Program Design for Life

The world continues to feel the strain of burgeoning health issues surrounding weight and inactivity. The fitness industry’s mission is to Inspire the World to Fitness^® and to help overweight and obese clients transform their lives with a sensitive, educated approach to program design. Part of your job as a personal fitness trainer (PFT) is to create a safe and nurturing environment where people can be physically active while feeling emotionally secure. If you are truly committed to working with overweight or obese clients, it may be necessary to change your usual approach to screening, assessment and program design. Your dedication to size acceptance and to helping clients improve their quality of life will boost adherence rates and improve function in activities of daily living (ADL).

Many of your regular prescreening techniques may not work with the plus-size client. For starters, suspend the idea of weight loss for a moment and look at things from a different angle. While this seems like a radical shift in mindset, many times when an overweight client stops losing weight or reaches a plateau, she stops exercising. This is why shifting the focus from short-term gratification to long-term lifestyle change may jar the client who is most familiar with the “quick fix.” Reframe and redefine goals from a healthier perspective.

Help the Client Reconnect With Life. Obesity is a lifestyle impediment for many. Identify specific obstacles, and help your client define activities he would like to do—things he stopped doing when weight became an issue. Focusing on short-term targets and solutions is a great way to open the discussion. For example, ask the client how he’d like to feel after a session (“refreshed,” “relaxed,” “alive”); and ask how the rest of his day went after he worked with you (“I had energy to go back to work”; “It felt peaceful to be home with my family”; “My stress decreased, so I could sleep”). Some clients may relish the freedom and independence to get down to and up from the floor, while others may want to ride a bike again or dance at a social event.

Set Unique, Nonstandard Baselines. While the fitness industry has set guidelines for strength and cardiovascular conditioning, it is often liberating to let the client create her own activity baseline. If she can walk two city blocks or one-tenth of a mile, let this be her baseline for cardiovascular activity. If she can carry her 20-pound toddler up the stairs, use this as a strength baseline. Create the program around activities like these. Help the client understand how the exercises you are teaching her apply directly to life, and measure success in terms of ADL. This will help her sustain interest in and adhere to activity. She will begin to understand and appreciate how exercise and movement correlate to ADL.

Clarify the Client/Trainer Relationship. Be clear with yourself that you can work with the overweight population without any bias, judgment or discrimination. Also be clear on your relationship to your own body and be sensitive to clothing issues. This will help the client stay focused on her body instead of yours. As fitness professionals, we tend to be excited and proud of our physical bodies and the work we do. However, in this case it is not necessary to display your physical attributes. Leave your personal life completely out of the sessions. Create a safe space for the client to experience herself. Help her stay connected to her body by noticing eye focus. If you see the “glazed over” look, ask where she is or what she’s thinking about. Coax her back into her body with breath. Always ask permission to touch, and let the client guide you when increasing activity.

Be One Step Ahead by Anticipating Needs. Look at things through the client’s eyes. Size up the physical space and navigate it as if you were the client. How is the furniture placed? How far is the walk to get to the gym? Approach your job with a size-sensitive mind. (See “User-Friendly Equipment” on page 52 for more details.)

To balance and move through space, the overweight body compensates in various ways, thereby putting more stress on some muscles and causing others not to engage effectively. Understanding how the overweight body holds itself from an anatomical perspective will help you teach a client how to strengthen and lengthen muscles without incurring secondary injuries. Here we review some prime areas of focus.

Breath Work

Proper breathing is fundamental to the success of a movement program. Instruct your client that the abdomen rises when he inhales and softens when he exhales, pulling up and in, navel to spine. Review the location of the diaphragm and its function in respiration. Discuss the different types of breath used for fitness, yoga, stress reduction and visualization. Familiarize the client with the application of breath work to daily activities. For example, improper breathing keeps cortisol levels high, slows metabolism and inhibits weight management. Inadequate breathing can also lead to overeating, poor digestion and difficulties with elimination.

Sample Exercise:

Diaphragmatic breathing: Client lies on his back with legs bent, feet flat on the floor. Place a folded towel or small pillow under his head for comfort and alignment, keeping the air passage open. (Note: If he cannot lie down, have him practice on an incline bench or while seated.) Place a hardcover book on the abdomen below or on top of the navel, depending on how the book rests on the flesh. Ask the client to inhale and to observe the book rising. As the client exhales, the book goes down and the navel draws toward the spine. Train the client to inhale through the nose and exhale through the mouth. If this is not comfortable, encourage him to breathe any way he feels comfortable until the breath becomes steadier, more regular and less assaulting to the nervous system. Gradually help the client build core strength.

Real-Life Application: Helps client begin to differentiate between fat, abdominal muscles, abdominal stress and digestion.

Abdominals/Core Strengthening

The abdominals are an elusive muscle group for the obese client. A client may say she wants to be “stronger,” “smaller” and “tighter” in that area, but she is unlikely to comprehend the origin, insertion, function or direction of the muscle fibers. Many overweight clients stand in what I refer to as the “spill out” position, or anterior pelvic tilt, where abdominal muscles are not used. A few simple “technique moments” can offer new insight.

Talk to your client about the rectus abdominis muscles, or “six-pack abs.” You may get a good laugh initially, but the visual is now in place. Ask her to palpate the sternum to get a sense of where these abdominals attach. Explain the connection to the pubic bone, but keep in mind that she may have to lift her abdomen up or off her thighs to sense where the pubic bone is.

Sample Exercises:

To increase awareness of the transversus abdominis muscles, ask the client to inhale, expand and draw the navel to the spine on the exhalation. Keep the muscles drawn in and count out loud to 10. The counting regulates breath while the transverse abdominals are isometrically contracted. Repeat the entire sequence three to five times, and relax. Clarify that these muscles hold the internal organs in place.

For the obliques, ask the client to sit on a step bench stacked with six to eight risers on each side. Thighs are parallel to the floor, and weight is equally distributed from right to left buttock (the client may not be able to feel the ischial tuberosities or sit bones because she has too much flesh). Squat behind the client and ask permission to hold the pelvis in place. Have her rotate to the right as you gently hold the left side of the pelvis back. Cue her to take five breaths, return to center and observe the weight from right to left buttock, monitoring any sensations from the rotation. Repeat on the opposite side.

Real-Life Application: Helps relieve lower-back discomfort.

Upper Back

Many overweight or obese clients have weak posture from spending hours at the computer. Some may also have a large amount of breast tissue that can pull the upper chest forward. The goal is to strengthen the rhomboids, which will help with alignment.

Sample Exercise:

Rowing exercises help support the back and can be done in a number of ways. With the client in a seated position (you are standing), hold resistance tubing for him and have him row. Watch for proper alignment; encourage the client to keep the chest lifted and to “knit” the shoulder blades together. If you have access to a seated cable row machine, use it; place two fingers between the client’s shoulder blades and ask him to wrap his shoulder blades around your fingers. Once he can properly isolate and strengthen the rhomboids, you should begin to see a difference in posture.

Real-Life Application: Alleviates upper-back discomfort; helps female client hook a bra.

Psoas

In the “spill out” position, or anterior pelvic tilt, the psoas is tight and shortened and the lower-back muscles contract. Stretching the psoas helps decrease strain on the lower back.

Sample Exercise:

Have the client stand with feet parallel, holding onto either a wall or your right shoulder with her left hand, for balance. The right foot is on top of a step bench 8 inches high. Ask the client to contract the left buttock and lift the abdominal wall up from the pubic bone to the best of her ability. The psoas stretch should be felt across the front of the left hip. Explain that this muscle attaches at the femur, crosses the hip, attaches at the lumbar spine (lower back) and lifts the leg.

Real-Life Application: Assists in a walking program and when climbing stairs.

Adductors

A plus-size client who has large thighs may stand in a wider than average position. He may also sit with his legs more open to make space for the abdomen. Therefore, the adductors may be weak, and proper alignment may be unclear.

Sample Exercise:

The client sits with a yoga block between his knees and applies just enough pressure to hold the block in place (legs may begin to quiver). While this placement may be challenging, remind the client that as the body changes shape, the femurs will need to come into proper alignment. Progress to ball squeezes and, eventually, the abduction/adduction machine, depending on the client’s comfort level.

Real-Life Application: May alleviate knee discomfort and/or create a healthier sex life.

Lower Leg

Walking programs are very popular with overweight clients, but the lower-leg muscles need to be stretched and strengthened.

Sample Exercise:

First, check for pronation or supination. Teach the client the proper way to roll through the foot. Abdominal mass over the thighs could be impeding her stride length, and she may feel safer “shuffling” her feet for fear of falling. The anterior tibialis picks the foot up to help us recover if we trip. Empower the client with this knowledge to alleviate the fear of falling. Strengthen the gastrocnemius with heel raises and the anterior tibialis with toe taps or “tib” taps.

Real-Life Application: Helps client move confidently through space.

The key to success with program design is to make a direct correlation to life. Help clients feel the appropriate muscles being worked; you want them to learn where muscles are located and how to access them effectively and efficiently. Build each client’s program around her realistic dreams and ambitions; don’t use a standardized formula. That’s not to say you can throw all caution to the wind; but understand the uniqueness of each individual, her personal journey, and the fact that she may have been here a thousand times before. You may be the one holding the key to success. You can help her connect to her body, sense movement as freedom and be independent in the world.

Now the application begins. Start with a few observations. What muscles are being used in the activity? Which ones are not working effectively? Understand that you are training the client so that she can be independent in the world and participate more fully. The body is hardwired for health and desires balance. Here are some examples of basic programs that line up with “real life.”

Urban Areas

Clients in urban areas need to walk; climb public-transportation stairs; carry large briefcases, handbags and groceries; and get in and out of taxis. To ease exiting a taxi, teach your client to lead with the pelvis and slide the buttocks across the seat instead of reaching for the handle and dragging the body. A walking program is a good place to start for the urban dweller.

Design Elements:

• proper head alignment
• upper-back strengthening with rowing exercises
• neutral pelvis
• core awareness/strength
• femur alignment
• balance exercises
• strengthening of anterior tibialis, to avoid shin splints
• foot care and ways to address chafing thighs

Suburban and Rural Areas

Clients in these areas lift packages in and out of car trunks; climb stairs with laundry or children; do outdoor chores and activities with kids; and climb in and out of trucks and SUVs. Try a program that focuses on how to climb stairs properly.

Design Elements:

• proper head alignment
• hand placement on the banister
• core awareness/strength
• awareness of pelvis moving up the stairs
• strengthening of quadriceps
• proper knee alignment/tracking
• strengthening of glutes
• foot placement
• balance exercises

Furniture Arrangement/Safety

Review the client’s chairs, couches and bed for height. Adjust each for maximum comfort when standing up. Height should allow for the pelvis to be higher than the knees. Teach the client the importance of body alignment and pelvic placement. Adjust height with sturdy pillows, blocks, phone books, plywood, etc. Encourage the client to clear clutter from the floor to allow easy access and exit for safety.

Shoveling Snow

When I speak in the Midwest and Alaska, people always talk about shoveling snow! At one facility, fitness professionals had prongs soldered to shovels and taught clients how to use leg, core and arm muscles to shovel snow properly. As clients became more proficient in their technique, they added weights to the shovels to simulate the snow they could be lifting.

Sit to Stand

Getting up and down from the floor or toilet is something a normal-weight person might take for granted. But it can be a challenge for the overweight or obese client. Both of these activities require an understanding of where the pelvis is in space. Help your client move from the pelvis instead of dragging the body through space. Perform modified squats with a chair. Have the client hover above the seat as if it were a public toilet, and then progress to getting up and down without holding onto anything. Placing a yoga block between the knees, while challenging, can help maintain alignment.

Design Elements:

• modified squats
• wall slides with stability ball
• modified standing lunges
• Kegels
• core awareness/strength
• balance exercises

Everyone deserves to lead an active lifestyle. You can create a bond of faith and trust that will strengthen this belief. When getting started, recommend one session per week for a minimum of 6 weeks to build brand loyalty, lifestyle changes and immediate achievement. If the client insists on more, the minute he misses one session, you run the risk of being back in the vicious cycle of failure. Encourage him to find a friend or buddy to support his lifestyle changes. While a “real person” is ideal, people find support in many forms these days, including online groups.

Don’t forget to call the day after the initial session to find out how the client feels, and send a personal thank-you note. In our automated world, a hand-written note lends a human touch to the journey! Make yourself available without getting in the client’s space. Overenthusiasm can be sensed as insincere, so find the delicate balance between reality and eagerness. Do not promise weight loss; instead, let your client grow! Encourage feedback, and track changes in better sleep patterns, more energy, less stress and improvements in mobility.

If you are sensitive to size, considerate of what is taking place anatomically and willing to shift your language (see “Size-Sensitive Language” on page 50), you will send a profound message to your client that you truly understand the overweight body. Commit to size acceptance. Strive for program integrity, where people can embrace themselves for who they are, experience themselves completely and live their lives fully in the present moment. Perhaps the fitness industry will start to see a transfer of energy from overweight to active, and people will live from the inside out.

Fitness professionals are in the business of helping people improve their health, and this often includes losing weight. However, language used in the media can sometimes be counterproductive. Think about alternative ways you can approach words. Here are some examples.

• Talk about “healing” versus “combating” obesity. The client is not the enemy, nor is her body!
• Use the word “movement” instead of “exercise.” Exercise has a negative connotation to the overweight person—it’s like punishment! Ask the client, “Did you move your body today?”
• Say, “As your body changes shape” instead of “As you lose weight.” Our bodies change shape naturally during the course of our lives, from puberty to adulthood, pregnancy, menopause and aging. Weight loss carries a success-or-failure mentality. A body that changes shape is less emotionally driven and is grounded in the fundamentals of alignment.
• Instead of letting your client say, “I was bad” or “I was good,” encourage, “The [fill in the blank: inactivity, food choices, caffeine, alcohol] did not work for my body.” This has a neutralizing effect.
• Use “disconnected from the self” instead of “lazy.” Clients can confuse laziness with being tired, inactive, sad or depressed. When they move their bodies, they become more connected to sensations, and therefore more connected to themselves.
• Differentiate between being in a restful state and slouching on the couch. Many clients think watching television is “relaxing”; however, they may actually be “zoning out,” disconnected from their bodies and from life. A person who reaches a relaxed state at the end of a movement session has a true sense of connection to her body.
  User-Friendly Equipment

  Take a moment and look at all your equipment and weight machines through the eyes of an obese client. Could you get larger seats for recumbent bicycles? Assess the space between machines and the accessibility of weight stack pins. Place free weights on shelves so the client doesn’t have to bend over to pick up weights. Use step stools for massage tables. “Open” a machine as much as possible before the client begins using it. For example, lift the thigh pad on the lat pull-down machine enough to make space for larger thighs, and move the seat all the way back on the leg extension machine to make room for abdominal mass. Adjust machines so that the client feels confident he can “fit.”

  resources
  

  Fitness Wear and Products

  Amplestuff, www.amplestuff.com

  Danskin, www.danskin.com

  Holistic Health Promotion at Every Size, www.jonrobison.net

  Junonia, www.junonia.com.

  Just My Size, www.justmysize.net

  Books and Magazine Articles

  Ashmore, A. 2005. Torque and Training Overweight Clients. IDEA Fitness Journal, 2 (1), 52–57.

  Campos, P. 2004. The Obesity Myth: Why America’s Obsession With Weight Is Hazardous to Your Health. New York: Gotham Books.

  Dahlberg, C.P. 2003. Living Large. Yoga Journal (178), 88–95.

  Erdman, C.K. 1996. Nothing to Lose: A Guide to Sane Living in a Larger Body. San Francisco: Harper.

  Fraser, L. 1998. Losing It: False Hopes and Fat Profits in the Diet Industry. New York: Plume Books.

  Gaesser, G.A. 2002. Big Fat Lies: The Truth About Your Weight and Your Health. Carlsbad, CA: Gurze Books.

  Goodman, W.C. 1995. The Invisible Woman: Confronting Weight Prejudice in America. Carlsbad, CA: Gurze Books.

  Kraus, S.J., & Maden, S.K. 2005. Unlocking Barriers for Heavy Clients. IDEA Fitness Journal, 2 (1), 46–51.

  Sullivan, Judy. 1997. Size Wise. New York: Harper Perennial.

  Organizations

  Council on Size & Weight Discrimination Inc., www.cswd.org

  National Association to Advance Fat Acceptance (NAAFA), www.naafa.org

  Fitness Wear/Books/Organizations.