Why Is Exercise Important After Bariatric Surgery?

Most likely, you have already heard that bariatric surgery is just a “tool”. You must make lifestyle changes in order to have results that will last you a lifetime. One of these lifestyle changes is physical activity.
Despite the proven benefits of physical activity, more than 50% of American adults do not get enough physical activity to provide health benefits. 25% of adults are not active at all in their leisure time.
Insufficient physical activity is not limited to adults. The CDC reports that more than a third of young people in grades 9–12 do not regularly engage in vigorous-intensity physical activity. Daily participation in high school physical education classes dropped from 42% in 1991 to 32% in 2001.
Just knowing that physical activity is good for us doesn't mean that we'll easily be able to make it part of our daily routines—it's sometimes difficult to adopt new habits. But it's important to remember that you can start out slowly and work your way up to a higher level of activity.
Physical activity or exercise is highly recommended as an essential component of the intervention plan to promote weight loss. The American Dietetic Association notes that not only does physical activity contribute to weight loss by altering energy balance, but also favorably affects body composition, risk for disease, mood and quality of life. Regular physical activity also appears to be one of the best predictors of successful weight maintenance. Therefore, the importance of physical activity in the role of weight management and overall health cannot be overlooked.
The only way to maintain weight loss is with the addition of regular physical activity.
1-Physically, exercise enhances weight loss while mitigating the loss of muscle mass associated with low-calorie consumption during the initial post-operative rapid weight-loss phase.
2-Exercise also assists in maintenance once weight stabilizes.
3-Exercise promotes bone strength and joint stability.
4-Keeps muscles toned and flexible.
5-Boosts the immune system.
6-Aids in skin elasticity and keeps the body functional for activities of daily living.
7-Regular exercise elevates mood, enhances self-esteem and confidence, reduces stress and anxiety and provides a sense of overall health and well-being.
8-Exercise provides a constant reminder of how your body has changed since surgery, how much more functional and capable you are and how much better you feel!
Many of you may have never exercised regularly or may have not done so in a long time. The activity habit will be one of the most difficult to learn and maintain. But once it becomes habitual, you are actually going to feel bad the days you are not able to exercise.

Pre-Operative Exercise
The goal of pre-operative exercise is to prepare you for an easier recovery from surgery and to start developing lifestyle changes. You should discuss with your primary care physician your decision to start an exercise program prior to surgery. This is important due to health history, medications and orthopedic issues. Take the time to educate yourself on how the medications you currently take can affect your ability to exercise and what precautions you need to take. And don’t be afraid that exercising may lead to weight loss, making it difficult for you to get approval for surgery from your insurance company. The goal is to lose weight and be healthier. The sooner you start the better off you will be.

First Month Out
During the first month after bariatric surgery, calorie intake is at its lowest therefore energy level is very low. Swelling from surgery may make it difficult to drink liquids, so dehydration easily becomes a problem. During this time, medications may be adjusted as well and, in some cases, discontinued within a few days of surgery.
The best exercise at this time is walking. You are going to be up and ambulating the halls of the hospital soon after your surgery. Once you go home, frequency will be as much and as often as tolerated, since movement helps the recovery and healing process while decreasing the risk of pulmonary embolism / blood clots.
Walking is usually the first form of exercise prescribed. It can help to take walks three or more times per day for at least 5 to 10 minutes, increasing the length of each walk as tolerated.
Strength training and sit-ups are contraindicated at this time, since it will increase your changes of developing hernias. No other forms of physical activity should be undertaken until approved by your surgeon, regardless of your fitness level prior to surgery.

Months 1-3
Your diet will vary by program during this early phase, but calorie intake overall is still minimal. The amount of food consumed varies greatly based on the diet protocol provided by your program, your tolerance to different foods, and your healing rate. At this point, your primary concern should be fluid and protein consumption. As expected, energy levels at this time may still be extremely low. This is the period of maximum weight loss.
By the end of this 3-month period, your energy level will start increasing again. This is mainly due to your increasing activity level, which becomes increasingly easier as weight is reduced. Depending on your physical activity level, your physician will authorize physical activity level beyond walking. Water exercise is most commonly prescribed, as the joint load is minimal and movement is easier in water. As tolerated, additional forms of aerobic activity can be added, including recumbent cycling and beginner-level (light-intensity) low-impact aerobics.

Months 4-6
Calorie intake during the 4-6 months following bariatric surgery ranges from 400-800 calories per day, depending on the type of procedure. Foods are added to the diet as per diet protocol and as tolerated. The maximal weight-loss period has passed, but this stage will continue to yield rapid weight loss for most of you, especially if you follow dietary guidelines and exercise consistently. This is the period when energy peaks and motivation is high, and physical hunger is almost nonexistent.
During this early stage, beginners should be set up on a program of strength training with light resistance a few times per week. Intermediate exercisers should strength train with light resistance initially, progressing to moderate resistance around the sixth month. Established exercisers should start with light resistance but will quickly progress to moderate resistance during this stage.

Months 6-12
During months 6-12 calorie intake increases to more than 1000 calories per day and, depending on the individual (basal metabolic rate and activity level), will reach a stabilizing point between 1100 and 2000 calories per day after one year. Although it is possible to consume additional calories, by the end of the first year most patients have determined the amount of calories they need on a daily basis to maintain their body weight. Weight loss efforts beyond the one-year mark becomes “normal”, meaning you need to do the same things as any other person trying to lose weight. At this point, your gastric pouch will have increased in capacity and your hunger will have returned. For those with malabsorptive procedures, the malabsorption will have decreased.
Depending on the amount of weight loss, mid-impact and potentially high-impact exercise, such as jogging / running, may be appropriate. Choices should be based solely on your preference, so explore the many options you have as you experience the freedom of movement that comes from your newly smaller body.
After six months you should be able to strength train up to 3 times per week with moderate resistance. Some may progress to heavy resistance. Somewhere around this time your hunger will return, so use exercise to help suppress your appetite and act as reinforcement for healthy behaviors.

12+ Months
Maximum weight loss occurs 6-18 months following bariatric surgery. Most of you will reach a stable weight shortly before or after the 1-year mark. You will then begin the lifetime task of maintenance. Dietary adjustments and exercise habits must remain permanent for weight maintenance to be successful.