There is very little info available on this, but it is improving. In the UK they are bringing out a REPS level 4 cert (gym instructors are L2 and personal trainers are L3, so it a specialisation for advanced instructors working in this area).
I am the exercise specialist for a 12-week diet and weightloss programme run by our local health service for overweight patients referred to us by their doctor.
Some issues in the morbidly obese: joints. Many obese clients won't be able to even stand for very long because of pressure on the joints. It is quite astonishing how good a workout can be achieved from a seated position using exercise bands - you can work pretty much all major muscle groups. You can get pretty creative here with practice. If you need more ideas, there are some seated cardio workouts available in teh US on amazon but they weren't cheap. Don't know if they are any good. Might give you some ideas.
As another poster said, they may not be able to get down on the floor. If they do, they may not be able to get up, so push ups against the wall are an option. STanding up and sitting down from a chair for squats.
As with all clients you should do a PAR-Q, but I would insist on a medical sign-off before exercising a morbidly obese client. If they haven't been referred by a GP/physician, write to their doctor explaining the situation and asking for guidance. There are all sorts of considerations for the various comorbidities - angina, hypertension, diabetes, arthritis etc etc. Make sure you are certified for this. (see below)
Be extremely observant of warning signs - if a client is very motivated, as they are likely to be if they are paying you, they tend to want to do more than they can. You have to stop them from pushing themselves too hard. Be absolutely anal about continued and correct breathing through resistance workouts. Get it tattooed on your forehead if need be.
And make sure you have had some training in working with obese clients. In the UK, REPS level 3 covers special populations, including obesity, hypertension, diabetes, etc. If you are training a client you are not qualified to train, your insurance won't cover you.
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