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

2. 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

3. 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.

4. 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.

5. 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

6. 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.

7. 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

8. Body Fat Percentage

9. 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)

10. The Obesity Epidemic
Briefly review each bullet point

11. 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)

12. 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.

13. 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)

14. 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

15. 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

16. 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

17. 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.

18. “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 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

19. 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

20. Obesity & Exercise
Review Table 16.6

21. 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

22. Obesity & Exercise
Review Table 16.5

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

24. Any questions?