Updated: Dec 27, 2019
Article published in American Fitness Magazine, Fall 2019:
In the gym, we expect to use our body’s full range of motion. In life, we’re entitled to a full range of emotions, too. Provided we’re able to express and manage our emotions appropriately, this is healthy. But for some people, emotions can affect health, well-being and self-care, including eating and exercising adherence and habits. One of the most common among these emotions is anxiety.
At this very moment, nearly 1 in 5 Americans is living with an anxiety disorder, according to the Anxiety and Depression Association of America. In fact, anxiety disorders are the most common mental health issue in the United States, affecting 40 million U.S. adults (ADAA n.d.). Given that statistic, there’s a good chance that fitness professionals will encounter clients, gym members and colleagues who are experiencing the effects of anxiety-related conditions.
Compassion and education are critical skills that can help fitness professionals be more accepting and understanding in working with these populations. It’s important that we understand how exercise can be helpful to people with anxiety, but it is equally important to understand the unique barriers and challenges that accompany anxiety so we can appropriately support our clients. The research in this article is intended to provide a basic understanding of anxiety and anxiety-related disorders and how to put that information to use, illuminating the role of exercise in diminishing the symptoms associated with anxiety, worry and stress.
SPOT THE SYMPTOMS OF GENERALIZED ANXIETY DISORDER
Women are twice as likely as men to be affected by generalized anxiety disorder (GAD), and GAD often occurs along with depression (ADAA n.d.). GAD affects the way we think and feel, but it can also lead to physical symptoms.
POSSIBLE SYMPTOMS OF GAD
a sense of fear or dread that is ongoing and interferes with daily functioning
worry that is exaggerated/excessive (disproportionate to the event or situation) and cannot be controlled
restlessness or nervousness
being irritable or feeling on edge
lack of focus or difficulty concentrating
being easily fatigued
muscle tension that may also include headaches, sweating and nausea
sleep disturbances, including difficulty falling or staying asleep, restlessness, or unsatisfying sleep
IMPORTANT ADDITIONAL CRITERIA
Excessive anxiety and worry about a number of events or activities must occur more days than not for at least 6 months.
At least three of the symptoms listed must be present for more days than not over the previous 6 months.
If these criteria and symptoms are present in a client or loved one, encourage the person to talk with a mental health professional or other healthcare professional right away.
EVERYDAY ANXIETY VERSUS ANXIETY DISORDERS
Knowing the difference between everyday anxiety and anxiety disorders can help fitness professionals understand what some of their clients are experiencing. According to the American Psychological Association (2019), anxiety is “characterized by feelings of tension, worried thoughts and physical changes.” People with anxiety often struggle with intrusive, unwanted, distressing thoughts, worries and concerns, and they may experience physical symptoms that include sweating, dizziness, increased heart rate and trembling.
Anxiety is among the many emotions we experience as we navigate life. We may fear an impending move or be troubled about a family member facing a difficult situation. We might get anxious about an upcoming review at work or an important certification exam. At some point, many of us will worry about health concerns (our own or those of a loved one), parenting challenges, career changes and financial stressors.
While we all feel anxious from time to time, our level of anxiety is relative to our tolerance for distress—and our perception of how well we believe we can manage the situation at hand. For some people, however, anxiety doesn’t feel manageable. It feels overwhelming. When worry, fear and uncomfortable thoughts and emotions don’t go away, get worse over time, or interfere with daily activities, job performance or relationships, it could be the sign of an anxiety disorder.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychological Association (2013), categorizes anxiety into different types of anxiety-related disorders. (The DSM-5 is the diagnostic handbook used by healthcare professionals in the United States and much of the world to define mental health disorders, listing symptoms and criteria to standardize care and consistency in diagnosis.) One of the most common anxiety-related disorders listed in the DSM-5 is generalized anxiety disorder (GAD), which affects 6.8 million adults, or 3.1% of the U.S. population (ADAA n.d.). See “Spot the Symptoms of GAD,” left, for more information.
ANXIETY DISORDERS: CAUSES AND TREATMENTS
According to the ADAA, anxiety disorders develop from a complex set of risk factors, including genetics, brain chemistry, personality and life events. Behavioral and lifestyle choices, serious medical conditions and chronic unrelenting stress can also increase a person’s risk of developing an anxiety disorder (ADAA n.d.).
It’s important to note that, just as it’s out of scope for fitness professionals to diagnose a physical medical problem, it’s not safe or recommended to diagnose a mental health disorder. However, being aware of the signs and symptoms can help us know when it’s time to recommend that a client seek guidance from a doctor or a licensed mental health professional, such as a counselor, psychologist or psychiatrist. This can be a tremendous help to clients because, though these mental health issues are highly treatable, only 36.9% of people who have them are receiving treatment (ADAA n.d.). By referring clients out, fitness professionals may be able to help them seek treatment and, ultimately, find relief.
Currently, effective treatments for anxiety disorders include conventional treatment options, alternative therapies and holistic approaches (see “Typical Treatments for Anxiety,” page 31). Among the holistic approaches, exercise has been suggested as a supplemental treatment for those with high anxiety sensitivity. For example, in a study conducted by Smits et al. (2008), participants with heightened levels of anxiety were randomly placed in a 2-week exercise intervention group, a 2-week exercise-plus-cognitive-restructuring intervention group or a control group. Both of the exercise groups showed significant anxiety reduction compared with the control group. (Interestingly, the addition of the cognitive component “did not facilitate the effects of the exercise intervention.”) While research into exercise and mental health—including anxiety and anxiety-related disorders—is still in its infancy, what follows is an overview of the encouraging research to date.
RESEARCH ON EXERCISE AND MENTAL HEALTH
As far back as 1988, research has demonstrated a positive correlation between physical activity and mental health. In data analyzed from four surveys involving 56,000 participants over 10 years, it was concluded that “physical activity is positively associated with good mental health” when mental health is defined as “positive mood, general well-being, and relatively infrequent symptoms of anxiety and depression.” Results were independent of socioeconomic status and involved both younger and older men and women (Stephens 1988).
Exercise may also have preventive benefits: The objective in a more recent study was to determine a link between regular physical activity and mental disorders, including anxiety, among adults in the United States. Regular physical activity was reportedly associated with a significant decrease in the occurrence of anxiety disorders (Goodwin 2003).
RESEARCH ON EXERCISE AND ANXIETY
A recent review of 49 studies evaluated exercise versus other treatment options as an intervention for treating symptoms of anxiety (Wipfli, Rethorst & Landers 2008). In these randomized controlled studies, results revealed greater reductions in anxiety among exercise groups than in groups receiving other forms of anxiety-reducing treatment. Reported benefits included
anxiety reduction in male and female participants of all ages and fitness levels, including those with anxiety disorders;
reduced anxiety in those who had both lower and heightened levels of anxiety; and
diminished anxiety after exercise regardless of intensity, duration or type of exercise.
Weinberg & Gould (2018) report that much of the research on exercise and anxiety is focused on redu