I am 65 years old and had the sleeve 2 years ago. Sagging skin is a bit of an issue, but I have been doing Water aerobics for the past five years. This has helped with muscle toning. I swim three nights a week. I alternate between shallow water jogging with weights and deep water aerobics. Swimming has also helped me keep the 90+ pounds I lost off. I would like to lose at least 10 more pounds, but I know that will be slow going.