Compassion and Consideration for Curves
Some easily implemented strategies for working with larger clients will make you a more effective professional.
We have an inactivity epidemic.
According to the World Health Organization (WHO), “Physical inactivity is the fourth leading risk factor for all global deaths, with 31% of the world’s population not physically active” (WHO 2011a). Physical inactivity is associated with 6% of deaths globally—behind only high blood pressure (13%), tobacco use (9%) and high blood glucose (6%) (WHO 2012; WHO 2011b). A 2009 WHO study found that physical inactivity was the leading cause of death in the United States.
The 2009 study directly measured physical inactivity levels, rather than relying on self-reported data. In other findings from that study, physical inactivity was associated with 3.2 million deaths globally per year (WHO 2009), including 2.6 million in low- and middle-income countries; over 670,000 premature deaths (people 60 years and under); and 27% of diabetes and 30% ischemic heart disease burdens (WHO 2009).
According to Steven N. Blair, PED, FACSM, professor of exercise science, epidemiology and biostatistics at the University of South Carolina, research has shown that approximately 25%–35% of American adults are inactive, meaning they have sedentary jobs, engage in no regular physical activity and are generally inactive around the house or yard. “This amounts to 40 to 50 million people exposed to the hazard of inactivity,” Blair states. “Given that these individuals are doubling their risk of developing numerous health conditions compared with those who are even moderately active and fit, we’re looking at a major public health problem.”
For trainers and health professionals, the solution to this issue is to embrace all sizes and shapes in our practices. This includes, but is not limited to, the overweight client. The Health at Every Size® (HAESsm) model promotes individually appropriate, enjoyable, life-enhancing physical activity, rather than exercise that is focused on weight loss (www.sizediversityandhealth.org).
“A larger person walks into the fitness facility with shame and damage from being stigmatized in our culture. Even if [this person feels] self-accepting on a day-to-day basis, the damage has still taken its toll,” says Deb Lemire, president of the Association for Size Diversity and Health.
As an industry, it’s imperative not to be focused on movement solely for the purpose of weight loss. To be more inclusive, try implementing these three suggestions:
- Greet all people equally. We are all human beings sharing the planet.
- Do not give a larger client the “twice-over” look. You know it. You’ve done it. And the client can feel it.
- Be respectful of all sizes. Your best student could be standing in front of you.
All bodies need to move in a movement program that feels right. Although our industry has become more size-sensitive over the past decade, we must still continue to embrace all shapes and sizes.
Functional fitness as well as movement for the sake of pleasure should be key when working with overweight or inactive individuals. Our goal as trainers should be to help clients succeed outside the facility. Each movement/exercise should have a direct application to everything that occurs outside the classroom. Focus on life functioning, not on weight loss. For example, a martial arts course could aid in self-defense; learning to ride a bike properly in an indoor cycle class could lead to an active family life at home; and building confidence in dance class may help clients participate in social celebrations such as weddings.
A number of formats work well with this philosophy:
Basic strength training classes may be an excellent place to begin. Focus on lengthening and strengthening muscles that size may have affected. These muscles include the rhomboids, which could be weak from poor posture or large breast tissue pulling the body forward; the adductors, potentially weak from standing in a wider parallel to accommodate larger thighs; and/or the anterior tibialis, which may need strengthening to avoid foot shuffling.
Teach clients that their “body weight is part of the solution to getting stronger,” says Kelly Bliss, MEd, of Lansdowne, Pennsylvania. A certified lifestyle coach recognized by the National Institutes of Health as a national leader in plus-size fitness and wellness, Bliss believes that “our beautiful resistance weights are right here attached to us like a Nautilus® machine.”
Clients’ own weight can be used as resistance in lower-body exercises such as squats, leg lifts and abduction/adduction movements. Help students appreciate the fact that lifting themselves up off the mat is extra weight training. This helps change the movement environment from a possibly self-critical one to one that is friendlier and more self-accepting.
Also, by articulating where muscles are located and how bones move, you can foster in clients a strong sense of ownership in their physical health and well-being. Take, for example, sitting down in a chair and standing up again. Overweight people have learned to accommodate this action with misinformation about hip flexion. Instruct clients about the movement of the pelvis in space; about hip flexion, knee flexion and use of the quadriceps and gluteals in sitting and standing; about relaxing the knees out of hyperextension in the standing position; about aligning the pelvis once returned to standing; and about breathing and using the abdominal muscles. Then explain the direct application of this knowledge to sitting at the office, at the dinner table and even on the toilet!
Latin-style classes such as Zumba® are great options for larger bodies. Consider modern dance, ballet, jazz, Bollywood, ballroom, belly dance, Hawaiian hula and other styles of dance as well.
Ragen Chastain is a full-figured, three-time national-champion dancer in the Austin, Texas, area who writes and speaks about HAES. She is a fan of early cuing, and before leading a class, she breaks down any complicated choreography. “As a teacher, I look ahead and think about the movement so I can offer options with no shame. Bodies of size are really different. Some people’s thighs are squishy; other people may have to tilt their bodies.”
Chastain believes that with proper instruction the body will do what is asked of it. “The only time weight can be used as an excuse is if the physical body gets in the way of the movement. An instructor should be able to offer options with no shame. What is most important are the weight changes. If the right foot is lifted off the floor to a parallel passé position, the next movement should be moving onto the right foot in a forward diagonal direction. Another important technique is pushing off the back foot and onto the new standing leg, which changes the quality of the movement dramatically. Instructors need to help clients commit to a full weight change in dance classes. There can be a lack of confidence and trust in the body, and the trainer’s job is to build up that confidence.”
When overweight students enter her class, Katiti King, a Simonson Technique teacher at Dance New Amsterdam in New York City, makes it a point to look into their eyes and not acknowledge the weight. “I’ve seen very overweight people be incredible movers,” she comments. Anatomically, the weight may be hindering some mobility, yet there may also be loose ligaments allowing greater flexibility in other moves. During transitions, King is careful to give more time for weight changes. She’s also aware that the pace and timing of the music can make it more challenging for a larger body to move through space. “Just because people are heavy doesn’t mean they’re not coordinated.” King adds that larger clients are sometimes stigmatized because there is an assumption that the overweight body cannot execute or complete movements.
Traditional-style boot camp classes often include many exercises that can present a challenge for larger bodies. Kim Tennyson of Oconomowoc, Wisconsin, is a Size Sensitivity Certified Trainer who believes push-ups on the floor, jump squats, running and calisthenics are really challenging from a joint perspective and should be completely restructured for larger clients.
“In The Biggest Loser workout on television, what’s often missing is the progression the contestants went through to get to that place of being able to execute an exercise successfully. It can be very misleading for the overweight client. As clients push to get through the workout, form and technique can be impaired, which can create a recipe for failure. Group fitness instructors need to respect the larger body’s capacity for movement and exercises. Ask yourself, ‘How can deconditioned people succeed and be successful in this type of class?’”
Sean Shuemate, a trainer certified by the National Academy of Sports Medicine (NASM), teaches Big Girl Boot Camp in Las Vegas. He believes women should have fun during boot camp. Naiomi Shuemate, his wife and cofounder of Shue Fit & Conditioning, is his client advocate. A full-figured woman herself, Naiomi will often demonstrate the exercises, showing participants that it is possible for a larger body to do boot camp moves, given proper instruction. The Shuemates recommend using songs such as Anthony Hamilton’s “Sista Big Bones” to promote diversity and empowerment.
Israel LoBue is an NASM-certified trainer in San Diego. “Many people feel they need to get in shape or lose weight before they can even come to boot camp class. Not so,” he emphasizes. His class is multilevel, and participants are encouraged to go at their own pace. Caution should be extended to new clients attending boot camp classes. There is the possibility of overwhelm both physically and emotionally, as well as a sense of failure, unless the client has fully understood the class parameters and modifications.
Joan Denizot is the founder of Super Sized Cycles in Fairfax, Vermont. “[Indoor cycling] classes scare me!” she exclaims. Denizot believes one of the greatest challenges clients face is saddle comfort. A larger seat provides comfort and stability for the pelvis. The other challenge is leg girth. If a client has larger thighs, the feet tend to be farther apart in a standing parallel position. On the bike, that means the femurs could be externally rotated to create space and the feet could be supinated, creating hip, knee and ankle/foot issues. Denizot recommends pedal extenders that allow the foot to be centered on the pedal, decreasing discomfort from chafing thighs.
A certified Spinning® instructor, Denise Moffatt of Agawam, Massachusetts, works with a weight management program at her facility. Seat sizes are not geared for larger bodies, but Moffatt recommends a gel cover for anyone with a sensitive coccyx. Being large does not necessarily mean a person has enough “padding” to be comfortable on a bike seat.
Moffatt encourages larger clients to bike at their own pace. Instructors who put some thought into creating both physical and mental comfort for larger participants have a greater chance of keeping those clients thinking positively about bike riding for the rest of their lives. “At the end of the class, we applaud new people for their efforts. The support and encouragement go far in anchoring a positive experience.”
A World Taekwondo Federation–certified black belt, April Hudson of Austin, Texas, was never skinny. She found that in tae kwon do classes she could succeed regardless of her size. She believes “fat people have to work harder to prove themselves, and trainers should keep an open mind. Some of the overweight people standing in front of you could be your greatest students. The person standing before you wants to be dedicated and good.”
Riley McIlwain is the program director for Jimmy Pedro’s Judo Center in Wakefield, Massachusetts, and he doesn’t expect less from overweight individuals than from any of his other students. They all learn the same techniques, and he encourages them all to take ownership of their bodies and their skills. “Judo is a big feel,” he states. “Students are offered the same curriculum, and as they grow in the discipline, there is a great deal of individuality. The student can pick and choose the moves and focus on what feels right to his/her body.”
With martial arts, be aware that kicking and punching, when not taught properly, can cause injury to the knees and elbow joints. Leg muscles that are not firing properly, coupled with an anterior pelvic tilt, can lead to tired legs and feet, plus discomfort in the low back when students stand for an extended period of time.
The greatest gift we can give our clients is a solid basis in technique so they can execute an exercise based on their bodies at that particular moment in time. Should the body begin to change shape, we need to adjust accordingly for muscular and skeletal alignment.
Our industry should concentrate on movement for pleasure, not for weight loss. Regular participation in a movement program has many wonderful benefits—mood elevation, greater confidence and self-esteem, plus increased engagement in life. These successes need to be celebrated.
Focus on movement that is pleasurable and appropriate for each person’s body. One hour of organized activity per week in a group setting for a minimum of 6 weeks could pull a client out of a failure cycle and toward a feeling of success and accomplishment. Pacing new clients on a once-per-week program allows time for the body to digest new information and sensations and reorganize its relationship to movement.
Fitness professionals need to leave behind cultural size myths and embrace the facts of plus-size fitness. We need to reinforce acceptance of size diversity. With cuing, what’s most important is being aware of and changing any cues that reflect cultural size prejudices. We are moving in the right direction, yet long-term results are possible only when there is a connection to the physical body. Creating a dialog from body to mind enhances this connection and guides participants to higher levels of self-awareness, wisdom and confidence. You are the catalyst for this transformation. Your size-sensitive programming can be part of the solution to our inactivity epidemic.
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Do talk about the body’s function, strength and flexibility.
Don’t focus on the body’s appearance.
Do choose action-oriented goals in class. Applaud effort, attendance and improvements. Give special appreciation to participants when they customize moves to meet their individual needs.
Don’t make it a goal to “get lean” or “look muscular.”
Do use positive, realistic words when speaking about bodies of all sizes, particularly large ones: “substantial legs,” “large belly,” “softness.” Use body weight as a fitness tool, not a liability.
Don’t ignore the existence of large people or parts of their bodies.
1. If possible have the client observe the class before taking it. This can decrease the risk of stress, overwhelm and injury by giving the client a chance to absorb what the class entails before diving right in.
2. Speak with the client ahead of time about his concerns around mobility issues.
3. Take a conservative approach for the first few sessions. Leave the client with the feeling of “Hey, that wasn’t so bad! I can do this!”
4. Review complicated choreography or moves at the start of the class.
5. Talk about the body’s function rather than its shape or form. Avoid expressions like getting “ripped.”
6. Ask the client how she feels and what she needs. Give her the space and breath to feel and respond. She will tell you.
7. Elicit responses from a sensory perspective to help anchor the connection to the physical body. For example, coach the client to pick up on sensations and describe how the body feels—energized, flowing, alive—instead of just saying, “I feel good.” This helps bring sensory awareness into the physical body.
8. Instruct the client on proper attire. Women need a well-fitted and supportive sports bra; men need appropriate support that keeps the male organs close to the body (going “commando” is not always safe). Both men and women need wide-fitting, sturdy sneakers; proper leg attire to avoid chafing at the thighs; and clothing that is light enough to allow for the release of heat. They should also be sure to remove wet clothing as soon as class is over and should dry between skin folds to avoid rashes and infection.
- Don’t underestimate how much weight clients can lift. You may, however, want to start with lighter weights to teach technique.
- Review all strength training exercises from a larger-body perspective. This means considering issues such as how larger thighs, breasts, buttocks, back fat and fuller thighs will fit into a machine or onto other equipment, such as stability balls. Become familiar with the weight limits on the gym equipment. Essentially, you need to analyze the effects of each exercise on both the equipment and the individual client.
- Be articulate and attentive to proper technique and execution of each exercise to avoid secondary injuries that could trigger a client to revert to a failure cycle.
- Consider an incline with a Step™ bench for supine abdominal exercises. Upper-back fat can create a severe head tilt/chin lift; placing a towel under the head will bring it into a more neutral position.
- Be mindful of the beats per minute. Larger bodies move through space differently from smaller bodies.
- Create choreography that flows.
- If you sense an increase in risk, use quarter-turn alternatives or half turns (still challenging to new people), rather than full 360-degree turns.
- Advise clients whether there will or will not be verbal cuing.
- Teach alternatives to moves like grapevine, which people with larger thighs may not be able to perform.
- Accept and respect the diversity of body shapes and sizes.
- Recognize that health and well-being are multidimensional and that they include physical, social, spiritual, occupational, emotional and intellectual aspects.
- Promote all aspects of health and well-being for people of all sizes.
- Promote eating in a manner that balances individual nutritional needs, hunger, satiety, appetite and pleasure.
- Promote individually appropriate, enjoyable, life-enhancing physical activity, rather than exercise that is focused on a goal of weight loss.
- Suggest at least three modifications for difficult moves. For example, push-ups can be done with hands on a wall or bench, or modified on the floor, depending on a client’s fitness level. To build confidence, begin with the easier options.
- In the beginning avoid jumping and other high-impact moves, to reduce torque and secondary injuries. Shin splints from a weak anterior tibialis (from “shuffling” the feet) and low-back pain from an anterior pelvic tilt can be exacerbated during boot camp classes.
- Use caution on lateral moves. Weak adductors and balance issues can lead to falls.
- “Open” machines to their maximum before larger clients work on them, so the clients feel more empowered. Raise thigh bars as high as possible (e.g., on lat pull-down and leg extension machines) and move seats back as far as possible (e.g., on leg extension, leg press, leg curl machines) to make more room for fuller bodies.
- Provide sturdy step stools for ease and comfort in getting on and off the bikes. This may help avert shame and embarrassment for larger clients, who may not be able to mount a bike successfully.
- Instruct clients on how to use pedal extenders.
- Advise clients to stay seated at first, working at a lower intensity.
- Recognize the overall alignment of a larger body on the bike. Focus on joint integrity.
- Be aware of hyperextended knees in standing positions.
- Notice any anterior pelvic tilt in the standing position due to weak core muscles.
- Instruct clients on weight exchange, leg extension and balance when doing kicks.
- Explain the benefits of these forms of movement. Because they seem to be lower-intensity exercises, clients may have misconceptions about their worth.
- Inform clients of the body-and-mind connection and the impact it has on resiliency.
Ashmore, A. 2005. Torque and training overweight clients, IDEA Fitness Journal, 2 (1), 52–57.
Bacon, L. 2008. Health at Every Size. Dallas: BenBella Books.
Gaesser, G.A. 2002. Big Fat Lies: The Truth About Your Weight and Your Health. Carlsbad, CA: Gurze Books.
Rice, R. 2005. The size sensitive schedule, IDEA Fitness Journal, 2 (6), 94–96.
Rice, R. 2007. Program design for life. IDEA Fitness Journal, 4 (1), 49–53.
Rice, R. 2009. Pilates for the overweight client. IDEA Fitness Journal, 6 (6), 56–63.
© 2012 by IDEA Health & Fitness Inc. All rights reserved. Reproduction without permission is strictly prohibited.
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