Training Clients with Chronic Health Conditions Safely
Has a client’s health condition ever made you question your ability as a trainer? If you’ve had a consultation where a client tells you they have a chronic condition, it might leave you dreading your next meeting with them. But it doesn’t have to. When I first started in the fitness industry, I knew I didn’t want to be afraid to work with anyone, and so I dove into studying chronic conditions and how to train them. Fast forward years later, and this is my favorite population to work with.
As a trainer, working with someone who has a chronic condition can be so rewarding. Exercise can play a substantial role in the treatment and management of many diseases and conditions. Regular physical activity is proven to improve heart health, reduce chronic pain, and strengthen major muscle groups.
In a recent conversation, someone asked me if I thought I should be working with a client who had two chronic conditions, and my answer to them was “Yes!” followed by the question, “I don’t know where a trainer would even find enough clients who don’t have a health condition of some kind.” And it’s true. A 2025 study reported just how many people have chronic health conditions:
- 6 in 10 young adults
- 8 in 10 mid-life adults
- 9 in 10 older adults
If you’re a trainer who doesn’t want or know how to train individuals with chronic conditions, you’re limiting yourself to a very small percentage of the population and missing out on a lot of great people out there. Of course, it isn’t for everyone, but I believe we can all benefit from having basic information about training clients with chronic health conditions.
In this guide, I’ll outline safe exercise programs for chronic health conditions and provide practical ways for fitness professionals to keep clients physically active while managing risk. We’ll explore some of the most common conditions and how to work with the people experiencing them. Remember, this is not medical advice for your clients, nor should you be providing medical advice. Each client is unique, and these general guidelines may need to be adapted to meet your client’s individual needs.
Safe Exercise Programs for Common Chronic Health Conditions
There are a few primary things to consider when creating an exercise program for someone with a chronic health condition.
First, is it safe? Above all, your client needs to be able to safely move through their routine and not exacerbate or cause further injury or malaise.
Second, what is the desired outcome of this program? Does your client want to relieve pain, build strength, or reduce symptoms? Most of the time, it’s a multi-pronged goal, and clients may not know exactly what they want; they just want to feel better.
Third, is this sustainable long term? In the initial stages of diagnosis and treatment of many chronic conditions, physical activity is recommended. People go get a gym membership, meet with a trainer, do their 6 or 12 weeks of work, and then disappear, never to be seen until their doctor pushes them to come back again. It’s a vicious cycle, but a good trainer can stop it. Teach and promote activities and exercises that can be done at varying ability and pain levels, showing clients that they can get and stay active, regardless of their condition.
This is where program personalization becomes paramount (try saying that five times fast)! Taking the time to learn about your client’s conditions not only helps keep your programming safe but also helps your clients see that you care about them and are committed to their success.
Let’s talk about five of the top conditions you’re likely to see and how you can program for your clients experiencing them.
Arthritis and Joint Pain
People with arthritis typically experience pain, swelling, stiffness, and weakness in the joints. It commonly affects the hands, shoulders, spine, hips, and knees. It may be helpful to have a longer warm-up for people with arthritis, to allow for ample time to move and increase blood flow to the joints.
Choose low-impact exercises that promote mobility and build muscle strength without undue impact.
Arthritis-Friendly Exercises:
- Chair squats (also called sit-to-stands) – Build core and lower body strength without added stress on the knees
- Inclined or wall push-ups – Promote mobility through the shoulders and strengthen core and upper body without strain on the shoulder joints
- Seated leg lifts – When done with care, unweighted or lightly weighted leg lifts can build quad strength, which can take pressure off the knees, resulting in less pain. If this exercise elicits pain or discomfort, choose an exercise like isometric quad contractions to build strength without requiring a large range of motion.
- Resistance band pull-aparts – Build strength in the back and shoulders, improve shoulder mobility, and support good posture
When working with your clients, emphasize consistency over intensity. Avoid high-impact activity or exercises that are highly repetitive, which may cause irritation or further joint degeneration. Activities like chair yoga, tai chi, and water aerobics are generally safe full-body options for flexibility and balance training.
Heart Disease and High Blood Pressure
Individuals with known or suspected cardiovascular disease (CVD) or high blood pressure, or with a family history of it, may need to be cleared by their healthcare provider before beginning an exercise program. For more info on this, refer to the PAR-Q+ and other industry screening tools. Once they have been cleared for exercise, start with low-to-moderate intensity aerobic activity that progresses to moderate-intensity exercise as tolerated. A primary goal with these clients is to improve cardiovascular health and decrease risk without causing overexertion.
Aerobic Exercises for Clients with CVD:
- Brisk walking – Working up to a moderate-intensity heart rate can help improve endurance
- Stationary cycling – Focus on a smooth cadence and build strength and stamina through controlled resistance
- Elliptical machine – This can provide low-impact cardio that involves the upper and lower body
- Step-ups – They provide functional aerobic conditioning and can be a great assessment of strength, endurance, and balance
When doing aerobic training with a client who has CVD, ensure that they warm up and cool down adequately to raise and lower their heart rate safely, and to prevent dizziness and fatigue. Be familiar with the signs and symptoms of CV incidents, and watch for them in your clients.
Diabetes
When programming for a client with diabetes, a combination of strength training and aerobic activity generally works most effectively. This duo can help improve glucose control and promote weight management. Clients with diabetes should be encouraged to eat before training to ensure their blood sugar is at a safe level. Glucose levels may need to be monitored throughout the workout as well.
Exercises to Promote Diabetes Management:
- Bodyweight training – Focus on compound exercises to maximize energy expenditure and build strength
- Machine-based interval training – Use a treadmill, bike, or elliptical to engage in light-to-moderate level interval training to increase fat loss
- Suspension training – TRX or other similar platforms can help safely build strength without needing machines
- Circuit training – Moderate-intensity strength or cardio and strength circuits build strength and endurance.
When working with a client who has diabetes, remind them to eat a healthy meal or snack following their workout to maintain blood glucose levels. Not eating after a workout can lead to a blood sugar dip, and if clients aren’t aware of this, they may associate the negative feelings with exercise, which can be detrimental to their program adherence.
Osteoporosis
Clients with osteoporosis, or who are at risk for it, should prioritize weight-bearing and balance exercises that stimulate bone strengthening and overall coordination. While they cannot gain bone density back, strengthening exercises can slow further loss. It can also improve muscle strength and size, which helps protect bones. Balance training decreases fall risk, leading to fewer bone injuries.
Exercises for Bone Health
- Step-ups – This functional exercise for core and lower body strength can be done with railings for extra balance
- Isometric exercises – Exercises like wall sits and planks load the bones without requiring much movement
- Single leg stand – Load the bones while improving balance, using a wall or railing for support where needed
- Dynamic weight shifts – Activities like tandem walking and lateral weight shifts build balance for safe movements in multiple directions.
Avoid plyometric or jumping movements that cause an excessive amount of force on the bones. In each of your sessions, reinforce the benefits of proper posture and movement control. This reduces unnecessary strain and twisting, and improves balance and stability.
Low Back Pain and Limited Mobility
Like other chronic conditions, low back pain can cause pain and a loss of mobility that is debilitating and sometimes overlooked. Begin slowly, with activities that cause minimal discomfort, to build up to pain-free movement. Incorporate core stabilization, hip mobility, and posture correction to reduce discomfort and restore movement confidence over time.
Exercises to Build Core Strength and Improve Mobility:
- Glute bridges – Build strength and learn to activate the posterior chain
- Bird-dogs – Strengthen the spine, improve coordination, and introduce unilateral movement
- Pelvic tilts – Gently mobilize the lumbar spine and engage the abdominals
- Cat-cow stretches – Mobilize the spine and learn to control spinal movement.
Through each of these exercises, encourage pain-free range and slow, controlled breathing throughout. One of the biggest helps for me has been to learn to teach core activation in several ways. Not everyone responds well to the same cues, so I like to have a few ways of explaining it. This isn’t restricted to clients with low back pain either. It applies to all my clients.
Foundational Training Principles for Chronic Health Conditions and Improved Heart Health
When it comes to chronic health conditions, each person’s case is unique. Be prepared to help someone at any stage of their journey with simple principles that will help you plan safe and effective workouts. Here are five foundational principles to help you train your next client with chronic conditions:
- Start with low or low-to-moderate intensity activity and increase gradually as the client can tolerate it. This helps avoid fatigue or pain that can worsen their condition or cause them to associate exercise with negative feelings.
- Be aware of their symptoms. Talk about how they’ve been feeling while you’re warming up. Be willing to modify their workout if they’re having difficulty. Monitor symptoms during and after sessions for discomfort, stress, or a prolonged elevated heart rate.
- Emphasize balance and flexibility training as part of their regular activities to reduce pain, stiffness, and discomfort.
- Incorporate variety in their activity and create a well-rounded weekly routine that includes strength, cardiorespiratory, and mobility work spread through the week.
- Encourage rest days and proper recovery to manage symptoms and inflammation.
When it comes to training individuals with chronic health conditions, don’t just rely on what you know. There are so many resources that can help you program with confidence and safety. Physical activity guidelines and recommendations from vetted health organizations help trainers like us design programs that are evidence-based, safe, and supportive of long-term health outcomes for our clients. When you have questions or concerns, communicating with your client’s healthcare provider (with their permission) helps manage risk and protect long-term progress.
Designing a Safe Session Plan for Clients With Chronic Disease and Limited Mobility
A training session for someone with a chronic disease or health condition typically looks very similar to someone without one, with a few minor modifications.
An effective and organized training session can look like:
- Warm-up (5–15 min): Start with gentle physical activity like dynamic stretches or low-intensity cardio. Modify warm-up time based on the needs of your client. They may need a longer warm-up than others. This is a great time to talk about their symptoms and any changes since your last session. Be ready to make changes to their routine that day if needed.
- Main Workout (20–30 min): Depending on their split, this can include strength training, balance, or aerobic activity suited to the client’s condition. For strengthening activities, focus on working major muscle groups 2-3 times a week.
- Cool-down (5–10 min): Begin to bring down the heart rate and start the recovery process with slow movement, stretching, or breathing exercises to reduce stress and close out the session. Continue to monitor heart rate and symptoms to ensure your client is recovering appropriately.
Throughout all stages of their workout, encourage your client and help them see their successes. Safe exercise programs for chronic health conditions prioritize longevity, not just intensity. A good program instills confidence in the client that they are able to manage their condition.
Conclusion
One thing I’ve told countless trainers I’ve worked with over the years is “You can do this!” It can be so intimidating to work with someone who has a seemingly complex health status. But with research, communication, and good judgment, your work can make a big difference in their lives. Safe exercise programs for chronic health conditions help clients reduce pain, improve mobility, and support overall quality of life.
Use these program ideas, follow appropriate physical activity guidelines, and maintain annual coverage to train with confidence. Get insured for all of 2026 today and continue building a safe, confident fitness career.
