These tips come from a larger article about building self-efficacy in obese clients. Use the following tips to help your clients avoid risks when starting a new exercise program.
Abdominal Exercises on the Floor. There are several reasons to avoid these with new clients. First, most obese individuals hold their weight in the midsection. When they lie on their backs, abdominal fat mass restricts their range of motion. Exercises in the supine position are therefore ineffective (and uncomfortable) because heavier clients can only lift the neck and not flex the spine in this pose. They may be left asking, “Where am I supposed to feel this?” avoiding supine exercises also protects clients from the embarrassment of getting onto the floor and having to figure out how to get on their backs. Finally, as calorie-burning exercises, crunches are not very efficient.
More Effective Choices. It is more effective to train the core upright through rotational movement, balance work or use of vector angles. Safe, effective exercises include planks on a weight- room bench, upright rotational movements, or pelvic tilts or crunches on a stability ball. Once a client has learned the concepts and lost some weight, he or she can move to the floor.
Unstable Surface Exercises. Balance training is important, especially for the active aging population. When thinking about balance, we often think of fun equipment like the BOSU® balance trainer or SPRI step360™. but balance training, like other aspects of physical activity, must be progressed. Most sedentary individuals just starting an exercise regimen find simple gait tasks and standing on one foot on the floor challenging enough. Exercise already triggers many fears in overweight clients, and placing them on highly unstable surfaces for core, balance or movement training will cause more fear and embarrassment if they fall.
More Effective Choices. Small progressions for balance include moving from a hardwood floor to carpet or a yoga mat. You can incorporate the vestibular system by including eye gaze and a hand movement or by cuing clients to (partially) close one or both eyes.
Direct Floor Work. Planks and push-ups do not work well with obese clients because gravity pulls their abdominal mass to the floor, leading to improper range of motion or posture. It is best to avoid orthopedic stress during the initial training phases.
More Effective Choices. Use elevated surfaces or vector angles. For example, progress a smith machine push-up by lowering the bar once the client has gained some strength. At an appropriate time, make getting down to and up from the floor an exercise.
Self Myofascial Release and Flexibility. Placing too much weight on a small surface is painful for that area, and since most obese clients lack the strength to move appropriately on the roller, other joints also get stressed. Flexibility exercises (such as trying to touch the toes) tend to embarrass clients, as fat is a hindrance.
More Effective Choices. Choose upright mobility exercises. Focus on flexibility later, once clients have lost more weight.
More Vegetables Into the Diet, Establishing a Weekend Family Walk With the Dog. To find the true meaning behind a client’s larger goals, and to set achievable objectives in his or her present-day life, “dig deep” by doing a thorough assessment and asking open-ended questions (see “Client Conversations”).
Use your judgment and expertise when deciding how to progress clients, as some obese people are self-motivated and others require much more coaching. The overall principle is to create a positive experience and increase self-efficacy in order to facilitate lifestyle changes.
To read the full article from the January 2014 issue of IDEA Fitness Journal click here.