Does anyone have suggestions/comments about training a client who has bipolar disorder?
I took on a new client a few months ago. She had been doing well with her meds and I obtained a medical clearance from her Drs. before starting with her. She has been a great client and making great progress- 2# fatloss per wk on average. After loosing 15 lbs, I started noticing a change in her emotionally. I'm not sure what to expect from here. Does anyone have any suggestions on how to modify her program to keep her motivated to exercise as she goes through this downswing?
You may need to have a goal of maintaining his or her current fitness level, until your client’s mood levels off. Any exercise is positive and in some cases, just getting them to the gym is an accomplishment. Try highlighting each of his or her efforts and promote positive self-talk. Depression causes an individual to focus on every little negative aspect in his or her life.
Structure is crucial to combat depression and you may need to call your client an hour before the training session to make sure that he or she is coming to train. On days that the client is working out by his or herself, you might want to shoot your client an e-mail or text, in order motivate him or her to workout. In addition, to help your client get to the gym, you may suggest that your client plans on driving to the gym with a friend.
Be aware that sometimes a medication change is needed and many mood-stabilizing medications can cause significant weight gain. These medications can increase appetite and slow down the metabolism. It might be appropriate to have your client keep track of his or her weight and watch for any sudden increases. In this situation, nutrition should be re-evaluated and you may want to suggest a nutritionist. In addition, food and hydration can play a vital in mood. In times of stress, people tend to neglect the basics.
Lastly, it is important to be patient and listen to your client. Some days your client might need a friend, while on other days, you will be able to push your client fairly hard. Be aware that bipolar can cause manic-depressive states, which can cause a person to be agitated and have racing thoughts. In this situation, try not to take your clients response personal. It is crucial to be understanding and have an open mind.
On an additional note, consider yourself part of the treatment team and offer to call your client’s doctor or therapist to determine how you can be most helpful. I strongly believe that open communication between treaters is not utilized enough, which would allow for a higher rate of success.
I hope this information helps and feel free to e-mail me if you have any further questions.
Alex C. Wisch
I notice that you are an ACSM HFS.
As a fellow ACSM certified professional, I find the resources published by ACSM to be invaluable.
Have you looking into the third edition of ACSM's Exercise Management for Person's With Chronic Diseases and Disabilities?
There is a chapter dedicated to mental illness.
That might be a good place to start.
I trained a client for over 12 years diagnosed with this challenging disease. She would have great weight loss and then great weight gain. She would have great mood and motivational swings as well. We used to laugh together about her losing over 100 pounds. It was my observation that the weight loss was during period of good emotional balance, and even high emotions, conversely, the weight gain was in her periods of depression.
Even adhering to meds does not guarantee balance. Over the years her meds were changed, often for new and better ones, and often for chemical adjustments.
While any client can become dependent on her trainer, or have ups and downs, clients with this disorder may have more intense responses on either end of the motivational spectrum.
All the best
2. When dealing with a client like this, see if they have a psychologist. Do not be afraid to make contact with other professionals. If you call them up and say "We share a client, I want to know how to best help them" they should be more than willing to help.
I should add a little personal experience as well. When I first started training, it was just a fun way to spend time with my boyfriend, following him around the gym and doing as he instructed. I was engaged and challenged and felt proud when I was able to complete the tasks he thought would be difficult for me. Exploit this process.
During the manic phases, I would take on any challenge he threw my way with flying colors, and the gains I made were enough to keep me dedicated during my depressions. I worked so hard and made so much progress that even though I felt like crap, I wouldn't blow my diet (too much), or skip too many workouts because I could see the bigger picture.
Try to exploit those manic episodes and during a depression, it's can be okay to pester your client - just to let them know someone cares. It's difficult lying in bed feeling like a failure. You can keep calling or texting - just keep a convo going - so that maybe they will come out of their funk that day for a bit, and get a little gym in, or a run, or... Be stern, hold them accountable without making them feel guilty, and you will see results (often, not 100% of the time of course).
We are used to people walking on egg shells because of our conditions. Keep it about the fitness and the goals and challenge them to beat their old scores and they just might get up and fight.
Thanks guys, keep on these folks, they have so much to offer when they feel good about themselves!