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ENHANCING WELLNESS DURING YOUNG ADULTHOOD

Sforzo, Gary A. Ph.D., FACSM, ACSM-CEP; Diggin, David Ph.D.

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ACSM's Health & Fitness Journal: 9/10 2020 - Volume 24 - Issue 5 - p 32-37
doi: 10.1249/FIT.0000000000000605
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If 80 is the new 60, and 60 is the new 40, then what is 20? Fortunately, fitness professionals need not concern themselves with this question. This thinking mainly reflects changes in life expectancy occurring with advances in medicine and technology over the last millennium. Remarkably, changes in life expectancy have had little effect on the primary fitness components. For example, cardiovascular fitness (V˙O2 max), muscular strength, and flexibility each predictably decline with age after young adulthood. Accordingly, we naturally achieve peak fitness in our 20s but are challenged to maintain it into our 30s, early 40s, and beyond. This predicted pattern of change in physical fitness makes young adulthood a key period when critical decisions and behaviors can either encourage lifelong wellness or speed up premature health declines.

A timeline for young adulthood is difficult to precisely define, but it is understood to be a period of human development involving complex and consequential issues (1). For organizational purposes, we classify young adults as roughly 18 to 45 years, allowing us to cover the transitional years following adolescence through adulthood. Experiences during the earlier stages of young adulthood (getting a job, finding a spouse, securing housing, making large purchases, having a family) make it challenging for individuals to prioritize physical activity (PA) and to develop a wellness-based lifestyle. Changes during this time often include decreased PA and significantly increased body weight (2,3). Young adulthood is also a time when initial signs of lifestyle-related diseases (e.g., obesity, hypertension, type 2 diabetes, heart disease) may begin to appear. Making sound behavior choices as a young adult is essential to avoiding health demise during this critical life stage. Health and fitness professionals can help clients with these choices, particularly encouraging a physically active lifestyle. PA can have a wide-reaching effect on the various dimensions of human wellness, as highlighted in Figure 1.

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Figure 1:
Components of wellness. Physical wellness is at the diagrammatic center emphasizing how this dimension of wellness might affect all other components.

Lifestyle decisions and habits formed during young adulthood can greatly influence the quality and quantity of living later in life (2,4). Although it is possible to begin new behaviors at any age, habits formed earlier in life tend to be easier to maintain with aging. The purpose of this article is to increase awareness of barriers to wellness experienced by young adults, while also suggesting strategies to encourage adoption of an active lifestyle to assist in the achievement of wellness.

Lifestyle decisions and habits formed during young adulthood can greatly influence the quality and quantity of living in later life.

Guiding young adult clients to adopt an active lifestyle has a positive effect on developing well-being.

BARRIERS ON THE PATH TO WELLNESS

Before helping young adults overcome barriers to wellness, it is important to recognize the challenges they face. Understanding what stands in the way of making wellness-enhancing choices is essential to ultimately forming beneficial lifelong habits. It is instructive and useful to have a general list of the top barriers to living a healthy lifestyle (Figure 2) (5,6). Although time pressures are often the top reason cited for not choosing healthy behaviors, the health and fitness professional must recognize that other barriers, such as lack of resources and personal preference, can also stand in the way of adopting healthy behaviors.

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Figure 2:
Potential barriers to a healthy lifestyle. Adapted from Gomez et al. (5) and Kelly et al. (6).

Understanding what stands in the way of making wellness-enhancing choices is essential to ultimately forming beneficial lifelong habits.

It also is important to find a good time to engage an individual on adopting new healthy behaviors. The intake process provides an excellent opportunity to identify how ready a person is for making lifestyle changes and addressing barriers to wellness. The transtheoretical model (7) is a highly useful tool to help understand readiness for change (information on this and other behavior change tools can be found in ACSM’s Behavioral Aspects of Physical Activity and Exercise [8]). Other opportunities for discussion, may be after someone misses time at the gym or calls to cancel a session, this also may reveal emerging barriers that affect healthy lifestyle choices. For example, if a person identifies time pressures or personal preference to eat fast food during lunch rather than walking, then it is reasonable to ask for a discussion of healthy lifestyle and time management options. The individual needs to realize and acknowledge that prepacking a healthy lunch, or leaving 30-minutes to exercise, provides a much healthier choice than an hour at the local burger place. Always seriously consider a person’s reasons for avoiding healthy lifestyle decisions because these keep good people from making good choices and should never be simply dismissed as just “excuses.”

Early young adulthood (~20 to 35 years) brings many different behavioral situations compared with later in this period (~35 to 45 years). For example, the wellness barriers of college students are not the same as those who are new parents or recent homeowners (9). In fact, Hochberg and Konner (10) eloquently argued for an emerging adulthood stage, whereas Levinson (1) proposed the “age 30 crisis” as a difficult time to create a basis for the next life structure. It makes sense to look specifically at barriers to wellness based on one’s point in young adulthood.

Barriers: Transition Years of Young Adulthood

The early transition years of young adulthood present unique barriers to wellness. Starting college or full-time employment often involves leaving home for the first time and presents a dramatic lifestyle change. Coupled potentially with greater financial uncertainty and a changing social circle, these situations create new challenges to wellness habits, and particularly sustaining or beginning PA (11). The start of college often coincides with decreases in PA (12), increases in body mass (2.7–2.9 lbs. 1.2–1.3 kg), and a deterioration in overall health (12,13). Arzu et al. (13) showed in college-aged students that primary barriers to PA were external in nature, including busy class schedules, parental pressures to achieve, and friends.

These barriers also present a challenge for those first entering the workforce. Technological advances enhance productivity but reduce on-the-job energy expenditure. This, along with work hours that are longer than a school day, reduces free time and the likelihood a young adult will engage in PA (14). In addition, external stressors can influence internal factors such as motivation and energy (13), creating a cycle that limits overall wellness in these transition years. Time pressures may influence dietary habits, as access to fast food presents a convenient and enticing choice over preparing healthier meals (11). The social aspect of eating out with friends is an attractive option, but it can negatively affect good nutrition, presenting a challenge to physical health and wellness. The transitional time of young adulthood is when the interconnectedness of barriers can lead to poor health choices (e.g., fast food), which at the time seem to be the best option or the default option. Mitigating these “traps” during the transitional years sets the stage for healthier aging in the years to come.

Barriers: Young Adulthood Posttransition

The good news for those in their later 30s and early 40s is an increased sense of family life and job security frequently happens. However, this does not mean barriers to a healthy lifestyle will abate. Instead, climbing the corporate ladder, caring for kids, new aches and pains, home repairs, and more may become the new barriers, still providing roadblocks to healthy behaviors and wellness. As work life progresses, a disconnect may develop between the daily pressure to be more productive and the need to care for family or have a meaningful social life. High stress (e.g., interpersonal, occupational, and financial), a hallmark of the 30s and 40s, often leads to unhealthy behaviors and poorer health (5), which leads to even more stress, and the creation of a downward-spiraling cascade.

During young adulthood, there also is reason to believe that low levels of self-rated health and self-efficacy can deter healthy behaviors, particularly exercise participation (15). Instead of poor health being a motivator to exercise, many perceive the enormity of the task and the threat for harm as barriers to beginning an exercise program (see Figure 2). Therefore, those who stand to benefit the most from exercise tend to also be the ones most likely to avoid it because they believe themselves to be “too out of shape” or too at risk.

Finding ingredients for a healthy recipe, or a facility to exercise, can be cost prohibitive. Easy access to fast or prepared foods with appealing taste (high fat and sugar) can save time, while satisfying appetite. Supporting children with their outside school activities is both a parental responsibility and, at times, a demanding social pressure. Working overtime to pay for house repairs may be a real need. An injury or health problem can appear and interfere with sound sleep, prevent regular exercise, and produce stress. Imagine this scenario: a work environment where a supervisor frowns upon employees participating in health breaks, such as small groups taking a walk or doing some stretching exercises; under such circumstances, it becomes difficult to engage in healthy choices. It is easy to see how interconnected barriers can prevent one from making good health and wellness decisions.

STRATEGIES FOR OVERCOMING WELLNESS BARRIERS

Although challenges may differ according to age and life situations, the general barriers to increased wellness, including time and social pressures, lack of resources, or a belief that they lack the ability or knowledge to take active steps, are common throughout young adulthood (see Figure 2). A savvy health and fitness professional will establish and maintain a strong network of professional colleagues (advisors, counselors, clergy, medical, and the like) to whom young adults can be referred when struggling with problems related to emotional, social, intellectual, financial, and spiritual challenges. PA and exercise may be part of the health solution, but often times more care is needed. However, there are times when all that is needed are short-term strategies that can help a client get started on a new healthy behavior.

The health and fitness professional can become familiar with a collection of extrinsic motivational tools documented to be effective in prompting short-term healthy behavior change. Gamification (16), persuasive technologies (17), and financial lotteries (18) each hold promise when trying to elicit healthy behaviors. Gamification implies making a process fun, challenging, and maybe competitive. Think about electronics such as cell phones, wearables, and video games when imagining persuasive technology. It is beneficial having an incentive system where an individual has a reasonable chance (15% to 20%) at earning a small reward ($5) or a small chance (1%) at a moderate reward (~$50). It is less motivational to set up a long shot (0.025% chance to win) for a really large payoff (~$500) when using incentives to encourage healthy behavior (18). Combining these motivational strategies together, you might have all your clients record steps using a shared tracking app on their phones in a 1-month walk-off competition, providing small rewards to many along the way and a moderate reward to a few in the end. A program like this may be a great way to jump start individuals on a new behavior (e.g., accumulating and monitoring steps) and a path to better health. Extrinsic motivators are proven effective, at least in the short term, and may be most practical in structured organizational settings (e.g., a corporate wellness program). The concepts of gamification, persuasive technologies, and rewards (financial lotteries) also can be applied to areas of wellness other than PA. For example, the same basic principles can be applied to enhance nutritional behaviors, better manage stress, or better job performance, all while encouraging healthy behaviors. Short-term motivators are often a great starting point, then the health and fitness professional needs to help individuals establish good lifelong habits.

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Behavior change is a difficult process, and fitness professionals serve individuals well by helping them develop new healthy habits. Habits can be developed to support healthy behaviors while requiring minimal effort or cognitive resources (19). As the health and fitness professional gets to know an individual better, they can personalize habit formation, replacing unhealthy ones with ones that are healthier. Preparing healthy lunches for the week on a Sunday afternoon can work, assuming the individual likes to shop and cook. Meditating for 10 minutes before a challenging meeting is great, if the person is interested in a spiritual approach to health habits.

This personalized approach works best when using positive affect and cognitive restructuring of negative thoughts (20). Helping a client set personally relevant, small, manageable short-term goals is a meaningful process (20,21). Using adaptive goals, based on performance, is more effective than static goals (e.g., setting a goal of 10,000 steps) (22). Instead, the fitness professional might suggest an initial goal of 5,000 steps, which can then be modified up or down each week based on personal experiences. Tapping into internal motivators, autonomy, and the development of self-efficacy are keys to long-term behavior change and lifelong wellness. The health and fitness professional should consult ACSM’s Behavioral Aspects of Physical Activity and Exercise (8) for greater detail on these important strategies to assist clients.

Health and fitness professionals need to know clients well enough to help them replace unhealthy with healthy habits.

Although behavior change and developing new habits are required for clients to optimize wellness, sometimes change is daunting. Adherence, or the ability to stick with it, can be the most challenging issue a person faces after initiating a new wellness habit. In instances when adherence is a larger task than the health and fitness professional can handle, referring a client to a well-trained health and wellness coach is a great strategy.

COACHING FOR HEALTH AND WELLNESS

Health and wellness coaching (HWC) is a client- or patient-centered process that assumes a working relationship/partnership develops to advance healthy lifestyle behavior change while using tools such as nonjudgmental dialogue, goal setting, and accountability. HWC is proven effective and can help clients develop new health habits (think better eating, smoking cessation, stress management, exercise adherence) while improving their risk factor and/or disease profile (23). Although effective, accessing HWC might be difficult for some because of the cost; therefore, the hope is HWC services will someday be a medically reimbursable service. The American Medical Association has established initial billing codes for HWC reimbursement, so widespread accessibility to health coaching may soon become reality. In the meantime, health and fitness professionals can be trained and certified as health and wellness coaches (see Learning Links), allowing them to provide coaching services on a broader scale. Health and fitness professionals can learn many coaching skills that will benefit individuals if integrated during exercise sessions (24), not unlike many nurses who use HWC strategies to better serve their patients.

SUMMARY

Young adulthood is a critical period to develop a physically active lifestyle and habits that will influence well-being later in life. However, there are many barriers to developing and maintaining good wellness habits. Extrinsic motivators and habit formation are both useful tools for health and fitness professionals to use while also using goal setting and encouraging development of intrinsic motivation. Such strategies can expand a young adult’s PA experiences and other healthy behaviors while helping to overcome barriers on their path to wellness. Based on individual need, referral to a health and wellness coach can be a source of meaningful assistance for the young adult trying to make behavioral changes for increased PA or for bettering any wellness component as part of a healthier lifestyle.

INFORMATIONAL AND LEARNING LINKS

BRIDGING THE GAP

Figuring out how to help young adults adopt and maintain healthy wellness habits is a challenge the successful health and fitness professional must navigate. Taking advantage of extrinsic motivators (games, rewards, and technologies) may kick start healthy actions for the short term. Setting personalized goals and creating daily habits are effective strategies to maintain new healthful behaviors. Understanding internal motivators is key to achieving long-term healthful behaviors. HWC may be very useful for many clients who are finding it difficult to initiate or adhere to wellness programming.

References

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Keywords:

Barriers to Physical Activity; Barriers to Wellness; Health and Wellness Coaching; Persuasive Technology Incentives; Young Adults; Wellness

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