In 2022, as the fitness industry was finding its footing after COVID’s disruptions, Dr. Karlie Intlekofer authored a series of columns for Athletic Business on exercise and mental health. The series was part of a broader initiative by Matrix Fitness to elevate mental wellness as a central pillar of the fitness experience — not an afterthought, but a core reason people walk through the door.
Four years later, the stressors have changed, but the need hasn’t faded. COVID’s acute disruption gave way to chronic uncertainty, primarily driven by political division, negative news cycles and the pull of our screens.
Intlekofer is a neuroscientist by training, with a doctorate in neuroscience and behavior, postdoctoral research on exercise and Alzheimer’s disease, and more than 1,000 academic citations to her name. As Global Research Scientist for Matrix Fitness, she translates that research into practical strategies for the fitness industry. Athletic Business executive editor Andy Berg sat down with Intlekofer to discuss what’s changed since lockdown, what the current science says and what facility operators should be doing about it.
The stressors have shifted since your 2022 columns. What does today’s landscape look like?
In 2022, we were bouncing back from the clear disruption posed by COVID, and operators benefited from helping their members find stress relief through their services. Today, COVID concerns are largely absent, yet surveys reveal that stress management remains a major challenge. And in the wake of the lockdowns, the evidence for exercise as a mental health intervention has continued to strengthen. Today’s stressors are more open-ended and socially charged, with no clear resolution. When stress has no finish line, vigilance becomes the default. That state is exhausting. It can undermine motivation to work out and connect, and it impacts everyday interactions. We now have stronger evidence showing meaningful reductions in depressive symptoms, with effects that complement clinical care. Matrix continues to revisit the idea of exercise for improving mental health because our current climate poses new questions: How do we support mental health when the stressor has no clear endpoint?
Short-form video is being flagged as a contributor to stress and anxiety, and not just for Gen Z. What should facility operators know?
Research links high exposure to short-form video with greater symptoms of stress, anxiety and attentional difficulties. It is not a simple cause-and-effect story. Higher use is associated with worse symptoms, and people who are already struggling often turn to these platforms more.
This pattern spans generations, with short-form content capturing a growing share of leisure time, including for adolescents. Experimental work suggests this primes the brain to prefer more immediate rewards and can reduce attention span. And it’s important to know that short-form video use is also associated with later bedtimes and worse sleep quality. In facilities, this may appear as lower tolerance for slow progress, less patience with skill development and a need for more frequent reinforcement. Simply showing up consistently becomes an achievement worth recognizing. Clear milestones and meaningful metrics acknowledge member follow-through and reinforce their workout motivation.
For the operator or coach who needs to make the case that their facility is a mental health resource, what’s the most compelling evidence right now?
The strongest evidence is outcome data. Some findings are correlational, showing that higher levels of physical activity are associated with lower stress, anxiety and depression, along with better sleep. But the most compelling evidence comes from exercise intervention studies. Randomized controlled trials demonstrate that structured workouts significantly reduce depressive and anxiety symptoms and they improve sleep quality, too. These effects are causal, and they are also reversible. That means that when active individuals become sedentary, measurable declines in sleep quality and mental health often follow. Not every member relates to clinical terms like anxiety or depression. Nearly everyone, however, understands the value of a steadier mood, sharper focus and better stress tolerance. In addition, the social benefits of in-facility workouts also matter because feeling connected to others is independently protective for mental health. A facility offers a structured environment that supports movement and connection. These are places that offer mental health resources because using them improves mood, sharpens focus and strengthens belonging.
Campus rec departments are introducing board games, e-sports lounges and other low-barrier social programming. Does the research support that approach?
Social connection is a core component of mental health. People who feel connected report lower perceived stress, fewer depressive symptoms and greater resilience. Loneliness, by contrast, is associated with a higher risk of anxiety and depression, as well as poorer long-term health outcomes. More than half of U.S. adults report feeling socially isolated or lonely. A board game night or e-sports lounge may not elevate heart rate, but it reduces isolation, brings students into shared space and creates repeated contact. It also builds behavioral familiarity, as students learn how to get there, who they might see and what the environment feels like. When members feel comfortable, movement becomes more accessible. When they feel known, they return. And repetition is where health gains accumulate. People are simply more willing to try new behaviors in places where they feel they belong.
Several states now allow physician reimbursement for exercise counseling. What could that mean for the industry?
Several payers reimburse physicians for preventive counseling that includes physical activity. Under Medicare, for example, the Annual Wellness Visit and certain behavioral counseling services can include assessment and discussion of exercise. This does not extend to covering gym memberships, but it does mean physical activity is formally embedded in preventive care conversations. National data show that exercise counseling remains inconsistent overall, yet it is addressed more often when patients have obesity, heart disease or metabolic risk factors. As these conversations become more routine, patients leave the office needing a safe and credible place to follow through. For operators, the opportunity is indirect but meaningful. Start by using health-related language in how you describe your programming. This could include terms like strength, functional capacity, fall prevention and heart health. Ensure staff credentials and safety standards are easy to understand. Also, align yourself as a clinic partner through outreach and highlighting accessible options within your facility. Demonstrating accommodations for people with mobility limitations, neurological conditions or larger body sizes signals readiness for referral. Barriers to entry are reduced by adaptive equipment, clear beginner pathways and staff trained to coach special populations without stigma. Healthcare continues to emphasize prevention, and facilities that can demonstrate safe and inclusive programming will be well positioned when patients are ready to take the next step.
What gives you the most optimism right now, and what keeps you up at night?
What gives me optimism is the growing recognition that modifiable behaviors like movement, sleep and social connection are central to mental resilience. The science is more rigorous, more mechanistic and more focused on scalability than it was a decade ago. What keeps me up at night is the gap between what we know and what people consistently do. Digital overload, fragmented attention and persistent loneliness compete directly with sustained engagement in movement. We understand the benefits of connection and an active lifestyle, yet the individuals who would benefit most from these spaces may also feel the greatest hesitation about entering them. The real test is whether facilities can make participation feel inviting and supportive.
