Ask a Trainer (Vol. 9)

Hi everyone, and welcome to Ask a Trainer, Volume 9.

If you’ve missed some in our running series, head on over to the Ask a Trainer archives and read on!

You got questions? We got answers! Send an email to with all your fitness, health, and wellness queries. You might even end up in the next Ask a Trainer!

Today we’re going to go for a two-fer, talking about exercising with medical conditions and how weight loss really works.

What can I do if a medical condition affects my ability to exercise?

Disclaimer: I am not a doctor. At all. I have worked with many clients who were cleared by their physicians to exercise but needed to scale the workout, one way or another, to accommodate specific concerns. These suggestions are based on my experience, however you should always talk to your doctor about what might exacerbate a serious condition.

This really depends on the medical condition, but in many cases you can scale weights, intensity, and movements to compensate for a decreased ability to workout. Let’s look at a few examples of conditions which might affect your ability to exercise, and what could be done about them. I’m going to talk about three typical conditions I’ve helped clients deal with, in order of severity, and my recommendations for each.

This list is obviously not inclusive of everything and everyone, and you may have a condition I didn’t list. I would be happy to talk about your specific questions by email if you’d like my perspective.

Flu/Cold/Basic Sickness

Symptoms could range from a slight cough to fever to serious respiratory distress. Generally, you can workout when you have a cold or the flu but be on the look-out for specific symptoms that should act as a warning sign that exercise is not a good idea. Avoid exercise if you are experiencing fever, trouble breathing, persistent dizziness, or gastrointestinal distress (vomiting, diarrhea).

Exercise will likely make these symptoms worse and should be avoided. For instance, exercise raises the body temperature and so does fever – don’t mix them! The same goes for the others we mentioned above.

In contrast, lesser symptoms such as “feeling crappy”, stuffiness that doesn’t significantly impair breathing, or general tiredness should not, in themselves, stop you from exercising. In these cases, dial back your efforts, dropping from 90-100% intensity down to 60-70% intensity. This should allow your to workout without doing any damage. At any point during the workout, if you feel like you need to stop for any reason, STOP. Don’t push if your symptoms get worse or if you develop new ones. Just stop, get some water, and rest.


Breathing restrictions are always a concern with exercise, because your body needs oxygen to support increased activity. If you have asthmatic symptoms that are easily controlled with an inhaler or other basic medication, you can likely participate in most activities as long as you pay attention to your breathing. If you start to have issues, use your prescribed medications as intended and see if they alleviate the symptoms. If they do, then you should be safe to continue, if not then you need to stop and bring your breathing under control before continuing.

With more sever symptoms, you may need to restrict your exercise to specific types and conditions. Walking, yoga, weight lifting, and short-burst activities are best because they require the least heavy, endurance breathing. They tend to be more controlled and less aerobically dependent. Running, sprinting, moving sports like soccer, and intense biking require you to monitor yourself very thoroughly for any issues. Swimming is typically tolerated well because the air around the head is usually warm and moist, making breathing easier.

Cold conditions are the enemy of asthmatics, as the air tends to be both cold and dry in many cases. This is a two-fold problem because the temperature and dryness both cause issues breathing. Avoid working out in these conditions as a general rule. If you do, have your inhaler handy.

Neuromuscular Disorders

For example. Multiple sclerosis. These are disorders that affect your brain’s ability to move your muscles effectively, and can lead to dangerous situations if not managed correctly. In many cases you will be prescribed medication by your doctor, and you should be cognizant of any side effects from those medications. If your symptoms are strong (shakiness, jerkiness, cramping, movement restriction) you may have to change out movements that require high levels of muscle control like cleans, snatches, etc. You should only lift if you can control the weight. Alternatives would be body weight movements that are easier to control if your symptoms interfere, such as squats, push-ups, and sit-ups.

With lighter symptoms (intermittent shakiness that subsides in a few moments, etc) you can usually lift weights and do other heavier strength work, but you should be working with a spotter/trainer who is aware of your condition. I do not recommend lifts that place the weight above your head/chest without a spotter if you are experiencing any symptoms, as it makes it very easy to hurt yourself if the weight comes out of control. Having a spotter adds a safety net that can prevent serious harm.

Will exercise lead to weight loss?

Yes and no. There are four things you need to consider to answer this question effectively.

What do you mean by “weight loss”?

If you’re the type of person who is looking at the scale as your primary indicator of whether or not you need to lose weight, STOP. Don’t be that person. The number on the scale is a deceptive and stupid, and it has very little ability to indicate your overall health and wellness. All a scale measures is the force of the Earth’s gravity pulling you towards the floor. The easiest way to “lose weight” is to go to the moon. BAM! Instant weight loss. If that sounds like a silly concept, it’s because it is! The idea of weight as a measurement of fitness is inherently silly because it’s not measuring your fitness at all: it’s measuring how two bodies interact together (in this case, you and the planet). Since weight isn’t really a measure of fitness, stop using it like one! From here on out, ignore the scale.

So that means we need to redefine the idea of “weight loss” into something that does measure fitness. To do this we can use the idea of Body Composition, which we’ll define as “Total Body Mass from all sources, broken down by source, expressed as percentages”. This measurement includes things you can change through lifestyle choices (Body Fat, Body Muscle) and things you can’t change without major surgery or debilitating injury (Organ Mass, Bone Mass, Skin Mass).

With this in mind, we should stop thinking “weight loss” and start thinking “fat loss, muscle gain”. Using this new train of thought, the answer becomes: Yes, exercise can lead to fat loss and muscle gain, if you eat right and exercise right.

How much are you eating (calories in)?

Your diet determines how many calories you take in during the day, and the foods you choose determine the form & quality of those calories. Healthy food choices are paramount in helping your body function properly, and are not just based on the calorie content.

For instance, a 300 calorie salad (lots of veggies, chopped chicken, avocado) is a healthy source of protein, unsaturated fats, and some low Glycemic Index carbohydrates. Contrast this with a 300 calorie package of cookies, which is basically all saturated fat and sugar. These meals are equal calorie, but the composition is far different. The salad will lead to healthy bodily responses (hunger satiation, protein used for muscle repair, no insulin spikes or crash) whereas the cookies will lead to unhealthy responses (insulin spikes, sugar crash, persistent hunger).

Get your calories from good whole foods, and avoid processed crap whenever possible.

How much are you burning (calories out)?

Your calorie burn per day is based on the energy it takes to live as well as the energy it takes to move. To figure out a good estimate of the calories it takes to simply maintain your body and stay alive day to day, we have two formulas. The first requires weight, height, and age (all of which I assume you know) and the second requires Body Weight and Body Fat % (one of which you may not know).

The Harris-Benedict Formula

Men  –  Calories per day = 88.362 + (13.397 x weight in kg) + (4.799 x height in cm) – (5.677 x age in years)
Women  –  Calories per day = 447.593 + (9.247 x weight in kg) + (3.098 x height in cm) – (4.330 x age in years)

The Lean Mass Method

Lean Mass = Bodyweight – (Bodyweight x Body Fat %)
Men  –  Calories per day = Lean Body Mass x 13
Women  –  Calories per day = Lean Body Mass x 11.5

I find that the Lean Mass Method tends to be more accurate, since it uses your body composition as a factor, but the Harris Benedict formulas are still really good. Next, adjust for your level of activity.  Here are the multipliers I use:

Sedentary (desk job all day, nothing extra): Calories x 1.10
Moderate (45-60 min training) – Calories x 1.25
Intense (60+ min cross-training) – Calories x 1.4

Track your calories in from food against your estimated calories out from living and activity level. You can work on losing a pound of fat every week by eating at a 500 calorie deficit per day (i.e. eat 500 calories LESS than what the formula tells you). Some people will have trouble with that low of calorie intake, and in those cases I recommend eating at a 250 calorie deficit day to day, which equates to 1 pound of fat loss every two weeks. It may not seem like much, but that equals out to 26-52 pounds per year. That’s a big change!

How are you exercising?

Lastly, you need to think about how you’re burning the extra calories per day. To get the most benefit from your workout you should be incorporating both cardio (high heart rate) and strength training (usually low heart rate, heavy weight movements).

Running, skipping rope, swimming, biking, and rowing are all good cardio exercises for building long term endurance (aerobic system). If you add in periods of sprinting (i.e. working as hard as you can for 20-30 seconds at a time) during a longer term workout, you can also build endurance in your short term energy systems (phosphagen, glycolysis). This will burn calories very quickly, to the tune of several hundred per 30 minutes.

For strength work, unless you have really specific goals you should be focusing primarily on compound movements like Squats, Deadlifts, and Shoulder/Chest Presses. You can supplement with abdominal work with sit-ups. There are many, many ways to get started in lifting, but that is beyond the scope of this article. Suffice to say that compound movements build the most muscle, and create a more metabolically active body (which means you burn more calories just to live, which is good to keeping the fat off).

A good split is Mon/Wed/Fri strength work and Tue/Thu/Sat cardio work, but you can use whatever schedule works for you as long as you aren’t training high volume on the same movements every day. For example, you can warm up with 8-10 push-ups every day and not hurt yourself, but you don’t want to do 50 push-ups every day, else you risk over-training.

And that’s it! Join us next time for more fitness and health goodness!