Section 17: Physical activity

The benefits of physical activity after surgery

There are many benefits to being more physically active after surgery as exercise:

• helps to optimise weight loss by burning calories and helping regulate appetite
• raises your metabolic rate (the rate at which you burn calories)
• tones up and strengthens your muscles
• improves your posture
• boosts self-esteem, mood, sleep quality and energy
• helps you to manage stress
• improves your overall mental well-being
• improves sleep

As your excess weight comes off, physical activity will become much easier and you will have a lot more energy which can increase your natural desire to be more active.

Long-term benefits of regular physical activity include a reduced risk of many health problems including:

• coronary heart disease, including high blood pressure and stroke – risk reduced by 35%
• type 2 diabetes – reduces the risk by 40%
• joint pain – reduces the risk by 25%
• depression – reduces risk by 30%
• cancers – reduces the risk by 20%

If these conditions already exist, your control of them will ultimately continue to improve if weight loss is combined with a healthy diet and being physically active.

Metabolic rate

Some of the weight regain that people often experience after drastic dieting is due to the loss of muscle that occurs with rapid weight loss. “Quick fix diets” can force your body to break down muscle for energy; however, exercise can help to offset this. Muscle burns lots of calories, even when we are resting, so it is important to combine a healthy diet with exercise in order to help you to keep the weight off.

Muscle is denser than fat but takes up less space; it also holds a lot of water, so it is possible that your weight could actually increase in the short term following exercise BUT you will still be losing inches.

Do not be disheartened if this does happen as an improvement in your overall body composition (i.e. the amount of lean muscle tissue in the body in comparison to the amount of fat) is equally important in helping to reduce overall health risks of being overweight.

When can I start to be active after surgery?

It is important to start getting up and moving around as soon as possible after surgery. This will help reduce the risk of blood clots in your legs (deep vein thrombosis – DVT) and will encourage your body to build up strength in your muscles. Keeping yourself mobile can also help alleviate trapped wind and constipation, which is common after surgery.

Gentle walking is encouraged and should be done as soon as you feel able. Most people feel ready to start increasing their activity levels 2 weeks after surgery, but ensure your wounds are fully healed and that you feel well in yourself before doing so. Most people are also able to return to work a couple of weeks after their procedure.

However we do recommend no heavy lifting or strenuous activity until 6 weeks after the surgery.

If you have had a hiatus hernia repair, you will need to avoid lifting heavy weights for 3-4 months. Speak to your GP if you are worried about increasing your levels of physical activity.

Does the band limit physical activity?

Your band may feel tighter when you are taking part in high altitude or underwater sports e.g. skiing, mountain hiking, rock-climbing or scuba diving. There is a theory that this occurs as a result of the changes in air pressure causing any air trapped in the band to expand. 

Consider a small aspiration (deflation) of the band prior to taking part in any of these sports. If you are experiencing discomfort on eating and/or regurgitation more than once a week, this may indicate that you are more likely to experience discomfort whilst at altitude or under water.

How much activity should I be doing?

The Department of Health released new guidelines in 2019 on physical activity.

Source: Department of Health (2019)

All adults and older people should get at least:

• 150 minutes (2 hours and 30 minutes) of exercise each week. Activity should be of moderate intensity - one way to approach this is to do 30 minutes of activity broken down as 3 x 10 minutes or 2 x 15 minutes on at least 5 days a week AND muscle strengthening activities (activity that works all major muscle groups e.g. legs, back, abdomen, chest, shoulders and arms) on 2 or more days each week.

    OR

• 75 minutes (1 hour and 15 minutes) of vigorous intensity activity spread across the week AND muscle strengthening activities (activity that works all major muscle groups e.g. legs, abdomen, chest, back, shoulders and arms) on 2 or more days each week. Note that older people who have not been exercising regularly may be advised to stick to moderate intensity exercise and strengthening activities.

OR

• An equivalent mix of moderate and vigorous intensity aerobic activity every week (e.g. 2 x 30 minute runs plus 30 minutes of fast walking) AND muscle strengthening activities (activity that works all major muscle groups e.g. legs, abdomen, chest, back, shoulders and arms) on 2 or more days each week.

A minimum of 15 minutes a day is a good place to start for those who currently do little or no activity. It is important to start at a level you feel comfortable with and with activity that is relatively easy to do, no matter how small it may seem. Little and often is the best approach for beginners, so try to find ways to move more every day; it’s never too late to get fit and healthy!

What is moderate activity?

‘Moderate activity’ refers to activity that you can work up to sustaining for 30-60 minutes – aim to start slowly and gradually increase the pace of the activity and the duration as you get fitter. A simple way of testing how intensely you are exercising is known as the ‘talk test’ – moderate exercise should raise your body temperature a little and leave you slightly out of breath; but you should be able to hold a conversation with someone. Moderate activity will vary depending on a person’s fitness level. For example, walking a few yards may be moderate activity for someone who is very unfit, whereas someone else may need to briskly walk for 30 minutes. Remember, doing regular, short bouts (10-15 minutes) of activity can be useful to build your fitness up. Examples include brisk walking, moderate paced swimming and easy cycling.

What is vigorous activity?

‘Vigorous activity’ means that you are breathing hard and fast and your heart rate has increased to the point where you won’t be able to say more than a few words without pausing for a breath. In general, 75 minutes of vigorous intensity activity over the week can give similar health benefits to 150 minutes of moderate-intensity activity. Examples include jogging or running, racquet or ball sports, faster cycling, stair climbing and group fitness classes.

What are muscle strengthening activities?

Any activity that provides resistance to your muscles and makes them work harder than normal. Examples include:

• lifting weights
• working with resistance bands
• heavy gardening, such as digging and shovelling
• carrying shopping bags
• climbing stairs
• hill walking
• push-ups, sit-ups and squats

Physical activity to aid weight loss or weight maintenance

It is important to note these are only recommendations - you may well find you need higher levels of activity to achieve your goals.

• 60-90 minutes (1 to 1½ hours) of moderate activity is recommended daily for people who want to actively lose weight
• 45-60 minutes (¾ to 1 hour) of moderate activity is recommended daily for people who want to avoid gaining more weight or are aiming for weight maintenance.

How can I start being more active? – The 3 Step Plan

The thought of exercise can be very daunting, especially if your activity levels were low before surgery. You can start being more active now by using the “3 Step Plan” which is based on 3 levels. Choose your current level and work your way up to level 3 or a combination of level 2 and 3.
 

Level 1:  Reduce sedentary behaviour

Sitting for long periods of time burns very few calories and can contribute towards weight gain. Aim to break up the amount of time you spend sitting down with some light activity. Here are a few suggestions:

• Taking regular standing breaks at work and take a walk to buy lunch.
• Break up sedentary travel time by getting off the bus a stop earlier and walking
• Doing housework at a fast pace
• If at work, walk over to colleagues and speak to them face to face rather than emailing or phoning.
• Stand up during advert breaks on TV or when on the phone and walk around the house or do some simple exercises.
• Avoid using the remote control for your TV, music system, etc. (take the batteries out if need be!) — get up out of your chair to do it instead. Better still, reduce time spent watching TV, using the computer or playing video games and try to do more active hobbies.

Level 2: Increase lifestyle activity

We can all become more active in our daily lives by making simple changes to our lifestyle. These healthy habits will eventually become part of your usual routine. Lifestyle activity is a great way of achieving your target of daily exercise. As you lose weight, become fitter and more confident, you can start doing more strenuous activity. Here are a few suggestions: 

• Walking is free, so try walking as much as possible, e.g. meeting up with friends in the park, find some footpaths near home to explore.
• Use the stairs instead of the lift or escalator (if you work on the 4th floor, why not start off by taking the lift to the 3^rd floor and walking up the last flight? When this is easy enough, start a flight earlier and so on).
• Get off the bus one stop before your destination and walk the rest. When this becomes a habit, you can aim to increase the distance you walk.
• Park your car further away from the entrance of the office or supermarket.
• Get out at lunch time and go for a walk.
• Take a 5 minute walk around the block on your coffee breaks. Aim to walk faster as you get fitter.
• Get yourself a dog or offer to take a friend’s dog for a walk each day.
• Take up gardening.

Level 3: Sporting activities

Taking up sport is another great way to become fitter. Pick a sport you think you will enjoy or set yourself the challenge of trying something new. Play it regularly with some friends or find out what is available at your local sports club. This is a great way to meet new people and at the same time introduce more activity into your life, improving co-ordination, balance and fitness at the same time. Sporting activities include badminton, tennis, basketball, football, tae-kwon-do, golf and swimming.

Count your steps

For those who are not used to a lot of exercise, walking is one of the best exercises of all and you may find it useful to purchase a pedometer or stepometer. This measures the number of steps that you take each day; several Smart Phone apps will do the same thing, e.g. Map My Fitness. The aim is to walk at least 10,000 steps per day, which for an average person’s pace, equates to five miles distance. The advantage of using a pedometer or app is that it gives you instant feedback on your progress through the day so if by lunchtime you are below your target, you can go out for a walk during your break. Start with your own baseline, then increase your walking target by just 10% per week and you will soon be doing the recommended   10,000 steps or more!

Source: Tudor-Locke C, Bassett DR (2004)

What types of exercise are best?

The benefits of being more physically active will diminish as soon as you stop doing it regularly. Therefore, physical activity needs to be a lifestyle change which is maintained. Choose activity that you enjoy as you are more likely to stick with it.

A combination of all three exercises is ideal with aerobic exercise being the most effective at controlling your weight.

Speak to your GP about being referred to your local gym for an exercise class or exercise referral schemes that provide tailor made programmes. Find out what free activities are happening in your area.

What is interval training?

An interval training workout involves alternating periods of high-intensity effort with periods of low-intensity effort, which is called the recovery. The recovery phase is a very important part of interval training. The stop-and-start pattern trains your body to recover quickly between bursts of higher intensity activity, which, over time will have excellent benefits in increasing overall fitness as well as burning lots of calories. There is growing evidence to support that short bouts of interval training might be as effective, if not more so, than longer, moderate-intensity aerobic workouts.

Interval training is hard work on the whole body, but particularly the heart, lungs and muscles, so only add into your routine if you have been exercising regularly at a moderate intensity for at least 6 months. If you’re out of shape or you’ve not exercised for a while, you should get the all clear from your GP before starting. It is advisable to make sure you have a good level of overall aerobic fitness before starting high-intensity training of any kind.

How many calories will I burn?

It can be easy to think that if you are exercising, it means you can be less mindful of food choices. The actual calories burned during exercise may be less than you think. Use the guide below to help.

Source: NHS DIRECT

Barriers to exercise

Choosing to be more physically active is going to have a great positive impact on your overall mental and physical well-being. However, despite the known benefits, for some there are still reasons that people avoid becoming more active. Below are some common reasons and some possible solutions to consider.

How can I stay motivated? – The 3 golden rules

Motivation is the key to long-term behaviour change. There will be times when you really do not feel like being active. Remember these 3 golden rules when it comes to physical activity:

1. Make your activity enjoyable – find something that suits you. Listening to music whilst you exercise can boost mood and motivate you. There are resources available online to find walks and activities in your local area.

1. Set realistic goals and track your progress
   • Set time-related goals – you can always alter the intensity of the exercise depending on how you feel that day, but try to do something rather than nothing.
   • Set health goals, not weight goals. Get into the habit of exercising for the benefit of your health and well-being long term, not just for your weight.
   • If you are feeling particularly demotivated, repeat your first work out or first activity that you did when you first decided to become more active. You will probably be surprised at how easy it is and will enable you to see how much progress you have made. Keep a diary of your log so you can look back at your progress.

1. Habit forming - think of physical activity as part of your daily routine, just like brushing your teeth!

Eating for exercise

It’s important to eat a balanced diet after surgery and for exercise. The main form of fuel for exercise is carbohydrates. Protein is needed in moderate amounts for muscle growth and repair. Carbohydrates are stored as glycogen in the muscles and liver. These stores are small, so a regular intake of carbohydrate is necessary to keep them topped up. Low glycogen stores will result in low physical and mental energy levels and can increase the risk of injury. Meals need to be balanced with a good source of carbohydrate, lean protein and vegetables or salad.

It is not advisable to exercise on a full stomach. Allow at least 1-2 hours to pass after a meal before you exercise. There are no additional benefits to the time of day that you exercise; just exercise when it suits you and when you feel you can fit it into your lifestyle. After sleeping, the overnight fast can deplete your liver stores of carbohydrates, so a quick boost of carbohydrate before longer or more intense exercise sessions is recommended, e.g. a small banana, slice of toast or a couple of crackers. 

Ensure you are well hydrated before, during and after exercising as dehydration can have a major effect on your energy levels. Water is usually sufficient for moderate activities lasting up to 90 minutes. For higher intensity exercise lasting over 90 minutes, sipping a sports drink may be of benefit. Remember, if you are exercising to lose weight, stick to water or a “lighter” version of sports drinks with fewer carbohydrates and calories.

Advice for those undergoing high intensity training

Good recovery is crucial to prevent a midweek slump in energy levels and to aid muscle growth and repair. For the person who undergoes intense training or sports most days of the week, a carbohydrate and protein-rich snack or meal within 30 minutes of exercise can help replenish stores and aid recovery. Examples include: bread roll with meat/chicken/houmous filling, wholegrain cereal or porridge with skimmed/semi-skimmed milk, 250ml skimmed/semi skimmed milk and a piece of fruit, e.g. banana, apple.

*Remember to discuss the appropriateness of adding extra snacks into your usual dietary regime with your dietitian, as unnecessary calories can slow down weight loss and contribute to weight gain.