JPEPFeb2006ClientInteraction

Client Interaction
Larry Birnbaum, PhD., EPC
Associate Professor
Department of Exercise Physiology
The College of St. Scholastica
Duluth, MN 55811

The following story was emailed to me by a friend. You may wonder what it has to do with exercise physiology as a profession. I hope to clarify that. Read on.

For my sixtieth birthday this year, my wife (the dear) purchased a week of personal training at the local health club for me. Although I am still in great shape since playing on my college football team 30 yrs ago, I decided it would be a good idea to go ahead and give it a try.

Called the club and made my reservation with a personal trainer named Belinda, who identified herself as a 26- yr-old aerobics instructor and model for athletic clothing and swim wear. My wife seemed pleased with my enthusiasm to get started! The club encouraged me to keep a diary to chart my progress.

MONDAY: Started my day at 6:00am. Tough to get out of bed, but it was well worth it when I arrived at the health club to find Belinda waiting for me. She was something of a Greek goddess -- with blonde hair, dancing eyes and a dazzling white smile. Woo Hoo!!!!! Belinda gave me a tour and showed me the machines. She took my pulse after 5 minutes on the treadmill. She was alarmed that my pulse was so fast, but I attributed it to standing next to her in her Lycra aerobics outfit. I enjoyed watching the skillful way in which she conducted her aerobics class after my workout today. Very inspiring, Belinda was encouraging as I did my sit-ups, although my gut was already aching from holding it in the whole time she was around. This is going to be a FANTASTIC week!!

TUESDAY: I drank a whole pot of coffee, but I finally made it out the door. Belinda made me lie on my back and push a heavy iron bar into the air, and then she put weights on it! My legs were a little wobbly on the treadmill, but I made the full mile. Belinda's rewarding smile made it all worthwhile. I feel GREAT!! It's a whole new life for me.

WEDNESDAY: The only way I can brush my teeth is by laying the toothbrush on the counter and moving my mouth back and forth over it. I believe I have a hernia in both pectorals. Driving was OK as long as I didn't try to steer or stop. I parked on top of a Geo in the club parking lot. Belinda was impatient with me, insisting that my screams bothered other club members. Her voice is a little too perky for early in the morning and when she scolds, she gets this nasally whine that is VERY annoying. My chest hurt when I got on the treadmill, so Belinda put me on the stair monster. Why the hell would anyone invent a machine to simulate an activity rendered obsolete by elevators? Belinda told me it would help me get in shape and enjoy life. She said some other crap, too.

THURSDAY: Belinda was waiting for me with her vampire-like teeth exposed as her thin, cruel lips were pulled back in a full snarl. I couldn't help being a half an hour late; it took me that long to tie my shoes. Belinda took me to work out with dumbbells. When she was not looking, I ran and hid in the men's room. She sent Lars to find me, then, as punishment, put me on the rowing machine -- which I sank.

FRIDAY: I hate that witch Belinda more than any human being has ever hated any other human being in the history of the world. Stupid, skinny, anemic little cheerleader. If there were a part of my body I could move without unbearable pain, I would beat her with it. Belinda wanted me to work on my triceps. I don't have any triceps. And if you don't want dents in the floor, don't hand me the *&%#(#&**!!@*@ barbells or anything that weighs more than a sandwich. The treadmill flung me off and I landed on a health and nutrition teacher. Why couldn't it have been someone softer, like the drama coach or the choir director?

SATURDAY: Belinda left a message on my answering machine in her grating, shrilly voice wondering why I did not show up today. Just hearing her made me want to smash the machine with my planner. However, I lacked the strength to even use the TV remote and ended up catching eleven straight hours of the Weather Channel.

SUNDAY: I'm having the Church van pick me up for services today so I can go and thank GOD that this week is over. I will also pray that next year, my wife, will choose a gift for me that is fun like a root canal or a vasectomy.”

While this story is humorous, it also provides some insight regarding how we, as exercise physiologists, interact with our clients. Obviously, that interaction should always be professional. Let’s use this humorous story to determine what went wrong and how Belinda, the trainer, should have interacted with this 60 year old football veteran whom we shall call Joe.

To begin with, an assessment should have been completed. Belinda should have discussed goals with Joe and determined his aerobic and anaerobic capacities. She should have helped him set realistic goals and establish a means for checking on progress toward achieving those goals. Perhaps all Joe was interested in was getting a cardiovascular (aerobic) workout. For the sake of discussion, let’s assume Joe wanted to improve his overall physical condition. Given Joe’s age and physical condition, submax tests would be most appropriate for assessing capacities. Once Joe’s capacities are known, mode, intensity, frequency, and duration of exercise must be determined. For the cardiovascular component, selecting the most suitable mode of exercise for Joe would help him continue with the program. Perhaps he would prefer variety (e.g., vary aerobic workouts with a treadmill, stationary cycle, elliptical machines, and so forth). Starting at a low intensity is generally recommended. Heart rate is the most common objective measure used to monitor exercise intensity. Typically, duration and frequency are initially modest as well.

A common rule of thumb for determining how much resistance to use for weight training is that the client should be able to do at least 12 reps of a given exercise. Starting light is always a safe bet (i.e., err on the conservative side). Continuous interaction with Joe is essential. Belinda should speak with Joe upon his arrival at the fitness center, at least check on him while he is working out if she cannot constantly monitor him, and briefly discuss how he is feeling and his progress before he leaves. Also, his heart rate and blood pressure should be checked before he leaves.

Safety is always an important issue for all clients, but more critical for older clients as balance, reaction time, and ability in general are reduced. In an ideal situation, an exercise physiologist (vs. a trainer) would always be present with Joe while he is working out. At the very least, an exercise physiologist must be present with Joe while he is learning to use various machines until both he and the exercise physiologist are confident that he has mastered the machines. Even then, if an exercise physiologist cannot be with him directly, s/he should always be nearby. If free weights are used, the exercise physiologist must be with him.

An integral part of safety is teaching Joe proper technique. Correct technique is best taught at low intensity for aerobic exercises and for resistance training (i.e., light weights). Once correct technique is mastered and as Joe’s physical condition improves, intensity can be increased very gradually. Alternatively, duration or frequency can be increased, depending on Joe’s goals. Again, constant communication with Joe is essential to assure proper adjustments in his workout routine.

It seems like Belinda is guided by the old adage "no pain, no gain". While this may be appropriate for competitive athletes who are attempting to maximize performance, it is not helpful for average persons trying to improve their fitness and health. Ultimately, as exercise physiologists we must develop exercise programs/prescriptions that can be adhered to in order to meet our clients' personal needs and goals.

There are a number of references that can be consulted for exercise guidelines for various clients. The following list is just a sample:

“We become what we think, what we talk about, and what we do. If we think our work is for the right reason, if we think that our actions will bring forth positive results, and if we start living as professionals, we will become our vision.” -- Tommy Boone