Abstract
The number of of bariatric (weight loss) surgeries performed is increasing annually, however, the surgery doesn't facilitate the lifestyle changes necessary for long term weight loss. This column focuses on strength and conditioning training for post bariatric surgery patients and it's role in bodyweight management, improving health and fitness, managing excess skin, body image and quality of life.
Introduction
Nearly 70% of South African women and 31% of South African men ore overweight or obese, of greater concern, 13% of South African children are overweight or obese, double the global average. As a result of this worsening epidemic of obesity, many are turning to bariatric surgery in the hopes of achieving and sustaining a significant weight loss.
South Africa Bariatric Surgery market is expected to witness a Compound Annual Growth Rate (CAGR) of 4.38% during the forecast period, 2020 - 2025. The key contributors in the market growth are increasing burden of obese patients and associated chronic disorders. The changing lifestyle in the people of South Africa such as reduced physical activity, poor diet, high consumption of sugar, etc. are leading to overweight and associated diseases such as hypertension, cardiovascular diseases, diabetes, etc.
According to the International Diabetes Federation, 2020, around 4,581,200 people in South Africa are suffering from diabetes. Hence, these factors are expected to propel the market growth during the forecast period.
The 2 most common procedures are Roux-en-Y gastric bypass and adjustable gastric banding, commonly known as gastric bypass and lap band.
During gastric bypass surgery, a small upper stomach pouch is created. This pouch is connected to the middle portion of the small intestine, bypassing most of the stomach and parts of the small intestine. This procedure reduces food consumption and nutrient absorption.
During the lap band procedure, a hollow band is placed around the upper portion of the stomach to create a small pouch and a narrow passage into the larger, remaining portion of the stomach. The band is adjustable and reversible. This procedure reduces food consumption.
Post Bariatric Surgery Weight Loss Program
Post-bariatric surgery (PBS) patients will be limited in their caloric intake, to facilitate weight loss. Engaging in exercise training is critical to maximize weight loss and prevent weight regain. The exercise program should emphasize cardiovascular activities and increased daily physical activity. Substantial cardiovascular training volume will eventually be required for long-term weight loss and prevention of weight regain (e.g., 5-7 days per week, totaling 45-60 minutes per day).
However, strength & conditioning (resistance training (RT)) plays a key role in the exercise training of PBS patients and it's role in bodyweight management, improving health and fitness, managing excess skin, body image and improving the quality of life.
Strength & Conditioning Training Benefits For Post Bariatric Surgery Patients
Strength & conditioning by itself will not provide substantial weight loss, what it does better than anything else is increase daily caloric expenditure. Training with resistance increases muscular strength, endurance and physical functionality, which make the patient more physically active on a regular basis, resulting in weight loss.
Most of your daily life requires muscular strength and endurance, climbing stairs, carrying shopping bags, engaging with children, pets or other adults. Strength & conditioning optimizes the performance of many tasks of daily living. Given that most PBS patients experience significant and rapid weight reductions, it would benefit the PBS patient to maintain as much lean muscle mass as possible through RT.
Dealing with poor body image is a lifelong struggle for most PBS patients. As the caloric restriction from the surgery begins to cause significant weight loss, there is a mental shift from weight loss being a primary goal to muscle toning, body shaping, and minimizing loose skin from a large weight loss. As a result, strength & conditioning will be of particular interest to PBS patients. Training with resistance can also help manage certain lifestyle diseases, such as type 2 diabetes and hypertension, which are common in PBS patients.
Effects of Weight Loss on Lean Mass, Strength, Bone & Aerobic Capacity
Dietary energy restriction causes weight loss and provides powerful protection against many chronic diseases. However, the catabolic state induced by calorie restriction not only affects fat tissue but it also causes undesirable catabolism of other tissues, including skeletal muscle, heart, liver, and kidney; many of these changes could have important functional and/or physiologic ramifications.
Skeletal muscle mass decreases during weight loss from dietary restriction, which reduces muscle strength and resting metabolic rate. Calorie restriction causes bone loss, which may increase fracture risk. Cardiac mass appears to decrease during calorie restriction, which may reduce maximal cardiac output and aerobic capacity.
Strength training is an important adjunct to calorie restriction for weight loss. It contributes to creating a greater energy deficit and provides a long-term solution to weight management after weight loss. Strength & Conditioning may also attenuate some of the negative consequences of weight loss on lean mass, bone, and aerobic capacity.
In a study, modest weight loss (~9%) induced by 1 year of 20% calorie restriction decreased muscle mass and strength, absolute aerobic capacity, and bone mineral density, while full preservation of these outcomes occurred during a similar magnitude weight loss induced by endurance exercise training. However, in the absence of diet modification, the amount of exercise required to produce meaningful weight loss is substantial (~1 hr. daily), especially for overweight and obese individuals who may have limited success in adhering to exercise programs.
Therefore, it may be prudent to use more modest amounts of exercise in combination with calorie restriction for long term weight loss success, exercise attenuates the reductions in lean mass, muscle strength, Bone Mineral Density (BMD), and VO2max that accompany modest weight loss induced by calorie restriction.
Strength & Conditioning Training Program For Post Bariatric Surgery Patients
My personal advice to my clients at Tiger Athletic who have are PBS patients, is to see your physician and get medical clearance prior to starting your strength & conditioning program with me, remember you're in this to get healthier and live your best life so lets start from a position of safety first!
Although the time frame varies according to the individual surgeon and other factors (e.g., surgery type, post-operation complications), patients are typically cleared to perform weight or resistance training 6 to 8 weeks after surgery. The abdominal incisions or incision, may also mean that your surgeon recommends abdominal exercises will be delayed longer, maybe 4 to 6 months.
PBS patients often will not properly fit comfortably into the normal cable and pulley machines found in most commercial machines because of their large body size and possibly feeling too self conscious to be getting coached in front of other gym patrons. Weight loss is an extremely personal journey with many emotional hurdles. As a result, Tiger Athletic uses larger plate loaded equipment, for comfort and bilateral strength training to workout strength and fat distribution imbalances, free weights and other training modalities such as elastic tubes and/or bands as a better alternative methods of strength & conditioning to ensure proper body alignment, technique, and avoid uncomfortable situations for both the client and instructor.
All sessions are also always private and by appointment, its always just you and your trainer in gym for your appointment. We are equipped to offer further program adaptations that may be required according to the client's needs and medical concerns (e.g., arthritic joints).
Strength & conditioning programs for PBS patients are time-efficient RT sessions because of the time required for cardiovascular and conditioning exercise. A typical session would be a full-body routine (8 to 12 exercises), performed 2-3 nonconsecutive days per week for 20-30 minutes.
Workouts that require limited time commitments may improve exercise compliance therefore long term exercise benefit however, If a client is interested in greater gains in a given area of muscular fitness (e.g., muscle hypertrophy or trail running), a greater time commitment will be required, and that time used for Strength & Conditioning should not affect the aerobic training program.
PBS patients often feel awkward exercising, particularly during the early phases of an exercise program and when other exercisers are nearby. It is critical to me that all my clients, particularly the PBS patient feels comfortable in order to increase their confidence in their ability to exercise. To this end we guarantee your privacy, Tiger Athletic is designed for 1 on 1 training. Its always just you and your coach.
Basic Resistance Training Guidelines For Post Bariatric Surgery Patients
These recommendations may vary according to the individuals goals, training level and medical considerations. I cannot stress enough how absolutely vital it is to consult your physician before embarking on a new exercise program.
Frequency - 2 to 3 times per week.
Modes - Plate loaded equipment, free weights, elastic tubes and bands, calisthenics (e.g. wall squats) and other modes (e.g. Boxing).
Exercises - Emphasis on compound or multi - joint exercises, complimented with single joint exercises, thoroughly work all muscle groups.
Sets - Begin with one set and then multi - set with progression.
Reps - 16 to 20 reps per set
Repetition Tempo - Client controlled tempo (recommend 2 sec concentric - 2 sec eccentric).
Rest Period - 1 to 2 minutes between sets, 48 hours between heavy workouts
Summary
With more obese persons undergoing bariatric surgery, It is absolutely to understand the importance of Strength & Conditioning for this population. Strength & Conditioning training will result in additional caloric expenditure due to the combination of resistance training with cardiovascular exercise. Strength & Conditioning will also enhance muscular strength and endurance, and improve body image.
You’ll want to go for steady progress over time and to make lifestyle changes that work for you for the long run. That way you can start losing weight and feel better.
Tiger Athletic is a modern, private, appointment-only gym in Sandton, Johannesburg using a rigorous, results-focused methodology we are passionate about helping you be the healthiest version of yourself, so you can lead a more fulfilling personal and professional life.
Our sessions are strictly 1 on 1 just you and your trainer. There is nobody else in the gym and all equipment used is sanitized at the end of each session for the safety of all my clients.
References
American College of Sports Medicine Position Stand. Appropriate intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc 33: 2145-2156, 2001.
Castaneda C, Layne JE, Munoz-Orians L, Gordon PL, Walsmith J, Foldvari M, Roubenoff R, Tucker KL, Nelson ME. A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care 25: 2335-2341, 2002.
Kelley GA, Kelley KS. Progressive resistance exercise and resting blood pressure: A meta-analysis of randomized controlled trials. Hypertension 35: 838-843, 2000.
Nguyen NT, Root J, Zainabadi K, Sabio A, Chalifoux S, Stevens CM, Mavandadi S, Longoria M, Wilson SE. Accelerated growth of bariatric surgery with the introduction of minimally invasive surgery. Arch Surg 140: 1198-1202, 2005.
Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States. 1999-2004. JAMA 295: 1549-1555, 2006.
Whaley MH, Brubaker PH, Otto RM, eds. ACSM's Guidelines for Exercise Testing and Prescription (7th ed). Baltimore, MD: Lippincott Williams, & Wilkins, 2005. pp. 154-158.
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