The majority of us who exercise in an effort to lose weight select low intensity, cardiovascular activities like the treadmill, elliptical, or stationary bike. While these are helpful for improving your heart and lung health, they do little to drive meaningful weight loss. Now that we understand that weight loss is not driven by a conscious modification of our behaviors to trigger the burning of calories, we have to take another look at exercise to ensure that the methods we choose will work to lower our metabolic thermostat’s set point. Exercising to build muscle is primarily dependent on the intensity of the movements, rather than the duration that you perform them. This critical paradigm shift requires us to completely rethink our workout.
One of the most important factors that influences our set point is the amount of healthy muscle that we have. Exercising to achieve weight loss should focus on movements that work to build muscle instead of those that work to burn calories. The weight loss effects of muscle building exercises are evident if you pay close attention the next time you walk through your local gym. The weight room is typically filled with well developed lean men and women while the treadmill and elliptical room houses those with less desirable physiques. Because we’ve been obsessed with calorie balance as the primary driver of weight loss for so many years, we bought into the idea that low intensity movement, performed for long periods of time, as the best exercises for weight loss. We’ve always believed that the longer you stay on the treadmill, elliptical, or stairmaster, the more weight you will lose.
Now that we are viewing obesity as an elevation in our set point, rather than an unfavorable tipping of our calorie balance, low intensity exercises like the elliptical, treadmill, or stairmaster no longer make sense as the optimal exercise regimen. Instead, we must look to higher intensity exercises, performed for a short period of time (typically 20 minutes or less), if we are going to use exercise to drive permanent, set point lowering weight loss.
High intensity exercise is not for everyone and must be implemented carefully under the guidance of your physician and an experienced personal trainer. I’ve found exercise to be an extremely useful weight loss tool for women under 30 and men under 40 years old. As you age, your ability to build muscle decreases, and the likelihood that you suffer from orthopedic problems increases, making high intensity exercise less effective and more dangerous.
Whatever exercise methodology you decide on, it is absolutely critical that you do everything within your power to decrease your chances of injury. As we discussed previously, an injury that results in a prolonged period of inactivity can result in significant- often irreversible- weight gain. The goal of our exercise plan is to improve our health and lower our set point. If you’re not careful and perform a workout that is beyond your physical capabilities, the opposite can occur. Another critical component of injury prevention is to use proper form when exercising. Selecting weights that are too heavy for you will prevent you from using proper form and is very dangerous. Again, exercising to the point of causing an injury will cause weight gain and decreased fitness, which is not what we’re aiming for.
Just as there is a nutritional spectrum for lowering your thermostat with foods, the same spectrum exists for exercise. Your goal is to select the most intense exercise that you’re capable of performing safely. Younger patients, without orthopedic limitations, should consider high intensity yoga, free weights, spin classes; as well as boot camp, CrossFit, and other High Intensity Interval Training (HIIT) workouts. HIIT drives you to work out at near maximal intensity for shorter time periods. Think sprinting uphill for a minute or doing as many pushups in a row as you can until you collapse from exhaustion. After a short interval of high intensity, you can rest for a minute or so before you jump right back into another high intensity session. Typically 10-20 minutes of these intervals are all you need to increase your fitness and drive weight loss. While this is a welcome change from 60 minutes on the treadmill, 15 minutes of HIIT can sometimes feel like an hour.
Those patients who are older, or suffer from orthopedic limitations, should select workouts from the lower intensity side of the spectrum like walking outside, or on an elliptical or treadmill, the StairMaster, Zumba or aerobics classes, or weight machines. However, even if you are limited by your age, low level of fitness, or orthopedic injuries, with a little patience you can usually work your way up to be able to participate in yoga classes. Yoga offers particular advantages over other lower intensity exercise techniques. First, it works more to increase your strength than the other exercises. Second, it is one of the safest forms of exercise when performed properly. Finally, it offers a guiding philosophy that enthusiasts find helpful in managing stress which we’ve already described as a major contributor to weight gain.
In fact, exercise may be the only reasonable treatment for chronic stress. Medications are largely ineffective and indulging in food, alcohol, drugs, or tobacco typically worsen stress in the long run, rather than relieve it. I always challenge patients who are having difficulty meeting their weight loss goals due to stress to use exercise. Not as a method for losing weight, but as a way to relieve stress. There are very few problems that aren’t improved by 30 minutes of exercise.
The most important reason to exercise is not for its assistance in weight loss. In fact, very few women over 35, or men over 45, are able to drive significant weight loss through exercise. And, while younger people are able to succeed using high intensity workouts, this weight loss is typically short lived unless it’s also accompanied by significant nutritional changes as well. Patients who rely on exercise as their primary mode of weight loss are one injury away from regaining every pound. So if this is true, why should we bother with exercise at all? The primary reason that we should exercise is not to drive weight loss, but to help maintain our weight loss over the long run. This point is critical and will be discussed in more detail in further chapters about the critical importance of lifestyle change after surgery.