2.8 Psychosocial aspects of Health and Fitness

The health benefits of regular moderate physical activity have been well-established, yet participation rates across the population need to be higher to accrue these benefits. Thus, the promotion of physical activity is a public health priority. Understanding the antecedent correlates of participation in physical activity is considered a useful first-stage endeavor to focus on intervention efforts.

Research has provided evidence that physical activity participation is related to many factors, spanning personal, social, and environmental categories. More precisely, Biddle and Mutrie (2008) exposed the following correlates that influence human behavior:    

  • personal and demographic
  • psychological
  • social
  • environmental.

Personal/demographic correlates

There are consistent positive trends for leisure-time physical activity in adults associated with male gender and higher levels of education and socio-economic status, but negatively associated with non-white ethnicity and age (Trost, 2002), with similar trends in youth (Sallis, Prochaska, and Taylor 2000). Gender differences are highly reproducible and one of the most consistent findings in the literature. Promoting physical activity in girls seems to be a particular challenge. However, trials with adults suggest that more women than men show interest in taking part in physical activity (Mutrie et al., 2002).

Psychological correlates

Findings on psychological correlates of physical activity are based on two main types of studies: those using descriptive approaches whereby psychological variables are assessed alongside physical activity and those that use a theoretical model. The latter enables us to build knowledge and understanding of how and why people might be motivated or not to adopt and/or maintain a physically active lifestyle. In addition, descriptive studies can help develop more explanatory research designs.

Theories on exercise psychology focus on beliefs and attitudes, perceptions of control, perceptions of competence, stage-based theories, and hybrid approaches.

Social correlates

Social support is associated with physical activity in adults and youth. Trost et al.’s (2002) review suggested that social support from friends/peers and family/spouse was significant. In addition, the influence of one’s family physician plays a role, particularly for adults, as may the leader of group exercise sessions. Finally, such a leader’s ‘motivational climate’ may determine whether people return for future sessions (Ntoumanis & Biddle, 1999). Evidence suggests that the most favorable climate will be when the exercise leader encourages cooperation and rewards effort over comparative performance.

Environmental correlates

A recent review of environmental correlates of walking in adults (Owen et al., 2004) found that walking was associated with aesthetic attributes; the convenience of facilities, such as trails; accessibility of destinations, such as shops; and perceptions of traffic and busy roads.

 

However, evidence of this correlate is limited. Facilities, including open spaces and parks, are likely only part of a solution to increase physical activity levels. Other factors include previous experiences of physical activity and current level of fitness.

2.8.1 Motivation for physical activity

Motivation for physical activity can be either motivation through feelings of control or motivation through feelings of competence and confidence. Of course, there are other approaches to why people start exercising, but studies show that self-efficacy, knowledge, and attitudes were generally associated with the adoption of vigorous and moderate exercise.

Motivation through feelings of control

The research and popular literature contain numerous references to the fact that changes in exercise and health behaviors are thought to be associated with the need to »take control« of personal lifestyles. The information that many modern diseases linked with premature mortality are »lifestyle-related« (Powell, 1988) conveys that we, as individuals, are at least partly responsible for our health and well-being.

Failure to initiate or maintain physical activity is often attributed to a lack of »willpower. « Weiner says that despite evidence linking obesity with biological and genetic factors, »fatness tends to be perceived as controllable, and people are considered responsible for being overweight« (Weiner, 1985).

It is clear from everyday experiences that we prefer, or are more motivated by, situations where some choice, control, and »self-determination« exist. Nevertheless, conversely, we usually prefer not to be controlled and pressured too much. 

In this regard, motivation can be intrinsic or extrinsic. Intrinsic motivation is motivation to do something for its own sake without external (extrinsic) rewards. Often this involves fun, enjoyment, and satisfaction, such as recreational activities and hobbies. The enjoyment is in the activity rather than any extrinsic reward such as money, prizes, or prestige from others, and participation is free of constraints and pressure. Rewards, money, pressure, or other external factors direct extrinsic motivation. This suggests that if these rewards or external pressures were removed, motivation would decline without intrinsic interest.

Findings based on different studies showed the importance of reward conditioning. They suggested that using rewards to enhance feelings of competence rather than a bribe is better. Also, use rewards and reinforcements for intrinsic motivation.

However, it should also be recognized that there are potential problems with health messages that consistently encourage personal control as the only way of changing behavior. Unfortunately, this approach is often associated with the »health fascist« label and the »victim blaming approach. «

Motivation through feelings of competence and confidence

American developmental psychologist Harter suggests that individuals are motivated when their competence can be demonstrated. Successful mastery attempts under such conditions are associated with positive emotion and low anxiety. Harter’s theory predicts that those high in perceived physical competence would be more likely to participate in physical activity. 

Another theory, presented by Fox (1997), presents the so-called ‘self-enhancement’ model of self-esteem, where positive self-perceptions plays a motivational role in behavior. For example, suppose someone feels competent in the exercise domain. In that case, he or she will more likely want to demonstrate that competence and hence be motivated to exercise.

The goal behind the motivation for physical activity can be either ability-orientated (‘ego’ goal orientations where success is defined as the demonstration of superiority over others, Duda 2001), task-orientated (‘the primary goal is to produce an adequate product or to solve a problem for its own sake rather than to demonstrate ability,’ Maehr and Nicholls 1980) and social approval-orientated (conformity to norms).

Remember: People define success in different ways, which will affect their motivation.

Competence and confidence present themselves mostly through self-efficacy, one of the most consistent correlates of physical activity.Another important aspect is self-presentation: Physical appearance, gestures and movement, public self-consciousness, weight, appearance, physique anxiety, and modesty are all constructs of physical activity and perceptions of confidence. Self-presentational concerns may affect physical activity choices, such as when one perceives the activity to be incompatible with one’s image, such as in aerobic dance or lifting weights, or where anxiety is felt in displaying low levels of physical competence (Leary, 1992).

2.8.2 Social and environmental correlates of physical activity

Physical inactivity is so pervasive in modern market economies that the problem is seen as one of »society« rather than just the individual. McElroy (2002) suggested» that significant improvements in physical activity for so many … requires us to look beyond individuals to societal factors «. Similarly, in its global strategy for diet and physical activity, the World Health Organization notes that inactivity cannot be considered simply as a problem for individuals. The strategy stated that increasing physical activity is a societal, not just an individual problem, and demands a population-based, multi-sectoral, multi-disciplinary, and culturally relevant approach.

So which social correlates influence physical activity?

The key correlates include gender, socio-economic status, family, and social support.

There is a huge gender difference in favor of the male sex in physical activity. There are more boys/men involved in physical activity than girls/women, maybe because girls are socialized early to believe that physically demanding pursuits are more male-oriented, particularly some sports. 

Gender, economic and social access, to various activities, parental support or support from family...

There are also some findings that higher levels of physical activity may be related to economic and social access to various activities, such as clubs, facilities, or physical activities requiring transport (Trost, 2002).

Family-related variables, such as parental support or family modeling, are frequently reported as correlates of physical activity. For example, Sallis (2000) found evidence for adolescents’ physical activity to be associated with direct parental help, parental support, support from significant others, and sibling physical activity.

Although evidence supports the potential influence of parents and families on young people’s physical activity, the relationship could also work in reverse through children constraining adult activity. For example, Brown and Trost (2003) found that certain family-related life events were associated with a greater likelihood of being physically inactive for young women (the risk of inactivity was increased if the women became married and had children, and it escalated by 50–230%).

 

We have to point out that there is not enough evidence that the family influence (behaviors learned in childhood and adolescence) will transfer into adulthood. Adults will be more physically active if they learn to do so in childhood. However, more studies are needed to confirm this.

 

Engstrom (1991) analyzed environmental circumstances and involvement in physical activity and found that these positively influence physical activity in adulthood:

 

– physically active mate/spouse

– most friends are physically active

– no children

– academic education.

In health psychology, social support has been studied and found to be beneficial for various aspects of health and well-being, such as stress control. Through emotional, informational, and material support (empathy, advice on exercise, direct help…), people can be influenced to become and/or stay more physically active. Social support can be associated with physical activity both in adults and youth, as Trosts’ review showed an apparent positive effect on physical activity for social support from friends/peers and family/spouse. 

Social support can inhibit or restrict physical activity. Many parents are concerned about the safety of their children and, as such, actively prevent them from taking some forms of physical activity, such as cycling on busy roads and walking or playing in certain areas. The latter is often associated with a perceived risk of physical attack (the fear of so-called ‘stranger danger’). 

An essential aspect of social environments on physical activity is the exercise environment, including the class leader and the group climate. Surprisingly little has been written about the role of the exercise leader, yet for this type of exercise setting, the leader could be the most influential factor for adherence. On the contrary, studies show that motivational climate in class is a good predictor of intrinsic interest and future intentions to participate (Biddle, 1995).

Other environments referred to as » behavior settings« are community spaces (for example, public recreational spaces or sports facilities), indoor and outdoor spaces at home, the workplace, educational settings, and transport. Each set has different choices between active or sedentary pursuits (Owen, 2000).

2.8.3 Well-being and physical activity

The importance of physical activity for well-being and disease prevention is well recognized. We have discussed the impact of physical activity on health and disease prevention in Chapter 1. In this chapter, we will discuss the evidence of the links between physical activity and psychological well-being

There is also the possibility that physical activity could have negative consequences on mental health and well-being, for example, by promoting unhealthy exercise or eating habits. Such issues will be dealt with later in this section.

Evidence of physical activity’s impact on psychological well-being has its foundations in narrative and meta-analytic reviews, epidemiological surveys, and controlled trials. The range of topics associated with psychological well-being includes, but is not limited to:

– health-related quality of life

– emotion and mood

– enjoyment

– exercise deprivation

– self-esteem

– personality and psychological adjustment

– exercise and sleep

– specific issues for women.

Health-related quality of life

Health-related quality of life is being established upon reviewing the evidence linking physical activity and exercise with measures of mood and affect. Health-related results of physical activity can be physical symptoms (more energy), emotional (better mood), social (social dependency), cognitive (better memory), and global (better life satisfaction).

Though it is hard to measure emotion and mood since they are relative and their perception differs from one person to another, studies that have been conducted show that exercise adherence is likely to relate to generic feelings of good or bad. McDonald and Hodgdon (1991) examined exercise and mood research. Results showed a clear relationship between exercise and vigor and a lack of negative mood. They concluded that aerobic fitness training produces some positive changes in the mood … at least on a short-term basis.

A meta-analysis summarising the effects of exercise on positive and negative affect in older adults (Arent, Landers, and Etnier 2000) also showed other beneficial effects: after a workout, people felt less tension, anger, and depression and felt more vigorous. 

Stephens’ (1988) study showed that the level of physical activity is positively associated with good mental health. Mental health is defined as positive mood, general well-being, and relatively infrequent symptoms of anxiety and depression. 

There is also some evidence that the beneficial affective changes with exercise depend on the intensity of exercise: the more vigorous the exercise, the more positive the feeling (responses immediately following moderately vigorous exercise are almost uniformly positive – (Ekkekakis, 2003).

Karageorghis, Vlachopoulos, and Terry (2000) study linked exercise effect and flow. A cross-sectional survey of over 1,200 adult participants (83 percent were women) from aerobic dance exercise classes in London health clubs showed that higher self-reported flow from exercise was associated with higher feelings of ‘positive engagement,’ ‘revitalization,’ and ‘tranquility.’

Health-related results of physical activity can be more energy, better mood, social dependency, better memory, better life satisfaction, less tension, anger, and depression.

Self-esteem

Self-esteem refers to the value placed on aspects of the self. Self-esteem is often the single most important measure of psychological well-being. Indeed, enhanced self-esteem resulting from physical activity is often claimed by those promoting exercise and sport participation and is a common rationale for teaching physical education to children.

When we measure self-esteem as a measure of physical self-worth, we mostly think about sport competence, body attractiveness, perceived strength, and physical condition (these factors were derived initially from research on an American student population but seems to hold well with other populations too, (Hagger, 2003).

Although a large meta-analysis by Spence, McGannon, and Poon (2005) has shown only a small effect of physical activity on self-esteem in adults, a larger effect was shown for those who improved their physical fitness over those who did not. Specifically, the most significant effects were noted for ‘lifestyle’ programs (including other activities alongside exercise, such as nutrition advice and relaxation).  

Nieman (2002) has pointed out some reasons why increased physical activity may be associated with improved self-esteem, including the following:

– achieving goals;

– becoming more competent;

– achieving mastery;

– having increased social desirability;

– developing self-preservation strategies; and

– developing social reinforcement.

Cognitive functioning

Cognitive functioning embraces tasks ranging from simple reaction time to complex information processing.

The literature on the effects of exercise on cognitive processing shows conflicting evidence on the (positive) effects of exercise on cognitive function.

On the one hand, the literature on physical activity and cognitive development in children shows the strongest links in the early pre-school years. Research in perceptual–motor development has suggested that the early development of psychomotor function and neuromuscular control could assist academic learning in young children. Increases in cerebral blood flow have been documented after physical activity, which could assist in cognitive functioning. Similarly, activity will increase blood flow in the prefrontal somatosensory and primary motor cortices of the brain (Williams, 1986).

From a meta-analysis of forty-four studies, Sibley and Etnier (2003) concluded that there is a significant positive relationship between physical activity and cognitive functioning in children aged 4–18 years, but it does not have any positive effect on academic, cognitive, or perceptual-motor performance from perceptual–motor training on children with learning disabilities (Kavale & Mattson, 1983). Similarly, Bluechardt, Wiener, and Shephard (1995) found that exercise programs had not improved motor performance in children with learning disabilities.

Studies in aging humans show that endurance exercise is protective against cognitive decline, especially executive planning and working memory. Exercise increases attention and performance on cognitive tasks. In a rat model of stroke, running exercise promotes neuronal dendritic branching and enhances relearning of forelimb motor skills (Kirk-Sanchez, 2014).

Currently, there are three hypotheses explaining how exercise may affect cognitive functioning.

Exercise may increase oxygen saturation and angiogenesis in brain areas crucial for task performance. For example, Kramer found that walking exercise increased the oxygen consumption rate in healthy older adults, which was associated with improved reaction time and enhanced performance in tests of executive functioning.

The second hypothesis suggests that exercise increases brain neurotransmitters, such as serotonin and norepinephrine, facilitating information processing. Brain electroencephalogram (EEG) detected increased levels of arousal and have been measured in persons exercising at less than 70% of their maximum oxygen capacity (considered within the moderate training zone).

The third, and probably most well-studied hypothesis, is that exercise upregulates neurotrophins such as brain-derived neurotrophic factor (BDNF), insulin-like growth factor (IGF-I), and basic fibroblast growth factor (bFGF) that support neuronal survival and differentiation in the developing brain and dendritic branching and synaptic machinery in the adult brain (Schinder, 2000). Clearly, youth, with brains ripe for new learning and sometimes with concomitant cognitive challenges, may require physical activity even more than adults.

Studies examining the intensity of exercise required to optimize neurotrophins suggest that moderation is important. Sustained neurotrophin levels increase with prolonged low-intensity exercise, while higher-intensity exercise elevates the stress hormone corticosterone (cortisol). Moderate physical activity is important for youth whose brains are highly plastic and perhaps even more critical for young people with a physical disability (Ploughman, 2008).

There is evidence of the exercise-cognition connection, especially in young adults. Aerobic fitness in children is associated with higher measures of neuroelectric responsiveness, faster cognitive processing speed, and better performance in a test of executive control. A meta-analysis done by Sibley confirmed the positive relationship between physical activity and cognitive and academic performance in school-aged children. Even though the level of physical activity can be confounded by other factors such as IQ and socioeconomic status, these findings are convincing.

Personality

Personality has numerous definitions, but generally, it is the combination of characteristics or qualities that form an individual’s distinctive character. Personality traits are defined as relatively enduring patterns of thoughts, feelings, and behaviors, which are expected to remain stable over time and consistent across situations (Stieger, 2020).

Every sport and exercise psychologist has asked, “does physical activity affect personality?’. Indeed, it is still commonly accepted that playing a sport, at least for children and youth, is inherently ‘good’ and associated with ‘character development.’

But in truth, athletic competition does not appear to promote character development. The evidence on exercise’s (positive) effects on personality is anecdotal and potentially biased. Some studies were conducted on this subject but they still need conclusive evidence.

McDonald and Hodgdon’s (1991) study shows only a small positive effect of aerobic fitness training on personality and adjustment. Doan and Scherman (1987) also found some positive effects and no negative ones.

Although there is not enough evidence, physical activity may have the potential for personal growth in qualities including persistence, deeper self-reliance, commitment, and motivation, and it may increase resourcefulness.

Sleep

Although sleep and exercise may seem to be mediated by completely different physiological mechanisms, there is growing evidence for clinically important relationships between these behaviors (Atkinson, 2007). In addition, there is anecdotal evidence and a commonsense belief that exercise can improve sleep quality. 

As more scientific knowledge has been gained about sleep, more links between sleep and physical activity have been postulated over and above the general and much-discussed notions that exercise can positively affect sleep (Horne, 1981; O’Connor & Youngstedt, 1995) and vice versa (Semplonius, 2018). In addition, two meta-analyses have been conducted. Kubitz et al. (1996) found that exercise yielded significant effect sizes for several sleep variables. The study showed that individuals who exercised fell asleep faster and slept longer and more profoundly than those not exercising. Kubitz also found that fitter individuals fell asleep faster and slept more profoundly and longer than less fit individuals.  

Similarly, the results of Meads’ study suggest that, in healthy young adults, physical activity may not promote healthier subsequent sleep. However, sleep duration and continuity influence physical activity in their own way. Young adults may respond differently to health promotion efforts, and a greater understanding of these temporal associations can enhance the efficacy of these efforts.

The effect of physical activity on sleep is not short-term, as there is no evidence of reciprocal associations between daily sleep and physical activity (Mitchell, 2017), as the higher physical activity did not improve sleep at night on a day-to-day basis (and vice versa).

The effect of physical activity on sleep is long-term, as research suggests that only »regular« exercise has small beneficial effects on total sleep time and sleep efficiency, small-to-medium beneficial effects on sleep onset latency, and moderate beneficial effects on sleep quality. For example, Kredlow (2015) found that exercising less than three h before bedtime was significantly associated with less disturbed sleep (lower wake time after sleep onset), and exercising less than three h before bedtime and greater than eight h before bedtime were significantly associated with less time spent in light sleep (stage 1 sleep). Also, a longer duration of exercise has a greater effect on sleep. The number of days per week of exercise did not significantly moderate the effect of regular exercise on any sleep outcomes. The research, however, showed that the exercise program’s duration in the total number of weeks (range 2–52 weeks) and total duration significantly moderated the beneficial effect of regular exercise on total sleep time.

Interesting to know: A paper on napping by Lastella et al. (2021) examined the effect of napping on physical and cognitive performance. The research showed that footballers, weightlifters, and karate practitioners improved their bench press, leg press, and grip strength following a nap. Furthermore, the research suggested that if clients do not get recommended 7 to 8 hours of sleep per night, they will benefit from a 20 to 90-minute nap between 1 and 4 PM.

Stress

Exercise can be an effective component of a stress management program, and all types of exercise can be beneficial for stress management. It is important to note that physical activity is an ideal way to raise and lower stress levels (Berger, 1994). In this chapter, however, we will focus on the stress-reducing benefits of exercise.

»Stress« is a commonly used term, and it is often used with different meanings. The standard definition for stress is the disruption of the body’s homeostasis or a state of disharmony in response to a real or perceived threat or challenge. The threatening or challenging situation is referred to as a “stressor.” When a person encounters a stressor, the body prepares to respond to the challenge or threat. The autonomic nervous and endocrine systems respond by producing the hormones epinephrine, norepinephrine, and cortisol—this hormone production results in a cascade of physiological reactions that make up the stress response. Epinephrine and norepinephrine are involved in the initial changes that take place to prepare the body to react and to prepare for a challenge (Chrousos, 1992).

Although there is a general stress response pattern, there can be variations in the response according to the characteristics of the stressor. Each person differs in his or her preferred level of stress. The stress response also varies depending on the level of perceived control one has over the stressor (Frankenhauser, 1991). There is also additional evidence that stress and how people cope with it mediates physical and psychological well-being.

It is important to note that not all stress is bad. Everyone experiences a certain amount of stress almost daily, which cannot be eliminated. However, stress becomes a problem when too much is experienced, and it has a negative impact on behaviors, relationships, and health. The term »eustress« refers to positive stress that is associated with improved performance and productivity. »Distress« is negative stress associated with performance decrement and negative health consequences. The individual’s perception of the stressor and coping resources determine whether a situation is a eustress or distress.

Another consideration of stress is whether it is acute or chronic.

»Acute stress« is what an individual experience at the time the stressor is encountered. The stress response is activated, and the body returns to homeostasis once the challenge of the stressor is removed or the person successfully manages the situation. When an individual experiences acute stress consistently, such as overcommitting at work or constant worrying, it is called» acute episodic stress. « Individuals who experience acute episodic stress often show signs and symptoms of stress that can negatively impact physical and psychological health. However, these individuals can learn to change behaviors and manage stress to prevent these consequences.

»Chronic stress« is the type of stress that is associated more commonly with negative health concerns. Chronic stress results when multiple or major life stressors are present. Money, work, and the economy were the most commonly reported factors contributing to chronic stress in the American Psychological Association’s (APA) 2022 Stress in America™ survey. Major events, such as the death of a loved one, divorce, and moving, also can produce chronic stress.

Exercise and stress research has typically focused on aerobic exercise. There have been consistent findings that people report feeling calmer after a 20- to a 30-minute bout of aerobic exercise, and the calming effect can last for several hours after exercise. Dishman’s study has shown that 30 min of aerobic exercise reduces muscle tension by as much as a dose of 400 mg of meprobamate. Subjective self-reports, electroencephalogram changes, and the reduction of peripheral deep tendon reflexes determined the relaxation effects. The tension reduction induced by exercise lasts 4 to 6 h in adults. The level and intensity of exercise may be important. Some studies suggest that only strong, sustained exercise leads to tension reduction; others suggest that moderate exercise is beneficial only when it occurs over an extended period and regularly.

Exercise is beneficial for reducing anxiety in children also. Brown’s study showed that 30 min of movement training for ten weeks reduced anxiety in healthy four-year-olds. Physically fit college students were shown to handle stress better than unfit subjects. Similar results were found when girls aged 11 to 17 years were studied. There have also been some case reports in adults that have indicated that regular physical activity may be helpful in the treatment of panic attacks and phobias.

But not only aerobic exercise but also anaerobic activities have a reduction of psychosocial stress, as Crews has noted. Although there is little research on resistance exercise and stress management, resistance exercise can provide a time-out from one’s stressors. Because resistance training produces different exercise adaptations compared to aerobic exercise, it might not affect how the body physiologically reacts to stress as aerobic exercise does. However, the acute effect of a time-out to reduce stress can be beneficial. For example, Tsoutsumi (1998) has found that with strength training the test groups have significantly improved positive mood (vigor), and reduced trait anxiety. They have also shown decreased tension and state anxiety after the training period. 

The exact physiological mechanisms to explain how exercise improves stress has yet to be delineated. Human and animal research indicates that being physically active improves how the body handles stress because of changes in the hormone responses and that exercise affects neurotransmitters in the brain, such as dopamine and serotonin, that affect mood and behaviors.

There is also a theory that it is not the exercise that reduces stress but the rhythmical abdominal breathing (generated by aerobic exercise and some less intense forms of exercise) (Berger & McInman, 1993).

How much exercise is needed to manage stress?

Although as little as 5 minutes of walking can be mood-elevating (Thayer, 1987), there is general agreement that a minimum of 20 to 30 minutes of exercise is needed to generate psychological benefits. The recommendations for exercise in stress management fit with the current health recommendations (see Chapter 1). The proposed physiological adaptations thought to improve how the body handles stress and recovers from stress can occur with a regular moderate to a vigorous aerobic exercise program, such as the recommendations of 150 minutes of moderate-intensity aerobic exercise per week or 75 minutes of vigorous-intensity aerobic exercise per week.

The studies included in the recent reviews of Tai Chi and yoga indicate that sessions between 60 and 90 minutes performed 2 to 3 days per week effectively reduce stress and improve feelings of well-being (Chong, 2011).

In addition to the exercise prescription, other characteristics of the exercise session (e.g., group vs. individual) and the individual also are important considerations. Because of health consequences associated with stress, high-stress clients are likely to be at increased risk for cardiovascular disease and cardiovascular events during exercise. Therefore, using the pre-exercise screening procedures is essential. Monitoring exercise intensity for those looking to »blow off steam« to reduce stress might be a concern when the client has high blood pressure or other cardiovascular risk factors that increase the risk for cardiovascular events.

Group exercise or encouraging stressed clients to find a workout partner is an excellent idea because it can provide a support network and accountability. However, some clients might find a group setting intimidating or competitive, which could be counterproductive in managing stress. In addition, those who report stress because of work or family obligations might enjoy the solitude of exercising alone. Using a variety of exercises or nontraditional exercises (e.g., exergaming, dance classes, yard work, or rock climbing) is a way to plan enjoyable activities to maximize adherence. Knowing your clients’ exercise barriers and stressors will help plan an exercise program that can address these variables to maximize the benefits of health and stress management benefits.

Competitive physical activity may increase stress and anxiety; however, this increase is thought to be transient and mild as long as the athlete is not pressured excessively by parents, teachers, or coaches. Individual sports such as gymnastics, ballet, ice skating, and wrestling generate more stress than team sports, but overall, the stress response to competitive sports is similar to that of band competitions and academic stress, for example.

Athletic competition may become destructive when the contest becomes linked to self-worth, personal integrity, and the virtue of the players. Individuals who may be at additional risk for developing stress due to athletic competition are those with low self-esteem and low-performance expectations.

Remember! It is important to note that exercise is as effective as other stress-management techniques, but not more so.

Personal trainers should recognize that referring a client to a psychologist or other health care provider might be necessary to help develop strategies for managing stressors that produce chronic and acute episodic stress.

2.8.3.1 Anxiety and depression

Mental disorders are major public health problems, and depression and anxiety disorders are among the most common. Depression is a common illness worldwide, with an estimated 3.8% of the population affected, including 5.0% among adults and 5.7% among adults older than 60 years. Approximately 280 million people worldwide have depression (WHO, 2023). In 2019, 301 million people lived with an anxiety disorder, including 58 million children and adolescents (WHO, 2023). Anxiety and depression can limit successful outcomes, including quality of life, psychological well-being, and physical activity status (Yohannes, 2010).

On one hand, where feelings of anxiety or depression are short-lived, physical activity may minimize the duration of these events and encourage more positive moods. This is considered to be the promotion of good mental health. At this point, people do not generally seek or need help to alleviate such feelings, so that physical activity can be seen as a self-help strategy.

In addition to the importance of mental health in its own right, it has now been recognized that negative emotions, particularly depression, as well as personality and socioeconomic status, may have a negative impact on the functioning of various organs and therefore increase the risk of chronic disease (for example coronary heart disease) (Trigo, Silva, and Rocha 2005).

Mental health is a public health concern, and physical activity may assist in prevention and treatment. Over the past years, the literature on physical activity, exercise, and mental health has been growing. Nonetheless, mental health agencies like the American Psychiatric Association have not endorsed exercise’s role in treating mental illnesses like depression. In the UK, an overview of depression and its treatment did not mention exercise’s value.

On a more positive note, there is some evidence that this reluctance to consider the ‘body’ in treating mental health may be shifting. In the UK, the National Health Service has produced a website to enable patients to understand what they are experiencing and to offer self-help strategies. In describing the prevention of depression, the website suggests that exercise could help. The treatment section suggests that increasing physical activity levels might be something to consider (www.nhsdirect.nhs.uk). In addition, recent leaflets about depression from the Royal College of Psychiatrists in the UK suggest that exercise is a good self-help strategy for depression.

Depression

During a depressive episode, an individual undergoes a depressed mood characterized by sadness, irritability, or emptiness or experiences a loss of pleasure or interest in activities. These symptoms persist for most of the day, nearly every day, for at least two weeks. Additionally, several other symptoms may be present, such as poor concentration, excessive guilt or low self-worth, hopelessness regarding the future, thoughts of death or suicide, disrupted sleep patterns, fluctuations in appetite or weight, and persistent fatigue or low energy levels (American Psychiatric Association, 2013). In addition, anxiety and depressive disorders often lead to passivity and withdrawal, which may result in decreased physical fitness compared to the general population (Martinsen, 1989).

 

A depressive episode significantly impairs an individual’s ability to function in various aspects of life, including personal, family, social, educational, occupational, and other essential areas.

Depressive episodes can be classified as mild, moderate, or severe based on the number and severity of symptoms and their impact on the person’s overall functioning. In instances of moderate or severe episodes, seeking professional help is crucial.

Anxiety

There are various types of anxiety disorders, each with distinct characteristics and manifestations. Some common examples include generalized anxiety disorder, which is marked by persistent and excessive worry; panic disorder, characterized by recurrent panic attacks; social anxiety disorder, involving excessive fear and anxiety in social situations; and separation anxiety disorder, typified by an intense fear or anxiety about being separated from individuals with whom the person shares a strong emotional bond (American Psychiatric Association, 2013). Other anxiety disorders, such as agoraphobia and specific phobias, also exist and can significantly impact an individual’s daily life.

Effective psychological treatments, such as cognitive-behavioral therapy (CBT), have been established to help individuals manage and cope with anxiety disorders (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012). Depending on factors like the patient’s age, severity of the disorder, and response to therapy, medications, such as selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines, may also be considered as part of a comprehensive treatment plan (Bandelow et al., 2012).

Physical activity in the prevention and treatment of anxiety and depression

Besides psychotherapy and medication, physical activity is becoming increasingly important in treating anxiety and depression.

The association between mental disorders and physical inactivity is potentially bidirectional, with physical inactivity leading to depression and depression leading to physical inactivity (Patten, 2009). The phrase »inactivity trap« describes this dynamic. The possibility that physical activity may prevent depression or reduce depressive symptoms has been the focus of many recent studies.

Nyström (2015) has conducted a systematic overview of treating major depression with physical activity and has concluded that all types of physical activity – both aerobic and aerobic – showed reduced depressive symptoms. This concurs with the suggestion that the activity mode is less important than just becoming physically active. However, it may not be the physical fitness element of the physical activity that has the most significant effect on depression, but rather other consequences of it – for example, enhanced self-esteem, increased self-efficacy, improved coping skills, and stronger social support.

Nyström’s research also showed that it is not the frequency, intensity, and duration of the physical activity that alleviates depressive symptoms but the activity itself. Patients should be encouraged to do something physical rather than on the type, frequency, and intensity of the physical activity. You must remember that inactivity is a large part of the illness, so that any physical activity may constitute a large enough step for this population.

One of the essential omissions from the La Forge model is how exercise can provide a sense of mastery and control. For example, one theory of depression suggests that depression results from feeling that no action can be taken to alleviate a problem. This feeling of helplessness is learned over time and from various situations and results in the person having an external locus of control. Exercise can play a role in helping the person who is suffering in this way to gain control in one area of life, namely the physical self. In addition, if the exercise is programmed correctly, the sense of achievement and progression from week to week builds on this sense of control. It may even provide a sense of mastery (Biddle).

In addition to the importance of mental health in its own right, it has now been recognized that negative emotions, particularly depression, as well as personality and socioeconomic status, may have a negative impact on the functioning of various organs and therefore increase the risk of chronic disease (for example coronary heart disease) (Trigo, Silva, and Rocha 2005).

Mental health is a public health concern, and physical activity may assist in prevention and treatment. Over the past years, the literature on physical activity, exercise, and mental health has been growing. Nonetheless, mental health agencies like the American Psychiatric Association have not endorsed exercise’s role in treating mental illnesses like depression. In the UK, an overview of depression and its treatment did not mention exercise’s value.

On a more positive note, there is some evidence that this reluctance to consider the »body« in treating mental health may be shifting. Many of the National Health Services have produced a website to enable patients to understand what they are experiencing and offer self-help strategies. In describing the prevention of depression, they suggest that exercise could help. In the treatment section, it is suggested that increasing physical activity levels might be something to consider.