Guest Author: Clayton Taylor, BA Psychology, SFSU, NASM-CPT
According to the National Institute of Mental Health, roughly 31% of U.S. adults and adolescents (ages 13-18) will experience an anxiety disorder.
-(Harvard School of Medicine, 2017), (Kessler et al., 2005)
How do you motivate a person to exercise when he or she doesn’t want to stand? This is a question whose answer extends well beyond the purview of this author’s professional expertise. What I can speak to however is my personal experience as a physical fitness professional, student of psychology, and person who manages a clinically diagnosed anxiety disorder. This essay is meant to provide a starting point for other fitness professionals, as well as laymen, to begin to understand how to better coach people who manage anxiety.
Folks manage their anxiety in all sorts of ways. When it comes to working-out however, easing in can benefit both those who prefer a more aggressive style and those who don’t. For example, a new client who is apprehensive to work out can benefit from a low-intensity, incrementally challenging exercise that builds confidence and a basic foundation of physical skills. On the other hand, a client may be more comfortable ‘jumping out of the plane’ so to speak. While this attitude is admirable on the surface, it can ultimately set an anxiety-prone client back, if not appropriately coached. Starting with meditation and hang stretching can be a great way for a client to start to feel out his or her own body before moving on to an appropriately challenging workout lead by mindful instruction, application of time- and range-variations, as well as specific exercises and techniques that may offer additional benefits to those who deal with high-levels of anxiety.
Starting with meditation can be the necessary cleansing process before a person submerges herself into physicality. It can be lead with guided visualization accompanied by appropriate audio cues (calm, lyric-free music), breathing techniques, and most importantly, consistent, gentle reminders to let go of one’s thoughts. The idea is that we work towards preparing both the client’s mind and body for exercise. 5-10 min should suffice, depending on the individual. Some will not be interested in the meditation and will want to move right on to the hang stretch. If this is the case, be accommodating, but continue to incorporate the use of meditation moving forward, and remind the client that learning to meditate in and of itself is a paradox, and that we should continue to use and develop this skill, as it is arguably one of the most important skills that can be learned by anybody, in particular a person who deals with extra anxiety.
The hang stretch allows a person to begin to engage their bodies in a way that will show current strength/flexibility, and also where gentle improvements can be made immediately. It is important at the beginning stages to ease the client into doing this safely. Begin by having the client leave both feet on the ground, supporting 100% of his/her weight, then gradually transferring tension and weight to the hang itself. Recommend no more than 30% to a beginner, to be adjusted according to client needs. This protocol can be repeated with a standing hamstring stretch for lower body evaluation, as well as an excellent start for anyone who has any kind of lower back or lower body flexibility issues.
A natural transition into strength training can be made right here at the end of the hang stretch. Beginning the strength portion of a workout in the same position as the relaxing and expanding stretch just performed can be a fun way to make it not feel like exercise. After a brief rest from the hang stretch, encourage the client to begin to appreciate the effects of strength training by challenging them first with assisted pull-ups (feet on ground for beginners), then eventually working up to full-range and intensity. We can call it our prison-yard warm-up (ha). Exercise can be modified to horizontal rows or similar. End with a few minutes of physically varied, but relatively tranquil cardio, and transition to inclined push-ups.
At this point, you likely have an idea of the fitness level of your client, so the idea is that you want to take this part of the workout as an opportunity to raise the intensity to the appropriate place for the person you are working with. This can range anywhere from assisted (inclined) push-ups to free-weight chest press. Any kind of guided machine is NOT ideal for a person with anxiety, however. This is because body weight exercises and free weights enlist ‘stabilizer’ muscles that require the brain to process and learn to modulate in a more complex and ultimately effective way. Basically, the more stimulating the exercise is both physically and mentally, the more effective it can be for alleviating symptoms of anxiety. Time variations and range variations can also be an invaluable tool when seeking to increase physical and mental stimulation.
From this point a combination of strength and cardio to be determined by the client and trainer involved can be used, but with a few key points in mind for the trainer:
1. Be patient. Being patient is nothing new to a trainer, but for a client who struggles with overwhelming anxiety in their day-to-day, simply showing up may have been a challenge in-and-of itself, for a variety of reasons. The best way that you can help your client is to aid them in finding their comfort zone.
2. Be kind. It might seem to go without saying, but being kind is an absolute caveat when working with folks with anxiety. There is a time and a place for tough love, and generally speaking, this is not it. That being said, this person often does benefit from an assertive approach, especially when backed by logic and expertise.
3. Be consistent. Consistency is the life-blood of learning. Consistently providing a safe environment of fun, kindness, and patience allows people the opportunity to learn and grow exponentially.
4. Don’t forget to have fun. It may sound silly, but the reality is that by the time that you’re done being all the things listed above, you may very well need to do a check-in with yourself. It can be a challenge accommodating somebody who manages mental health issues, but I assure you, helping somebody face and overcome a hurdle like this will ultimately pay out dividends to both you and your client, often in ways that you may never see or know. So smile! Be happy! It’s why we got into this business in the first place.
Clayton Taylor trains at Tri Valley Trainer in Pleasanton, CA. He holds a BA in Psychology from San Francisco State University and is certified with the National Academy of Sports Medicine.
Harvard Medical School, 2007. National Comorbidity Survey (NCS). (2017, August 21). Retrieved from https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 1: Lifetime prevalence DSM-IV/WMH-CIDI disorders by sex and cohort.
Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):617-27. PMID: 15939839