Melissa Elder

For someone trying to lose a substantial amount of weight, the idea of building muscle may sound counterproductive. You may fear that it will make you larger and bulkier. Don’t worry: Muscle is a very dense fiber that actually takes up far less space than fat! Let’s start by defining what is meant by “strength training”. This term loosely refers to the use of resistance -- in the form of machines, free weights, bands, or even one’s own bodyweight -- to increase the strength and size of muscles. (We’ll get into more specifics later.) For someone trying to lose a substantial amount of weight, the idea of building muscle may sound counterproductive. You may fear that it will make you larger and bulkier. Don’t worry: Muscle is a very dense fiber that actually takes up far less space than fat! In fact, you should worry more about losing muscle. Muscle is increasingly hard to develop as we age, yet it’s incredibly important to maintain for a variety of reasons. Sarcopenia -- essentially the wasting of muscle -- is a condition that contributes to a significant number of health problems. In his 2006 study, “The underappreciated role of muscle in health and disease”, Robert R. Wolfe found that: “Both cardiac failure and cancer are often associated with rapid and extensive loss of muscle mass, strength, and metabolic function (cachexia)” (American Society for Clinical Nutrition, 2006). The fact that muscle plays a tremendous role in metabolic function explains its significant impact on overall health. In addition to burning significantly more calories per day than fat tissue, muscle tissue also helps to stabilize blood sugar and hormones. A study conducted by researchers in the Life Sciences Institute at the University of Michigan found that white muscle, the type formed through resistance training, utilized glycogen and controlled blood glucose more efficiently than red muscle, the muscle associated with cardiovascular training (Williams, 2013). This is not to say that cardiovascular exercise is not important, only that strength training is also highly beneficial. In addition to building new muscle, resistance training can prevent the catabolization (breakdown) of the muscle you already have. According to the National Council on Strength & Fitness, “Losses of lean mass during the ‘dieting’ process reduce the caloric contribution of muscle and just 10 kcals/day equates to the metabolic equivalent of one pound of fat in a year” (“A Pound of Muscle Burns 30-50 Kcal/Day, Really…”, n.d.). Therefore, in order to properly recover from training and preserve muscle, you may need to increase your protein intake. Speak with your nutritionist about how much you need! Not only does building strength affect you physically, it can also greatly benefit your mental health by boosting confidence and self-esteem. You will stand taller and feel more grounded in your own body. You will feel more powerful and competent in all areas of life. And, as a bonus,, building muscle can help improve the appearance of loose skin caused by losing large amounts of weight. There are a few things to consider before beginning a strength training program. Most importantly, as with any workout program, always consult with your physician first. Those with high blood pressure may be discouraged from lifting particularly heavy weights until the blood pressure is controlled. You then need to consider the safest and most efficient exercise equipment. For example, machines are rarely a “perfect fit”, and they also dictate a single pattern of movement that may not be ideal for the mechanics of your body. However, most machines are used while seated, so they might be a good option if you have difficulty standing. Using free weights, cables, and bands allows you to move more naturally and in a space that feels more comfortable. In addition, training with these tools (as opposed to machines) will force you to use your own body to do much of the stabilization. In other words, you do more work, and, as a result, burn more calories. When you start an exercise program, start with low weights and high repetitions (around 12-15), as performing repetitive actions many times creates the neurological pathways for new movement patterns. This initial phase of training is known as the muscular endurance stage. As form and endurance improve, gradually lower the repetitions and increase the weight, in order to build muscular strength, or “a muscle’s capacity to exert force against resistance” (Cespedes, 2013). A repetition range of 8-12 will cause hypertrophy, the point at which you begin to see an increase in the muscle size, while six or fewer reps results in the greatest improvement in actual strength and power. With resistance training, you will need to rest between exercise sets in order to give your muscles a chance to recover. As a beginner, stick with one exercise at a time to allow your body to acclimate and adapt to the new stressors you’re placing on it. Once you’re ready for a little more of a challenge, you can try supersets, or circuits. These terms refer to combining two or more exercises in sequence, generally for different muscle groups, so that one muscle group gets to rest while another is working. This also keeps the calories burning! For example, a simple circuit could include bodyweight squats, seated rows, and planks. Another way to “up the ante” on your calorie burn is to choose triple-joint or compound movements, as opposed to single-joint or isolation movements. Examples of triple-joint exercises include squats and bench presses, as opposed to single-joint leg-extensions or bicep curls. Movements that require you to move more joints engage more muscle fiber, because they use larger, more calorie-consuming muscles. So, in addition to burning more calories, these movements can increase the efficiency of your workouts and save you time. Speaking of joints, strong muscles stabilize joints and can help you avoid injuries. However, performing an exercise in bad form can actually harm your joints. Muscle soreness is fine, but do not push through sharp pain in a joint, as pain might a red flag that you are not doing something correctly, or that your body is not ready to move in a certain way. Ask a personal trainer or physical therapist about modifications or corrective exercises. It can be tempting to want to show off, but always prioritize form over weight! As long as you have medical clearance, try adding some resistance training to your workout regime. It can boost your weight loss and be a fun break from the monotony of cardio! References A Pound of Muscle Burns 30-50 Kcal/Day, Really… (n.d.) [retrieved from https://www.ncsf.org/enew/articles/articles-poundofmuscle.aspx] Cespedes, Andrea. 2013. The Difference Between Muscular Strength & Muscular Endurance. Retrieved ___________ (http://www.livestrong.com/article/154326-the-difference-between-muscular-strength-muscular-endurance/). Williams, Laura J. 2013. Lift weights to lower blood sugar? White muscle helps keep blood glucose levels under control. University of Michigan News. Retrieved from http://ns.umich.edu/new/releases/21363-lift-weights-to-lower-blood-sugar-white-muscle-helps-keep-blood-glucose-levels-under-control Wolfe, Robert R. 2006. “The underappreciated role of muscle in health and disease”. American Society for Clinical Nutrition.

Let’s start by defining what is meant by “strength training”. This term loosely refers to the use of resistance -- in the form of machines, free weights, bands, or even one’s own bodyweight -- to increase the strength and size of muscles. (We’ll get into more specifics later.) For someone trying to lose a substantial amount of weight, the idea of building muscle may sound counterproductive. You may fear that it will make you larger and bulkier. Don’t worry: Muscle is a very dense fiber that actually takes up far less space than fat! In fact, you should worry more about losing muscle. Muscle is increasingly hard to develop as we age, yet it’s incredibly important to maintain for a variety of reasons. Sarcopenia -- essentially the wasting of muscle -- is a condition that contributes to a significant number of health problems. In his 2006 study, “The underappreciated role of muscle in health and disease”, Robert R. Wolfe found that: “Both cardiac failure and cancer are often associated with rapid and extensive loss of muscle mass, strength, and metabolic function (cachexia)” (American Society for Clinical Nutrition, 2006). The fact that muscle plays a tremendous role in metabolic function explains its significant impact on overall health. In addition to burning significantly more calories per day than fat tissue, muscle tissue also helps to stabilize blood sugar and hormones. A study conducted by researchers in the Life Sciences Institute at the University of Michigan found that white muscle, the type formed through resistance training, utilized glycogen and controlled blood glucose more efficiently than red muscle, the muscle associated with cardiovascular training (Williams, 2013). This is not to say that cardiovascular exercise is not important, only that strength training is also highly beneficial. In addition to building new muscle, resistance training can prevent the catabolization (breakdown) of the muscle you already have. According to the National Council on Strength & Fitness, “Losses of lean mass during the ‘dieting’ process reduce the caloric contribution of muscle and just 10 kcals/day equates to the metabolic equivalent of one pound of fat in a year” (“A Pound of Muscle Burns 30-50 Kcal/Day, Really…”, n.d.). Therefore, in order to properly recover from training and preserve muscle, you may need to increase your protein intake. Speak with your nutritionist about how much you need! Not only does building strength affect you physically, it can also greatly benefit your mental health by boosting confidence and self-esteem. You will stand taller and feel more grounded in your own body. You will feel more powerful and competent in all areas of life. And, as a bonus,, building muscle can help improve the appearance of loose skin caused by losing large amounts of weight. There are a few things to consider before beginning a strength training program. Most importantly, as with any workout program, always consult with your physician first. Those with high blood pressure may be discouraged from lifting particularly heavy weights until the blood pressure is controlled. You then need to consider the safest and most efficient exercise equipment. For example, machines are rarely a “perfect fit”, and they also dictate a single pattern of movement that may not be ideal for the mechanics of your body. However, most machines are used while seated, so they might be a good option if you have difficulty standing. Using free weights, cables, and bands allows you to move more naturally and in a space that feels more comfortable. In addition, training with these tools (as opposed to machines) will force you to use your own body to do much of the stabilization. In other words, you do more work, and, as a result, burn more calories. When you start an exercise program, start with low weights and high repetitions (around 12-15), as performing repetitive actions many times creates the neurological pathways for new movement patterns. This initial phase of training is known as the muscular endurance stage. As form and endurance improve, gradually lower the repetitions and increase the weight, in order to build muscular strength, or “a muscle’s capacity to exert force against resistance” (Cespedes, 2013). A repetition range of 8-12 will cause hypertrophy, the point at which you begin to see an increase in the muscle size, while six or fewer reps results in the greatest improvement in actual strength and power. With resistance training, you will need to rest between exercise sets in order to give your muscles a chance to recover. As a beginner, stick with one exercise at a time to allow your body to acclimate and adapt to the new stressors you’re placing on it. Once you’re ready for a little more of a challenge, you can try supersets, or circuits. These terms refer to combining two or more exercises in sequence, generally for different muscle groups, so that one muscle group gets to rest while another is working. This also keeps the calories burning! For example, a simple circuit could include bodyweight squats, seated rows, and planks. Another way to “up the ante” on your calorie burn is to choose triple-joint or compound movements, as opposed to single-joint or isolation movements. Examples of triple-joint exercises include squats and bench presses, as opposed to single-joint leg-extensions or bicep curls. Movements that require you to move more joints engage more muscle fiber, because they use larger, more calorie-consuming muscles. So, in addition to burning more calories, these movements can increase the efficiency of your workouts and save you time. Speaking of joints, strong muscles stabilize joints and can help you avoid injuries. However, performing an exercise in bad form can actually harm your joints. Muscle soreness is fine, but do not push through sharp pain in a joint, as pain might a red flag that you are not doing something correctly, or that your body is not ready to move in a certain way. Ask a personal trainer or physical therapist about modifications or corrective exercises. It can be tempting to want to show off, but always prioritize form over weight! As long as you have medical clearance, try adding some resistance training to your workout regime. It can boost your weight loss and be a fun break from the monotony of cardio! References A Pound of Muscle Burns 30-50 Kcal/Day, Really… (n.d.) [retrieved from https://www.ncsf.org/enew/articles/articles-poundofmuscle.aspx] Cespedes, Andrea. 2013. The Difference Between Muscular Strength & Muscular Endurance. Retrieved ___________ (http://www.livestrong.com/article/154326-the-difference-between-muscular-strength-muscular-endurance/). Williams, Laura J. 2013. Lift weights to lower blood sugar? White muscle helps keep blood glucose levels under control. University of Michigan News. Retrieved from http://ns.umich.edu/new/releases/21363-lift-weights-to-lower-blood-sugar-white-muscle-helps-keep-blood-glucose-levels-under-control Wolfe, Robert R. 2006. “The underappreciated role of muscle in health and disease”. American Society for Clinical Nutrition.

The prospect of “working out” may feel a little daunting. There are lots of things you might be afraid of -- getting hurt, being bored, feeling embarrassed, infringing on work or family time, and possibly the worst, not seeing results! These are all normal and every new exerciser experiences these emotions. Whether you’ve already undergone surgery or are preparing to, these strategies can make it easier to begin exercising to support your weight-loss goal. The prospect of “working out” may feel a little daunting. There are lots of things you might be afraid of -- getting hurt, being bored, feeling embarrassed, infringing on work or family time, and possibly the worst, not seeing results! These are all normal and every new exerciser experiences these emotions. Whether you’ve already undergone surgery or are preparing to, these strategies can make it easier to begin exercising to support your weight-loss goal. #1- Speak with your doctor about the safety of your intended program. Are your heart & joints strong enough to handle the type of workout you have in mind? Are there side effects from your surgery that may be exacerbated by certain types of exercise? #2 Get organized! Take out your calendar and put in everything you do during the day. How long does it take you to get ready for work? To commute? To eat lunch? You need a very clear picture of where you can make time for a workout. Ideally, you’ll find one time for exercise everyday -- at least on weekdays. Consistency is crucial for creating a new habit. The more routine a behavior becomes, the less it will provoke anxiety! Give yourself a bedtime & wake-up time; consider spending a week or so getting into better sleeping habits before you begin a new workout routine. #3 Set Realistic & Reasonable Goals Be honest with yourself -- are you SO not a morning person? Don’t set yourself up for failure by scheduling a workout before dawn. Maybe hitting the gym after work is better for you! You might be a little late for dinner, but at least you’ll get it in. Remember that your body is NOT a Ferrari; it can’t go from 0-60 in 3 seconds! Start by doing 5-10 mins/day of very light activity, and build up gradually. Take a rest if you start to feel overwhelmed. Don’t expect to see physical changes overnight, and don’t measure progress by weight-loss. As you begin to build muscle, the number on the scale may not shift at first. Remember that you’re still becoming stronger & healthier, and increasing your metabolism. #4 Have a “Plan B” The most common exercise for beginners is walking. But what about the weather? What if you’re knees are super sore? What if you’re travelling and don’t know your way around the neighborhood? Invest in a set of free weights, resistance bands, and/or a gym membership. This will give you options for every situation. Flexibility not only helps you stay consistent -- varying your workouts can also stave off boredom & help you stay motivated! #5 Involve Your Friends & Family, but Don’t Depend on Them. Let the people close to you know that you plan to start a new routine and how your schedule will change. Tell them how important this is for your health, and ask them to be supportive. It’s great if your spouse/friend/kids want to join you for a workout, but don’t expect them to be as committed as you are. Someone might bail out at the last minute; you have to be prepared to go it alone. #6 Make Exercise a Priority We all juggle so many responsibilities, and often feel pulled in ten directions at once. It can be tempting to ditch our workouts to save time. Think of working out as being as fundamental as brushing your teeth -- it’s simply non-negotiable. “Put the mask on yourself first.” Whether it’s caring for children or older relatives, we often neglect our own needs to take care of others. But remember -- if you’re in poor health, you can’t be there for anyone else. You may need to turn down some social invitations -- staying up late and drinking is simply not conducive to working out the next day. If your friends want to hang out, invite them along to the gym! #7 Eat Around Your Workouts Working out on a full stomach or totally starving will make you feel sluggish. Eat your pre-workout meal close enough to keep you energized, but give yourself some time to digest a bit. This is especially true post-surgery, when you’ll be more likely to become nauseated from vigorous movement. You may need to experiment with different types of food and timing! Most WLS patients are on low-carb diets to prevent “dumping syndrome,” a condition caused by sugary foods. However, if you’re going to have carbs, consider placing them in your post-workout meal, along with some protein. Slower-digesting sources, such as sweet potatoes with skin or lentils, can help repair your muscles while avoiding gastric discomfort. #8 Positive Vibes Only Acknowledge your hard work with self-praise, but don’t beat yourself up when you’re struggling. Making yourself feel bad is de-motivating and can even make you more likely to engage in self-destructive behaviors. Have compassion for yourself! Changing your habits requires major psychological, neurological, and physical adaptations. These things take time, and they’re not easy! Having a hard day doesn’t mean you’re lazy or weak. Focus on how your mood, energy, sleep quality, and even sex life, are improving. #9 Ask for Help Walking into the gym for the first time can be overwhelming and confusing. If you don’t know how to use a piece of equipment, ask a trainer. Unless they’re with a client, trainers are generally eager to help. Most gyms offer a free introductory session when you join. Take advantage to learn the layout of the gym and how everything works. *While you might feel embarrassed about sharing personal details with a stranger, always tell your trainer if you’ve had surgery and what your physical limitations are. Unfortunately, many people in the fitness world aren’t educated about surgical procedures for weight-loss. #10 Don’t Let the Haters Get You Down! You may be embarrassed about your size, and might worry that people will laugh or stare while you exercise. The truth is, they might, but that’s they’re problem! Most people will actually applaud your efforts and be extremely encouraging. The few bad apples aren’t worth worrying about. This is YOUR life -- don’t let anyone suck the health & happiness out of it!

The prospect of “working out” may feel a little daunting. There are lots of things you might be afraid of -- getting hurt, being bored, feeling embarrassed, infringing on work or family time, and possibly the worst, not seeing results! These are all normal and every new exerciser experiences these emotions. Whether you’ve already undergone surgery or are preparing to, these strategies can make it easier to begin exercising to support your weight-loss goal. #1- Speak with your doctor about the safety of your intended program. Are your heart & joints strong enough to handle the type of workout you have in mind? Are there side effects from your surgery that may be exacerbated by certain types of exercise? #2 Get organized! Take out your calendar and put in everything you do during the day. How long does it take you to get ready for work? To commute? To eat lunch? You need a very clear picture of where you can make time for a workout. Ideally, you’ll find one time for exercise everyday -- at least on weekdays. Consistency is crucial for creating a new habit. The more routine a behavior becomes, the less it will provoke anxiety! Give yourself a bedtime & wake-up time; consider spending a week or so getting into better sleeping habits before you begin a new workout routine. #3 Set Realistic & Reasonable Goals Be honest with yourself -- are you SO not a morning person? Don’t set yourself up for failure by scheduling a workout before dawn. Maybe hitting the gym after work is better for you! You might be a little late for dinner, but at least you’ll get it in. Remember that your body is NOT a Ferrari; it can’t go from 0-60 in 3 seconds! Start by doing 5-10 mins/day of very light activity, and build up gradually. Take a rest if you start to feel overwhelmed. Don’t expect to see physical changes overnight, and don’t measure progress by weight-loss. As you begin to build muscle, the number on the scale may not shift at first. Remember that you’re still becoming stronger & healthier, and increasing your metabolism. #4 Have a “Plan B” The most common exercise for beginners is walking. But what about the weather? What if you’re knees are super sore? What if you’re travelling and don’t know your way around the neighborhood? Invest in a set of free weights, resistance bands, and/or a gym membership. This will give you options for every situation. Flexibility not only helps you stay consistent -- varying your workouts can also stave off boredom & help you stay motivated! #5 Involve Your Friends & Family, but Don’t Depend on Them. Let the people close to you know that you plan to start a new routine and how your schedule will change. Tell them how important this is for your health, and ask them to be supportive. It’s great if your spouse/friend/kids want to join you for a workout, but don’t expect them to be as committed as you are. Someone might bail out at the last minute; you have to be prepared to go it alone. #6 Make Exercise a Priority We all juggle so many responsibilities, and often feel pulled in ten directions at once. It can be tempting to ditch our workouts to save time. Think of working out as being as fundamental as brushing your teeth -- it’s simply non-negotiable. “Put the mask on yourself first.” Whether it’s caring for children or older relatives, we often neglect our own needs to take care of others. But remember -- if you’re in poor health, you can’t be there for anyone else. You may need to turn down some social invitations -- staying up late and drinking is simply not conducive to working out the next day. If your friends want to hang out, invite them along to the gym! #7 Eat Around Your Workouts Working out on a full stomach or totally starving will make you feel sluggish. Eat your pre-workout meal close enough to keep you energized, but give yourself some time to digest a bit. This is especially true post-surgery, when you’ll be more likely to become nauseated from vigorous movement. You may need to experiment with different types of food and timing! Most WLS patients are on low-carb diets to prevent “dumping syndrome,” a condition caused by sugary foods. However, if you’re going to have carbs, consider placing them in your post-workout meal, along with some protein. Slower-digesting sources, such as sweet potatoes with skin or lentils, can help repair your muscles while avoiding gastric discomfort. #8 Positive Vibes Only Acknowledge your hard work with self-praise, but don’t beat yourself up when you’re struggling. Making yourself feel bad is de-motivating and can even make you more likely to engage in self-destructive behaviors. Have compassion for yourself! Changing your habits requires major psychological, neurological, and physical adaptations. These things take time, and they’re not easy! Having a hard day doesn’t mean you’re lazy or weak. Focus on how your mood, energy, sleep quality, and even sex life, are improving. #9 Ask for Help Walking into the gym for the first time can be overwhelming and confusing. If you don’t know how to use a piece of equipment, ask a trainer. Unless they’re with a client, trainers are generally eager to help. Most gyms offer a free introductory session when you join. Take advantage to learn the layout of the gym and how everything works. *While you might feel embarrassed about sharing personal details with a stranger, always tell your trainer if you’ve had surgery and what your physical limitations are. Unfortunately, many people in the fitness world aren’t educated about surgical procedures for weight-loss. #10 Don’t Let the Haters Get You Down! You may be embarrassed about your size, and might worry that people will laugh or stare while you exercise. The truth is, they might, but that’s they’re problem! Most people will actually applaud your efforts and be extremely encouraging. The few bad apples aren’t worth worrying about. This is YOUR life -- don’t let anyone suck the health & happiness out of it!