How to Find Your Target Heart Rate

Most experts agree that low- to moderate-intensity workouts are best for weight loss.

“For overweight or obese adults trying to lose weight, we recommend at least 200 to 300 minutes a week of moderate-intensity aerobic activity,” says Gary B. Korus, MD, FACS, member of the Penn Metabolic and Bariatric Surgery team. “It’s also good to get two days of strength training exercise per week.”

The intensity of a workout depends on how hard your heart is working. To learn how intense your workouts should be, you need to know your target heart rate.

Your target heart rate can be found with this equation:
220 – Your Age = Maximum Heart Rate

For example, if you are 50, your target heart rate is:
220 – 50 = 170

Be aware this serves only as a guide and applies to healthy people.  Consult your health care professional to determine the appropriate heart rate for you.

How to Take Your Heart Rate

It’s easy to take your heart rate while working out.

One way to do this is to wear a heart rate monitor. A heart rate monitor uses a strap on your chest, and tracks your heart beats while sending them to a receiver you wear on your wrist like a watch. Some heart rate monitors allow you to input your height, weight and age to get the most accurate exercise and heart rate recommendations.

For a lower-tech alternative, you can take your pulse at your wrist. Rest your middle and index fingertips lightly on the opposite wrist, directly below the base of your thumb. Count the beats for one minute, or, for 30 seconds and multiply that number by two.

Working out at your target heart rate

Now that you know your target heart rate, and how to take it,  you can calculate where your heart rate should be while working out at different intensity.

Low-Intensity Workouts

Low-intensity workouts stay within 60 to 65 percent of your target heart rate.

So, if you want a low-intensity workout and you are 50 years old, use this calculation:

170 x .60 = 102
170 x .65 = 110

This means that while working out, your heart rate should be between 102 and 110 beats per minute.

If you are working out at a low intensity  you should be able to breathe easily, or sing while exercising.

Some examples of low-intensity workouts include:

• Walking for 30 minutes
• Biking for 30 minutes
• Taking a low-impact aerobics class for 45 minutes

Moderate-Intensity Workouts

Moderate-intensity workouts stay within 65 to 75 percent of your target heart rate.

So, if you want a moderate-intensity workout and you are 50 years old, use this calculation:

170 x .65 = 110
170 x .75 = 127

This means that while working out, your heart rate should be between 110 and 127 beats per minute.

If you are working out at a moderate intensity you should be able to speak in sentences while exercising.

Some examples of moderate-intensity exercises include:

• Walking two miles in 30 minutes
• Biking four miles in 15 minutes
• Going up and down stairs for 15 minutes
• Doing water aerobics for 30 minutes
• Shooting baskets for 30 minutes
• Jumping rope for 15 minutes

High-Intensity Workouts

High-intensity workouts are workouts that stay within 75 to  80 percent of your target heart rate.

So, if you want a high-intensity workout and you are 50 years old, use this calculation:

170 x .75 = 127
170 x .80 = 136

This means that while working out, your heart rate should be between 127 and 135 beats per minute.

If you are working out at a high intensity  you should be able to speak only in short phrases. Most high intensity workouts can only be maintained for short periods of time.

Some examples of high intensity workouts include:

• Running for 15 minutes
• Biking uphill for 10 minutes
• Swimming for 45 minutes
• Interval training for 30 minutes
• Jumping rope for 10 minutes

Ready to kick off your exercise routine? What will you do to get started?

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Exercises for People With Knee Pain

It’s a dilemma many overweight people face: They want to exercise, but their knees or other joints hurt too much to do anything strenuous.

Rather than get caught in cycle of not exercising because your knees hurt  and your knees hurt because you are not exercising, here are some exercise ideas for your aching knees.

Spinning® / bike riding

Any activity that takes pressure off of your knees and back is a great exercise. When you are fitted properly for a bike and ride in a safe, correct way, your knees are protected. That’s because most of the weight falls on your seat – not on your knees like in walking or running. And, if you’re wearing special shoes fit for your body, they can help center the pressure on the ball of your foot and take the pressure off of your knees.
Pros: Spinning classes are easy to join in and follow.
Cons: Bike equipment can be expensive, need to join a gym for classes.

Swimming / water aerobics

If you think swimming and water aerobics is for sissies, think again! Water exercises are extremely beneficial because the water acts as natural resistence to your body. When you work out in the water, your body is tasked to push against that resistance and build muscle. At the same time, the water makes you buoyant and takes pressure off of your joints.  This is why so many fitness experts refer to swimming as the perfect aerobic exercise.
Pros: An all-around great excercise for cardiovascular and muscular strength, easy on joints,
Cons: Must have access to a pool.

Walking

Most experts agree that walking is one of the best forms of exercise. You can do it anywhere, it costs nothing but a good pair of shoes and you can do it in any climate. When beginning a walking program, start slow – walk only 20 to 30 minutes at a time, three to five times a week. Gradually build up endurance by walking longer and more frequently.

And if your knees are aching, visit a shoe store that offers shoe-fitting consultation. Finding the right support and cushion can help minimize your knee pain.
Pros: Can walk anywhere – no gym needed!
Cons: Must invest in a good pair of walking shoes.

Do you suffer from knee pain? What exercises have you found to be "nice to your knees?"

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Prevent Weight Gain After Weight-loss Surgery

Many people who have weight-loss surgery are excited at the new opportunities for them post surgery. They imagine a life without medical conditions associated with obesity and are ready to begin living without the extra weight.

They are also concerned about the possibility of gaining weight back post surgery.

Unfortunately, over time some people do regain the weight after weight-loss surgery. Therefore, to achieve optimal weight-loss results, it is important to follow the nutritional guidelines provided post-surgery as a part of your new lifestyle.

To prevent weight regain after weight-loss surgery patients must follow a healthy diet plan with the focus on whole foods and continue to follow the guidelines for eating after surgery. Suggestions to stay on track include:

• Eat lean proteins, whole grains, low-fat dairy, fruits and vegetables.
• Avoid foods containing more than 15 grams of sugar per serving.
• Select foods low in fat.
• Track protein intake and get at least 60 to 80 grams/day. Protein containing foods will help keep you full and satisfied.
• Making time to eat, at least 3 times a day. Eating slowly (20 to 30 minutes/meal) is also very important.  
• Make sure your fluid needs are met with 48 to 64 ounces of low or non-calorie beverages.
• Separate eating and drinking by 30 minutes. This is a primary diet principle that must be continued. 
• Continue to take suggested multivitamins and mineral supplements on a daily basis.
• Exercise 250 to 300 minutes per week. This level of activity plays an import role in the maintenance of weight loss.

Poor food choices

In some cases, people who resume eating foods high in fat or sugar regain weight or experience minimal weight loss following weight-loss surgery. Therefore, to achieve optimal weight-loss results, it is important to follow the nutritional guidelines provided post-surgery as a part of your new lifestyle.

Foods to avoid include:

• Milk shakes, malt drinks and all high-calorie liquids
• Cakes and pastries
• Fried foods
• Pudding
• Chips and other high fat snack foods
• Soft drinks
• Ice cream
• Candy

You can also find many healthy recipes after weight-loss surgery on this blog.

Learn more about weight-loss surgery at Penn by attending a free information session about weight-loss surgery.

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Alcohol After Weight-loss Surgery

People considering weight-loss surgery often ask if it is possible to safely incorporate alcohol into a healthy diet and lifestyle after surgery. The short answer is “yes,” but gradually and with modifications.

Here’s why:
       
Altered metabolism
Research shows that blood alcohol levels peak higher and faster and take longer to return to normal due to altered metabolism after gastric bypass surgery. In addition, many post-surgical patients consume less food when they’re drinking alcohol, which contributes to expedited absorption of alcohol in the blood stream. For many post-surgical patients, all it takes is a single drink to elevate blood alcohol level to the point of legal intoxication. This is important to remember for maintaining a healthy diet and before getting behind the wheel.

Low blood sugar
Rapid weight loss and low carbohydrate intake can lead to reduced sugar or glycogen in your body. Alcohol consumption further depletes glycogen, which causes your blood sugar levels to drop, putting those who have had bariatric surgery at higher risk for developing low blood sugar.

Hypoglycemia, or low blood sugar, is a dangerous condition that can lead to loss of consciousness, brain and nerve damage or even death if left untreated. As a result, it’s important to be on the lookout for symptoms, which include loss of coordination and balance, slurred speech, poor vision and confusion.

If you experience symptoms of hypoglycemia, drink diluted juice or take a glucose tablet immediately to raise your blood sugar level, and then have a snack with complex carbohydrates and protein to sustain it. If hypoglycemic episodes occur frequently even without alcohol consumption, make sure you seek proper medical treatment.

Excess calories
Alcohol is high in calories and low in nutrients, which is why excess calories from alcohol can slow weight loss or even contribute to weight gain. 

Addiction transfer
Patients with a history of addiction are at higher risk for developing a new addiction. With the dramatic reduction of food consumption after bariatric surgery, some patients may trade their food addiction for other addictive behaviors, including drugs, shopping, gambling, sex and alcohol.

Guidelines for drinking:
Follow these guidelines to re-introduce alcohol without compromising your commitment to a healthy lifestyle after weight-loss surgery:

• Avoid alcohol for the first six months after bariatric surgery.
• When you get permission to start drinking alcohol again, avoid carbonated beverages and sugary drink mixers. 
• Remember that after surgery, even small amounts of alcohol can cause intoxication and low blood sugar. 
• Never drink and drive, even after consuming only minimal alcohol. 
• Only drink with meals or while eating to help slow absorption of alcohol. 
• Be aware of the calorie content of alcohol.
• If you find yourself drinking regularly to cope with emotions or stress, seek help by consulting with your doctor.

- Cara Stewart

Cara Stewart, RD, LDN, is a member of the Penn Metabolic and Bariatric Surgery team.

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Healthy Take on a Coastal Classic: Crab Cakes and Spicy Mustard Sauce

Celebrate the last couple weeks of summer with crab cakes that won’t break the bank — or your diet. Rather than ordering expensive, high-fat crab cakes at a restaurant, you can save money and make this healthier version at home.

The recipe uses panko breadcrumbs to provide a crispy but airy outer texture. You can also use light mayonnaise to reduce the fat content.
So, enjoy this healthy, flavorful and economical coastal classic before summer officially sets sail.

Nutritional Information 
Amount per serving

• Calories: 404
• Fat: 23.7 g
• Saturated fat: 3.1 g
• Monounsaturated fat: 13.5 g
• Polyunsaturated fat: 5.4 g
• Protein: 2 g
• Carbohydrate: 16.3 g
• Fiber: 1.2 g
• Cholesterol: 219 mg
• Iron: 1.6 mg
• Sodium: 670 mg
• Calcium: 149 mg

Ingredients
Crab cakes

• 1/3 cup red bell pepper, chopped
• 2 tablespoons mayonnaise
• 1/4 teaspoon kosher salt
• 1/4 teaspoon black pepper, freshly ground
• 2 green onions, chopped
• 1 large egg, lightly beaten
• 1 large egg yolk, lightly beaten
• 1 1/3 cups panko (Japanese breadcrumbs), divided
• 1 pound lump crabmeat, drained and shell pieces removed
• 2 tablespoons olive oil, divided

Sauce

• 2 tablespoons mayonnaise
• 2 tablespoons reduced-fat sour cream
• 2 teaspoons fresh parsley, chopped
• 2 teaspoons Dijon mustard
• 1 teaspoon white wine vinegar
• 1/8 teaspoon red pepper, ground

Preparation

1. Combine the first seven ingredients. 
2. Add 1/3 cup panko and crab; toss gently.
3. Divide crab mixture into eight equal portions; shape each into a 3/4-inch-thick patty. Place remaining panko in a shallow dish. Gently dredge patties in panko.
4. Heat a large skillet over medium-high heat. Add one tablespoon of oil to pan. Add four crab cakes to pan; cook for four minutes on each side. Remove from pan; keep warm. Repeat procedure with remaining oil and crab cakes.
5. Combine remaining ingredients; serve with crab cakes.

This recipe is courtesy of Vanessa Pruett, Cooking Light (September 2011).

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3 Weight-loss Plans That Work

Juicing, fasting, low-carb, high-fat… Have you tried everything to lose weight?

“It seems like every few months, another book comes out that spurs a diet trend,” says Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team. “Weight loss comes down to one thing: creating a calorie deficit by eating less and being more active."

A plan may help some people stay on track. Are you one of them? Then read below for three weight-loss plans that might work for you.

Weight Watchers®

Weight Watchers uses a points system to track food, calories and exercise. Founded in 1963, Weight Watchers has outlasted every fad diet by allowing you to eat anything you want, as long as you stay within your daily point allotment.


“The new Weight Watchers Point Plus program encourages the selection of nutrient-rich foods that are low in calories,” says Buzby.  “Fresh fruit and non-starchy vegetables are unlimited on the new plan. It is these fiber containing foods along with lean proteins that promote a sense of fullness and a healthy slow weight loss.”

One thing Weight Watchers offers that some other plans do not is weekly meetings.

“The weekly Weight Watchers meeting is a great way to hold yourself accountable for what you’ve eaten the previous week,” says Buzby. “It’s also a great time to get peer support from other people trying to lose weight.”

Pros: Points system makes it easy to know how much you are allowed to eat, meetings provide support, online tools.
Cons: Cost – monthly fees can vary depending on how you want to pay.

The Biggest Loser® Diet

Made famous by NBC’s reality show “The Biggest Loser,” this plan is modeled after the same diet and lifestyle changes the show participants follow. The diet and exercise guidelines are straight forward: the calorie controlled meal plan focuses on eating small frequent meals of whole foods and the exercise plan emphasizes starting a cardio and a strength training program.

“If you follow the Biggest Loser guidelines, yes, you will lose weight,” says Buzby. “The problem for many of us is that without a personal trainer it may be hard to stay motivated to exercise 60 minutes a day.”

The Biggest Loser books tell inspirational stories from people who have been on the show as well as give guidelines for implementing the diet and exercise plans.

“Online support is available to help you stay motivated and reach your goals,” says Buzby.

Pros: Inspirational, balanced diet and exercise plan that includes healthy foods.
Cons: Weight loss will most likely be slower than the results achieved by TV contestants.

The DASH Diet for Weight Loss

The Dietary Approaches to Stop Hypertension (DASH) Diet was originally developed to help people make dietary changes to lower their blood pressure.  However, following the DASH  diet’s calorie guidelines can also help promote slow and steady weight loss.  The diet is based on an eating plan that focuses on fruits and vegetables, balanced with protein and low fat foods.  The book, The DASH Diet Action Plan, provides calorie adjusted menus and shows you how to implement the plan.

“Research studies show this diet has heart-healthy benefits, lowers the risk of certain diseases and improves health. “I like this plan because it is a healthy, nutritious diet that the whole family can enjoy,” says Buzby.

Pros: Diet based on tasty foods that promote fullness and improves health.
Cons: The primary focus is on heart health and reducing hypertension lower, calorie levels may be needed for weight loss in some individuals.

What diets have you tried? Which ones have worked for you?

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Preparing and Recovering from Weight-Loss Surgery

Samantha Warner-Grimsley, RN, CBN, member of the Penn Metabolic and Bariatric Surgery team, explains how the team at Penn Medicine helps patients prepare and recover from weight loss surgery. 

Preparing people for weight-loss surgery and the lifestyle adjustments that are necessary after surgery are crucial components for long-term weight loss. That is why the Penn Metabolic and Bariatric Surgery team helps prepare you for your weight-loss surgery and then assists in your recovery so you can quickly get on track for achieving your weight-loss goals.

All patients scheduled for bariatric surgery at Penn Medicine attend a nutrition class approximately two weeks before surgery. The purpose of the class is to prepare you for the post-surgical dietary changes that are necessary for successful weight loss. 

During the class, a nurse reviews important information about your surgery and post-operative care. Knowing what to expect during and after surgery can help reduce anxiety and promote well-being during the recovery phase. The nurse also addresses any concerns or problems that you may have.

To bridge the transition from hospital to home, the Penn Metabolic and Bariatric Surgery team offers homecare or visiting nursing services for people who have had gastric bypass and gastric sleeve surgery. These services provide you with the expertise of a professional health care provider within the comfort of your own home, acting as a liaison between you and the bariatric surgery team.

Even with homecare services after bariatric surgery, health care professionals only come to your home for prescheduled visits. Therefore, it is important that you are aware of symptoms that can signal post-surgical complications and know when you need to contact your surgeon.

If you experience any of the following symptoms, call your bariatric surgeon’s office immediately:

• Fever greater than 101 degrees
• Severe pain
• Persistent nausea
• Vomiting
• Wound redness or drainage
• No bowel movement within three to four days after surgery
• Inability to consume adequate liquids
• Inability to tolerate your medications

When you make the decision to have bariatric surgery, you’re making a life-long commitment to a healthier you. A vital part of that commitment includes follow-up care. Regular visits with your bariatric surgery team, including the surgeon, nurse practitioner and dietician, can help you achieve and maintain long-term weight-loss success.

- Samantha Warner-Grimsley, RN, CBN

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