What is the best exercise for weight loss?  The short answer is “anything you’ll stick with long-term!” But when it comes to weight loss surgery (Gastric Bypass, Gastric Sleeve and LAP-BAND^®), this often isn’t as simple as it sounds.  Excess body weight, loose skin, a smaller stomach and pre-existing joint or spine conditions are just a few of the things bariatric surgery patients may need to consider when embarking on the fitness portion of their weight loss journey.

Before we get into what bariatric exercises are best or how to exercise, let’s explore why exercise is so important for Gastric Bypass, Gastric Sleeve or LAP-BAND^® patients. After all, you’ve probably tried exercise for weight loss before with mixed results so you’re skeptical that you will find something that works for you. Some bariatric patients believe they won’t need exercise because the surgery does all the work to lose the weight. Nothing could be further from the truth. In fact, studies have shown that a critical factor for the long-term success of weight loss surgery patients is committing to a safe, sustainable exercise program.

Physical activity is the second most important behavioral factor for predicting long-term weight loss success after surgery, second only to improved dietary habits.  By incorporating exercise prior to surgery, patients may experience a boost in metabolism and shorter recovery times.  A recent study also found that adults who add walking to their daily routines following Gastric Bypass improved cardiovascular health and reduced their risk of diabetes.

Are you convinced yet? Before you jump up and tie on your running shoes, you’ll need to learn how to incorporate exercise in a way that maximizes its benefits and minimizes the chances of injury. All it takes is a little careful planning and extra thought and you’ll be off walking, biking and training in no time. And remember, before beginning any exercise or fitness program be sure to consult with your physician or surgeon.

Start SMART. Too often I hear vague statements of intent from my patients, like “I plan to start exercising more.”  I tell them to get SMART - Specific, Measurable, Attainable, Realistic and Timely – to  improve the quality of their goal and increase the chances it will actually be met. A SMART goal sounds like this: “I plan to start walking on my lunch break at the park near my office beginning next Monday.  My goal is 4 times per week for 30 minutes, weather permitting.”  Now that’s music to my ears!

Start slowly. Don’t make the mistake of going full speed ahead only to regret it the next day.  Start with 5 or 10 minutes and gradually increase to 60 minutes for five or more days per week.  Thinking more like the tortoise and less like the hare will greatly improve the odds of staying committed long term and help lessen soreness or, worse, injury.

Count it all. Activities of Daily Living or ADLs include things like cleaning the house, grocery shopping, doing laundry, parking the car further away and taking the stairs instead of the elevator.  These little things can add up when done consistently over a period of time, and they don’t require a gym membership or huge time commitment.

Consider the impact. If you have a BMI greater than 30, you’re at increased risk for joint injuries when exercising.  For this reason, it is generally recommended to avoid high-impact activities such as running, jumping and contact sports.  Some of these activities may be accessible post-surgery once you are at a healthier weight, but they are generally not safe choices for beginners.

Track wisely. Using a pedometer or app to count steps and record completed activities can be a great motivator, but be wary of the features that estimate the number of calories burned.  Too often these calculations are inaccurate, sometimes by as much as 30%, and there’s a tendency to overeat as a result of believing you expended a specific amount of energy.  If you find you fall into that trap, try setting a non-food reward for meeting a fitness goal, such as a new book for walking 10,000 steps every day for a week.

Train smarter.  Exercise for maximum effectiveness by choosing a plan that incorporates both cardiovascular and strength-training activities. Strength training should consist of two to three sets of 8-12 repetitions for each major muscle group. Aim to do total body resistance exercises two or three times per week.  Lower impact aerobic exercise that raises your heart rate to 50% to 80% of your maximum target and lasts at least 30 minutes should be the daily cardiovascular goal.  And always allow time to warm up and cool down before and after any exercise session. This helps reduce both soreness and the chance of injury.

Get offensive. While I don’t suggest reusing yesterday’s t-shirt, it is a good idea to get offensive when planning your exercise routine.  If joint issues or prior injuries are a concern, consider working with a certified personal trainer to develop a safe and effective routine.  Many strength exercises can be done from a seated position, and activities such as water aerobics or stationary biking may be less likely to cause new or repeat injuries.

Support your skin. Post weight loss surgery, patients may experience loose or sagging skin.  This poses a unique challenge when exercising as chafing can result in discomfort or open wounds.  So what is there to do short of having plastic surgery?  Topical lubricating gels that decrease friction and supportive workout clothes or undergarments can help make exercise more tolerable.

Forget “no pain, no gain.” Or at least learn what type of pain is reasonable versus what isn’t.  Muscle soreness, especially at the beginning, is almost a given.  Cooling down and stretching can help reduce the severity and duration, and it should improve within a few days.  Joint pain, however, is never OK and it is always an indicator to slow down or stop.  Also be sure to get permission from your surgeon before lifting weights as it is generally advisable to avoid anything heavier than 10 pounds for at least the first month after surgery.

Choose the right fuel. Finding the right balance of nutrients to fuel your workout is key. Limitations on portion size and the emphasis on high-protein, low-carbohydrate foods can make this challenging, but it is manageable.  Be aware that extremely low carbohydrate intake can cause dizziness or lightheadedness in some people, so it is important to stop any activity and seek guidance from your doctor or dietitian if this occurs.  Meeting your fluid goals, generally 64 ounces per day, is also essential to reduce muscle cramping and prevent fatigue.  Just be sure to separate eating and drinking by at least 30 minutes before and after to prevent flushing of food or dumping syndrome.

Make some space. Just as important as deciding which exercises to try, is designating time and space to actually do them.  Scheduling time on your calendar for fitness increases the likelihood of following through.  And designating a space for your activities, such as a room in your home, the gym or a nearby park, will help you establish a routine and minimize distractions.

By choosing bariatric surgery, you are making a valuable investment in your future health status.  Regular exercise is the insurance policy that will help support your recovery after surgery and guard against future weight regain.  Follow these tips and you’ll be fit and healthy for many years to come.  Now lace up those sneakers and get moving!