Mental Barriers to Exercise Adherence
Exercise is challenging, no question about it. People who have spent years leading a sedentary lifestyle cannot expect to strengthen muscles, make new demands on the heart and lungs, lose weight, and reach performance goals in just a few weeks. However, it will not take a great deal of time to feel better and adjust to new physical demands they place on themselves. They simply need patience. Without it, they will quit. They will lack adherence, and this is exactly the problem with at least half the people who initiate exercise programs. Our high-achieving, impatient culture, made worse by personality traits such as negative perfectionism, high trait anxiety, and pessimism about the future, often does not allow us to set reasonable goals and to develop strategies to reach those goals.
Emotions, thoughts, and feelings drive behavior in one of two directions: positive, toward achieving success and developing a better, healthier, more energetic lifestyle, or negative, toward maintaining unhealthy habits, being overweight, lacking energy, and living a life inconsistent with one’s values about what is important. Improving a client’s lifestyle takes effort—and a plan. Health and fitness professionals need to revisit the client’s values, connect each value to a new routine that will create and maintain a more active lifestyle, and improve physical and mental health. Adherence to a program of regular exercise, the theme of this chapter, is of paramount importance in doing everything in our power to take control of our destiny. In the words of former British prime minister Sir Winston Churchill, “Continuous effort—not strength or intelligence—is the key to unlocking our potential" (qtd. in Cook, 1993).
A person’s decision to discontinue an exercise habit often has a psychological explanation. Here are some of the more common conditions that can lead to dropping out of an exercise program. Hopefully, health professionals can develop and apply effective responses to these excuses that will change the client’s mind about quitting.
Anxiety consists of feelings of worry or threat about the future, as discussed in chapter 5. Anxious thoughts cause worry and distract the exerciser from the task at hand—and waste energy. Sources of exercise anxiety include worry about meeting goals, physical appearance, being accepted by others (even strangers at a fitness club), and using time to exercise instead of doing something else (“I could be watching TV or finishing a report instead of going to the gym”). Ironically, exercise actually reduces both short-term (acute) and long-term (chronic) anxiety. Exercise is what the doctor ordered for improved mental health, including reduced anxiety (deMoor et al., 2006). Health professionals should strongly consider exercise as one behavioral strategy for helping their clients manage anxiety, particularly if clients are given social support in their new exercise program.
Most people experience unhappiness and negative emotions; this is normal. Ongoing, deeply negative mood states, however, may be a more serious mood disorder referred to as clinical depression (APA, 2000). Depression is a mood disorder that ranges from mild to severe and can be due to a medical condition, substance use, or psychopathology (mental illness). A sedentary lifestyle may induce or promote depression, but exercise has been shown to reduce it in over 70 studies across various age groups and for both genders (Leith, 1998).
One factor that influences the effect of exercise on depression is whether the person has selected and is enjoying the type of physical activity. A second factor is whether the exercise is of sufficient intensity, frequency, and duration to improve fitness outcomes and lead to psychological benefits. Taking a quiet, slow walk through the park, although pleasant and relaxing, may not be sufficient to reduce depression (Brosse, Sheets, Lett, and Blumenthal, 2002). Buckworth and Dishman (2002), in support of recommendations from ACSM, suggest the following exercise guidelines for people with depression who are otherwise healthy: three to five days a week (frequency) for 20 to 60 minutes each session (duration) at 55% to 90% of maximal heart rate (intensity). Certified fitness coaches should aim to meet these standards when prescribing exercise for depressed clients.
It is impossible to remain motivated and on task if self-talk is negative, such as, “I don’t like this,” “I feel terrible,” or “I’m tired.” Replacing those thoughts with positive statements that are optimistic and enthusiastic induces more effort and energy. Examples include, “I can do this,” “I feel good,” “Just three more minutes to go,” and “Hang in there.” To quote an anonymous writer, “You cannot be unhappy and enthusiastic at the same time.
”Negative and antagonistic feelings and emotions can impair the development of an exercise habit, especially for novice performers. The problem with negative thinking is that it results in low effort and sets up the individual to fail. This process is similar to the self-fulfilling prophecy; one’s performance level will be consistent with one’s expectations.
Examples of negative thinking that serve as barriers to exercise success include lack of confidence (e.g., “I don’t think I can do this”), intimidation (e.g., “I don’t belong in this fitness facility,” “People are laughing at me”), pessimism (e.g., “I’ll never lose weight,” “Exercise will never be enjoyable”), self-criticism (e.g., “I can’t run even one lap of that track, so why even try?”, “Exercise is not for me; I’ll always be weak”), impatience (e.g., “I’ve been exercising for three weeks and still run out of steam when jogging”), and irrational thinking (e.g., “I’ve always been heavy; why change now?”, “People just have to accept me the way I am,” “My spouse thinks my weight and appearance are just fine”).
There are several implications for health care professionals when it comes to addressing mental health. First, consultants should not attempt to diagnose or treat mental illness unless they are licensed psychologists or have other appropriate credentials related to this area. There are serious legal implications of providing treatment to a person who did not request it, was not diagnosed correctly, or did not receive the proper treatment. The key term that reflects the proper thing to do if mental illness is suspected is referral; that is, health care professionals must refer clients to a licensed mental health professional for diagnosis and treatment if mental illness, such as depression, chronic anxiety, or another condition, is suspected.
A second implication for dealing with psychological barriers to maintaining healthy habits, particularly related to exercise and nutrition, is the need to schedule meetings between the client and qualified health coaches, such as a certified personal trainer and a registered dietitian. Exercise and nutrition both influence mental health and should not be ignored when attempting to change client health behavior. Relationships with local experts in these areas should be established before referral in order to become familiar with the expert’s background, skills, location, types of services rendered, and personal qualities. Sometimes clients prefer a male or female coach or can meet the consultant only on certain days at certain times. It is essential that the health care professional try to coordinate the client’s needs and preferences with the coach’s characteristics.
Perfectionism is a trait reflecting a person’s disposition toward "setting excessively high standards of performance in conjunction with a tendency to make overly critical self-evaluations" (Frost, Marten, Lahart, and Rosenblate, 1990, p. 450). It is usually studied as a trait measure—stable and cross-situational—not a state (situational) measure (Antony and Swinson, 2009).
Perfectionism has both positive and negative features. The positive aspects of perfectionism include setting and attempting to achieve high personal standards, striving to achieve lofty but realistic goals often leading to success, and being conscientious and self-confident (Flett, Hewitt, Blankstein, and Mosher, 1991). Negative features, not uncommon among people who go overboard in attempting to achieve goals, include feeling deep concern about making mistakes, which leads to heightened anxiety; having doubts about one’s actions; setting excessively high standards; having difficulty recognizing success; and overemphasizing precision, neatness, order, and organization. People who fit these behavior and thought patterns are referred to by clinical psychologists as neurotic perfectionists. They have a propensity to engage in self-destructive behaviors, excessive self-criticism, failure to recognize achievement and competence, and feelings of “It’s not good enough” (Antony and Swinson, 2009; Adderholdt-Elliott, 1987).
Neurotic perfectionists set unattainable goals and might engage in overtraining or exercise addiction. Their self-talk is based on messages they received when they were young, reminding themselves that “It’s not good enough” and “I can do better.” Their expectations of others are also excessive. Perfectionists need to learn how to set reasonable goals and to recognize their own achievements and those of others, especially in exercise settings. They need to have indicators of success and to acknowledge when they have reached those indicators.
Implications for working with clients who reveal perfectionistic thinking include referral to a mental health professional so that its sources can be identified and treated. Perfectionism can play a role in attempts at self-improvement; however, when standards and goals are excessively high, when self-expectations for achievement are unrealistic, and when the person expects others to meet these same excessive standards, often at the expense of alienating others, then this condition becomes an obstacle to happiness, confidence, and mental health.
Another implication for working with perfectionistic clients is the need to help them set realistic but challenging goals that are measurable and observable, to help them detect times when they have met their performance expectations, and to verbally and directly recognize their accomplishments. One important strategy that validates positive feedback and gives the consultant credibility is to base feedback on numbers—perhaps fitness test results, blood test results, improved exercise performance (e.g., increased resistance in weight training, faster jogging times, reduced body-fat percentage), or some other measure that quantifies improved physical performance.
Finally, perfectionists often need to change their irrational thinking by being reminded of their accomplishments, favorably comparing their competence level with others, and being more realistic about their self-expectations. Perfectionism, particularly when excessive (also referred to by mental health professionals as irrational, maladaptive, or neurotic), has specific sources, such as parents, sport coaches, or teachers, and this may be pointed out as an issue that is nothing to be ashamed about and that might require professional consultation to address it.