Please need advice for older client with health issues

[Shane7518]

Hey guys, I have a challenging client that I am looking for advice with please. She's a 57 yr old female, Obese at 250 lbs (goal to lose body fat, increase lean body mass), and is a retired Nurse. Which means she has done heavy lifting all her life and as a result she has bad knees and back. To add to it she is also getting arthritis in her hands and knees and osteoporosis. I have told her that I can help her with the Osteoporosis with exercise, but the trouble is she can't run/jog so I got her to walk on the treadmill. She can do this for only 10 minutes at a time until her knees give out. I told her if she can even do 10 minutes 3 times a day would help if she can't go for 30 min at once, she is following this advice and can do 10 minutes most times. I have tried some resistance exercises with light weights but have failed at that as well. It's difficult for her to do weight bearing exercises (Obese), yet difficult as well with exercises such as leg curls (arthritis). I am thinking my last option is isometrics with her as her joints wouldn't be affected as much. I have also suggested swimming as well, which she has followed and says she loves. This client has achieved her goal weight of 150 lbs about 3-4 years ago and gained it all back. In desperation she is on the waiting list for surgery (Gastric Bypass), they basically cut out her stomach and leave her with the size of about an apple left. I am trying to talk her out of it (as I feel this is a drastic measure) and my goal is to help her get healthy again through proper diet and exercise. I am hoping if I can "show her the way" to a healthy lifestyle and help her lose at least some weight, and exercise enough that she starts feeling good about herself again that she won't go through with such an extreme measure as Surgery. I would appreciate any feedback, Thanks!

[KyleAaron]

What she needs is outside the scope of practice of most personal trainers, mate.

[Endevorforever]

Hey guys, I have a challenging client that I am looking for advice with please. She's a 57 yr old female, Obese at 250 lbs (goal to lose body fat, increase lean body mass), and is a retired Nurse. Which means she has done heavy lifting all her life and as a result she has bad knees and back. To add to it she is also getting arthritis in her hands and knees and osteoporosis. I have told her that I can help her with the Osteoporosis with exercise, but the trouble is she can't run/jog so I got her to walk on the treadmill. She can do this for only 10 minutes at a time until her knees give out. I told her if she can even do 10 minutes 3 times a day would help if she can't go for 30 min at once, she is following this advice and can do 10 minutes most times. I have tried some resistance exercises with light weights but have failed at that as well. It's difficult for her to do weight bearing exercises (Obese), yet difficult as well with exercises such as leg curls (arthritis). I am thinking my last option is isometrics with her as her joints wouldn't be affected as much. I have also suggested swimming as well, which she has followed and says she loves. This client has achieved her goal weight of 150 lbs about 3-4 years ago and gained it all back. In desperation she is on the waiting list for surgery (Gastric Bypass), they basically cut out her stomach and leave her with the size of about an apple left. I am trying to talk her out of it (as I feel this is a drastic measure) and my goal is to help her get healthy again through proper diet and exercise. I am hoping if I can "show her the way" to a healthy lifestyle and help her lose at least some weight, and exercise enough that she starts feeling good about herself again that she won't go through with such an extreme measure as Surgery. I would appreciate any feedback, Thanks!

Okay dealing with obese clients is not like dealing with an apparently healthy individual. I hope you got medical clearance for all this. I usually start obese clients on body weight exercises. Use resistance bands as they help people who have arthritis and can not bear weight. Remember obese clients need to move... a lot. A stationary stair step machine can help her get cardio for practically no impact on the knees and back. Folks with knee problems should not be jogging/running or walking for long periods. Flexibility training should also be a major part of her exercise program.

If she is seeking GB surgery, that means she might also have tried "dieting" get her used to eating real food again and ask her to reduce junk/fast food to her favorites once a week a most. Make sure gets the doctor recommended amount of protein and calcium because she is losing lean mass.

She is going through many challenges, but she can lose the weight without the surgery. I hope this helps.

[SFT]

I agree with Kyle. She should really be working with someone that has a background in working with people at higher risk. For example, someone with experience in a therapy settings, or a clinical exercise physiologist.

I disagree with Endevor regarding obese clients moving a lot. I suggest you strap a 50-100lb. vest on to get a feeling for how she feels day to day. Most of the work she needs is in the kitchen. Unless there is something else going on medically, her diet is probably atrocious. She could likely lose weight working out as little as three days per week, with serious diet modification.

As far as exercise goes, the pool would probably be my first choice. Jogging shouldn't even be a thought. Even if she could do it, again, go throw the 50-100lb. weight vest on and see how running feels. She seems like a perfect candidate for a knee replacement in the coming years. A recumbent bike would be great for reducing the load on the knees.

[KyleAaron]

There have been a lot of these threads here over time. In the US, what guidelines are given PTs as to their scope of practice?

Here Down Under, what it comes down to is this: if the person has a condition which might kill them on the spot (heart disease, BP>145/90, emphysema, etc), then refer.

If they have just one serious but no life-threatening medical issue (gross obesity, diabetes, osteo/rheumatoid arthritis, recent hip replacement, etc) then you can train them provided you have some further study and experience in that area and you are in communication with their medical professional.

If they have two or more serious but non-life-threatening issues, then in almost all cases you'll refer. That's because the combination of the issues makes things too complicated for people with our level of expertise. This is a problem with the grossly obese, since while they may be keen to seek the assistance of a PT, in general they'll have several serious problems at once.

I don't know if these guidelines are the same in the US, or if they are but most PTs manage to make it through their courses without remembering them, or if they do learn and know them but are encouraged by sales-greedy gym managers to ignore them. But whatever: professional ethics requires that you keep in mind your scope of practice. A simple guideline: if you have to ask random strangers on internet forums what to do, it's probably outside your scope of practice.

[SFT]

There have been a lot of these threads here over time. In the US, what guidelines are given PTs as to their scope of practice?

Here Down Under, what it comes down to is this: if the person has a condition which might kill them on the spot (heart disease, BP>145/90, emphysema, etc), then refer.

If they have just one serious but no life-threatening medical issue (gross obesity, diabetes, osteo/rheumatoid arthritis, recent hip replacement, etc) then you can train them provided you have some further study and experience in that area and you are in communication with their medical professional.

If they have two or more serious but non-life-threatening issues, then in almost all cases you'll refer. That's because the combination of the issues makes things too complicated for people with our level of expertise. This is a problem with the grossly obese, since while they may be keen to seek the assistance of a PT, in general they'll have several serious problems at once.

I don't know if these guidelines are the same in the US, or if they are but most PTs manage to make it through their courses without remembering them, or if they do learn and know them but are encouraged by sales-greedy gym managers to ignore them. But whatever: professional ethics requires that you keep in mind your scope of practice. A simple guideline: if you have to ask random strangers on internet forums what to do, it's probably outside your scope of practice.

Scope of practice is really defined by our certifying bodies - of which there are too many to keep track off. Legally, there is no scope of practice and personal trainers aren't even mentioned in law in some states. The problem is that so few personal trainers actually work in an environment where they have guidance and oversight. Medical clearance is often not asked for even in the most obvious cases (hypertension, heart disease, etc.)

I've seen personal trainers, with nothing more than a weekend certification, training people with considerable health histories (diabetes, hypertension, spinal fusions, CP, MS, and more). The problem is that we don't have anyone to refer to here. Hospital based programs don't seem to be enticing to most people. Exercise physiologists seem to have very dry personalities in my experience. Many programs just throw people up on a treadmill and treat them like a machine.

In my case, I have a BS in Exercise Science and I follow ACSM guidelines. As a result of my background, I tend to get many high risk clients, but they all receive medical clearance. I get clients with diabetes, hypertension, joint replacements, MS, CP, and more. Some of them would be more appropriate for a hospital-based program, but they simply won't go there. So, as long as I can obtain medical clearance, which helps to save my ass, I will take on most clients aside from orthopedic issues that are not controlled (no previous therapy + still exhibiting considerable pain), or higher risk CVD clients that I believe need ECG monitoring.

So in short, most personal trainers here have NO oversight. Realistically, they should be overseen by someone with BS in Exercise Science and experience with risk stratification. Nobody would be on the boards asking these questions if there was oversight and clients were referred to the right professional for the job. Your last sentence pretty much sums it up. The state of personal training, and fitness in general, in the United States makes me sick. Too many people are treating the profession as a hobby.

[Endevorforever]

Scope of practice is really defined by our certifying bodies - of which there are too many to keep track off. Legally, there is no scope of practice and personal trainers aren't even mentioned in law in some states. The problem is that so few personal trainers actually work in an environment where they have guidance and oversight. Medical clearance is often not asked for even in the most obvious cases (hypertension, heart disease, etc.)

I've seen personal trainers, with nothing more than a weekend certification, training people with considerable health histories (diabetes, hypertension, spinal fusions, CP, MS, and more). The problem is that we don't have anyone to refer to here. Hospital based programs don't seem to be enticing to most people. Exercise physiologists seem to have very dry personalities in my experience. Many programs just throw people up on a treadmill and treat them like a machine.

In my case, I have a BS in Exercise Science and I follow ACSM guidelines. As a result of my background, I tend to get many high risk clients, but they all receive medical clearance. I get clients with diabetes, hypertension, joint replacements, MS, CP, and more. Some of them would be more appropriate for a hospital-based program, but they simply won't go there. So, as long as I can obtain medical clearance, which helps to save my ass, I will take on most clients aside from orthopedic issues that are not controlled (no previous therapy + still exhibiting considerable pain), or higher risk CVD clients that I believe need ECG monitoring.

So in short, most personal trainers here have NO oversight. Realistically, they should be overseen by someone with BS in Exercise Science and experience with risk stratification. Nobody would be on the boards asking these questions if there was oversight and clients were referred to the right professional for the job. Your last sentence pretty much sums it up. The state of personal training, and fitness in general, in the United States makes me sick. Too many people are treating the profession as a hobby.

Look if you kill a client who has controlled high blood pressure with exercise, then something is wrong with you as a trainer. If a client has uncontrolled high blood pressure, then they probably wont be training anyways because they will feel too poorly to exert themselves anyways. The guidelines for working with clients with diabetes is not very complicated either. Physical therapist and hospitals are not the right sources for help with these clients. Now our trainer here is not using his mind when it comes to exercise, but to say that personal trainers need a B.S degree and such to help some one exercise is rubbish. Hospitals and physical therapist jobs are to keep the person alive, and then get the person the use of their body back. Strengthening, and conditioning a person is the job of the personal trainer. Furthermore, there are plenty of CEUs that cover these problems better than most colleges.

As far as scope of work goes, if the doctor clears the client for exercise then they can engage in an exercise program.

[alex061587]

Well, it's important to remember that our clients do have the freedom to make these decisions for themselves - sometimes there isn't anything we can say or do. As was stated above me, I would try and focus on flexibility training and emphasize workouts that do not put lots of pressure on the knee. Based on all the problems you've mentioned though, it may be better to take a step back and have her consult with a specialist who is more familiar with these types of clients. Just my two cents.

Alex

[KyleAaron]

Look if you kill a client who has controlled high blood pressure with exercise, then something is wrong with you as a trainer.

The thing is that it doesn't take much knowledge to not hurt someone, the question is whether you can help them. To not hurt them, just give them something easy to do. But since we're looking to produce an adaptation to imposed stress, we need to impose a stress - which will help them, but might hurt them too.

Knee reconstruction? Um, okay, we won't use that knee, just do upper body stuff - but while that doesn't hurt the person, it doesn't help them, either.
High blood pressure? Um, okay, we just won't get your heart rate up in cardio or have you lift heavy weights. Won't hurt you, but won't help you, either.
etc

While most PTs will have the knowledge to avoid hurting someone with several serious health conditions, they won't have the knowledge to help them.

[SFT]

Look if you kill a client who has controlled high blood pressure with exercise, then something is wrong with you as a trainer. If a client has uncontrolled high blood pressure, then they probably wont be training anyways because they will feel too poorly to exert themselves anyways. The guidelines for working with clients with diabetes is not very complicated either. Physical therapist and hospitals are not the right sources for help with these clients. Now our trainer here is not using his mind when it comes to exercise, but to say that personal trainers need a B.S degree and such to help some one exercise is rubbish. Hospitals and physical therapist jobs are to keep the person alive, and then get the person the use of their body back. Strengthening, and conditioning a person is the job of the personal trainer. Furthermore, there are plenty of CEUs that cover these problems better than most colleges.

As far as scope of work goes, if the doctor clears the client for exercise then they can engage in an exercise program.

I agree with what Kyle said, but to expand on the degree vs. no degree debate, the people who usually feel as if degrees are unnecessary don't have a degree. There are trainers that are great and don't have degrees. Likewise, there are mediocre trainers with degrees. However, if someone has graduated from a good clinical exercise science program, I can guarantee they have more knowledge than 95% of the trainers out there, with the same experience, when it comes to special populations.

If you read my post, I alluded to the fact that people don't like, and don't want to attend, fitness classes in hospitals. This is my experience anyways. That being said, many trainers outside of this type of a setting are even too lazy to collect information about what medications a client is on. The average personal trainer probably doesn't know about post-exercise hypotension or hypoglycemia with hypertensive or diabetic clients. They also probably don't know that a diabetic person should be getting advice from a dietitian. In some cases, it isn't as much about knowing what you should do, but also what you shouldn't do.

If you need any other convincing, how many times do you see someone asking these basic questions with a degree in Exercise Science? Don't get me wrong. There are great trainers with a CPT. Some of them surpass my knowledge in training a variety of clients. However, on average, I will know considerably more than most CPTs I meet, particularly when it comes to special populations. I think it would be nice to a have a "Senior" trainer that overlooks the training department. Like I said before, you wouldn't have as many trainers seeking the advice of strangers.

[rallen4a]

i'm not certified, and i'm not a professional.

but using some common sense, with age/risk/knee's/weight. she should be working only on a diet. she would be able to lose a lot of weight with little to no working out. once the weight comes down then introduce resistant training.

[Endevorforever]

The thing is that it doesn't take much knowledge to not hurt someone, the question is whether you can help them. To not hurt them, just give them something easy to do. But since we're looking to produce an adaptation to imposed stress, we need to impose a stress - which will help them, but might hurt them too.

Knee reconstruction? Um, okay, we won't use that knee, just do upper body stuff - but while that doesn't hurt the person, it doesn't help them, either.
High blood pressure? Um, okay, we just won't get your heart rate up in cardio or have you lift heavy weights. Won't hurt you, but won't help you, either.
etc

While most PTs will have the knowledge to avoid hurting someone with several serious health conditions, they won't have the knowledge to help them.

Fair enough let me elaborate. Every trainer should know, and I say this because most certifications cover at least this point, that you don't put a hypertensive in a prone, or supine position where their head is lower than their heart. Also you don't allow them to hold their breath or use the valsalva maneuver or engage in intense isometric exercise. They should move relatively quickly with a light load(~50% of 1RM) when doing weighted resistance training. Their training should include proper warm up, high repetitions more than higher weight, and flexibility training. Within these guidelines we can help the client.

I am not trying to start an argument I am just saying that you have to be negligent to kill someone with controlled hypertension with exercise. I also am not saying you can cure a clients hypertension. If a client has weight loss goals, which most hypertensive clients do, then we as certified personal trainers can help them.

[Endevorforever]

I agree with what Kyle said, but to expand on the degree vs. no degree debate, the people who usually feel as if degrees are unnecessary don't have a degree. There are trainers that are great and don't have degrees. Likewise, there are mediocre trainers with degrees. However, if someone has graduated from a good clinical exercise science program, I can guarantee they have more knowledge than 95% of the trainers out there, with the same experience, when it comes to special populations.

If you read my post, I alluded to the fact that people don't like, and don't want to attend, fitness classes in hospitals. This is my experience anyways. That being said, many trainers outside of this type of a setting are even too lazy to collect information about what medications a client is on. The average personal trainer probably doesn't know about post-exercise hypotension or hypoglycemia with hypertensive or diabetic clients. They also probably don't know that a diabetic person should be getting advice from a dietitian. In some cases, it isn't as much about knowing what you should do, but also what you shouldn't do.

If you need any other convincing, how many times do you see someone asking these basic questions with a degree in Exercise Science? Don't get me wrong. There are great trainers with a CPT. Some of them surpass my knowledge in training a variety of clients. However, on average, I will know considerably more than most CPTs I meet, particularly when it comes to special populations. I think it would be nice to a have a "Senior" trainer that overlooks the training department. Like I said before, you wouldn't have as many trainers seeking the advice of strangers.

Whoa lets wait before we speculate on the OP's credentials. I'd wager the OP is not a even certified. I am not saying that folks who have a degree don't know their stuff, I am just saying that most certifying organizations teach people how to train clients with these challenges.

[SFT]

Whoa lets wait before we speculate on the OP's credentials. I'd wager the OP is not a even certified. I am not saying that folks who have a degree don't know their stuff, I am just saying that most certifying organizations teach people how to train clients with these challenges.

Certifications provide very, very basic guidelines. Would you rather have a physical therapist with 20 years of experience treating you, or the guy right out of school. The new guy should have learned everything he needs to know in school right? We all know that this is not the case.

My point is that having the basic guidelines are a start, but it is not good enough. Most trainers don't even follow these guidelines unfortunately. Having a trainer with a degree that included further training in orthopedic injuries, training special populations, proper assessment practices, taking blood pressures, etc. that can oversee other trainers can be beneficial. Again, I'm not saying someone with a degree is inherently better than a trainer without a degree. However, having a degree from a good school provides said person with a guaranteed baseline level of knowledge. This is not always the case with certifications (most are far too easy). Despite the bad name they get, there are really good Exercise Science programs out there, if your goal is to work with clinical/special populations. Can you gain the same knowledge from being a CPT and taking a lot of extra certifications, interning, and lots of self study? You sure can. However, these people are few and far in between.

More than anything, getting a degree taught me how to find the answers on my own, or to know what people to ask. I think the point that I am trying to make (and Kyle as well), is that new trainers are seeking the advice of strangers. I'm constantly amazed by how much I don't know. Luckily, after only a few years out in the field, I have developed a pretty decent network of individuals that I can contact. I know quite a few people who have been in the field for 20+ years including physical therapists, chiropractors, and personal trainers. Who do you think I'm going to with most of my questions? I understand that new trainers don't have a network of people to talk to, but that is why I think there should be oversight with moderate to high risk clients. In my opinion, training isn't about not killing people, its about developing optimal programs to improve an individual's health and fitness. A good program will help your client reach their goals in a timely manner, efficiently, with the smallest risk of injury possible.

[PeteratCastle]

Hey guys, I have a challenging client that I am looking for advice with please. She's a 57 yr old female, Obese at 250 lbs (goal to lose body fat, increase lean body mass), and is a retired Nurse. Which means she has done heavy lifting all her life and as a result she has bad knees and back. To add to it she is also getting arthritis in her hands and knees and osteoporosis. I have told her that I can help her with the Osteoporosis with exercise, but the trouble is she can't run/jog so I got her to walk on the treadmill. She can do this for only 10 minutes at a time until her knees give out. I told her if she can even do 10 minutes 3 times a day would help if she can't go for 30 min at once, she is following this advice and can do 10 minutes most times. I have tried some resistance exercises with light weights but have failed at that as well. It's difficult for her to do weight bearing exercises (Obese), yet difficult as well with exercises such as leg curls (arthritis). I am thinking my last option is isometrics with her as her joints wouldn't be affected as much. I have also suggested swimming as well, which she has followed and says she loves. This client has achieved her goal weight of 150 lbs about 3-4 years ago and gained it all back. In desperation she is on the waiting list for surgery (Gastric Bypass), they basically cut out her stomach and leave her with the size of about an apple left. I am trying to talk her out of it (as I feel this is a drastic measure) and my goal is to help her get healthy again through proper diet and exercise. I am hoping if I can "show her the way" to a healthy lifestyle and help her lose at least some weight, and exercise enough that she starts feeling good about herself again that she won't go through with such an extreme measure as Surgery. I would appreciate any feedback, Thanks!

OK, so how much weight is she losing through her new diet?
I assume she has been signed off by a doctor as fit for some sort of exercise?

Why did the resistance exercises fail? Why can't she do basic back exercises on a lower back resistance machine? Or short lifts on a balance ball? Why can't she do wall squats?

Quick question; why do you have her on the treadmill rather than the X-trainer?

What is the swimming doing for her? Why not train her in the pool? I do loads of sessions with my clients in the pool, they love it (and you can take dumbells and VIPRs into a pool) and it takes the pressure off their joints.

How much weight has she lost since starting with you and starting her new diet and be specific why resistance exercises failed?

I am thinking, like Kyle and SFT stated already, that this client is a bit outside your scope. Nothing personal but you have failed with all your approaches but they all seem to be too far inside the box for this client. How long have you been a PT?
I'm don't mean to be critical, I just need to know why she's failing with everything as I have clients that (sound like) they are in a worse position that do get results.

Edit; I'm not online much but am more than happy to answer any questions about new approaches with this client mate.
BTW. SFT is right when he says you need to build a support network. Like him I am working with chiropractors, GPs, dieticians etc etc etc You simply need a sounding-board sometimes...and the internet is probably not it.

[Shane7518]

Hey everybody, My thread created lots of discussion and I'd like to thank you all for your feedback. While I do admit I may have "bitten off more than I can chew" with this client, I don't feel I am asking a bunch of strangers for advice on the internet. I posted my question in this "Personal Trainers" room for a reason on this website, not just in some random area on the internet. I feel we are all professionals in this room (Personal Trainers) and when I post a question to you all I feel I am confiding in colleagues, not just some strangers over the internet. I also feel while this client is certainly a challenge, the potential exists to learn more about Personal Training in the end rather than training "Soccer Mom's" looking for an excuse to go to the gym.
I had a discussion with my client after reading everybody's feedback and we have decided in the end that I will support her in her weight loss for now and we are going to seek medical help together (Family Physician, Exercise Physiologist), and try resistance training and more weight bearing exercises when she loses more weight. To answer your question PeteratCastle, the resistance exercises failed because of her arthritis. If something triggers while bending a joint, she is in pain for days afterwards and this is something that she really wants to avoid. You are also correct that I am still new at Personal Training and that's why I posted my question to what I consider fellow colleagues, not strangers over the internet. I agree, I do need to build myself my own support network, but that will come with time.
Thank you all again for your feedback, I hope you all don't mind if I need to ask a question again in the future, maybe some day I will be able to return the favour.

[KyleAaron]

You've made the right decision in seeking help from EPs and the like. The funny thing is that when you say, "I don't know," they actually trust you more... since when you do say you know something, they believe you.

[Wolfex]

Okay, I'm not a trainer. But I have a KINE degree.

Anyways, don't make her to anything with impact. So no treadmill. Have her do the eliptical, or a stationary bike.

Also, forget about bodyweight exercises. Have her stick to machines for now. I'd focus on the ones that do not aggravate her arthritis, but hit large muscle groups. I think the most important thing though is for her to modulate her diet, and ease her into training

Also, since resistance training is causing her pain. I would suggest that she start some type of stretching routine. This may help alleviate some pain in her joints, as well as taking her joints and muscles through a good range of motion, which, hopefully will benefit her until she can engage in resistance training.

I would also advise her that surgery is not going to address the issue of her poor dieting/eating habits. With that said, and given consideration to her age--exercise is essential to her maintaining bone/joint/muscle/heart health, as well as warding off chronic disease. Surgery will not fix her issues.

[Shane7518]

Okay, I'm not a trainer. But I have a KINE degree.

Anyways, don't make her to anything with impact. So no treadmill. Have her do the eliptical, or a stationary bike.

Also, forget about bodyweight exercises. Have her stick to machines for now. I'd focus on the ones that do not aggravate her arthritis, but hit large muscle groups. I think the most important thing though is for her to modulate her diet, and ease her into training

Also, since resistance training is causing her pain. I would suggest that she start some type of stretching routine. This may help alleviate some pain in her joints, as well as taking her joints and muscles through a good range of motion, which, hopefully will benefit her until she can engage in resistance training.

I would also advise her that surgery is not going to address the issue of her poor dieting/eating habits. With that said, and given consideration to her age--exercise is essential to her maintaining bone/joint/muscle/heart health, as well as warding off chronic disease. Surgery will not fix her issues.

You took the words out of my mouth! I am trying to convince her that even after surgery, you will still have to eat right anyways...so why not just start now and avoid the surgery all together. I'll tell ya, it's a challenge! She's convinced in her head that surgery is the only way out, and it's my mission to try and change that thought process.
Anyways, she loves swimming so I am going to incorporate some pool exercises as well (less joint impact). Thank you all again for your input, it's greatly appreciated!

[Garage Rat]

Bottom line is she needs the weight loss to be able to train.
Her knee and back issues are almost certainly caused from her weight.
To much stress for her joints to takes.
You will rarely find a client that sticks to a diet that is provided by a trainer.
They need a support group and some one to be accountable to other than the trainer.
Something like weight watchers were you have a group of like minded people going for the same goal of weight loss and to be accountable via weekly weigh ins.
You on the other hand would be handling the physical part of the journey.
I wouldn't be surprised if she lost twenty pounds her joints and back would feel much better and you can get training going from there.
IMO swimming for obese people is better than nothing but IMO most won't put forth enough effort in the pool to get a good cardio going for weight loss.
Don't get me wrong the pool is ok for mobility and get moving in ways you just wouldn't other wise but for a goal of weight loss i don't feel it's ideal but i guess you have to start somewhere.
You could incorperate TRX type straps for some easier body weight type workouts that are easy on the joints.
As kyle said above this may be beyond the scope for most trainers and certainly a project if you stick with her.
It may take more time and effort on your part than it is worth and as already said a higher risk client with her health issues.
You should also contact and speak with her doctor if you continue with her to see if he concurs with your recommendations.
Best of luck to you.

[bcop]

Hey guys, I have a challenging client that I am looking for advice with please. She's a 57 yr old female, Obese at 250 lbs (goal to lose body fat, increase lean body mass), and is a retired Nurse. Which means she has done heavy lifting all her life and as a result she has bad knees and back. To add to it she is also getting arthritis in her hands and knees and osteoporosis. I have told her that I can help her with the Osteoporosis with exercise, but the trouble is she can't run/jog so I got her to walk on the treadmill. She can do this for only 10 minutes at a time until her knees give out. I told her if she can even do 10 minutes 3 times a day would help if she can't go for 30 min at once, she is following this advice and can do 10 minutes most times. I have tried some resistance exercises with light weights but have failed at that as well. It's difficult for her to do weight bearing exercises (Obese), yet difficult as well with exercises such as leg curls (arthritis). I am thinking my last option is isometrics with her as her joints wouldn't be affected as much. I have also suggested swimming as well, which she has followed and says she loves. This client has achieved her goal weight of 150 lbs about 3-4 years ago and gained it all back. In desperation she is on the waiting list for surgery (Gastric Bypass), they basically cut out her stomach and leave her with the size of about an apple left. I am trying to talk her out of it (as I feel this is a drastic measure) and my goal is to help her get healthy again through proper diet and exercise. I am hoping if I can "show her the way" to a healthy lifestyle and help her lose at least some weight, and exercise enough that she starts feeling good about herself again that she won't go through with such an extreme measure as Surgery. I would appreciate any feedback, Thanks!

1: Get her on a STRICT Zone/Paleo type diet. No cheating.

2: Treat the walking like a weight exercise. Make her go 1 minute longer every day. One day for 10 minutes, one day for 11 min, ect.

3: Try to get her to do some rowing on a Concept 2 rower.

4: Make sure that she gets to sleep at 10PM every night.

After 2/3 months of this, many of her problems will be solved, or at least partially solved, and you can start with the weight exercises.

[missmurray]

I’m not a trainer, but I’m similar to your client, so would like to pass along my experience in working with a trainer. (please forgive me if posting here is a faux pas) I honestly wish that obese people everywhere could know just how much a good trainer can help them, and what a difference it can make in their everyday quality of life. You guys are worth every penny, and then some.

I’m 5’ 5”, 49 years old, have bad knees, arthritis in my spine, hips and hands, and pain in all my other joints. When I started working with my trainer, I weighed 240 pounds. Literally every type of movement and exercise caused me pain, to some degree.

My trainer said that he could help me if I was willing to do the work. I agreed.

I bought a food scale and weighed/measured all my food, followed my doctor’s advice on daily calorie limits, (my diet is mostly lean protein and vegetables) and kept my promise to show up at the fitness center and try my best, no less than 3 days a week.

My trainer started me off with step ups at a very low level, assisted body weight squats using TRX straps, assisted sit ups, and a variety of other exercises using only either my own body weight or resistance bands. And I did a few minutes of cardio on a stationery bike. (My knees couldn’t handle the treadmill.)

In the beginning, everything was difficult for me, I moved very slowly, I could only do a few reps of anything at a time, and I would have to stop frequently to rest. But my trainer kept pushing me to try my hardest to do whatever I could do, and to try to do one or two more reps today, than I did yesterday. When I felt I couldn’t do any more, he would push me to do just 30 seconds more. If I said I couldn’t do that, he’d push for just 10 or 20 seconds more.

I never imagined that just one or two more reps, or ten more seconds of an exercise could make a difference, but it did.

It has only been 12 weeks, but I have seen some pretty amazing progress. (or “Phenomenal!” As my doctor says) I have lost 40 pounds, the pain I’ve had in my joints for years is gone, my knees are much improved, my blood pressure has dropped, and my strength and stamina have increased leaps and bounds beyond what I even thought possible for such a short period of time.

When I first started, I couldn’t even do one single body weight squat. On cardio, I could only do 5-10 minutes on the bike.

Now, not only can I do squats (72 on my last workout), but I can I do 4 sets @ 120 pounds on the leg press. Today was my cardio day and I did 20 minutes on the stair climber, 30 minutes on the elliptical and 6 minutes on Jacob’s ladder. I’m amazed at me. And it has only been 12 weeks!!!
I know I wouldn’t have been able to do any of this if I hadn’t been lucky enough to find a trainer who is so passionate about what he does. I’m grateful for his hard work and dedication. I have a long way to go before I could be considered “fit”, but with his help, I know I will get there.

Anyway, if your client has medical clearance to exercise, then I’m willing to bet that she can amaze herself too. She just has to want it badly enough to work through the pain.

[KyleAaron]

Thanks for sharing your experience, missmurray, something for the OP to pass on to his client.

[Shane7518]

I’m not a trainer, but I’m similar to your client, so would like to pass along my experience in working with a trainer. (please forgive me if posting here is a faux pas) I honestly wish that obese people everywhere could know just how much a good trainer can help them, and what a difference it can make in their everyday quality of life. You guys are worth every penny, and then some.

I’m 5’ 5”, 49 years old, have bad knees, arthritis in my spine, hips and hands, and pain in all my other joints. When I started working with my trainer, I weighed 240 pounds. Literally every type of movement and exercise caused me pain, to some degree.

My trainer said that he could help me if I was willing to do the work. I agreed.

I bought a food scale and weighed/measured all my food, followed my doctor’s advice on daily calorie limits, (my diet is mostly lean protein and vegetables) and kept my promise to show up at the fitness center and try my best, no less than 3 days a week.

My trainer started me off with step ups at a very low level, assisted body weight squats using TRX straps, assisted sit ups, and a variety of other exercises using only either my own body weight or resistance bands. And I did a few minutes of cardio on a stationery bike. (My knees couldn’t handle the treadmill.)

In the beginning, everything was difficult for me, I moved very slowly, I could only do a few reps of anything at a time, and I would have to stop frequently to rest. But my trainer kept pushing me to try my hardest to do whatever I could do, and to try to do one or two more reps today, than I did yesterday. When I felt I couldn’t do any more, he would push me to do just 30 seconds more. If I said I couldn’t do that, he’d push for just 10 or 20 seconds more.

I never imagined that just one or two more reps, or ten more seconds of an exercise could make a difference, but it did.

It has only been 12 weeks, but I have seen some pretty amazing progress. (or “Phenomenal!” As my doctor says) I have lost 40 pounds, the pain I’ve had in my joints for years is gone, my knees are much improved, my blood pressure has dropped, and my strength and stamina have increased leaps and bounds beyond what I even thought possible for such a short period of time.

When I first started, I couldn’t even do one single body weight squat. On cardio, I could only do 5-10 minutes on the bike.

Now, not only can I do squats (72 on my last workout), but I can I do 4 sets @ 120 pounds on the leg press. Today was my cardio day and I did 20 minutes on the stair climber, 30 minutes on the elliptical and 6 minutes on Jacob’s ladder. I’m amazed at me. And it has only been 12 weeks!!!
I know I wouldn’t have been able to do any of this if I hadn’t been lucky enough to find a trainer who is so passionate about what he does. I’m grateful for his hard work and dedication. I have a long way to go before I could be considered “fit”, but with his help, I know I will get there.

Anyway, if your client has medical clearance to exercise, then I’m willing to bet that she can amaze herself too. She just has to want it badly enough to work through the pain.

Thank you for sharing! It's stories like yours that are exactly the reason I went into Personal Training. To make a positive difference in someones life such as yours I think is one of the most fulfilling jobs a person could do. Keep up the hard work Missmurray, you can do it!