You have consultations with two people over the course of the week. Both are women, in their mid-fifties, wanting to re-gain strength and improve overall fitness. I will call them Mary and Beth. Both have had bouts of low back pain in the past. Mary has a high stress job as a lawyer, her children are both in college, she is separated from her husband, and wants to work hard. She sees exercise as a way to mitigate stress, and isn’t worried about discomfort. Beth also a high stress job at a technology firm. She has an aging mother that refuses to move into a care facility despite the fact it would benefit her, a stable marriage, and no children. She knows she needs to get stronger- her doctor is worried about her bone density, which means she is worried about her bone density, but every time she has tried to begin an exercise program, she gets hurt or her back acts up. Do you train these two women the same way?
Stress is funny. It has earned a really negative reputation in the press, despite the fact it is part of every day life. The stress response clearly evolved to increase chance of survival (why else would blood pressure, heart rate, and respiration rate go up if not to aid us in running away or fighting the predator threatening our well being), and all creatures trying to survive have a stress response. Exercise, in fact, is simply a stressor, but because it is one that is “good for us,” we don’t perceive it as adding stress to our lives. Many, like Mary, feel it reduces stress. The other interesting thing about stress is we don’t all react to it in the same way. When there is acute stress, our physiological response depends on whether we view the situation as a challenge or a threat (Jamieson, et al., 2012). Our perception of the situation is dependent upon whether we deem the resources available to us in that situation greater than what the situation demands. For instance, say you have two people, roughly the same age, who need to pick something heavy up off of the floor. Person A recognizes the item is a little bit heavier than he is accustomed to, but because he regularly picks up heavy things in the gym, views the item as an extension of a stress to which he is accustomed. He picks up this heavy, awkwardly shaped item, moves it where he needs to go, and moves on with his day. He viewed it as a challenge. Person b avoids picking things up because he has been told he has a bad back. It is necessary he pick this item, and he immediately feels a sense of concern for his back as he approaches it. He views the necessary requirement as a threat. Both people would experience an increase in sympathetic activation; however, how they experience the sympathetic activation would be different. Person A would experience an increase in cardiovascular efficiency and blood vessels would dilate to improve blood flow, prepping his muscles for the necessary task. Person B, on the other hand, would experience a decrease in cardiac efficiency and blood vessels would constrict, anticipating potential harm. (As an aside, more fit individuals have the added benefit of a primed physiological system, a concept known as “physiological toughness.” This is believed to improve performance during periods of acute stress).
In a study that examined muscular responses to stress that compared individuals with chronic low back pain and individuals with temporomandibular pain with healthy controls, researchers found stressful imagery resulted in an increase in EMG activity near the pain sites in the chronic pain subjects. Healthy controls, on the other hand, experienced an increase in heart rate, but no increase in EMG activity in low back musculature or jaw musculature under the same conditions (Flor, et.al, 2007). Further, Marras et.al, (2000) found when individuals were asked to perform symmetrical lifts under stressful situations versus non-stressful situations, there was an increase in compression and lateral shear in some subjects, with a correlation found between spinal compression in stressful situations and certain personality traits. (Introversion was a personality trait that correlated to an increase in compression. When you consider that one of the healthy aspects of the stress response is tending and befriending, as Kelly McGonigall points out in her book, “The Upside of Stress,” this begins to make sense. As much as introverts want to be alone during times of distress, sometimes social support can have a positive impact on their perception and reaction to stressful situations).
Like all things in life, we are constantly striving to find a balance. The stress state is no exception. The amount of arousal we experience based on the situation and our perception, as well as our natural tendencies appears to affect how we respond to stress. This suggests to me that training two people who are experiencing stress in their lives in the same manner is only okay if they respond to stress in a similar way. Many years ago, I trained someone that was very much like Mary in his view of exercise and stress. One day he came, informed me he wanted to put him through a strenuous session, and proceeded to tell me his mother had committed suicide earlier that day. He had just received the phone call. I put him through a brutal interval workout, trying to give him the outlet he needed in that moment. In contrast, I have also worked with people similar to Beth. I usually spend a good portion of our early time together establishing a calming routine as soon as they walk in. Our warm-ups involve lots of breathing as well as gentle, non-threatening movements. In the early sessions, we do mostly warm-up type exercises, with 2 or 3 controlled, strength and balance based movements thrown in the middle. I have to establish a non-threatening environment where there is a sense of safety and trust. Once that is accomplished, the warm-ups become shorter, until gradually, the warm-up is the standard 5-7 minutes, and next 40-45 minutes is spent working. These individuals become habituated to a sense of calm almost as soon as they walk in the door. This is similar to the approach Josh Waitzkin describes in his book, “The Art of Learning.” When he is working with coaching clients and wants them to establish a sense of flow in stressful situations, he identifies times when they feel that state of flow. He then develops a routine around that. The routine at first is long, 30 minutes or so, but over time, it becomes shorter, until eventually one aspect of the routine is enough to trigger the flow mindset.
My goal with clients experiencing fear or anxiety around exercise and injury is to create a focused, non-threatening atmosphere. This takes a bit of time at first, and when life throws serious curveballs aimed directly at them, their movement patterns sometimes change enough that the sense of calm they normally have when they walk in is replaced by a less focused, more pain prone persona, it is my cue to not try and push them through it. Rather, we breathe, do mobility work, play with rhythmic patterning in an effort to quiet the mind and maybe calm the body, even if it’s just a little bit. A state of arousal is necessary for the appropriate hormones to be released to increase muscular strength. It is impractical to think that a calm, relaxed session will do anything to improve fitness levels. However, as demonstrated earlier, the type of arousal will impact how a person perceives the challenge of exercise and, in some cases, how movement skills are performed. It is the job of the trainer to create a safe environment where work can take place.
As trainers, we are not psychologists. This doesn’t mean we shouldn’t be aware of the impact a psychological state might have on someone, especially if it’s indicated in a person’s health history. Things like “chronic low back pain,” and “a history of neck spasms,” are tricky, especially if the person they are attached to fears movement and is worried about provoking pain. If the person experiences painful episodes that correspond with stressful situations, it is important that as a trainer or coach you can practice flexibility in your programming. The mind and the body are connected. Respecting this, and acknowledging this when a client is undergoing stress can be more beneficial to long term goals than ignoring a client’s emotional state. Some, like Mary, will excel physically in stressful situations. Others, like Beth, are a little more physically sensitive. The ability to back off on programming, or remove skills that might pose a threat on days when it is clear a client is experiencing outside stressors is simply good coaching. One response is not better than the other, and just like we respect individual differences during a squat, we should respect individual emotional responses during periods of stress. There is nothing wrong with a more restorative session, and there is nothing wrong with a high intensity workout. And sometimes, a client's mindset plays a role in skill selection for that day. Exercise should support, not hinder, a person's emotional and physical well-being.
Your in health and wellness,
Jamieson, J.P., Mendes, W.B., & Nock, M.K., (2012). Improving acute stress responses: the power of reappraisal. Current Directions in Psychological Science, XX(X), pp. 1-6.
Flor, H., Birbaumer, N., Schugens, M.M., & Lutzenberger, W., (2007). Symptom-specific psychophysiological responses in chronic pain patients. Psychophysiology, 29(4), 452-460.
Marras, W.S., Davis, K.G., Heanet, C.A., Anthony, B., & Allread, W.G., (2000). The influence of psychosocial stress, gender, and personality on mechanical loading of the lumbar spine. Spine, 25(23), pp. 3045-3054.
Waitzkin, J., (2008). The Art of Learning: An inner Journey to Optimal Performance. Free Press: New York.
McGonigal, K., (2015). The Upside of Stress: Why Stress is Good for You, and How to Get Good at It. Avery: New York