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Exercise After Bariatric Surgery
How important is exercise after bariatric surgery? Michael Caromano, physicians assistant, discusses exercise after surgery.
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Learn more about Michael Caromano, PA-C
Michael Caromano, PA-C
Michael Caromano, PA-C is a Surgical Physicians Assistant.Learn more about Michael Caromano, PA-C
Transcription:
Bill Klaproth (Host): So how important is exercise after bariatric weight loss surgery? Let’s find out with Michael Caromano, a physician assistant at Garden State Bariatrics and Wellness Center. Michael, thanks so much for your time. So when do you first meet the patient? Is it pre-surgery?
Michael Caromano PA-C (Guest): Yes. You know I typically meet each patient upon their initial visit. Usually they’ll have me take the patient back and record their height and weight, and then begin the process of going over their medical and surgical history.
Host: Gotcha. So then you get to know the patient right from the very start. So does that help you in evaluating or working with them to create an exercise plan?
Michael: It absolutely does. I typically upon walking the patient back, you can get a feel of like an eye test or an ear test. How the patient is walking towards the scale or is the patient breathing heavily with minimal exertion? So yes. I can get a fair sense of their condition early on during that visit.
Host: Yeah. I could see where that’s really important. So then when you do sit down with the patient, you develop a specific plan for that patient. Is that correct?
Michael: I begin the process at that initial visit. I don’t finalize things that early, but we can at least get an idea of their limitations leading up to the actual exercise prescription.
Host: Okay. So I like how you call that an exercise prescription. I love that. So what is generally in an exercise prescription?
Michael: I mean the basic basis for an exercise prescription typically is called the FIT principle. That stands for frequency, intensity, time, and type. I can go into each one in detail, but basically the frequency is referring to how often that patient will exercise. The intensity will be more of the amount of work or effort that patient would have to do to perform that activity. The time is basically how long they will perform that activity, and the type is basically the type of exercise. Is it cardiovascular in nature, resistance training, flexibility, or a modified version based on their limitations?
Host: You're dropping some knowledge on us here Michael. I love it. The FIT principle and the exercise prescription. I love these terms. So the FIT principle, you explained that very nicely. So very easy to understand. So do you give them a frequency? Like you have to do this exercise this many times a week. Is it all laid out a week for them?
Michael: In a perfect scenario, yes. But we understand that some of our patients do have some limitations. So we would definitely modify each part of that FIT principle so they are able to start at a level that they are comfortable with, and to make sure that we decrease the risk of injury that might occur with exercise.
Host: Really important because you don’t want somebody injuring themselves right after surgery and then they're unable to exercise. So that’s a really important component. So speaking of after surgery, how do you follow up with the patient then to help them make sure that they're hitting the goals of the exercise prescription?
Michael: Well, immediately with the first post-operative visit besides just doing a review of their diet and how we have a program mapped out to progress their diet from liquids back to a solid diet. I also kind of inquire about their exercise habits or, I guess, their initial attempts in some cases to exercise. Then from there try to suggest some modifications. Again, according to the FIT principles areas that we can potentially work upon or improve upon.
Host: So for the bariatric weight loss surgery patient who might be looking ahead to after the surgery, thinking about the exercise afterwards, how intensive and rigorous is this exercise?
Michael: Well that’s the art of exercise. Besides the science of exercise, it’s finding the right activity for each patient. Now in some patients, if they enjoy running, well that’s fine. That will produce enough intensity in terms of the workout to achieve their exercise goals. However, the other patient may despise running. So we have to kind of come up with a custom activity based on their likes and hopefully produce similar results with that patients.
Host: Yeah, that’s good. The art of exercise. So then do you also when you give them the plan, do you sit down with them and say here’s how you do this stretching exercise. Here’s how you do this lifting exercise so they really understand it mechanically and can perform it exactly as they should when they're at home?
Michael: Yes. I have to kind of gauge their exercise literacy, we’ll say. Then from there if I can add or instruct or educate that patient on proper form, that’s what I will do. Many cases, surprisingly, patients do have a good sense of proper form or at least how to do it. It’s just the motivation of to doing it.
Host: So Michael, speaking of motivation, that can be tough for a lot of people. How do you help keep people engaged? Or if they are struggling, how do you help them continue on?
Michael: Well, I guess when talking to a patient, if I initially have a sense that they are resistant to exercise, I try to go in and try to uncover the routes of that resistance. So why are they…Is it because of a physical limitation? Past experiences? Maybe embarrassing experiences in the past. Maybe in terms of family upbringing, their exposure to exercise in the past. I try to go in and see what can be done to overcome these barriers that are in place. If it just is encouragement with words, show them that in studies exercise has improved long term and short term outcomes with weight loss surgery. I try to at least map out the reasons why the exercise will benefit that particular patient.
Host: That makes sense Michael. So lastly then, why is exercise so important after bariatric weight loss surgery?
Michael: The studies that have been conducted on exercise with bariatric patients did show that physical activity alone will have modest effects on body weight. That’s besides the dietary modifications. It is, however, most effective to couple your physical activity and dietary modification in terms of the best results. Dietary modification by itself without physical activity is less effective for both short and long term weight control. Finally, despite the lack of weight loss, physical activity has independent association with numerous health benefits. So in those patients who may not achieve their weight goals, if they do start to incorporate exercise as part of their routine, they will benefit in terms of risk reduction long term.
Host: Which, of course, is the long-term goal. Michael, thank you for your time. For more information, please visit the Garden State Bariatrics and Wellness Center website at gsbwc.com. That’s gsbwc.com. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is winning through losing, a weight loss surgery podcast with Garden State Bariatrics. I'm Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): So how important is exercise after bariatric weight loss surgery? Let’s find out with Michael Caromano, a physician assistant at Garden State Bariatrics and Wellness Center. Michael, thanks so much for your time. So when do you first meet the patient? Is it pre-surgery?
Michael Caromano PA-C (Guest): Yes. You know I typically meet each patient upon their initial visit. Usually they’ll have me take the patient back and record their height and weight, and then begin the process of going over their medical and surgical history.
Host: Gotcha. So then you get to know the patient right from the very start. So does that help you in evaluating or working with them to create an exercise plan?
Michael: It absolutely does. I typically upon walking the patient back, you can get a feel of like an eye test or an ear test. How the patient is walking towards the scale or is the patient breathing heavily with minimal exertion? So yes. I can get a fair sense of their condition early on during that visit.
Host: Yeah. I could see where that’s really important. So then when you do sit down with the patient, you develop a specific plan for that patient. Is that correct?
Michael: I begin the process at that initial visit. I don’t finalize things that early, but we can at least get an idea of their limitations leading up to the actual exercise prescription.
Host: Okay. So I like how you call that an exercise prescription. I love that. So what is generally in an exercise prescription?
Michael: I mean the basic basis for an exercise prescription typically is called the FIT principle. That stands for frequency, intensity, time, and type. I can go into each one in detail, but basically the frequency is referring to how often that patient will exercise. The intensity will be more of the amount of work or effort that patient would have to do to perform that activity. The time is basically how long they will perform that activity, and the type is basically the type of exercise. Is it cardiovascular in nature, resistance training, flexibility, or a modified version based on their limitations?
Host: You're dropping some knowledge on us here Michael. I love it. The FIT principle and the exercise prescription. I love these terms. So the FIT principle, you explained that very nicely. So very easy to understand. So do you give them a frequency? Like you have to do this exercise this many times a week. Is it all laid out a week for them?
Michael: In a perfect scenario, yes. But we understand that some of our patients do have some limitations. So we would definitely modify each part of that FIT principle so they are able to start at a level that they are comfortable with, and to make sure that we decrease the risk of injury that might occur with exercise.
Host: Really important because you don’t want somebody injuring themselves right after surgery and then they're unable to exercise. So that’s a really important component. So speaking of after surgery, how do you follow up with the patient then to help them make sure that they're hitting the goals of the exercise prescription?
Michael: Well, immediately with the first post-operative visit besides just doing a review of their diet and how we have a program mapped out to progress their diet from liquids back to a solid diet. I also kind of inquire about their exercise habits or, I guess, their initial attempts in some cases to exercise. Then from there try to suggest some modifications. Again, according to the FIT principles areas that we can potentially work upon or improve upon.
Host: So for the bariatric weight loss surgery patient who might be looking ahead to after the surgery, thinking about the exercise afterwards, how intensive and rigorous is this exercise?
Michael: Well that’s the art of exercise. Besides the science of exercise, it’s finding the right activity for each patient. Now in some patients, if they enjoy running, well that’s fine. That will produce enough intensity in terms of the workout to achieve their exercise goals. However, the other patient may despise running. So we have to kind of come up with a custom activity based on their likes and hopefully produce similar results with that patients.
Host: Yeah, that’s good. The art of exercise. So then do you also when you give them the plan, do you sit down with them and say here’s how you do this stretching exercise. Here’s how you do this lifting exercise so they really understand it mechanically and can perform it exactly as they should when they're at home?
Michael: Yes. I have to kind of gauge their exercise literacy, we’ll say. Then from there if I can add or instruct or educate that patient on proper form, that’s what I will do. Many cases, surprisingly, patients do have a good sense of proper form or at least how to do it. It’s just the motivation of to doing it.
Host: So Michael, speaking of motivation, that can be tough for a lot of people. How do you help keep people engaged? Or if they are struggling, how do you help them continue on?
Michael: Well, I guess when talking to a patient, if I initially have a sense that they are resistant to exercise, I try to go in and try to uncover the routes of that resistance. So why are they…Is it because of a physical limitation? Past experiences? Maybe embarrassing experiences in the past. Maybe in terms of family upbringing, their exposure to exercise in the past. I try to go in and see what can be done to overcome these barriers that are in place. If it just is encouragement with words, show them that in studies exercise has improved long term and short term outcomes with weight loss surgery. I try to at least map out the reasons why the exercise will benefit that particular patient.
Host: That makes sense Michael. So lastly then, why is exercise so important after bariatric weight loss surgery?
Michael: The studies that have been conducted on exercise with bariatric patients did show that physical activity alone will have modest effects on body weight. That’s besides the dietary modifications. It is, however, most effective to couple your physical activity and dietary modification in terms of the best results. Dietary modification by itself without physical activity is less effective for both short and long term weight control. Finally, despite the lack of weight loss, physical activity has independent association with numerous health benefits. So in those patients who may not achieve their weight goals, if they do start to incorporate exercise as part of their routine, they will benefit in terms of risk reduction long term.
Host: Which, of course, is the long-term goal. Michael, thank you for your time. For more information, please visit the Garden State Bariatrics and Wellness Center website at gsbwc.com. That’s gsbwc.com. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is winning through losing, a weight loss surgery podcast with Garden State Bariatrics. I'm Bill Klaproth. Thanks for listening.