Fitness professionals have a unique opportunity to not only support and mentor their clients on their journey to improve their fitness, but to speak to their clients’ more general health and wellness goals. Clients may talk with you about how they are travelling more broadly in the world and share things about their relationships, their workplace highs and lows, and/or their mental health concerns. Understanding the latter is particularly vital for fitness professionals. This article offers insights to develop your understanding of mental health concerns and to help you support your clients who may be grappling with them.
According to statistics from Beyond Blue, almost a third of people in Australia will experience an anxiety condition in their lifetime, and one in seven people will experience depression in their lifetime. Overall, one in five people in Australia have experienced some sort of mental health challenge in the past 12 months. These statistics confirm that mental health challenges are very real and very common. Based on these statistics, a portion of your clients have had, currently have, or will have some form of mental health concern in their lifetime.
The fact that you are a ‘helping professional’ makes the relationships that you have with your clients unique and important. You might be the only person outside of your clients’ immediate circle of family and friends who sees them on a regular basis. This presents a unique opportunity for you to support them. But, as you’ve probably heard many times before, it’s important to set boundaries. When your support for a client ventures from their specific fitness goals into the area of how they are travelling with their mental health, it’s important to know how you might be helpful, while still adhering to your scope of practice.
Before delving into how best to support a client who is struggling with their mental health, it’s important to understand how mental health issues are defined.
Like many things, mental health struggles are dimensional. On one end of the dimension, there are mental health issues that would qualify as ‘diagnosable’ by the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association.
The DSM (currently in its 5th edition) is used internationally by doctors and psychologists to diagnose mental disorders. The DSM-5 lists characteristics and criteria for a wide range of disorders including anxiety, depression, personality disorders, eating disorders, neurocognitive disorders, obsessive compulsive disorders, schizophrenia, substance-related or addictive disorders and more.
In the category of anxiety, for instance, it outlines the diagnostic criteria for panic disorder, social phobia, PTSD, and generalised anxiety disorder. Health professionals use these criteria to firstly diagnose, and then recommend treatment options. Of course, this is NOT the level of diagnosis that is applicable to fitness professionals. It is, however, important to understand that this may be the way someone is assessed by a health professional.
At the other end of the dimension are mental health struggles that do not fit these diagnosable criteria but are still impacting someone’s life. For example, someone may not fit the criteria for generalised anxiety disorder, but still find themselves feeling anxious at times. During these times, they may find themselves self-medicating with alcohol or drugs, eating or exercising more or less frequently, having trouble concentrating at work, feeling unsettled about relationships, or doubting themselves more. This is where having a general understanding of mental health issues is important. If you, as a fitness professional are attuned to these types of symptoms, you may be able to gently encourage your client to seek additional support.
For the purpose of this article, I will focus on the two mental health concerns that are most prevalent: anxiety and depression. It is beyond the scope of this article to go into each of the possible mental health concerns that you may come across as a fitness professional, but hopefully you can use these guidelines to help encourage your client to seek additional support.
It’s good to have a bit of an informal ‘checklist’ that helps you assess if your client might be struggling with their mental health. One of the best ways to formulate this is to use the valuable resources provided by Beyond Blue and the Black Dog Institute. Both have excellent resource banks and online assessment tools that you can use, to familiarise yourself with the signs and symptoms of the most common mental health concerns.
For example, Beyond Blue lists the signs and symptoms of anxiety as:
As you can see, there are a few overlapping symptoms between anxiety and depression. Remember, it’s not your job to diagnose which one it is. But it is your job to be aware of these symptoms, and if you feel your client may be struggling, to encourage them to seek additional support.
Another valuable tool is the Online Clinic provided by the Black Dog Institute. The Online Clinic is a questionnaire that takes you through a range of clinical assessments and gives you a personalised report of whether you may be struggling with a mental health concern. It also includes suggested support services and free or low-cost resources to access.
Important: the Online Clinic is not a substitute for professional advice, but it’s a great starting point to assess whether there is a mental health concern that merits further attention. If you are committed to understanding how mental health concerns are assessed, it can be very informative to do the questionnaire yourself, taking on board the types of questions that are being asked. You can then recommend the Online Clinic to your clients who might be struggling with their mental health.
Remember, not everyone who struggles with their mental health is aware that how they are feeling might be caused by anxiety or depression. These terms have been stigmatised in some circles making some people shy away from admitting how they are feeling. Therefore, it’s important to go gently and carefully as you talk with your client about how they are travelling. However, it’s also important not to shy away from checking in on the mental wellbeing of your clients.
The first rule of thumb is to ask open-ended questions. An open-ended question is one that cannot be answered with a “yes” or “no” answer. They normally start with words such as “how…” or “what…” or “tell me about…”. For example, instead of asking “are you feeling okay?” ask “how are you feeling today?” Give your client time and space to answer and be attuned to them; listening for signs that they may be struggling. If you are sensing some markers that point to a possible mental health concern, you can say something like, “that sounds really hard, how are you coping with _________” (insert not sleeping, feeling so tired, feeling overwhelmed, etc).
If they say they don’t feel like they are coping well, then a more direct approach would be to say something like, “I’m really concerned about you. What are you doing to support yourself during this time?” They may share that they have a strong network of friends and family who they turn to for support or they may say they don’t know. If it’s the latter, you can then ask if they have thought about talking to a professional about what’s going on. This may be the small nudge that helps them consider getting additional support.
It can be very helpful to develop your own network of counsellors, psychotherapists, psychologists, and/or doctors whom you know and respect. It can also be useful to have handouts available with their names, contact info and links to further resources. If you don’t want to make your own, you can find myriad resources for both professionals and consumers on the Black Dog Institute and Beyond Blue websites. Of course, there are other excellent organisations that support people with mental health concerns. You can find a comprehensive list here.
One of the most important elements when supporting a client who is struggling with their mental health is to meet them where they are. For example, sometimes, a client might want to be pushed hard in a session to help them feel as if they have challenged themselves, leading to a sense of feeling better about themselves and their mental health. At other times, a client might want to ease off on the push and do lower intensity work that reconnects them to their body in a gentler way. Either way, asking the client how they are feeling and what they need – giving them permission to choose any intensity – is what is most important. This signals to them that you are interested in meeting them where they are, and that you know that all different exercise modes and intensities can deliver equal benefits.
Encouraging slow, deep breathing is also a vital part of helping a client regulate their sympathetic nervous system, which may be in overdrive when they are struggling with their mental health. Whether the symptom is feeling anxious or feeling low, both states can lead to a physiological overload. Slow deep breathing is a tonic to an overworking system; giving the body a chance to self-regulate.
At the start of the workout, you could incorporate a small ‘body-check’ where you ask your client to close their eyes, take 10 slow, deep breaths while noticing any sensations in their body. They might recognise things like feeling tight, tense, ‘wound-up’, tired, open, or light. Accept whatever they notice while you give them time to breath. Use this information to tailor your next steps; determining the intensity of the workout, adding more stretch breaks, incorporating some yoga movements, or inviting more challenge. Be mindful of what your client notices and repeat the 10 deep breath exercise at the end of the session, to give them time to notice how the exercise has changed how they feel. You can then encourage them to use the ’10 deep breath exercise’ throughout their day.
There are two things that you are doing when you work with clients who have mental health struggles. The first is that you are providing a meaningful relationship with them as a ‘skilled helper’ who cares about how they are travelling. People develop mental health struggles when relationships in their world are not safe and supportive. As a contrast, being a calm, supportive, encouraging presence in their life can be very meaningful. This does NOT mean that you become their best friend, become overly responsible for their wellbeing, or get overly involved in their care. It’s very important for your own mental health that you remember that it is not your responsibility to solve their problems. Your responsibility is to help them monitor how they are travelling, and encourage them to get additional support.
The second thing you are doing is providing technical expertise around what exercise is best for your client given how they are feeling. We know that exercise can be a tonic to the soul, and it is widely proven to improve mood disorders. You can read an excellent research article about that here. As a fitness professional, you have a unique and valuable opportunity to encourage your client to use the power of exercise as a part of their toolkit to help them feel mentally well. Remember, it does not have to be intense exercise. All forms of exercise can be beneficial for your clients who are struggling.
Kate has been personally training her client Mark for more than two years. Mark has been enthusiastic about his training and dedicated to attending his sessions each week. One week, Mark arrives to his session a little late, complaining of not sleeping well and being a bit preoccupied with work. Kate gently asks Mark to say a bit more about not sleeping well, trying to assess if this is something new. Mark says that he hasn’t really been sleeping well for the past two weeks since there has been a restructure at work. He also shares that he has been finding it hard to concentrate and is feeling tired all the time. Kate begins to wonder if Mark might be anxious or depressed. She asks Mark how he’s doing more generally to see if he shares anything else. Mark says he just wants to get on with his training. Kate respectfully asks if he’d like a slightly lighter session or if he feels like he wants to push himself. Mark, with a sigh of relief, says a slightly lighter session might be good. Kate makes a mental note of what Mark has shared and decides to check in with him the following week to see if he is sleeping better and feeling more himself.
The following week, Kate asked Mark how he had been travelling and he said that it had been another tough week. He said that he’d been staying home a lot, didn’t feel like socialising, was not getting to sleep until after midnight and was still having trouble concentrating at work. Kate felt sure that something was not right with Mark’s mental health and so asked him how he felt he was coping. Mark replied that he really wasn’t coping at all. Kate then asked if he thought it might be helpful to talk to someone. She said she knew of a good counsellor in the area and asked Mark if he would like her contact details. Mark politely declined, at which point Kate suggested he might do the Black Dog’s Online Clinic questionnaire to get a measure on what he was experiencing. Mark said that he was okay with doing that and Kate agreed to send him the link. Kate made a mental note to check in with Mark the following week to see whether he followed up. Kate then suggested that Mark do a ’10 deep breath’ exercise before deciding what kind of training session he felt up to and they proceeded with the session.
After the session, Kate repeated the ’10 deep breath’ exercise and suggested that Mark use it throughout his day to check in with how he was feeling and help regulate his stress levels.
Not only are depression and anxiety prominent in Australia, but the additional stressors of the COVID-19 pandemic, racial injustice, war and unrest in the world and climate change are all contributing to a rise in mental health struggles. Being a mindful fitness professional means being aware of the signs and symptoms, not shying away from asking how your client is travelling, asking open-ended questions to learn more, and encouraging them to seek additional support and having good referral sources available.
Lisa is a psychotherapist in private practice in Pyrmont NSW where she works with individuals, couples and athletes. Before her career switch to psychotherapy, Lisa was actively involved in the Australian fitness industry for more than 30 years, as Director of Australian Fitness Network and as an international presenter, author, and trainer of trainers. In 2016, Lisa won a Lifetime Achievement Award for her contribution to the Australian fitness industry. A self-described lifelong learner, she is currently pursuing her PhD in psychotherapy.