Vital Signs

1. Vital Signs Working with Clients that are Obese

2. General Information Regular physical activity and exercise is one of the most important factors related to long-term successful weight loss People who remain sedentary throughout their lifespan will lose approximately 5 pounds of muscle per decade while simultaneously adding 15 pounds of fat per decade

3. General Information Carrying excess fat mass is difficult and uncomfortable, particularly for those with low percentages of muscle mass. Activities that are simple for healthy-weight individuals become difficult, if not impossible for the obese.

4. General Information Obese people often struggle to breathe while just sitting Trying to go from a seated position to a standing position is difficult

5. General Information Obese individuals often have additional health concerns such as type 2 diabetes, high blood pressure, high cholesterol, asthmaand other conditions which they may be on medication for A 5-10% loss in body weight significantly improves blood pressure, cholesterol levels and glucose tolerance

6. Calculation • A client is 5’8” and currently weighs 300 pounds and has a BMI of 45.1. How much would the client weigh with a 10% loss in body weight and what would their new BMI reading be?

7. Calculation • A client is 5’5” and currently weighs 220 pounds and has a BMI of 36.6. How much would the client weigh with a 10% loss in body weight and what would their new BMI reading be?

8. Calculation • A client is 5’11” and currently weighs 225 pounds and has a BMI of 31.4. How much would the client weigh with a 10% loss in body weight and what would their new BMI reading be?

9. Goals When working with Obese Clients Maximize caloric expenditure Maintain/increase lean body mass to maintain Resting Metabolic Rate Improve metabolic profile Lower mortality (death) risk Promote appetite control Improve mood state

10. Special Considerations When working with Obese Clients • Body temperature regulation may be a challenge • Extra layers of fat make it difficult for a body to dissipate heat • Fat is a natural insulator that traps core body heat • An obese person’s heart must pump harder to cool the body • Educate clients about proper clothing attire to help keep the body cool during exercise

11. Special Considerations When working with Obese Clients • Higher Risk of passing out • Obese individuals usually have issues with blood circulation • When a person is standing up the most difficult place to circulate blood is to the brain • Inadequate circulation can cause someone to be lightheaded and to faint.

12. Special Considerations When working with Obese Clients • Greater risk of dehydration • Obese individuals sweat more, which results in greater water loss • Make sure obese clients drink water at least every 15 minutes

13. Special Considerations When working with Obese Clients • Risk of orthopedic injuries due to stress on joints • Excess weight causes wear and tear on the cartilage – particularly in the hips, knees and lower back • Results in pain, stiffness and inflammation around the joints which may develop into arthritis

14. Special Considerations When working with Obese Clients • Balance may be compromised • Postural problems such as lordosis (abnormal curvature in lower back) shift the center of balance and increase risk of falling

15. Special Considerations When working with Obese Clients • Lungs of obese cannot expand normally because of excess fat which crowds the internal organs and limits the movement • Results in shorter, shallower breaths and difficulty breathing • May need to allow obese individuals more recovery time to prevent hyperventilation

16. Special Considerations When working with Obese Clients • In general, walk slower and take shorter steps compared to apparently healthy population • Increased risk for a cardiac event or stroke • The heart of an overweight or obese person has to work harder than the heart of a healthy-weight person • Blood pressure can reach dangerously high levels

17. Exercise Prescription For Obese Clients Moderate exercise alone often does not result in significant weight loss in obese individuals Most studies find that the greatest amount of weight loss occurs by performing vigorous exercise Most obese people cannot sustain high intensity exercise because of weak muscles and their increased risk for a heart attack or stroke Safest approach encourages a combination of moderate exercise and dietary changes

18. Exercise Prescription For Obese Clients • Make sure your client is comfortable • Be aware of positions of exercises and if the exercise will make the client self-conscious • Perform exercises in a standing or seated position

19. Caloric Expenditure For effective weight loss obese client should burn 200-300 calories per exercise session Minimum goal should be 1,500-2,000 calories burned per week

20. Cardiovascular training • Low impact exercise • Want to avoid putting excess stress on joints • Treadmill walking, rowing, stationary cycling or water aerobics are some of the best forms

21. Cardiovascular training Perform 5 or more days per week 40 – 60 minutes per day once per day OR 20-30 minutes twice per day

22. Cardiovascular training – Time Required To prevent disease must perform a minimum of 150 minutes per week of moderate intensity physical activity To lose weight and prevent regaining weight must perform 250-300 minutes per week (that 4-5 hours per week)

23. Resistance training Important component of any weight loss program because it helps increase lean body mass, which results in a higher metabolic rate

24. Resistance training- Benefits Improve blood cholesterol levels Improve insulin sensitivity Reduce glucose-stimulated plasma insulin concentrations Improve systolic and diastolic blood pressure Improve the maintenance of lean body mass in clients on calorie restricted diets

25. Resistance training • Perform 2-3 times per week • Perform 1- 3 sets of 10-15 repetitions • Select 8-10 exercises targeting the major muscle groups • Chest, Back, Shoulders, Abdominals, Low Back, Quadriceps, Hamstrings and Glutes

26. Resistance training • Consider having clients perform exercises in a circuit-style • Fast paced program in which you do one exercise for 30-60 seconds and then move to the next exercise • Typically alternates between cardiovascular and resistance exercises • Focus is on improving muscular endurance

27. Core and Balance Training Important for the obese population because they typically lack strength in abdominals/low back and have poor balance

28. Exercise Selection • Machines are often not designed for obese individuals and require a significant amount of mobility to get in and out of • Use dumbbells, cables and resistance tubing instead

29. Exercise Selection • May be a good idea to recommend that some exercise be performed in the privacy of their own home or a more discrete location of the fitness area as obese individuals are often self-conscious • Avoid having clients roll or lie on floor

30. Exercise Selection • Use caution when having an obese client get into a prone (on stomach) or supine (on back) position because obese individuals are more likely to experience hypotensive or hypertensive reactions to exercise • Having obese clients perform exercises in a standing position may be more appropriate and comfortable for them

31. Exercise Selection • Instead of: • Try This: Prone Plank Plank on bench

32. Exercise Selection • Instead of: • Try This: Supine crunches Standing crunches with resistance from cross over

33. Exercise Selection • Instead of: • Try This: Bicycle Crunches Standing side bends with dumbbells

34. Exercise Selection • Instead of: • Try This: Traditional Mountain Climbers Elevated mountain climbers

35. Psychological Aspects of Working with Obese Clients Obesity is a unique condition because it also affects a person's sense of emotional well-being and self-esteem

36. Psychological Aspects of Working with Obese Clients • Need to make sure your client feels socially and emotionally safe • Be sensitive to an obese client's needs and avoid embarrassing situations • Need to create trust between the personal trainer and the client

37. Psychological Aspects of Working with Obese Clients • Time requirements may be overwhelming to obese clients • Initially keep duration of exercise short and encourage clients to become more active during their typical daily activities • As clients become more confident begin increasing the duration of exercise sessions

38. Psychological Aspects of Working with Obese Clients • Unrealistic expectations • Shows like the Biggest Loser, advertisements showing extreme weight loss can create a mentality of wanting quick fix results • Most people do not understand that exercise alone is not very effective for weight loss • Explain that exercise is beneficial even if weight loss goals are not met • Realistic goal is 1-2 pounds per week • People that lose more than 2 pounds per week are more likely to regain the weight • Typically takes 6-12 weeks before changes begin to take place • Can take 6 -12 months for significant weight loss

39. Psychological Aspects of Working with Obese Clients Unrealistic Expectation

40. Psychological Aspects of Working with Obese Clients

41. Psychological Aspects of Working with Obese Clients • Creating goals with clients • Change the goal of exercise from weight loss to mood enhancement or fatigue reduction • Ask clients how they feel after a workout • Ask how quality of sleep improves after starting an exercise plan • Give clients a method of measuring their success that does not depend upon the scale

42. Psychological Aspects of Working with Obese Clients • Remind clients of the benefits of regular exercise • Decreased anxiety and depression • Improved feelings of well-being • Reduction in stress levels • Decreased risk of falls • Improved cardiovascular and respiratory function • Reduction in coronary artery disease risk factors • Increased metabolic rate • Improved bone health

44. Supporting Obese Clients With continued support obese clients can make improvements in their health. You have the tools to help someone change their life!

45. Supporting Obese Clients

46. Vital Signs Height and Weight Answers to Calculations

47. General Information Answer Key • BMI Calculation • 703 x 270/682 • 703 x 270/4624 • 703 x 0.05 • 41, still obese category 3, but at least lower • A client is 5’8” and currently weights 300 pounds and has a BMI of 45.1. How much would the client weigh with a 10% loss in body weight and what would their new BMI reading be? • Weight loss • 300 x .10 = 30 • 300 – 30 = 270 • 270 pounds

48. General Information Answer Key • BMI Calculation • 703 x 198/652 • 703 x 198/4225 • 703 x 0.047 • 32.9, went from obese 2, to obese 1 • A client is 5’5” and currently weights 220 pounds and has a BMI of 36.6. How much would the client weigh with a 10% loss in body weight and what would their new BMI reading be? • Weight loss • 220 x .10 = 22 • 220 - 22 = 198 • 198 pounds

49. General Information Answer Key • BMI Calculation • 703 x 202.5/712 • 703 x 202.5/5041 • 703 x 0.040 • 28.2, went from obese 1, to overweight • A client is 5’11” and currently weights 225 pounds and has a BMI of 31.4. How much would the client weigh with a 10% loss in body weight and what would their new BMI reading be? • Weight loss • 225 x .10 = 22.5 • 225 – 22.5 = 202.5 • 202.5 pounds