An exercise program that includes resistance training is vital for obese clients. Not only is the increase in caloric expenditure important, resistance training will preserve and increase lean body mass, and improve overall health. The maintained lean body mass plays a key role in burning calories long after exercise is finished, which is vital to weight reduction. Other benefits of resistance training with obese (and other) clients are increased bone density, improved self-esteem, increased energy levels and encouraging positive lifestyle changes, which include better diet and sleeping patterns.

Some things to watch for include avoiding the Valsalva maneuver (holding breath), which elevates blood pressure. Also, take time to start slowly. Often, obese people have been sedentary, and weightlifting can be intimidating and threatening to self-esteem. Focus should be on muscular endurance and not gross strength, so use lighter resistance with higher repetitions. Keep in mind that range of motion is usually limited due to size and inactivity. Also, make sure goals are realistic and attainable. Whatever type of resistance is decided upon by the trainer and client, the trainer must take the time to teach proper range of motion, speed of movement and technique to decrease risk of injury.

Pre-adolescents. The young client has many different needs when it comes to resistance training. It used to be thought that they should avoid "weightlifting," but there certainly are creative and safe ways to introduce resistance training to young people. It is a good rule of thumb to have young clients start with their body weight as resistance, such as during pull-ups, push-ups and sit-ups, and then progress from there. Basic plyometic exercises are also fine to introduce, such as hopscotch, leap frog and jump rope.

The young body is versatile and adaptable to stresses, so teach proper technique and correct body mechanics early. Implementing a resistance-training program at these early ages may help to improve coordination, motor-skills, fitness and self-esteem. It also sets a positive pattern for an active lifestyle later in life.

Factors to consider with young clients are limb length; body temperature regulation (they heat up much faster); grip strength (usually less); low attention span; r nge of motion issues or possible hyper-mobility; and unclosed epiphyseal plates (growth plates) -- too much stress may cause damage. Studies have indicated that resistance training for adolescents is relatively safe when properly supervised. (For more information on strength training this population, refer to Wayne Wescott's article in Fitness Management, April 2001, pp.28-30.)

Older adults. As people age, their bodies' abilities to adapt to stresses decreases. Resistance training can be beneficial in delaying many of the mental and physical "signs" of aging. Resistance training is one way to tap the "fountain of youth."

One problem for older adults is the years of being sedentary. Throughout the midlife years,5 pounds of muscle are usually traded or 15 pounds of fat in sedentary individuals. This can add up after a few years. Resistance training for seniors is the first step in winning that battle. Resistance training also has other health benefits. Blood lipid levels improve, lean muscle mass is increased, metabolic rate is increased, blood pressure is lowered, low-back pain is lessened and bone mineral density is increased, just to name a few.

When putting a program together for older adults, remember to take it slow. Use lower weights. Also, ACSM recommends to keep the number of reps between 10 and 15. Only two days a week is needed to see results, and intensity should be a little less than is "traditional." Remember to keep the speed of motion under control. Again, it is important to avoid the Valsalva, and avoid isometric contractions, as they encourage the Valsalva, which, as stated earlier, increases blood pressure.

Starting your program

When working with special populations, keep in mind is the diversity of strength training available. No longer is it just dumbbells and iron-clad weight rooms. There are a number of ways to introduce resistance training. Each client deserves to have a variety of options, and creativity and ingenuity are the duty of the trainer.

The benefits of strength training are obvious; however keep in mind that the same programs do not work for everyone. Take each client differently, learn about their disabilities, special concerns and needs, and create a safe and effective program. Use professional organizations, and physician specialty organizations (pediatricians, oncologists, sports medicine, etc.) to help you create a safe program. Most of them have position stands or recommendations on exercise and fitness for the groups they govern.

Many people with special needs are afraid to begin something new; they often feel as if it is too tough or dangerous for them to start strenuous activity. As a fitness professional, it is important to promote the benefits and necessity of strength training for all groups, healthy or otherwise.



REFERENCE

ACSM Guidelines for Exercise Testing and Prescription(5thed.),Baltimore, Md.: Williams & Wilkins, 1995.

Wayne L. Westcott, Ph.D., is fitness research advisor at the South Shore YMCA in Quincy, Mass., and author of 21 books on strength training.