Editor's Note: This article is part of a series of articles focusing on several niche markets of the fitness industry. Search "Special Populations" in our archives for past articles in this series.

As a fitness professional, you are bound to encounter clients with special health concerns, ranging from common conditions such as diabetes, obesity and joint replacements to more complex conditions such as metabolic and neurological issues. While each of these populations presents its own unique challenges, there is an increasing number of disabled individuals who need to work with qualified professionals - and no profession is in a better position to fill this void than the fitness profession. While the term "disabled" can include individuals with cognitive, physical or chronic health conditions, this article will focus mainly on those individuals looking to improve their functional capacity.

Stay within the Scope of Practice
We must be careful not to cross the line between training and conditioning and that of physical and occupational therapy. When in doubt, refer your client to the appropriate therapist or physician. Doing so not only helps your client but also creates an excellent referral source. Additionally, when working with a disabled person, it is essential that you gain as much knowledge about the diagnosis or disability. While obtaining an in-depth history is necessary, you must also educate yourself on the client's diagnosis.

The Swelling Need
While many individuals may be classified as "disabled" and function at a high level, many struggle to perform even seemingly simple tasks such as ambulation or activities of daily living. This has created an increased need for qualified professionals equipped with the technical skills to adequately provide post-rehab conditioning and training programs. Consider these disabled clients:

- Individuals over the age of 85, the most rapidly growing population in the US
- 250,000 to 350,000 individuals with multiple sclerosis (MS), with approximately 200 new MS cases diagnosed every week 
- 10 million individuals diagnosed with cancer, with 3,400 more diagnosed each day

While these statistics represent just a few of the ever-expanding group of individuals requiring our services, we must be ready to address their unique needs. There are three principles: First, as with any client, it is crucial to identify the client's current health status. This includes obtaining medical clearance from the individual's physician as well as any special exercise guidelines or limitations. Next, each client must be treated as an individual - there can be no cookie-cutter routines. For example, one client that is diagnosed with MS may be able to run a marathon, whereas another may require the use of a walker. Finally, each client must be progressed based upon their own functional capacity, the individual's ability and tolerance to deal with and withstand any additional stress on their body.

Functional Challenges
Prior to evaluating, testing or training, identify their functional capacity. They may experience physical challenges requiring simultaneous management from other health care professionals, such as physical therapists, chiropractic physicians or medical professionals. Challenges include but are not limited to: loss in range of motion; decreased muscle mass and increased weight gain; decreased energy and sense of well-being; and diminished strength, coordination and balance.

Trainers are in the perfect position to address and improve on several of these, specifically strength, coordination, balance and range of motion. While low-impact exercises such as yoga, swimming and biking can benefit many clients, resistance training should be included for most special needs individuals. Resistance exercise has been shown to enhance many of the above challenges, while research has demonstrated the following benefits to resistance training:

- Increased energy expenditure and muscle mass of disabled elderly adults
- Increased gait mechanics in clients with MS
- Improved sense of well-being in most clients

When designing resistance workout programs, you will want to manipulate several variables including frequency and intensity. Use the following FIT principles for optimal results:

Frequency and intensity: Frequency and intensity is dependent on the degree of disability and the current condition of your client. Generally, allow at least one day between exercise sessions when performing resistance training; workouts focused on balance, coordination and flexibility can occur more frequently. Fatigue will be a limiting factor, so adjust your workout accordingly - the greater the intensity, the more time needed between workouts. Generally, allow one to two minutes or for their breathing to return to normal. Focus on resistance and movement progressions early in the workout, when the client has the most energy and greatest ability to focus, while reserving cardio and flexibility exercises for later.

Example: You are working with a client who is experiencing severe osteoarthritis and uses a walker. Your workout should take into consideration your client's range of motion limitations and provide them with plenty of time to warm up. Allow them to perform resistive exercises, being sure to work within their strength and range of motion capacity. Use the downtime between sets to work on breathing or imagery exercises. Finish up the workout with some light aerobic or range of motion activities.

Imagery: Imagery is a technique to bring conscious awareness to an inhibited muscle or region of the body. Several approaches, including The Feldenkrais Method and The Alexander Technique, utilize imagery or mind/body awareness to restore and improve movement patterns. Imagery techniques have been shown to improve gait patterns in individuals with post-stroke hemiparesis.

Example: One of the symptoms of MS is decreased sensation in the trunk extensors; therefore, many of these individuals develop a thoracic hyperkyphosis. As a corrective technique, ask your client to visualize a wire connecting them on the back of their head that's gently lifting them upward through their movement patterns.

Teach: Each session should focus on teaching to both increase client awareness and improve movement efficiency. Teach clients proper diaphragmatic breathing. Regardless of the level of disability, establishing optimal respiratory patterns will improve general tissue oxidation and help develop proper stabilization patterns. Teach your client proper stabilization, and progress them through movement patterns based upon their ability.

Example: You are working with a client with breast cancer that has metastasized to her bones. Her physician gave her lifting restrictions to a maximum of 10 pounds. Focus on improving her breathing and stabilization to help protect her from further injury. Teach her how to squat and lunge in addition to using cables or thera-tubing to progress her through push and pull patterns. Use visual, verbal and tactile techniques to help your client improve her movement efficiency.

By identifying the needs and working together with other health care practitioners, the fitness professional can be instrumental in improving quality of life and functional capacity for these special needs individuals. And making a difference in their lives will certainly be gratifying!

Dr. Evan Osar (evan@fitnesseducationseminars.com) received BS and DC degrees from the Palmer College of Chiropractics, a diploma in clinical massage therapy as well as national certifications from ACE, NASM, NSCA and MAT. He has written five manuals and two DVDs on corrective exercise and performance enhancement, and he presents internationally for Perform Better, NSCA and Fitness Education Seminars.