Gym Programs for Special Populations

Every person who joins your gym is unique and requires a customized workout program. There are some populations, however, that require special considerations. In this article, I’ll delve into how you, as a gym instructor or personal trainer, can go about designing workout programs for the following special populations:

• People with disabilities
• Children
• Seniors
• Pregnant women

People with Disabilities

People with disabilities deserve to be treated just like all your other clients. They should have full access to all of your services. As a gym manager, you also have the responsibility to ensure that your staff treat them with respect and not view them as ‘a person with a deficit’. 

The fitness industry does not have a very desirable reputation when it comes to being inclusive of people with disabilities. So, before we get down to the details of programming for this population, you should take stock to ensure that your gym is disability-member-friendly.

Making your Gym Disability Inclusive

Here are four things that you can do immediately to make your gym more accessible for people with disabilities.

Do an Environmental Inventory

You should spend some time going through the gym looking for potential trouble spots for members who are impaired. Make it your goal to create a warm and inclusive workplace by going above and beyond the call of duty. Here are some questions to ask yourself:

• Can a person using a wheelchair or crutches pass through the spaces between the equipment and throughways?
•  Do you have a range of equipment that is disability accessible? 
• Does a blind person have access to your gym floor safely? 

Consider enabling caregivers to attend at no extra cost because some disabled members need more assistance. To cater for those who are sight and hearing impaired, a screen or message board should be used for both written and audible announcements in the studio

You also need to confirm that your gym conforms with the Americans with Disabilities Act (ADA). To make sure that your club complies with all of the act’s standards and restrictions, research the precise provisions of the act and then hire compliance professionals to conduct an audit. 

Based on the findings of the inspection, come up with a strategy to assist your club in staying fully compliant. Additionally, in a fitness class situation, direct your staff and instructors to provide changes as acceptable alternatives and demonstrate numerous methods to carry out exercises. This will make the sessions much more accessible. It is in your best interest to recognize and appreciate the possibility that members in the same fitness class may have various needs and skill levels. 

Communicate Effectively with Special Populations

When it comes to dealing with all members, but especially those with disabilities, you should never assume. Remember when you assume, you make an ASS of U and ME.

So, don’t presume that a person with a disability wants or requires your assistance. Instead, let them know that you and your team are accessible for help, just as you would with any other member. Remain vigilant for roadblocks while taking a step back and viewing the gym from their perspective. Ultimately, you need to make sure that everyone feels at home and included. 

The member will start the conversation if they want to talk about their impairment. So, you should train your staff to refrain from prying information from them. Maintaining a good level of customer service for your members means staying committed and remaining positive at all times.

Don’t Be Weight Loss Focused

If a person who is overweight comes into your gym, it is easy to focus first on the need to bring the scale down.  However, linking fitness exclusively with weight loss can quickly turn off participants, particularly those who are bullied for their weight outside of the gym, have physical or mental conditions that have affected their metabolism or weight, or have battled eating disorders.  Remember that not everyone who enters your gym has come to lose weight.

Numerous studies have demonstrated the benefits of regular exercise for the heart, lungs, and bones, as well as for preserving and enhancing cognitive function. It frequently forms a crucial component of rehabilitation programs for a range of mental and physical illnesses. Endorphins released during exercise can aid in stress reduction and self-confidence development. Emphasize these benefits before talking about weight loss. 

Ease the Financial Burden

Most people with disabilities or chronic illnesses live on fixed incomes and spend the majority of their money on healthcare costs, making joining a gym an  expense that is frequently out of their price range. 

Can you consider waiving the initiation price that prevents many people from joining a gym or offer lower monthly membership fees?

Programming for People with Disabilities

Here is a four steps to creating a fitness program for members with disabilities:

1. The Initial assessment

Be sure to conduct a thorough preliminary assessment with the new member. Include a thorough analysis of their medical background. Before beginning an exercise regimen for a client with a disability, it’s also advisable to get their doctor’s approval.

Ideally, the staff member who is conducting the interview should have a special education certificate. This will put them in an excellent position to know how to assess if the member is capable and able to engage in a workout program. 

The more you are aware of their impairment, the better equipped you are to design a customized program for their individual requirements. Asking the client directly is the best method to achieve this. Since they are the ones who experience the condition on a daily basis, only they will be able to accurately describe how it affects them and what they are able to or are unable to do.

You could ask the following questions of a disabled client:

• What is the name of the condition you have?
• For how long have you had a disability?
• What impact does your disability have on how you move?
• Is there anything I can do to help you feel more secure or at ease during our sessions?

Whoever is conducting the assessment, they should also make an effort to treat a disabled client the same way they would any other client—that is, as a fellow human being!

To put it another way, even if a client has a disability, it shouldn’t define them or affect how you interact with them personally. Although it may seem simple, many trainers overlook it when working with clients who have disabilities because there are so many other factors to take into account.

Here are some straightforward ideas to bear in mind when instructing individuals with disabilities:

• When you are speaking to them, avoid gazing at any medical aids or equipment, such as a wheelchair.
• Address them directly. If your client is accompanied by another person, be it a caregiver or relative, speak to the member rather than the other person. 
• Converse informally. Despite the fact that you should initially enquire about their impairment, don’t make it the sole topic of conversation! This demonstrates that you respect them and are curious about all of the other facets of their lives and do not consider their handicap to be a defining or restrictive factor.

2. Find Out What Their Goals Are

As I’ve already mentioned, you need to avoid assuming what your disabled clients want to achieve from a gym membership. It may be that they want to build muscle, get stronger or get rid of that spare tire. But they may also have goals that are related to their condition. 

For instance, a person in a wheelchair who has a lower body injury may desire to strengthen their upper body so they can lift and carry objects around their home on their own.

Similar to this, someone who suffers from a mental illness like anxiety or depression may wish to start exercising regularly to lift their spirits and feel better about themselves. 

When the two of you have identified suitable objectives, use the SMART acronym to establish meaningful goals.

SMART is an acronym for goal setting that stands for …

• Specific
• Measurable
• Achievable
• Realistic
• Time Bound

3. Prioritize Member Needs

At this stage, you are aware of any potential medical issues your customer may have. You also know what the member wants to achieve from their workouts. Ideally, their objectives are compatible with their level of physical fitness and capacity to engage in the physical activities you’ve previously imagined.

You must, however, assume the role of consultant and determine whether the goals they have expressed are actually what they need to focus on for their overall health.

As a health professional, you should make an assessment of what to prioritize given their current state. Is it exercising their heart, training their muscles or working out balance and flexibility?

To find out, you should conduct a fitness assessment. This should cover the following, modified for the needs of the member:

• Body composition
• Flexibility and range of motion
• Balance and coordination
• Cradio fitness and aerobic capacity

4. Create a Training Plan

You are now in a position to create a training plan for your disabled member. The Department of Health and Human Services (HHS) recommends 150 minutes of exercise per week, or 75 minutes of vigorous activity. Use these guidelines as your programming baseline.   However, you also need to consider your client’s objectives, fitness requirements, schedule, regularity, and even how much they enjoy and are able to work out. 

You may need to adapt workouts for a disabled member, especially those who have mobility issues. 

Consider the scenario when you are working out with a client who is in a wheelchair and wants to add a chest exercise to their routine. If your client uses a wheelchair, you may not always be able to have them perform a chest press on a bench.

You might utilize a resistance band or pulley cable machine to allow them to do a seated chest press. I’ve discovered that resistance bands of various strengths are a terrific investment when training people with disabilities. They are very adaptable pieces of equipment for persons with restricted mobility to use for strength training.

Programming for Children

Children today are more inactive than at any time in human history. Just the other day, I saw a news report on a survey stating that 90% of boys aged between 12 and 17 are not getting the amount of exercise recommended by the department of HHS. For girls, the figure was 87%. 

Figures like these present opportunities for gyms. The motion that children can’t do structured workouts has, thankfully, been long debunked. So has the idea that kids can’t do resistance training. As a result, you should market to families and be prepared to program for children.

Here are some guidelines when creating a program for kids.

Age Related Program Progression

The typical ages for programming children will vary depending on who you ask. A child’s physical activity starts as an infant and develops into exercise and athletic performance as they get older. Whether a child belongs in a kid’s fitness class, on a sports team, or one-on-one with a personal trainer or coach depends on their age and ambitions.

The following divisions are generally accepted:

• Between ages two and six, the focus should be on coordination, proprioception, brain / muscle connectivity, and the building of strong bones.
• Between seven and twelve, the youngster is able to work on fine motor skills, strength development using bodyweight resistance and aerobic capacity.
• Between thirteen and seventeen, the teenager can begin to build strength with external resistance, as well as building endurance and increasing their cardio capacity. 

Make it Fun

No matter the age of the child, it is universally acknowledged that youth fitness programming must be enjoyable and interesting! According to research, play is important for young children’s brain development and that requirement doesn’t go away as we get older. Boredom is avoided and program retention is increased via exciting, diverse, and engaging play and exercise, team sports, and competitiveness.

A good youth fitness program will emphasize inclusivity, free play, participation, good form, and team building. You can foster this by having provision for small group training where four or five kids team up to do circuit training type workout sessions. 

Group Size

If you do decide to work with a group of kids, you need to make sure that the group isn’t too big. You still need to be able to monitor that each child is using the correct form and fully engaged. As a result, I do not advise an instructor-to-child ratio of more than 1:6. The exception is if you’re doing a group fitness class with a group of kids. 

Exercise Progression

Your programming will be age appropriate. Depending on age and capacity, fundamental exercises like balancing, a push-up, or treadmill running can be introduced. From experience, though, you need to be careful about introducing kids to the concept of a treadmill. Having the ground move under you is s foreign concert that takes some getting used to. I ran a kids’ boot camp for 10 years and have seen too many face plants for my liking! As a result, I would not have a child who is under 12 using a treadmill. 

You should change the fundamentals to make them progressively harder, much like you would in adult programming, to hold interest and promote development.

The length of a balance beam can be walked by a toddler practicing balance while they are seated on it or just above it. For older children, you can make the push-up more difficult by changing the width of the hands or by making it into a load-bearing floor chest press.

To increase the difficulty of the cardiovascular workout, change the elevation, speed, or duration on the treadmill.

Consider that older, more coordinated children’s growth plates are likely still open and that their bodies are still developing when you add resistance to the exercise. There are numerous elements to take into account, but there is no real consensus on when to begin strength training. Exercises must be age-appropriate, the progression must be correct, and there must be enough time between sets for recovery.

Form is King

Exercise form should be the top factor taken into account while developing kids’ exercise programs. Teaching and reinforcing appropriate movement patterns is crucial because their motor skills and neural connections are still emerging and evolving.

Explain new movements to children in a verbal and visual manner that they can grasp. To describe the demands of the skill or activity, use appropriate and consistent cue words. Never be afraid to stop a youngster and fix their form; just make sure your corrections are brief, encouraging, and positive.

Teach Them to Warm Up & Cool Down

Even young children should stretch and cool down after warming up. Similar to adult muscular tissue, their muscle tissue reacts to activity. If they skip these steps, they become weary, sore, and vulnerable to damage.

Before a workout, they should engage in activity to increase their heart rate and loosen their muscles. Use your imagination to make it fun. The tone for the coming workout will be set by the warm-up. 

Programming for Seniors

As fitness professionals we often get guidelines on what exercise or types of workouts are “suitable for senior clientele”. This may imply that many of the activities we are familiar with and enjoy are inappropriate for elderly individuals. It can also assume that elderly clientele have some sort of inherent limitation. Neither of these beliefs is true.

The reality is that programming for seniors doesn’t have to be different from your programming for younger people. Regardless of the member’s chronological age, good fitness professionals work with them to improve their lifestyle and functional capacity in line with their health and fitness objectives. To do this, we must change our perspective from “age-based” to “capacity-based” program design. 

In its 2015 report on aging and health, the WHO gave the following definition to healthy aging …

the process of developing and maintaining the functional ability that enables well-being at an older age.

As a fitness professional, your job is to help your senior members enhance that functional ability. So, let’s define functional ability.

The  connection between a person’s environment and natural abilities leads to functional ability. All of a person’s mental and physical abilities are considered intrinsic capacities, along with heredity, a propensity for or presence of disease, and a variety of lifestyle choices. Environment refers to everything in a person’s immediate surroundings, such as their home, neighborhood resources, and society as a whole. A member’s surroundings includes you as a fitness center or provider of fitness services. 

It is not random nor the result of a genetic lottery that we preserve our health as we age. What matters more is whether we have access to proper health care, programs, and services, as well as the opportunity to choose a healthy lifestyle in our physical and social contexts.

Some experts claim that only 25%–40% of healthy aging can be attributed to heredity.. This indicates that lifestyle choices and environmental factors account for the remaining 60%–75%. It is understandable why creating a program for an older client is a wholly unique process given the broad variation of health among older populations and the relatively minimal impact of genetic factors. 

Programming for Seniors

In order to build a customized exercise program for any of our members, we first work to establish their baseline fitness level and skills. We then use this information in conjunction with their objectives and goals. To maximize outcomes, the program is then gradually advanced (i.e., the difficulty level is changed).

With an elderly client, we should follow this same process. Two points, though, should be kept in mind: 

(1) We must not make any assumptions about a client’s capability prior to completing the intake and assessment procedures.

(2) Exercise variable selection may require more creativity than it would for a younger person.

Exercise programming may need to account for the physical changes that seniors typically encounter.

These include decreases in bone mineral density and muscle mass, a loss of connective tissue flexibility, and a degradation in balance and coordination abilities. Older customers may also have lower maximum heart rates and cardiac output than they did earlier in life, although their blood pressure will often be greater both at rest and when exercising. Similarly to clients of any age, exercise performance and capacity may be impacted by medical issues, prescription drugs, and past injuries.

Provide your senior member with an initial movement assessment. This can include such tests as the parallel squat, single leg balance and five time sit to stand test. I also recommend having the member fill out an ABC Confidence Scale questionnaire.

The Activities Specific Balance (ABC) Balance Confidence Scale is a self assessment that involves rating your confidence level to do 16 different activities between 0%, where you have no confidence at all, and 100% where you are absolutely confident. [9]

Score yourself between 0 and 100% on the following activities without the use of a walking aid:

1)  Walk around the house? 

2)  Walk up or down stairs? 

3)  Bend over & pick up a slipper from the floor? 

4)  Reach for an item on a shelf at eye level? 

5)  Stand on tiptoes & reach for an item above your head? 

6)  Stand on a chair and reach for something? 

7)  Sweep the floor? 

8)  Walk outside the house to a parked car? 

9)  Get into or out of a car? 

10)  Walk across a parking lot to a mall? 

11)  Walk up or down a ramp? 

12)  Walk in a crowded mall with people walking past you? 

13)  Get bumped by people as you walk in a mall?

14)  Step on or off an escalator while holding onto a railing? 

15)  Step on or off an escalator while holding parcels & not holding a railing? 

16)  Walk outside on icy sidewalks?

Now add up your total score (the maximum is 1600) and divide by 16. This will give you an overall balance confidence percentage. The table below indicates your level of balance functionality based on your percentage:

ABC Score	Balance Level
80-100%	Highly functional
50-80%	Moderately functional
0-50%	Low functionality

Other tests can be modified for this group as well, keeping in mind age-related declines in cardiac output and muscle mass. One-repetition maximum strength tests, for instance, can be replaced by 10-RM tests, and the “talk test” can be used to gauge cardiorespiratory fitness. To fit the aims and abilities of the client, assessments should be chosen and changed.

Exercise Progression for Seniors   

One of the most important skills that gym instructors must develop is proper workout progression. Exercise selection alone is not sufficient for good exercise progression. In order to gently push the body to get better in order to adapt to the stimulus, it is necessary to consciously and methodically create a stimulus that is just difficult enough to test it. If the challenge is insufficient, the body could not react as desired.

If a workout is too difficult, the muscular system may become overworked and not recover adequately. While the general recommendation for seniors is 40% to 85% of VO2 peak, the intensity for all movements should be suited to the client’s goals and ability.

Strength Training for Seniors

Long-term strength training can help older exercisers maintain strength, power, muscle mass, and function despite age-related losses in muscle tissue. Additionally, when resistance training is done correctly, individuals with impaired neuromuscular control, obvious movement restrictions, or fragility can still benefit from it.

The American Council of Aging has identified the following 10 biomarkers of health:

1. Muscle Mass

2. Strength

3. Bone Density

4. Body Composition

5. Blood Lipids

6. Hemodynamics

7. Glucose Control

8. Aerobic Capacity

9. Gene Expression

10. Brain Factors

Every single biomarker of health as identified by the American Council of Aging is improved through a consistent strength training program. That cannot be said for any other form of exercise. That makes including a strength training element an important prerequisite to an effective exercise program for seniors. 

Do not be afraid to program heavy strength training for your senior clients. Of course, heavy is a relative term and should be determined by what the person is capable of lifting with good form for 6-8 reps. 

Speed, Agility & Quickness Training for Seniors

Speed, agility, and quickness (SAQ), along with plyometric training are two integrated training techniques that are frequently underutilized with seniors, despite the fact that everyone can benefit from being able to move more quickly, explosively, and efficiently—especially older clients who are suffering mobility concerns.

Too frequently, trainers envision intense cone or ladder drills for an older adult when they think about SAQ, and they avoid this kind of training out of worry that it may cause harm. The reality is that if ladder drills, easy step patterns, and everything in between are chosen, tailored, and used properly, they’re wonderful for older folks. Same thing with plyometric exercise.

The key when designing SAQ and plyometric sessions for seniors is to be creative and adaptive at their level – and not to disregard this vital aspect of holistic fitness. 

Programming for Pregnant Women

Programming for women who are pregnant requires making certain adaptations to ensure that both mother and baby remain safe and well through the session. 

More women are working out at gyms during pregnancy as research shows that physical activity and effort are not only acceptable but also crucial components of a healthy pregnancy. As a result, moms and babies are not only healthier but also happier.

Women with low-risk pregnancies are strongly encouraged by the American College of Obstetricians and Gynecologists (ACOG) to exercise at least three times a week, if not more. Women who are carrying high-risk babies or in dubious situations can frequently discover a safe type of exercise in consultation with their doctor. 

Scientific research has demonstrated that exercise can lessen the amount of weight gained during pregnancy. Additionally, pregnant women who exercise frequently also experience less pregnancy-related problems like backaches, sciatica, or muscle cramps. Exercise-related motions can also help with other pregnancy-related issues, such as weariness, which is a major source of annoyance for expectant mothers and their families.

Additionally, mothers who exercise had shorter, simpler labors than mothers who didn’t. 

Pregnancy fitness aims to preserve the mother’s present level of health and fitness while avoiding any potential physical issues. To the female who is already in great shape, this can actually include slowing down a regular workout as the pregnancy gets farther along. Clearly, exercise will result in a rise in activity if a woman is just beginning a fitness regimen. Women start a fitness routine safely throughout pregnancy, though an increase in activity shouldn’t be too dramatic as now is not the time to rebuild the body.

Fitness Consultation

As part of your initial fitness assessment, ask your pregnant member the following questions:

• What injuries have you experienced in the past (including broken bones, accidents, falls, previous surgeries, or other problems)? 
• Do you have old injuries that still require nurturing? If so, can you find ways to 
• alter different exercises to accommodate this injury? 
• What medical conditions, if any, did you have before your pregnancy (e.g., 
• chronic conditions including high blood pressure, heart disease, diabetes, 
• arthritis, etc.)? Are they under control now? Do you have any specific concerns 
• about these conditions? 
• Are you suffering from current pregnancy discomforts (e.g., swelling, nausea, 
• backache, etc.)? 
• Have you developed potential complications during pregnancy, like gestational 
• diabetes, anemia, or pregnancy-induced hypertension (PIH)? If so, how can you 
• still fit in exercise? 
• Will there be restrictions on which exercises you are able to 
• complete?

Considerations During the First Trimester

The physical signs of pregnancy, like morning sickness and exhaustion, are typically not felt until around six weeks after the last menstrual period, though they will vary from woman to woman. The hardest part of exercising in the early stages of pregnancy for individuals who have physical symptoms can be learning to cope with them.

Anyone who has experienced pregnancy will tell you that the term “morning sickness” is misleading because the condition can occur at any time of day or night. Morning sickness can prevent a woman from feeling well enough to work out. You should advise your member to consume some protein, drink plenty of water, and exercise only if she feels comfortable. According to some women, exercise actually helps them avoid unpleasant nauseating sensations.

During the entire pregnancy, you should not program any exercises that involve a woman lying on her stomach. The side lying position is appropriate for all trimesters. 

The essential thing to pay attention to is how your pregnant member is exercising. Maintaining proper posture will keep her and the child safe. While exercising, be sure to keep an eye out for any symptoms, especially those related to dehydration and high temperatures. In early pregnancy, overheating poses a greater risk than it does in the second and third trimesters. The baby may become ill if the mother’s body becomes too heated.

Warming up is perhaps even more crucial during pregnancy than before  due to the physical changes that are occuring. Being in the first trimester is peculiar because the woman doesn’t yet “feel” pregnant. She may forget that you are pregnant because your body isn’t displaying many overt indicators of the good news. As a trainer, you need to monitor that she isn’t skipping the warm up. 

Considerations During the Second Trimester

The second trimester is usually less taxing than the first, when nausea, vomiting, and fatigue were at their worst. In fact, the majority of pregnant women consider this to be the easiest stage. If a woman comes to you during the second trimester of pregnancy, you should ask her to get a doctor’s clearance before you start working with her.

A woman’s center of gravity will start to change throughout the second trimester. Since it is so faint, she probably won’t notice much of it. Some women do, however, report feeling a little more clumsy now than they did before becoming pregnant. This is a factor you need to take into account when designing  a workout program.

After the sixteenth week of pregnancy, it was widely accepted that pregnant women shouldn’t lie on their backs. According to the idea supporting this, the uterus grew to such a size after this stage in pregnancy that sleeping on your back reduced blood flow from the vena cava, the main vein that runs down your posterior side. This was believed to restrict the blood returning from the legs, decreasing blood pressure and nutrient supply to the baby.

Maternal supine hypotension syndrome is a disorder that has just lately undergone thorough research. Numerous women were found to not actually experience any of the indications of problems, according to the research. This has led the medical community to assume that short bursts of exercise on the back are entirely fine in the latter trimesters if a woman does not have maternal supine hypertension syndrome.

Considerations During the Third Trimester

Precautions for the third trimester include keeping an eye out for indications of maternal supine hypotension syndrome, preterm labor, dehydration, and safety concerns. A woman should stop exercising right once if any issues stemming from these or other factors occur during your activity. As a fitness professional you should be overseeing her exercise sessions to ensure that she is not exercising when she shouldn’t. 

At this stage of a woman’s pregnancy, prenatal appointments will be significantly more frequent. You should encourage her every time that she sees her doctor, to discuss exercise with them to make sure that all three of you are on the same page. 

There are requirements for a woman to stop exercising prior to going into labor. Many pregnant women continue to work out up until the day of delivery. 

Summary

In this article, we’ve done a deep dive on how to program workouts for the key special populations that make up your gym membership. An underlying theme is to treat all of your members with the respect and dignity that you would want others to give to you. 

References:

1. WHO (World Health Organization). 2015. World Report on Ageing and Health. Accessed Mar. 30, 2020: apps.who.int/iris/bitstream/handle/10665/186463/9789240694811_eng.pdf?sequence=1

2. Seguin R, Nelson ME. The benefits of strength training for older adults. Am J Prev Med. 2003 Oct;25(3 Suppl 2):141-9. doi: 10.1016/s0749-3797(03)00177-6. PMID: 14552938.
3. Steves, C.J., Spector, T.D., & Jackson, S.H.D. 2012. Aging, genes, environment and epigenetics: What twin studies tell us now, and in the future. Age and Ageing, 41 (5), 581–86.
4. Langhammer B, Stanghelle JK. The Senior Fitness Test. J Physiother. 2015 Jul;61(3):163. doi: 10.1016/j.jphys.2015.04.001. Epub 2015 Jun 1. PMID: 26044346.
5. Milanović Z, Pantelić S, Trajković N, Sporiš G, Kostić R, James N. Age-related decrease in physical activity and functional fitness among elderly men and women. Clin Interv Aging. 2013;8:549-56. doi: 10.2147/CIA.S44112. Epub 2013 May 21. Erratum in: Clin Interv Aging. clin interv aging. 2014;9:979. PMID: 23723694; PMCID: PMC3665513.