Exercise is one of the most essential parts of any successful bariatric programme. Exercise is required as part of the pre operative preparation of bariatric surgery and also helps in post operative recovery and long term weight loss.
Before undergoing bariatric surgery, the doctor generally advises the patients to go for long walks to improve cardiovascular fitness and do some deep breathing exercises to increase lung capacity. Some patients may be advised to get a spirometer and do breathing exercises for 1-2 weeks before their procedure especially if their lung capacity is compromised. These would help to increase the overall safety of the procedure and reduce the risk of lung related complications.
Immediately after surgery, doctors generally advise the patients to ambulate early. This means going to the wash room on their own and getting up from their bed to and walking about in the room. This is followed in the early post operative period while the patients are still admitted in the hospital. Once they are discharged, they can do all their routine activities within a matter of 5-7 days after their surgery. They should go for 10-15 minute walk daily and complete around 3000 steps/day in the first 15 days of their procedure. After their first post operative visit, the doctor checks their wounds and removes the external stitches. Following this, the duration and level of physical activity can be increased gradually. Patients should start light aerobic exercises including some stretches and floor exercises at this point to limber up their body. Walking is increased to minimum 30 minutes and aim for 5000-7000 steps daily.
After a period of one month post surgery, the patients complete their second post operative visit to the doctor and are advised a more robust exercise plan. They have started their solid diet now and advised to take high protein and build up more muscle. This is possible with weight training. People who have never trained before are encouraged to start with body weight exercises and less number of repetitions to avoid injury or over straining. Once they get the proper form and strength, light dumbbells or any other weighted objects can used to strengthen the arms and shoulders. Resistance bands are also are very helpful way for exercising both the upper and lower limbs and do not require any other specialised equipment. Cardio training should be continued along with weight training to keep metabolic rate high and encourage fat burning. Patient should aim to complete 10000 steps per day to achieve the proper metabolic rate.
Core exercises should be started in the third month after bariatric surgery to strengthen the abdominal muscles. This would help to prevent the sagging of skin in the lower abdomen that usually accompanies the rapid weight loss in the initial few months. Core exercises along with regular massages and stretches will keep loose skin to a minimum and avoid the need for a cosmetic procedure later on. Strengthening the core muscles also decreases the risk of post operative hernia formation.
After a period of 3-4 months, the exercise routine needs to be continued regularly with careful weight charting. The exercise should become a habit and a necessity and not be taken as a burden. It is important to enjoy your routine and keep on bringing some novelty into it to avoid boredom. Sports, adventure clubs, biking, mountain climbing, swimming, etc are excellent ways to burn calories and have fun at the same time. The focus should shift from recreational activities that involve consuming more calories to those involving burning them.
Pre surgery – Walking and breathing exercise.
First week – 10-15 minute walk daily.
First month – 30 minutes walk daily, stretching and joint movements.
Second month – 40 minutes walk daily, Begin weight training and resistance exercises.
Third month – Start core exercises with stretching.
Six months onwards – Do all exercises plus group outdoor adventure and sporting activities.