Answers (10)
1
The more deconditioned people are, the more important it is to get the first few weeks of exercise right. The underlying psychology of obese clients’ beliefs about exercise is as important as the physiology of obesity. Typically, weight loss is the main goal—bordering on an obsession. My exercise programs for this type of client proceed from two main objectives: (1) to use what they already have in order to (2) change their expectations of what they will experience with exercise. Usually, with a weight loss goal for severely obese individuals, the emphasis is on endurance training. In my opinion, this emphasis is a mistake. When people weigh several hundred pounds, they commonly lack endurance. [Considering] the possible embarrassment from performing poorly on even small amounts of aerobic activity, a different approach is in order. Obese clients possess surprising levels of strength in exercises relating to everyday movements. The need to carry around significant body mass in day-to-day life naturally develops a certain degree of strength in the absence of any structured exercise program. My programs for obese clients focus primarily on strength exercises that mimic everyday movements and on very limited amounts of endurance activities. “Feel better first” is my driving concept in program design. I want clients to feel better in their bodies and enjoy a more capable day-to-day movement experience. Once you provide that, their abilities and their outlook on exercise often improve, and the likelihood of program adherence goes up. By using the strength they already possess on exercises like squats, lunges, upper-body pushes and pulls, they experience greater self-efficacy. I also introduce body awareness exercises to reconnect them with what is “under their head,” as they’ve often lost track of it! This frequently involves exercises where their aim is to prevent movement (stability) while I apply a gentle external force. If necessary, I will avoid putting them on the floor if this is overly difficult for them. For endurance activity, whatever they can do at first is enough for me. If they can walk only for a few minutes initially, I’m fine with that. A few minutes are the stepping stone to 5 minutes and beyond. Overreaching in this area provides a negative physical and mental experience during the early days of a program. Progressions are added in small increments in the first few weeks and then in larger steps later on, after those essential first few weeks are over. At this point, the program can begin to look more like a traditional program.
0
I think of three important areas when working with severely obese clients. First are behavioral change and goal-setting objectives. Second are the psychological concerns regarding the training environment. Third are the cardiovascular training principles of frequency, intensity, duration and modality (FITT Principles). Core exercises are equally important in the initial training period as clients often have a “disconnect” between their abdominal and back muscles and their importance to structural integrity in maintaining a fitness program. Behavioral change and goal setting are the first tools that I use. Obese clients need to see what they are doing well and what they want to improve. If their goals are specific, and if they write out barrier prevention strategies before initiating exercise, then they will be better able to visualize their goals and be motivated to work toward them. I keep core exercises to four initial exercises that improve postural integrity: modified front planks, glute bridges, bird dogs and back extensions. While getting down and up from the floor is an essential life skill, initially I work with clients on a surface that is above ground level so that they become more confident. I use a Pilates rehab reformer for their core and resistance training, as the carriage is 22.5 inches off the floor and 24 inches wide. This strategy helps them feel comfortable with the exercises because they don’t feel like their bodies are too wide for a weight training bench, and they don’t have to get up from the floor. Before I begin their fitness programs, I complete a thorough health screening, seeking information on injuries, equipment likes/dislikes and risk-factor identification. From this set point, the objective is to increase cardiovascular endurance to reach the minimum of 150 minutes a week by the second week of cardiovascular training. To maintain interest and variety, I recommend three 15-minute periods three times a week on the treadmill, recumbent bicycle and rower or arm ergometer (arm cycling) machine. Blood pressure is taken pre- and postworkout to monitor improvement and to provide automatic feedback on the benefits of exercise. Endurance is built up over the first 2 weeks so that clients gain confidence, muscular strength and self-esteem from their accomplishments. My goal for them is to complete the workouts thinking they could have done more and eager to come back, until the desire for exercise as a lifestyle modification is established. Pedometers are an invaluable tool for monitoring physical activity outside of the structured training environment because they provide measurable feedback. I ask clients to increase their total steps by 50–100 steps every day until they reach the 10,000 steps/day goal. Gradually increasing the steps they take motivates clients and is something they can do with friends, co-workers and family members. Once they accomplish 150 minutes a week in the gym, they increase the duration spent on each cardiovascular setting until they can maintain a minimum of 30 minutes of consistent heart rate intensity on each piece of equipment. Once duration goals are met, we increase frequency to a minimum of 4 days a week, preferably 5. Only after duration, frequency and modalities are all monitored, and physical responses (heart rate, skeletal and muscular) are observed, do we increase intensity. Remember that many severely obese clients may have muscular/skeletal concerns due to [excessive] weight. Overuse symptoms may occur sooner than with clients of lower weight. The knees, hips and back are primary areas of concern. Obese clients are often initially afraid and unwilling to watch their form in a mirror while working out. In resistance training, they turn sideways or turn away from the mirrors all together. However, after they improve self-confidence, they begin to see their bodies as amazing, functioning assets. Then they will independently turn to face the mirrors, watching their bodies and checking form. When I see this magic “a-ha” moment of taking ownership and becoming awakened to the beauty of their bodies, I know they have made that next big leap into their level of wellness.
0
Each client, obese or not, has a unique personal background, as well as exercise, injury and psychological profiles. Until these factors are considered, you can’t create the most effective approach and program for obese clients. Determining the psychological triggers of severely obese clients is the most important factor in helping them create lifelong change. All the exercise in the world will not create long-term change unless clients have dealt with the personal, professional, lifestyle and social factors that led them to put on so much weight. While trainers must be careful to stay within their scope of practice and not offer “counseling” services, having clients “open up” and share their feelings, fears, concerns and frustrations with you will provide valuable insight into their mindset and the psychological barriers they are facing. Depending on the client and situation, working with a psychologist or qualified counseling professional can help overcome these barriers. Anybody can make someone sweat for a few training sessions, but the true change comes from connecting with clients’ “hot buttons” and motivational triggers. Until this happens, the behavior change will be subject to myriad external factors and interference. Clients can hire the world’s best trainers and nutritionists and follow the most customized programs ever made, but if psychological, social or physical barriers are stopping clients from actually following the program, then the work and effort are wasted. Figure out what makes [your clients] tick, and you will have the key to creating virtually any change they want. From an exercise standpoint, severely obese clients vary as much as nonobese clients in ability levels and modifications that are needed. While there are some specific modifications necessary because of sheer size, it generally isn’t the size as much as the movement skills of the client that determine the greatest modifications needed. I’ve worked with some obese people who have better movement skills than some fit-looking clients. A lot of it has to do with exercise history, current or previous injuries, medical conditions and psychological perspective on exercise and health.
0
Sandi, it is so very important that we as fitness professionals work within the scope of practice of the credential that we possess in addition to applying the researched and evidenced based guidelines that truly facilitate exercise prescription and program design.
However, to answer your question, it is important that the fitness professional have experience working with populations that present with clinical conditions and in the case of the severely obese this would mean having experience working with the severely obese. It is important to acknowledge that obesity is a disease.
From my perspective it not wise to work with this population if one doesn't understand the pathophysiology of obesity, recommendations for exercise testing, recommendations for exercise programming, exercise response, effects and special considerations of this disease called obesity. One must also know and understand the different classes of obesity as it relates to disease risk for type two diabetes, hypertension and cardiovascular disease. Does the fitness professional understand who is classified as severely obese?
Hence, having said the above a good place to start is:
1. Being prepared. This would require that any fitness professional who is working with the population you highlight in your question--the severely obese, question themselves and ask themselves if they are prepared to work with this population or should they refer him or her to a clinical exercise specialist.
2. Collaborate with other allied health professionals such as your client's physician, their endocrinologist if necessary and their certified diabetes educator.
3. Educate yourself regarding current exercise guidelines as far as working with the severely obese population.
However, to answer your question, it is important that the fitness professional have experience working with populations that present with clinical conditions and in the case of the severely obese this would mean having experience working with the severely obese. It is important to acknowledge that obesity is a disease.
From my perspective it not wise to work with this population if one doesn't understand the pathophysiology of obesity, recommendations for exercise testing, recommendations for exercise programming, exercise response, effects and special considerations of this disease called obesity. One must also know and understand the different classes of obesity as it relates to disease risk for type two diabetes, hypertension and cardiovascular disease. Does the fitness professional understand who is classified as severely obese?
Hence, having said the above a good place to start is:
1. Being prepared. This would require that any fitness professional who is working with the population you highlight in your question--the severely obese, question themselves and ask themselves if they are prepared to work with this population or should they refer him or her to a clinical exercise specialist.
2. Collaborate with other allied health professionals such as your client's physician, their endocrinologist if necessary and their certified diabetes educator.
3. Educate yourself regarding current exercise guidelines as far as working with the severely obese population.
0
We must definitely start slowly and carefully with them then gradually increase their cardio and resistance withing 2-3 weeks. All while asking them how they feel and watching closely.
0
First we need to understand that post traumatic disorder or another severe mental challenge is probably at work. We have to understand that these people are actively poisoning themselves- they are slowing committing suicide. I know that is harsh but we are a culture of co-dependency on this issue and enabling behavior.
Most pts are just not qualified for this situation. I think unless you are very experience working with these clients that you do not attempt it. It is very dangerous for them to be with someone who doesn't understand their illness.
To help someone, I would suggest they try tai chi. It is very gentle and will start the client on the movement journey with the lowest possibility of injury or medical emergency. Additionally, a traditional tai chi instructor will be teaching a philosophy that will support a new self esteem.
Most pts are just not qualified for this situation. I think unless you are very experience working with these clients that you do not attempt it. It is very dangerous for them to be with someone who doesn't understand their illness.
To help someone, I would suggest they try tai chi. It is very gentle and will start the client on the movement journey with the lowest possibility of injury or medical emergency. Additionally, a traditional tai chi instructor will be teaching a philosophy that will support a new self esteem.
0
After having obtained the necessary approval from the physician, I perform an assessment that is usually very curtailed. In ordinary circumstances, I do body composition and take pictures for a musculoskeletal assessment. For a very overweight client, I may forego the body composition assessment and will only take pictures if the client is okay with it. I just take good notes of imbalances that I perceive. I may perform a cardiovascular assessment to see how far a person can walk fo 5 minutes.
I found that the most important strategy is to start very, very easy and to try to keep the sessions positive by finding exercises that the client is successful in. Very overweight clients find enough fault with themselves already, and I do the best I can not to add to the list. As the client begins to gain confidence and starts seeing the first positive results from exercising, I gently raise the bar.
I tell all my clients that personal training is an interactive process, and that I have to rely on their feedback to make sure that I am on the right track. For overweight clients, that means learning to get back in touch with their bodies. I have found that they often try to disassociate themselves from the physical aspect of their existence.
I found that the most important strategy is to start very, very easy and to try to keep the sessions positive by finding exercises that the client is successful in. Very overweight clients find enough fault with themselves already, and I do the best I can not to add to the list. As the client begins to gain confidence and starts seeing the first positive results from exercising, I gently raise the bar.
I tell all my clients that personal training is an interactive process, and that I have to rely on their feedback to make sure that I am on the right track. For overweight clients, that means learning to get back in touch with their bodies. I have found that they often try to disassociate themselves from the physical aspect of their existence.
0
First and foremost with an evaluation and authorization from the client's physician. Then, once cleared and assuming all assessments etc have been performed by me, I'd start them with a combination walking program mixed-in with light resistance training (e.g. body weight exercises for the lower body, and light resistance with bands etc. for the upper body). My goals when starting out with an obese client is to challenge them within their capabilities, teach them how to begin to actually enjoy exercise and movement, and help them begin to experience some level of success so that they will feel motivated to continue.
Constant monitoring is extremely important with this type of client and so I constantly remind my client that I want them to tell me how they are feeling periodically throughout their workout so that I can make adjustments as we go along.Communication, communication, communication!
LaRue, CSCS
www.lecfitness.com
lecfitness@yahoo.com
Constant monitoring is extremely important with this type of client and so I constantly remind my client that I want them to tell me how they are feeling periodically throughout their workout so that I can make adjustments as we go along.Communication, communication, communication!
LaRue, CSCS
www.lecfitness.com
lecfitness@yahoo.com
0
Morbid obesity is, in and of itself, only one risk factor for disease. Although clinicians now treat a waist circumference of over 40 inches for men, and 35 for women as an independent risk factor.
I currently design over 30 individual programs for over weight and obese clients every three months. After assessing CAD health risks, medicial history, symptoms, known disease, and exercise history I follow ASCM guidelines (eight edition) for physician's release request, and exercise protocol.
While most of these people do not present with symptoms, most have 4 or 5 risk factors, and many have diabetes or metabolic syndrome. Exercise protocol for the over weight, obese, diabetic, and those with metabolic syndrome, according to ACSM is as for the regular population, start at low dose; intensity of low to moderate, frequency of cardio 5 days a week, and 2 to 3 of resistance and flexibility.
Start small and build, this empowers self efficacy and safety.
Danielle
I currently design over 30 individual programs for over weight and obese clients every three months. After assessing CAD health risks, medicial history, symptoms, known disease, and exercise history I follow ASCM guidelines (eight edition) for physician's release request, and exercise protocol.
While most of these people do not present with symptoms, most have 4 or 5 risk factors, and many have diabetes or metabolic syndrome. Exercise protocol for the over weight, obese, diabetic, and those with metabolic syndrome, according to ACSM is as for the regular population, start at low dose; intensity of low to moderate, frequency of cardio 5 days a week, and 2 to 3 of resistance and flexibility.
Start small and build, this empowers self efficacy and safety.
Danielle
0
Slowly but consistent. I have found that you can lose them easier within the first 2 months. Make sure you push them but also learn to form a dialect with them during activity. The best indicators during a session with a severly obese client are the ones they formally tell you. Once they trust you, and their new program, magic happens.
