Many patients come to the Weight Center because their orthopedic surgeon requires weight loss before joint replacement surgery. This is a long road and I am constantly amazed at the determination of patients to endure two surgeries to reduce their life-limiting pain.
In the past decade researchers have gained a much greater understanding of how to reduce the risks of having any kind of surgery. The American Collage of Surgeons has a program called Strong for Surgery that provides information about nutrition, medications, blood sugar and other medical conditions that, when considered before surgery, improve the success with surgery. One of those factors is cardiovascular fitness.
Your cardiovascular system works harder during surgery, so the stronger it is, the easier surgery and recovery is for your body. Cardiovascular exercise also helps your body reduce the amount of fat that is closer to your organs. For any abdominal surgery this makes it easier for the surgeon to do his job. We recommend all of our patients improve their cardiovascular fitness before surgery. For people with joint pain, our job is to find ways to do this without straining their already painful joints. Many people believed they could not exercise because of joint pain and are pleasantly surprised to find there are many options.
I recently came across this very interesting article reviewing the current research on body weight recommendations for people with hip arthritis. Many orthopedic surgeons use body weight or body mass index as a guide for knowing if patients will do well with joint replacement surgery. This article however sheds new light on the fact that body weight is not near as important as the type of weight a person is carrying.
It turns out, a persons level of muscle mass tells us more about their readiness for surgery than body weight. As important as weight loss is for health, we are understanding how much what you lose matters even more. Losing muscle has been shown to slow the wound healing process and increase the chance of a longer hospital stay. Muscle mass also effects your longevity, risk of fractures, balance, coordination and function in daily life. The problem is, the scale does not tell what you have lost, just that you lost body weight. Studies show that when you lose weight, you are not just losing fat, you will also lose muscle, unless you are telling your body you are using your muscles and need to keep them. (Think of the old saying. ‘use it or lose it’).
After the age of 30 most people start to lose muscle mass. This is sped up by conditions such as diabetes, cancer, pulmonary disease, arthritis and any condition that requires bed rest for more than 24 hours. The problem is, this change in your body is invisible. Even thought many people believe that muscle weighs more than fat, that statement is misleading. The fact is, getting on the scale will not tell you if you have lost or gained muscle. It takes a specific type of exercise and a lot of time to gain muscle, and generally most people will not gain enough to be detectable on the scale. While direct measurement of body fat and muscle is not very convenient, there are other ways you can determine if you might be losing muscle:
- You feel like you are getting weaker as you age and/or lose weight. (ie: difficulty opening jars, climbing stairs, getting up off the floor, or more fatigue when carrying heavy objects)
- You don’t exercise or only do cardio or stretching type exercises. Strength training is the best way to preserve muscle mass. Other types of exercise do not preserve muscle mass near as well.
- You are losing weight but not doing strength training. Studies show that up to 30% of weight lost is muscle when not doing strength training. Weight loss while preserving muscle mass is the way to be healthy, strong, and reduce pain.
- You do strength training but only for ‘toning’, keeping the resistance light for fear of gaining too much muscle. Most people do not have the time, motivation or energy to gain too much muscle. We have so much working against our muscle mass as we age. More of a concern is not doing enough to maintain muscle.
- You stay away from strength training because you fear it will be painful or bad for your joints. The fact is, when you do strength training exercises in the way your body was designed to move, pain is reduced. If strength training is painful, it is a sign you are either doing too much too soon or doing exercises that go against how your body is designed to move well.
- You believe your muscles get enough strength exercise in daily life. If you are doing very heavy work with your whole body, and you feel like your strength is being maintained as you age, then what you are doing is probably helping you hold on to muscle. However, is that exercise seasonal or sporadic? Fill in the times you are not consistently doing those strength requiring activities with some strength training to maintain in the ‘off season’.
If you are looking at joint replacement surgery (or any surgery) in the future, you are part of the surgical team. There is much you can to do help your body handle surgery well and make recovery easier. Doing regular cardiovascular exercise AND strength training exercise are two of your best ways to get the most from your surgery.
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.