Hopefully, you are lucky enough to get a bariatric surgery client before he or she has surgery. The first thing you will notice is the determination of your client. Every hospital has different candidacy requirements, but one aspect is clear: candidates must be willing to go through the wringer to even qualify. They must meet age, weight, body composition and BMI criteria as well as see several physicians, dieticians and specialists, undergo a preoperative mental status exam, sonograms, stress tests and attend group classes as well as have documentation of past weight loss attempts.
Most often when you take on a client who is morbidly obese, he or she will have low self esteem and will view the gym environment as intimidating. The best position to take is to be a friend, guardian and teacher. By forcing yourself to take that position, you will be prepared for potentially difficult situations. We already know a bariatric surgery client has determination, but your job is to help him or her find a way to feel the same way in the gym. Many other members have plenty to say about the way your client looks before and after the surgery. Before the dramatic weight loss, individuals might make negative comments in front of your client or to you on the side. Having a scripted answer is the easiest way to prevent your client from feeling uncomfortable and from you becoming too defensive. Usually current gym users are the “beautiful people” who have never dealt with large fluctuations in weight. What these individuals do not understand is the vicious cycle in which obese people find themselves.
Here are some guidelines for you to follow:
- Maintain professional prudence. Accurate records of workouts and body stats (i.e., weight, measurements, BMI) become vital for safe progress and demonstrate your client's hard work is paying off.
- Talk to a primary care physician. Before and after surgery, it is important to maintain a relationship with the physician to understand the limitations of your client and to obtain medical clearance. Until your client reaches the goal weight, the amount of medication required will change.
- Stay within your scope of practice. Make sure to refer your client to a qualified person when it is beyond your area of expertise.
- Remember the goals of your client. Do what you can to make sure your client meets set goals, even if it means more effort than an average client. I have a client who is always late. To ensure he arrives on time, I made it a habit to give him a call an hour beforehand until he was able to fit a fitness appointment into his life. The extra effort has gone a long way to helping him reach his goals.
- Be creative. Your job is “selling” a product (i.e., fitness) to someone who in most cases does not enjoy exercise. Find ways to make the experience positive. For example, I had a client who would complain every time we reached the cardio activity in her circuit training program. To change her attitude, I would let her choose a song, and I would sing and dance for her during the segment. She had a blast laughing at me, and soon it became her favorite part of the workout.
Pre Surgery Training
Most of the time, a candidate for gastric bypass/bariatric surgery has some form of cardiovascular disease, Type 2 diabetes, hypertension, dyslipidemia, respiratory or liver disease, and caution must be taken. Even with multiple dysfunctions, the importance of exercise before surgery cannot be stressed enough. Going into surgery with strong muscles and increased lung and heart function is critical for rapid recovery. In addition, a requirement to qualify for the surgery is to lose a certain percentage of body weight. To help your client meet this requirement, exercise is key. Swimming is certainly an appropriate cardiovascular activity because of the reduced joint impact, although many clients may be reluctant to bare it all in their bathing suits. One way to be sensitive to potential self consciousness in this situation is to let your client know that early in the morning or later in the evening is the best time to use the pool because lanes are more likely to be available. The client assumes you are being courteous by telling him or her when to find a more peaceful atmosphere, and it also squashes the fear of being seen. You can also approach the situation by having a session where you swim with your client. Whatever your method, the goal should be to make your client feel as comfortable as possible.
Resistance training can include stability and balance as long as the progressions are appropriate. Circuit training or any mode to keep heart rate elevated during resistance training is important to increase heart function but also for weight loss. Usually, the challenge resides in putting the client in comfortable positions. Often times, exercises on a mat or lying on a bench or stability ball are not appropriate because getting up and down is almost physically impossible. Consequently, choosing exercises where your client can only succeed will help with mental preparation for physical activity. This does not mean you should not challenge your client, but rather, you should design programs to ensure success.
The actual bariatric surgical procedure tends to be the easiest part of the entire process. It is not abnormal for a gastric bypass patient to be out of the hospital within 24 hours. But clearance is not usually given to work out for two to three weeks. Many side effects occur post surgery, including internal bleeding, infection and abscesses. The surgery reduces nutrient absorption, and a daily regimen of nutritional supplements may be suggested.
Egoism is the only personality trait found as an obstacle for long term weight loss in gastric bypass patients. As a fitness professional, you must stay within your scope of practice; however, sharing this information with your client could help him or her focus on what obstacles will stand in the way of set goals. The awareness of the ego as a predictor of weight loss can help your client stay focused on what is important.
When your client returns to the gym, he or she will be extremely weak and will fatigue easily. The size of the stomach is small, so staying hydrated is a task. Post surgery weight training is crucial to get a client’s strength up again, but the rest periods between sets dramatically increases. Do not be surprised if it takes your client three minutes between each exercise. The rest periods are a perfect time to have your client sip on water. A safe way to resume working out is by training with selectorized equipment. For the first couple of months, abstain from balance or stability training and cardio circuit training. Adding back different training modalities is appropriate when rest time between sets becomes normal.
Do not forget, just because a client has successfully made it through bariatric surgery does not mean he or she is immune from complications months or years afterward. Internal bleeding, calcium and Vitamin D deficiencies as well as many other nutrient deficiencies can occur. Being educated by a physician on the basic signs of these complications is critical. Some quick indications to look for are decrease in strength or stamina, dizziness and increase amount of rest between sets. Also, bone density after surgery can significantly decrease and is a real concern. A well rounded resistance training program is vital to maintain bone mass and should be a consideration in program design.
Most changes transpire, physically and emotionally, during the first year after bariatric surgery. Seeing the transformation in your client’s mood and self esteem will be truly remarkable. He or she will want to share the excitement about the magnitude of this life change, including the details of what pant size they are now wearing! You will certainly enjoy hearing it all, and in the back of your mind, you will know your work helped your client not just meet set fitness goals but meet them safely.
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