June 16, 2008

Exercise is the key for the pre and post Bariatric patient to maintain a healthy range BMI and to become more independent, with increased base line functional movement. The question of exercise is something that is under increasing debate in the Bariatric community. Some surgeons recommend a structured and progressive exercise routine, such as stretching and a basic walking regimen, while other surgeons feel that it is less important. They may feel it is less important because the actual exercise routine may only burn 150-250 calories after 20-30 minutes of slow walking. This may seem overwhelming to the obese patient, especially if he/she has many health concerns such as high blood pressure or joint concerns. In order to lose one pound of fat through exercise one must burn 3500 calories or some combination of increased activity and decreased caloric consumption.

Many patients both pre and post Bariatric surgery feel frustrated when they only burn 100-200 calories after a power walk. Depending on the weight class range certain patients feel short of breath even taking 50 steps. The point is every person is an individual and every workout should be customized based on of course, your individual Bariatric surgeons recommendation, and your own check in assessment of how you are feeling. One day you may feel you have more energy than others and some days your joints may not fell up to excess movement. Therefore, it is essential to educate your self on ways to adjust your intensity on days your motivation and energy level is lower. I recommend purchasing a pedometer to check your step count and a diary to record the steps of how you’re feeling after each workout. As you progress you have a recording of your exercise progress chart, which is a solid indication of overall improvement. This information should be shared with your surgeon and or your support group leader so that they may advise you to increase or decrease your intensity and duration. This will also motivate you in the future when you refer back to a time when you were unable to move as freely or experienced a fatigue at a shorter interval of walking.

The benefits of a structured plan include an increase in oxygen and of course, an increase in one’s metabolism. Increasing metabolism (increase in muscle%) will increase the number of calories required by your body for all other activities. It causes the body to burn calories more efficiently, as it helps maintain the resting metabolic rate. Regular exercise may also help control appetite and improve psychological outlook when trying to lose weight. An exercise program conducted 3 times per week (at an intensity and duration eliciting 300-400 kcal/session) could result in a 16-pound weight loss in one year.

Timing of exercise is important when designing exercise programs for obese individuals. In a study looking at the thermogenic effects of predprandial (before a meal) and postprandial (after a meal) exercise in obese females, investigators found those who exercise after a meal produce the greatest thermogenic response, compared to those who did not eat before exercise or those who ate after exercise (Davis, 1992)*

The human body was designed to move, but also designed for homeostasis. So, the less we do-the less we feel like doing. The more we do, the more we feel like doing. The point is we are creatures of habit and the body will adjust either way. The recommended step count per day is 10,000 steps, however, if you can only do 100 comfortably, try to increase by 5-10 % and then adjust slowly. My suggestion, take your exercise one day or even one moment at a time. Listen to your body, surround your self with the best medical team, be your own health advocate and have fun!

Lisa Avellino
Focus28 Fitness Expert