"What About Exercise?"

"What about it?" patients often ask in return.

From Pati.Clark.blogspot.com

I must say I ask the exercise question at least 15 times a day seeing patients in follow up after their Bariatric procedures. The answers honestly often disappoint, but it is a teaching and coaching start point nonetheless.  It is an essential part of the path toward wellness after surgery.

So, What is considered exercise?  What role does exercise play in the post-procedure lifestyle of a surgical patient?  What do we expect from them? Furthermore, what is to be expected from a regular exercise program to lose or maintain weight?

Exercise certainly has its numerous literal definitions, but in the obese and unfit population, the definition becomes a bit more relative and has to be taken in context to their current health situation.  We are certainly not going to expect a patient with a BMI of 50 who hasn't been very active, and has little prior formal exercise experience to 'work out' 5 x per week for 30 minutes each time right off the bat. That may be a long term goal, but initially needs to be scaled back.

Essentially, any increase in their current energy expenditure through informal or formal exercise is a plus, on the way to a healthy lifestyle that includes regular exercise. This may include parking farther away from your car when you shop, walking at lunch time while on a break at work, consistently doing stairs instead of the elevator, walking instead of a cart for 9 holes, etc.

Now, our expectations do certainly increase for those who have had surgery and are losing weight, and those patients are required to get into regular exercise as a part of their usage of their "tool" that surgery has created for them.

In Band patients, who customarily lose weight at a slower rate, exercise may be the missing component that is needed to lose more weight / more consistently, when the Band is tuned up reasonably well and their diet is relatively sound (portion size and quality of foods).  Additionally, whatever they tell me as far as frequency and duration of exercise when I ask, if their weight loss is lacking, I usually say that they can do more than they currently are doing (exercise)...either more frequently or more intensely.  Those that do take it to heart are usually very surprised at the results!

Additionally, with the Sleeve and Bypass patients, regular varied exercise helps to maintain lean body mass when weight loss is occurring  rapidly. This often requires at least the 60-80+ grams of protein per day we recommend to inhibit muscle breakdown, depending on the intensity of the exercises performed.

Once patients start to lose weight, get some momentum going, and feel better about their body image, it gets easier to get them out there - to the gym or the great outdoors.  Many come to experience that they actually love exercise, and/or return to love it like they did when they were younger and more fit.

During the weight maintenance phase, generally starting 12 - 15 mos after their surgery when they are near or at their goal weight, exercise also plays another key role, stabilizing the their weight in addition to making up for some other behavioral / dietary indiscretions that will occur now and then.

And when all else fails, bring sex into the equation... It is one of the studied benefits of regular exercise!  That often gets some attention.  Other benefits, especially in our obese, post operative population include:

     *Improving Cardiovascular Fitness and Lipid Profile
     *Improving Bone Density
     *Preventing or Delaying development of Type 2 DM
     *Increasing Lean Body Mass and Strength
     *Controlling Anxiety and Depression
     *Promoting a Sense of Well-Being
     *Increasing Resistance to Infection
     *Improving Energy Level and Quality of Sleep
     *Reducing Symptoms of DJD
     *And, Yes, Improving Sexual Desire, Arousal, and Performance.  There, I said it.

Whatever it takes!  Just Do It.