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Exercises for Deconditioned Clients: What You Need to Know

As a coach, you probably expect most clients to have at least a basic fitness foundation. You know––basic stuff:

  • Do a few bodyweight squats and push-ups
  • Run for a couple of minutes at a time
  • Be able to lift the 10-pound dumbbells

But what should you do if a new client doesn’t have that base because they’ve been sedentary for the last five, ten, or twenty years? What if your client has spent an extended period in bed, healing from a severe injury or illness? 

In that case, you’re dealing with a physically deconditioned person who requires a different approach from how you’re used to approaching new clients. 

Fortunately, as with most things, there is a solution. Read on to find out exactly how to approach sedentary clients and what behavioral change needs to occur for long-term success.

Understanding Deconditioning

Put simply, a deconditioned person is someone out of shape. They might have been active and fit in the past, but that is no longer the case.

Some people end up in that situation due to lifestyle choices like disordered eating (over and undereating) and never exercising. Others end up that way through no fault of their own. For instance, an injury or illness might leave someone bedridden or in pain for weeks, months, or, in rare cases, years

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According to research, even brief periods of bed rest can lead to significant muscle atrophy and loss of insulin sensitivity in otherwise young and healthy men (1). So you can imagine how big of an impact long-term inactivity can have.

As a result, a deconditioned person often has less muscle, and their physical capacity is much lower than that of the average person. This can make it difficult to complete even simpler everyday tasks, which means such people must rely on others for help. 

To make matters worse, deconditioning can put people at risk of falls, which can lead to bone fractures and further loss of mobility. The risk is particularly high for elderly individuals (2, 3).

Common symptoms of deconditioning include:

  • Poor endurance
  • High fatiguability
  • Difficulty performing even basic activities (e.g., climbing stairs)
  • Below-average muscle strength
  • Balance and stability issues

As a coach, you must address deconditioned people differently and understand that it could take months for them to reach the same fitness level as someone who is active but doesn’t necessarily follow a structured exercise program.

Despite their worse starting point, deconditioned people are not in a hopeless situation. The same rules apply, and good exercise programs can help such individuals transform their lives. 

Related article: The Best Exercises for Obese Clients: A Complete Guide

How to Treat Deconditioning

Deconditioning is a nuanced problem that affects people on many levels, including physically and psychologically. Due to inactivity and possibly even social isolation, these clients need a different approach. 

Let’s go over some crucial points:

1. A Holistic Approach

One common characteristic among deconditioned people is their overall lack of fitness: strength, endurance, and mobility. 

Therefore, you must develop a comprehensive exercise program that helps your client on many fronts. Ideally, their program will include strength work, cardio, stretching, and balance exercises

Attacking the problem from several angles would help them build a strong foundation and see initial results early on. 

In addition to proper fitness guidance, you should help each client in their daily living by providing actionable tips. For instance, you can give the person some homework in the form of stretches they should do in the morning or before bed.

2. Gradual Progression

Some deconditioned trainees will have a better starting point than others, allowing them to do effective training early on. 

For instance, one client might have a decent joint range of motion that allows them to start doing some multi-joint exercises within a couple of personal training sessions.

Unfortunately, others won’t be so lucky and might have to embark on their journey by walking for five to ten minutes at a time, two to four times daily.

As a personal trainer or coach, part of your job is understanding where each client stands and helping them progress. For example, even with walking, the client could begin with 20 minutes daily and gradually go up to 30, 40, and even 60 minutes.

3.  Making Adjustments

Tracking your clients’ progress in every training session is necessary to determine whether they are improving or need adjustments. 

For instance, if a client is doing resistance training, you must gradually increase the difficulty while monitoring how they are doing:

You could investigate further by tracking their heart rate with a monitor or a smartwatch to see if it decreases. 

For instance, if the person is doing the same amount of work, but their heart rate doesn’t increase to the same degree as before, that could indicate improvements in their cardiovascular capacity.

Consider all the variables, gradually increase the difficulty, and introduce more variety. For example, a deconditioned client might start with just walking, but you could later introduce other activities:

4. Proper Nutrition

Whether your client is an underweight 50-year-old woman or an obese 32-year-old man, you must pay attention to their nutrition and ensure that it aligns with their training and goals.

For instance, an overweight or obese person should focus on gradual weight loss:

In contrast, an underweight person must focus on weight gain by consuming more calories, getting enough protein, and combining strength and cardiovascular exercise.

Of course, you don’t want to overwhelm your client immediately. Very few clients in that situation will be able to handle a lot of information and thrive. 

Start by focusing on physical activity and then guide them in other ways. Many clients become more invested in the process as time passes and they see results. 

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Core Exercises for Deconditioned Clients

The core musculature is at the center of many movement patterns, including push-ups, squats, and glute bridges (7). Strengthening the area would allow deconditioned trainees to perform more movements safely, feel comfortable, and avoid injuries (8).

A strong core is also crucial for everyday tasks: carrying groceries, loading and unloading the car, etc. Therefore, helping your clients develop a strong core first would improve their quality of life and make them more independent.

There are two primary types of movements new clients can do to strengthen their core: static and dynamic. You should leverage both types when training clients. 

Examples of static core exercises include the plank, and its variations, hollow holds, boat pose, and Superman holds. Effective dynamic core movements include:

  • Torso flexion (crunches, sit-ups, etc.)
  • Torso rotation (Russian twist, cable woodchop, etc.)
  • Lateral torso flexion (side bend and such)
  • Torso extension (hyperextensions and such)

Deconditioned people rarely have enough core strength to do more than a few crunches or hold a plank for more than 10 to 15 seconds, so it’s crucial to modify each movement to fit their abilities. 

Here are a few examples:

  • Crunch – have them do the bodyweight version, focusing on proper torso flexion
  • Russian twist – perform the movement with the feet on the floor, emphasizing proper torso rotation
  • Plank – begin with knee planks on the elbows, reinforcing proper abdominal activation with minor spinal flexion

Physical Therapy Exercises for Deconditioning

Physical therapy is a medical treatment designed to restore physical abilities, including basic ones like standing and walking. A good therapist can restore joint range of motion, alleviate chronic pain, improve mobility, and treat movement dysfunction.  

Often, a deconditioned person must work closely with a physical therapist to develop a foundation before moving on to more advanced things, such as gym training and cardiovascular exercise. 

Every deconditioned person will have unique needs, so it is the physical therapist’s job to determine the best approach. Further, the person must work with the right type of specialist based on their unique needs. Here are the primary categories of physical therapists:

  • Orthopedic – restoring function in the musculoskeletal system
  • Neurological – focusing on neurological conditions and impairments (brain injury, multiple sclerosis, stroke, etc.)
  • Cardiopulmonary – helping people with cardiovascular and pulmonary conditions to improve their endurance and overall health
  • Geriatric – helping older adults manage disease (cancer, arthritis, osteoporosis), recover from surgery (e.g., hip replacement), etc.

As a personal trainer or coach, you must evaluate each potential client to determine if your expertise is enough to help them lead better lives. If not, encourage them to work with a physical therapist first.

Reversing Severe Deconditioning

Physical deconditioning isn’t a precise diagnosis but a spectrum. The level of deconditioning varies from person to person and determines how everyone should go about improving their situation.

For instance, a healthy but sedentary person in their fifties could begin with more intense activities and work up to a solid gym routine within a few months, if not weeks. 

In contrast, a 75-year-old person recovering from hip replacement surgery will likely be more deconditioned and need more specialized treatment and guidance.

We included the previous point on physical therapy for deconditioned folks to illustrate that you might not be able to help every person seeking your services. In some cases, the wisest thing you can do as a trainer or coach is to recognize your limited expertise in an area and refer the person to a specialist. 

But what does that mean for deconditioned clients? The best thing you can do is evaluate each potential client to determine if you would be a good fit. Ask questions:

  • How would you rate your current physical abilities?
  • How active are you on a daily or weekly basis?
  • Do you suffer from severe physical limitations?
  • Do you have medical conditions that affect your physical abilities or put you at any health risks?
  • Have you had any serious medical interventions done in recent years?
  • What is your daily life like (stress, sleep, nutrition, smoking habit, etc.)?

Asking these and other relevant questions can reveal a lot about a person. 

Reversing severe deconditioning is undoubtedly possible and highly beneficial for people, but you must know if you’re the person who can help.

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A deconditioned person is someone with moderate to severe physical limitations caused by a sedentary lifestyle. In some cases, deconditioning results from lifestyle choices, such as chronic overeating, not doing structured exercise, and avoiding any form of physical activity like the plague.

Sometimes, the physical condition results from extended bed rest because of a severe injury or illness.

Similar to physical development, there are levels of deconditioning that determine how each person should go about improving their situation. For example, a younger person with no health issues might have a below-average starting point, but they could work up to a solid exercise plan in just a few months or weeks.

In contrast, older individuals with health conditions and those recovering from surgeries might need specialized guidance from a physical therapist to prosper. 

Part of your job as a trainer or coach is to determine whether you can help potential clients or if it would be better to refer them to a specialist. 

Should you decide to work with a deconditioned client, be patient and understand that their road to good fitness might be longer than average. In any case, the same rules will apply: doing what’s sustainable, gradually making workouts more challenging, and focusing on proper training form.

Hevy Coach is a platform that makes it effortless to create training plans for your clients, track their progress, make adjustments on the go, and more.

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