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Chronic illness and the Gym: A personal trainer's guide

Exercising with chronic illness can be a bit of a minefield just working out how much to do with fatigue and pain. Maybe you want to go to the gym but don’t have a clue where to start or feel overwhelmed at people grunting whilst lifting huge weights (I know this is a huge stereotype but seen it numerous times whilst I’m on the mat with my 1kg weights). Or maybe you just don’t want to cause an injury or risk your health even more. That’s when having a personal trainer to guide you can really help, but how much do they ‘get’ or understand about working with people with chronic illnesses. I chatted to my friend James who is a personal trainer and has a tonne of experience working in sports performance to boot camps.

How does it work as a new client, what sort of assessment would you do?

Most personal trainers (PT's) in a gym would normally start with a consultation lasting 15-30minutes either face to face or over the phone, where we would discuss where you are now in terms of your health and wellness. This would be a great opportunity to talk about your past, if you have any injuries or conditions that would affect your performance in the gym. Also adding in what you are currently doing with exercise. This can give a PT a good base level about you and where you currently start from then I tend to find out where you would like to go and what your goals may be. Once we together have determined a direction of travel then I would come up with a suitable plan to get you there.

After an initial consultation with clients who have greater needs than just weight loss, I tend to do a functional movement screen and fitness test. This is very tailored to the person. The functional movement screen to see how you move and if there are any immediate red flags that we would want to address. The fitness test again would be tailored to the person, typically I do a 6minute run, some intervals on the watt bike and some jump tests. But if the client can only complete low impact I would adjust to a bike or cross-trainer to minimise or completely scrap accordingly. Doing a functional movement screen and fitness test gives me a good base of understanding you, your needs and where to go to improve you towards your goal.

How much do you think the average personal trainer knows about chronic illnesses and related symptoms?

It can take a person off the street to be a fully qualified level 3 PT in 8 weeks from an online course but this course would not cover any chronic illnesses in any detail.

A PT can go on to do a GP exercise referral level 4 course. The course will go more in depth around health screening, and the prescription of exercise to clients with health issues. But the course still only covers illnesses such as arthritis, osteoporosis, diabetes, hypertension. These can overlap with other chronic illnesses or induced by side effects from medication from the chronic illnesses so if possible try to get a PT with a level 4 GP referral qualification.

In my opinion the fitness industry hasn’t made a suitable course for general PTs to understand chronic illness. Which I am sure/hope will change in the future. But it doesn't mean that you are unable to see a PT as there are many very good PTs out there which would be great at helping people with chronic illnesses in fitness. Finding a patient, willing to adapt and research, experienced and empathic PT is essential. The personality of the PT is essential to making you feel at ease the gym and keep you motivated to keep going when it becomes difficult. Finding the right PT can take time. Simply reading the PT profile boards at the front of the gym may not be enough.Try these tips to find a good one:

- Get chatting to multiple PTs and find who you click with

- Follow some PTs on social media

- Spy on a session or two when they are training someone else

- Take your time on your choice

How do you create and then adapt your gym programs for those clients who have chronic pain and fatigue?

A good programme all starts from a good foundation of knowing your current levels of fitness and going up a small level up towards an important goal. It’s the same as making a lego kit, step by step you keep adding layers until you have built the castle.

For example if your long-term goal (1+ year) was to be able to squat 40kgs and currently you squat a 4kg kettlebell to half depth. Then your programme would include a ton of mobility drills to get you to a full range squat first with good form. Then begin to load up the squat slowly increasing load and volume until the point of squatting 40kg.

Creating a programme is the easy bit, the harder bit is adapting when things are not going according to plan. Everyone has ups and downs, it could be a poor nights sleep, splitting up with the other half, got a big project at work or a chronic flare up. Stressors in our lives can reduce our performance in the gym and that is completely normal. Doesn’t matter if you are in the Olympics going for gold or trying to keep fit and healthy, stress and life sometimes gets in the way. Adapting a programme down a level or even knocking it on the head completely is fine.

If you always have a plan B or C or even Z when you do not think you are up for plan A that is completely fine.

There is nothing wrong with just trying to do your best at the time, it is better than doing nothing.

If you cannot manage anything then you are doing something... recovering to do something soon!

Life is a marathon not a sprint, there are going to be a few hills and tight corners to get around.

How do you help to motivate your clients overcome barriers to exercise?

This is a really hard question. It is highly individual. Everyone has their goals and wants in life. It is finding the persons goals and wants, then giving someone a challenge which is worth pushing for. Muhammad Ali said if it is important to you, you will find a way. Which is so true, if a client of mine cannot see the benefit of completing a certain part of the programme then their motivation is super low. For example my U18s rowing boys cannot see any benefit in foam rolling. They want to come in and lift straight away. I am on them all the time to get it done as it is hugely important for them as they are so tight from the volume of rowing they do. It was until a few of them got an injury or niggles they saw the importance and began to appreciate it.

My approach to training someone is that it is highly lead by the client. The motivation comes from the person and me holding their hand through it with a word of encouragement. I don’t shout or scream to get you to do something, you’re not at school you can go if you don’t enjoy or see the benefits of the sessions. I love to see when someone starts to love and enjoy fitness, it makes it a lifelong habit rather than a chore. That is the moment when I know I have done my job well.

What do you recommend are great low impact ways to lose weight? I know a lot of people want to manage their weight but struggle as 'normal' exercises recommended for weight loss are high impact like running or squats.

The biggest factor to weight loss is the food that you eat. Trust me I have tried to train out a poor diet for a long time, it doesn’t work. Keeping in a calorie deficit is highly important for weight loss. Doesn’t matter what sort of diet that you follow if it regularly brings you into a calorie deficit.

In terms of low impact exercise for weight loss. Consistency is key, regularly exercising across the week will aid weight loss. Completing strengthening exercises 3 times a week would be a great start. Completing large compound exercises such as a squat will aid weight loss. Reformer Pilates would also be a good foundation to strengthening exercises. Low impact cardio will also boost your weight loss. This can include going for a walk or a light cycle. In the gym going on the cross-trainer, rower or bike are great low impact exercises. Swimming is also a perfect low impact cardio exercise.

Try to stay clear of the treadmill (unless walking), Hiit workouts, most classes in the studio such as bodypump or legs bums and tums if you are struggling with joint pain. Completing a daily stretching routine is a great way to keep mobile without loading up and aggravating the joints. This can be done with a yoga routine or your own stretching routine.

How many sessions with a personal trainer do you recommend to get the most out of attending the gym?

Good question, and it depends on the person and their goals. If you are new to the gym, then maybe it would be recommended to see a PT 2-3 times a week until you get to a point where you could do 1 a week with a PT then 2 by yourself.

If you are someone who struggles for motivation or extremely anxious then maybe you keep with a PT 2-3 times a week every time you go to the gym. If you are comfortable and have had previous experience in the gym maybe once every two weeks or month to check in and regress/progress the programme as needed as long as they follow the programme by themselves as well.

These sessions could be 30, 45, 60 minutes in length all depending on the person. For example if you session was to complete a foam rolling and mobility session then 30 minutes would be more than enough time. On the other hand, if your session was to complete 5 sets of 5 maximal back squats then 60 minutes would be needed.

There is also the option of online training. Online training is great for someone who isn’t quite ready for the gym yet. They can get advice over the phone or over Skype about how, what and when do to things. This can also work for people who really like/connect well with a certain PT who doesn’t work at their gym. If none of your local PTs can help you with needs that you may have then the best option is to go online and find a suitable person to help you.

One thing I worry about in gyms is germs as I am immunosuppressed, how clean do you find most gyms/equipment are?

Gyms can be seen as a dirty sweaty dungeon but in reality, most gyms are cleaned on a regular basis. In every gym I have worked in every piece of equipment is cleaned most days. Most gyms now also have antibac sprays so you can give the equipment a wipe down before you use it.

Air con units are well serviced, at pure gym where I have worked, they were cleaned nearly every month! If you ever have any issues with hygiene always relay back to management. It is a major point for each gym to be clean and tidy. If you haven’t joined a gym yet and would like to. I would recommend having a look at multiple gyms to compare them.

What times do you recommend going to gyms if you want to go when its quieter?

Gyms typically have two peaks, one in the morning before work around 6-8:30. Then one in the evening after work 5-8:30ish. I prefer training around 9-11 am if I can, it is normally dead!

James currently trains a client with Fibromyalgia who recently posted this:

"Exercise is a great way of learning about your body. Breaking down boundaries and then building new ones. #broken. Today is a bad fibro day BUT... the amazing news is that these are now getting less and less. So much so this caught me off guard. The good news also is I knew why it is bad today. It is amazing that a year ago this was my every day. Still got a way to go and I may never be rid of it completely but progress"

Really great to hear James experience on how to work with clients like us! I agree with James that training for personal trainers is limited regarding specific chronic illnesses and more awareness is needed. However personal trainers do have loads of great adaptable skills to work with clients with complex issues as long as we communicate clearly what we can and cannot do. It's important if you are about to start any exercise to get clearance from relevant doctors. If you have any specific pain/past injuries you feel need addressing it may be best to see a physiotherapist or physical therapist first who can help you transition into an exercise program with a personal trainer.

I think its important that we break down the view that gyms are only for the fit and healthy, there is plenty of room for anyone who needs to lie down after lifting up a 1kg weight! Massive thanks to James for this detailed blog post, if you want to hear more from him check out his details below.

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