The Essentials of Working Out Under a Medical Diagnosis

Alex McBrairty

Physique, Fitness, Sports Psychology


Every trainer has had a client who simply loves to exercise. These clients love pushing themselves to get better, are constantly aiming to set new PRs, and will quickly inform you when a workout is too easy. They often remind us of how fun our job can be. One day, however, it could happen that they find out they’ve been diagnosed with a serious medical condition that will affect their health at large, as well as their ability to exercise.


This article is for trainers to help them navigate how to help a client in this position, and for clients to understand what they should expect if their trainer is paying attention to their needs. While the specific medical condition will vary, the goal and challenges are the same: how can a trainer help the client that is used to limitless, intense exercise adjust to the new boundaries their condition may cause and maintain an active lifestyle?



Do The Research

When a client comes to a trainer with a new medical diagnosis, it is his or her responsibility to learn as much relevant information as they can about the effect of the condition on that client’s exercise program. The first step should always be to get into contact with the client’s doctor (with the client’s permission).


From the doctor, a trainer may be able to learn blacklisted exercises and any relevant information about the relationship between physical activity and the potential onset of symptoms.


Unfortunately, unless a client is severely overweight, many doctors will be quick to write off exercise as a priority for the client. They’ve got their hands full dealing with the treatment of whatever medical condition has presented itself, which is considered the higher priority in managing their patient’s health.


Therefore, a trainer will often find they have to do some research on their own. They can use Google searches to find articles and research studies that can provide additional insights into programming considerations given these new limitations. It's not that difficult to find reliable information if you take the time.


For example, I had a client come to me with a condition called idiopathic intracranial hypertension (IIH)—a condition most often seen in young women where pressure inside the skull increases without an apparent cause.


Her symptoms included tingling and numbness throughout her body, headaches, ringing in her ears, neck and shoulder pain, as well as vision abnormalities. Many of these symptoms were exacerbated when she performed any type of strength training, and her doctor’s only guidelines were to reduce intensity.


After this client reached out to me, I spent about two weeks of intensive research online to become as familiar with the condition as possible. Through that independent research I was able to establish additional exercise guidelines, including no prone or supine positions, no caffeine intake, and avoiding the valsalva maneuver during lifts.


Even a seemingly small change, like switching from a conventional to sumo deadlift, helped to reduce the amount of head movement and resulting pressure change. Through this newly uncovered information, we were able to implement a strength program that allowed her to progress while also reducing the onset of her symptoms.


Be Prepared To Scale Back

These fitness-loving clients enjoy being pushed in their workouts. However, high amounts of physical stress can often be counterproductive, ineffective, or even downright dangerous for clients suffering from some medical conditions.



In cases where the client is used to high-intensity workouts and is unlikely to reduce intensity on their own, it is up to the trainer to appropriately scale back the client’s sessions to a manageable level. There may be some resistance at first, but trainers should kindly remind their client the importance of proper recovery and the avoidance of any potential negative side-effects related to their condition.


I had a long-time client return to me after her second bout with cancer. When she returned she was still suffering from the side-effects of her chemotherapy, including: extreme fatigue, appetite changes and some nausea.


This particular client was used to being very active. Just prior to her diagnosis she had trained for her first marathon, and had been regularly lifting with me for a number of years—she was exercising almost every day of the week.


Even though she was eager to return to her former level of activity, it was clear that pushing too hard would leave her extremely weak for days afterward. On numerous occasions, we had to discuss the importance of scaling back to ensure she could remain active without suffering the consequences of pushing too hard before she was ready.


Encourage Client Feedback

Learning as much as a trainer can about their client’s diagnosis will help them uncover appropriate exercise prescription considerations, but even that will only take them so far.It is of utmost importance that they constantly remind their client to provide honest feedback about how they feel, both during and between workouts.


These highly active clients are used to being superstars in the gym, and will likely remain silent to avoid “complaining” to their trainer. However, it’s important that the client takes an active role in mitigating and managing the onset of symptoms by being forthright about how they are feeling during workouts.


The Essentials of Working Out Under a Medical Diagnosis - Fitness, rest and recovery, exercise plan, rehabilitation, active recovery, thyroid, scaling, daily exercise, diagnosis, workout programming, stress management


When training a client who suffered from fibromyalgia—a condition characterized by widespread muscle pain—it was clear that overall intensity had to be controlled. What wasn’t immediately clear was that squats affected her knees more than any other lower body exercise (even with considerable focus placed on proper form).


There was no indication that this was something to consider, especially since she could perform other lower body exercises just fine. It was only after some clear signs of discomfort that she finally told me that squats really bothered her after the workouts.


It’s important that you continuously seek the client’s feedback about how they’re feeling. Remind them that pushing through pain or discomfort isn’t productive, nor is the need to substitute exercises, or scale back intensity, a sign of weakness.


Be Empathetic

As a trainer, the most important thing you can do for a client who has just experienced a serious medical diagnosis is to be as empathetic and understanding as possible. Keep in mind, these individuals have just had their lives turned upside down, and they may be in a grieving process about their diagnosis and the new limitations it imposes.


Many might even struggle with the motivation to return to the gym at all. It is important that a trainer remain a consistent source of positive reinforcement, motivation, forgiveness, and a gentle nudge for them to keep taking care of themselves. The trainer may even find it is up to them to reach out to a client after they’ve been diagnosed to get them restarted on a fitness plan.


Here are some other medical conditions that require mindfulness of the above considerations:


  • Heart Disease
  • Carotid Sinus Syndrome (CSS)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Cancer Treatment
  • Hashimoto’s or other Hypothryroidism
  • Behcet’s Disease
  • Chronic Fatigue Syndrome
  • Athritis (Rheumatoid or Osteoarthritis)
  • Lupus
  • Multiple Sclerosis (MS)
  • Ehlers-Danlo’s Syndrome (or other hypermobility spectrum disorders)
  • Degenerative Disc Disease
  • Lyme Disease
  • Migraine Disorders
  • Ménière's Disease
  • Positional Vertigo


With everything a client is going through physically and mentally, the last thing they need is a trainer who isn’t being considerate of the new realities they’re facing. This is why learning about the medical condition, appropriately mitigating and managing symptoms by adjusting the workout intensity, and listening to the client about their physical experience during the workouts is so important.


If the trainer can maintain the same (or greater) level of care and trust as they did when they were constantly pushing for PRs, then they can help their clients continue their fitness plan in spite of any medical diagnosis they face.


Clients must also learn to understand their own situation and provide honest feedback on their experiences. There is nothing wrong with truthful. Your health is more important than your ego.

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