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approved: PAGE 82

By Amy Ashmore, PhD

The more you know about modifications and yourclients, the easier it is to design a successful session.

Design,^Execute and

Modifya Program

for Your Client

One of the most common obstacles per-sonal trainers face is the need to modifyan exercise program during a session.

A good trainer comes to a fitnessappointment with a series of exercises forthe client to do. However, even the mostwell-planned program may need to bemodified. The key to success is knowing,based on the client's unique biomechan-ics and movement patterns, which mod-ifications to make and how to implementthem with confidence.

Getting Started:Break Down MovementBefore deciding how to modify exercisesduring a session, you need to considerthe rationale that underlies the programdesign. If you know how movement hasbeen broken down to build a program, itbecomes easier to analyze an exerciseduring a session and make adjustments.Here are some of the more common waysthat trainers break down movement tobuild an exercise program:• Goal-oriented. The aim is to develop

a series ot exercises that the client willexecute over a period of time to reachdesired goals. >>

February 2012 IDEA Fitness Journal I 27

CASE STUDY

The client was a 40-year-old woman with

osteopenia and a previously fractured

peivis. Her program was designed with her

prior injury in mind. Program components

included exercises that

• eiiminated compression forces on the

spine and peivis:

• reduced balance requirements to mini-

mize the risk of faiiing: and

• isoiated the primary and supporting

musculature of the hip joint.

Modifications Invoived having the ciient

do some exercises seated or lying down, to

eiiminate compression forces. Doing exer-

cises iying down or seated aiso eiiminated

baiance concerns and aiiowed for target

isoiation work of the most critical muscles.

in addition, iying down instead of standing

changed the exercise plane. (Having your

ciient stand during a standard crunch, for

exampie, wouid change the movement

plane. Target muscles would work in the

same movement pattern, but the plane

would change.)

This ciient often compiained of pain dur-

ing iateral hip abduction exercises. The rerr-

edy was to stop and reset the start position.

Think about trajectory: where you end up is

based on where you start. Sometimes the

exercise trajectory Is simpiy off and needs

to be reset for the ciient to execute the move

correctly and comfortably.

Finaliy, modifications were based on the

concept of building blocks. In this case, the

program progressed from sit-to-stand to wali

squats to nonweighted squats. Eventuaiiy,

weighted bartieii squats were added.

• Disease- or injury-driven. Ihe point isto tailor the program to certain limita-tions or to provide a starting point (e.g.,postrehabilitation) for the client. Fitherway, the program is designed to helpmanage or overcome an obstacle, and it'simperative to account for it when choos-ing exercises and making modifications.

• Muscle-specific. This can refer to along-term program that unfolds overtime (i.e., periodization) or to eachsession as an independent entity (i.e.,agonist/antagonist muscle groups).

• Joint action focused. A session mightfocus, for example, on muscles thatinsert at the knee to allow for kneeñexion and extension.

• Compound versus isolation training.Isolation exercises are single-jointmovements that focus on one musclegroup (e.g., a biceps dumbbell curl).Compound exercises use multiplejoints and muscle groups (e.g., a lunge).Isolation exercises are best suited formuscle size and strength goals and arealso great for beginners, youth, seniorsand persons who may have limitedmotor coordination or who have beeninjured. Compound movements aregood for total-body training, time-lim-ited sessions, functional training,advanced exercisers and athletes.

Program DesignOnce you've decided how you'll breakdown various moves, it's time to choosethe exercises for each session. Developinga sound exercise program for a client isanalogous to developing a business plan;you create a blueprint for what you intendto do, while being realistic about factorsthat will influence what you actually doonce you implement the program.

The key is to remember that the pro-gram you design is like a rough draft of aterm paper—it's a starting point.Focusing on a few key action areas canguide you step-by-step through thedevelopment of a program draft. Theseinitial evaluations are your guide to theclient's biomechanical characteristics andcan be an easy way to discover whatmodifications you need to make duringsessions. Before you get started, addressthese action statements:

• Scan for structural limitations. Theselimitations include any type of thera-peutic aid or physical challenge.

• Watch for unusual movement patterns.Unusual patterns include a limp, asway or other postural deviations thatcould cause a muscle imbalance.

• Estimate the client's age group. Thisaction applies only to youth and olderadults. During youth and late adult-hood, motor learning factors are pres-ent that influence learning andspecific exercise capabilities.

• Look at body weight and mass. Move-ment biomechanics for everyday tasksare different for an obese person thanthey are for a normal-weight person(Runhaar et al. 2011). For example, anobese person performs "sit-to-stand"from a chair differently than a normal-weight person (Sibella et al. 2003). Thepatterns of muscle activation and jointaction are different. Although it appearsto be the same movement, the dissimi-larities are analogous to those betweena barbell squat and a wall squat. Inother words, the mechanics and work-load are not the same.

• Listen carefully to the client's statedgoals. Ihis is the most important eval-uation of all and can deliver valuableinformation about the client's biome-chanical characteristics. By listening,you learn how your client views hisor her body, including its capabilitiesand limits. For example, an older adultmight say she is concerned aboutchronic low-back pain (CLBP) andwants to feel better. This informationalerts you to two potential obstacles:( 1 ) you must select exercises that areboth CLBP- and age-appropriate, and(2) you can anticipate that your clientwill complain of low-back discomfortduring exercise and may be timidabout performing some of the movesyou select. You will need to be preparedwith modifications to keep her on taskwhile easing her discomfort.

Program ImplementationThe greatest obstacle that trainers face dur-ing sessions, particularly with new clients,is that each person has a unique combina-tion of factors—age, disease, injury, exer-cise history and motor coordination—that

28 I IDEA Fitness Journal February 2012

TRAINER TIPS

• Ri, i : If your

client gets flustered during an

exercise, back up and have

her do a simple exercise that

works the same muscle group

or is a component of the more

complex movement. Isolation

exercises are effective for

building strength and tone.

• Break down moveiiients into

simpler parts. Think of move-

ment in terms of building

blocks. A simple biceps curl

can lead to a biceps curl with

an overhead press and return

through the eccentric phase

of the curl. A squat can be

taught first with a chair or wail

and then progress to body

weight only, to a weighted

squat, to a squat with an over-

head press or to plyometrics.

Start simple and end strong.

Recognize tnc .

movement. If you encounter

resistance or if your client

complains that learning

and/or executing an exercise

is painful or difficult, move on.

Never allow a client to feel

that he cannot do something

or that you don't have another

plan for him.

If you have a

hard time flowing from one

exercise to another in a logi-

cal, effective way, structure

each program around a joint

or muscle group and stay

focused until it is time to

move on to the next series of

exercises. Don't jump around

between muscle groups.

Understand tne concept ot

general motor ability (GMA).

GMA simply means that peo-

ple will be good at motor

skills that are related to what

they already know how to do

(Schmidts Lee 2011). For

example, a client who has

been bodybuilding for years

will be excellent at executing

power lifts, yet may be hesi-

tant to try the BOSU'̂ Balance

Trainer.

Know your client's exercise

history and be prepared to

incorporate / i

fications. This will help you

design a program that (1) the

client feels familiar with, (2)

incorporates exercises that

the client has already per-

formed safely and effectively,

(3) helps the client feel suc-

cessful and (4) lielps you

move the client from the

known to the unknown.

When a client

struggles with an exercise

that requires coordination,

balance and strength, it is

time to reassess the program.

A complex exercise executed

poorly is not nearly as valu-

able as an isolation exercise

executed well.

determine his or her ability to learn andexecute exercises. Simply put, all peoplediffer in what movements they can do.

YOUTHYoung people who have not yet reachedskeletal maturation are a unique group,because their bones are still developing.The American Academy of Pediatrics(AAP) recommends strength training foryouth (AAP 2001), with minimal loadbecause bones are immature. All exer-cises should be modified to use lightweights. Training may also include bodyweight-only exercises; however, bodyweight exercises can be contraindicatedfor overweight youth. Their extra weightis an advantage when it comes to movingexternal loads, but it's an obstacle duringpopular calisthenic exercises. Therefore,modifications for overweight youth mustinclude eliminating body weight exer-cises, while not allowing clients to overdothe use of external loads.

Also, youth training should focus onteaching motor skills associated with fit-ness. You can help youth develop lifetimefitness habits by frequently changing theexercises you choose, both during ses-sions and for independent training(between sessions), as youth learn bestthrough varied practice (Schmidt & Lee

2011). Popular ways of introducing varietyinclude circuit training and supersetting.

ADULTSWhen modifying sessions for adults, theopposite is true. Adults, particularly olderones, prefer consistency. Training meth-ods such as pyramiding work well, as domore advanced training techniques likeforced repetitions (for the conditionedchent). The key is to take into account thefact that adults learn exercises best whenoptions are minimal.

As people age and become affected byconditions like arthritis, decreased bonedensity and postural changes, modifica-tions are essential. Arthritis limits range ofmotion (ROM) and differentially affectsjoints. Modifications to arthritic programsmay include using isolation exercises—todecrease the total number of jointsinvolved—or using partial-ROM exercises.

Clients with decreased bone density arevulnerable to compression forces. It is there-fore important to limit forces that act down-ward on the spine (as in barbell squats).

If posture is swayed or deviated due toage, the program must take muscleimbalances into account. Modificationsshould focus on rectifying the differencesbetween opposing muscle groups andopposing sides of the body. For example.

modifications for a client with stoopedshoulders would include a strong focuson strength training for the posteriormuscles of the back versus the anterior.This is in contrast to the traditional wayof thinking about program design andagonist/antagonist muscles.

Modifications are a part of fitnesstraining. The key is to know when andhow to make them for each client'sunique biomechanics, movement pat-terns and personal preferences. •

Amy Ashmore, PhD, holds a doctorate inkinesiology from the University of Texas,Austin, She is a professor of sports and healthsciences with American Public University,

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ReferencesAmerican Academy of Pediatrics: Committee on Sports

Medicine and Fitness Strength Irainmg by Chiidrenand Adolescents. 2001. Pediairics, 107 (6), 70-72.

Runhaar, J., et al. 2011. A systematic view on changedbiomechanics of lower extremities in obese individu-als: A possible roie in development of osteoarthritis.Obesity Reviews, i.2(12), 1071-82.

Schmidt, R., & Lee, T. 2011. Motor Control arid Learning:A Behavioral Emphasis (5th ed.) Champagne, II,:Human Kinetics.

Sibella, F., et al. 2003. Biomechanicai analysis of sit-to-stand movement in normal and obese subjects.Clinical Biomechanics, 18 (8), 745-50,

February 2012 IDEA Fitness Journal I 29

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