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.

Why Is Exercise Important After Weight Loss Surgery

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 Walking after gastric bypass improves heart health and reduces diabetes risk.

How Soon After Bariatric Surgery Can You exercise?

Before you tie your running shoes, you’ll need to learn how to learn how to exercise safely and effectively. With a little careful planning and extra thought and you’ll be off walking, biking and training in no time. To determine how soon you can begin any exercise or fitness program, speak with your physician or surgeon. Here are a few general guidelines to consider.

Set S.M.A.R.T. Goals

How often do we say, “I plan to start exercising more” and weeks go by without action. I tell patients to get SMART - Specific, Measurable, Attainable, Realistic and Timely. This improves 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. Start slowly, with 5-10 minutes of exercise. Gradually increase to 60 minutes, 5+ days a week. Don’t make the mistake of going full speed ahead only to regret it the next day.  Think more like the tortoise and less like the hare. This can 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. Train smarter with a plan that includes cardio and strength training. Aim for 2-3 sets of 8-12 reps for each muscle group, 2-3 times per week. Set a goal to do total body resistance exercises two or three times per week.  In terms of daily cardio, aim for 30+ minutes, raising your heart rate to 50-80% of your max. Always warm up and cool down to reduce soreness and injury risk.

Be proactive: If you have joint issues or past injuries, work with a certified personal trainer for a safe and effective routine. Seated strength exercises, 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. Be sure to get your surgeon's OK before lifting weights. Avoid heavy lifting (10+ lbs) 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!