Approximately 34.1% of U.S. adults are overweight, and 32.2% are obese (5). As a result of this worsening epidemic of obesity, many persons are turning to bariatric surgery in the hopes of achieving and sustaining a significant weight loss. From 1998 to 2002, there was a 450% increase in the number of bariatric surgeries performed in the United States (4). There are a number of different weight loss surgeries that are performed. 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, which will facilitate weight loss. However, 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, resistance training (RT) plays a key role in the exercise training of PBS patients.
RESISTANCE TRAINING BENEFITS FOR POST-BARIATRIC SURGERY PATIENTS
Although RT by itself will not provide substantial weight loss, it does increase daily caloric expenditure. Resistance training will also increase muscular strength and endurance, which can lead to being more physically active on a regular basis, resulting in weight loss (1). Many activities of daily living require muscular strength and endurance. Examples include carrying groceries and climbing stairs. As a result, RT 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.
It is important to know that PBS patients have had a poor body image for most, if not all of their lives. As they begin to achieve a significant weight loss, they start to think more about muscle toning, body shaping, and minimizing loose skin from a large weight loss. As a result, RT will be of particular interest to PBS patients. Resistance training can also help manage certain diseases, such as type 2 diabetes and hypertension (2,3), which are common in PBS patients.
RESISTANCE TRAINING PROGRAMMING FOR POST-BARIATRIC SURGERY PATIENTS
PBS patients should always receive medical clearance from their surgeon and /or physician prior to starting a RT program. 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 RT 6-8 weeks after surgery. Because of the abdominal incisions or incision, abdominal exercises will be delayed longer (e.g., 4-6 months). See Table 1 for a summary of basic resistance training recommendations for PBS patients.
PBS patients often will not properly fit into selectorized machines (e.g., Cybex) because of their large body size. As a result, free weights and other training modalities such as elastic tubes and/or bands will be better alternative methods of RT to ensure proper body alignment, technique, and avoid uncomfortable situations for both the client and instructor. Other RT program adaptations may be required according to the client's needs and medical concerns (e.g., arthritic joints).
Time-efficient RT sessions may be needed because of the time required for cardiovascular exercise. An example would be a full-body routine (minimum 8-10 exercises), performed 2-3 nonconsecutive days per week for 20-30 minutes. Resistance exercise sessions that require limited time commitments may improve exercise compliance (6). If a client is interested in greater gains in a given area of muscular fitness (e.g., muscle hypertrophy), it should be expressed that a greater time commitment will be required, and that time used for RT should not affect their 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 that the exercise professional make the PBS patient feel comfortable in order to increase their confidence in their ability to exercise.
With more obese persons undergoing bariatric surgery, it is important for the exercise professional to understand the importance of RT for this population. Resistance training will result in additional caloric expenditure when done in combination with cardiovascular exercise. Resistance training will also enhance muscular strength and endurance, and improve body image. Following the basic recommendations presented in this column will ensure safe and effective RT programming to help PBS patients realize these benefits, and improve their quality of living.▪
1. 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.
2. 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.
3. Kelley GA, Kelley KS. Progressive resistance exercise and resting blood pressure: A meta-analysis of randomized controlled trials. Hypertension
35: 838-843, 2000.
4. 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.
5. 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.
6. 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.