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Exercise

Your healthcare provider will want you to commit to an exercise plan before surgery. After surgery, you will be expected to exercise as part of the weight-loss process. According to the Ronald K. Evans study on Surgery for Obesity and Related Diseases, statistics show that bariatric surgery patients who perform moderate physical activity five days a week for 30 minutes had significantly more weight loss than those who didn't perform physical activity.

In addition to aiding in weight loss, exercise can:

  • Reduce the risk of dying prematurely from heart disease or other co-morbidities.
  • Reduce the risk of developing diabetes, high blood pressure, and colon cancer.
  • Reduce blood pressure in people who already have high blood pressure.
  • Build and maintain healthy bones, muscles and joints.
  • Reduce feelings of depression and anxiety.

Getting Started with Exercise

Walking

Walking is the first exercise for bariatric surgery patients, and an easy way to get moving! Walking as exercise can be started before and after surgery. In fact, nurses at St. Claire Regional will encourage you to get walking as soon as possible to aid in the healing process. An exercise regimen featuring walking can be followed year-round, outside when the weather is nice, and at the gym or indoors when the weather isn't so great.

Walking tips to help you control your weight after bariatric surgery:

  • Start by walking on a flat surface and gradually add hills or slopes as you get stronger.
  • Start with small distances and gradually increase the distance or amount of time you walk.
  • Alternate your walking routes to help keep you from getting bored with your walking program.
  • It may help to walk with a family member or friend to stay motivated.
  • Walk only where you feel safe.
  • If you can, invest in a good pair of walking shoes.
  • A great way to see activity progress is to use a pedometer.
  • You can use a variety of GPS applications, like Google Maps, to map out a route and check distances.
  • Take a bottle of water with you on longer walks. Sip water at intervals, especially if you walk outside on hot days.

Aerobic Exercise

Aerobic exercise can also be a great way to help transform your life after your bariatric surgery. Before beginning an aerobic exercise, either before or after surgery, it is very important that you check with your healthcare provider.

  • The best form of aerobic exercise is one that you will enjoy. It is difficult to stick with an exercise program if you dread it!
  • A variety of aerobic activities can keep you from becoming bored with your exercise program. Try doing different activities on different days.
  • Swimming and water aerobics are good forms of exercise, especially if you have joint problems or joint pain.
  • If you want to take an aerobic class, always start with a low-impact class geared for beginners. Examples include swimming, seated exercise, biking (elliptical and recumbent), rowing and Zumba Gold.
  • Research has shown that increasing lifestyle activities can have the same effect on health and weight loss as a structured exercise program.

It's easy to work more exercise into your everyday life. Small choices made to benefit your health can add up quickly. Some examples include:

  • Taking the stairs instead of the elevator.
  • Parking at the far end of the parking lot and walking to the office or store.
  • Mowing the lawn and raking leaves.
  • Getting up from your desk to deliver a message instead of using email.
  • Walking to do errands instead of driving.

Strength Training

Strength training may include the use of weight machines, "free" weights (hand-held weights) and resistance bands. Strength training is not recommended for the first 3 to 4 weeks after your surgery. As with all exercise programs, it is very important to check with your healthcare provider before starting a strength training program. Here are some quick tips to help you in your strength training:

  • It is very important to use correct form when doing strength training. This will help to prevent injuries.
  • When starting a strength training program, it may be helpful to take a class or hire a personal trainer. The instructor or trainer will show you the correct way to use the equipment.
  • Strength training workouts should always be preceded by a 10- to 15-minute warmup (such as walking, using the treadmill or riding an exercise bike). This will raise the core body temperature and ready the joints and muscles for the workout.
  • To begin, use light weights (a set of 1 to 5 pound dumbbells is a good starting place).

Goals

By the time you reach your six-week post-op appointment, you should be able to complete 30 minutes of walking per day. After six weeks, it may be time to begin a more intensive exercise routine, including aerobic, strengthening and flexibility exercises. Patients sometimes complain about having losing motivation or sight of their goals. Try to stay motivated by practicing the following tips:

  • Begin your exercise program gradually and progress slowly over time.
  • Vary workouts to alleviate boredom.
  • Develop specific, realistic and achievable goals.
  • Anticipate obstacles—have a backup plan.
  • Keep your walking shoes or exercise clothes in the car.
  • Share your progress with others.
  • Work-out with a partner.

Nutrition

The main purpose of bariatric (weight-loss) surgery is to help you reduce the amount of food you are able to eat by decreasing the size of your stomach. However, it doesn't guarantee successful long-term weight reduction; it is simply a tool to help you reach and maintain a healthy body weight. Achieving optimal and permanent weight loss requires commitment to changing old behaviors into healthy lifelong habits!

Listed below are some guidelines that can help you be successful with weight management after your procedure:

Protein First!

Protein deficiency can cause issues such as hair loss, skin problems, swelling, muscle wasting, weakness, poor healing, impaired immunity and increased risk of infection. Since you will not be able to eat much, it is important to eat your high protein foods first. Concentrate on lean meat, dried beans, fat free dairy products, tofu, eggs or egg substitutes. The general recommendation is to consume 60 to 80 grams of protein a day. Even after you are back to eating regular foods, you may not be able to eat this much, so a protein shake or powder will help you reach this goal.

Hydration is Key

You will need 50 to 64 ounces of fluid each day to avoid dehydration. About half of this should be plain water; the other half may be clear liquids or may have a protein supplement added. Each morning, fill a container with your daily water regimen. Then, keep a cup with you and sip all day long, spreading your fluid intake out evenly throughout the day. This will help you drink the needed amount without overfilling your stomach. (Sip, don't gulp! Drinking large amounts of liquid quickly may cause nausea and vomiting.)

Nutritious Food—Smaller Portions

It is important pre- and post-bariatric surgery to build healthier eating habits. Before surgery, you should begin education to prepare you for your post-op journey and start making changes in your food choices. After your operation, you will only be able to eat small amounts, which will help you lose weight. But it is extremely important to fill the limited space with foods your body needs to be well-nourished and healthy! Otherwise, you may develop nutritional deficiencies that may have a negative impact on your health. Over time, you will be able to eat more and it is possible to stretch your small stomach so that you overeat again—life-long portion control is a must. Work with your dietitian to learn more about portion sizes and how to choose and prepare healthier foods!

Avoid Junk Food

Junk food and overly processed foods usually digest quickly and don't keep you satisfied for long. Generally, junk food is not very nutritious, as it may contain a lot of fat, sugar and calories. These "empty calories" can add up quickly, causing weight gain. To successfully lose weight and prevent weight gain, you must avoid these foods. That means no cakes, pies, pastries, cookies, doughnuts, muffins, candies, snack chips, fried or greasy foods, etc. Choose "real food," not processed, food-like substances.

Cook but Don't Fry

Dining out and eating pre-packaged foods makes eating healthily very difficult. Purchase less processed ingredients and prepare your own foods. Think about your knowledge of cooking techniques. If you tend to fry most foods, it's time to explore other ways to cook! If you tend to season everything with fats, like oil, margarine, grease, creamy sauces and gravies, it's time for some new recipes. Keep an open mind. You may be making big changes, and it takes time. If you don't like something the first time, keep trying it!

You Must Eat Vegetables!

Non-starchy vegetables are nutrition powerhouses! They provide lots of nutrients that make us healthy, have very few calories, provide fiber and fill you up—not out. Half of your plate should be covered with non-starchy, low-fat vegetables. This is nonnegotiable!

Rethink Your Drink

Sweetened beverages are a source of large amounts of unnecessary calories, and usually add little to no nutritional value. Avoid carbonated soft drinks; sweetened, caffeinated or alcoholic beverages; sports drinks; and juices. Water is always the best beverage choice!

Practice Portion Control

Even if you eat healthy foods, you can consume too many calories if you eat large portions. Learn the appropriate portion of various types of foods and measure out those portions accordingly. (Try using our handy portion control infographic for help!) You may have learned to take larger portions from your family members, from dining out or elsewhere, but now is the time to re-evaluate what you think is an appropriate amount to eat. Over time, this will become your new norm. Pre-portion foods, use a small plate, and remember: It's OK to leave food on your plate if you get full!

Recommended Vitamin Supplements

Vitamin and mineral deficiencies have been observed in patients after weight-loss surgery. Iron, folate, vitamin B12, calcium and zinc are most affected after gastric sleeve surgery. View a complete list of our recommended vitamin supplements below. They are available over the counter at your local pharmacy. If you have difficulty locating or tolerating any of the supplements, call your dietitian or surgeon for suggestions.

Multivitamin (MVI) and Mineral Supplement

  • Buy only a complete adult multivitamin/mineral supplement with iron.
  • The number you need to take each day depends on the individual product. Aim for about 200 percent RDA for iron (36 mg), folic acid (800 mcg) and thiamine (3 mg), and 2 mg of copper. It is best if MVI also contains selenium and zinc.
  • If you decide to switch to a pill form after six months, soft gels or capsules may be better absorbed than tablets.
  • Do not take MVI in gummy form. Gummies do not usually have all the vitamins and minerals you need.
  • If you need to take more than one dose, it may improve absorption to take them at different times of day.

Vitamin B12

  • Take 500 to 1,000 mcg sublingual (under your tongue) tablet or liquid once a day.
  • Do not buy time release.
  • You can take vitamin B12 once a day. You do not need to spread out the doses.

Vitamin D3

  • Take 3,000 IU (International Units) of vitamin D3 per day.
  • Chewable and liquid D3 vitamins are best absorbed. If you switch to a pill form after six months, soft gels or capsules may be better absorbed than tablets.
  • You can take vitamin D3 once a day. You do not need to spread out the doses.

Calcium Citrate (with vitamin D)

  • Take 500 to 600 mg of calcium three times per day to equal at least 1,500 mg per day.
  • Spread doses out throughout the day to improve absorption.
  • Do not take calcium supplements at the same time as your other vitamins. Calcium and iron (in the multivitamin) compete for absorption sites. It is best to take your multivitamin with iron 2 hours apart from your calcium supplement.
  • Chewable and liquid calcium supplements are best absorbed.
  • Do not use gummy calcium supplements. Chewy supplements are acceptable, but gummies do not usually contain calcium citrate and are not the best absorbed.
  • Choose calcium citrate. Avoid calcium carbonate, calcium triphosphate, oyster shell, bone meal, etc.