Wednesday, 7 September 2016

Exercise and Weight Loss Surgery Patients

 Why is Exercise Needed?

Exercise is needed both pre-op and post-op. I hear a swear word being uttered out there but it is important. We have often gained our excess weight by eating more food/drink calories than we use in our exercise (movement). Our metabolic rate has probably been lowered by the number of diets we have tried before. Exercise helps to raise the resting metabolic rate for a time after the exercise. If you exercise regularly it stays at a higher rate than without exercise.

Pre surgery exercise needs

In New Zealand if you are getting your weight loss surgery done then you have to reach certain targets of weight lost and keep it off. You are encouraged to start exercising before the surgery for a number of reasons.

Reasons for exercise pre-op

  1. To get healthier, meaning less risk during the operation
  2. To improve core strength which keeps you stable and upright
  3. To lessen the amount of abdominal fat making it easier to do the operation
  4. To heighten the chance of you continuing to exercise post-op as it is already a habit.

Difficulties in exercising pre-op 

  1. Inability to move freely because of physical size
  2. Very sore joints in your lower body that limit how much you can do
  3. Comorbidities that make exercise difficult
  4. Depression that makes it hard to motivate getting up and out to do the exercise
  5. Finding clothes to exercise in
  6. Finding an exercise to do that won't cause further physical problems

Exercises that can help pre-op

  1. Walking: start with a small amount of time, 30 minutes a day can be divided into 3x10 minutes if that is your limit. Wear comfortable loose clothing and supportive shoes. The shoes don't have to be expensive as long as they support well. This can be done outside or on a treadmill inside. Speed can increase as you find it easier to do and you can include inclines to add extra effort. I used this as a way to learn what my local area was like. It was lovely.
  2. Swimming: this supports the majority of your weight and has the added benefit of the resistance of the water to push through. It includes water exercises for range of movement, water walking and aqua jogging etc. You do find that when you get out of the pool you feel heavy for a while. I liked to walk and swim laps as I felt longer and looser afterwards. I could lose 20 kgs each summer. It is hard to see bodies through water so you don't have to be self conscious. Check with the Pool if you can swim in something other than a swim suit if you are currently unable to find one in your size. Some pools open earlier or stay open later for certain groups. Ask them about it.
  3. Cycling: using a recumbent cycle is easier on the body than the ordinary cycle. The seat is larger making it easier to sit on and you extend your legs forward instead of up and down. This means you are likely to cycle for longer and get better results from it.

Things to keep in mind

  1. Personal safety. Forget those headphones as you can't hear what is happening around you. Be aware of people, animals, cars and other moving objects. Stay in the now when you are outside. Enjoy the weather, the trees, the flowers, saying hi to fellow walkers, the clouds in the sky, the feathers you find and anything else you enjoy looking at. I have harvested crabapples (for jelly) and picked up litter to make the area I live in a better place. Carry a personal alarm, safety feature in you hand (keys) or a phone to call for help if you are worried at all.
  2. The downers. Those slobs that go past in their grotty car and call out derogatory remarks. They have no right to and it can cause further depression if you take it onboard. I usually catch up to them at the next lights. "I may be fat but you are ugly and I can diet" is a phrase I use to good effect. Gestures can get you into trouble with some idiots so be careful with those. Be proud. You are actively working on reducing your size, they are not. Kudos to you. Idiot Award to them.
  3. Don't push too hard. If you do too much your body will let you know. It makes it harder to get out there the next day and do something to get closer to your goal. Do use enough energy to help lose that weight and/or get fitter.
  4. Write down what you have done. There are many food/exercise diaries out there now. Even a school notebook that you rule up is useful. It shows you what form of exercise, how much, time taken, amount of repetitions, weights used or anything else you want to note. It helps you to decide when you have to up the intensity or even add new forms of exercise.
  5. Decide on your goals you want to reach. When those goals are reached, celebrate. Set your next set of goals. Onward and upwards (or in our case, downward in weight)

Post Surgery exercise needs

Diet is very important post surgery but for quite a while the surgery keeps what you eat to the forefront. Eat too much or the wrong sort of food and you will either be sick or experience "dumping". You mostly need a high protein, low carbs diet that has enough fruit and vegetables to keep your body healthy. Supplements are needed by most people for the vitamins and minerals but that is fairly normal. Drinking enough water is something you learn to do. That water bottle is never far from your hand. Sip, sip and sip all day. Keep it up during your exercise. I find I automatically drink more when exercising. Weight loss support groups, whether online or physical, help to keep you on course. They are places to talk out feelings and problems. You get solutions and support from them. Exercise completes the triad that helps you lose the weight and keep it off.

Importantly at the start of your WLS exercise regime be guided by your doctor on when to start exercising, how much and what form of exercise as you don't want any problems with the operation site.

Reasons for post-op exercise

  1. Those who exercise regularly helps you lose more weight (can be 4.2% lower BMI)
  2. 2.5 hrs of moderately intense exercise means more actual weight loss compared to those who haven't done the same.
  3. It can give you more than 5% extra weight loss in 6/12 months
  4. Sticking to an exercise program usually means you are sticking to the diet as well. You are making your new body a priority.
  5. I find it helps to define muscles more and some of the skin will appear to be less (always good)
  6. Exercise has been proven to improve the mood.
  7. Exercise can help your mobility improve.
  8. Your metabolic rate stays higher than it would have. Your body thinks you are starving so it lowers the metabolic rate to conserve your body reserves. This makes it difficult for you to lose weight.
August 2013
February 2016 _slight weight gain back to 103 from 99 kgs

 Physical results in your body due to exercise

  • Longer life span
  • Less abdominal fat which leads to less risk of heart disease
  • Lower blood pressure so less heart/stroke risk
  • Triglycerides improve; less bad cholesterol, more good cholesterol
  • Better insulin control/improved or no diabetes
  • Lower risk of cancers in its many forms
  • Improved balance so less risk of injury (very good if you are older)
  • Muscles,bones,heart and lungs are stronger so you are fitter
  • More bounce (vitality) in your step

Mental results due to exercise

  • Improvement in mood. I think if doctors prescribed 90 minutes of good frequent exercise to their patients that the need for antidepressants would drop
  • Improved appearance as you become taut, trim and terrific
  • Mental acuity improves so it is easier to complete that crossword etc
  • For the guys and gals; improved libido (yay, a sex life again, hehe)
  • I get through my housework faster after I have been to the gym

Things to think of

  • Start slowly and work up carefully. You are relearning your body in a new way
  • Wear supportive clothing so you don't create problems
  • Drink plenty of water while exercising
  • Wear good supportive footwear. It doesn't have to be expensive it just needs to hold your foot in a good position, inserts may help here.
  • Warm up and cool down with exercise. A cold muscle may tear more easily. I briskly walk to my gym then do the recumbent bike as my first exercise. A brisk walk home is my cool down.
  • When aerobically exercising your heart rate needs to be between 50-85% of the Maximum for your age - this is easily found on the Net.
  • If it is painful, stop! No, that doesn't mean the ache at the end of your rep, it means pain. 

So what forms of exercise are good for post-op WLS people

You want the exercise you do to fill three needs: endurance, flexibility and strength. These may have waned when you were bigger and it is time to treat your body as a temple; not a waste disposal unit. You have worked on how much you can eat and what sort of food helps you feel fit. You are working on why you want to eat and this can be on-going after your operation. Now the third part of doing the best for your body is to get it physically fit. Exercise in its many forms is a way to meet this need.

Walking (Endurance)is the first form of exercise that doctors encourage you to do. Even 10 minutes/3 times a day helps. Each day you should try to get just a bit further. The best way to know how much you are doing is to get a Pedometer or today's gadget; a FitBit or others similar. Write down or record in some way just how much you have done. This gives you something to improve on tomorrow but you can look back at other days and see how far you have improved. 30, 300, 3000, 10,000+ steps; it is a positive result you can celebrate. When it gets too easy add hills or steps to climb up/down. Attempt that hill walk you never thought you could do. Enter a 5 or 10 km walk; finish it. Why? Because you can. The progression from there is a stationary bike or something similar.

And you can take time out together

Yoga (Flexibility) This is to get those joints moving freely again. Start in a beginners class and, as you improve, progress in the forms you do. There are classes, videos, downloads and YouTube videos that you can follow. You might want to check out something like Tai Chi. You might just do the stretches on the wall-chart in the gym. To get you body moving freely through the full range of movements you may even need to use other health professionals to get you going at the start. Use them.

Big and flexible -high aims

Oh, to be so flexible

Weights (Strengthening) You can do these at home or at the gym. Many forms of weights are available for limited cost. Start light, between 1-5 lbs, and work up as your strength grows. Gyms have machines that assist you as well as free weights. Lower weights and more repetitions improve your muscles but still keep you trim. Most males want bulging muscles so they use higher weights and less reps. Whatever you desire to look like is up to you. Do get formal help with higher weights as you can cause injuries if you do them incorrectly. An added benefit is they strengthen bones and stave off osteoporosis which is a possible side effect of WLS. Exercise balsl help with core strength and there are other exercises you can do using them that improve your body strength.

Start small
Aim high

Swimming (Strength, flexibility and endurance) The best all round form of exercise is in the pool. You can go swimming for as long and what ever style you are comfortable with. You can walk the pool lengths and you can do flexibility exercises holding on to the edge of the pool. This can be done pre/post-op with good effect. You are supported by the water and you have to push against it. Win/win for your body. You don't feel your full body weight in the water so you move more freely.

Leg exercises in water

Water exercising

Best things to help you keep exercising

Set and track your goals as it makes you happy to see improvements happening. This can be weighting your self regularly; taking your body measurements afterwards so you see changes happening. Sometimes your measurements go down and the scales don't. Having a partner that works along with you can help get you out there on the days your mind doesn't want you to do it. Fit-bits mean you can have a digital partner if the physical one is too difficult. They encourage you to better your own targets too. Try different forms of exercise or different places. Mix it up and you won't get bored. Your body can get used to doing the same thing and it doesn't get as much result from it. So use the gym today, go for a swim tomorrow, climb Mt Kilimanjaro, do something different. Do something you have always wanted to do and never thought you could. and  are two big girls that prove anyone can be a yoga body.

Be consistent with when and where you exercise as your body gets used to it and makes you feel antsy when you don't do it. Share what you are doing with other because you know they are going to check up and you want to be able to say "yes,I did". Don't push yourself but do progress each time. Injuries will stop you otherwise. Gyms are useful as they have equipment you can't afford and trainers to make sure you use it right.

At home you can do your exercise routine outside in good weather. If not, then have one particular space inside where you exercise every time. Have what you need stored there. Set a definite time to do it then carry through. There are DVDs, online resources and cheap equipment out there. Use it. Be the best you can be for you. 

Gym at least 3-5 times a week for me; back there tomorrow. How often do you exercise and what sort do you do?