American Council on Exercise by American Council on Exercise

Emily Kramer Throckmorton is the owner and head strength and conditioning coach of Kaizen Athletics, a functional fitness gym located in Virginia Beach, Va. The gym specializes in semi-private small-group training, adaptive athlete training, nutrition, mindset and all things community. Kramer is also the CEO and founder of Kaizen Adaptive Training, a 501c3 nonprofit organization that makes fitness accessible and inclusive for everyone, regardless of ability or impairment, and offers continuing education, in-person seminars, online programming, affiliate programs, and much more. 

How would you define the term “adaptive athlete/client”? 

The term “adaptive athletes” refers to those with various physical or neurological conditions, stroke survivors, persons with amputations, wheelchair users, and those with other long-term ailments that prevent them from participating in everyday sports like swimming, soccer and basketball. There are various categories in the adaptive world, including the following: (1) amputation, which means the loss or removal of a body part, (2) limb salvage, which means surgery to remove a tumor in a limb without removing the whole limb, (3) spinal cord injury, which may be caused by a sudden blow or cut to the spine (this is the case for most of the athletes I work with), (4) neurological damage from injury or changes to the functioning of the brain, spine or nerves, which affects the function of muscles due to problems with the nerves and muscles in your body [examples include amyotrophic lateral sclerosis (ALS) and multiple sclerosis] and (5) sensory disorders that affect how the brain processes sensory information, such as autism spectrum disorder, low vision, blindness and deafness.  

I work with a lot of individuals with invisible wounds such as traumatic brain injuries (TBIs) and post-traumatic stress disorder (PTSD). This is especially prevalent among our Wounded Warriors and veterans. I coach 40+ adaptive athletes including veterans/Wounded Warriors, first responders and law enforcement officers who are stroke survivors, had amputations, experienced spinal cord injuries and have invisible wounds such as TBIs and PTSD. I have seen first-hand what fitness and community can do for these individuals, not only physically but also mentally. There is something so special about shared challenges.  

What would you like health coaches and personal trainers to know about working with adaptive athletes/clients? 

Create a place where individuals can regain their strength and independence post-physical or post-traumatic impairment. The goal is to bridge the gap between healthcare and functional fitness training for adaptive athletes. Physical therapy is great for technique and functionality, while occupational therapy is great for learning aids for activities of daily living. Exercise professionals are a great addition because they focus on building strength and increasing stamina, range of motion and mobility for these athletes. They provide extended activity outside of these forms of therapy. They also provide a form of programming for individuals who have given up on physical therapy or occupational therapy, or who don't qualify for therapy but still have physical ailments that need attention. Understand your scope of practice and work hand in hand with healthcare providers!  

What advice would you give to health coaches and personal trainers who want to work with this population? Are there any resources you would recommend?  

The best way, in my opinion, for these individuals to move and live a healthier life is through functional fitness training. Functional fitness movements mimic activities of daily living outside of the gym. These are movements that will pop up in the real world, not just a controlled environment. The main goal of functional fitness is to help each of these athletes regain their strength, mobility and independence. Our top five functional fitness movements are the hip hinge, squat, press, pull and carry. For educational resources, check out our online Kaizen Adaptive Coach course at We provide education, tips, tools, videos and even a quiz at the end!  

How might a session with an adaptive client be different from a session with any other client? 

First off, it should be fun and second, it should be safe. Finally, adaptive athletes should be moving well. Ultimately, it shouldn't look any different than training an able-bodied athlete. Understand that while these athletes are injured, they still want to be challenged physically and mentally. I use the International Classification of Function, Disability and Health Model to measure health and disability for the individual. It's important for the athlete to understand tasks and be able to follow through, especially in a group setting.  

The biggest takeaway from this is that the health condition does not predict functional status. Their identity is not their medical diagnosis. Exercise professionals should aim to improve their clients’ cardiovascular and respiratory endurance, stamina, strength, power, speed, coordination, agility, balance and flexibility. Your athlete is as fit as they are competent in each of these skills. This is why we aim for a well-rounded athlete as opposed to specializing in only one area. Focus on functional training for these athletes just like you would for any other athlete. This might include deadlifts, squats, pulling, pushing and carrying something heavy.  

What is your favorite part of working with this population? 

The mental health aspect. An adaptive athlete's mental health is 100% tied to their physical well-being. A study published in the British Journal of Sports Medicine found that physical activity is 1.5 times more useful at treating mild to moderate depression, stress and anxiety then traditional medication or cognitive therapy. I have seen athletes come into our facility with these feelings post-traumatic injury. They might feel like the world is crashing around them or like they are alone... and then they realize that they are in a room full of individuals with the same injury. I distinctly remember starting to work with an adaptive athlete who was injured very young in a motorcycle accident. He came to us depressed. He wouldn’t smile or talk, but he kept showing up. Fast forward to today, and he has a big smile on his face when he rolls up to the gym, he hangs out with other adaptive athletes outside of the gym, and he participates in activities with me, including triathlons. I've never been prouder of anything, and it starts with inclusion.  

What issues/problems do you see in the industry related to this population and what can health coaches and exercise professionals do to help? 

I found out that there are 61 million American adults, or 27% of the adult population, living with a disability. Why weren't there adaptive programs for this population? Why weren't they included in a gym class setting? Who was advocating for them? This population needs us the most and that is exactly why I started my nonprofit organization, Kaizen Adaptive Training.  

We also realized that there were a lot of barriers to participation. The first one is usually financial. These individuals spend so much money on medical care; the least we could do is make a program that is free for them. Transportation is usually an issue for adaptive athletes, as well. Accessibility is huge. Is your facility Americans with Disabilities Act (ADA) compliant? Is it set up for seated athletes to get in and out of equipment safely? This is why we like free weights or barbells. They are more accessible and functional than a stationary piece of equipment. Last but not least, there is the emotional and phycological barrier. Create an environment where these athletes can be treated as whole, by addressing their physical, mental, and emotional health.  

To learn more about working with adaptive athletes/clients, check out these two ACE continuing education courses: 

  • Adaptive Fitness Exercise Programming (worth 0.4 ACE CECs): In this course, you’ll learn how to effectively work with clients with Down syndrome and autism spectrum disorder, as well as non-ambulatory individuals. The focus is on communication, individualized programs and motivating both clients and caregivers. 

  • Adaptive Fitness for Clients with Special Needs (worth 0.1 ACE CECs): In this course, you’ll learn how to modify exercises and programs for clients with various diagnoses, behaviors and physical limitations, as well as communication strategies that encourage client compliance and motivation to learn. 

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