Adapting Training for Chronic Conditions

This final chapter provides practical strategies for adapting calisthenics training for clients with chronic conditions. The goal is not to treat conditions but to provide safe, effective exercise that improves function and quality of life while respecting medical limitations.

General Adaptation Principles

The Conservative Approach

When working with chronic conditions:

Start lower than you think necessary:

• You can always progress
• Setbacks are harder to recover from
• Build trust through safe experiences
• Let the client prove their capacity

Progress more slowly:

• Allow longer adaptation periods
• Smaller incremental changes
• Watch for delayed responses
• Patience is essential

Prioritize safety over performance:

• Some "optimal" approaches aren't appropriate
• Good enough and safe beats optimal and risky
• Function matters more than fitness metrics
• Quality of life is the ultimate goal

The FITT Framework

Adapt each component for chronic conditions:

Frequency:

• May need more recovery time between sessions
• More frequent, shorter sessions may work better
• Consistency at lower frequency beats intensity

Intensity:

• Lower than general population typically
• Use RPE over heart rate for many conditions
• Prioritize moderate over vigorous
• Leave room for error

Time:

• Shorter sessions often necessary
• Build up gradually
• Quality over duration
• Allow adequate warm-up and cool-down

Type:

• Choose appropriate exercise modalities
• Avoid contraindicated movements
• Prioritize low-impact options
• Select exercises with easy regression options

Cardiovascular Adaptations

General Cardiovascular Guidelines

Warm-up:

• Extended duration (10-15 minutes)
• Very gradual intensity increase
• Allow cardiovascular system to adapt

Intensity management:

• Use RPE primarily (heart rate often affected by medications)
• Target moderate intensity (RPE 11-14)
• "Talk test" as simple gauge
• Avoid pushing to high intensities without clearance

Cool-down:

• Extended duration (10-15 minutes)
• Gradual intensity reduction
• Avoid sudden stops
• Allow blood pressure to normalize

Recovery:

• Longer rest between exercises
• Watch for unusual fatigue
• Don't rush between sessions

Specific Adaptations

For hypertension:

• Avoid breath-holding during exercises
• Continuous breathing throughout movements
• Lower resistance, higher reps
• Avoid prolonged isometric holds
• Skip exercises with inverted positions initially
• Monitor for symptoms

For heart conditions:

• Follow prescribed heart rate or RPE limits
• Keep sessions shorter
• Avoid upper body exercises with arms overhead for extended periods
• Ensure easy access to rest
• Know emergency procedures
• Stop immediately for any cardiac symptoms

Sample Cardiovascular-Friendly Session

Extended warm-up (15 min):

• Walking, gradually increasing pace (5 min)
• Light mobility work (5 min)
• Movement preparation (5 min)

Main session (20-25 min): Circuit style, 30 sec work, 30 sec rest:

1. Wall push-ups (continuous breathing)
2. Supported squats
3. Seated band rows
4. Standing hip abduction
5. Dead bugs (coordinated breathing)

2-3 rounds with 2-3 min rest between rounds

Extended cool-down (10-15 min):

• Slow walking (5 min)
• Seated stretching (5 min)
• Breathing exercises (5 min)

Metabolic Condition Adaptations

Diabetes Adaptations

Pre-exercise considerations:

• Check blood glucose if able
• Timing relative to meals/medication
• Have fast-acting carbs available
• Know hypoglycemia signs

During exercise:

• Monitor for hypoglycemia symptoms
• Regular hydration breaks
• Watch for changes in energy or behavior
• Be prepared to provide carbohydrates if needed

Exercise selection:

• Foot inspection awareness (if neuropathy)
• Supportive footwear essential
• Avoid barefoot training
• Both resistance and aerobic beneficial

Hypoglycemia protocol: If symptoms occur:

1. Stop exercise immediately
2. Have client sit down
3. Provide 15-20g fast-acting carbohydrate
4. Wait 15 minutes
5. Recheck symptoms
6. Don't resume if symptoms persist
7. Document incident

Obesity Adaptations

Environmental considerations:

• Temperature-controlled environment
• Access to water throughout
• Equipment appropriate for body size
• Private or semi-private space if preferred

Exercise modifications:

• Seated exercises to start
• Supported standing exercises
• Reduced range of motion as needed
• Low or no impact options
• Extended rest periods
• Shorter initial sessions

Progression approach:

• Build endurance before intensity
• Gradual weight-bearing progression
• Protect joints throughout
• Focus on function and habits

Sample Diabetes-Friendly Session

Pre-session check:

• Blood glucose check if available
• Ensure carbohydrates are accessible
• Discuss recent food intake/medication timing

Warm-up (10 min):

• Seated marching (3 min)
• Standing supported movements (3 min)
• Light mobility (4 min)

Main session (25 min):

1. Incline push-ups: 2 x 10
2. Chair squats: 2 x 10
3. Resistance band rows: 2 x 12
4. Supported hip hinges: 2 x 10
5. Pallof press: 2 x 8 each side
6. Standing calf raises with support: 2 x 15

Hydration break between exercises

Cool-down (10 min):

• Walking (3 min)
• Stretching with foot inspection reminder (5 min)
• Discuss any symptoms noticed (2 min)

Respiratory Condition Adaptations

Asthma Adaptations

Pre-exercise:

• Ensure rescue inhaler is present
• Extended warm-up (10-15 min)
• Avoid known triggers
• Consider environmental factors

During exercise:

• Monitor breathing patterns
• Allow self-regulation of intensity
• Avoid cold, dry environments if triggering
• Be prepared for symptoms

Exercise selection:

• Interval training may be better tolerated
• Swimming often well-tolerated
• Avoid dusty or pollinated areas
• Indoor training if outdoor triggers symptoms

COPD Adaptations

Intensity management:

• Expect breathlessness—it's their normal
• Use dyspnea scale, not heart rate
• Allow pursed-lip breathing
• Rest as needed

Exercise selection:

• Lower body may be tolerated better than upper body
• Upper body exercises may increase breathlessness more
• Seated options when needed
• Resistance training important for function

Breathing strategies:

• Coordinate breathing with movement
• Exhale during exertion
• Allow rest for breathing recovery
• Don't rush between exercises

Sample COPD-Friendly Session

Warm-up (10 min):

• Seated arm movements with breathing (3 min)
• Standing with support, gentle leg movements (3 min)
• Pursed-lip breathing practice (2 min)
• Mobility work (2 min)

Main session (20 min): Slow pace, extended rest as needed:

1. Chair squats: 2 x 6-8 (exhale on standing)
2. Wall push-ups: 2 x 6-8 (exhale on push)
3. Seated band rows: 2 x 8
4. Standing hip extension: 2 x 8 each leg
5. Supported balance work: 2 x 30 sec each leg

Allow breathing recovery between all exercises

Cool-down (10 min):

• Seated arm movements (3 min)
• Breathing exercises (4 min)
• Gentle stretching (3 min)

Musculoskeletal Condition Adaptations

Arthritis Adaptations

Joint protection:

• Avoid aggravating movements
• Modify range of motion as needed
• Low-impact only
• Warm-up is essential for joint preparation

Pain management:

• Some discomfort is expected, sharp pain is not
• Pain shouldn't be significantly worse after exercise
• If joints are hot and swollen, reduce or avoid loading

Exercise selection:

• Water exercise excellent if available
• Closed-chain exercises often better tolerated
• Avoid repeated impact
• Strengthen muscles around affected joints

Osteoporosis Adaptations

Safety priorities:

• Fall prevention paramount
• Avoid forward bending under load
• Minimize twisting under load
• Safe training environment

Beneficial exercises:

• Weight-bearing standing exercises
• Balance training (essential)
• Posture work
• Resistance training for muscle strength

Exercises to avoid:

• Crunches and sit-ups
• Loaded forward flexion
• High fall-risk activities
• Exercises with flexion-rotation under load

Sample Arthritis-Friendly Session

Extended warm-up (12-15 min):

• Gentle range of motion all joints (5 min)
• Light walking or marching (5 min)
• Dynamic mobility (5 min)

Main session (20 min): Avoid affected joints or modify as needed:

1. Modified push-ups (appropriate level): 2 x 8
2. Box squats (height based on tolerance): 2 x 8
3. Band rows: 2 x 10
4. Glute bridges: 2 x 10
5. Bird dogs: 2 x 6 each side
6. Balance work (supported): 2 x 30 sec each side

Cool-down (10 min):

• Gentle walking (3 min)
• Stretching (avoid overstretching inflamed joints) (5 min)
• Range of motion review (2 min)

Monitoring and Adjusting

Daily Readiness Assessment

Before every session:

• How are they feeling today?
• Any changes in condition or symptoms?
• Sleep quality and energy level
• Medication changes?
• Condition-specific questions

Adjusting on the Fly

Signs to reduce intensity:

• Unusual fatigue
• Increased symptoms
• Poor form quality
• Mental distraction or anxiety
• Reports of poor sleep or stress

Signs session is going well:

• Good energy
• Proper form maintained
• Appropriate perceived exertion
• Positive attitude
• No unusual symptoms

Long-Term Progression

Progress when:

• Current level mastered with good form
• No adverse responses
• Client reports feeling ready
• Healthcare provider approves (if relevant)

Progress by:

• Small increments only
• One variable at a time
• Extended time at each level
• Careful monitoring of response

Communication and Documentation

Session Documentation

Record for each session:

• Exercises performed with sets/reps
• Client's reported condition status
• Any symptoms during exercise
• Modifications made and why
• Overall session tolerance
• Notes for next session

Healthcare Provider Communication

Report to healthcare provider:

• Unusual responses to exercise
• Concerning symptoms
• Progress made
• Questions about progression
• Requests for updated guidelines

Request from healthcare provider:

• Updated clearance if condition changes
• Specific guidelines when needed
• Clarification on restrictions
• Collaboration on goals

Key Takeaways

1. Apply conservative approach—start low, progress slow
2. Adapt all FITT components for the condition
3. Cardiovascular conditions require extended warm-up/cool-down and intensity management
4. Metabolic conditions require attention to glucose, hydration, and joint protection
5. Respiratory conditions require breathing management and appropriate pacing
6. Musculoskeletal conditions require joint protection and movement modification
7. Monitor every session and adjust accordingly
8. Document thoroughly and communicate with healthcare team
9. Safety and function trump performance every time
10. Exercise is medicine—but only when dosed appropriately