DOMAIN FOUR

Special Populations
EXAM WEIGHT 9% / CHAPTERS REFERENCED 21-29
 DOMAIN FOUR

Special Populations
Developing personal training skills to work with special populations is essential. Special populations are
now one of the fastest growing segments of the personal training industry. Gathering and understanding
client’s medical considerations and collaborating with their healthcare providers to discuss their needs
is a necessary part of the job. Understanding signs and symptoms of distress and making sure exercise
guidelines are appropriate are critical. Being able to develop safe and effective programs for your clients
with special considerations can truly enhance the physical, mental, and emotional wellbeing of your client.
This will leave a lasting effect on health and wellness.

LIFESPAN CONDITIONS
These can be considered populations that require different attention based on a life situation, rather than
an acquired condition.

OLDER ADULTS
Aging affects the function of all body systems. This can include things like decreases in hormone
production; elasticity diminishment in muscles, skin, and blood vessels; and deterioration. Although all
systems are affected, physical activity can slow it considerably. Recovery time becomes an important
consideration when working with older adults. Fitness professionals should consider the following:
• Most adults 55 and older will experience decreased ROM, with limitations more pronounced at 70
years and older
• Once adults reach 65, programs should be based on and modified from medical recommendations
• Closely monitor signs of fatigue, muscle weakness, and joint pain in clients 65+
• Low exertion levels with close monitoring and a focus on overall posture improvement, strength
increases, and injury avoidance are especially important for clients 80+
• There are many contraindications such as:
°° Coronary heart disease - most serious form of heart disease (obstruction of blood supply to
the heart)
°° Uncontrolled hypertension - arterioles stay constricted, driving pressure in blood vessels up
°° Myocarditis - inflammation of the heart muscle
°° Thrombosis - clotting of blood in a part of the circulatory system

800.545.4772
DOMAIN FOUR /SPECIAL POPULATIONS WWW.ISSAONLINE.COM
 DOMAIN FOUR

YOUTH CLIENTS
Fitness professionals will also have youth clients. In youth clients, the most important goals to focus on and
consider are form and technique. Further, neurological factors, rather than hypertrophic factors, are primarily
responsible for strength and resistance training gains.
• Youth clients can be conceptualized into two groups, Category 1 and Category 2. Regardless of
category, trainers should be most mindful of intensity when designing a program for youth clients.
°° When training Category 1 clients (5 – 12 years), training at too high an intensity or duration
is contraindicated. Further, training in hotter or more humid climates is cautioned because
their thermoregulatory mechanisms aren’t fully developed.
°° When training Category 2 clients (12 – 17 years), be cautious of tendinous injuries, Osgood
Schlatters (inflammation of the patellar ligament at the tibial tuberosity and presents as a
painful lump below the knee), low initial fitness levels, excess body weight, and
musculoskeletal disorders.
°° When training children, it’s important to remember that:
°° Children aren’t miniature adults.
°° Children are susceptible to heat exhaustion and heat stroke.
°° Children are susceptible to cold injuries.
°° Children are particularly vulnerable to Osgood Schlatters disease (contraindication
for Category 2 youth clients)

PRENATAL
For a pregnant woman and her fetus, sensible exercise can be a safe undertaking. When working with
pregnant clients, the following conditions should preclude the expecting mother from exercising:
• Coronary heart disease
• Ruptured membranes
• Premature labor
• Placenta previa
• Incompetent cervix
• Vaginal bleeding
• History of three or more spontaneous abortions or miscarriages
However, the trainer should be ready to consult the doctor at any unexplained contraindication. For example,
a pregnant client experiences persistent severe headaches and unexplained spells of dizziness. In this
situation, you should immediately have her discontinue the training session or program and immediately
consult with her doctor.
800.545.4772
DOMAIN FOUR /SPECIAL POPULATIONS WWW.ISSAONLINE.COM
 DOMAIN FOUR

ADAPTIVE FITNESS
Whether at the onset of birth or through life conditions clients might present with a handicap, disability, or
impairment. When working with these clients, you must get medical clearance first. It’s important to know
these terms:
• A handicap is a circumstance that makes progress or success difficult.
• A disability is a physical or mental condition that limits an individual’s movements, senses, or
activities. With the adoption of the Americans with Disabilities Act, there’s the protection of rights
for people with disabilities to include equal employment opportunities, rights to purchase goods and
services, and participation in state and local government programs and services. This means all
public gyms must be accessible for wheelchair users.
• An impairment is the state of being impaired, especially in a specified facility.
With an adaptive fitness program, the overall goal should be improved fitness, mobility, and self-efficacy. And
although these programs can be enjoyed by anyone with a disability, fitness professionals should specifically
consider orthopedic and joint dysfunctions. To be an effective fitness teacher and professional, one must
adapt, modify, and create until the client is successful. Finally, true education in adaptive fitness programs
implies full involvement of the mind and body.

CHRONIC CONDITIONS
Certain conditions will present themselves as part of lifestyle or acquired over time and pervasive. These
types of diagnoses are considered chronic conditions, and you should be familiar with common types you’ll
likely encounter.

HYPERTENSION
Hypertension is a medical condition of a chronically elevated level of arterial pressure. Readings as low
as 140/90 are considered the threshold for high blood pressure by some authorities. When working with
clients who are hypertensive, it’s critical to get medical clearance first.
• There’s a number of ways individuals can prevent hypertension, they include:
°° Maintaining healthy bodyweight
°° Limiting alcohol intake
°° Not smoking
°° Moderating the amount of salt in the diet
°° Consuming adequate amounts of calcium
°° Exercising on a regular basis
800.545.4772
DOMAIN FOUR /SPECIAL POPULATIONS WWW.ISSAONLINE.COM
 DOMAIN FOUR

• Program design recommendations for hypertensive clients (especially beginners) are:

°° Non-weight-bearing or low-impact aerobic activities
°° Low intensity (50% to 75% MHR)
°° Exercise duration 20 – 30 minutes, four times per week
°° Prolonged warm-up and extended cool down
°° RPE to monitor intensity

DIABETES
When blood sugar levels increase, the pancreas produces insulin, which regulates many metabolic
processes. Diabetic bodies either do not produce enough insulin or cannot properly use the insulin it
makes. Diabetes also increases the risk of:
• Heart disease - conditions that involve narrowed or blocked blood vessels
• Stroke - blood supply to part of the brain is reduced, depriving brain of oxygen/nutrients
• Gangrene - localized death and decomposition of body tissue from obstructed circulation or bacterial
infection
• Kidney disease - kidneys become damaged and can no longer filter blood and wastes properly
• Retinopathy - serious eye disorder resulting from diabetes complications
When designing a program for a diabetic client, it’s important to know the type (category) and severity of the
diabetes.
• Type I diabetics can exercise at an intensity level similar to a healthy adult, 55 – 85% MHR, whereas
Type II should be advised to exercise on the lower end of the range.
• Type I diabetics should exercise 20 – 30 minutes per session and Type II should exercise for a
longer duration, 40 – 60 minutes per session.
• When accompanied by obesity, Type II diabetics should primarily perform low impact, non-weight
bearing activities with the intensity 55 – 85% of MHR in moderation.
• When working with diabetics on a nutrition plan, it’s imperative that a personal trainer refer them to
a dietitian.

800.545.4772
DOMAIN FOUR /SPECIAL POPULATIONS WWW.ISSAONLINE.COM
 DOMAIN FOUR

ARTHRITIS
This is a common condition that’s caused by pain or stiffness in skeletal joints is arthritis. In some
instances, the cause of arthritis is known as an injury to the joints, an infection like Lyme disease, the
product of medication, etc. In other instances, the cause might be hereditary, food allergies, nervous system
malfunction, and an attack on the immune system. Body temperature is key to safe and effective workouts;
therefore, warm showers, saunas, and extended warm-ups and cool downs are important.

CORONARY HEART DISEASE

Obesity and stress are confirmed risk factors for coronary heart disease (CHD); however, exercise has
been shown to help control both obesity and stress. Coronary artery disease is the narrowing and even
blockage of the arteries and blood vessels that provide oxygen and nutrients to the heart. Sometimes called
atherosclerosis, CHD can sometimes go without symptoms but the number one sign of this condition is
anginal chest pain.
High impact activities will not be suitable for this population during early stages of programming and heart
rates should be carefully monitored.

ASTHMA
A tightening of the airways in the lung, known as asthma, results from either undue inflammation of the
lining of the airways or specific triggering factors. Environmental considerations are key for this population
and include pollen, allergies, smoke, extreme temperatures, and chemicals.

800.545.4772
DOMAIN FOUR /SPECIAL POPULATIONS WWW.ISSAONLINE.COM