People with unique needs or health considerations need to be treated differently when beginning an exercise program.
* When beginning an exercise program a personal trainer needs to be careful in the development of an
exercise program for people with special needs.
BEWARE of "Meathead" personal trainers! you could be at risk.
* Do NOT take it for granted that just because a person holds themself out as a "personal trainer" or markets themself as a "personal trainer," that they are necessarily qualified or are knowledgeable in the development of a "safe & effective" program that will meet your needs. People can get hurt and experience adverse effects to their health and even die as the result of a personal trainer not taking safety precautions or appropriately adjusting the intenisty of a program and also because of the use of inappropriate exercise selection for an individual. All personal trainers should screen potential clients for health risk factors "before" developing an exercise program for a client.
* Just because somebody has worked out for years in gyms and or competed in body building contests doesn't in and of itself qualify them to be responsible for the safety and health of other individuals. I have observed individuals who hold themself out as a personal trainer, have their clients engage in "unsafe" exercises that put them at risk for injury as a result of that client having special needs or health issues that were not taken into condiseration.
* There is certainly nothing wrong with having been a competitive athlete or body builder as these activities can be useful and positive experiences that you can draw upon to help and to inspire others. However, having been an athlete or body builder "in and of itself" does not always or necessarily qualify a person to be knowledgeable and competent in the design and implementation of safe exercise programs for the different populations of potential clients. Past quality experience along with education/training in the exercise science field is a plus. The "QUALITY" of experience of a Personal Trainer is more important than the "QUANTITY" of experience of a Personal Trainer. A person can have 40 years experience of doing things the "wrong way." There are numerous factors involved in designing exercise programs for reaching a wide variety of fitness goals such as resistance training, aerobic/cardiovascular training, and other forms of training such as cross training and anaerobic training to circuit training to name a few. A Certified Personal Trainer should have some knowledge of the structure and function of the muscular, nervous, and skeletal systems, structure and function of the cardiovascular and respiratory systems, bioenergetics (how the body uses energy), biomechanics, and safe program design for both resistance training and aerobic endurance training. Who a Personal Trainer is certified by in terms of a respectable credentialing agency does matter. Not all are equal. Education and background are very relevant as well. Don't be afraid to ask any personal trainer what their credentials, experience, and education are regarding their personal training profession.
* I will use a real example I have witnessed of "unsafe" exercise selection, program design, and irresponsible supervision. A few years ago I observed clients of a personal trainer being instructed to do deep lunges for quads and glutes dropping the knee low to the ground the entire length of the gym and back for multiple sets. Two of these clients were obese with one clearly weighing well over 300lbs and the other not far behind in weight who also had "Arthritis." It was evident that they were not able to safely perform the lunges and were almost falling over while attempting this exercise. They were not able to perform the range of motion required for this exercise. The older gentleman was grabbing at his knees with an expression of discomfort on his face. Lunges require a lot of control, balance, and extreme range of motion. Depsite the apparent and evident difficulty these two clients were experiencing, they were instructed by the personal trainer to continue doing the lunges the entire length of the gym. Furthermore for people who needed to focus on weight-loss, they were not doing any significant aerobic/endurance training to expedite losing weight. I will let you form your own opinion in regard to a personal trainer who uses this type of judgment or lack there of.
* Clearly there are exercises that are not appropriate for certain individuals due to their current level of fitness as desribed in the example given above.
HERE ARE SOME GENERAL SAFETY GUIDELINES AND CONSIDERATIONS FOR PEOPLE WITH SPECIAL NEEDS:
GENERAL EXERCISE SAFETY GUIDELINES AND CONSIDERATIONS FOR OBESE AND OVERWEIGHT PEOPLE:
* A well designed progressive program avoids the incidence of injury in addition to making the initial exercise sessions comfortable and tolerable for the person who is overweight or obese.
* With people who are obese, movement restriction or limited mobility due to the excess fat mass may require the modification of various exercises.
* Weight-Bearing stress is definately a concern for people who are overweight or obese, especially those who have osteoarthritis or musculoskeletal injuries. Low impact activities, not necessarily low in intensity, will prevent some of this stress.
* Balance concerns for people who are obese needs to be taken into consideration. A personal trainer should not be making an obese person attempt exercise movements that require extreme movements and range of motion such as lunges that require a lot of control. This may result in injury.
* Generally avoid extreme movements or extreme ranges of motion exercises due to limited movement restriction and mobility concerns.
* As an obese or overweight person begins to lose weight and excess body fat then at a progerssive rate, he or she will be able to perform a wider variety of exercises, however this needs to be done at a rate that is consistent with their fitness level and ability to safely perform the exercise.
* Although resistance/weight training can be part of an exercise program for weight and fat loss it should not be the only method or modality of exercise as part of an exercise program designed for losing weight andexcess body fat. Resistance training should be done 2-3 days per week on non-consecutive days. 1-3 sets, 10-15 repetitions/set, up to 8-10 exercises with gradual load increases in regard to amount of weight being lifted. Aerobic and cardiovascular training needs to be a more frequently occuring component of an exercise program to lose weight and excess body fat. Aerobic conditioning may be done 5 days per week beginning with 20-30 minute sessions with an eventual goal of 40-60 minutes.
* An overweight or obese person needs to "move" and burn off calories. Essentially create a "negative energy balance" which basically means that a person is burning more calories than they are taking in. For more information about weight loss see WEIGHT LOSS.
GENERAL EXERCISE SAFETY GUIDELINES AND CONSIDERATIONS FOR OLDER AND OR ELDERLY ADULTS:
* Generally speaking, seniors whould perform resistance training two or three nonconsecutive days per week.
* Breathing considerations are especially important for seniors. Emphasis is on exhaling during the lifting phase and inhaling during the lowering phase or exhaling during the exertion/sticking point of the exercise and inhaling during the eccentric phase.
* Older Adults should AVOID "hard-to-control" exercises such as lunges or step-ups. This can cause injuries to their joints, connective tissues, and muscles.
* Older adults should begin with weight-supporting machine exercises before progressing to weight-bearing free weight exercises.
* Older adults should begin with weight-supporting aerobic endurance exercise such as stationary cycling before progressing to weight-bearing alternatives such as treadmill walking and stair climbing.
* Older Adults should also AVOID extreme movement range exercises such as lunges as this may also result in injuries and aggravate arthritic conditions.
GENERAL EXERCISE SAFETY GUIDELINES AND CONSIDERATIONS FOR PEOPLE WITH DIABETES:
* People with "proliferative diabetic retinopathy" should avoid strenous high- intensity activities as this may cause additional hemorrhaging/bleeding in their eyes/retina due to blood vessels bursting. Proliferative diabetic retinopathy causes people to go blind and can be progressive.
* People with a loss of protective sensation in their feet (peripheral neuropathy) should avoid outdoor walking and jogging. Swimming and biking is recommended.
* Evidence or reports of underlying cardiovascular disease that has not been medically evaluated should be referred to a physician first before even begining an exercise program in order to determine exercise restrictions.
* Glycemic Control is very important. A person with diabetes needs to be first evaluated by a physician in order to determine that hte person has glucose control through medication and is relatively stable in this area. It can be dangerous for a Hypoglycemic (blood glucose level of 65 mg/dL or lower) individual to attempt to engage in exercise.
* Factors that predispose a person to hypoglycemia during exercise inlude:
- increased exercise intensity
- longer exercise time,
- inadequate caloric intake prior to exercise
- excessive insulin dose
- insulin injection into exercising muscle
- colder environments
* If a person becomes hypoglycemic, immediate treatment with a carbohydrate is essential. If blood glucose is below 70 mg/dL 1/2 cup of regular soft drink or fruit juice, or about 6 saltine crackers, or 1 table spoon of sugar or honey.
* Resistance training and Aerobic training can be beneficial to people with diabetes, however should be done at a rate that is progressive and appropriate to their fitness level. resistance training and aerobic training should be done on non-consecutive days.
GENERAL EXERCISE SAFETY GUIDELINES AND CONSIDERATIONS FOR PEOPLE WITH HYPERTENSION (HIGH BLOOD PRESSURE):
* People with Stage 1 or greater readings < 140/<90 should not be trained until their blood pressure is CONTROLLED "and" a Physician has cleared them for exercise.
* People with "Controlled hypertension" may participate in many types of training with limited restrictions including but not limited to the use of free weights, weight machines, body weight, elastic bands, aerobic exercise and circuit training to name a few.
* If you have hypertension or history of high blood pressure, you or your personal trainer should take your resting blood pressure "before" your workout session as a safe guard. If your resting blood pressure is elevated above the cut off or borderline for hypertension, then you should cancel that workout session and consult your physician about controlling your blood pressure.
* The good news is that resistance training and aerobic training can have a positive training adaptation which is a lowered resting blood pressure. This can be achieved by exercising at intensities of 40% to 50% of maximal oxygen uptake.
* For resistance training, rest periods or "rest intervals" between sets initially should be two to three minutes longer to allow the person to "fully" recover between sets. This is especially important for those individuals who may be taking prescription medication for hypertension control such as beta-blockers.
* Hypertension is a disease of not just the old, but also young people as well.
* Over 50 million Americans age 6 and above have this disease defined by a Systolic reading of 140 + mmHg and /or a Diastolic reading of 90 + mmHg.
* Elevated blood pressure puts an individual at risk for a heart attack, stroke, or both. Mildly elevated blood pressure (over time) can lead to kidney disease and generalized vascular disease.
PEOPLE WITH UNDERLYING CORONARY ARTERY DISEASE WITHOUT ASSOCIATED CHEST PAIN:
* It is important for Personal Trainers to recognize that there is a subpopulation of people who have underlying coronary artery disease without associated chest pain during activity. These people are at risk for "sudden death" since they will exercise to the point of coronary artery spasm, acute heart attack, with a sudden stoppage of beating of the heart.
* Due to this fact, a responsible Personal Trainer should screen their clients for any medical history and or health problems in order to determine if they are at risk for coronary artery disease and if necessary refer them to a Physician in order to get the appropriate test done such as a stress test that may reveal whether an individual is in this subclass. A personal trainer should NOT train people in this subclass. These people with underlying coronary artery disease should exercise in a "medically supervised setting."
GENERAL EXERCISE SAFETY GUIDELINES AND CONSIDERATIONS FOR PREGNANT WOMEN:
* Check with your health care provider before you begin exercising.
* Exercise at a comfortable level at which you can maintain a conversation.
* Do not exercise if you have a fever
* See your health care provider if you experience bleeding, a large amount of
discharge or swelling in your face and hands.
* Avoid lying on your back after the THIRD MONTH.
* Avoid straining or stretching to the point of discomfort.
* Avoid fatigue and over training.
GENERAL EXERCISE SAFETY GUIDELINES AND CONSIDERATIONS FOR POST MYOCARDIAL INFARCTION (HEART ATTACK):
* People who have had heart attacks are not to be trained until they have received clearance from their cardiologist, cardiovascular surgeon, or both. At that point, the medical professional should or must be able to provide an intensity level and training range for the personal trainer to use and work with. Other restrictions may be advised as well particular to the exercise program as a result of coexisting medical conditions or "comorbid disease."
* People who have suffered heart attacks (myocardial infarction) should NEVER hold their breath during exercise or the exertion phase of a movement. This will increase undue pressure and stress on the heart.
PEOPLE WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE:
* People or patients with COPD should exercise in a "Formal pulmonary and respiratory rehabilitation facility" and NOT under the direction of a personal trainer.
EXERCISE CONSIDERATIONS FOR PEOPLE WITH ORTHOPEDIC CONCERNS:
* Muscle contusions, muscle strains, tendinitis, tendinopathy, bone fracture, joint dislocation, joint subluxation, and joint sprains.
* It is not up to the personal trainer to determine movement or exercise restrictions for people with orthopedic concerns; rather these should be determined through "consultation with the person's physician or physical therapist."
* People with herniated lumbar discs are generally encouraged to AVOID lumbar flexion in favor "extension" to prevent the posterior protrusion of the disc material. Therefore they should AVOID exercises involving significant lumbar flexion such as full sit-ups, all rowing movements e.g., seated row, bent-over row,. The deadlift should be avoided as well.
* People with herniated disc should also AVOID lumbar rotation such as knee to chest stretch and spinal twist.
* People who have undergone total knee arthroplasty should avoid excessive knee flexion, such as in a deep lunge as shown here:
* There are numerous other considerations and alternative methods to use for conditions such as shoulder impingement or problems that can be advised by a physical therapist or physician who has done range of motion test in a medically supervised setting. This information can be given to a personal trainer to use as a guideline when doing exercise selection with you.
* Don't take it for granted that a personal trainer will know that you may have orthopedic issues. You need to communicate and tell him or her and make sure they understand any and all limitations associated with your condition. If you are not sure then consult your physical therapist or physician first before performing any exercise technique in question.
THERE ARE NUMEROUS OTHER CONDITIONS WHICH MAY REQUIRE SPECIAL CONSIDERATION AND TREATMENT BEFORE BEGINNING AN EXERCISE PROGRAM. REGARDLESS OF WHETHER OR NOT YOU HAVE A DISABILITY OR NOT, ALL EXERCISE PROGRAMS SHOULD INCLUDE THE FOLLOWING PRINCIPLES:
1. Screen for any health risk factors
2. Specificity
3. Overoad (challenging the body)
4. Progression
5. Variation.
For more information about program design and these concepts click on this link PROGRAM DESIGN.
For a free initial consultation to discuss safe and effective exercise programs to meet your individual needs call me today or contact me through this website.
