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Exercise, weight loss surgery and bone strength

Why exercise for diabetes_(7)


Losing weight after weight loss surgery is quite exciting.  To see the weight finally coming off, wear smaller clothing, and be able to move through life with more ease are some of the things that put a smile on the face of many patients here at the Weight Center.

Those markers of success do not however tell you what you are losing.  Over time what does show up is a loss of bone mass in people who have weight loss surgery.  We all know the loss of bone can lead to a fracture which really puts a damper on life.  Maintaining bone is not just about your body, its about your lifestyle and ability to enjoy life.

An encouraging study was just published in the Journal of Clinical Endocrinology & Metabolism that concludes “exercise should be incorporated into post-op care of bariatric patients…to mitigate the adverse effects of the surgery on bone mass”.

They came to this conclusion because the folks in the study who did exercise three times  for six months consisting of 30 – 60 minutes moderate intensity cardio (walking) and three sets of 8-12 repetitions of seven strength training exercises were able to maintain bone mass. The people in the ‘usual care’ group lost bone mass.

What the study does not tell us is if this is the amount of exercise you need to maintain bone mass after weight loss surgery.  Could you get away with less?  Maybe.  What we do know from many other studies is that walking or cardio is just not enough. Strength training is needed to maintain bone.  So if you have had, or plan on having weight loss surgery, plan on making strength training part of your post surgery routine.

One thing is for sure, exercise gives you something weight loss cannot – stronger bones and thus a better chance of staying active for a long time.

Keep Moving, Be Well,


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by | July 31, 2019 · 6:19 pm

Exercise and joint replacement surgery

Why exercise for diabetes_(6)

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.

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by | July 23, 2019 · 6:48 pm

Exercise and Osteoarthritis

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What is Osteoarthritis?

In normal joints, a firm, rubbery material called cartilage covers the end of each bone. Cartilage provides a smooth, gliding surface for joint motion and acts as a cushion between the bones. In osteoarthritis or OA, the cartilage breaks down, causing pain, swelling and problems moving the joint. As OA worsens over time, bones may break down and develop growths called spurs. Bits of bone or cartilage may chip off and float around in the joint. In the body, an inflammatory process occurs and cytokines (proteins) and enzymes develop that further damage the cartilage. In the final stages of OA, the cartilage wears away and bone rubs against bone leading to joint damage and more pain.  Arthritis Foundation Website

How does exercise help?

Exercise is considered the most effective non-drug treatment for reducing pain and improving movement in osteoarthritis.

Movement in general can reduce inflammation, the cause of pain in arthritis.   Your lymph system relies on movement to keep this fluid part of your blood moving so your body can lower inflammation.  All three types of exercise work well for osteoarthritis:

  • Stretching reduces stiffness that makes movement more difficult.  Simply moving a joint through its full range of motion a few times several times a day can be very beneficial in reducing stiffness and movement limitations from OA
  • Strength training helps your muscles, ligaments and tendons support arthritic joints. Strength training has been shown to reduce arthritis pain.  The key is knowing how to do strength training with proper alignment so your joints work there best and you minimize strain.  In your exercise visit, we practice this to ensure strength training is not painful so your body can gain strength without strain.
  • Cardio can reduce pain, but there are several factors to consider.  If the activity is weight bearing (such as walking), your joints probably won’t tolerate it for as long. However, since walking is a type of activity needed for daily life, it is important to incorporate if at all possible.  Use a cane or walker if it helps you walk with less pain.   Walk in several short bouts for the duration that does not increase pain.  Supplement with a form of cardio that is non-weight bearing and allows you to move for a longer period of time,  such as an exercise bike or seated aerobics. The key is doing the amount and type that decreases, not increases pain and then repeat that more frequently to make up for the lower duration.

The key to each of these  is listening to your body.   When movement decreases pain, it is lowering inflammation.  When pain increases, so does inflammation.  So doing small bouts throughout the day, doing the types of exercise that reduce pain and stiffness is the way to use exercise as the most effective non-drug treatment for reducing pain and improving movement in OA.

One last thing to consider is stress.  If exercise or physical activity is stressful, it will increase inflammation.  Choose types of movement you enjoy, that leaves you feeling good about yourself, and do it in a way that it does not increase your pain, and you will be using exercise in the way that it can make it easier to live with osteoarthritis.

In the next blog, I will address why exercise is important if you are having  joint replacement surgery.

Keep moving, be well,


Exercise in the management of knee and hip osteoarthritis. Elizabeth Wellsandt and Yvonne Golightly. Current Opinion in Rheumatology. 30(2):151–159, MAR 2018
Educating patients about the benefits of physical activity and exercise for their hip and knee osteoarthritis. Systematic literature review. C.Gay, A.Chabaud, E.Guille, E.Coudeyre.  Annals of Physical and Rehabilitation Medicine.  June 2016, Pages 174-183


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.



by | July 9, 2019 · 7:30 pm

Exercise and Sleep Apnea


Obstructive Sleep Apnea or OSA is an involuntary cessation of breathing that occurs while a person is asleep.  Left untreated, sleep apnea can lead to health concerns such as high blood pressure, heart disease, stroke, automobile accidents caused by falling asleep at the wheel, diabetes, depression, and other ailments. Typical symptoms of sleep apnea include heavy snoring, excessive daytime sleepiness or fatigue, difficulty with concentration or memory, and waking during the night feeling short of breath. ( )

There is growing evidence that exercise is an effective part of treatment for OSA.  Although it used to be thought that exercise was helpful only when a person lost weight, study’s show that exercise helps sleep apnea even before losing weight. 

According to one meta-analysis, for every 1 unit increase in the level of sleep apnea (Apnea/Hyponea Index or AHI), there is a 6% increased risk of stroke  in people with mild to moderate sleep apnea.  Exercise alone (without weight loss) can reduce the level of sleep apnea between 2 and 17 units showing that it can lower the risks of sleep apnea even before you lose weight. In other studies, people with sleep apnea who exercise have fewer symptoms such as daytime sleepiness and low energy.

In these studies, exercise worked within a wide range of types, amounts and frequency of exercise.  Cardiovascular exercise is most commonly used. However,  future studies are looking at strength training and mind/body exercise programs as well. 

While all that sounds great, the fatigue from sleep apnea is a major challenge when it comes to finding the motivation to exercise. So when using exercise to help withe sleep apnea, we need to be realistic if it is going to work.  Keep these tips in mind as you plan exercise when you have sleep apnea:

  • Think of exercise as small focused bouts of movement you do frequently rather than one long session you do a few times a week (i.e: 5-15 minutes of exercise or more a day)
  • Plan one bout at the time of day  you have the most energy
  • Choose types of exercise that have an inherently lower risk of injury.  Your balance, reaction time and coordination are likely effected by the lower quality sleep. 
  • Try different types of exercise and assess what types give you energy at different times of day and what types help you sleep better at night.
  • When you think you are too tired to exercise, try just a few minutes to see if it helps.  If it does, keep going. If it doesn’t, stop exercise and try another type of a different time of day. 

If you have sleep apnea, know that exercise is part of the treatment plan.  However, set yourself up for success by adjusting your expectations until your symptoms are under control.

Keep Moving, Be Well,




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by | July 3, 2019 · 6:53 pm

Exercise and asthma


Asthma is a medical condition where parts of your airway tightens making it difficult to breathe.  There are many triggers and exercise can be one of them.  For this reason, many people with asthma avoid exercise. This is unfortunate because exercise, when done right, can actually help give you more days free of asthma symptoms.

Along with all the other benefits,

regular exercise has been shown to improve asthma control

What makes exercise a trigger for asthma?

  • Exercise induced asthma seems to be caused by dehydration of the airways.  When you breathe heavier, the airways are more likely to dry leading to a series of events that causes asthma symptoms
  • When water loss is prevented, by breathing warm humid air, exercise does not provoke an attack of asthma

What are the benefits of exercise for people with asthma?

  • More symptom free days
  • Reduces risks of asthma exacerbation
  • Improved exercise capacity
  • Improved quality of life
  • Improved pulmonary function

How can I prevent an asthma episode with exercise?

  • Exercise regularly
  • Do a pre-exercise warm up
  • Cover your mouth with a scarf or mask while exercising in cold temps
  • Avoid exercising in
    • High pollution areas
    • Periods of high allergen levels
    • Extreme temperatures
  • Avoid exercising when asthma is exacerbated or during a respiratory tract infection
  • Ask your doctor about using a fast acting asthma medication 10-15 minutes before exercise can help you avoid or minimize an asthma episode during exercise.
  • Use all of your asthma medications as directed
  • Treat other medical conditions that can worsen asthma symptoms, such as gastric reflux


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.


Leave a comment

by | June 26, 2019 · 6:50 pm

Exercise for heart health


You probably hear all the time that exercise is good for your heart health, but what does that mean?   In a past blog I highlighted how your fitness level seems to be more strongly connected to your risk of heart disease than your weight. Let’s take a closer look at how exercise helps to prevent heart disease.    There are many types of heart disease.  Here we will talk specifically about exercise for preventing coronary artery disease, the kind that can lead to a heart attack.

What leads to a heart attack?  A heart attack (or MI – myocardial infarction) is when one of the arteries of the heart is blocked. Since the job of arteries in the heart is to deliver oxygen and other nutrients to the different parts of the heart muscle, blockage means that part heart muscle is damaged from lack of oxygen.

There are many reasons why a blockage can occur.  Generally it is the gradual accumulation of fats, sugars and on the walls of arteries.  The risk factors for heart disease increase the chances of these deposits forming:

  • High blood pressure:  Normally the inside lining of arteries is smooth.  But high blood pressure over time wears down the walls of arteries so substances like fat and sugar in the blood are more likely to stick to the walls building up and leading to a blockage
  • Diabetes: The higher amount of sugar that stays in the blood with diabetes means there is more substances to stick to the walls of the arteries
  • High cholesterol:  The higher the amount of fats floating in blood, the more chance it has to stick to the walls of arteries
  • Smoking: Smoking increases the risk of  blood clots which can block an artery in the heart (or anywhere in the body).   Smoking also doubles the level of risk of developing other risk factors for heart disease.
  • Stress:  When your body is in a stress response, it increases the amount of fats and sugars in your blood, constricts your blood vessels, and increases clotting in your blood (in case you are injured).  All of these increase the chance that your arteries become damaged and blocked.

When you exercise, several things happen right away that directly improve these conditions and thus helping to prevent a blockage in your arteries.

  • Your body releases nitric oxide, a natural blood vessel relaxer.  This counteracts the effects of high blood pressure and stress to reduce the chances of damage to the walls of your arteries from these conditions. Nitric oxide remains in your system for up to 22 hours after one 30 moderate intensity bout of exercise.
  • Your body uses fats and sugars in your blood to fuel moving muscles.  This way they are not hanging around in your arteries ready to attach to the walls and create a blockage. Depending on the type and intensity of exercise, this higher usage of fats and sugars in the blood can last up to 72 hours after one single exercise bout.
  • Your body shifts to a relaxation response IF exercise is not stressful.  Since stress prepares your body for movement, exercise that is not stress producing gives your body what it has prepared for in the stress response, allowing your nervous system to shift back to the job of healing and repair.
  • Brain chemicals for a calmer body.  When you exercise your brain releases chemicals that help you stay calm, think clearer, and focus better for hours after. It also lowers chemicals that increase inflammation (like cortisol) that can exacerbate a blockage.    Even just ten minutes has been shown to release these chemicals.   Improved brain function means a better mood and less stress.

Over time with consistent exercise, your body changes in ways that help to give it even further protection from heart disease.

  • New blood vessels grow in your heart to provide more blood flow to the heart muscle.  This is called collateral circulation and provides protection if one artery is blocked, these smaller vessels can get blood to that area of the heart, reducing or preventing the damage of a blockage.
  • Muscles become more efficient so every day activities are less strain on your heart.  When you improve your stamina and strength, your heart does not have to work as hard for everyday activities.  Less strain means less demand of oxygen with physical activities, making your heart handle daily activities and stress better.
  • Your heart becomes a more efficient pump.  Your hearts job is to pump blood to the rest of the body.  As you improve your fitness level, your body does not need to beat as fast, because it pumps more blood with every beat.   A stronger pump means it does not need to work as hart do to its job.
  • Better management of other risk factors.   When you exercise regularly, all of the other risk factors that contribute to blockages in your heart improve.  Regular exercise is the all in one treatment for lowering your risk of heart disease.

Exercise directly and indirectly reduces the root causes of heart disease.  Even if you already have heart disease, exercise has been shown to reduce the risk of a second heart event.   There is no other treatment available that does all of this at once.  Exercise truly is medicine!

Keep Moving, Be Well,


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by | June 18, 2019 · 7:19 pm

Exercise and fibromyalgia


If you or someone you care about has fibromyalgia, you know it can be one of the most frustrating illnesses around.  The symptoms of widespread pain and tenderness (sensitivity to touch) that tends to come and go and move about the body mean you never know what will hurt next.   The fatigue is compounded by sleep problems, which compounds other problems.  The wide range of symptoms effect every aspect of life and can leave you feeling like your body is the enemy.

Exercise is part of the standard recommended treatment, yet this can often lead to even more frustration when it only leads to more pain and fatigue.  Let’s look at why exercise with fibromyalgia so you know how to make exercise work for you.

Since the cause of fibromyalgia is unclear, we can only use exercise to treat the symptoms rather than the root cause of the illness.  Exercise has the most impact on preventing the secondary symptoms of fibromyalgia, the ones caused by living with pain and fatigue.  Let me explain.

The first secondary symptom is the loss of strength, stamina and mobility the comes when movement is limited by pain and fatigue.   This leads to the spiral of inactivity where you move less because of pain and fatigue, which causes you to lose function, which causes you to move less, and so on. This downward spiral continues so it looks like the disease is progressing when in reality it is the direct result of moving less.

So first and foremost, having regular routines for exercise that includes strength, cardio and stretching will help you recover from a flare up by reclaiming what is lost when you were resting.  Equally as important is having a ‘flare up’ routine you can switch to so you can keep moving but adjust the way you move to help with healing.   This duel approach to exercise gives you the ability to use exercise to help your body get what it needs in each stage; one is about rebuilding, one is about recharging.

That leads to the next important factor in fibromyalgia – mindfulness. Mindfulness, paying attention to what is happening in the present moment has been shown to be helpful with fibromyalgia pain.  When combined with exercise, mindfulness helps you stay out of the frustration of comparing your body to what you used to do or think you should do.  The focus on noticing when you are judging, and shifting to curiosity helps you move in the way your body needs to move now.  The most important ingredient of mindfulness is kindness.  Remembering that you are exercising to take care of your body, rather than trying to overcome it.  Mindfulness during exercise is the mindset that keeps you exercising in the way that helps fibromylagia.

Another side effect of fibromyalgia is depression.  Exercise, done in a way that helps your body feel better, will also help your brain function better.  Just ten minutes of exercise releases a natural balance of brain chemicals that raises mood and calms nerves.  Since stress is a trigger for fibro flare ups, using regular exercise to reduce stress in some way every day in your brain and body can help to lower the frustration of the changing symptoms of fibro.

For all of us to function well in daily life, we need strength, stamina and mobility.  There is no one type of exercise that gives you all three of these.  When you have fibromylagia, finding the balance between these three types of exercise is even more important. It helps you avoid doing too much of one kind and straining your body rather than helping it regain function.

  • Stretching: Helps your connective tissue regain some elasticity, reducing pain and stiffness, and helps your lymph system reduce inflammation. Stretching is the foundation of exercise for fibromyalgia because it can help directly improve the symptoms both in a flare up and between flare ups.
  • Strength training: Helps your muscles and bones and metabolism stay strong and counteract the effects of prolonged times of resting during a flare up.  Do strength training in a way that teaches your body to be strong for movements of daily life.  Stay clear of the athletic type strength training that tends to push your body to do more faster. Also stay clear of the  aesthetic fitness style strength training that is more about changing the look of your body (which is mostly myth and marketing based anyway) than the function of your body.
  • Cardio:  Helps keep your stamina up so that you have more energy for every day activities.   Find a kind of cardio that feels good on your joints and allows you to modify the intensity depending on how you are feeling that day.  Doing shorter bouts, like 5-10 minutes, often feels better and still improves stamina.  Starting with one a day and then gradually adding more bouts during the day makes it easier on your body to adapt well without increasing pain.

Lastly, one sure way to put yourself in a flare up is doing too much too soon.  The fact is,  the body can adapt to a 10% increase in exercise a week.  That is not much.  When you have a medical concern like fibromyalgia, the rule is 5% increase per week. That means if you are doing a 10 minute walk, increase by 30 seconds! That is much less than your brain thinks you should, but is the amount your body can do. By working with your body in this way, you help avoid flare ups and can better use exercise to help you manage fibro well.

Bottom line: When you have fibromyalgia, it is extra important to be sure your brain and body are working together.  When you work with your body, listening to it as your best guide, giving it the right balance of rest and movement, exercise can be a great part of your fibro management toolbox.

Keep Moving, Be Well,


  1. Fibromyalgia:
  2. Mindfulness and Fibromyalgia:
  3. Mindful Movement and pain management:  https://med.stanford

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by | June 11, 2019 · 7:14 pm