I am wondering how much experience everyone has training morbidly obese clients?
In 5+ years of being a full-time indy trainer I have only had 1 morbidly obese client. It reminded me of coming directly from a NCAA Div 1 Strength & Conditioning program to 9-5 office workers.
Most of the techniques I use with healthy clients either had to be severely modified or left out of the exercise.
My question is, do they have or should there be a special certification for training the morbidly obese people which physical activity could may well be a matter of life and death?
On a serious note, training a morbidly obese client means very little in the aspect of movement. It is more mental and nutrition being they can only do so much. I don't support aggressive training for the morbid obese.
There are additional CE's in that via NASM and ACE at least that I know of.
On a serious note, training a morbidly obese client means very little in the aspect of movement. It is more mental and nutrition being they can only do so much. I don't support aggressive training for the morbid obese.
There are additional CE's in that via NASM and ACE at least that I know of.
The mental aspect would be huge for a certification. I mean, probably 99% of personal trainers would find it hard to relate to someone who's over 100lbs. overweight.
It is interesting that, (may due to location: San Francisco) that I see very few obese clients working with personal trainers when I know they're out there and they need the help the most.
Im sure some certification companies out there have certs specific to the needs of overweight/obese people but I dont think its necessary esp with your advanced degree. I certify personal trainers and have worked with many overweight people in the past. A couple of issues/things to think about include:
1.don't use BIA (bioelectirc impedance) to calculate body fat. It probably wont work on those over 300 lbs. all youll get is a big letter "E" (error) that you will have to explain
2. if they are very large they may have a pacemaker. Again, dont use BIA if that is the case
3. if using tape measuires to do circumference, be careful of the abdominal region. in very large people (BMI > 40) the tape may not make it around. same for the hips also.
4. they may have poor balance and low staimina. as such try intermittant exercise at first instead of steady state exercise
5. the person may be type II diabetic. if you are not sure and the client is african american, look at the skin on the back of the neck. darker skin there may be a sign of type II diabetes / metabolic syndrome.
6. circuit training (incorporating some aerobic activity into the cirucit) is probalby the safest mode of exercise for this individual. keep the weight light (ie 12-15RM) use the RPE scale to guage fatigue level.
7. if diabetic, see if you can get an idea of their Hb A1c levels. they should know this or their doctor certinaly knows this.
I hope some of this helps. let me know if you have any other questions
good luck.
Joe
my website: www.Joe-Cannon.com
2 - as might any trainee - not just obese clients
3 - or get a tape that is longer - they are available.
4 - as might any new trainee
5 - any trainee might have medical conditions - surely you screen all clients for diabetes, heart trouble, COPD, arthritis or any other actual medical condition. Also - any race person can get ancanthosis nigricans.
6 - why? what's the safety issue that high rep circuits circumvents
7 - fairly useless advice (find out the number) unless you include advice on what you would do differently if it was higher
I'd say look for medical conditions you should be aware of in all of your new clients, not just the morbidly obese and be prepared to accomodate any exercise scheme as as result. So, you might want to read up on any changes that you would make for the common conditions that any of your new trainees might come in with.
Now, larger clients might have issues due to their size outside of any disease state. For example, her center of gravity might make some standard movements more difficult or his size could make some movements quite uncomfortable - chafing and bouncing issues come to mind. Not to be crude, but ATG BW squats are an issue when your thighs hit your calves after a very small range of motion. Pushups or even planks can be an issue if there is too much of a belly to really clear the floor - so you might need to do slanted pushups and planks to get the effects you want. That sort of thing.
But you'd tailor any program to your clients individual movement issues and weaknesses, right?
Here in the UK there have been some great CPD courses that target trainers working with those who are morbidly obese. This is becoming a very popular area of speciality in the UK.
I found this thread when googling "personal training for the obese" and I have to tell you, I think it's a hugely lacking area! I myself am not a trainer, but rather I'm a bariatric patient who has lost 80 lbs since my surgery in Fall 2007, and I've worked with trainers on and off since long before my surgery (in the end, it was what helped me get on track and stay on track). One of my biggest frustrations is finding how little trainers know about life as a "large person" and how to modify workouts to make it doable and not too intimidating.
My niece and I are actually thinking of starting a business for training and support of the morbidly obese, including modifications for nutrition to match gastric bypass and lap-band dietary needs. I also have some ideas on how to help trainers.
1. it's HARD WORK moving around with extra bulk and weight. I'm thinking about designing a "fat suit" that's weighted so you get a better idea of how it feels to sit, stand, kneel, fit into equipment, step up/down, balance..... it's all VERY different (in fact, I'm still relearning balance right now). Try strapping on an extra 100 lbs (or more) and go through a boot camp. I managed it... can you?
2. subscribe to some of the support sites for weight loss surgery patients. You'll find it is NOT a cop-out (and NO, I will NOT remove my lap-band because you think it is a cop-out), and in fact, it offers challenges traditional approaches don't have (but it's totally worth it in the end).
3. don't go over the top with the "you can do it!" enthusiasm. Just be supportive and know that it really does hurt in ways you won't realize unless you've been there. Don't be surprised if big emotions crop up while the person is working out (anger, frustration, even tears). If you keep your cool and are supportive, they'll come back. If you don't, they're much more likely to quit (or at least find a different trainer).
4. that extra bulk gets in the way of folding up. For example, just "sitting on your feet" when kneeling can put stress on the knees - try doing it with a foam roller wedged in behind your knees and you'll get the idea.
5. put a few wide chairs and benches around so bigger people have a place to rest when they need it.
6. if you're measuring or testing a client, find a quiet spot out of main sight, and YES, please get a larger tape measure. Be as calm and nonchalant as possible, because the person you're measuring/testing is showing HUGE trust in you (we don't let just anyone know what we weigh or measure).
I'm sure I can find other examples, but this gives a good idea. I'm actually considering coming up with a business model to do seminars on working with bariatric patients or at least obese patients, to give the trainers a better idea of what it's like to be the client. Is this something you'd find useful and would pay for?
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.
Certification for Training Obese Clients
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