It is no secret that obesity is a growing worldwide epidemic. With rising awareness has come a growing desire to create positive change, and fitness professionals are in a powerful position to help facilitate this change. The following article is an exploration of some of the key issues and strategies for creating a supportive training environment for obese clients.
You will need a large space (ideally closed off from the rest of the gym) to train an overweight client. Group exercise studios are great. The wide open space ensures the client will have ample room to move around and not be limited to small movements. The wide space also decreases the risk of running into things, tripping and/or feeling unsafe. Also, having their own space offers the client a degree of comfort he likely doesn't have in the larger gym setting. When the client is feeling comfortable, he will feel less self conscious about body image and performing basic exercises.
Progression will probably be one of the biggest challenges, but it is vitally important to your client's success. If progression is not done properly, the risk of injury is increased. The client is most likely not accustomed to any exercise, and the new stimulus is very hard on an untrained, overweight body. If you progress too quickly, not only will the chance of injury rise, but the client may also feel like he is too out of shape to do the things you are asking, and he'll become discouraged. Building a base is hugely important, so the client knows the goals he is trying to achieve and has a foundation to build on in each stage of progression.
Sometimes we don’t remember how difficult it is for an obese person to fit onto things or get up or off of things. This plays a bigger part than you would realize as far as the exercises they can safely do. An obese person most likely will not be able to lie on a bench or get up from a lying position. Not only is this dangerous for them but may make them very uncomfortable. Most machines are not made for an obese person and the weight of sitting on some machines may not be safe for your client. Also their body may just not fit period sitting or lying on some surface areas. For these reasons, it is very important to pick your exercises wisely.
While an obese person may not have ever been able to see their “core muscles” it is important to train these muscles as well. It will be really difficult for the client to understand these exercises. But the core training is extremely important for body awareness and understanding muscle contractions. Again a large discrete place is good for the client to feel comfortable not only getting into a lying position but also working on “ab muscles” may not seem like the most relevant thing to the client. Making sure the client understands that even though the ab area is the least favorite part of their body that the muscles need to be strengthened as well.
Ideally the client will wear a heart rate monitor. This is good to know your client’s limits and how they feel at different heart rates. However this may not be an option due to the large girth of the body, a heart rate monitor may not fit, or fit comfortably. In such a case where there is no heart rate monitor it will be up to you to monitor your clients work rate. Making sure that (especially at the beginning) you ask your client how he/she feels multiple times throughout the workout, and making sure that they have ample breaks. It is important to keep the heart rate up but it is also important that the client feels well throughout the session. With some clients there may not be a huge drive to push themselves and in this case you need to work for shorter bouts with a little bit more intensity (they will work harder knowing they only have to sustain an exercise for 30 seconds to 1 minute) and ample rest in between exercises. Always (as with any client) be aware of fatigue, pay close attention to the clients sweating, skin color, energy levels, and their own enthusiasm about their workouts.
Always a huge aspect of any trainer’s job description, encouragement becomes especially important when it comes to your obese clients. It’s tough to start working out when you haven’t in a while, but when you have never worked out in your life, sometimes your client sees this up hill battle as a chore. In this case, make sure your client knows he is doing well and provide frequent encouragement and praise. He may feel like he is doing things a six-year-old child is capable of doing, but letting him know he is doing a great job will help him get through it. A little bit of positive feedback will go a long way! Knowing he is progressing and improving every day will help your obese client see the importance of the little goals.
When your client tells you they walked for an extra two minutes yesterday, this is a huge thing. To the average person, achievements like this may not be note worthy, but to an obese client, it is comparable to a fit person running an extra mile. The client needs to know that every little bit counts. Things like being able to get down and up off the floor may be a baby step, but it accounts for something. Showing enthusiasm for the little things as well as the big things (like when your client can buy “normal” clothes at a “normal” store) will mean a lot in the end.
Speed of progression will vary from person to person. The hardest part about being a trainer and training an obese client is knowing when to move to the next level.
This stage is composed of general body movements. Trying to utilize full body, and full ROM of upper body. At the early stages of this program use only movements in place. This allows the client to feel comfortable in the space as well as keeping the balance and coordination (which at this point is probably pretty poor) to a minimum. Doing this program by time is helpful, again because it allows the client to work towards a short goal (30 seconds to 1 minute). Make sure to give the client breaks in between each movement. I find it helpful to participate with the client to help encourage them and help them keep up the correct movement. In this stage it is also very important to get a good warm-up as well as stretching at the end. Make sure your client drinks plenty of water and understands that he/she may find that they become fairly sore after the first couple of meetings.
Traveling Body Movements
This stage is designed to help the client move the body more (increasing heart rate and difficulty of exercises). Now the focus moves more towards coordination and balance as well. It is helpful to use length (i.e. Down and back in a studio is one set) as a tool in conjunction with time. Keep sets to a minimum (no more than three); always make sure the client knows what the focus is. Anyone can speed walk but let them know to focus on posture, feet positioning, and or gait. Most obese people have learned how to compensate for the extra weight (i.e. turning feet out when walking, hunching over when standing, etc.) so pay attention to those deviations and as little as possible make sure that you remind them to work on those things as well during drills. If you get too specific with the little things with this type of client then it just adds to the already up hill battle they are facing. So make sure they are aware of the things their body does involuntarily and let them know that those things are important to work on but not a main goal. It is important to try and work in all planes of motion.
Balance and Coordination
The obese client usually doesn’t have too much of balance or coordination. Imagine trying to step off a curb with an extra 200 lbs on your back. That is what some of these people face every day. So this stage can be particularly difficult, frustrating, and scary for your client. Make sure to start with the basics (as standing on one foot for longer than 2 seconds may be a huge challenge). Do all balance work focusing on just one body part (so at this point no standing on one foot and trying to lift weights). Shoot for very small goals. Do balance work after the client is sufficiently warmed up but make sure not to do it at the end of the workout, as he/she will probably be completely fatigued by that time. Stress the importance of this stage; your client will notice a difference in everyday life with the improvement during this phase.
So now (could be one month to six months later) you can start incorporating weights. Again, going back to the basics. Trying to include some weights with the body movements in place. Now instead of stepping and punching hold a weight, bend the knees more, etc. Free weights, tubing, bands, med. balls and body bars are the best way to start this process. Again, light weights (nothing more than 10lbs) with simple movements. Focus on ROM and keeping heart rate up. It is best at this early stage in weight lifting to focus on reps as opposed to time. Usually reps of 15-20 for two to three sets. In this stage again, go back to focusing more on core work as well. Start with learning how to contract the abdominal muscles.
Free Motion with Complex Body Movements
Now that your client understands muscle contractions you can really utilize the Free Motion equipment and use it to work on all planes of motion (especially important for this client because for the most part they only know straight forward, backward movement is very difficult). Incorporating lower body movements (squatting, lunging, bending, etc.) with upper body weight lifting. This is a great tool for getting the heart rate up as well as building strength. As always (but particularly in this stage with so much movement) be sure the client knows what to focus on and what is the main goal of the exercise. Keep your critiques and queues as simple as possible.
Timed Complex Body Movements
This may be one of the more tough phases of the program. This is a really great way to keep the heart rate up. Here you will want to push the client to try new things that may be somewhat scary for them (step ups, more complex backward movements, hops etc.) Make sure first and foremost that the space you are working in is safe and wide open. Start slow, giving tips on how to move through the motion and how to control the body. *With an overweight person momentum can be a huge difficulty when doing body movements. Work with the client to control and shift their weight for balance.
The backward movements, again, will be the most challenging. Always start on the floor then progress to short boxes, moving on to a challenging but comfortable middle ground. Encourage the client, again this stage will be difficult but let the client know that this is a hard thing to do and that he/she is doing very well.
Timed Isometric Contractions
This is a good way to push the client in a completely new and unfamiliar way. The goal here is to find challenging but do able poses for the client to hold. Start out with using body weight, such as, holding a squat. Go for time, start low, about 30 seconds. After getting the client comfortable holding positions you can add in weight. For instance, holding a small ROM lunge stance with an isometric hold of a free motion fly. In this stage we are trying to push the client to obtain burnout by holding the contractions.
Timed Body Movements with Burnout
This stage will be one of the most challenging. Now that we have established good body movements with control we are going to add in one more component, ending with a burn out. So here the client goes through complex body movements such as a squat with a dumbbell shoulder press. He/she does the movement for time (1-2 minutes), with the last 10-15 seconds (at this point the client should be working very hard) being a quickened motion to result in a “burn out” of the body. Be sure to keep an eye out for form and the deviation of the client’s body (the old habits). Make sure again, that the client is aware of what his/her body is doing during the motions (and what they are doing to compensate for lack of strength, balance, and or coordination).
With an obese person you must always remember (especially at the beginning stages of training) that he/she has little to no connection with their body and the way it moves. The first few training stages should be used help the client understand how their body works. Make sure they know how they compensate for their extra weight when they move (which will be extremely evident when they walk). This is the base for all that is to follow so while any exercise is better than none make sure they understand how to increase their self-awareness of their body movements.
Encourage, encourage, encourage and patience, patience, patience are the best tools to success with your obese clients!