Bariatric surgery and exercise

Physical activity is defined as movement of one’s body produced by the contraction of skeletal muscle which increases energy used above the basal level of activity (household, transportation, occupational and leisure time). It is measured in metabolic equivalents (MET). The resting metabolic rate or 1 MET is the basal oxygen consumption at rest and is 3.5 mL of O2/kg/min.

Exercise is defined as a form of physical activity that is planned, repetitive, purposeful and structured. The main objective is improvement or maintenance of one or more components of physical fitness. Normal daily activities, such as walking at work, are not exercise.

Physical fitness is defined as the ability to carry out daily tasks with vigor and alertness, without undue fatigue, and with ample energy to enjoy leisure-time pursuits and meet unforeseen emergencies.

If one wants to maintain current weight, the goal for diet and exercise is to balance calories in and calories used. To lose weight, one would want to burn more calories compared to those eaten. To lose 1 pound, one would need to eliminate 3,500 calories. Bariatric surgery aids in weight loss by allowing patients to restrict calories from their food. The ultimate goal is to make patients healthier, improve their energy and achieve remission of their medical problems.

Physical inactivity is a major problem worldwide. Our technologies enable us to be more sedentary, which results in lower use of the calories eaten and weight gain. More than half of our hours awake are spent sedentary. A sedentary lifestyle leads to poor health outcomes and accounts for over 5 million worldwide premature deaths annually. For a sedentary person, only 15 minutes of daily walking will result in a 14% reduction in all-cause mortality and increase life expectancy by three years. The more physically active one is, the less likely one is to die prematurely.

Unfortunately, in the U.S., about one-fourth of adults do not engage in physical activity, and only 50% of people perform the recommended amount of exercise. Doctors do not routinely screen patients for physical inactivity or provide adequate counseling. Studies show that less than one-third of patients reported receiving physical activity advice from a primary care physician (an internist or family medicine physician).

Exercise leads to a healthier heart and weight. Exercise also improves blood pressure, glucose control and cholesterol levels. Exercise thus results in a better quality of life. Bariatric surgery with exercise allows those with morbid obesity to do this to a greater degree. A 10% increase in activity can avert half a million deaths annually.

Sometimes people are scared to start an exercise regimen for fear of embarrassment or injury. The most common injury that occurs with exercise is muscle strain, which can be avoided by having a warm up and cool down that includes stretching. Here in the South, it is also essential to stay hydrated in the summer heat. If you have severe cardiac disease or an active infection, you should consult your doctor before beginning an exercise regimen. It is important to wear appropriate attire when exercising. If you are going to run, running shoes are appropriate. If you are going to do a dance fitness class, you should have on dance sneakers, not running shoes. Also, if you are going to be outside in the winter, you should wear warmer clothing.

There are many different types of exercise. Resistance or strength training involves weights and repetition of movements. It helps to build and maintain muscle mass. Stretching adds in flexibility and helps prevent injury. Cardiovascular exercise or endurance training involves more intense activity. Moderate intensity uses 3 to 6 MET and vigorous intensity uses more than 6 MET. That means you are using more than triple the oxygen you use at rest. High-intensity interval training involves varying your intensity throughout an exercise, including short bursts of high intensity.

The American Heart Association recommends endurance training three to five times per week for 30-60 minutes. Resistance should be done two to three times perweek for 20-30 minutes. It can be overwhelming trying to figure out where to begin an exercise regimen. There are many types of exercise, and the key is to find something you enjoy. Any exercise will provide you with the benefits previously stated. There are group fitness classes, sports, water-based activities, weight training and many classes that incorporate both endurance and resistance. You want to start slow and work your way up. Everyone is different in how quickly they can progress and advance activity.

It is OK to break up the exercise if you can only do minutes at a time. It will build your endurance, and you can increase duration as exercise becomes easier. The hardest thing about starting an exercise routine is to make it a routine. Set a reminder on your phone until it is a habit. When starting, try to have a 10% increase in activity each week. Remember, for the sedentary person, even a short duration of modest increase in physical activity has health benefits. If you have limited mobility, as many bariatric patients do, water-based aerobics and strength training will aid the most and help prevent injury.

If you choose to do a group fitness class, remember to go at your own pace. Don’t try to keep up with the instructor or others in the class. Get a heart rate monitor and try to achieve your target heart rate. There are apps for your phone that can tell you what your target heart rate is.If you’d like an exercise workout you can do at home, check out Prisma Health’ss MoveWell program, where you can find monthly workout videos that are easy to do at home. As you become more active, you will need to increase your intensity to continue to reach that target heart rate and get the same benefits.

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