As a health and exercise professional, you know that exercise contributes to physical health, but what about mental health and well-being? While it’s common knowledge that people feel better when they move, what is the role of exercise in mental health and well-being? 

The answers to these multifaceted questions are complex, in part because of how we measure or use the terms exercise and mental health, which can have both positive and negative associations. Consider what exercise and mental health means to you, and then ask someone you coach or lead in fitness what it means to them. You'll likely uncover differences in how you define these commonly used terms, and these simple differences can complicate both understanding as well as communication. 

This article examines the multifaceted nature of mental health, what the research says about how exercise can impact mental health, and how to talk to your clients about this important topic without veering outside your scope of practice as a health and exercise professional.

What is Mental Health? 

Mental health is a state of well-being. It is so much more than the absence or presence of mental health conditions that come with a diagnosis or a billable code. Mental health contributes to how people make decisions, build relationships and influence the world around them. An individual’s mental health impacts how they cope with stress, relate to others and make behavior choices about physical activity, engage with friends, or use alcohol or drugs as a coping strategy. 

The recognition of the importance of mental health is not new. In 1949, an official mental health awareness month was established due to the increased number of veterans suffering from mental illnesses after returning from World War II. 

While early efforts focused on creating mental health awareness, this month was also a time to celebrate those who had recovered from a mental health crisis or substance use disorder. However, some have argued that the perception that mental health can be “cured” has created significant biases and challenges to helping individuals manage many mental health conditions, such as depression and anxiety, as well as feelings of stress. 

It is essential to note that mental health isn’t always a choice that can be made, and can be impacted by a wide range of physiological, environmental and social factors. Personal experiences such as financial insecurities, a family health crisis, or growing up without close emotional relationships can create ongoing mental health challenges. Likewise, being raised in an environment that expects nothing less than perfection, which can lead to fear of failure and poor self-worth, can also contribute negatively to mental health. Mental health challenges are not bound by demographics, geography, socioeconomics or gender. 

Not surprisingly, those fortunate to have been raised in secure, supportive environments tend to have better mental health, greater resilience and habits related to a healthy lifestyle, including exercise and social connectedness. 

While mental health has been an increasing concern over the past decade, the impact of the COVID-19 pandemic has drawn increased attention to the factors that impact mental health. One year after the pandemic, the reported number of anxiety and depression symptoms had quadrupled. Close to half of Americans report mental health issues, with more than 12 million adults reporting serious thoughts of suicide. Without clinical care or support, almost 11% of adults reported an alcohol use disorder, while 6.82% reported using illicit drugs.

The Connection Between Exercise and Mental Health

How does exercise fit into the mental health discussion? Why does having a regular exercise routine matter? Movement, although a physical action, is crucial to brain health, including memories and emotions. 

Movement increases the heart rate, increasing blood flow to the brain and providing oxygen and nutrients to build new neurons, or brain cells. These neurons help release chemical messengers such as dopamine, oxytocin, serotonin and endorphins (Figure 1). 

Figure 1. Chemical Messengers

These messengers are mighty and have many roles, including creating feelings of happiness, pleasure, relaxation, connection and accomplishment. They also help reduce physical and mental pain and improve one’s pain threshold. In addition to improving mental health, exercise helps reduce hormones such as cortisol that are byproducts of feeling stressed. 

In short, this is why simple actions such as taking a walk, lifting weights or dancing to some upbeat music can help reduce stress levels, improve sleep quality and increase one’s ability to handle adversity and the myriad challenges of life.

Recently, the important role of exercise in mental health was highlighted by a powerful new research review of nearly 100 studies that included more than 128,000 individuals. The researchers recommended that exercise should not only be included in the treatment prescriptions for depression and anxiety, but also as a first-line therapy consideration, even before pharmacological interventions, for individuals with appropriate-level symptoms.

To be clear, there are severe mental health conditions that have no correlation to exercise and are not the topic of this article. Individuals with these diseases, which includes schizophrenia, bipolar and associative personality disorders, are not the focus of this article. For many individuals, physical activity and exercise can be used successfully in combination with psychiatry and prescription medications for some of these mental health conditions.

How to Talk About the Mental Health–Exercise Connection With Your Clients

As a health and exercise professional, talking about mental health with your clients may seem outside your scope of practice, but educating them about the mental-health benefits of physical activity is not only within your scope, it is essential. Table 1 offers some ideas for how to engage with your clients about how they are feeling and perhaps uncover how their physical activity or other lifestyle habits might be impacting—positively or negatively—their mental health and well-being.

Asking these types of questions can serve multiple purposes, including to determine if referrals are needed. They also can be used to establish any goals that a client may have related to their happiness or subjective well-being. The idea of coaching for happiness or subjective well-being comes from positive psychology and is covered in detail in ACE’s Coaching Behavior Change book. Broadly speaking, most people would like to be happier, and the questions presented in Table 1 can help clients subjectively discuss their level of happiness or well-being. These questions address the four domains of happiness: the pleasant life, the engaged life, the meaningful life and the full life. 

Based on what is uncovered from these questions, the next step is to either make a referral or further assess specific areas such as stress, sleep or depression. ACE Certified Professionals have exclusive access to a list of recommended activities that increase happiness in each of the four domains mentioned above; this list can be downloaded from the link at the top of the page and shared with clients.

Table 1. Questions to Encourage Engagement

I would love to hear about the personal or work-related activities that you’ve been involved with recently. How much enjoyment do you get from these?

What gives your life a sense of purpose?

What things have you been doing that are meaningful to you?

How would you describe the connections you have with work, relationships and hobbies?

How would you describe your support system?

Thinking about the past three months, what can you tell me about your sleeping habits?

Over the past few months how often have you felt overwhelmed, overly stressed or sad?

How do you feel that exercise impacts your mood? Do you have any specific kind of workout that you enjoy more than others? Is there any specific type of workout that makes you feel more stressed?

How confident do you feel about tackling your personal or professional responsibilities?  

On a scale from 0 to 10, where 0 means not at all confident and 10 means the most confident, how confident do you feel about tackling personal responsibilities?

And why are you at a ________ and not a _____? (Be sure that the first number is higher than the second number; that way clients give more positive responses.)

How do you balance self-care with your responsibilities for family or work? What self-care activities do you enjoy the most? How have you been successful with regularly fitting in self-care activities?


Move More or Sit Less? 

Current levels of physical activity and exercise remain well below recommendations, with less than 25% of Americans meeting the general guidelines of 150 minutes of moderate- to-vigorous physical activity per week. Unlike many areas of fitness and exercise, physical-activity recommendations related to mental health and well-being are generally less specific. While it is important to help your clients meet minimum exercise recommendations for fitness, disease prevention and greater overall health—including mental health—implementing a strategy to reduce inactivity and prolonged periods of sitting can be an impactful place to start.

Prolonged periods of sedentary behavior, including working long periods without standing breaks, can reduce mobility, cause chronic damage to the spine and increase blood pressure. Physically inactive individuals also have higher rates of morbidity and healthcare expenditures for themselves and for health systems.  

Here are five strategies for reducing inactivity that you can share with your clients and community:

  1. Keep moving throughout the day. Encourage your clients to try exercise snacking by moving for one to five minutes every hour. Seated options include chair marching, performing soleus push-ups and moving from sitting to standing. Going up and down a flight of stairs, if available, is also a great way to raise the heart rate and strengthen the legs.
  2. Add intensity. Higher-intensity exercise increases blood flow to the brain and promotes the release of endorphins. Depending on the needs of your client, this might be accomplished through activities such as running, cycling or high-intensity interval training workouts.
  3. Seek variety. It can be easy to get stuck in a rut of doing the same exercise routine day after day, but simple changes can add variety and increase both the brain and body benefits of exercise. For example, urge your clients to create a new playlist to listen to during a run or resistance-training workout or to try a new class or workout.
  4. Get outside. Nature is a great form of brain medicine. Being outside not only can improve one’s mood, it’s also a great way to increase the body’s natural intake of vitamin D, which is great for bone health, reducing inflammation and bolstering the immune system. 
  5. Prioritize enjoyment. Urge your clients to engage in exercise that they enjoy at least once per week. It doesn’t matter if it improves their fitness outcomes, weight or overall health. Doing something purely for pleasure is great for one’s mood and mental health.

Overall, encourage your clients to strive to meet exercise guidelines consistently. Along with the many benefits of fitness and reduced mortality, research has shown that meeting physical-activity guidelines can reduce the risk of depression by 30% and is an ideal target, even if it takes several months to help your client reach this goal.

The ACE Mover MethodTM in Action

The following is an example of how the ACE Mover Method and the ACE ABC Approach™ can be used to incorporate mental health and well-being into your work with a client, and to empower the client to keep moving forward with actionable steps toward meeting their physical activity goals and achieving greater mental health and wellness.

Health and Exercise Professional: Hi, John. It’s great to see you today. Let’s get warmed up while we catch up. How was your trip to the beach this past weekend?

John: It was not what I expected. We had so many delays and then the weather was awful, so we didn’t get to do the things that we wanted to do.

Health and Exercise Professional: Things did not go the way you planned. Do you want to share more?

John: Not really. I felt like I let my family down and we were all looking forward to it. It seems like every time I try to plan something fun as a getaway for my family, something happens. I know that I’ve been working a lot and feeling so much pressure lately. My company has been going through changes and I always feel on edge and can’t let go of work.

Health and Exercise Professional: I know you have mentioned that before. Would you mind sharing how having a regular training time has made you feel, particularly when it comes to work stressors?

John: I know that it is helpful, but every day that I have an appointment, I worry constantly that something is going to happen and I’m going to miss my appointment. I specifically set this time to be my transition from work to home and it really makes a difference to my energy and my attitude.

Health and Exercise Professional: I know that you may stress about being here, but our past meeting schedule shows you’ve only had to cancel once in the past five months.

John: Wow, I didn’t realize that. Maybe I worry too much about not being able to make it. I know that I often feel anxious throughout the day about missing my time, but maybe I should stop worrying about that.

Health and Exercise Professional: It’s important to try to keep in mind that often we feel that way when it’s something that’s important to us, just like your family trip. But worrying or feeling anxious about something doesn’t really change the outcome.

John: Actually, now that you mention it, I was so worried about the perfect family trip that I tried to plan every single detail, but didn’t consider that a flight delay or bad weather might occur. I know that I made my family a bit anxious as well. I think that my kids and wife were also worried about making sure I enjoyed it, but we really had a great time.

Health and Exercise Professional: That’s fantastic. Tell me more about your trip.

John: Well, once we realized that the weather was not going to allow us to get out to the beach, we looked around the place we were staying and found some board games. It was really fun, and we realized that we didn’t really use our phones or even watch TV. Actually, now that I think about it, the last time we went to the beach we didn’t really interact as much as we did this time. My son even challenged us to a plank contest one day and it was so much fun watching everyone try to beat one another. This turned into a lot of other fitness games!

Health and Exercise Professional: It sounds like you might have had a better time than you thought, and that your family was engaged in physical activity even while you were stuck indoors. Sometimes, we set ourselves up for disappointment by adding more pressure and increasing our anxiety. Often, we need to let go of things that we can’t control.  

John: You are so right. We had a great time, and we all came back feeling relaxed and connected.

Health and Exercise Professional: I love this! Let’s get going. I have some new exercises planned as part of your workout today and I know you are going to really enjoy these!


Expand Your Knowledge

The Step-By-Step Guide to Teaching Relaxation

In this course, you’ll build an understanding of how society, work and family influence your clients’ mindsets, stress levels, and their ability to relax. Plus, you’ll gain tools to help your clients truly feel what’s going on in their bodies, so they can destress, be still and relax. By guiding your clients toward healing and rejuvenation through relaxation, you will absolutely have a positive impact on their overall well-being.

Mental and Physical Exercises for Long-term Stress Management

Nothing can be as powerful as stress for preventing the full experience of happiness, health and high performance in life. Stress impacts every single cell and system of human body and is often only exacerbated by exercise. In this course, you learn stress-reducing exercises to keep in your personal and professional toolbox that are drawn from various fields and practices, including psychology, psychiatry, tai chi, and yoga.

Sleep, Stress Management and Recovery

This first-of-its-kind program equips you with the comprehensive science and advanced coaching methods you need to help everyone—from everyday people who are stressed-out and struggling to see results, to elite athletes and top performers who are seeking that extra edge—achieve restorative sleep, manage daily stressors and learn how to recover in ways they never knew existed.