If you are going to actually get out on the training floor with an obese client, there are a few important points to understand regarding the clients physical limitations. Many of the “normal” exercises that you use with “regular” clients (if there is such a thing) may not be within the reach of a 300-400+ lb male or a 200-300+ lb female. Modifications, substitutions, and alterations will be the name of the game. General exercise principles apply to this population just like any other though, and optimal results will be achieved only when diet, cardio, AND a strength program are all in place. Diet and cardio both work to help keep the trainee in a caloric deficit which obviously has to occur for weight loss to take place. Strength training doesn’t really burn many calories, but it does preserve muscle mass. This will ensure that the trainee is working to keep their bodies resting metabolic rate high. We want the diet and cardio to strip away fat, not muscle.
Before we get into some of the nuts and bolts of programming let me make this general point to coaches and trainers: Do not humiliate your obese client with embarrassing and unnecessary movements in the gym. The fact that they are even in the gym standing next to you required a significant break from their comfort zone, so don’t push the limits. This is especially true if working in a public gym with crowds around. Obese clients will sweat more, breath harder (even wheeze), and generally struggle more so than an average-weight client. And don’t think they aren’t aware of this -they are. Try to avoid movements that exacerbate these conditions. I’m not saying to put them on a recumbent bike in front of the TV. But there is a difference between working your client hard and embarrassing them unnecessarily.
One of my general rules of thumb is to avoid ANYTHING on the floor. Getting up and down off the floor is difficult for an obese person and they don’t want to have to repeatedly do it in front of other people, including you. To most, getting up and down off the floor is not an exercise; it’s just something you do as part of life. For an obese person, it’s an event. And a hard one at that. They don’t want to be seen struggling with something that is easy or routine for everyone else. As a novice, there really isn’t a reason to get down on the floor anyways. A 350 lb man is in no danger of seeing his abs anytime soon anyways, so there really isn’t much of a need for ab exercise. Squats, Presses, and Deadlifts will do the job for them. If you decide that you just have to do some ab work then there are standing abdominal exercises that can be done with bands or pulleys. Do those.
Difficulty getting up and down off the floor may even extend to using flat benches. Lowering down onto a flat bench and especially getting off the bench is an extreme challenge to their strength and balance. They will likely need help if you are going to be doing flat bench presses. Once I get them settled onto the bench and through the instructions and warm ups I will generally tell them along the lines of: “You can just stay flat on the bench. You don’t need to get up until we’re done.” Most welcome the chance to rest! Once the final set is complete, I will come around to the side of the bench and extend a hand to help the client off. Most will not be able to sit up while lying on the flat bench. Their only alternative is to roll off the side. Do NOT make them do this. Be a professional and help them get up with some dignity. In the past I have had clients that were big enough that stability on a flat bench was a safety issue. For some, lying flat on the bench puts tremendous pressure and strain on the lower back. Often this can be fixed by shimming their feet. Sometimes it can’t. An incline bench press unit is a good alternative in either situation. The incline bench is more stable, and doesn’t put pressure on the back in the way the flat bench can.
Other than floor exercises (and sometimes flat bench work), the only other thing I avoid with obese clients is certain types of high intensity cardio work. At this point they don’t really need it anyways. Weight training, lower intensity/long duration aerobic work, and a low carb/low fat diet is a proven formula for getting weight off clients and improving their body composition. They’ll get all the anaerobic conditioning they need from the weight training at this point. There are several reasons to avoid extremely high intensity interval work when beginning with a new obese client: (1) It’s unnecessary. They can lose weight without it. (2) It’s too hard at this point. They’ll quit. (3) They can’t push hard enough to get anything out of it. (4) Depending on the modality – it’s humiliating and embarrassing. Television shows like The Biggest Loser are irresponsible in their representation of how an obese client should be conditioned. Watching the morbidly obese trying to Jump Rope, Bear Crawl up hills, do Burpees, and awkwardly cram themselves into a Concept 2 Rower may make for interesting television, but it’s a sure fire way to humiliate them, injure them, and make them quit your program.
So how should an obese client condition?
My personal preference is to start the person off on a treadmill. It’s simple, safe, and proven to work. From day one I don’t allow them to use the handrails. I want them supporting their own bodyweight. The drawback to an elliptical machine or stair master/step-mill is that many clients will support too much of their own bodyweight on the supports and this reduces their work output. I don’t like stationary bikes because….well, they just suck.
When the client starts on the treadmill I place them on a very moderate speed, erring on the side of too slow rather than too fast. This will get them comfortable and avoids lower extremity discomfort. Foot pain, ankle pain, and shin splints are common when a really heavy/weak client starts this type of work. High speeds make these things more likely. Once I get them going I will bump the incline up to about level 2 or 3 and leave it. Most treadmills have incline settings from 1-15. The incline is how we will scale and progress the client. Not speed. This is the primary advantage of the treadmill over having them just walk outside. It’s very hard to find a low grade incline that someone can walk up for a sustained period of time. And it’s impossible to progressively increase the degree of incline by tiny increments from workout to workout unless you are using a treadmill. There is no set “program” to use for the treadmill work. Start with anywhere from 10-20 minutes. Over time increase the duration and the incline being used, while holding speed constant.
How much, how often?
For someone struggling with obesity, staying in the habit of physical exercise is extremely important, and doing the cardio will help with adherence to the diet. Taking a day off from their training often leads to several days off. And several days off almost always means their diet will slip too. For this reason, I like to have people do the cardio work 6-7 days per week. Build them up to 1 hour per session over time. Once the duration is up to one hour, then just work on increasing the intensity of the workouts during that hour time frame. I realize there is a debate about the effectiveness of doing fasted cardio first thing in the morning versus doing it at some other time of the day. I don’t really care about the debate – I know that fasted cardio works. It has worked for me personally and it has worked for my clients. So this is what I recommend. BUT if the client can’t or won’t do their cardio first thing in the morning then doing it at some other time of the day is of course fine.
Brand new commercial grade treadmills are extremely expensive to buy and maintain. Almost all “big box” gyms will have them, but many smaller training facilities will not. “Key Card” gym franchises are growing in popularity around the country. Franchises like SNAP and Anytime Fitness have large membership bases, but to no one’s surprise they are empty for most of the day and they are open 24/7. Most of these places have at least 1 row of nice treadmills. And they are cheap. Memberships for $25-35/month are common and most allow you to cancel anytime. This is not a bad option for an obese trainee – low cost, plenty of accessibility, and a degree of privacy you won’t get at a larger commercial establishment.
Strength Training – Muscle Burns Fat
Strength training for the obese trainee or client doesn’t have to be any different than for a trainee of average weight – at least on paper. In practice, things can get tricky.
In general, I like to stick with 2-3 full body workouts per week. It is best if the workout template can follow the Starting Strength model as closely as possible. Here is the general template that I would use at my gym:
Workout A:
- Squats 3-5 x 5
- Bench Press or Incline Press 3-5 x 5
- Deadlifts or Rack Pulls 3-5 x 5
- Barbell Curls or Seated Rows 4 x 10-15
Workout B:
- Squats 3-5 x 5
- Overhead Pressing 3-5 x 5 or 4 x 8-12 (if using dumbbells or machines)
- Lat Pulls 4 x 10-15
- Dumbbell Romanian Deadlifts 3 x 10
Squats
Excessive body-mass and low leg strength will make squats tricky. Watch this video for information on how to use the leg press when the client is too heavy to squat: http://startingstrength.com/index.php/site/video/platform_the_leg_press. When there isn’t access to a leg press, use this method: https://www.youtube.com/watch?v=ISgao34vNrk
Once the trainee is able to squat to parallel with loaded dumbbells, then he/she should attempt to progress to the barbell squat. The barbell squat can be done with or without the box. I tend to leave the box there for a while. It has been my experience that the security of the box helps the client feel a little more comfortable with the movement. And remember, comfort and security are a good thing for an obese client. Your mindset, as a coach, should be that this trainee is constantly on the precipice of quitting the program (because they usually are). Think long term, and remove as many obstacles for them as possible. In the grand scheme of things there isn’t going to be a helluva lot of difference between a box squat and a regular squat for this particular client. We’ll work on transitioning off the box later. Bar positioning is likely going to be an issue. Inflexibility often accompanies obesity and the bar may have to settle a little higher than you would like. As long as the coach understands how the bar position affects the angle of the torso, good squats can still be performed.
Deadlifts
It isn’t uncommon for the girth around an obese trainee’s torso to impede their ability to do a correct deadlift. The set up for a proper pull just can’t happen until some weight is lost. The simplest solution is just to forgo deadlifts for the time being and do rack pulls or block pulls. This is essentially the exact same movement – one uses a power rack and one uses a set of pulling blocks. Either way, elevating the bar to somewhere between the top of the shin and the knee will allow an obese client to get in some heavy pulling with good mechanics.
On days when the client is not Rack Pulling, a good light day exercise for the posterior chain is DB Romanian Deadlifts. This is a good way to finish a workout. Its less stressful than a barbell RDL, allows a little freer range of motion, and does a surprisingly adequate job of working the hamstrings despite the overall lighter poundages being used.
Pressing/Bench Pressing
If they can be done they should be done. Both Presses and Bench Press are staple movements for building muscle mass in a novice – but they can be difficult for an extremely obese trainee. The difficulty with the flat bench has already been discussed, and incline pressing provides a suitable alternative. Standing Presses can sometimes be difficult if a trainee has extreme inflexibility in their shoulders. Coaches and trainers can experiment with DB Presses or even some seated machine variants of the movements until they find an overhead press variation that is comfortable for the trainee to perform.
Lat Pulls/Seated Rows
Work with an obese client should be largely focused on training the legs and the back. This is where the most muscle resides, so building up these areas will have the most impact on their metabolisms. Because of weight and girth, chins and barbell rows (my two favorite back builders) will be inaccessible. Lat Pulls with various grips and machine-based rowing variants will be good exercises to include in the program. When you select your seated row variant, try and choose a machine that allows the hands to come to the outside of the torso. Traditional seated cable rows with a v-grip bring the hands to the belly. This will limit the range of motion for a very heavy client. Bringing the hands to the outside of the torso will allow a longer range of motion and more scapular retraction. My favorite models are made from Life Fitness, Icarian, and Cybex. Hammer Strength also has a wide variety of back machines that would be suitable for this purpose. Back work is a great way to sneak variety into your client’s program. Introducing some new things to your client’s routine will help keep the workouts from getting too stale.
Thanks for the article Andy! Great stuff as always.
Great article. Worth waiting for.
Andy I admire the respect you show to to your clients!!!!!!!!!!