First of all - you are to be commended for your work. We can choose to be part of the solution - or part of the problem. I love your choice. That said you are wise to be looking for guidance. Over the years, i have learned through my work with my clients- I have had to rely on them for hands on teaching as there are few resources available. Additionally, I have closely followed research on exercise and obesity to see what is pertinent to Pilates. This year at ECA Peak Pilates offered Pilates for the Overweight, and at IDEA World this summer we will premiere Pilates for the Obese Client- I hope you can come.
Basically, look at your obese clients as individuals- each one is unique - just like with healthy clients. Don't presume to know anything about their goals, what they can and can not do. If so you will be a limiting factor in their progression and realization of their goals. Dialogue is key, be genuinely concerned and compassionate. Many of our clients here at the InnerSpace in Avon, CT start off not really having strong goals, not realizing what is achievable. They just generally want to feel healthier, but as they begin to connect mind and body to the work, their goals to evolve. Make sure to not only conduct a thorough health screening, but make sure to ask what exercise they have tried and quit- what didn't they like? Ask what they have tried in the past that they did like, and why. Take into consideration their age, their lifestyle, and where they carry their weight as well as looking at posture and muscle imbalances.
This information will give you some clues as to how to work with them as a whole person. Following are some GENERAL guideline that I hope you find useful:
1. Use the Introductory System as your framework
2. Be creative and adjust how each piece of that framework-- exercise to exercise comes to life.
3. Help them by getting the weight off their body- use a wedge (you can order one from Mancino) to help with upper body weight that can collapse on them and make breathing difficult. You can use a cube mat (again from Mancino), or stability ball to help carry the weight of their legs for mat work. Dynabands and yoga straps can also be helpful tools.
4. Use props to help with alignment as well as support.
5. Be compassionate and don't be afraid to ask - does that feel OK? Do you have enough space for this set up?
6. Be aware that some obese clients tire very very quickly. They may need more transition time - keep them connected to their breathing, add extra stretches and fundamentals to keep them moving with out overdoing.
7. Help them as needed - but protect your own body.
8. On the reformer, move the gear out and foot bar down. Think in terms of what the springs are doing - are they offering resistance or support? Most obese clients have relatively strong legs, but weaker cores.
9. Be playful - have them do extra on exercises that are super accessible. For example, have them go for a 'walk' a 'jog' and a 'run' when you reach running.
10. Make movement joyful - one hour of fluidity.
11. Spend time on how to do things in 'real life' so they understand how to translate Pilates into daily activities.
12. Omit exercises that just aren't do- able due to body size or body shape restrictions such as Stomach Massage Round.
13. Use props to help these clients connect to their body and get a 'feel' for how the exercises feel properly performed. For example, if your clients doesn't have a place to put their arms for reformer supine work- then have them hold the short box pole and keep their pelvis aligned using it as a level.
14. Think bones - it will help you 'see' alignment.
15. Touch, this is a touch starved population generally. Especially use supportive and guiding touches. Use your whole hand to touch.
16. Build trust and rapport over time.
As this bridge is built you will find that the door opens to other areas such as nutrition, cardiovascular exercise, health issues.
Good luck - I hope to meet you at IDEA this year!