued, or he lacks sufficient knowledge of various movements. Aspects of cooling down – in an effort to lower heart rate and respiration rate — can take the form of a light walk, stretching/flexibility moves, or even a few yoga poses. Remember to ease into these stretches gently and avoid pushing too hard.
2-3 Months Post-Op
During this window of recovery, many patients shift from walking to cardio equipment typically found in a fitness center or a home gym: treadmills, elliptical machines, and /or stationary cycles. While any of these choices promotes the building of endurance, none of them will stress the site of incisions and therefore allow for further healing.
4-6 Months Post-Op
At this point in time, the majority of patients have lost some significant weight and find it easier to move around. Resistance training with light weights helps foster a return of, or development of, strength in the form of lean muscle mass.
6-12 Months Post-Op
Most patients at this stage demonstrate an ability to engage in a full workout that incorporates both cardiovascular movements and strength training. At this point, individuals often return to their former favorite sports activities, and add in flexibility/balance work. After a substantial weight reduction, one’s center of gravity changes, commonly affecting balance. Paying attention to stretches and movements that can foster a new kinesthetic awareness helps tremendously.
Recouping The Benefits of Exercise
All physicians tell patients to begin moving slowly; however, we must stress the importance of receiving full clearance from one’s bariatric surgeon prior to progressing to a more moderate exercise program. Only the surgeon knows the patient’s detailed health history, including aspects of how the surgery progressed and the success of the outcome, and thus should remain the expert on life post-surgery.
The benefits of exercising after weight-reduction surgery include:
- increases your cardiovascular endurance
- decreases body fat percentage
- fosters the building of lean body mass, which boosts metabolism
- promotes a better outlook/disposition
- reduces the chances of many weight-related conditions
Strength Training
Individuals who have never participated in strength training, or who plan to return to this endeavor following bariatric surgery, have several things to keep in mind. Resistance training does get easier as one sheds excess body weight; however, one also needs to focus on the type of weight lost and not just the overall amount. As body composition shifts, personal trainers can help the individual learn how to make sure what he achieves reflects a loss of actual fat mass while simultaneously adding lean muscle mass. Muscle tissue, more metabolically active than fat mass, burns more calories throughout the day, even at rest. Maintaining and building muscle will also help support bones and connective tissue, thereby preventing injuries. Additionally, amassing a greater amount of lean muscle tissue can aid in building bone density, a highly important consideration following bariatric surgery and in general as we age.
Building A Strength Program
Following bariatric surgery, even the most seasoned lifter will experience a considerable setback in terms of time away from the gym. Therefore, the process of returning to the weight room, for purposes of this article, will refer to all post-op participants as beginners.
A program that works all muscle groups seems prudent for one’s first foray into resistance training. If one can commit to working with weights 2x/week, a trainer can easily design a gentle yet comprehensive whole-body regimen that includes legs/glutes, biceps/triceps, back, chest, shoulders and abdominal muscles.
Whether this serves as a refresher course or a first-time endeavor, the trainer will focus on teaching proper form for each exercise, rather than the amount of weight the client lifts. Having good form goes a long way towards preventing injuries as well as protecting incision sites. It may feel challenging at first, especially following abdominal surgery, to maintain good posture (chest lifted, shoulders back, and abs held tight during each movement). As the internal organs settle into their new rearrangement, the mechanics of resistance training will get easier.
After the first or second workout, the trainer and client work together to select how much weight to use with each exercise. While the client may seem eager to get started, the trainer must remind him that the body needs to adjust after such traumatic surgery; starting with a load that both challenges the individual while respecting the body’s boundaries remains a top priority. Some clients might choose to touch base with their surgeon as the training process continues, just to make sure the internal healing proceeds according to plan.
Sample Training Paradigm
For those patients comfortable enough in the gym to work out on their own following surgery (and having received the doctor’s full clearance), we offer some suggestions for getting started safely:
Upper Body
- Dumbbell bicep curls
- Chest presses
- Modified pushups
- Chest flies
- Dumbbell triceps overhead extensions/kickbacks
- Lateral and front delt raises
Lower Body
- Bodyweight squats
- Forward, lateral and reverse lunges
- Calf raises
- Wall-sits
- Glute bridges
Resistance Bands
Following surgery but before starting back at the gym, working with resistance bands adds a fun and gentle dimension to many exercises. Resistance bands can challenge muscles in a different manner than weight machines/barbells, while still conferring much of the same benefit.
Flexibility
Some individuals find they enjoy stretching and mastering flexibility moves with the newfound freedom that a smaller body size affords them. Experts do not find it mandatory to stretch every single day in order to reap the benefits. Start by incorporating flexibility exercises 2-3 days/week. Over time, as the muscle tissues and neuroplasticity efforts learn their abilities, one will cultivate the ability to stretch further without pain or tightness. Even on pure flexibility days (without strength training or cardio), muscles behave better when warm, so try doing a light walk or jog beforehand.
When engaging in stretching exercises, aim for smooth, slow and controlled movements, holding each stretch in a comfortable position for 10-15 seconds. Gradually work up to a 30 -second hold. Be sure to breathe normally while you are stretching, avoid jerking motions, and always keep joints slightly bent to avoid injury.
For those individuals who do not favor weight training, or do not feel quite prepared to engage in higher-impact aerobic exercises yet, programs like yoga and Pilates can serve as a wonderful way to begin more aggressive movement.
Both of these endeavors will help tone the body, while also offering an opportunity to learn restorative breathing and concentration. The moves that comprise yoga and Pilates range from simple to highly challenging, and also place a great emphasis on posture and a strong core.
While low impact by nature, these types of movements most likely will cause some muscle soreness and minor aches, especially for a relatively deconditioned body. This will wear off quickly as one adapts to an increased level of movement. Engaging in these practices should not prove detrimental to post-surgical healing or recovery.
Take-Home Message
After making the decision to undergo life-changing bariatric surgery, take some time to get educated on the process itself, the recovery, and the new lifestyle necessitated for a successful outcome. A proactive mindset will facilitate adherence to this new meal/exercise plan throughout one’s life. Pay close attention to surgeon’s/physician’s/dietitian’s advice, including any vitamin or probiotic supplements they may prescribe. Couple this with adequate hydration, and you have a recipe for a healthier future!
References:
https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258#:~:text=Overview,problems%20because%20of%20your%20weight.
**Possible CEC Questions**
- Who is a good candidate for bariatric surgery?
- How long is a typical full recovery?
- What are some considerations for resuming exercise post-surgery?
- Can one build muscle on such a restrictive meal plan?
- What responsibilities fall on the personal trainer when working with a client after bariatric surgery?
- What are some good ways to prepare the body before surgery?
Cathleen Kronemer is an NFPT CEC writer and a member of the NFPT Certification Council Board. Cathleen is an AFAA-Certified Group Exercise Instructor, NSCA-Certified Personal Trainer, ACE-Certified Health Coach, former competitive bodybuilder and freelance writer. She is employed at the Jewish Community Center in St. Louis, MO. Cathleen has been involved in the fitness industry for over three decades. Feel free to contact her at trainhard@kronemer.com. She welcomes your feedback and your comments!
