Exercise for Bariatric Surgery Patients
Exercise for bariatric surgery patients is often the first part of a patient's long-term plan to get skipped following surgery. In reality, it is almost as important as your diet. This page explores why along with the best weight loss surgery exercise options…
- Why it’s important
- When is it safe?
- General post-weight loss surgery exercise guidelines
- Best exercises
- 8 tips to keep you on track
The successful bariatric surgery patient regularly takes part in three main activities in their life after surgery:
- Follows an appropriate bariatric diet plan
- Actively participates in weight loss surgery support groups
- Follows a consistent and progressive exercise routine
Two of these are easier to adhere to…
If you don’t follow your diet plan, you will most likely get sick… ranging from trouble with digestion to vitamin deficiency. This risk – or actually getting sick as any patient who has had dumping syndrome can tell you – keeps most patients in line regardless of their motivation.
Participating in weight loss surgery support groups is the next easiest thing to keep consistent. They’re interactive and fun, and if time is an issue there are great at-home options available in the form of online weight loss support.
Not surprisingly, exercise for bariatric surgery patients is often the component that slips. It can seem daunting, especially after a long day at work or an especially difficult week.
But you must make it a priority for two big reasons:
We’ll let the research do the talking…
- A recent meta-analysis found that consistent exercise for bariatric surgery patients leads to a 4.2% lower body mass index.1
- Another study compared the weight loss of gastric bypass surgery patients who completed moderately intense physical activity for a minimum of 2 ½ hours per week against those who did not. The 2 ½ hours+ per week patients showed significantly greater weight loss:2
- 6 months after surgery – 5.5% greater excess weight loss (56.0% vs. 50.5%)
- 12 months after surgery – 5.7% greater excess weight loss (67.4% vs. 61.7%)
- Still not convinced? A third study evaluating 200 bariatric surgery patients found that physical activity adherence was the sole significant behavioral predictor of weight loss outside of dietary habits. In other words, other than sticking to your diet plan it’s the main thing you can do to achieve and sustain your weight loss goals.3
So how does exercise contribute to weight loss?
Recent research suggests that your metabolic rate may not be as important as previously thought, especially when compared to an improved diet.
Regardless, good weight loss results and better overall health speak for themselves... a healthy diet combined with an appropriate exercise program equals long-term success.
As you probably know, it burns calories. But this is not the main reason it works. After all, if you weigh 275 pounds, you will burn 200 calories per mile walked at a pace of 5 mph. One cup of dried apples has over 200 calories, let alone your entire daily intake. Exercise will only directly burn a small portion of your daily calories.
The more important reason exercise for bariatric surgery patients works is by boosting your metabolism, which is especially important considering your body’s natural tendency to slow down your metabolism as you lose weight (see Set Point Theory). A higher basal metabolic rate means that your body will automatically burn calories at a faster rate even while you are resting, thus leading to additional weight loss.
To determine exercise’s impact on weight loss surgery patients, one study divided 60 morbidly obese gastric bypass patients into two groups:
- Low-exercise (worked out 1 time for 1 hour per week)
- Multiple-exercise (worked out 2 times for 1 hour each per week)
In addition to quicker weight loss, the multiple-exercise group had significantly earlier resolution or improvement of obesity health problems.4
In fact, exercise for bariatric surgery patients and obese individuals alike has been shown to improve a vast array of physical and mental issues, including:
Physical Improvements Caused By Exercise for Bariatric Surgery Patients
- Increased life expectancy5
- Reduced abdominal fat
- Stronger heart, muscles, bones and lungs
- Reduced risk of heart disease
- Lower blood pressure
- Reduced triglycerides
- Increased good cholesterol and reduce bad cholesterol
- Improved blood sugar control
- Improved insulin control
- Reduced risk of cancer
- More energy
- Improved balance
Mental Improvements Caused By Exercise for Bariatric Surgery Patients
- Improved appearance
- Improved motivation and mental “sharpness”
- Improved libido
Check with your surgeon to be sure, but exercise for bariatric surgery patients can generally begin within three to six weeks following surgery.
But you should begin walking for 20 to 30 minutes per day as soon as you get home. Start with a slow pace and gradually increase the speed at which you walk as your endurance improves.
At first, it’s probably best to spread this out over the day instead of doing it all at once. For example, try going for a 10 minute stroll in the morning, midday and in the evening.
By the time you reach six weeks post-op, you should be able to complete three 10 minute walks per day while walking at a relatively quick pace. After week six, it may be time to begin a more intensive exercise routine including strengthening, flexibility and more aggressive endurance exercises.
It’s normal! You may even feel more sore two days after exercising. The best way to reduce soreness is to get blood flowing to your muscles by moving and drinking plenty of water… sitting on the couch may only may it worse.
And remember… weight loss surgery patients should typically avoid NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen or Aleve.
First, recognize that your ultimate goal is NOT to exercise like a young, lean person. Not only will this make your goals feel more achievable, but it’s simply not necessary.
This stance was confirmed by researchers studying the exercise habits of 100 people: 50 of normal weight who exercised regularly vs. 50 post-gastric bypass patients who achieved 80% or greater excess weight loss. They found that compared to the normal-weight group, the weight loss surgery group maintained a similar body mass index with less rigorous but equally consistent exercise.6
In short, you need to stick to a routine, but you don’t need to win Cross-Fit Trainee of the Year to achieve and maintain a normal BMI.
Now that that’s out of the way, let’s set the foundation for safe and effective exercise for bariatric surgery patients:
- Start slowly and work your way up. At best, the soreness and fatigue caused by getting too aggressive out of the gate will discourage you. At worst, you could get injured, leaving you unable to exercise for months. Be patient!
- Prevent skin problems. As you lose more and more weight, loose and sagging skin may present a problem. Short of plastic surgery after weight loss, there are a few things you can do to keep the chafing under control…
- Apply gels such as Bodyglide to sensitive areas or skin folds to reduce friction.
- Wear supportive clothing or undergarments that keep the skin tight (but not too tight) against your body.
- Drink plenty of water – your smaller stomach following surgery can make it tough for your body to absorb the water it needs… especially during and after exercise. Always have water by your side and drink regularly. (See Water After Weight Loss Surgery)
- Wear good shoes – no one shoe is right for everyone, despite a high price tag. Only buy a pair of shoes if they feel great INSTANTLY after trying them on. In other words, don’t buy a pair hoping to “break them in”.
- Warm up before exercising and cool down afterwards. The goal of your warm-up is to slowly get your heart rate and breathing up and your muscles loosened in order to prevent muscle injury and maximize the effectiveness of your workouts.
Your cool down will bring your heart rate and breathing down slowly to prevent dizziness or fainting and to remove waste products from your muscles such as lactic acid. Cooling down may also help to prevent or reduce the severity of sore muscles.
- Keep your heart rate within the proper range – Your maximum heart rate is a function of your age – the younger you are, the higher it is. According to the American Heart Association (AHA), you should measure your pulse periodically as you exercise and keep your heart rate within 50% to 85% of your maximum heart rate (see chart below).
Immediately following weight loss surgery (and until you are less than 50 pounds overweight), stay towards the lower end of your range and slowly work your way up as your fitness level progresses. There are two ways to track your heart rate while you exercise:
- Use a heart rate monitor – this is the easier option, as all you have to do is read the screen. The Omron Heart Rate Monitor/Wristband (aff) is a good option. It's reasonably priced and has all the bells and whistles, including an alarm option for low and high heart rates and a mounting bracket for treadmills and bikes.
- Manually take your pulse – place the ends of your index and middle finger on the inside of your other wrist just below your thumb pad muscle. Pressing softly, move your fingers around until you feel your blood pulsing below the skin. Count the beats you feel for 10 seconds using a clock or watch with a second hand as a guide, then multiply your count by six to determine your heart rate per minute.
||Target HR Zone
|Source: American Heart Association|
|20 years||100–170 beats per minute||200 beats per minute|
|25 years||98–166 beats per minute||195 beats per minute|
|30 years||95–162 beats per minute||190 beats per minute|
|35 years||93–157 beats per minute||185 beats per minute|
|40 years||90–153 beats per minute||180 beats per minute|
|45 years||88–149 beats per minute||175 beats per minute|
|50 years||85–145 beats per minute||170 beats per minute|
|55 years||83–140 beats per minute||165 beats per minute|
|60 years||80–136 beats per minute||160 beats per minute|
|65 years||78–132 beats per minute||155 beats per minute|
|70 years||75–128 beats per minute||150 beats per minute|
- If you feel pain, STOP IMMEDIATELY. Do not try to work through it. Instead, choose exercises that do not irritate the affected area. For example, if walking hurts your knees, try using a stationary bicycle or elliptical machine.
The AHA also suggests using a “conversational pace” to keep your heart rate within range in the absence of a monitor or knowledge of how to take your pulse. They advise that “if you can talk and walk at the same time, you aren’t working too hard”, but “if you can sing and maintain your level of effort, you’re probably not working hard enough”.
The best exercise for bariatric surgery patients achieves a balance of three fitness keystones:
Walking should be the first exercise for bariatric surgery patients and is a perfect first step (no pun intended) towards a robust exercise routine.
Begin your walking plan by setting an initial daily goal. Then increase the goal by 10% each day that you walk.
A great way to go about this is to count your steps using a pedometer such as Omron's HJ-112 Digital Pedometer (aff). To set your baseline goal, clip on your pedometer (Omron's also works when it's in your pocket or bag) and walk for 20 or 30 minutes throughout the day.
Spread your walks throughout the day so you don’t get too tired… three 10 minute walks, for example.
At the end of the day, take a look at your pedometer and write down the number of steps you took (use your free diet and exercise journal so you can track your progress over time). This will include both the steps taken during your planned walks and steps taken throughout your regular daily activities.
Next, multiply the total steps listed on your pedometer by 1.1 to determine your daily goal for the next day. Continue this process each day, making sure that your pedometer reads the new higher number (your ongoing new goals) at the end of each day.
After a few weeks, you’ll be well on your way to better shape and will be ready to take your endurance routine to the next level…
As the walking gets easier increase the difficulty of your daily steps. First, start taking the stairs instead of the elevator whenever possible, or walk hills instead of flat ground if you have them in your area.
Next, consider moving on to marching (not jumping) on a mini trampoline. Mini trampolines provide great exercise for bariatric surgery patients for a few reasons: they give you a good indoor workout option when the weather won’t allow you to walk outside; they’re a better workout than walking on the ground; and they improve your balance and core strength… a perfect lead in to your endurance and strength exercises.
We like the 40-inch Foldable Exercise Trampoline (aff) from ActiveForever. It can support weight up to 300 pounds and can be ordered with an optional stabilizing bar - a huge help with balance for beginners.
It's also extremely portable... it collapses to less than one-fourth of its open size and comes with a free carrying case.
As you progress, you can continue to increase the difficulty of your endurance training by riding a stationary bike at home or in the gym.
For a cheaper and more convenient alternative, consider using a pedal exerciser. As you would expect, it won't give you nearly the workout that a full-sized bike will give you and they are much less stable, but their convenience and much lower price tags make up for it - especially for beginners.
Pedal exercisers also allow you to work out anywhere you can find a seat, including (for the time-strapped) your desk while working.
The Stamina InStride Cycle (aff) is the quietest and sturdiest of the ones we tried and is one of the most compact - a big deal if you're working out at your desk and don't want your knees to hit.
Another effective and inexpensive (and fun!) exercise for bariatric surgery patients is a hoola hoop. In addition to improving your endurance, it’s an excellent way to strengthen your core, arm and leg strength. Exercise by swinging the hoola hoop around your waist, arms and legs.
The last but certainly not least recommended exercise for bariatric surgery patients is swimming, especially while you are still overweight or obese. It contributes to endurance, strength and flexibility with minimal impact on the joints and works virtually every part of your body.
The benefits of stretching and becoming more flexible can not be overstated and are an essential part of your overall exercise plan. Try it just once, despite the burn… when you’re done, it’s difficult to deny the slight euphoria you feel. That “good feeling” only multiplies over time, and it leads to a better mental state and lower stress.
Just as importantly, flexibility exercise for bariatric surgery patients improves coordination, increases blood flow to your muscles resulting in less soreness and more energy and improves chronic problems such as lower back pain.
To stretch properly, you should go far enough to “feel the burn” but not so far that it hurts. Hold the stretch for at least 10 seconds while feeling the burn, breath deeply and consistently, and don’t bounce.
To get started, we highly recommend a beginner’s yoga class.
What’s wrong? Can’t get the image of a contortionist out of your brain? While the stereotype can make yoga seem intimidating, don’t let it dissuade you from giving it a shot. Beginner’s yoga will ease you into stretching and teach you all of the proper stretching techniques for each muscle in your body.
Yoga also goes a long way towards building strength. After all, holding those stretches takes muscle!
Strengthening exercises are the third leg of your three-legged exercise routine and should be started only after your endurance and flexibility routines are well underway.
As mentioned above, good transitions into strengthening exercises include walking up and down hills or stairs, swimming, yoga and using a mini trampoline, stationary bike, pedal exerciser or hoola hoop.
We recommend three avenues to begin building strength:
- Exercise balls– these provide a great low-impact workout for core strength...
Valeo makes good ones (aff) that are available online and include a brochure with exercises, but you can also pick one up at any local sporting goods store. Just sitting on them while watching TV or working at your desk will work your abs, sides and lower back. As you get stronger, start to incorporate exercises.
The size you need depends on your height:
- Under 5 feet - 45 cm
- 5'1" - 5'8" - 55 cm
- 5'9" - 6'2" - 65cm
- 6'3" - 6'7" - 75cm
- Over 6'8" - 85cm
- Bodyblade – the
Bodyblade (aff) is a flexible handheld bar that uses inertia and low level vibration to force your muscles to contract quickly, leading to strength along with balance and coordination.
To use it, you simply grip the center of one or both of the blades with one or two hands and shake the blade(s) back and forth while doing one of many exercises.
It's a very low impact exercise for bariatric surgery patients (good on the joints) and provides a solid whole-body workout. The following video will give you a better understanding of how it works...
The Bodyblade also comes with an instructional DVD to teach you the proper form and techniques for various body parts. It's available online from ActiveForever.
- Weights – to begin, use very light weights… a set of one to five pound dumbbells is perfect.
MedEx has a reasonably priced 10-piece set available online (aff) (1 through 5 pounds, 2 each), but you can also find them in your local sporting goods store.
In addition to using them on a dedicated basis (standing arm curls, for instance), you can also incorporate them into your other routines which is a great way to pack the most exercise into the least amount of time.
For example, start carrying one pound weights with you on your walks or start doing arm and shoulder exercises with them while you march on the trampoline or use the bike. Increase the weight you’re using when you’re able to do three sets of 15 or 20 repetitions.
Now that you know the equipment you need and have some good endurance, flexibility and strengthening exercise ideas, you’re ready to get started. Before you do, understand that regardless of how fired up you feel now, there will be times that exercising is the last thing you feel like doing.
But you must fight through it and stick to your routine no matter what! Following one or more suggestions in the next section will help…
Everyone feels the urge to let their routine slip from time to time. The following will help keep you on track…
- Set and track goals – If you only do one thing on this list, make it this one. Goal setting and tracking not only helps to keep you motivated by proving your progress, but it provides an easy way to share your progress with your surgical team to help them if a problem arises.
We strongly recommend using a good online tool such as FitDay (aff) that integrates both your diet and exercise activity and goals. They allow you to chart your progress and have calendars for planning your schedule. See our Free Diet and Exercise Journal page for more information and reviews.
- Work out with a partner – This is a close second to goal setting and tracking, as it can automatically incorporate the rest of points on this list. If you can afford it, a personal trainer is ideal. They are trained to know how to push you to just the right level with each workout. The trainer you choose should have experience working with overweight people, so ask your surgeon’s office for a referral if you are unable to find one on your own.
A committed family member of friend is also a good idea with or without a trainer. You’ll be less likely to bail out of a scheduled workout if you know someone is counting on you to be there!
- Mix it up. Constantly doing the same exercise can get boring, and being bored can reduce your motivation. If you start to feel bored, change up the routine. Listening to music, reading a book or magazine or watching TV while working out can also help.
- Keep the timing of your workouts consistent. For example, you could start with 15 minutes of strength and flexibility exercise (on top of your daily walking goals) Monday, Wednesday and Friday mornings to “get it out of the way” at the beginning of the day. Making your exercise a part of your routine will quickly cause it to feel “weird” or at least noticeable if you don’t work out.
- Share your progress and how you stack up against your goals with your surgical team and support groups. Print your charts and calendar from your online journal and take them with you to your in-person weight loss surgery support group meetings, or share them in your online weight loss support forum. It will help you (and your peers) stay motivated!
- Don't stop pushing yourself. Easier-feeling workouts mean you’re getting in better shape, but you’ll need to continue to push yourself in order to improve. Increase the time spent working out, the intensity of your workouts or both (but don’t forget to keep that heart rate within range!).
- Consider joining a gym. Gyms are great for several reasons…
- They give you access to all of the equipment you’ll ever need without having to buy it for yourself.
- Limited distractions. At home, there are 101 things that can cut your workout short or cause you to skip it altogether – pets, kids, the phone, email… you name it. If you make going to the gym part of your routine (on the way to or home from work, for example), it will be easier to follow through.
- Trainers are usually available for free advice such as how to use machines, ideas about new exercises, etc.
- They may have a pool, and as mentioned above, swimming is a GREAT weight loss surgery exercise.
You may be surprised to find a relatively empty gym along with others working out who have a similar body type as yours.
- If you decide to work out at home, do it outside if the weather permits or do it in a designated part of the house. It will help you establish a routine and limit the distractions.
Also consider picking up a good workout DVD to guide you... there are countless to choose from depending on your goals, style and fitness level.
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References - Exercise for Bariatric Surgery Patients
- Livihits M, et al. Exercise Following Bariatric Surgery: Systematic Review. OBES SURG (2010) 20:657–665. DOI 10.1007/s11695-010-0096-0
- Ronald K. Evans, et al. Participation in 150 min/wk of moderate or higher intensity physical activity yields greater weight loss after gastric bypass surgery. Surgery for Obesity and Related Diseases - September 2007 (Vol. 3, Issue 5, Pages 526-530, DOI: 10.1016/j.soard.2007.06.002)
- Welch, Garry, et al. Physical Activity Predicts Weight Loss Following Gastric Bypass Surgery: Findings from a Support Group Survey. Obesity Surgery 2008-05-01 Vol 18 Pgs 517-524. DOI: 10.1007/s11695-007-9269-x.
- Shang, E, et al. Aerobic endurance training improves weight loss, body composition, and co-morbidities in patients after laparoscopic Roux-en-Y gastric bypass. Surgery for Obesity and Related Diseases. Volume 6, Issue 3, Pages 260-266 (May 2010).
- Franco OH, et al. Effects of Physical Activity on Life Expectancy With Cardiovascular Disease. Arch Intern Med. 2005;165:2355-2360.
- Ehab A, et al. Survey of the Effective Exercise Habits of the Formerly Obese. Journal of the Society of Laparoendoscopic Surgeons, Volume 14, Number 1, January - March 2010 , pp. 106-114(9)
[ Last editorial review/modification of this page : 10/9/2013]