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Coaching Lifters with Depression (Part 4): Programming Strategies

It’s normal to see a lifter’s strength progress slip during depressive episodes—with or without programming adjustments. As a coach, watching this happen can be uncomfortable. You cannot compare the lifter’s performance to where they would be if they had stayed on their pre-depression programming, with no bumps in the road. To be realistic, you should measure current progress by what they would be doing if you hadn’t changed their programming, which is usually nothing at all.
This series by BLOC Staff Coach Brooke Haubenstricker about coaching lifters with depression has been a welcome addition to Barbell Logic’s content on lifting and mental health. Part 1 laid a framework for thinking about depression as a coach. Often, we fill an important supporting role at the nexus of a person’s physical and mental health. Part 2 analyzed the myriad of benefits lifters with depression get from training and looked at some comparisons between strength-based training and other types of physical activities. Part 3 gives us practical advice, including building or maintaining trust and having conversations about depression. And Part 4 helps shore up many coaches concerns about programming and how to provide value as a coach while supporting lifters through challenging times.

Coaching Lifters with Depression (Part 4): Programming Strategies

By: Brooke Haubenstricker, BLOC Staff Coach

Programming for lifters with depression can be a challenge all on its own. Reliable programming strategies that produce steady, predictable progress may actually be much less effective on depressed lifters, and that’s if the lifter is able to complete the workouts at all. To better understand why, we have to consider the effects of two components: physical health and mental health.

The physical health component is relatively straightforward. It’s common for depressed lifters to have issues sleeping and eating, which can make it more difficult for them to recover from training stress. Of course, someone with compromised recovery cannot train like they would at their peak, and they will not benefit from training in the same way. For experienced strength coaches, programming for diminished recovery is familiar ground. There are plenty of resources available on recovery and coaching lifters through less-than-ideal recovery situations, so I won’t go into detail on that subject in this article. (For example: Strength Training for the Low-Priority Lifter.)

The mental health component is the more sensitive and complicated programming issue. It includes the obstacles to training and poor communication that were explained previously, as well as other irrational thoughts and behaviors, like giving up on sets that they are physically capable of completing, having emotional breakdowns during workouts, and ending workouts prematurely. Continuing to power through workouts without addressing these issues can cause the lifter to develop a negative view of training and to doubt their own abilities. The worst possible outcome is a lifter who begins to think they’re not cut out for strength training, gives up, and leaves it entirely.

It’s normal to see a lifter’s strength progress slip during depressive episodes—with or without programming adjustments. As a coach, watching this happen can be uncomfortable. You cannot compare the lifter’s performance to where they would be if they had stayed on their pre-depression programming, with no bumps in the road. To be realistic, you should measure current progress by what they would be doing if you hadn’t changed their programming, which is usually nothing at all.

One of the reasons why programming in these situations can be such a test for coaches is that it can require temporarily abandoning conventional strength metrics—things like linear progression, tonnage, and PRs. Instead, the coach has to embrace different markers of successful training and encourage and celebrate those things as much as any PR. These “new metrics” may be things like weekly communication, not skipping a frustrating exercise, and completing workouts, even if they didn’t go as planned. While they aren’t directly tied to strength progress, they’re still focused on continued involvement in training, which will improve their quality of life, now and in the future. By remaining physically active, the lifter will be better able to recover from their depression and quickly resume normal strength training afterward. With correct adjustments, the lifter keep a positive view of training post-depression, which will play a huge role in their long-term training success.

Tiered Programming Adjustments

When it’s determined that a lifter needs adjustments to their programming, it’s best to adopt as much of a Minimum Effective Dose (MED) approach as possible. MED helps find a balance between maintaining the physical stress needed to sustain progress and reap the benefits of resistance training while keeping mental stress at a tolerable level. Depending on the lifter and the severity of their depression, this may not be possible, but thoughtful adjustments can make the process of finding the best programming balance feel less like shooting in the dark.

Tier 1: No adjustments or secondary exercise adjustments

Ideally, a lifter won’t need any changes to their programming. Their workouts may feel harder and take longer, but otherwise, they can be completed as prescribed. This will allow the lifter to continue making largely uninterrupted progress through their depressive episode.

If workouts are taking too long, the main lifts are very mentally taxing, or the lifter’s recovery is compromised, consider replacing, reducing, or removing secondary exercises from their program temporarily—any exercise that’s not a main lift or variant, possibly including conditioning. The intention is to decrease workout stress to avoid worsening depression symptoms and derailing progress.

Tier 2: Rep and set scheme adjustments

There are a few options for adjusting rep and set schemes. The first option is to reduce the reps per set while increasing the total number of sets, so the lifter’s total tonnage is similar. This adjustment helps when the lifter handles higher intensities well but struggles through longer sets. For example, a lifter who burns out at the end of their sets, physically or mentally, may benefit from switching from 3×5 to 5×3.

A second option is to decrease total stress when a lifter is feeling physically worn out. (Remember that many lifters struggle with both eating and sleeping, which are huge hits to recovery.) Changing from 3×5 to 3×3 on squats, even temporarily, can give them a better opportunity to recover and avoid the mental stress of ugly or missed reps. Targeted reductions in stress can also be useful when a specific lift is a big contributor to a lifter’s non-compliance.

Lastly, a total rep prescription can be used when a lifter’s performance is inconsistent or when it’s vital that the lifter doesn’t have a negative experience with an exercise. For example, if a lifter gets so frustrated after missing a rep or failing to correct a technical error that they end their workout prematurely, you might consider a total rep prescription. So, instead of prescribing 5×3, you task the lifter with completing 15 reps in as few sets as possible, stopping each set with one or two reps in reserve or when form breakdown becomes intolerable.

Tier 3: Weight adjustments

If recovery or compliance is a major issue, a reduction in intensity on one or more lifts may help to ensure successful completion. Weight reductions may benefit a lifter who struggles mentally with a lift. They may be physically capable of completing the prescription but are experiencing a disproportionate amount of frustration or angst, causing them to miss reps.

Productive weight adjustments can take several forms: a normal deload, weight reset, the introduction of ascending sets or descending sets, or top sets with backoffs sets.

Tier 4: Main exercise adjustments

There are situations in which a particular lift causes a high amount of mental stress, to the point where it could affect the lifter’s compliance and overall opinion of training. Since it’s important to make sure training continues to be a positive experience for the lifter, replacing this lift with one that has similar benefits but is more tolerable may prove to be a critical adjustment.

As an example, a lifter may be incredibly frustrated whenever they deadlift. Let’s say it’s not solely linked to the weight on the bar: they don’t like deadlifts when the weight is light, either. Perhaps it’s related to their technique or how they feel: as hard as they try, they can’t seem to set their back correctly, or it always feels awkward and unnatural. It’s to the point where they will end a workout prematurely and on a negative note, even if the rest of the workout had gone incredibly well. There is no improvement after providing encouragement, reducing and then eliminating critical deadlift feedback, and trying different prescriptions. In this instance, it would be beneficial to take a break from the deadlift until they are mentally in a better place to tackle this exercise. Try replacing it with a more manageable variant, such as block deadlifts or RDLs.

Tier 5: Complete workout changes

A complete workout change should be used as a last resort for lifters who are moderately to severely depressed and have missed many workouts already. In this situation, the lifter is struggling to overcome obstacles to training and likely has difficulty communicating as well. Standard strength training may not be feasible. Since they will still benefit from any type of physical activity, some experimentation may be warranted.

The goal should be for the lifter to do some sort of regular physical activity with the fewest barriers for completion as possible. Prioritize movements that aren’t very taxing and can be completed in a short timeframe. Going on 10-minute walks three or more days every week is a good place to start, especially if the weather is nice where they live. Maybe they can shoot hoops, do yoga, or knock out a few bodyweight exercises at home. If the lifter really enjoys long-distance running, it’s ok to play around with a running progression.

These prescriptions likely won’t be physically (or specifically) demanding enough to have significant strength training outcomes, but that’s no longer the objective. The new objective is to keep them moving and following a fitness routine in order to lessen depressive symptoms and create a pathway for a smooth transition back to strength training later.

Structure vs. Flexibility

In these tiers, you may have noticed that some adjustments maintain structure while others introduce flexibility. There are benefits and downsides to both.

For many skilled coaches, structure is a key component of personalized programming. The coach prescribes every variable of the program, making it a wonderfully effective way to control progression. For the lifter, highly structured training takes out all of the guesswork. The downside for depressed lifters is that highly structured programs create expectations that the lifter may be unable to meet, which can contribute to an already poor mental state. With these programs, it’s clear when a prescription has been fulfilled or failed, and the measures of success tend to rely on traditional strength metrics, which may not be appropriate for a depressed lifter.

Injecting flexibility to one or more programming variables allows for adjustments based on how the lifter is feeling or performing that workout. It can be helpful when a lifter’s performance has been unpredictable or when it’s important to avoid missed reps or frustration during a workout. Common examples of flexible programming include total rep prescriptions, rating of perceived exertion (RPE), reps in reserve (RIR), and ranges.

Certainly, too much flexibility can be a problem as well. At the extreme, a completely flexible prescription would be, “Go to the gym and do whatever you want.” This can be tempting when working with a lifter who has completely stopped training. After all, something is better than nothing. Unfortunately, vague prescriptions can be hard for depressed lifters to follow due to indecisiveness. The number of possible exercises, weight, rep, and set combinations can be overwhelming. Plus, they may feel apathetic about exercising; nothing is exciting or motivating for them.

If a lifter is able to follow a flexible prescription, they may struggle to judge the difficulty of an exercise. Depression can make lifts feel uglier, tougher, and slower than they actually are, which can make it more difficult to pick an appropriate weight and accurately judge RPE and RIR. This “grey area” in lifting can be stressful to some people, particularly those who have perfectionistic tendencies.

Flexibility isn’t an answer, but it is a useful tool. It should be added gradually and only where necessary. That way, the coach can strike a suitable balance between structure and flexibility without the lifter experiencing additional mental stress.

Closing Thoughts

As strength coaches, it’s our mission to help other people become stronger. Certain populations will require additional programming or coaching considerations, but regardless of those specifics, we will always build out from our basic coaching education and skillsets. Managing the mental health needs of lifters with depression can be tricky, but I hope that this series makes you feel more equipped to steer your lifters through those rocky phases.

Remember that our goal as strength coaches is not simply to increase the weight on the bar. The ultimate goal is to improve our lifters’ quality of life. When we keep that ideal at the forefront of our interactions, we can provide better service to our lifters now and in the future.

<—Read Part 3: Coaching Considerations


A special thank you to these wonderful lifters for offering their unique perspectives:
Adam H., Bill H., Gabe S., Scott B., and coach Mike Burgos. I’ve learned so much from you. Thank you for helping me become a better coach.

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