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.
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!
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.