Training Overweight and Obese clients Based on NASM CPT Textbook & ACE CPT Textbook © 2018 NPTI Colorado  | Slide 1 | Revision 7 (6/5/18) DM

Lecture Objectives Students should be able to: Define and describe how body mass index is used to estimate a healthy body weight Describe common characteristics of overweight and obese clients Recognize how acute and chronic responses to exercise vary in overweight and obese clients Describe how to modify a program for overweight and obese clients

Body Composition Body composition is the relative percentage of body mass that is fat and fat-free tissue. Estimations can be be made using various methods Body Mass Index Circumference (WHR) Skinfold All of these provide valuable information on general health and risk stratification.

Body Mass Index Body Mass Index (BMI)-ratio of weight relative to height. kg/m2 Obesity-related health conditions increase beyond a BMI of 25.0 kg/m2 BMI fails to differentiate between fat and fat-free mass.

Waist-to-Hip Ratio Body fat distribution is an important indicator of health and chronic disease. Android obesity (higher amounts of abdominal fat) is highly associated with obesity-related conditions

Waist-to-Hip Ratio Waist-to-Hip Ratio (WHR) is the circumference of the waist divided by the circumference of the hips Used to identify high amounts of abdominal fat that puts an individual at risk for disease.

Skinfold Skinfold thickness measurements estimate total body fat by directly measuring subcutaneous fat at selected skinfold sites. Within +/- 3.5% accuracy Higher body fat percentages correlate with disease risk

Body Fat Percentage

The Obesity Epidemic Excess body fat, particularly when located centrally in the abdomen, is associated with: Hypertension Metabolic syndrome Type II diabetes Stroke Cardiovascular disease (CVD)

The Obesity Epidemic Briefly review each bullet point

The Obesity Epidemic Worldwide, obesity has more than doubled since 1980 More than two-thirds of American adults are overweight and of these, 33% are obese One-third of youth are overweight or obese Source: World Health Organization (2011)

The Obesity Epidemic The diagnosis and treatment of obesity can be challenging: Medical, physical-activity, and dietary histories are necessary to determine the cause(s) of obesity. In many cases, obesity is caused by complex psychosocial issues that may require referral to a psychologist or professional counselor.

Video: Obesity and chronic disease The Obesity Epidemic Video: Obesity and chronic disease The prevalence of overweight/obesity and its health implications has increased an awareness in the health benefits of exercise. The key to successful long term weight-stability is the adoption of: Lifelong physical activity Sensible eating habits Source: World Health Organization (2011)

Obesity and Exercise Excess weight-related concerns are common among clients seeking personal training services Negative past experiences may shape their perceptions of exercise and physical activity An individualized program should consider current training status, fitness assessment results, and enjoyability Goals must remain self-determined using motivational interviewing techniques

Obesity and Exercise Management of bodyweight is dependent on energy balance. Energy expenditure must exceed energy intake A weight loss of 5-10% provides significant health benefits Moderate reductions in energy consumption combined with adequate levels of physical activity maximizes weight loss for overweight and obese clients

Obesity and Exercise Testing The presence of comorbidities may increase the risk classification and result in additional medical screening and/or medical supervision during fitness testing Comorbidities-one or more secondary disease that occurs at the same time as the primary disease Primary disease: Obesity Secondary disease(s): Hypertension/diabetes/dyslipidemia

Obesity and Exercise Recommendations: Target at least 5-10% of initial body weight over 3-6 months through a combination of eating and exercise behaviors Incorporate behavioral modification strategies that facilitate the adoption of healthful behaviors Communicate with healthcare providers, dietitians, and other professionals during and after the weight-loss period.

“More is better” may be correct (to a certain extent): Obesity & Exercise “More is better” may be correct (to a certain extent): 150 minutes/week of moderate-intensity aerobic exercise results in modest weight loss 225−420 minutes/week results in greater weight loss Obese clients should expend 200-300 kcal per session (weekly goal of 1,250 kcal expended) Progressively increase the intensity and duration Deconditioned obese clients may have to start at a low intensity in multiple 10-minute bouts

Obesity & Exercise Resistance training: May enhance muscular strength and physical function May improve CVD risk factors The same exercise training guidelines for apparently healthy clients apply Core and balance training is important Use caution with prone and supine positions

Obesity & Exercise Review Table 16.6

Obesity & Exercise Psychosocial Aspects of Working with Obese Clients: Obesity can alter the emotional and social aspects of a person’s life Trainers should pay attention to a client's emotional and physical well-being Proper exercise selections and positions are very important Walking is often a preferred activity Enjoyability is KEY for enhanced compliance

Obesity & Exercise Review Table 16.5

Exercise Modifications Aerobic exercise incorporating multiple muscle groups is desired Zumba TRX Squat modifications Plank modifications Chair exercises for Obese Clients

Any questions?