Your Guide to Exercising After Bariatric Surgery

Bariatric surgery is a very effective weight-loss treatment for those who have obesity. But it's not as simple as surgery and done: For the best outcomes, exercise is key. It plays an important role in building muscle, improving metabolism and keeping excess weight off.

We spoke with experts to find out the best timeline for starting cardio and strength training after weight-loss surgery.

According to the National Institutes of Health (NIH), most people will lose between 38 and 87 pounds in their first year after weight loss surgery. Results can vary, however, and some people can lose much more. Gastric sleeve, gastric bypass, adjustable gastric band and duodenal switch are the most common types of bariatric surgeries for weight loss.

"The most important thing to remember about exercise after bariatric surgery is that it is a tool for toning and boosting your metabolism," Felix Spiegel, MD, a bariatric surgeon at Memorial Hermann in Houston, Texas, says. "What we are trying to achieve is total body weight loss to increase your organ function and health."

"The main purpose of exercise is to preserve as much muscle mass as possible while you are losing fat after bariatric surgery," Dr. Spiegel says.

A 2021 systematic review and meta-analysis in ‌Obesity Reviews‌ showed that exercise not only helped people who had bariatric surgery lose more weight — but also helped them keep it off.

The review found that exercise programs consisting of aerobic and resistance training helped to improve muscle strength, as well as boosted fat and weight loss.

In addition, a regular exercise program improved cardiorespiratory fitness — which means you can walk farther and do more activities without getting tired. Exercise was also found to reduce bone loss, which is especially important as you get older.

Exercise also helps prevents weight regain after surgery. A 5-year follow-up study in ‌PLOS One‌ found that those who maintained regular moderate to vigorous physical activity after bariatric surgery were less likely to gain weight back.

Following an exercise program will help you reach your weight-loss goals, but Dr. Spiegel says following a healthy diet and eating fewer calories is still vital. "[The majority] of the fat loss is achieved by a low-calorie intake. Do not use exercise as a tool to think you can eat more. This will slow down your weight loss," he says.

The key to exercise success, according to Alberto Zarak, MD, a bariatric surgeon on staff at Palm Beach Gardens Medical Center, is to find something that you will do on a regular basis.

"I recommend my patients find something they enjoy and create a routine that works for their schedule," Dr. Zarak says. "I have patients who compete in marathons, triathlons and weightlifting. Some of my patients have become personal trainers and yoga instructors. I love seeing them thrive with all different types of exercise."

It is always important to get clearance from your surgeon before starting an exercise program, as recommendations may differ depending on the type of surgery and other preexisting conditions. But in general, you should expect to start doing some gentle activity the first week after surgery.

"There is very little downtime after bariatric surgery. Most patients start with some light walking within just a few days after surgery. Once patients are meeting their fluid and protein needs, they can increase exercise intensity," Dr. Zarak says.

"The first few days after surgery, we focus on building their endurance back up. Most patients are getting some light cardio exercise in by the time I see them in my office for their one-week post-op visit," he says.

"Immediately after surgery we recommend patients walk three to four times a day for a minimum of 5 to 10 minutes each walk," Omar Bellorin-Marin, MD, a bariatric surgeon with Holy Name Medical Center in Teaneck, New Jersey, says.

"In general, you can start light exercise about one week after, progressing to moderate exercise two weeks after. I allow my patients unrestricted exercise one month after," Dr. Spiegel says.

Make sure you check in with your doctor to get clearance before amping up your exercise — and be aware of the signs that you are overdoing it. According to Dr. Bellorin-Marin, these include:

• Sustained shortness of breath
• Chest pain
• Dizziness
• Dry mouth
• Excessive sweating

"It is also important to always hydrate as the workout is in progress," he says.

"I challenge my patients to find some activity they don't mind doing and focus on doing it consistently. It could be walking or water exercise. Several of my patients will start with some seated exercise videos," Dr. Zarak says.

Physical therapist Michael Massi, PT, DPT, recommends low-impact cardio exercises after bariatric surgery. "Low-impact exercises are ideal to minimize stress on the surgical site and joints," he says.

Other activities include hiking, rollerblading or, once you get clearance, sports activities like tennis, pickleball and golf. Massi says to avoid high-impact activities, such as jumping or heavy lifting, to allow you to heal and to avoid putting too much stress on your joints.

Once you have been cleared by your doctor for more moderate-intensity exercise (usually a week or two after surgery), ease yourself into more activity. "Initially, aim for short sessions, around 10 to 15 minutes a few times a day, gradually increasing the duration per tolerance," Massi says.

To get cardiovascular benefits, make sure you are working at a moderate-intensity level, which experts like the CDC say means you are working hard enough that you have broken a sweat. Another good measure is that you should still be able to talk, but are too out of breath to sing the words to a song.

After you have been cleared for unrestricted exercise as tolerated (often four to six weeks after surgery), it is time to develop a lifelong exercise plan you can stick to.

"I recommend exercising four days per week for 30 to 60 minutes. For most people, that amount of time is sustainable for years to come," Dr. Zarak says.

"We want the incisions fully healed before incorporating strength training into your routine," Dr. Zarak says. "We typically introduce it around four to six weeks post-surgery."

"Strength training is really encouraged for patients as they lose weight. It can help maintain lean muscle mass, keep their metabolism high and help them keep the weight off long term," Dr. Zarak explains. "Patients who incorporate strength training into their exercise routine after surgery are more likely to maintain their weight loss."

Massi suggests starting with body-weight exercises, before adding weights such as dumbbells, resistance bands or machines.

As your strength improves, you can use dumbbells for a lower-body workout or upper-body workout. You can also use resistance bands for a total-body workout. If you prefer the gym, you can get full-body strengthening from the cable pulley machine.

Get clearance from your doctor before starting abdominal exercises, as you want your incision to be fully healed to prevent injuries or hernias. According to the Obesity Action Coalition, you may need to wait 8 to 12 weeks before starting core strengthening moves.

Once you do start, do gentle core strengthening exercises.

Once you have mastered those, you can progress to a more advanced abdominal strengthening exercise routine.

As far as how many sets and reps to do to gain muscle, try to perform 2 to 6 sets of 6 to 12 repetitions, resting 30 to 90 seconds in between each set.

Remember, start slowly and gradually work your way up. Once you start using weights, the weight should be heavy enough that the last few reps are difficult, but you can maintain proper form. Once it becomes too easy, increase the weight.

You should plan on doing strength-training exercises at least twice a week.

An exercise routine after bariatric surgery offers many benefits, including promoting weight loss, strengthening and toning up muscles, improving cardiovascular fitness, boosting metabolism and even improving bone health. In addition, a regular exercise routine helps to keep the weight off.

Once you have passed the four- to eight-week mark after surgery and are cleared for full exercise, it is important you come up with a regular exercise plan that works for you.

Do a combination of cardio and strength training and aim to get your body moving every day. You should at least do 30 to 60 minutes of exercise, four days a week, consisting of moderate-intensity cardio exercise and strength training.

"The main message is to be active. The more the patient is engaged in an activity mindset (small or big), the better," Dr. Bellorin-Marin says. "A change in lifestyle is what will bring consistent and [lasting] results."