I have a client who had a gastric bypass five years ago and did not exercise. She wants to build her endurance. So far, she is doing well, but I am not sure what to do about her abs. She knows she has a lot of excess skin, and I want her to be as fit as possible. At the time, I am working on her glutes and quads so she can move better in everyday living. She eats a lot of protein and her H2O intake seems to be fine. She is not losing weight or very many inches. She is able to do cardio for 20 minutes, and I want her to bump it up to 30 minutes. How hard should I push her? Is there someplace I can go to learn about this operation?
Let’s get the uncontrollable elements out of the way. The extra skin your client has, especially around her abdominal area, cannot be taken away with any amount of exercise. Excess skin is a byproduct of a large weight reduction and occurs because of the lack of elasticity in the skin. The extra skin is not only displeasing to the eye, but it can also cause skin irritation and pose hygienic problems. The only way your client will get rid of the skin is surgically through abdominoplasty (i.e., a tummy tuck). This procedure is quite common with people who undergo gastric bypass surgery. The down side to something as dramatic as a tummy tuck is the recovery time after surgery is far greater and much more painful than most gastric bypass surgeries. I would tell your client this information with the sole intention of letting her know what to reasonably expect from hiring a personal trainer. Muscles can also become loose as a result of surgery, which is where you can help.
I cannot stress enough how important it is to talk to your client’s physician(s). Usually, one primary care physician is assigned to head the team of physicians your client saw before and after surgery. That doctor would be the first person to speak with, and if this doctor suggests talking to another physician, you should follow through with the specialist. This is important for two reasons. First, your client’s health and safety is your priority and that relies on your education about gastric bypass. Second, the personal training industry is growing exponentially. If we are going to be viewed as an important component to maintain health, every personal trainer needs to make an extra effort to establish relationships with physicians and physical therapists within their community.
I’m sure you already have the medications your client is currently taking and have determined which might potentially affect her during exercise. In addition to the medications, your client is probably tested regularly for nutritional deficiencies. She more than likely already takes nutritional supplements. This does not mean she is immune to more deficiencies over time, especially once a regular exercise routine has begun because her body is using more to repair itself. The most common deficiencies are Vitamin D and B (specifically B12), calcium, iron, phosphorus, magnesium and albumin. It would not be unrealistic to even ask her physician if more frequent testing should occur for the first year of exercise.
If your client’s goals are related to endurance, there are many resources for this sort of training. Recommended guidelines for endurance training are 12 to 25 repetitions at 50 to 70 percent of 1RM. In general, she should progress like any other individual who is new to exercise. Your only concern should be if you see your client’s rest time increase (more than normal) or she begins to experience dizziness and tiredness later in the day. I would assess her like any new client and design her program based on her goals and what you found during your assessment. Working the inner unit muscles of the core, which includes the pelvic floor, is an important component to her goal of overall strong abdominals. Good luck!