One of the most daunting tasks for a fitness professional is to program for select populations. Programming for healthy clientele is challenging, but when medical conditions and specific needs enter the mix, the process quickly can become overwhelming. A previous article outlined a system that streamlines functional programming for general populations called Movement-Based Programming (MBP) (9). This article demonstrates how to adapt the MBP method for select populations using that systematic framework. The first section provides a brief overview of the general structure and principles of the MBP method, followed by strategies for modifications to the exercises, the template, and progression/regression schemes. Older adults, clients with peripheral arterial disease (PAD), and clients with metabolic syndrome represent sample populations to demonstrate implementation of the modification strategies.
THE MBP METHOD
Functional training is a crucial part of all exercise programs, including ones designed for select populations. Training for function means focusing on exercises that will strengthen not just the muscles but competency and confidence to execute movement patterns one encounters in everyday life. Designing workouts in this fashion enables the fitness professional to move away from exercises that isolate muscles in a single plane toward compound and complex movement patterns that challenge the entire neuromuscular system. By design, the MBP method simplifies the process of creating functional workouts, resulting in the ability to program a large number of workouts in a short period. Program development using the MBP method requires two steps. First, the fitness professional creates a personalized exercise database by listing all available equipment (i.e., dumbbells, medicine balls) and then designating pushing, double-leg, pulling, and single-leg exercises for each available modality. Locomotion, which involves moving the body from point A to B, may vary the movement pattern (i.e., running vs. skipping) and also may be paired with equipment. Second, these exercises are plugged in to a circuit-based template. Each circuit consists of three rounds, and selected movements are modified to emphasize a different plane of motion within each round (See Tables 1). The template structure provides a systematic method for programming multiplanar movements rather than the traditional approach of exercises that target individual muscles. The database allows the trainer to program different modalities and exercises into the template for literally thousands of workout combinations. See the January 2013 issue of ACSM’s Health & Fitness Journal® for a more detailed explanation of the MBP method (9).
MBP provides a useful starting point for functional programming, but it also is highly adaptable to certain select populations. The purpose of this article is not to provide an overview of disease pathology or even to make a case for the benefits of exercise within different populations. Other authors and organizations address these topics in depth elsewhere (e.g.,4–6,8,11). Fitness professionals working with select populations should be familiar with the physiology, potential medication effects, and exercise contraindications for specific individuals. It also is the responsibility of the trainer to ensure that participants have medical clearance for exercise and be aware of any unique needs for a given client. The primary goal of this article is to demonstrate how MBP is an effective tool when working with select populations and how to adjust the template accordingly. Adaptations will include how to modify/select template exercises, ways to adjust the template, and incorporating progressions/regressions from baseline exercises. Sample select populations to demonstrate these modifications to MBP, along with the rationale for each, include older adults, clients with PAD, and those with metabolic syndrome.
There are common themes of program modification for many select populations. Consistent recommendations include reduced exercise intensity, increased frequency, slower rates of progression, specialized exercise selection, and extended warm-up/cool-down (4,5,12). The degree of modification necessary within each of these areas is somewhat population specific but, generally, these adjustments are necessary for many individuals categorized within a number of select groups. The MBP method is highly adaptable to meet these unique programming needs. Note, however, that each modification strategy is presented with a specific select population to demonstrate implementation but should not be viewed as an exclusive relationship. For example, the template demonstrating how to alter exercise selections uses older adults, yet clients with PAD may require significant exercise tailoring as well. Similarly, the need for regressing exercises is necessary for those with metabolic syndrome, but older adults also may need extensive exercise regression modifications. The underlying message is that the fitness professional should first learn how to adapt the MBP template and then decide which strategy is most appropriate for a given client within a select population. Sample exercise videos representing multiplanar movement patterns are available online; see Sidebar for links.
Call Out Box/Sidebar
Sample Movement Videos
SFT Shoulder Reaches
Locomotion: Sagittal Plane Walk
Locomotion: Frontal Plane Walk with Anterior Step
Locomotion: Frontal Plane Walk with Posterior Step
Locomotion: Transverse Plane “S” Walk
STRATEGY 1: EXERCISE TAILORING
One simple way to adapt the MBP template is through individual exercise tailoring. When working with the general population, creating a modality/exercise library with common pushing/pulling and single-/double-leg exercises is effective because of the limited restrictions typically associated with that group. Select populations, however, often have unique needs that are best matched with specialized exercises. For example, older adults require exercises that focus on activities of daily living (ADL). Although the MBP template does not contain an ADL category, the “sit-to-stand” exercise is both an ADL and a form of squatting, making it a double-leg exercise. Because of the functional movement focus of MBP, only rarely would an exercise not “fit” into the push, double-leg, pull, single-leg, or locomotion classification.
Exercise for older adult populations is not only beneficial, but it may be necessary to prevent some of the common ailments or accidents that may impact quality of life with aging. For example, loss of muscle mass and power reduces one’s ability to be independently mobile, and loss of balance and stability significantly increase the risk of hip fracture (8). There is a wealth of available literature regarding exercise for the older adult, and a majority of this work contains several consistent recommendations. Common strategies suggest including general aerobic and moderate- to high-intensity resistance training (3), particularly programs that train all major muscle groups (7). Incorporating power exercises (4), uncommon walking patterns (2), and exercises designed to improve ADL function, such as balance (8), also has proved to be beneficial. In other words, a well-rounded program for the older adult includes many “general” fitness exercises, which have been tailored to reduce exercise intensity or enable a slower rate of progression. Table 2 shows a sample MBP template with appropriate exercises to accommodate these recommendations for the older adult, with planar changes inserted when appropriate.
The inherent structure and pace of the MBP template satisfies the general recommendation for aerobic and resistance training with variable resistance. Changing the client’s body angle during base stance TRX Rows to 80 degrees, or near vertical, shifts the intensity to a more moderate load. Medicine ball chest passes provide a power exercise performed with a very light load. Locomotion generally consists of activities such as walking, skipping, or running. A matrix is an exercise performed in all three planes of motion. Thus, a walk matrix, which requires the client to locomote forward/backward (sagittal), laterally (frontal), and in an “S” pattern or circle (transverse), provides sufficient overload for many clients. Other clients may benefit from adding a proprioceptive challenge to the vestibular system, such as head shaking, when appropriate. These activities would be termed an “uncommon” walking pattern and often are recommended for older adults. Balance is enhanced through the step matrix, and ADLs are integrated with “chair” squats. Clients respond positively to creative workouts that are enjoyable and challenging, potentially increasing adherence and improving outcomes. The MBP template is a flexible tool for trainers to adapt and integrate unique exercises that are ideally suited for an older population, who greatly benefit from training real-life movements in all three planes of motion.
STRATEGY 2: TEMPLATE RESTRUCTURING
The second strategy to adapt the MBP template for a select population is to modify the template structure. The original template order and execution have a circuit training focus that works well for conditioning the general population. However, some select populations require specialized exercise prescriptions that emphasize one particular functional movement pattern. For example, clients with PAD generally need sustained walking or stair-climbing exercises. Because the basic MBP template guides the practitioner to compartmentalize locomotion for short periods, altering the template structure to accommodate longer walking/climbing segments retains the functional benefits of training movement while integrating an activity matched to a specific training goal.
As with the older adult population, there is consensus in the literature that general recommendations for resistance training are beneficial for clientele with PAD (11–13). The biggest obstacle for this group to overcome is to commit to sustained bouts of walking and/or climbing activities. Standard prescription when programming for those with PAD is consistent with recommendations for a healthy population, with the addition of extended durations of walking and stair-stepping/climbing activities (11–13). The structure of the MBP template needs to change when modified for clients with PAD: it is still triplanar, but the locomotion segment integrates and extends the walk/climb phase.
Three sample options (Tables 3–5) demonstrate how to incorporate multiplanar walking or stair climbing in the MBP template. Table 3 simply plugs the sustained walking or stair climbing into the locomotion segment. Extending the locomotion phase to match the needs and goals of a particular client is the simplest strategy. Table 4 alternates each functional movement with a multiplanar walking series. For example, the client would perform the pushing exercise for 20 seconds, followed by 40 seconds of walking forward and back, and so on. During the course of the movement-based workout, clients perform sustained walking in addition to mastering beneficial functional movement patterns. Table 5 blends the movements with the walking, maintaining the same push-double leg-pull-single leg-locomotion order. For example, during the “push” segment, the client walks while performing alternating arm reaches overhead in all three planes. During the double-leg segment, the client might walk 10 steps and then perform three squats, repeating for either time or reps. To satisfy the pulling requirement of MBP, the client performs alternating dumbbell raises while walking. Pausing for a single-leg balance every 10 steps delivers the single-leg exercise. Combining movements and multitasking allows the practitioner to meet the sustained walking recommendation for this clientele, requiring mental focus and body position awareness as well. Any of these circuits would be functional for PAD clients, challenging them with real-world activities that have direct impact on their ability to move well for extended periods. An added benefit is that the intensity of the workload is modified easily to match a wide variety of fitness levels by varying weight loads or speed of movement.
STRATEGY 3: PROGRESSION/REGRESSION SCHEMES
Mastering the skill of effectively progressing or regressing a particular exercise is essential for working with all clients, especially when adapting MBP to select populations. The original template may be viewed as a programming method for high-functioning individuals because of the use of a wide range of modalities and varied movement patterns. However, basic exercise regression methods make the template appropriate for most select populations. For example, 4 sets of 10 jump squats (double leg) or clap push-ups (push) are not appropriate for an untrained individual. Instead, these exercises could be regressed to 3 sets of 5 assisted body weight squats (double leg) or wall push-ups (push) to make the intensity level acceptable for a client with a lower level of fitness.
Many fitness professionals are interacting with clients who have metabolic syndrome, a collection of risk factors that correlate often to lower levels of fitness (5). The positive impact of aerobic training on obesity and of resistance training on insulin resistance indicates that a generalized fitness program is beneficial for those with metabolic syndrome (5,6,10). Unlike older adult populations, clients with metabolic syndrome do not necessarily need specifically tailored exercises, nor do their programs require the template restructuring seen with a PAD client. Because of the low fitness levels, the exercise recommendations are centered on lowered intensity and duration, as well as slower progressions, and are independent of modality or method (5,6,10). In other words, it does not matter what exercise type the individual chooses, as long as it incorporates both resistance training and aerobic exercise (5,6,10) and follows ACSM intensity/duration recommendations (1). The MBP template flexes to meet the necessary time and intensity recommendations, offering an option with functional whole-body movements. This design enhances caloric expenditure and helps self-efficacy among low-fit clients when challenged with ADLs. The common element in programming strategies for a population with symptoms of metabolic syndrome is to start with low-intensity total-body workouts and progress from week to week at a rate slower than healthy more fit populations. Careful consideration of program variables is essential, including the number of repetitions, the length of rest time, and exercise complexity. Other than measures of intensity, these programs look very much like those used with a more fit population; therefore, the MBP template does not change significantly. Table 6 provides an example of how MBP exercises would be progressed slowly during the course of several weeks.
Viewed as a whole, the template demonstrates various methods for progressing overload. Overload variations include load, distance, difficulty, repetition, and stability. The progression strategies are not complicated or abstract. They emphasize simple baseline movements in the beginning, followed by small incremental changes, whether 3 lbs or 3 ft. This is not to say all programming for a lower fit population should follow a 9-week format that progresses exactly in this manner but rather it demonstrates how amenable the MBP template is for any progression style, particularly for a client with low fitness. That MBP emphasizes movement over muscle isolation and may enhance total caloric expenditure increases its long-term application with clients desiring to lose or maintain body weight.
The MBP template and method are valuable resources for health practitioners to use when programming for any clientele. They become especially useful when programming for select populations. This article provides three different strategies to extend the usefulness of MBP: exercise tailoring, template restructuring, and progression/regression schemes. Sample populations included older adults, clients with PAD, and those with metabolic syndrome to demonstrate how to adapt workouts to match specific or unique needs. The templates for each population demonstrate how different strategies take advantage of the inherent flexibility of MBP. Learning how to modify MBP allows fitness professionals to develop appropriate exercise programs for select populations that more accurately reflect how the neuromuscular system operates during movement. For trainers searching for ways to truly make their workouts more “functional,” the MBP template and method provide useful tools for strategic programming.
BRIDGING THE GAP
This article provides modification strategies for the Movement-Based Programming template, including exercise tailoring, template restructuring, and regression/progression schemes, that can be used with select populations. Older adults, those with peripheral arterial disease, and those with metabolic syndrome are used as example populations to demonstrate modification techniques.
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Keywords:© 2015 American College of Sports Medicine.
Select Populations; Movement-Based Programming; Functional Training; Program Design; Personal Training