Filed under: Exercise Programming, Flexibility, For Trainers, Special Populations
Flexibility programming for the pre-natal client poses challenges distinctive from clients with general fitness goals. The body of the pre-natal client undergoes several key biomechanical and hormonal changes that will affect flexibility work. Body mass increases affect center of gravity, making any flexibility exercise requiring balance-work not only difficult, but potentially dangerous for expecting mothers. Additionally, as the lower back will have to bear new weight, it’s necessary to avoid overloading the back during flexibility and overall training sessions. Lastly, one notable hormonal change to keep in mind is the increased levels of estrogen, progesterone, and relaxin, which cause connective tissue to loosen, compromising joint stability. This is another reason to avoid exercises that overload the lower back considering that joint instability can create an additional strain on sacroiliac and hip joints.
When designing flexibility and exercise programs for pregnant clients, ACOG has one important recommendation to keep in mind. For the pre-natal client, staying healthy during pregnancy is the most important thing–the priority is to continue being healthy, not to increase fitness as strenuous, vigorous challenges can often put the mother and unborn child in danger. For flexibility, avoiding most dynamic flexibility exercises along with deep stretches and extension of joints is not recommended as most of these exercises require the client to take stretches to a maximum, causing stress to the pregnant woman’s body. Stick to seated or supine stretches for safety and to achieve mild stretches in targeting muscle groups. However, keep in mind that after the first trimester, it is often recommended to avoid supine exercises because in a supine position, blood and oxygen flow is reduced to the baby due to a depressed superior vena cava. If you are do include supine exercises after the first trimester, try to have your client lie on their side in between recovery periods of sets.
Once your client has delivered her baby, keep in mind that it can take up to six weeks for biomechanical and hormonal changes due to pregnancy to return to pre-pregnancy states. Be sure to continue with seated/supine flexibility exercises, and gradually work up to active and dynamic flexibility depending on your individual client’s fitness level.
Agility tests have often been used exclusively for athletes as most athletic activity involves changing direction in a controlled, efficient manner. But considering the nature of everyday activity, agility is relevant to all exercisers. Everyday motion involves changing direction efficiently: getting into and out of your car or desk chair at work, keeping up with small children, and even some housework. These activities may not require quick movement characteristic of sports, but they do require the body to switch direction efficiently, making agility play an important role in everyday movement and injury prevention. The more efficient a body is in its ability to change direction, the more prepared it will be for such instances, hopefully reducing the risk of injury.
Testing agility agility in clients with chronic pain poses some challenges. Most traditional agility tests like the T Test and Hexagon Test require hops, shuffles, and running, which are often too stressful on all ready aching joints. The Edgren Side Step test is a good alternative to traditional agility tests as it involves stepping quickly while changing direction. Depending on the severity of a client’s symptoms or their cardiovascular fitness level, you may want to adjust the length between each mark. Rather than spacing each mark three feet apart, try 18 inches apart or use individual rungs of an ABC ladder to delineate distances between each mark. Whether or not you use the original evaluation or a modification, the Edgren test will provide a good benchmark for measuring progress in agility.
Similar to agility, coordination, although not a typical fitness component, is an important aspect of everyday physical movement. There is no definitive test for coordination, so completing a simple exercise should give you a good idea of your client’s level of coordination. A simple exercise like tossing a small stability ball while your client is standing is a good way to measure and improve hand-eye coordination–this activity can serve as both a test and exercise. Observe the relative ease or difficulty your client may have in catching the ball, and be sure to record these observations as they will provide a starting point from which to improve. Coordination deteriorates with age and inactivity, so including related drills in an exercise program will help in improving neuromuscular efficiency: the ability of the body’s nervous system to transmit signals to the muscular system to initiate movement (yes, this is just another fancy way of describing coordination!).
Testing strength and cardiovascular fitness for clients with chronic pain will require some creativity and adjustments on a case-by-case basis. Since traditional strength implements like free weights, cables, and sometimes even tubing can be too strenuous on joints for clients with chronic pain, bodyweight exercises may be more appropriate as they can help us assess relative strength and muscular endurance. Although push-ups and squats are not absolute strength tests, establishing a benchmark to measure progress in muscular endurance is often a more reasonable and relevant assessment to clients with chronic pain than maxing out. It’s very unlikely that your chronic pain clients will want to improve their 1 RM, but they will most likely need to increase the endurance of typically fatigued muscles.
For testing cardiorespiratory or cardiovascular fitness, assessments like the mile-run and even step test are too rigorous for chronic pain patients. Still, evaluating cardiovascular fitness is important for all clients as this fitness component provides a good gauge for overall fitness. We can establish a benchmark for clients with chronic pain through a modification of the conventional step test.
Before starting the step test, be sure to measure the client’s resting heart rate. Depending on the severity of a client’s symptoms, try the step test for anywhere from 10 seconds to a minute; be sure the selected time-frame will be challenging, but not exhausting. Immediately after completing the step test, measure the client’s pulse, and after the client has rested for one minute, measure the pulse again to see how much they have recovered. In a traditional step test, you would wait a minute before estimating a client’s heart rate and plug that number into an equation to determine cardiovascular efficiency. By measuring their heart rate right after the step test, you can get a good idea of how intensely they may be working with respect to their max heart rate. You can also observe how quickly (or efficiently) their cardiovascular system may be in returning close to their resting heart rate through comparing their pulse right after the step test to their heart rate after a minute of rest. This will be especially helpful in cardio programming for a very deconditioned client that may be drained after walking for a minute (or even less!). You will be able to use results from their step test to determine appropriate work:rest ratios to improve cardiovascular fitness and endurance over the course of their training.
NEXT: Agility/Coordination Assessments
Putting together flexibility assessments for a client with chronic pain is similar to assessment design for all other clients. Fitness evaluations are based on goals with consideration of any individual medical issues. Regardless of the goal a client with chronic pain will have, depending on the severity of their symptoms, it would be best to tweak some traditional fitness assessments.
Filed under: Exercise Programming, For Trainers, Networking, Special Populations
It’s common knowledge among trainers and fitness club owners that most clients join a gym and sign up for training to lose weight. But clients with common goals often have unique medical needs we have to consider when designing an appropriate exercise program. One of these medical needs include a wide range of chronic, debilitating pain conditions like arthritis, chronic fatigue syndrome, fibromyalgia, and persistent back pain/sciatica.
