When Mental Health Gets in the Way of Exercise: Meeting People Where They Are
By Amanda L. Rebar, University of South Carolina, USA
Physical activity is increasingly recommended as part of mental healthcare – and for good reason. The evidence is compelling: regular physical activity can reduce symptoms of depression and anxiety, improve wellbeing, and complement psychological and pharmacological treatments.
There is, however, a practical question at the heart of physical activity promotion for mental health: how do we support people to be active when poor mental health can undermine the motivation and capacity needed to do so?
When Symptoms Become Barriers to Being Active
Increasingly, research suggests that mental health symptoms are not simply barriers to physical activity; they are an important part of the process itself, shaping people’s motivation and capacity to be active.
For someone experiencing depression, anxiety, or high levels of stress, symptoms themselves may become important determinants of physical activity behavior. Depression can drain energy, make everyday tasks feel more effortful, and reduce the enjoyment people get from activities they once valued. Anxiety can make social settings, unfamiliar environments, or even the physical sensations associated with exercise feel uncomfortable or threatening. Stress can narrow attention to immediate demands, leaving little mental space for longer-term health goals.
Supporting Activity Through Changing Symptoms
In this way, mental health symptoms can influence not only how people feel, but also whether they are able to engage in behaviors that may support their mental health. Recognizing this shifts the focus from simply prescribing physical activity to supporting engagement with it.
How, then, can practitioners help people stay connected to physical activity when symptoms make participation difficult?
A useful starting point is recognizing that mental health is rarely static. Symptoms change over time, and so too will a person’s ability to engage in physical activity. Someone who is active and engaged one week may find the same activity much harder the next. These changes often reflect shifting symptoms and circumstances rather than a lack of commitment.
Viewing Setbacks as Information, Not Failure
This perspective encourages practitioners to move away from viewing lapses in activity as failures. When physical activity does not happen as planned, it provides information. Rather than asking why someone failed to follow through, it may be more useful to ask what got in the way. Was the goal unrealistic given their symptoms that week? Did fatigue make the activity too demanding? Did competing demands take priority? Or did the activity simply feel unenjoyable or overwhelming? Understanding these barriers can help practitioners and patients adapt future plans rather than abandoning them altogether.
Reducing Reliance on Motivation and Self-Control
A second implication is that support should not rely entirely on motivation. Motivation naturally ebbs and flows, particularly during periods of poor mental health. Practitioners can help create conditions that make activity easier to initiate and maintain.
Adapting Activity Goals to Changing Needs
Flexible goals, clear action plans, supportive environments, and consistent routines can all reduce reliance on momentary motivation. For example, goals may need to be flexible enough to accommodate changing symptoms, while action plans can help link activity to specific cues and opportunities in daily life.
Importantly, this does not mean lowering expectations. It means recognizing that progress is rarely linear. During more difficult periods, success may involve maintaining a routine, taking a short walk, or finding a manageable way to stay connected to movement. During periods when symptoms are less burdensome, goals can be expanded and activity increased.
Why Enjoyment Matters
Finally, enjoyment deserves greater attention in physical activity promotion. Recent evidence suggests that leisure-time physical activity has stronger associations with mental health than activity undertaken in other domains, highlighting that context matters. Activities that feel enjoyable, meaningful, and self-directed may be easier to sustain and more beneficial for mental health than activities undertaken purely because they are perceived as beneficial. Supporting people to find forms of movement they genuinely value may therefore be just as important as helping them achieve a particular activity goal.
Meeting People Where They Are
Together, these principles reflect what it means to meet people where they are. Not lowering expectations or abandoning goals, but adapting support to changing symptoms, circumstances, and opportunities.
Physical activity can be a powerful tool for supporting mental health. But recommending it is only the beginning. The real challenge (and opportunity) for practitioners is helping people stay connected to physical activity when symptoms make participation difficult. Meeting people where they are, adapting support as circumstances change, and treating setbacks as opportunities to learn may be just as important as the recommendation itself.
Practical Recommendations
- Expect fluctuations, not consistency.
Mental health symptoms, motivation, and energy levels change over time. Discuss physical activity as something that may need to be adapted from week to week rather than expecting a steady, linear progression. - Treat setbacks as information, not failure.
When physical activity does not happen as planned, explore what got in the way. Was the goal unrealistic given current symptoms? Were there competing demands, environmental barriers, or challenges with enjoyment? Use these insights to refine future plans rather than abandoning them. - Build plans that do not depend entirely on motivation.
Help people identify simple routines, cues, and action plans that make activity easier to initiate, particularly on more difficult days. The goal is not to maximize motivation, but to reduce reliance on self-control. - Prioritize engagement before progression.
During periods of poorer mental health, staying engaged with physical activity may be more important than achieving guideline targets. A short walk, a familiar routine, or a manageable form of movement can help preserve confidence and provide a foundation for future progress. - Make enjoyment a treatment target.
Activities that feel meaningful, satisfying, or enjoyable are more likely to be sustained over time. Support people to find forms of movement they genuinely value rather than focusing exclusively on what appears optimal in theory.
