This describes a lot of my clients. I assume that you have obtained the necessary approval’s from a health care provider as appropriate. You indicate patello-femoral syndrome. This person should have seen a physical therapist, and there should be a set of exercises that the physical therapist recommended.
In my experience, every time you are dealing with as orthopedic problem, you have to address that problem first before you give the question of exercise intensity and duration too much thought. The person needs to be out of knee pain first. Follow the exercise recommendations from the physical therapist until the client no longer complains about knee problems.
After that, you can ease into some form of cardiovascular exercises. The client should be encouraged to listen to her body. I would only be specific in terms of intensity and duration when there is no more risk of re-injury. In the long run, it is more important that the client exercises at all, even if not in the perfact fashion, than not at all because of pain.
If all is clear, you can try to get your clients to works towards 3 to 5 days per week of light to moderate intensity exercise (Rating of Perceived Exertion 3 – 6) of 30 – 60 minutes per day (according to ACSM exercise guidelines). If that is tolerated well, you can encourage to increase intensity and duration.
Make it clear to the client that he needs to back off immediately if there is any resurfacing of the knee problem.
One last comment: it would be nice if there was an exercise to get to the visceral fat. Unfortunately, the body has a mind of its own on that count, and you cannot target certain areas. In conjunction with overall weight loss, there will also be loss of visceral fat. Exercise alone usually does not do it, and the client will need to be reminded that weight loss usually requires a reduction in caloric consumption as well.
I think it is important to point out that this person very well might be on hypertensive medication, cholesterol medication and who knows might be pre-diabetic. I say this as the treatment approach recommended by the National Cholesterol Education Program (NCEP) includes, weight control, physical activity and pharmacotherapy.
Designing an exercise program for an individual with multiple clinical conditions is indeed complex and requires more than knowing the correct intensity and duration of exercise. Clinical exercise testing MUST be utilized to know how to write the exercise prescription.
I am moved to question whether the personal trainer understands how a diseased body responds to exercise? What exercise tests are they performing for the person presenting with more than one clinical condition who is clearly high risk? Why high risk? If this is a male according to the question the person is over 45, presents with abdominal adiposity, dyslipidemia and hypertension and impaired fasting glucose and we don’t know whether there is a family history of disease. Even if the doctor gives clearance the question still exists does the fitness professional understand the exercise response in someone with diagnosed clinical conditions.
Professionally, I have never heard of “a little bit of metabolic syndrome.” There are clear clinical criteria for the diagnosis of metabolic syndrome.
I would first learn what is metabolic syndrome and ask myself whether I am adequately qualified to design a fitness program with health outcomes as the objective (raising HDL levels, lowering BP, decreasing body fat percentage as well as improved fasting glucose levels.
If the approach is solely to lose visceral fat, then it might be a good idea to refer this client to someone experience in designing and training individuals with clinical conditions.
Both answers thus far by Joanne and Karin are fabulous. My further advice is think long term. This person can not lose weight quickly because that would involve an exercise intensity that could be dangerous. If you set a base now though, you could increase the intensity in the future and really see some great results!
The answers are great. I agree with Karin to consult with the client’s physical therapist to determine the extent and history of the patellofemoral is essential prior to beginning the exercise program.
I would suggest high impact excises, like running because the p-f history. Rather, eliptical, recumbant cycle, cycling outdoors. will probably be the best.
I encourage intervals to ventilation threshold. Speed up to the point where your client begins to lose his/her breath, then slow down until he/she has caught there breath. Your client can complete 6, 5 minute intervals in 30 minutes and will most likely will be less fatigued than in doing 30 minutes of sustained pace. Pushing to threshold is important because that’s caloric expenditure is accelerated. However, most untrained to moderately trained people can’t sustain threshold intensity for more than a couple of minutes due to the increase in lactate.
Good luck, take care.