Muscle loss v Fat Loss: Get Thee To A Gym!

Hey Guys, I've just finished reading an interesting abstract of a study done by WLS surgeons suggesting that during the first 6 months after lapro-RNY surgery. Guess what, and I quote: "The losses in lean body mass [LBM] during the first 6
postoperative months following LRYGB are significant and
equal to the losses in fat mass. The majority of losses in
LBM during this period are derived from trunk muscles.
These changes require reassessment of our strategies to
prevent lean body mass loss postoperatively and require
readjustment of our exercise strategies to curb trunk muscle weight loss." So you recently post-op and pre-op guys might want to ask your docs about going to the gym ASAP, and of course ingesting lots of good protein. The rest of us no doubt benefit also from strength training along with all our other copius good habits. I got this info from a nifty link Dave in Japan posted earlier today (Friday). So let's hoist a few in thanks to Dave--a few barbells, that is! (I'd have included a link to Dave's post but am not sure how to it. )

I don't think I have any mucles in my trunk....maybe my heart.  But thanks for pointing that out Doug.  I have my "strength training for old farts" book ready to go, soon as the doctor says I can lift weights again.  Special thanks to Dave for finding this info for us! Bobby - "5 days to go!"

Hey Bobby, Hang on to that old farts exercise book; it can help you pop some great post-op FARTS. 5 days will fly by!

Wow, Doug!

I didn't even see that one in there. Not sure how I missed it. It does hold true, though. Although I have done a lot of deadlifts for the muscles in my back, I haven't done any abdominal work and my ab muscles are about 1/3 their original size. It does make for a slender waist, so maybe that's okay, but if I hadn't worked my back with the deadlifts (or other "safer" exercise of your choice), I'd probably be dealing with lower back pain.

Glad that abstract popped up!

Thanks, 

Dave

Hey Dave, I'm not surprised you didn't notice that one. I'm half blind from reading through the abstracts. They're pretty interesting. Even the ones I'm smart enough to know I don't quite understand. I don't know about my abs--still hiding under some, er, "tissue." But some of the exercises I do are tightening them up. I'm finally able to some real (man-style) pushups and the tightening of the entire old bod are helping. So are some of the flyes and other dumbell stuff. I concentrate on tightening the core. My most noticeable atrophy is my puny forearms and consequent puny grip--bird arms. I'm working on them, doing curls with thumbs and fingers on top of a barbell and doing flyes with weight plates so that I have to grip them almost at fingertips. We'll see how that works. Thanks again for the heads-up about the abstracts.

Hi Doug,

You know one type of exercise I forgot to recommend for the trunk is swimming (duh! I only used to swim 8 hours a week! How could I have overlooked that?). If people can't do trunk or leg exercises, then an excellent alternative is swimming to exhaustion at least two times a week. 

One precaution: I don't do any single stroke for more than 400 yards (meters) nonstop. I find that doing freestyle (crawl) or backstroke for more than that can cause shoulder problems. Also, continuing breast stroke for more than that might cause knee or hip problems. So, it's good to break them up, both for injury prevention and for balanced muscle development.

If I only have a half hour, what I'll do is:

Freestyle 400 + Breast 400 then Freestyle 400

If I have a little more time, then I'll add in Backstroke and Butterfly too.

Breast stroke gets the legs in ways that few other exercises can, while doing equal amounts of freestyle and backstroke (maybe 20 minutes of *actual* swimming on each) will provide a phenomenal workout for the trunk muscles.

I think what you have is the legs, kicking and the shoulders doing their reaching and pushing motion, so the trunk, which is stuck in between, has to stabilize and support all of this.

Don't know why I didn't think of this before.

Well, my swimming partner just called. He wants to swim one day early. So off to the pool!

Dvae

I'm not surprised we lose a lot of muscle; beyond the caloric restriction issue, we all know it simply takes much less muscle to carry around a body that weighs 50 pounds or so less, so effectively you are "working out" less every day (all else equal). But the numbers from the study were pretty staggering.  Huge muscle loss in the first 6 months, almost none in the following 6.  Particularly incredible were the drops in trunk muscle loss (7.5kg fat versus 14.4 kg lean in the first six months, 5.6 kg fat versus 0.4 kg lean in the second six months) while the arms and legs suffered comparably much less.  Given this dropoff is the average across numerous subjects, I think it's fair to assume that most of the muscle loss in the first six months actually occurred in the first few months for most people, and had crawled to a halt by the six month mark. When I used to weightlift, it was much easier to preserve muscle than to build it.  So my response to this study is, "how do I preserve the muscle they are suggesting I will otherwise lose?"  I had assumed my huge quads would suffer the most, and was accordingly planning on focusing on those the most.  But now I'm rethinking my plans.  Here's my proposed prescription for the "readjustment of our exercise strategies" that the study invited:
1. You have to start working out ASAP after surgery to stimulate the muscle before it disappears.  Even a few months later it's too late.

2. Particular emphasis should be put on the abs and back (and maybe chest) in the first six months after surgery, because they are the areas that otherwise will suffer the most.  Ex: weighted crunches, leg lifts, wide grip pulldowns, and rows.  Perhaps the best exercise to fight this trunk loss would be (NotDave will love this) DEADLIFTS.

3. After six months, you can safely shift more emphasis to arm and leg development, but still need to hit the trunk muscles to make sure you haven't just delayed the loss.  Also, continuing to stimulate these large muscle groups will help muscle throughout the body. Side thought: Perhaps the reason the legs show less muscle loss than I expected is that so many WLS patients begin walking/running/cycling after surgery, but don't do weight training.  So the quads and calves are already getting much more stimulation than any other muscle group. Thoughts, anyone?

I should add that this study wasn't specific to men, and therefore was probably 75%+ females.  That could explain the surprisingly low loss of trunk fat (7.5kg) compared to leg fat (7.8kg) and arm fat (2.5 kg) in the first six months.  (I assume the butt counts as leg).  But I think the muscle data is probably still instructive for what guys can expect. Hmm, can't do deadlifts on a bowflex.  I may have to get my freeweights back from my brother. And yet another thought: Most research I've seen suggests we shouldn't lose muscle this fast during weight loss as long as we get enough protein.  So doesn't this data strongly suggest that many people may not be getting nearly enough in the months after surgery, despite the fact it's already so emphasized by most doctors? 

Good point. The protein issue is a major one for RNYers. First, in the early weeks of post-op our pouches are swollen and hence capacity is pretty low. Add to this the issue of malabsorption and it is difficult to get in enough protein. You've hit on a good solution re strength building asap before surgery and then getting into some sort of core-building or maintaining routine as soon as possible post-op. I lifted weights right up to surgery and was able to get back into it (with light weights, of course) two weeks after I got home. I was weak and a one-hour workout clobbered me for the rest of day, but on balance I did not lose as much strength as I thought I might. And I pretty much lived on protein--still do for the most part.

Doug, Thanks for posting this information.  I need to ramp up my exercise routine to include trunk exercises.