June 1, 2026, 11:46 am | Read time: 4 minutes
On Thomas Kälicke’s operating table, many people end up who have made a well-intentioned but ill-considered return to sports. Many of them weigh 120 kilograms or more. With excess weight, the mechanical stress on joints and tendons is extremely high. The surgeon and orthopedist explains the training he recommends to help overweight patients avoid returning to the clinic.
I Keep Seeing the Same Pattern
In my daily life as a surgeon and orthopedist, I keep seeing the same pattern: Highly motivated people want to jump back into action after a long break. They play badminton, soccer, or basketball for the first time in years. And then comes the sentence I hear almost daily: “During the first sprint, there was a sudden snap.” At that moment, the Achilles tendon ruptured.
The reason, which most affected individuals completely misattribute—they usually suspect arthritis—is simple but fatal: The fit muscle performed at a level that the untrained tendon was not yet structurally prepared for.
The 120-Kilogram Challenge: Understanding Mechanics
For clients starting at 120 to 150 kilograms, this situation becomes significantly more severe. Every additional kilo increases the mechanical stress on joint capsules, ligaments, and tendons. Often, individuals interpret the first pains in the knee or elbow as “arthritis” and believe their body can no longer handle the sport. But in most cases, it is not joint wear but a classic overload of the soft structures, which simply need more time to adapt.
My Coaching Approach – Step 1: Zone-2 Training
To avoid returning to the clinic, I start extremely conservatively. In the first few months, the focus is almost exclusively on moderate endurance training in the so-called Zone-2 area. I choose the intensity so that one can still converse easily.
It may seem unspectacular, but it brings about essential improvements:
- The mitochondria—our cell powerhouses—become more efficient.
- Heart pumping capacity and maximum oxygen uptake (VO2max) improve.
- Most importantly, it gives tendons the time they crucially need to adapt to the high body weight!
Step 2: Smart Strength Training – Technique Before Intensity
From the age of 30, we continuously lose muscle mass without training, which can lead to falls and dangerous fractures in old age. The medical reality is drastic: Falls often lead to hip fractures, which for many are the beginning of a negative cascade—immobilization, need for care, and death. About 20 to 30 percent of patients die within a year after such a fracture.
Strength training is therefore essential. But at the beginning, clean movement is key, not maximum weight. We choose control over exhaustion. Even if the visual progress in muscle seems slower at first: We are primarily training for the resilience of the tendon structure. Only when this foundation is established do we follow with intensive sessions like HIIT (High-Intensity Interval Training).
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The Secret Factor: Stretching for Structure
A crucial, often underestimated factor is stretching. A brief 20-second loosening only reaches the muscle. To truly change the tendon tissue, stretching positions must sometimes be held for minutes. Professional athletes have internalized this principle. In recreational sports, it is the key to combating tendons that have become stiffer over the years.
Why do tendons become stiff over the years?
Young tendons are slightly springy and resilient. But over time, sugar residues from the blood accumulate on the collagen fibers, which mainly make up tendons. This process, called “glycation,” makes them stiff. Stretching counteracts this.
Patience as an Investment in Your Own Autonomy into Old Age
A high VO2max value and good muscle strength are the most important factors for lower mortality and a longer healthy lifespan. But the path there leads through structure. Successful training is not based on what feels good for the muscle in the short term, but on what the tendon needs. Those who give their body this time at the beginning will later be rewarded with real performance and autonomy—perhaps even into old age.
About the Author: Prof. Dr. med. Thomas Kälicke is a specialist in surgery, orthopedics, and trauma surgery with additional qualifications in special trauma surgery, hand surgery, and physical therapy. In early 2011, at the age of 38, he became chief physician at the GFO Clinics Bonn. Since 2025, he has also been the chief physician of general surgery at CURA Hospital in Bad Honnef. In addition to his clinical work, he has been advising and accompanying people who want to change their lifestyle and stay healthy in the long term for many years. As a sought-after speaker, he conveys scientifically sound insights into longevity in an understandable and practical way. He is the author of the book “LNGVTY – LÄNGER – BESSER – LEBEN.”