Exercise and Fitness Forum

You have heard over and over again that exercise constitutes a very important aspect of post weight loss surgery life. This is no mystery! The real mystery often presents itself when you consider the “whats,? “whys? and “hows? of your exercise program. What should my heart rate be? Why must I exercise for certain duration's and at levels of intensity? How quickly should I progress? Obtaining the proper answers to questions such as these is vital to the success of your exercise program.

The contents of this article will provide you with the tools you need to design and safely execute an effective cardiorespiratory (CR) training program. Take these recommendations and apply them to your exercise regimen. Employ exercise as a weapon in the fight against obesity, ensuring your long-term success after bariatric surgery. It has been proven that regular exercise is associated with successful long-term weight loss maintenance.¹ Get ready, grab a calculator, pen and paper; you are about to receive a lot of great information in a short amount of time. But most of all—enjoy!

Heart Rates and Exercise Intensity

CR training is analogous to endurance or cardiovascular exercise. There are three stages of CR exercise conditioning: the initial conditioning, improvement and maintenance stages. For optimum results, each stage consists of specific exercise intensities, durations, and frequencies.

Becoming familiar with the manner in which exercise intensity is determined is a great place to begin. Heart rate reserve (HRR) is an excellent reference for exercise intensity. Calculating your HRR is quite simple. Using the equations provided in Table 1, first calculate your estimated maximum heart rate (MHR). Keep in mind that all heart rates (HR) are expressed in beats per minute (BPM). After figuring your MHR, take your pulse for 60 seconds while at rest. This will be your resting heart rate (RHR). Input your MHR and RHR into the proper equations. 

As you will soon realize, it will also be very valuable to know the various percentages of your HRR. Finding percentages of your HRR is also fairly easy. The basic equation can be found in Table 2. You will also find several desired percentages of HRR and instructions about how to insert them into the equation.

Your desired HR for an exercise session is also known as your target heart rate (THR). For the purposes of this article, percentages of your HRR will be in the range of 40-85%. So, before moving on, take the time to calculate your HRR and percentages of your HRR ranging from 40-85% in 5% increments. This will help you have an understanding of your THR at various exercise intensities, soon to be discussed.

The CR Stages

All of the conditioning stages include a warm up, exercise period, and cool down. The warm up should include your choice of low-intensity exercise for 10 minutes at 40% of your HRR. The cool down should be similar to the warm up, but stretching should also be included. The warm up and cool down for each stage of conditioning can remain the same and should not be included in total exercise time. Table 3 provides an outline of the progression you should utilize through each conditioning stage.

Ok ,don't like math too much? Use the heart rate reserve calculator below.

Initial Stage

The initial stage of a CR training program is used to develop a baseline level of fitness. Muscle soreness and discomfort should be kept to a minimum. Remember, exercise needs to be an enjoyable experience. If you are so sore you can’t get out of bed in the morning, the chance of you adhering to your exercise program is reduced.

The duration of the initial stage is normally 1-6 weeks. Much of this will depend on your ability to adapt to the exercise program and the recommendation made by your doctor in regards to exercise. The type of procedure you have had and recommendations made by your surgeon will establish when you are able to participate in vigorous activity. Generally speaking, this can be anywhere from less than 1 week to as many as 6 weeks post-surgery. Exercise intensities associated with the initial stage are not considered vigorous and should not violate your surgeon’s recommendations.

Initial stage exercise intensity will range from 40-60% of your HRR. The duration of each exercise session should last 15-30 minutes. A frequency of 3-5 days a week is suggested. Keep in mind that duration is more important than intensity. Do not become overly anxious to increase exercise intensity; follow the guidelines and you will get there soon enough.

During the initial stage, it may be advantageous for you to choose low impact exercise such as stationary cycling, swimming, rowing or elliptical training; walking is also encouraged.

Improvement Stage

The improvement stage will last from 4-8 months. Your THR for this stage will range from 60-85% of your HRR. Exercise duration may be increased incrementally by no more than 20% on a weekly basis. Once a goal of 30 minutes at 70% of HRR is met, an increase of no more than a 5% of your HRR may be applied to your THR every 6 exercise sessions. You should experience significant weight loss during the improvement stage due to WLS. As a result, a high level of satisfaction, motivation and the ability to participate in higher impact exercise, such as jogging or running, will often occur in the middle to later phases of this stage. If you have orthopedic limitations, you may need to avoid these higher impact exercises.

Maintenance stage

 This stage represents a lifestyle and lifetime of exercise and fitness. You can maintain or build upon the level of fitness you have worked hard to develop thus far. Take advantage of this time in your life; continue to cultivate a love for an active and healthy lifestyle.² Although these recommendations suggest exercise 3-5 days a week, exercise or other physical activities should be done on most if not all days of the week.

Recognize the importance of goal setting. Before you go taking off to hit the treadmill, give yourself something to look forward to; something real, something attainable, something satisfying. If, in 3 months from now, you would like to be able to do gentle hiking in the mountains with your children or grandchildren, you would be seeking a reasonable, realistic, and gratifying goal. However, deciding to run a marathon in a month would be unreasonable. Goals easily become stumbling blocks if they are not set reasonably. Be aware of your limitations and abilities. Follow the guidelines that have been set forth, allow your level of fitness the necessary time to progress, and you will achieve your goals.

Not only does CR exercise assist in weight loss, but the health and functional benefits it provides are well worth the effort. Frequent participation in a structured exercise program is a direct reflection of your commitment to your health, fitness and long-term weight loss goals following WLS. But you don’t have to be post-op to start putting this into action. If you are reading this and know you are going to undergo WLS, take action now! The same goes for those of you who have had WLS and remain sedentary. These guidelines apply to everyone. Use these tools, apply them properly, and build a better you!

 
References

1. Perri MG, Foreyt JP. Preventing Weight Regain after Weight Loss. In: Bray GA, Bouchard C. Handbook of Obesity: Clinical Applications. New York: Marcel Dekker Inc. 2004: 192.