This is a very complicated topic. I am assuming that the client is cleared to exercise. But if not, it is absolutely necessary to get clearance. And you need to get more information on the current condition. Also, did the client have spinal fusion in addition to the laminectomy? The smoking by itself will have greatly reduced the healing process. Combine that with age and overweight and the client is set up to have a poor outcome. Weight management is very important here. While I can’t comprehend why anyone still smokes with all we know about, it is still a huge health problem in all countries. I would advise the client to get into a cessation program. Clearly they are not able to quit on their own.
If the client is cleared to exercise, I would recommend aquatic aerobic workouts. For this client there is really no better way to do cardio for extended lengths of time. The addition of walking and building up their endurance is another important component, but it may take a long time to be able to walk fast enough and far enough for any real benefit. So, combine the two. Start with short duration and range of motion and build from there as tolerated.
As to resistance exercise, I would need to consult their physician, surgeon, and physical therapist to give any advice. As should you. I would be happy to discuss this a bit more for free with you. If you get clearance and the additional information needed, you can contact me through IDEA on my profile or go to my website www.hawaiifitnessacademy.com .