PT on the Net Research

Overweight, Diabetes and Herniated Disc


I have a male client who weighs 420 pounds, has Type II diabetes, tendonitis in both elbows and a prior history of a herniated disc in his lower back. His knees bother him also, I believe due to the additional weight. He has a one term goal of wanting to get down to 290 pounds. His daughter is getting married in two months, and he would like to walk her down the aisle without becoming out of breath. I was wondering if you could give me any advice to help this gentleman reach his goals. He is also currently working with a nutritionist. Any advice would be great.


Thank you for your question. First and foremost, you should seek clearance from your client’s doctor regarding his weight, diabetes and any other possible health issues that may be lurking. Your client is obese and isn’t healthy, therefore your primary concern is NOT to add unnecessary stress to his system. Unnecessary stress to an already stressed system is potentially hazardous. The solution is to first get clearance to exercise with recommendations. Typical activity guidelines are as follows:

  1. Make sure blood glucose is monitored before and after exercise – take recommended action if blood glucose is too high or too low.
  2. Know whether macrovascular and/or microvascular complications exist – these require special attention and can modify exercise application.
  3. Report any uncomfortable perceptions or problems you are having.
  4. For TYPE II diabetes, LOW LEVEL exercise every other day is recommended.
  5. Omit machine strength training due to the over stress that results. Instead, focus on body weight movements using gravity, ground reaction force, mass and momentum (see Momentum in Training).

Once you have obtained clearance and have gone through your client’s health history, I would recommend a light flexibility/cardio session of approximately 15 to 20 minutes. With his weight and known low back history, my recommendation (without seeing his function) is to start by stretching in a True Stretch cage, which creates the necessary stability to allow the body to elongate. A main focus may start at his spine (we term the stretches spinal distraction). If a True Stretch is not available, placing your client in a Smith Machine (bar overhead), or a doorway can also create the points of contact necessary to stretch the spine. To view such stretches please visit and look for the True Stretch cage.

Following the spine stretches, you may find success on a stationary bike, providing you set the seat to match his anatomy. This movement will get him moving, yet it will not create unnecessary compression through his foot/ankle, knees, hips, etc. I would only recommend three to five minute intervals on the bike followed by ground based BODY WEIGHT movement. The body weight movement may be a split stance with a two arm reach anterior to posterior (front of the body to behind the body) followed by a split stance with two arm rotation mimicking the walk cycle yet through a great range. After approximately two to three minutes, progress back to the True Stretch spine distraction exercise. This would conclude session one. Monitor how your client responded the next day and progress accordingly. Although this is a GENERAL program for a person I have never seen, I hope you see the logic. You must always know WHY certain movements are selected. By understanding a client’s condition, following guidelines and most importantly the principles of function, you will be on your way to changing your client’s life! Start slow and explain to your client the WHYs, which are by no means absolute. However, they create a “check-n-balance” system of management that allows you to tweak the program for your client’s individuality. Good luck!