Category Archives: Medical

Lower the risks, raise the benefits!


We hear stories of people getting injured or having a heart attack during exercise. You might have even experienced this yourself.    At the same time, we are flooded with all the reasons we “should” exercise.  How do we make sure we are getting the benefits and keeping the risks low.

The risk of having a heart attack or dying as a result of exercise is relatively low.  Only 4% to 17% of heart attacks in men are linked to physical exertion, with much lower rates observed for women.  The risk is greater for people who are unaccustomed to exercise and for those at the lower fitness levels.   Compare that to the fact that regular physical activity cuts the risk of getting heart disease by about 40%.  In fact, regular physical activity has been shown to reduce the risk of dying from any cause by 40%.

Does anything jump out at you with that last set of facts?  The risk goes up if your fitness level is low and you get protection as your fitness level goes up.  Regular physical activity offers amazing protection, and irregular physical activity increases risk.

One of the best ways to protect yourself is be consistent with some physical activity because it provides protection from doing nothing.   Notice also the statistics from the Exercise is Medicine Fact Sheet   are for physical activity – which is a broad term that includes regular movement, not necessarily a rigid exercise program.  Bottom line, move and move often and regularly!

The second big factor that has been shown to increase risk is the intensity.  Vigorous exercise tends to increase risk.  Doing a moderate intensity lowers the risk while keeping benefits.  But what does vigorous or moderate mean?  Often you will hear it described as an absolute level; vigorous is jogging 6mph and moderate is walking 3mph.  But in reality, it all depends on your fitness level!   For some 6mph jog will be moderate and for others a 3mph walk will be vigorous.

Exercise at the level that is a moderate to comfortable challenge for your breathing – above what you would feel when you are resting but not so uncomfortable that you can’t wait to stop.   Avoid vigorous intensity where your breathing is heavy or uncomfortable.

The risks also go up with a sudden burst of intense (vigorous) exercise followed by a sudden stop in activity.  When you do feel like your breathing is uncomfortable (like when climbing stairs or a hill), keep moving slowly until breathing level comes back down to moderate to light before stopping completely.

Finally, if you have concerns with your heart, diabetes or high blood pressure and are not exercising regularly, discuss your plans to start with your doctor. Your best bet is to start with a light intensity activity that you can do on a very regular basis.  As you improve your fitness level, your risks will reduce and the benefits go up.

If you have symptoms such as pain anywhere above your waist that comes on with exertion and goes away with rest, or have more shortness of breath with usual activities, tell your doctor.  If you have pain in joints with activity, adjust what you are doing so it does not cause pain.  (either by doing that activity for less time or lower intensity or do something different until your body is stronger).  Pushing through pain only requires your body to “speak” louder to get your attention to let you know something is not right.

The bottom line is listen to and be kind to your body!  When you move it regularly at the just right challenge level, you can relax about the risks and enjoy the benefits of exercise.

Keep Moving, Be Well,


Please share these posts with anyone you know interested in losing weight with or without weight loss surgery.  Click here to learn more about the UMass Memorial Weight Center

These weekly blogs are general guidelines. These guidelines apply to patients who are cleared by a physician for the type of exercise described. Please contact your physician with any concerns or questions. Always report any symptoms associated with exercise, such as pain, irregular heartbeats, and dizziness or fainting, to your physician.


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by | September 20, 2017 · 6:48 pm

Follow-up After Weight Loss Surgery

roadWeight loss is a journey. And bariatric surgery is a milestone in that journey. Surgery marks a whole new chapter, a beginning of a new journey within that weight loss journey. Sure, it’s a faster, smoother ride after, than before surgery. It’s like getting onto a highway after driving for miles on bumpy, traffic light-filled roads. The appetite restriction makes it much easier to feel full with smaller meals. The quick weight loss in the initial months after surgery opens up a whole new world of possibilities for exercise. With your joints carrying less weight than before, moving becomes much less painful, and the increase in physical activity leads to further weight loss.

But even highways can be fraught with traffic jams and lane closures at times. The journey after surgery may be easier than before, but no one said it would be perfect. The stomach is an elastic bag, after all. And everyone is different. Some people experience appetite restriction for a longer time than others. Different people experience different levels of “hunger” at different points during their journey.

• Not eating 6 small meals a day, and sometimes skipping a few of those small meals, is one factor that can slow down weight loss, as it can lead to intense hunger, which can lead to eating fast and too much, which, in turn, can lead to stretching of the stomach. Skipping meals can also slow down the metabolism and cause weight re-gain.
• Not getting enough protein can be another factor, as protein helps with feelings of fullness and with preserving muscle mass that boosts metabolism.
• Usually consuming too little protein can lead to consuming too many carbohydrates – starchy foods such as bread, crackers, rice, etc. – which can cause weight re-gain. Starches are not only higher in calories, they are also notorious for causing “cravings,” as they spike blood sugar levels, sending hunger signals to the brain.
• Sometimes people can get off track with exercise, especially during the winter months. And, after not moving for a few days or weeks, they lose all motivation to get back on track because they have feelings of guilt and “failure.”

None of these things are easy – eating 6 small meals, getting enough protein, watching the carbs, exercising regularly. They take a lot of planning, time and effort. And, it is only natural to get off track with them after surgery, just as it is pre-surgery. Yet, a lot of people mistakenly think that once they have had surgery, there are “no room for mistakes.” People think, “I have invested a lot in surgery, I better not get off track ever again.” But holding yourself to such high standards, putting that kind of pressure on yourself, can actually backfire because it is self-defeating and leads to discouragement. Humans are not perfect, and neither is life. Even after surgery, you will still have good days and bad days, holidays and sick days, stressful days and vacations.

If you start the journey thinking “I cannot afford to fail,” then if things do go wrong, you are bound to chalk it up to “your fault” instead of examining what led to it.
Sometimes we spend so much energy beating ourselves up that we don’t see the complete picture, we don’t focus on the things that led to the lapse – some of which could well be out of our control.

For example, overeating could be the result of not drinking enough liquids or skipping meals, but we get too caught up thinking, “oh no, I’m back to my old ways” instead of back-tracking to see what led to it. Not exercising for a week or two could lead to a loss of motivation – but only if you had assumed in the first place that you were supposed to be perfect and not miss a single day.

Moral of the story? Success with weight loss isn’t defined by how many weeks, months, or years you can go without breaking down and indulging, overeating or not exercising. Rather, it is defined by how soon you can get back on track after a day, week, month, or even year of being off track. It is never too late to get back on track – ever. And the secret to getting back on track as soon as possible is having a curious, compassionate, non-judgmental attitude towards yourself. “It’s okay.” “I’m only human.” “What led to that?” “What can I do differently next time?” “What’s the lesson here?” This is the right way to talk to yourself, instead of “I’m so lazy” or “I failed” or “I’m back to my old ways.” Don’t forget about all of the pounds you lost before you start focusing on the pounds you gained.

Of course, all this is easier said than done. We humans are hard-wired to be our own worst critics. It is so much easier to offer hope and empathy to our friends than to ourselves! That’s precisely why you need the objective, non-judgmental perspective of your provider. You could be unnecessarily scolding yourself when all you needed to do was make some small changes to your meal or exercise routine. You could be avoiding a follow-up visit with your doctor or dietitian because you are thinking, “How can I face them after having gained this weight?” when in reality, you are the only one judging yourself.

Here’s another reason to stay in touch with your surgeon, dietitian and exercise physiologist:
• Your nutritional needs – calories, vitamins, etc. can change through the years after surgery based on your medical conditions, deficiencies, and general health status.
• Your exercise plan, too, can need alterations based on your fitness level.

It is difficult to try guessing these changes yourself. Regular appointments and blood tests make it so much easier to always have an accurate sense of your needs and to make it possible to update your diet and exercise plan at regular intervals. So, regular check-ins with your healthcare providers are extremely important for permanent weight loss success after bariatric surgery.

Remember, no one said that weight loss is supposed to be easy after surgery forever, or that you are expected to be 100% prefect with eating healthy and with exercise. It is still a journey with traffic jams and bumps in the road. Support makes that journey easier, whether it is from your family and friends or from your professional and compassionate healthcare providers.

Special Thanks to Narmin Virani RD for writing, Kayla Scally NP for editing, and Robin Mason NP for reviewing this blog.  

Please share these posts with anyone you know interested in losing weight with or without weight loss surgery.  Click here to learn more about the UMass Memorial Weight Center

These weekly blogs are general guidelines. These guidelines apply to patients who are cleared by a physician for the type of exercise described. Please contact your physician with any concerns or questions. Always report any symptoms associated with exercise, such as pain, irregular heartbeats, and dizziness or fainting, to your physician.


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Filed under Life After Weight Loss Surgery, Medical