The journey following a vertical sleeve gastrectomy (VSG) involves significant changes, and integrating physical activity is a necessary step for achieving long-term weight management and metabolic health. Exercise helps preserve muscle mass and optimize body composition as rapid weight loss occurs. The safe timeline for resuming physical activity is not a fixed schedule but a progression dictated by surgical recovery, making medical clearance from your bariatric surgeon the single most important factor before advancing any exercise routine.
Immediate Post-Surgery Mobility (Days 1–Week 2)
Movement begins almost immediately after the procedure, focusing on safe recovery and minimizing complications. Gentle walking is encouraged within the first 24 hours post-surgery to stimulate circulation and prevent blood clots (DVT). This initial activity is often restricted to short walks around the hospital room or house, prioritizing frequency over duration. Even a few minutes of movement several times a day is beneficial in this earliest phase.
The primary restriction during this time is avoiding any strain on the healing incision sites. Patients must not lift anything heavier than five to fifteen pounds (roughly the weight of a gallon of milk). Straining or lifting too much can place undue pressure on the abdominal muscles and internal surgical staples, significantly increasing the risk of developing an incisional hernia. The goal is simply to maintain basic mobility and promote healing, not to exert effort or build fitness.
Gradual Reintroduction of Aerobic Activity (Weeks 3–6)
Around three weeks, once surgical wounds are stable, you can begin low-impact aerobic activity. This phase focuses on building endurance without jarring the body or aggressively engaging the core muscles. Safe activities include stationary cycling, using an elliptical machine, or increasing the pace and duration of brisk walking. Swimming is also an excellent low-impact option, but submersion must be delayed until all incisions are fully closed and cleared by the surgeon (often four to six weeks) to prevent infection.
Monitoring intensity is best done using the Rate of Perceived Exertion (RPE) scale, rather than relying on heart rate maximums. Rapid weight loss and nutritional changes can alter the body’s response to exercise, making heart rate data less reliable. Aim for an RPE of about 12 to 14 on the Borg scale, which feels “somewhat hard,” allowing you to hold a conversation but making it challenging. This ensures you build cardiorespiratory fitness without overexerting the healing body.
Integrating Resistance and Core Training (Week 6 Onward)
The most significant shift occurs around six to eight weeks post-surgery when the body is healed enough to begin structured resistance training with surgeon approval. Resistance training is necessary because rapid weight loss can lead to a loss of lean muscle mass. Resistance work helps signal the body to preserve and build muscle, which is metabolically beneficial for long-term weight maintenance.
The initial focus should be on light weights and higher repetitions (two to three sets of 12 to 15 repetitions) to build muscular endurance before increasing weight. Begin with bodyweight exercises, like wall push-ups or gentle lunges, then progress to machine weights, which offer greater stability and support. Free weights can be incorporated later, once foundational strength and control have been established.
Core work requires particular caution due to the location of the surgical incisions. Aggressive abdominal exercises like traditional sit-ups or crunches should be avoided for a longer period (often eight to twelve weeks or more). Initial core training should involve gentle, static activation, such as pelvic tilts or short planks, to re-engage the deep stabilizing muscles without placing excessive strain on the healing tissue. Delaying intense core exercises minimizes the risk of a hernia at the incision sites, which remains a concern until full internal healing is complete.
Recognizing Warning Signs and Hydration Needs
Throughout all phases of post-operative activity, recognizing warning signs and maintaining hydration are paramount for safety. Any sharp, shooting pain in the abdomen, especially near the incision sites, requires immediate cessation of the activity and consultation with the care team. Other red flags include excessive incision discharge, fever, or a rapid, irregular heart rate that does not recover quickly after stopping exercise.
Dehydration is a constant risk after VSG because the reduced stomach capacity makes it difficult to consume large volumes of fluid at once. Exercise, which increases fluid loss through sweat, compounds this challenge. You must sip fluids frequently before, during, and after activity, aiming for small, measured amounts. Signs of dehydration include dark urine, persistent dry mouth, lightheadedness, or feeling dizzy when standing up. If activity lasts more than 40 to 60 minutes, a sugar-free electrolyte beverage may be necessary to replace lost minerals.