On Happiness Arthur Brooks writes about happiness vs. happy feelings and says,? ‘they are not the same thing; feelings are not happiness; feelings are evidence of happiness; a part of the

STRESS RELIEF: The Role of Exercise in Stress Management

by Erica M. Jackson, Ph.D., FACSM

LEARNING OBJECTIVE

• Exercise can be an effective component of a stress management

program, and all types of exercise can be beneficial for stress

management. Exercise programs consistent with the current

recommendations to improve health can be prescribed to manage

stress. Fitness professionals should recognize that it might be

necessary to refer a client to a psychologist or other health care

provider to help develop strategies for managing stressors that

produce chronic and acute episodic stress.

Key words: Stress Reduction, Physical Activity, Mind-Body Exercise, Yoga, Chronic Stress, Aerobic Exercise

WHAT IS STRESS?

‘‘S tress’’ is a commonly used term, and

it is often used with different mean-

ings. The standard definition for

stress that will be used in this article is the

disruption of the body’s homeostasis or a state of

disharmony in response to a real or perceived

threat or challenge (8). The threatening or chal-

lenging situation is referred to as a ‘‘stressor.’’

When a person encounters a stressor, the body

prepares to respond to the challenge or threat.

The autonomic nervous and endocrine systems

respond by producing the hormones epineph-

rine, norepinephrine, and cortisol. The result of

this hormone production is a cascade of

physiological reactions that make up the stress

response. Epinephrine and norepinephrine are

involved in the initial changes that take place to

prepare the body to react and to prepare for a

challenge. These responses include increases in

heart and respiration rates, blood pressure,

perspiration, and energy production (8). There

also is a suppression of immune function,

production of "-endorphin (the body’s natural

pain killer), and increased acuity of the senses.

These changes make up the fight-or-flight

response, which prepares the body to cope with

the stressor. If the stressor is perceived as

negative or more as a threat than as a challenge,

cortisol production is increased. Cortisol is

involved in energy production but also sup-

presses immune function.

Although there is a general stress response

pattern, there can be variations in the response

according to the characteristics of the stressor

(10). Individuals tend to respond differently

based on the familiarity of the stressor. For

example, the perceived level of stress and

physiological response when giving a presen-

tation to a group of work colleagues will likely

be less than when presenting to an unfamiliar

group. The stress response also varies

depending on the level of perceived control

one has over the stressor (10). If there is a way

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for one to actively cope with the stressor that is reasonable,

then the individual usually perceives more control over the

situation. Consider an individual who has to take a certification

examination for work and has 6 months to prepare. He can

adjust his schedule to accommodate study time. However,

waiting for medical test results that show whether one has a

serious illness does not allow a sense of control over the

stressor, and the individual passively endures the stressor or

may try to avoid the stressor. With this uncontrollable type of

stressor, there is a more negative reaction with greater

productions of cortisol, which can have damaging health effects

because of the suppression of immune function (10).

It is important to note that not all stress is bad. Everyone

experiences a certain amount of stress on an almost daily basis,

and it cannot be completely eliminated. Stress becomes a

problem when too much is experienced, and it has a negative

impact on behaviors, relationships, and health. The term

‘‘eustress’’ refers to positive stress that is associated with

improved performance and productivity. ‘‘Distress’’ is negative

stress that is associated with performance decrement and

negative health consequences. The individual’s perception of

the stressor and coping resources determine whether a situation

is eustress or distress. College graduation is a stressor for most.

The student who has a job or who has been accepted to a

graduate program likely perceives the stress of graduation as

eustress, whereas the student who has student loans and no

immediate plans of a job or further education perceives distress.

Another consideration of stress is whether it is acute or

chronic. ‘‘Acute stress’’ is what an individual experiences at the

time the stressor is encountered (4). The stress response is

activated, and the body returns to homeostasis once the

challenge of the stressor is removed or the person successfully

manages the situation. For example, an individual on the way

to an important meeting gets into a traffic jam and realizes she

is going to be late; the stress response starts. When she calls her

boss and learns that she can conference into the meeting while

on the road, the stress response subsides with the resolution of

the situation. When an individual experiences acute stress on a

consistent basis, such as with overcommitting at work or

constant worrying, it is referred to as ‘‘acute episodic stress’’

(4). Individuals who experience acute episodic stress often

show signs and symptoms of stress (Table 1) that can nega-

tively impact physical and psychological health. These in-

dividuals can learn how to change behaviors and manage their

stress to prevent these consequences.

‘‘Chronic stress,’’ however, is not so easily resolved. This type

of stress is associated more commonly with negative health

concerns. Chronic stress results when there are constant multiple

stressors or major life stressors present (4). Money, work, and the

economy were the most commonly reported factors contributing

to chronic stress in the American Psychological Association’s

(APA) 2011 Stress in Americai survey (3). Additional

significant stressors include relationships, family responsibilities,

family and personal health problems, job stability, and personal

safety (3). Major events, such as the death of a loved one,

divorce, and moving also can produce chronic stress.

STRESS AND HEALTH Stress is a significant individual and public health problem that

is associated with numerous physical and mental health

concerns. It is estimated that between 75% and 90% of primary

care physician visits are caused by stress-related illnesses (2).

Cardiovascular disease, obesity, diabetes, depression, anxiety,

immune system suppression, headaches, back and neck pain,

and sleep problems are some of the health problems associated

with stress (4,8). These conditions are some of the most

burdensome health problems in the United States based on

health care costs, the number of people affected, and the impact

on individual lives. Extreme levels of stress were reported by

22% of respondents from the 2011 Stress in Americai survey,

and 39% reported that their level of stress had increased during

the past year (3). More than 80% of the survey respondents at the

WorldatWork Conference in 2012 reported that stress moderately

or significantly contributed to their health care costs (6).

Just as stress can increase the risk for chronic diseases and

other health problems, dealing with chronic conditions and poor

health can increase the amount of stress one experiences. Stress

also influences behaviors that affect health. Diet choices, sleep

habits, and drug use are behaviors that are often negatively

affected by stress (3). The APA’s 2011 survey showed that 39%

percent of respondents reported overeating or eating unhealthy

food because of stress, and 29% reported skipping a meal (3).

In addition, 44% reported lying awake at night because of

stress (3). On a positive note, 47% of respondents reported

walking or exercise as a way of managing stress (3).

STRESS MANAGEMENT There are general recommendations for stress management that

can be applied in most situations. However, keep in mind that

TABLE 1: Common Symptoms of Stress Headaches

Sleep disturbance

Muscle tension

Irritability or short temper

Lack of concentration

Fatigue

Change in dietary habits

Upset stomach

Anxiety

Frequent colds

This list includes some of the common symptoms associated with stress. See http://www.apa.org/ for a more complete list.

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there are individual differences and preferences, so a ‘‘cookie

cutter’’ approach should be avoided when making recommen-

dations. A comprehensive stress management program will

include specific techniques prescribed on an individual basis,

but general stress management recommendations are presented

in Table 2.

EXERCISE AND STRESS Exercise and stress research has typically focused on aerobic

exercise. There have been consistent findings that people report

feeling calmer after a 20- to 30-minute bout of aerobic exercise,

and the calming effect can last for several hours after exercise.

Recently, there has been an increased amount of research on the

role of mind-body types of exercise such as yoga or Tai Chi.

Unfortunately, there is somewhat limited research on the role of

resistance exercise in stress management.

The exact physiological mechanisms to explain how exercise

improves stress have not been delineated. Human and animal

research indicates that being physically active improves the way

the body handles stress because of changes in the hormone

responses, and that exercise affects neurotransmitters in the

brain such as dopamine and serotonin that affect mood and

behaviors (9,11). In addition to the possible physiological

mechanisms, there also is the possibility that exercise serves as

a time-out or break from one’s stressors. A study that tested the

time-out hypothesis used a protocol that had participants

exercise but did not allow a break from stress during the

exercise session (5). Participants were college-aged women

who reported that studying was their biggest stressor. Self-

report of stress and anxiety symptoms was assessed with a stan-

dard questionnaire before and after four conditions over 4 days.

The conditions were quiet rest, study, exercise, and studying

while exercising. These conditions were counterbalanced across

Photo courtesy of the U.S. CDC/Amanda Mills.

Photo courtesy of the U.S. CDC/Amanda Mills.

Photo courtesy of the U.S. CDC/Amanda Mills.

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Exercise and Stress Management

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participants, and each condition was 40 minutes in duration. The

‘‘exercise only’’ condition had the greatest calming effect (5).

When participants were not given a break from their stressor in

the ‘‘studying while exercising’’ condition, exercise did not

have the same calming effect.

Summaries from recent reviews on yoga or Tai Chi clinical

trial interventions indicate that these mind-body types of

exercise can be effective in reducing stress (7,14,17). The

authors of these reviews suggest that the results should be

viewed with caution because study quality was varied (7,17).

However, it should be noted that reductions in stress reported

in one review were similar to or greater than reductions

from other types of commonly used stress management

techniques (7).

In addition to understanding how exercise can help manage

stress and the types of exercise to recommend for stress man-

agement, it is important to understand common barriers that

might affect exercise participation in high-stress clients. Lack of

time is the most commonly reported exercise barrier for

individuals in general. A lack of motivation, fatigue, poor sleep

habits, and poor dietary habits are factors associated with stress

that can negatively impact exercise compliance and adherence

(4). Common exercise barriers and stress-related health prob-

lems should be taken into consideration when developing an

exercise prescription for high-stress individuals.

HOW MUCH EXERCISE IS NEEDED TO MANAGE STRESS?

Fortunately, the recommendations for exercise in the role of

stress management fit with the current health recommendations

(12). The proposed physiological adaptations thought to

improve the way the body handles stress and recovers from

stress can occur with a regular moderate to vigorous aerobic

exercise program (12,13,16), such as the recommendations of

150 minutes of moderate-intensity aerobic exercise per week or

75 minutes of vigorous-intensity aerobic exercise per week. If

an individual is using exercise as a time-out from stressors,

shorter duration activity can serve the purpose, especially when

lack of time or fatigue is a concern. Consider an individual who

reports significant work-related stress. Breaking the exercise

into two 10- to 15-minute sessions, one before work and one at

lunch time when possible, can help combat stress throughout

the day. Although there is not a lot of research with resistance

exercise and stress management, resistance exercise can be used

to provide a time-out from one’s stressors. Because resistance

training produces different exercise adaptations compared with

aerobic exercise, it might not affect the way the body physiolog-

ically reacts to stress as aerobic exercise does. However, the acute

effect of a time-out to reduce stress can be beneficial. In addition,

clients can receive the numerous health benefits associated with

resistance training. The resistance exercise prescription for

general health benefits of 2 to 3 days of exercise to target all of

the major muscle groups performed at a moderate intensity of

8 to 12 repetitions can be recommended.

The studies included in the recent reviews of Tai Chi and yoga

indicate that sessions between 60 and 90 minutes performed 2 to

3 days per week were effective in reducing stress and improving

feelings of well-being (7,14,17). A study conducted in a worksite

environment showed that 15 minutes of chair-based yoga

postures was effective in reducing acute stress when assessed

by self-report and with physiological measures (e.g., respiration

rate and heart rate variability parameters). This finding indicates

Photo courtesy of the U.S. CDC/Debora Cartagena.

TABLE 2: General Stress Management Recommendations Identify stressors Take inventory of stressors and determine whether there are stressors that can be eliminated.

Make a commitment to develop a plan to address those stressors.

Get adequate rest Set regular bed and waking times to prevent fatigue and to maintain energy level.

Develop a time management plan Stress often can be reduced with an improvement in time management. When planning a new schedule, make sure exercise is included!

Develop a healthy eating plan Diet changes or poor dietary habits are common with stress. Maintain a healthy diet to help prevent unhealthy weight changes and to maintain energy level.

Mobilize a support network Establish a support network with individuals who can be trusted to provide an outlet and assistance with resolving stressors. Discussing stressors also can keep them in proper perspective.

This list includes some general tips for stress management. Other strategies may be helpful depending on individual circumstances.

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that shorter duration sessions can be effective in reducing acute

stress with this type of exercise (15).

In addition to the exercise prescription, other characteristics

of the exercise session (e.g., group vs. individual) and the

individual also are important considerations. Because of health

consequences associated with stress, high-stress clients are

likely to be at increased risk for cardiovascular disease and

cardiovascular events during exercise. Therefore, using the

preexercise screening procedures outlined and endorsed by the

American College of Sports Medicine is essential (1). Moni-

toring exercise intensity for those looking to ‘‘blow off steam’’

to reduce stress might be a concern when the client has high

blood pressure or other cardiovascular risk factors that further

the risk increase for cardiovascular events.

Group exercise or encouraging stressed clients to find a

workout partner is an excellent idea because it can provide a

support network and accountability. However, there might be

clients who find a group setting intimidating or competitive,

which could be counterproductive in managing stress. In

addition, those who report stress because of work or family

obligations might enjoy the solitude of exercising alone. Using

a variety of exercises or nontraditional exercises (e.g., exer-

gaming, dance classes, yard work, or rock climbing) is a way to

plan activities that are enjoyable to maximize adherence.

Knowing your clients’ exercise barriers and stressors will help

with planning an exercise program that can address these vari-

ables to maximize the benefits for health and stress management.

CONCLUSIONS Exercise can be an effective component of a stress management

program for many individuals and should be recommended to

help those who are dealing with acute, acute episodic, or

chronic stress. An advantage of incorporating exercise into a

stress management program compared with other stress

management techniques is the well-documented physical and

psychological health benefits of exercise. However, it is im-

portant to remember that exercise is only one component of a

stress management program, and there might be situations that

require assistance beyond the expertise of a fitness profes-

sional, especially in working with individuals who are ex-

periencing acute episodic or chronic stress. Although exercise

might be effective in helping an individual feel calmer who is

dealing with these types of stress, it will not solve the problem

of major chronic or regular stressors. It may be necessary to

refer these individuals to resources who can help them to

address their stressors, such as a psychologist or other health

care providers.

References 1. American College of Sports Medicine. ACSM’s Guidelines for Exercise

Testing and Prescription. 8th ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2010. p. 18Y39.

2. American Institute of Stress Web site [Internet]. Yonkers (NY): The American Institute of Stress; [cited 2012 July 2]. Available from: http://www.stress.org.

3. American Psychological Association. Stress in America: Our Health at Risk. Washington (D.C.): The American Psychological Association; 2011. 78 p. Available from: www.stressinamerica.org.

4. American Psychological Association Website [Internet]. Washington (D.C.): American Psychological Association; [cited 2012 June 27]. Available from: http://www.apa.org.

5. Breus MJ, O’Connor PJ. Exercise-induced anxiolysis: a test of the ‘‘time out’’ hypothesis in high anxious females. Med Sci Sports Exerc. 1998; 30(7):1107Y12.

6. CCH Business Law Daily Web site [Internet]. Riverwoods (IL): CCH Business Law Daily; [cited 2012 June 27]. Available from: http://www. employmentlawdaily.com.

7. Chong CSM, Tsunaka M, Tsang HWH, Chan EP, Cheung WM. Effects of yoga on stress management in healthy adults: a systematic review. Altern Ther Health Med. 2011;17(1):32Y8.

8. Chrousos GP, Gold PW. The concepts of stress and stress systems disorders. JAMA. 1992;267(9):1244Y52.

9. Esch T, Stefano GB. Endogenous reward mechanisms and their importance in stress reduction, exercise and the brain. Arch Med Sci. 2010;6(3):447Y55.

10. Frankenhaeuser M. The psychophysiology of workload, stress, and health: comparisons between sexes. Ann Behav Med. 1991;13(4): 197Y204.

11. Greenwood BN, Fleshner M. Exercise, stress resistance, and central serotonergic systems. Exerc Sport Sci Rev. 2011;39(3):140Y9.

12. Jackson EM, Dishman RK. Cardiorespiratory fitness and laboratory stress: a meta-regression analysis. Psychophysiology. 2006;43(1):57Y72.

13. King AC, Baumann K, O’Sullivan P, Wilcox S, Castro C. Effects of moderate-intensity exercise on physiological, behavioral, and emotional responses to family caregiving: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2002;57(1):M26Y36.

14. Li AW, Goldsmith CW. The effects of yoga on anxiety and stress. Altern Med Rev. 2012;17(1):21Y35.

15. Melville GW, Chang D, Colagiuri B, Marshall PW, Cheema BC. Fifteen minutes of chair-based yoga postures or guided meditation performed in the office can elicit a relaxation response. Evid Based Complement Alternat Med [Internet]. 2012 [cited 2012 June 27]; Available from:

Photo courtesy of the U.S. CDC/Amanda Mills.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3265094/?tool=pubmed. doi:10.1155/2012/501986.

16. Spalding TW, Lyon LA, Steel DH, Hatfield BD. Aerobic training and cardiovascular reactivity to psychological stress in sedentary young normotensive men and women. Psychophysiology. 2004;41(4):552Y62.

17. Wang WC, Zhang AL, Rasmussen B, et al. The effect of Tai Chi on psychological well-being: a systematic review of randomized controlled trials. J Acupunct Meridian Stud. 2009;2(3):171Y81.

Disclosure: The author declares no conflicts of interest and does

not have any financial disclosures.

Erica M. Jackson, Ph.D., FACSM, is an

associate professor of movement science at

Delaware State University. Dr. Jackson

conducts research on the roles of exercise

and stress in the prevention of hypertension.

Her research also focuses on increasing

physical activity among women and minor-

ity populations to prevent chronic diseases.

CONDENSED VERSION & BOTTOM LINE

Everyone experiences stress, and not all stress is bad. Individuals who experience acute episodic or chronic stress are at increased risk for developing stress-related health problems. Research supports the idea that exercise can improve the way the body handles stress, and it can provide a time-out from stressors. Exercise programs meeting the current recommendations for health included within a stress management program can be effective in stress reduction. However, it is important to consider the client’s stressors and physical activity barriers, activities the client will enjoy, and the exercise setting. Prescribing exercise for clients seeking stress management is rec- ommended, but fitness professionals should recognize that some clients will need additional assistance for managing stress and major life stressors.

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