One of the most common obstacles personal trainers face is the need to modify an exercise program during a session.
A good trainer comes to a fitness appointment with a series of exercises for the client to do. However, even the most well-planned program may need to be modified. The key to success is knowing, based on the client’s unique biomechanics and movement patterns, which modifications to make and how to implement them with confidence.
Getting Started: Break Down Movement
Before deciding how to modify exercises during a session, you need to consider the rationale that underlies the program design. If you know how movement has been broken down to build a program, it becomes easier to analyze an exercise during a session and make adjustments. Here are some of the more common ways that trainers break down movement to build an exercise program:
- Goal-oriented. The aim is to develop a series of exercises that the client will execute over a period of time to reach desired goals.
- Disease- or injury-driven. The point is to tailor the program to certain limitations or to provide a starting point (e.g., postrehabilitation) for the client. Either way, the program is designed to help manage or overcome an obstacle, and it’s imperative to account for it when choosing exercises and making modifications.
- Muscle-specific. This can refer to a long-term program that unfolds over time (i.e., periodization) or to each session as an independent entity (i.e., agonist/antagonist muscle groups).
- Joint action focused. A session might focus, for example, on muscles that insert at the knee to allow for knee flexion and extension.
- Compound versus isolation training. Isolation exercises are single-joint movements that focus on one muscle group (e.g., a biceps dumbbell curl). Compound exercises use multiple joints and muscle groups (e.g., a lunge). Isolation exercises are best suited for muscle size and strength goals and are also great for beginners, youth, seniors and persons who may have limited motor coordination or who have been injured. Compound movements are good for total-body training, time-limited sessions, functional training, advanced exercisers and athletes.
Once you’ve decided how you’ll break down various moves, it’s time to choose the exercises for each session. Developing a sound exercise program for a client is analogous to developing a business plan; you create a blueprint for what you intend to do, while being realistic about factors that will influence what you actually do once you implement the program.
The key is to remember that the program you design is like a rough draft of a term paper—it’s a starting point. Focusing on a few key action areas can guide you step-by-step through the development of a program draft. These initial evaluations are your guide to the client’s biomechanical characteristics and can be an easy way to discover what modifications you need to make during sessions. Before you get started, address these action statements:
- Scan for structural limitations. These limitations include any type of therapeutic aid or physical challenge.
- Watch for unusual movement patterns. Unusual patterns include a limp, a sway or other postural deviations that could cause a muscle imbalance.
- Estimate the client’s age group. This action applies only to youth and older adults. During youth and late adulthood, motor learning factors are present that influence learning and specific exercise capabilities.
- Look at body weight and mass. Movement biomechanics for everyday tasks are different for an obese person than they are for a normal-weight person (Runhaar et al. 2011). For example, an obese person performs “sit-to-stand” from a chair differently than a normal-weight person (Sibella et al. 2003). The patterns of muscle activation and joint action are different. Although it appears to be the same movement, the dissimilarities are analogous to those between a barbell squat and a wall squat. In other words, the mechanics and workload are not the same.
- Listen carefully to the client’s stated goals. This is the most important evaluation of all and can deliver valuable information about the client’s biomechanical characteristics. By listening, you learn how your client views his or her body, including its capabilities and limits. For example, an older adult might say she is concerned about chronic low-back pain (CLBP) and wants to feel better. This information alerts you to two potential obstacles: (1) you must select exercises that are both CLBP- and age-appropriate, and (2) you can anticipate that your client will complain of low-back discomfort during exercise and may be timid about performing some of the moves you select. You will need to be prepared with modifications to keep her on task while easing her discomfort.
The greatest obstacle that trainers face during sessions, particularly with new clients, is that each person has a unique combination of factors—age, disease, injury, exercise history and motor coordination—that determine his or her ability to learn and execute exercises. Simply put, all people differ in what movements they can do.
Young people who have not yet reached skeletal maturation are a unique group, because their bones are still developing. The American Academy of Pediatrics (AAP) recommends strength training for youth (AAP 2001), with minimal load because bones are immature. All exercises should be modified to use light weights. Training may also include body weight–only exercises; however, body weight exercises can be contraindicated for overweight youth. Their extra weight is an advantage when it comes to moving external loads, but it’s an obstacle during popular calisthenic exercises. Therefore, modifications for overweight youth must include eliminating body weight exercises, while not allowing clients to overdo the use of external loads.
Also, youth training should focus on teaching motor skills associated with fitness. You can help youth develop lifetime fitness habits by frequently changing the exercises you choose, both during sessions and for independent training (between sessions), as youth learn best through varied practice (Schmidt & Lee 2011). Popular ways of introducing variety include circuit training and supersetting.
When modifying sessions for adults, the opposite is true. Adults, particularly older ones, prefer consistency. Training methods such as pyramiding work well, as do more advanced training techniques like forced repetitions (for the conditioned client). The key is to take into account the fact that adults learn exercises best when options are minimal.
As people age and become affected by conditions like arthritis, decreased bone density and postural changes, modifications are essential. Arthritis limits range of motion (ROM) and differentially affects joints. Modifications to arthritic programs may include using isolation exercises—to decrease the total number of joints involved—or using partial-ROM exercises.
Clients with decreased bone density are vulnerable to compression forces. It is therefore important to limit forces that act downward on the spine (as in barbell squats).
If posture is swayed or deviated due to age, the program must take muscle imbalances into account. Modifications should focus on rectifying the differences between opposing muscle groups and opposing sides of the body. For example, modifications for a client with stooped shoulders would include a strong focus on strength training for the posterior muscles of the back versus the anterior. This is in contrast to the traditional way of thinking about program design and agonist/antagonist muscles.
Modifications are a part of fitness training. The key is to know when and how to make them for each client’s unique biomechanics, movement patterns and personal preferences.
- Regress to progress. If your client gets flustered during an exercise, back up and have her do a simple exercise that works the same muscle group or is a component of the more complex movement. Isolation exercises are effective for building strength and tone.
- Break down movements into simpler parts. Think of movement in terms of building blocks. A simple biceps curl can lead to a biceps curl with an overhead press and return through the eccentric phase of the curl. A squat can be taught first with a chair or wall and then progress to body weight only, to a weighted squat, to a squat with an overhead press or to plyometrics. Start simple and end strong.
- Recognize the value in any movement. If you encounter resistance or if your client complains that learning and/or executing an exercise is painful or difficult, move on. Never allow a client to feel that he cannot do something or that you don’t have another plan for him.
- Stay focused. If you have a hard time flowing from one exercise to another in a logical, effective way, structure each program around a joint or muscle group and stay focused until it is time to move on to the next series of exercises. Don’t jump around between muscle groups.
- Understand the concept of general motor ability (GMA). GMA simply means that people will be good at motor skills that are related to what they already know how to do (Schmidt & Lee 2011). For example, a client who has been bodybuilding for years will be excellent at executing power lifts, yet may be hesitant to try the BOSU® Balance Trainer.
- Know your client’s exercise history and be prepared to incorporate it into your modifications. This will help you design a program that (1) the client feels familiar with, (2) incorporates exercises that the client has already performed safely and effectively, (3) helps the client feel successful and (4) helps you move the client from the known to the unknown.
- Reassess often. When a client struggles with an exercise that requires coordination, balance and strength, it is time to reassess the program. A complex exercise executed poorly is not nearly as valuable as an isolation exercise executed well.
The client was a 40-year-old woman with osteopenia and a previously fractured pelvis. Her program was designed with her prior injury in mind. Program components included exercises that
- eliminated compression forces on the spine and pelvis;
- reduced balance requirements to minimize the risk of falling; and
- isolated the primary and supporting musculature of the hip joint.
Modifications involved having the client do some exercises seated or lying down, to eliminate compression forces. Doing exercises lying down or seated also eliminated balance concerns and allowed for target isolation work of the most critical muscles. In addition, lying down instead of standing changed the exercise plane. (Having your client stand during a standard crunch, for example, would change the movement plane. Target muscles would work in the same movement pattern, but the plane would change.)
This client often complained of pain during lateral hip abduction exercises. The remedy was to stop and reset the start position. Think about trajectory: where you end up is based on where you start. Sometimes the exercise trajectory is simply off and needs to be reset for the client to execute the move correctly and comfortably.
Finally, modifications were based on the concept of building blocks. In this case, the program progressed from sit-to-stand to wall squats to nonweighted squats. Eventually, weighted barbell squats were added.
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