We know that exercise is great for mental health; it can help improve mood and reduce symptoms of anxiety, depression and stress. However, something that’s not often talked about is that it can be extremely challenging for people who are struggling with their mental health to get started or stick with an exercise routine. Here’s why:
1) Some people may be physically unable to get out of bed
One symptom of major depressive disorder is what’s known as ‘psychomotor retardation’. This is when a person may move, speak or think very slowly. Many other mood disorders, as well as some of the medications used to treat them, can also cause low energy and tiredness. These symptoms can make seemingly simple tasks like getting out of bed, showering or preparing a meal extremely difficult, so telling someone who is struggling with their mental health to ‘just do some exercise’ is a bit like telling a healthy person to ‘just run a marathon’. It probably feels like too big a goal to even contemplate. Although people generally mean well by saying this, it’s not always the most helpful thing to say to somebody who is struggling.
2) Many forms of exercise can be anxiety-provoking
Many traditional forms of exercise such as going to a class, gym or running can create feelings of anxiety for the best of us (I still get nervous before a challenging workout), so imagine how these activities feel for somebody struggling with an anxiety disorder. They may feel like everyone else is watching them and judging them if they’re exercising in a public place. Many people with social anxiety also find that having to interact with others makes exercise more challenging, e.g. they might be afraid to ask a gym instructor how to use a machine or not want to speak in a class.
3) Some effects of exercise are similar to symptoms of anxiety
When we exercise it’s normal to experience an increased heart rate, sweating and breathlessness. However, these bodily changes are also common symptoms of anxiety. So if somebody with anxiety starts exercising and is unfamiliar with these sensations in an exercise context, yet recognises them as anxiety symptoms, this could cause alarm and make them worry that they may be about to have a panic attack. As a result, they might avoid exercising to prevent these sensations from recurring.
4) Negative self-talk is common
It’s common for people with mental health issues to think badly of themselves and talk to themselves in unkind ways. Phrases such as ‘I’m not good enough’, ‘I’m rubbish at this’ and ‘I’m lazy’ may be widely used. The problem with negative self-talk like this is that it is damaging to our self-esteem, and it’s so powerful that it can prevent us from taking action and doing things which can help us to feel better, like exercising.
5) People may lack social support
Mental health issues can cause people to become withdrawn from their social networks. Sufferers may struggle to reach out for help from family and friends and may find themselves feeling isolated. Although having close social relationships is one of the best things we can do for our mental health, it can be challenging to seek support when you’re feeling low and your head is telling you to refrain from social interaction. However, a lack of social support can mean people miss out on the opportunities for physical activity and accountability that our social circles can provide, e.g. going for a walk with a friend.
6) People may struggle to plan exercise into their lives
Anxiety and depression can affect peoples’ ability to think, and in particular to engage with tasks that require executive functioning (taking the steps to get something done) and cognitive flexibility (switching between thinking about different concepts). This can make it challenging for people struggling with their mental health to plan activities like exercise into their lives, and to change the plan if necessary. As a result, the exercise simply might not happen.
What’s the solution?
Not all of these problems will affect everybody, but in my experience of working with clients and learning about mental health and behaviour change, these are some common barriers to exercise for people with mental health issues. I think it’s especially important to be aware of these factors now, given that mental health issues are on the rise as a result of Covid-19, and more of our current and future clients may be struggling with their mental health.
Fortunately, there are things we can do as exercise professionals to help support clients who have made the brave and wonderful decision that they want to exercise, but are struggling to do so because of their mental health. Some of the ways I like to do this are:
1) Make movement as accessible as possible, e.g. by providing the option of home workouts and encouraging walking if exercising in a gym feels too intimidating
2) Provide flexibility with workouts and be prepared to change the plan each day depending on a person’s energy level and mood
3) Help people feel prepared for and comfortable with the bodily sensations brought on by exercise
4) Challenge anxiety-provoking situations using exposure therapy, e.g. entering the free weights area of the gym
5) Help people to discover what types of movement feel good to them by exploring different options and giving them autonomy within workouts
6) Encourage people to create an association between their chosen form of movement and feeling good, so that over time it becomes a self-care habit
7) Support people to recognise and challenge their negative self-talk and turn it into positive self-talk
8) Celebrate peoples’ wins, however small they may seem
9) Help people to plan physical activity into their week
10) Ensure that I’m part of a team of health professionals in a person’s recovery. Exercise should be part of a mental health toolkit alongside medication and/ or therapy, but it is not a replacement for these things.