Chapter 28: Exercise, Mental Health, and Lifestyle Considerations

There is a reciprocal relationship between mental health, a positive healthy lifestyle, and exercise. In addition to exercise and fitness training, fitness professionals can deliver coaching toward healthy lifestyle practices, which can be highly beneficial for clients.

The effects of such habits as proper exercise, nutrition, and other wellness practices can result in mental and emotional health improvements.

As with all other aspects of personal training, fitness professionals must be aware of the limits of their scope of practice when it comes to mental health and lifestyle coaching.

Introduction to Exercise, Mental Health, and Lifestyle Considerations

The role of a personal trainer can be broad as the trainer guides a client to a myriad of improvements in all health and wellness pillars. The benefits of the personal trainer’s guidance include enhanced quality of life for the client through improved physical condition and fitness levels.

This in turn affects overall physical health but can include facilitating greater confidence, a more positive outlook, and improved mental and emotional health based on reaching new fitness peaks  

These holistic improvements can be achieved through the trainer’s coaching the client to adopt healthy lifestyle habits, including the following:

  • Getting enough quality sleep
  • Hydrating adequately
  • Practicing good nutrition habits
  • Managing stress
  • Limiting alcohol
  • Quitting smoking

For coaching clients to improve their lifestyle habits, personal and in-depth discussions and analysis of the client’s current lifestyle practices must take place. 

These discussions are more readily accomplished when a high level of trust is established between the client and the personal trainer, which precipitates greater compliance with the coaching.

However, with such a level of trust, the definitive line marking the scope of practice boundaries of a personal trainer can become hazy and a client’s expectations can exceed the scope of practice limitations.

It is not uncommon for a client to perceive their personal trainer as their professional mental health counselor, encroaching into the scope of practice for a licensed mental health professional.  

Providing services outside the scope of practice can result in a personal trainer losing their accreditation or even may result in expensive legal action against the trainer.1, 2, 3 

holistic-lifestyle-practices

The boundaries of the professional scope of practice for a personal trainer must be maintained, yet it is the personal trainer’s responsibility to decipher what might be an overstep into a licensed health professional’s scope of practice. 

To be careful not to overstep the boundaries of other licensed professional domains, the personal trainer should not:

  • Counsel or advise
  • Diagnose
  • Attempt to heal disease or treat/rehabilitate an injury
  • Prescribe medication, supplements, dietary plans, or other approaches to prevent, treat, or cure any disease

The personal trainer can avoid the legal liabilities by remembering that they serve as a guide or facilitator, helping the client reach their own conclusions and helping them problem solve versus problem-solving for them.

Lifestyle coaching should be a client-led collaborative process that guides the client to analyze, think, plan, set goals and work towards them.   

To guide a client, a personal trainer would be wise to practice coaching techniques which include active listening, reflective listening, and motivational interviewing, which is not unlike the practice of a counselor. However, a personal trainer should not directly advise a client on how to handle problems or manage the personal aspects of their lives.

The trainer should exhibit empathy and compassion, impart no judgment when listening to a client express their concerns or daily experiences, and acknowledge the client’s feelings expressed. However, a personal trainer will be outside their professional scope of practice if he or she provides counsel.   

The personal trainer can be an educator of evidence-based strategies and techniques for improved fitness, health and wellness, mental well-being, confidence, self-improvement, and empowerment.

Sharing quality resources from evidence-based sites and publications is one way to begin exposing clients to new information that may inform their decision making. Allowing the client to be the decision maker in the collaborative process will be best for the client’s chances for success.

Counseling Referrals

If a personal trainer perceives that a client needs professional counseling, a referral should be made to a licensed counselor, psychologist, psychiatrist, or social worker in a non-insulting and nonjudgmental manner.

The statements above refer to common venting on personal issues from a client who perceives the trainer as a confidant. However, If the situation seems extreme and/or if there is any indication that the client is in danger of harming themselves or others, a direct question regarding their intentions for harm should be asked. If the answer affirms such intentions, emergency personnel should be contacted. A suicide hotline should be contacted if self-harm is intended.

Similarly, when coaching or training a client with the adoption of healthy nutrition habits, the personal trainer must not infringe on the scope of practice of a registered dietitian. The personal trainer should not recommend specific diet plans or quantities of nutrients nor should they offer advice on supplementation. However, they can help the client track food intake and educate them on evidence-based healthy nutrition plans and portion control, provide quality science-backed resources, and help the client analyze and determine healthier choices.2   

Likewise, as a personal trainer instructs a client on exercise and designs an effective exercise plan, they must not infringe on the scope of practice of a physical therapist, medical doctor, or another licensed practitioner.

The personal trainer cannot decide whether it is safe for the client to exercise and must refer the client to an appropriate licensed professional if they suspect the client may have an issue that makes exercise unsafe.

In summary, it is the personal trainer’s responsibility to respect the boundaries between them and licensed professionals in all overlapping fields.

There is a risk for liability if a personal trainer’s action could be in any way construed to have contributed to any harm to a client, but any actions that can be interpreted as operating beyond the scope of practice of a personal trainer can be cause for legal action.

The Benefits of Physical Activity on Mental Health

Good mental health is often determined by self-reports of positive moods, resilience, a lack of any significant or consistent anxiety or depressive symptoms and the ability to regulate emotions.

In an era with high incidence of mental health issues, many health professionals and affected individuals are searching for all avenues to assist in improving mental health.4 

Many studies link exercise and consistent physical activity with better mental health and even more studies are being conducted on this topic every year.  

In one such study with a large test group of 1.2 million American adults, it was recorded that those who exercised regularly exhibited better mental health than those who did not, taking in account other factors such as background and demographics.5 

In one of the many meta-analyses, researchers found a correlation between exercise and positive mental effects for those with mental health disorders, as well as those without. These effects were most evident in those who had exhibited higher levels of anxiety and depression.6

In this review, the findings concluded that regular rhythmic moderate or low intensity aerobic exercises delivered the most improvements. In some case improvements in anxiety and depression were evident after just one bout of exercise of 15-30 minutes in duration.6 

According to another meta-analysis on the prevention of anxiety and depression, more than over 80,000 participants across multiple studies showed that participating consistently in physical activity reduced the chance of suffering higher anxiety levels or developing an anxiety disorder.7

On the other hand, lower activity levels correlated with greater risks of less-than-optimal mental health.

Another study review including more than 250,000 people across 49 studies showed that consistently participating in more physical activity reduced the chance of suffering from depression.8 

As for improvements in the mental health of those who suffer from more severe mental health disorders, research concludes that marked symptoms such as adverse moods, difficulties with focus and concentration, dysfunctional sleep habits and other symptoms of psychosis improve with physical activity and exercise.9

Personal trainers assist their clients not only with improving their physical health, but also their mental health and well-being, which then, affects every aspect of their lives.

How to Maximize the Mental Health Benefits of Exercise

  • Encourage clients to exercise outdoors. Time spent in nature was also proven to provide mental health benefits, so combining the two may provide a double boost.12   
  • Have clients choose activities they like for exercise/physical activity.
  • Let clients choose several short bouts of exercise in a day versus one long one if the single workout seems daunting. It was proven that several 10-minute bouts were as effective as a 30 minutes single session.13
  • Encourage clients to take rest days and listen to their bodies. Exercise can become a dreaded chore when it creates excessive stress. 
  • Encourage small celebrations after activities using positive language and expressions. The feelings that result from a mini-celebration give a boost of dopamine that fosters the desire to repeat the activity that brought about such feelings.14
  • Listen to enjoyable music during exercise. Studies prove music decreases stress and boosts positive feelings.15
  • Practice mindfulness (for example, notice the birds or the plants on a walk or jog outdoors, listen for the sounds around when taking a swim.)  Attune all senses to the experience.26

Helping Clients Identify and Practice Healthy Behaviors and Lifestyle Habits for Better Mental and Wellbeing

Clients can often make great leaps in their health and fitness goals once they adopt healthier lifestyle habits. Trainers can facilitate these changes in all lifestyle pillars. There are many studies supporting this potential for boosting mental health, moods, cognitive functioning, and more when improving these four lifestyle habits.

Hydration

Some clients may not recognize the correlation between hydration and mental health, so it is essential to educate them on the need for water intake and the many benefits it bestows to both physical and mental health.  

One study revealed that drinking less than 2 glasses of water every day more than doubled the risk of depression for women and increased the risk by more than 70% in men.16

Additionally, links between obesity, metabolic disorder, and inadequate water consumption have been established which feeds into the mental health aspect, as those with obesity and other health issues have higher rates of depression as well.17

There is growing evidence that lack of adequate water consumption is linked with mental health disorders.16 Research suggests even slight dehydration adversely affects mood and the perception of the difficulty of a task for women.18 Likewise, a study on healthy young men showed a decrease in alertness and memory and increased feelings of fatigue and anxiety when moderately dehydrated.19  

The first objective as a trainer and coach could be to help the client identify his or her current hydration habits by tracking them daily, then setting goals to increase the amount of water they drink in the day.

Awareness of inadequate hydration often prompts extra efforts and tracking can provide both accountability and awareness.

Examples for a trainer to follow could include having the client determine a small goal of increasing his or her water consumption and then having them problem-solve as to what they can employ to prompt the behavior throughout the day.

If they can’t think of solutions, the trainer could provide a list of suggestions and let them choose. They might put a sticky note on their desk and check off tally marks, they may fill up a water glass when they get coffee in the morning and then do it again each time they get up to use the restroom.

They may buy an attractive new water jug and keep it in a prominent place. The trainer can start the list of suggestions to get them thinking and then ask them to finish it. The idea is for them to come up with what might inspire them to maintain adequate hydration.

Sleep

Adequate sleep is another healthy habit that should not be ignored for improving both physical and mental functioning and health. It is, therefore, imperative when working with a client to discuss their sleep patterns and educate them on the evidence-based value of 7-9 hours of quality sleep each night.

Helping a client to identify their current sleep patterns by tracking and analyzing them, and then strategizing on ways to improve these patterns where necessary can greatly improve their rate of success in reaching health, fitness, and wellness goals.

It is reported that one-third of US adults report getting less than 7-9 hours of sleep as recommended by the CDC.20 Without adequate sleep, both physical performance and mental performance decline. Psychological distress is increased, showing up in the form of anxiety and depression, low moods and agitation, low energy, fatigue, and even cognitive decline and memory issues.21

Both short sleep duration and poor quality of sleep have associations with depression.21 One study of over 28,000 people concluded that mental health was negatively affected by both inadequate quantity and poor quality of sleep.21

Earlier, researchers in the US found that inadequate sleep duration (less than 7-9 hours per night) and sleep problems within the duration were linked with higher levels of clinical depression.22

It has even been observed that individuals averaging 6 or fewer hours of sleep per night were approximately 2.5 times more likely to experience frequent mental distress than the participants who sleep consistently more than 6 hours.20

As with hydration, having clients track to become aware of their current patterns can often inspire more adherence to the recommendations. Tracking can be done simply with pen and paper logging bedtime and wake-up time and any waking throughout the night. Many apps are also available for smartphones and smartwatches and fitness trackers can track sleep time, as well as the quality of sleep.

the-effects-of-lack-of-sleep

Exercise can often be a remedy for sleep problems for those who have trouble getting to sleep or staying asleep, but if sleep problems persist, collaborate problem-solving with clients regarding other lifestyle changes such as stopping screen time in the evening, eliminating caffeine or alcohol, taking an evening walk, meditating, listening to calming music and other strategies can be tried.

As always, let the decision-making of strategies be client-led. The personal trainer simply facilitates problem solving with open-ended questions and active listening. 

If sleep problems persist, a referral to a sleep specialist or counselor should be made.

Nutrition

Good nutrition habits can result in more energy and vigor, healthy digestion, greater focus and alertness, improved moods, greater exercise and sports performance, better mental health, cognitive functioning, and more. In short, good nutrition can affect all bodily functions and is instrumental to overall good health and wellness.

As a personal trainer, providing evidence-based resources on healthy nutrition plans is expected, however, as in the previous segment on mental health, it is the responsibility of the trainer to not overstep the boundaries of the personal trainer’s scope of practice. 

The role of a personal trainer is to both help their clients identify and practice the recommendations for consuming a balanced diet consisting of health-promoting nutrients and to share quality science-backed resources.

Alcohol limitation and Smoking Cessation

It would be rare to find a client who does not already know that smoking is an unhealthy habit or that drinking too often or too much is also not good for your physical or mental health either.

Although there are personal trainer scope of practice limitations when it comes to counseling, fitness professionals can be a source of guidance and support for clients wanting to stop smoking or those who want to refrain from drinking excessively.

Smoking Cessation

As for smoking cessation, according to a report by the CDC, about 70% of adult smokers have proclaimed they want to quit, yet only about 1 out of 10 successfully quit each year.24  

Dependence on tobacco often takes strong intervention and several tries before success.

With those track records, a personal trainer should consider referring the client to a smoking cessation practitioner who is highly trained in this specific area and works diligently with the latest evidence-based practices. The personal trainer can continue supporting the client at the same time.

One of the many resources available to share with clients who want to quit is a government “quit line” provided by the CDC which uses evidence-based practices and can be called 24 hours per day. 

English: 1-800-QUIT-NOW (1-800-784-8669)

Spanish, 1-855-385-3569.

Mandarin & Cantonese: 1-800-838-8917

Vietnamese: 1-800-778-8440

State Quit-Lines can be found at map.naquitline.org Visit www.cdc.gov/tobacco/campaign/tips/quit-smoking for additional resources to share. 

Additionally, nicotine replacement medications such as the patch, nicotine gum and nicotine lozenges can be helpful. Although a personal trainer would not be in the scope of practice to prescribe or recommend a product, they can learn more about these to answer questions and send the client to the websites that educate on the details including recommended dosage and duration of use. 

Motivational interviewing techniques common in health coaching and behavior change guidance techniques are again, a great way to allow the client to fully engage and make decisions. These techniques keep the trainer or coach within the scope of practice by supporting and facilitating, not advising.

Limiting Alcohol Consumption

Educating a client on the risks and the adverse effects on physical health and mental health of drinking too much or too often is certainly within the scope and helping a client track, analyze and define their current drinking habits are as well.

Assist the client in identifying their true perspectives about their habits along with setting goals first. The client must also take note of the triggers that prompt excessive drinking and brainstorm solutions for avoiding or countering them. Finding replacement behaviors is another task for the client. Again, the client is the one solving the complex problem and the personal trainer cannot give advice.   

Since drinking heavily can be a sign of an addiction, recommending a counselor, a mental health professional or even a rehabilitative treatment program is usually the best choice. This needs to be done tactfully and without judgment. 

When allowing the client to explore their present habits, goals, and the barriers to achieving them with open ended questioning, the client might come up with this need for treatment on their own.

reducing-alcohol-consumption

Strategies for Trainers to Encourage Healthy Lifestyles

The following is a list of a few practical tips for fitness professionals to encourage healthy lifestyles in their clients:

  • Model healthy behaviors to help inspire clients to adopt such habits.
  • Share resources where healthy lifestyles are modeled and the rewards of those lifestyles are visible, which provides a subliminal message that encourages others to make healthy choices.
  • Hold the client accountable while utilizing positive approaches.
  • Acknowledge and celebrate the small wins to encourage continued efforts.
  • Provide positive yet sincere affirmations encouraging clients to scaffold one small win onto another.
  • Encourage clients to set goals small enough to be reached but big enough to be satisfying, and then build on their success once each small goal is reached.

Summary

The role of the fitness professional includes guiding clients towards improvements in all health and wellness pillars. Just as exercise creates better physical and mental well-being, further health and wellness improvements such as proper sleep, hydration, and better nutritional choices can drastically improve health and fitness outcomes.

Additional lifestyle habits include limiting the use of substances like cigarettes and alcohol, which is something fitness professionals can discuss with clients.

In all cases of behavioral and lifestyle coaching, it is imperative that fitness professionals stay within the Trainer Academy Certified Personal Trainer Scope of Practice.

References

  1. Herbert, D.L., JD, Services of a Personal Trainer are Not Medical in Nature, THE EXERCISE, SPORTS AND SPORTS MEDICINE STANDARDS & MALPRACTICE REPORTER, Vol. 3, No. 5 (September, 2014):74, 75.
  2. Sass C, Eickhoff -Shemek JM, Manore MM, Kruskall, LJ. Crossing the line: understanding the scope of practice between registered dietitians and health/fitness professionals. ACSM Health Fitness J. 07; 11(3): 12-19.
  3. Melton DI, Katula JA, Mustian KM. The current state of personal training: an industry perspective of personal trainers in a small Southeast community. J Strength Cond Res. 2008 May;22(3):883-9. https://doi.org/10.1519/JSC.0b013e3181660dab. PMID: 18438226; PMCID: PMC4021014.
  4. World Mental Health Report: Transforming mental health for hall. Executive summary. Geneva: World Health Organization; 2022. License: CC BY-NC-SA 3.0 IGO.
  1. Chekroud SR, Gueorguieva R, Zheutlin AB, et al. 2018. Association between physical exercise and mental health in 1.2 million individuals in the USA between 2011 and 2015: a cross-sectional study. Lancet Psychiatry 5:739–46 
  2. Guszkowska M. Wpływ ćwiczeń fizycznych na poziom leku i depresji oraz stany nastroju [Effects of exercise on anxiety, depression, and mood]. Psychiatr Pol. 2004 Jul-Aug;38(4):611-20. Polish. PMID: 15518309
  3. McDowell CP, Dishman RK, Gordon BR, Herring MP. 2019. Physical activity and anxiety: a systematic review and meta-analysis of prospective cohort studies. Am. J. Prev. Med 57:545–56 [PubMed] [Google Scholar]
  4. Schuch FB, Vancampfort D, Firth J, et al. 2018. Physical activity and incident depression: a meta-analysis of prospective cohort studies. Am. J. Psychiatry 175:631–48
  5. Alexandratos K, Barnett F, Thomas Y (2012) The impact of exercise on the mental health and quality of life of people with severe mental illness: a critical review. British Journal of Occupational Therapy, 75(2), 48-60. https://doi.org/10.4276/030802212X13286281650956
  6. Fischer S, Cleare AJ. Cortisol as a predictor of psychological therapy response in anxiety disorders-Systematic review and meta-analysis. J Anxiety Disord. 2017 Apr;47:60-68. https://doi.org/10.1016/j.janxdis.2017.02.007. Epub 2017 Feb 24. PMID: 28273494.
  7. Ng JS, Chin KY. Potential mechanisms linking psychological stress to bone health. Int J Med Sci. 2021 Jan 1;18(3):604-614. https://doi.org/10.7150/ijms.50680. PMID: 33437195; PMCID: PMC7797546.
  8. Zhang X, Zhang Y, Yun J, Yao W. A systematic review of the anxiety-alleviation benefits of exposure to the natural environment. Rev Environ Health. 2022 Mar 24. https://doi.org/10.1515/reveh-2021-0157. PMID: 35334194.
  9. Sharma A, Madaan V, Petty FD. Exercise for mental health. Prim Care Companion J Clin Psychiatry. 2006;8(2):106. doi: 10.4088/pcc.v08n0208a. PMID: 16862239; PMCID: PMC1470658.
  10. Fogg,BJ. (2020). Tiny Habits: The Small Changes That Change Everything. Boston, Houghton Mifflin Harcourt,
  11. Koelsch S, Fuermetz J, Sack U, Bauer K, Hohenadel M, Wiegel M, Kaisers UX, Heinke W. Effects of Music Listening on Cortisol Levels and Propofol Consumption during Spinal Anesthesia. Front Psychol. 2011 Apr 5;2:58. https://doi.org/10.3389/fpsyg.2011.00058. PMID: 21716581; PMCID: PMC3110826.
  12. Haghighatdoost F, Feizi A, Esmaillzadeh A, Rashidi-Pourfard N, Keshteli AH, Roohafza H, Adibi P. Drinking plain water is associated with decreased risk of depression and anxiety in adults: Results from a large cross-sectional study. World J Psychiatry. 2018 Sep 20;8(3):88-96. https://doi.org/10.5498/wjp.v8.i3.88. PMID: 30254979; PMCID: PMC6147771.
  13. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW,   Zitman FG. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010; 67:220–229. [PubMed] Lawrence E. Armstrong, Matthew S.
  14. Ganio, Douglas J. Casa, Elaine C. Lee, Brendon P. McDermott, Jennifer F. Klau, Liliana Jimenez, Laurent Le Bellego, Emmanuel Chevillotte, Harris R. Lieberman, Mild Dehydration Affects Mood in Healthy Young Women, The Journal of Nutrition, Volume 142, Issue 2, February 2012, Pages 382–388, https://doi.org/10.3945/jn.111.142000
  15. Ganio,M., Armstrong, L., Casa, D., McDermott, B., Lee, E., Yamamoto, L., . . . Lieberman, H. (2011). Mild dehydration impairs cognitive performance and mood of men. British Journal of Nutrition, 106(10), 1535-1543. https://doi.org/10.1017/S0007114511002005
  16. Blackwelder A, Hoskins M, Huber L. Effect of Inadequate Sleep on Frequent Mental Distress. Prev Chronic Dis 2021;18:200573. DOI: http://dx.doi.org/10.5888/pcd18.200573
  17. Jiang J, Li Y, Mao Z, Wang F, Huo W, Liu R, Zhang H, Tian Z, Liu X, Zhang X, Tu R, Qian X, Liu X, Luo Z, Bie R, Wang C. Abnormal night sleep duration and poor sleep quality are independently and combinedly associated with elevated depressive symptoms in Chinese rural adults: Henan Rural Cohort. Sleep Med. 2020 Jun;70:71-78. https://doi.org/10.1016/j.sleep.2019.10.022. Epub 2019 Dec 16. PMID: 32229420.
  18. Chunnan L, Shaomei S, Wannian L. The association between sleep and depressive symptoms in US adults: data from the NHANES (2007-2014). Epidemiol Psychiatr Sci. 2022 Sep 8;31:e63. https://doi.org/10.1017/S2045796022000452. PMID: 36073029.
  19. MyPlate. www.ChooseMyPlate.gov. Accessed 13 June 2022
  20. U.S. Department of Health and Human Services. Smoking Cessation. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020. https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf [PDF – 9.8 MB]
  21.  https://www.cdc.gov/tobacco/campaign/tips/quit-smoking/index.html
  22. Keng SL, Smoski MJ, Robins CJ. Effects of mindfulness on psychological health: a review of empirical studies. Clin Psychol Rev. 2011;31(6):1041-1056. https://doi.org/10.1016/j.cpr.2011.04.006

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