COPING WITH STRESS: THE EFFECTIVENESS OF EXERCISE

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Coping With Stress: The Effectiveness of Exercise and Other Techniques Article  in  Quest -Illinois- National Association for Physical Education in Higher Education- · January 1994 DOI: 10.1080/00336297.1994.10484112

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QUEST. 1994.46. 100-119 © 1994 American Academy of Kincsiotogy and Physical Education

Coping With Stress: The Effectiveness of Exercise and Other Techniques Bonnie G. Berger This paper examines conceptual issues related to using exercise as a stress-management technique. It appears that specific types and dosages of exercise are associated with selfreported mood benefits, ^lf-esteem, and decreased stress reactivity. To further understand the relationship between physical ^tivity and stress, researchers need to examine exercise mode, practice, and environmental factors that might influence the benefits for a variety of populations and to explore possible underlying mechanisms. To maintain perspective, it is important to note that exercise is as effective as other stress-management techniques, but not more so. Stress is a major influence on the quality of eveiyday life. Too much stress.' more accurately termed distress, is a common malady in industrialized nations. It has undesirable health consequences and greatly detracts from the overall enjoyment of life. Note that too little stress also results in distress as well as in boredom and apathy. Some stress is needed to add excitement, stimulation, and color to our lives. As Hans Selye (1975) observed: "Stress is the spice of life" (p. 83). After working in the area for many years, Seiye (1975) at the age of 68 poetically captured the importance of stress: It seems to riK that man's ultimate aim in life [italics added] is to express himself as fully as possible, according to his own lights, and to achieve a sense of security. To accomplish this, you must first fmd your optimal stress level [italics added], and then use yotir ad^tation energy at a rate and in a directicm adjusted to your innate qualifications and preferences, (p. 110) Stress is an exceedingly complex concept. As illustrated in Figure 1, both highly positive and negative events require adjustment, detract from the quality of life, and affect one's stress levels. Negative life events (e.g., losing one's job, the death of a child, a serious illness) are obvious stressors. Desirable events (e.g., job promotion, travel, invitation to present one's research at a national convention) are also stress-producing— especially when they occur within a narrow time span or are too numerous. Although too much stress greatly detracts from the quality of life, some stress is highly desirable. As Selye (1975) noted, "complete fieedomikmi stress is death" (p. 20). To maintain an optima] level of stress, people need to regulate the amount of stress in their daily lives and to control their stress responses. The term eustress emphasizes the desirable aspect of

Bonnie G. Berger is with the School of Physical and Health Education at the University of Wyoming, Laramie, WY 82070.

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QUALITY OF LIFE

\ /

\

/ /

\

\

Extremely pleasant

Extremely unpleasant

—

\

EXPERIENCE CONTINUUM

+

Figure 1 — Experience continuum. Note, Adapted from Selye (1975, p. 20). stress. Eustress is sought by participants in sports such as rock climbing and skiing. Eustress is exhilarating and thrilling. This more unusual type of stress adds zest to our sometimes mundane lives. Competitive sport is another source of eustress. Eustress generally is desirable; however, as illustrated by the right half of Figure 1, too much eustress also detracts ftxim life quality. The intensity and frequency of the demand upon one's adaptive capacities determines whether the stress is pleasent or unpieasmit. Each person differs in his or her preferred level of stress. As presented throughout these Academy Papers, there is little doubt that stress profoundly affects our psychological (Dishman, 1994; Gill, 1994) and physical well-being (Plowman, 1994). The pervasiveness of stress and its serious consequences were illustrated by including ii as a covox story in Time 10 years ago (Wallis, Galvin. & Thompson, 1983). Today there is additional evidence that stress, and how people cope with it, mediates physical and psychological well-being (e.g., Benson & Proctor, 1984; Compas, 1987; Omish el al.. 1990). The papers in this issue of Quest provide several different models of stress. I would like to reemphasize that stress is a complex process that both occurs within the individual and highlights the often verbalized but seldom experienced unity of mind and body (see Figure 2). "Psychological stress refers to a relationship with the environment that the person appraises as significant for his or her well-being mid in which the demands tax or exceed available coping resources"" (Lazarus & Foikman. 1986, p. 63). This description supports the disparity model of stress depicted in Figure 2. The disparity model suggests that stress is a process that results from a ' "call to action."" Stress occurs when one's personal capabilities or resources are appraised by the individual as insufficient to meet the needed behavior. Stress results from a perceived disparity between one's capabilities and the necessary behavior or response rather than from the stressor itself.

Role of Physical Activity in Stress Management Physical activity is an ideal way to both raise and lower one's stress levels. My paper ifXM^Qs exclusively on using exercise as a technique to reduce stress. The underlying mechanisms influencing the stress-reducing benefits of exercise are unclear. However,

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Stressor: Ufe Event Demands. Consmints xtd Oppoiiunrtws

f Call lor Action Requiring an Adjustment in Behavior 'Ive got lo do somethinfl' 'I'm in a spot' J

stress: Appraisal ol Personal Resources Inlluenced by 1 Importance ol the outcome 2 A\sitabilnv ot a plan as aann 3 Uncertamtv of outcome W ^

Phystcal and Psychological Symptoms 1 2 3. 4 5 £.

Moderator Factors

Rapid heari beai Upset stomach Tiredness PorQettutness Anxiety OepressKXi

1 2 3 4 S i 7

Social support Anhcipalion ot the event Degree ri control crver its occurrence Previous experience with simitar evams History of Stress-arousing e^jenencas PersonaMy(eg. TypeAj Cognitive style

i

Thought Ponern

Task Oriented Thoughts

Self-Preoccupying Thoughts

1. steps to toHow 2. Time frame

1 Anxiety 2 Depression 3 Anger

Observabie Behavior

Figure 2 — A model of stress. Note. Adapted from Berger (1983/1984) and Sarason (1980). . exercise is associated with psychological and physiological benefits that enable participants to cope with stress more effectively. The specific stress-management benefits of exercise thai I will examine are mood enhancement, improved self-concept and selfesteem, and changes in stress reactivity.

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Reduction of Psychological Stress Indices Anxiety, depression, and hostility (or negative affect) are typical stress symptoms (Repetti, 1993; Watson, 1988). Since exercise is associated with short-term mood benefits, it is an effective approach to stress reduction for members of both normal and highly stressed populations. Current evidence supports the relationship between exercise and short-term decreases in psychological stress indices such as anxiety, tension, depression, and anger (e.g., Berger, 1984a; Berger & Owen, 1983, 1987, 1988; Berger, Owen, and Man, 1993; Long & Haney, 1988a. 1988b; Steptoe & Bolton, 1988; Steptoe & Cox, 1988). Recent meta-analyses and literature reviews also support the short-term mood benefits of exercise (Crews & Landers, 1987; Dunn & Dishman. 1991; Morgan & Goldston, 1987; North, McCullagh, & Tran, 1990; Petnizzelio, Landers, Hatfieid, Kubitz, & Salazar, 1991). In comparison with possible long-term changes that are difficult to attribute to exercise, the acute changes are more clearly associated with the exercise itself (Berger, Friedmann, & Eaton, 1988).

An Exercise Taxonomy to Maximize the Benefits I would like to emphasize that benefits of exercise are not automatic. It is quite likely that they depend on complex Exerciser x Activity x Exercise Environment interactions. The type or mode of exercise and exercise intensity, for example, seem to be important variables. Noting a need to develop exercise guidelines for maximizing the mood-enhancing benefits, my colleagues and I (Berger, 1986; Berger & Mclnman, 1993; Berger & Owen, 1988, 1992a) have proposed a preliminary exercise taxonomy, which is summarized in Table 1. Some of the factors in Table 1 are based on empirical research; others are more speculative. The taxonomy needs further investigation, but it is helpful in highlighting current research issues in the relationship between mood alteration and exercise. Enjoyment. A primary requirement is that an activity be pleasing or enjoyable. This adjusts for individual differences in movement and sport preference. Exercise activities that a person finds unpleasant are unlikely to be associated with increased

Table 1 Preliminary Taxonomy for Maximizing the Psychological Benefits of Exercise Major requirements

Subcomponents

Pleasing and enjoyable activity Mode characteristics

"Aerobic" or rhythmical abdominal breathing Absence of interpersonal competition Closed, predictable, or temporally and spatially certain activity

Practice requirements • • : ; : . . : • . , v> \ . .,-.

Intensity: moderate Duration: at least 20 to 30 minutes Frequency: regularly included in weekly schedule

Note. From Berger, Owen, and Mmi (1993, p. 133). Reprinted with permission.

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psychological well-being, even though they have many fitness benefits. Recognizing the importance of exercise enjoyment encourages kinesiology specialists to view exercise as an end in itself rather than as a means to an end (a vehicle for cardiorespiratory fitness, weight loss, or even stress reduction). Qualitatively, exercise is more than medicine. Exercise is fun. It also can be a pleasurable opjx)rtunity to increase one's internal awareness (Benson & Proctor. 1984; Kabat-Zinn, 1990; Omish, 1990). Emphasizing the need for exercise to be enjoyable. Dean Omish (1990) suggests that the term workout be replaced with playout (p. 329). Enjoyment influences the likelihood of adopting and adhering to an exercise program. A person who dislikes exercising is unlikely to participate in physical activity on a regular basis. Thus enjoyment has practical implications for the effectiveness of exercise as a stress-reduction technique. The many benefits of exercise are of little value if a person does not exercise. Mode Characteristics. Mode characteristics refer to types of exercise that are most likely to be stress reducing. As noted in Table !, the exercise either should be aerobic or should facilitate rhythmical abdominal breathing. The need for aerobic exercise is cited frequently in the literature (e.g.. Long & Haney, 1988a, 1988b; Petruzzello et a^., J99I). Relatively few studies, however, have investigated this characteristic directly. Psychological effects of exercise below the aerobic training zone often have been investigated primarily as a control condition for comparison with aerobic activities (e.g., Bosscher, in press). It is possible that the rhythmical abdominal breathing (generated by aerobic exercise and some less intense forms of exercise) rather than aerobic training leads to stress reduction (Berger & Mclnman, 1993; Berger & Owen, 1988, 1992a). Kabat-Zinn (1990; Moyers, 1993), director of the Stress Reduction Clinic at the University of Massachusetts Medical Center, emphasizes the importance of mindfully tuning into one's breathing as a technique for stress reduction. Attention to one's breathing is a central component in a variety of stress-management techniques (e.g., Benson, 1984; Fried, 1983; Peper & Holt, 1993) and in an experimentally validated program for reversing heart disease (Omish, 1990). Competition is another mode characteristic that may be related to mood alteration. When there is little or no competition in a physical activity, participants avoid the negative psychological effects (disappointment or even depression, hostility, lower selfesteem) associated with losing. Not only is competitive sport not conducive to stress reduction, it is an ideal way to increase one's stress levels as emphasized in such sports as skydiving and white-water rafting. The book Anxiety in Sports (Hackfort & Spielberger, 1989) highlights the stress-producing aspects of competitive sport. The phenomenon of overtraining further illustrates the stress-enhancing characteristics of competitive sport. If stress reduction is a primary goal of participating in physical exercise, competition probably should be avoided. The lack of research conceming stress reduction in competitive, interactive sports suggests an obvious need to investigate a possible relationship between interactive physical activities such as tennis and basketball on a recreational level and stress reduction. A final mode characteristic is that the activity be closed or predictable. Jogging, swimming, Hatha yoga, and riding a stationary bicycle are highly predictable activities. Predictable activities enable participants to "tune out" the environment and to engage in free association while exercising. Closed sport activities provide opportunities for solitude, contemplation, reflection, and withdrawal from the cares and concems of the day. Joggers and swimmers often note their appreciation of the solitary nature of their sport activities (Glasser, 1976; Rimer, 1990). As George Sheehan (1990), the aging running guru commented, "Where once I found all my good thoughts on the run, I now

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fmd them in other solitary movements litaiics added]. Given the choice I might walk rather than run—or choose to cycle over either one" (p. 210). Personal comfort with the solitude in sport is highly individual. Some individuals are attracted to solitary types of physical activity; others clearly are nol. Practice Requirements. The practice requirements listed in Table 1 illustrate the possibility that exercise guidelines for the physiological benefits (e.g., American College of Sports Medicine, 1991) may differ from those that enhance the psychological benefits. This section provides a brief overview of exercise intensity, duration, and frequency guidelines that help to maximize the psychological benefits. The relationship between exercise intensity and mood alteration is unclear. Increasing evidence, however, supports the effectiveness of less intense exercise such as walking (Thayer, 1987), Hatha yoga (Berger & Owen, 1988, 1992a), and bicycling at a very low intensity (Moses, Steptoe, Mathews, & Edwards. 1989; Steptoe & Cox, 1988). Moderate rather than high-intensity exercise seems most likely to be associated with psychological well-being (Berger & Owen, 1988; Steptoe & Boiton, 1988). High-intensity or long-duration exercise may be stress-producing (e.g., Berger & Owen, 1988, 1992b; Morgan, Brown, Raglin, O'Connor, & Eilickson, 1987; Steptoe & Cox. 1988). The relationship between exercise intensity and mood alteration, however, needs further examination—especially in regard to an individual's preferred level of intensity (Berger & Owen, 1994). Although as little as 5 minutes of walking can be mood elevating (Thayer, 1987), there is general agreement that a minimum of 20 to 30 minutes of exercise is needed to generate the psychological benefits (Bahrke & Morgan, 1978; Berger, 1984b; Berger & Owen, 1983, 1992a; Steptoe & Boiton, 1988). Three exercise durations (10, 25, and 40 minutes) significantly reduced cardiovascular reactivity to a stress task when compared with a control activity; reactivity, however, did nol change as a function of the different exercise durations (Hobson & Rejeski, 1983). As suggested by Petruzzello et al. (1991) in their meta-analysis, researchers need to examine further the relationship between exercise duration and mood alteration —especially for exercise sessions between 1 and 20 minutes in length. Exercising longer than 30 minutes may be associated with additional psychological benefits. For example, Glasser (1976) suggested that 40 to 50 minutes are needed to attain the positive addiction state in which the mind spins free. Mandell (1981), a psychiatrist who runs with his patients, suggests as long as 2 hours: Thirty minutes out, and something lifts. Legs and arms become light and rhythmic. . . . The fatigue goes away and feelings of power begin. I think I'll run twentyfive miles today. I'll double the size of the research grant request. I'll have that talk with the dean. . . . Then, sometime into the second hour comes the spooky time. Colors are bright and beautiful. . . . A cosmic view and peace are located between six and ten miles of running (pp. 211-212). Frequency of exercise seems likely to increase exercise enjoyment. As the exerciser becomes more fit, the physical discomforts of exercise decrease. Habitual exercisers also have leamed to relax while exercising, to pace themselves, and to appraise the seriousness of various physical sensations. Exercise becomes more enjoyable. Illustrating the need for frequent or long-duration exercise, Boutcher and Landers (1988) found that a single, high-intensity (80-85% of maximum heart rate IHR]) session on a treadmill was associated with acute reductions in state anxiety and an increase in alpha brain waves. These changes occurred only for those who habitually had run 30 miles or more

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per week for the previous 2 years. Novice runners did not report any changes in state anxiety after the high-intensity exercise. In their meta-analysis of exercise and depression. North et al. (1990) reported that the benefits increased as the length (number of weeks and sessions) of the exercise program increased. Another reason to exercise regularly is that in nonpsychiatric populations the mood benefits appear to last for 2-A hours after exercising (Raglin & Morgan, 1987). The short duration of these benefits may seem to detract from the usefulness of exercise as a stress-reduction technique. However, if exercisers feel less anxious and depressed or less stressed for 2-4 hours, their interactions with people and their decisions within this time spill over to the remainder of the day. The transient nature of the mood changes supports the need for frequent exercise.

Enhancement of Self-concept and Self-esteem Quite likely, feeling competent, liking one's self, and feeling good about one's self also are inversely related to stress. There is little research, however, relating feelings about one's self to stress. One problematic issue in self-concept research is how best to define the terms self-concept and self-esteem (Mclnman & Berger, in press; Sonstroem, 1981). Several researchers have implied that there are no conceptual or empirical distinctions (Shavelson, Hubner, & Stanton, 1976; Shephard, 1979). Others have considered self-concept a larger abstraction that incorporates self-esteem (e.g., Coopersmith, 1967; Watkins & Dhawan, 1989). Self-concept conventionally refers to all aspects of who one is. It is a central concept in one's conscious life (Campbell, 1990). There are many ways to define self-concept. Marsh (1992), for example, suggested that one's selfconcept has 13 independent dimensions: general, academic, emotional stability, language competency, honesty, math, opposite sex relations, parental relations, physical ability, physical appearance. probJem solving, religion, and same sex relations. In summary, self-esteem is more evaluative than is self-concept and reflects the cognitive comparisons between an individual's ideal and true selves (Rhodewait & Agustsdottir, 1986). High self-esteem is a strong predictor of subjective well-being and life satisfaction (Diener, 1984; Fox. 1990). Individuals with positive self-concepts may experience less stress. Intuitively, people with positive self-concepts or high levels of self-esteem would be less likely to appraise their capabilities and talents as insufficient to meet needed behavior. Exercise being associated with developing more positive self-concepts could help individuals reduce their habitual stress responses. I am not aware of any study that has investigated the relationship between exercise, self-concept, and stress directly. In a tangentialiy related study, Mclnman and Berger (in press) observed that aerobic dance participants reported short-term changes in both self-concept and mood, a psychological stress index. There was no evidence, however, to indicate that extent of mood change mediated the changes in self-concept. Evidence of a positive relationship between exercise and self-concept or selfesteem is equivocal. Results of cross-sectional studies comparing exercisers and nonexercisers are more supportive of a relationship than are exercise intervention studies. Exercisers and those who are more fit in comparison to those who are less fit have more positive global se)f-e.steem. higher seif-concepts, and higher body concepts (e.g.. Tucker, 1987; Young, 1985). These cross-sectional studies provide little information about whether exercise causes these benefits, or whether people who have more positive selfconcepts to begin with are attracted to exercise. Sonstroem and colleagues (Sonstroem, Harlow, Gemma, & Osbome, 1991; Sonstroem & Morgan, 1989), however, are testing a model that might explain therelationshipbetween exercise and enhanced sejf-esteem.

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This promising model includes dimensions of self-efficacy, perceived physical competence, and self-acceptance. Studies assessing pre- and postexercise change in programs lasting between 3 and 13 weeks have less consistent results than the cross-sectional investigations. Some investigators have observed significant improvements in self-concept (Hayden, Allen. & Camaione, 1986; Mclnman & Berger, in press; Perri & Templer, 1984). Others have not (e.g.. Ford. Puckett, Blessing, & Tucker, 1989; Jones, 1985). Puretz (1982) found significant improvement in body-image for participants in a body conditioning class, but not for those in three types of dance classes. Thus the relationship between selfconcept and exercise participation may vary according to mode of activity. Sonstroem (1981) suggested that exercise programs designed to enhance self-esteem need to emphasize success experiences, feelings of increased physical comf^tence. and goal attainment. The conflicting results in the self-concept literature reflect methodological problems that plague this research area. These problems include the difficulty of randomly assigning subjects to exercise programs, the need for appropriate placebo-control groups, and choice of self-concept inventories. Use of poorly validated inventories such as the Tennessee Self-Concept Scale (Roid & Fitts, 1991) also has handicapped much of the research (Berger & Mclnman, 1993; Demo, 1985; Hoffman, Davis, & Nelson, 1988). Newer inventories such as the State Self-Esteem Scale (Heatherton & Polivy, 1991), Physical Self-Perception Profile (Fox, 1990; Fox & Corbin, 1989; Sonstroem, Speliotis, & Fava, 1992), the Perceived Competence Scale for Children (Harter, 1982), and the SelfDescription Questionnaire series (Marsh, 1992; Mai^h, Smith. & Bames, 1983) offer stronger instrumentation and new research opportunities in studies of physical activity.

Exercise and the Reduction of Psychophysical Stress indices Using exercise to modify one's physiological responses to stressful situations is an important consideration in any discussion of coping with stress. Psychophysical stress responses have been probed throughout these proceedings (Dishman. 1994; Plowman, 1994; White & Kem, 1994). Thus I will offer only a few brief comments in this section. When I examine studies of the psychophysical influences of acute and chronic exercise, I become aware of highly diverging conclusions. The contradictory results are especially difficuh to interpret because the studies differ from one another in many ways: the exercise stimulus (exercise duration and intensity, acute and chronic programs), subjects' fitness levels, and the dependent variables measured. The nature of the stress tasks themselves and their timing in relation to exercise also add to the difficulties of comparing the results of one study to another. Within the same study, subjects often report psychological benefits, but no psychophysical changes (e.g., Roskies et ai., 1986; Roth, 1989). Subjective levels of psychological stress may be independent of psychophysical indices. Interindividual differences in stress patterns also may account for some of the disparate findings. For example, one person may exhibit increased systolic and diastolic blood pressure; another, higher level of norepinephrine; still another may have no physiological changes, but may feel more anxious. Highlighting the complexity of measuring physiological stress indices, Claytor (1991) concluded that highly fit and sedentary men have similar cardiovascular and sympathetic nervous system responses to novel stressor tasks. However with repeated exposure to the tasks, fit individuals have attenuated arterial pressure and cardiac output responses. The diverse studies of exercise and physiological responses to stress often raise more questions than they answer (Dienstbier, 1989; Dishman, 1994; Sothmann, 1991).

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For example, Omish et al. (1990) reported that a program of moderate aerobic exercise. a low-fat vegetarian diet, and stress reduction was successful in reversing coronary artery lesions. This well-designed, prospective, randomized study, however, did not provide information conceming the relative contributions of the three lifestyle factors. Future research needs to clarify the key factors influencing the likely relationship between exercise and psychophysical reactivity. Although the evidence is inconclusive, individuals who exercise frequently and/or those who are physically fit may (a) have reduced (or higher) psychophysical stress responses (Dienstbier, 1989; Holmes & Roth, 1985; Light, Obrist, James, & Strogatz. 1987; Rejeski, Gregg, Thompson, & Berry, 1991; Rejeski, Thompson, Brubaker, & Miller, 1992), (b) recover more rapidly from various types of stressors (Crews & Landers, 1987; Keller & Seraganian. 1984), (c) be characterized by both a and h (Sinyor, Schwartz, Peronnet. Brisson, & Seraganian, 1983), (d) have less illness when experiencing many negative life events (Brown, 1991; Brown & Siegel, 1988) and have a lower incidence of colon, breast, and prostatic cancer (Mackinnon, 1992; Stemfeld, 1992), and (e) trigger immunosuppressive effects by overexercising (Mackinnon, 1992).

Coping Strategies Other Than Exercise Exercise is an effective stress-management technique. To me, a special advantage of using exercise to reduce stress is that it has highly substantiated health and fitness side effects: weight control, muscle definition, and cardiorespiratory fitness. Despite the desirable effects of exercise, it is important to maintain perspective conceming the value of exercise in stress management. Exercise is not the only effective stress-management technique. Exercise also can be combined with some of the techniques described in this section, such as meditating while jogging (Benson & Proctor, 1984). "Hiis section briefly overviews a few well-established techniques. Stress-management techniques other than exercise are especially important for the many people who need to reduce their stress levels and have physical disabilities that preclude exercise and for those who dislike exercise. These techniques also are of value to competitive athletes who wish to regulate their stress levels. An appealing guide to technique selection is the three-part specific-effects hypothesis outlined in Table 2 (Davidson & Schwartz, 1976). The specific-effects hypothesis suggests that a technique from one of the three categories has the greatest benefits for stress symptoms in that same category (Davis, Eshelman, &. McKay, 1985). Somatic techniques such as jogging and yoga focus directly on the body and are most effective in treating somatic stress symptoms: tense muscles, rapid heart rates, and lack of energy. Cognitive approaches are most effective in changing mental processes that result in cognitive symptoms such as anxiety, worry, insomnia, and negative self-talk. The third category of behavioral techniques helps individuals change their stress-producing behavior, such as overscheduling their daily activities and accepting too many responsibilities. Despite some technique specificity, it is likely that most of the techniques effect the generalized, trophotropic relaxation response, which is opposite to the fight-or-flight response (Benson, 1984; Lehrer & WoUfolk, 1984). (In contrast, exercise is similar to the fight-or-flight response; behavioral techniques effect the trophotropic response only indirectly.)

Cognitive Stress Management (Mind-Body) Techniques Most cognitive techniques focus on quieting the mind to reduce conclusions that one's competencies are insufficient to meet the demand. Meditation, thought-stopping, and hypnosis exemplify effective cognitive approaches to stress reduction.

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Table 2 Specific-Effects Hypothesis for Determining Relaxation Technique Effectivenras Technique categories

Relaxation techniques

Cognitive, or mind-body

Meditation and the relaxation response Thought-stopping Cognitive restructuring and reframing Stress innoculation Hypnosis

Somatic, or body-mind

Physical exercise Yoga Progressive relaxation Diaphragmatic breathing Massage Biofeedback

Behavioral

Time management Changing Type A behavior pattems Assertiveness training Developing social support skills

During meditation and its popularized version of the relaxation response, panicipants sit quietly, close their eyes, relax their muscles, focus on their breathing, and select a word and repeat it with each exhalation for approximately 20 minutes once or twice a day (Benson. 1976; Benson & Proctor, 1984; Maharishi, 1966). Meditation reduces autonomic functions (reduced oxygen consumption, slower respiration, decreased HR, and lower blood pressure [BP]) and the responsivity of the sympathetic nervous system (Feuerstein, Labbe, & Kuczmierczyk, 1986. p. 189). The state of relaxation associated with meditation is qualitatively different from that of simple rest as evidenced hy panicipants' respiration rates, plasma iactate. and basal skin resistance (Dillbeck & Orme-Johnson, 1987). During and after meditating, participants report the paradoxical effects of reduced somatic arousal and greater alertness. Thought stopping is another cognitive stress-management technique. It assists in identifying and correcting maladaptive conceptualizations and dysfunctional beliefs. In the first stage of leaming, the individual imagines a situation in which unwanted thoughts are likely to occur, and includes his or her normal obsessive thinking. After about 3 minutes, a loud verbal command, "Stop," is given either by a therapist or by the participant in response to a self-set timer. The individual then keeps his or her mind blank for the next 30 seconds, repeating the word stop if thoughts reoccur. The second stage eliminates the therapist's role in indicating the time to stop. In the third stage, panicipants leam to substitute positive, assenive statements for unwanted, obsessive thoughts (Davis et al., 1985). Thought-stopping is panicularly effective in treating a variety of obsessive, reoccurring, stress-producing thought processes, such as worrying, hypochondriasis, and thoughts of failure. Hypnosis is less mysterious than the word implies, but it does require specialized professional training. Hypnotic induction generally provides suggestions for deep relax-

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ation, positive life changes, and specific therapeutic goals such as smoking cessation, weight loss, or successful sport performance. Participants need to accept what is being said—either by the therapist, or by themselves in self-hypnosis (Kirsch, in press). During hypnotic induction, the therapist or participant in self-hypnosis should (a) allow a minimum of 20 minutes to enter and deepen the hypnotic state, (b) use positive suggesdCHis, (c) repeat suggestions until they begin to take hold, (d) focus on the immediate future, and (e) avoid worrying about progress (Davis et al., 1985).

Somatic Stress-Management (Body-Mind) Techniques Somatic techniques focus directly on reducing physical stress symptoms: muscle tension, migraine and tension headaches, backaches, and chronic fatigue. They also help to reduce the more generalized stress emotions of anger, embarrassment, and resentment (Everly & Rosenfeld, 1981: McGuigan. 1992). As noted in Table 2, physical exercise, progressive relaxation, and biofeedback exemplify somatic relaxation techniques. Progressive relaxation is a time-intensive somatic technique that was introduced to the medical community by Edmund Jacobson (1929) more than 60 years ago. Jacobson theorized that daily stressors and hassles evoke the startle reaction either overtly or covertly. When stress-related muscular and autonomic changes extend beyond an emergency, chronic muscular overtension develops. This muscular tension and mediating hormonal involvement increase autonomic nervous system activity. As practiced today, progressive relaxation consists of deliberate, conscious contraction and relaxation of specific skeletal muscle groups throughout the body. The purpose of tensing a particular muscle group is to create a conscious awareness of what muscle tension in that part of the body feels like. During the relaxation part, the client completely "lets go" of all muscle tension. Systematic tensing and relaxing of the muscles theoretically decrease the intensity of sympathetic responsiveness (McGuigan, 1992). In progressive relaxation, participants leam a series of exercises that increase their general muscular awareness and enable them to "tum off the power" when needed. While leaming progressive relaxation, according to McGuigan (1992), clients relax specific muscle groups in 30minute sessions that focus specifically on their left arm (7 sessions), right arm (7 sessions), left leg (10 sessions), right leg (!0 sessions), trunk region (10 sessions), neck region (6 sessions), eye region (12 sessions), and visualization (9 sessions). Progressive relaxation seems particularly useful for individuals who have a highly developed sense of muscle awareness, such as athletes and exercisers. Progressive relaxation might aid athletes and exercisers in improving their performance by helping them to consciously relax while exercising (Unestahl, 1986). Biofeedback is another effective somatic approach to stress reduction. This technique is especially helpful in treating the stress-related disorders of asthma, essential hypertension, tension and migraine headaches, and a variety of pain syndromes. Clients receive augmented "feedback" from electromyographic (EMG), skin temperature, electroencephalographic (EEG), or galvanic skin response (GSR) recordings. During biofeedback training, an imperceptible physiological process such as muscle tension (EMG) is picked up by the equipment and electronically amplified into an auditory tone or other signal that the patient learns to regulate. Clients leam to control the somatic system from which the biofeedback signals originate. Finally, clients generalize and use their ability to adjust physiological arousal in a variety of stressful situations. Biofeedback enables participants to regulate the physical responses that (a) ordinarily are not voluntarily or consciously controlled or (b) have broken down due to trauma or disease.

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Effectiveness of Exercise in Comparison to Other Stress-Management Approaches In studies employing a variety of populations, exercise has been as effective as other stress-management approaches in reducing tension, depression, and anger (Bahrke & Morgan, 1978; Berger et al., 1988; Long, 1985; Long & Haney, 1988a, 1988b). The mood benefits of exercise were panicularly impressive because the panicipants in the previously mentioned studies were randomly assigned to treatment. Thus, exercise was stress reducing for individuals who were not self-selected exercisers. Note that exercise was no more effective than the other stress-management techniques that included meditation, the relaxation response, progressive relaxation, and stress inoculation training. The lack of superiority of exercise in no way denigrates its effectiveness. Exercise is an effective stress-management technique. It simply is not more effective than other techniques.

Recommendations for Future Research Future research needs to examine funher the specific stress-management benefits— both the lowering and the raising of ongoing stress levels. Present research effons seem to capture just the "tip of the iceberg" in this area. We who exercise regularly know that we "feel better" and feel qualitatively "different" after exercising than before. Perhaps this is reflected in our mood levels; in feelings of competency, self-efficacy, and enhanced self-concepts; or in various physiological responses such as brain waves, muscle tension, and catecholamine responses. Somehow, present research effons are incomplete in capturing the stress-management benefits of exercise. Use of qualitative approaches and the new quantitative measures of self-esteem and physical self-perception may be useful. We need careful analysis of the current literature combined with imaginative, theoretical approaches as we continue the quest to understand the relationship between physical activity and stress. One promising approach is to examine the exercise mode, practice, and environmental factors that might influence the stress benefits of exercise. The taxonomy proposed by Berger and Owen (1988) is a beginning. Does the exercise need (a) to be enjoyable, (b) to develop aerobic fitness or abdominal breathing pattems, (c) to be temporally and spatially certain, (d) to be moderate in intensity, (e) to last between 20 and 30 minutes, and (f) to be included regularly in a weekly schedule? The guideline that the physical activity be noncompetitive reflects a deanh of research focusing on mood and competitive spon. Testing one's abilities in competition is anxiety producing (Hackfon & Spielberger, 1989). Habitually taxing one's physiological limits during practice sessions in competitive swimming has been associated with increased mood disturbance (Berger, Grove, & Prapavessis, 1994; Morgan et al., 1987). Little is known about the stress-reducing benefits of interactive, competitive spons such as a "friendly" tennis match or basketball game among adult recreational participants. Discussing the possibility of practicing the relaxation response while exercising to facilitate stress reduction. Benson and Proctor (1984) observe that "almost any endurance exercise will fit into this approach as long as it doesn't demand your complete attention and alenness. Clearly, handball, squash, or downhill skiing would be out of the question" (p. 140). In direct contradiction to Benson and Proctor's suggestion for non-attentitHidemanding physical activity, Lyne (1993) suggests that recreational basketball may be stress reducing:

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"It's [basketballl a release, an escape from life and work," said William Rudin, a third-generation New York real estate developer. "While you have to focus and concentrate, it's a different kind of concentration than at work." . . . It's also about winning. Playing hard is mandatory, even among the best of friends. . . . "It's not O.K. just to finish in our game," he said. "That's not the point. You have to win." (Lyne, 1993, p. F-37) Lyne (1993) does note that winning in basketball becomes more difficult with increasing age. Maintaining one's position within a league over a period of 20 years could be a major source of stress. Participation in competitive sport is fun, but it often results in self-talk such as "I'm not good enough," or "I've got to do better." Researchers have investigated the mood benefits of noncompetitive, noninteractive types of physical activities that are temporally and spatially certain. This is a beginning, but there is a need to study other types of sports and physical activities to test the appropriateness of the taxonomy. It is possible that a variety of exercise modes are stress reducing—for different reasons, and for different individuals. Another area of needed research is to explore the stress-reduction benefits of physical activity in specific populations. Considerable research has focused on a convenient population—college students. Students definitely need stress-management techniques during their college years. However, conclusions based on college students may not generalize automatically to all other populations. Researchers need to focus on adult populations; those who are experiencing high stress levels (and those who are not), patients with coronary heart disease, older populations, and psychiatric patients. Researchers have just begun to investigate the benefits for cancer patients and those who are HIV positive. Examining possible mechanisms underlying the relationship between exercise and psychological well-being is another area for further research. The artificial mind-body dichotomy in Western society is perpetuated by the proposed psychological and physiological mechanisms. Possible psychosocial mechanisms include expectancy, social interaction, an opportunity to commune with nature, meditating while exercising, feelings of competence and the ability to "take charge" of one's life, and distraction or "time out" from daily activities (Bahrke & Morgan, 1978; Berger, 1984a; Dunn & Dishman, 1991; Long & Haney, 1988b). Hypothesized physiological mechanisms include physiological/mental toughening, thermogenic benefits, more efficient catecholamine responses, and increasedendorphins (CJaytor, 1991: Dienstbier, 1991; Morgan & ElJickson, 1989; Petruzzello et al., 1993). Various combinations of these mechanisms may interact to affect the stress-reduction characteristics of different types of physical activities performed at various intensity levels by members of specific populations. 1 think that we need considerably more information about the stress-management effects of exercise in various populations before we know how to examine possible underlying mechanisms.

Implications for Professional Practice Both too little and too much stress are major detriments to one's health and psychological well-being. The appealing special-effects hypothesis suggests that a stressmanagement technique from one of three categories (somatic, cognitive, and behavior) has the greatest benefits for stress symptoms in that same category. Thus, exercise may have greater benefits on somatic stress sj^nptoms. Despite many unanswered questions, the potential benefits of exercise as a stress management technique argue well for cautious

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application (Intemational Society of Sport Psychology, 1992; Morgan & Goldston, 1987). Habitual exercise also has the previously mentioned desirable side effects of increased cardiovascular fitness, weight control, and preservation of muscle mass. Physical educators and other kinesiology professionals need to be familiar with the knowledge presented in this issue of Quest. They also should use moderation when extolling the stress-reduction benefits of exercise. Promising too much too soon discourages novice participants who have unrealistic expectations. As noted by Singer (1993) in his presentation at the Academy meetings last year, kinesiology practitioners have a responsibihty to (a) be knowledgeable and competent in stress management and exercise, (b) make accurate public statements that reflect good judgement and objectivity, (c) refer students and clients to professionals in medicine and psychology when complimentary services are needed, and (d) use appropriate assessment techniques that have acceptable validity, reliability, and normative data when measuring stress levels and coping styles and effectiveness. I highly recommend that all kinesiology professionals complete courses and inservice workshops in exercise psychology as well as in sport psychology. In addition, researchers need to bridge the proverbial gap between research and practice by proposing tentative guideJines for application. The taxonomy depicted in Table 1 is a cautious guide for maximizing the effectiveness of exercise as a stress reduction technique. Until there is research data conceming the stress-reduction benefits of competitive sport, practitioners could regard competitive spon as stress enhancing. As emphasized in Table 2, exercise is onJy one of many effective stress-reduction techniques. A final suggestion for professional practice is that physical education teachers present instructional units on the use of exercise for stress reduction. This unit would focus on a noncompetitive type of activity that promotes rhythmical abdominal breathing and predictable movement patterns. Activities such as stride walking, race walking, jogging, and swimming would be ideal exercise modes. To emphasize stress reduction, physical educators would encourage students to exercise continuously in class at an enjoyable or pleasani intensity for at least 20 minutes. Teachers also could suggest that students exercise regularly at home to experience training effects thai would reduce unpleasantries associated with performing beyond one's physical capabilities. This teaching unit would provide students with an opportunity to get to know their bodies, to interpret and adjust their level of exertion according to the physical sensations of exercising, and to explore their physical capabilities. Mindful attention to the physical sensations associated with exercise can promote its stress-reduction benefits (Kabat-Zinn, 1990). Notations of personal progress, accomplishment, and exercise-related feelings in a personal joumal format could augment student progress. An experiential teaching unit on exercise and stress reduction could help participants discover the value and meaning of physical activity for their own needs and could promote lifetime physical activity.

Ultimate Goals and Implications for Society Teaching diverse segments of the population to use exercise as a stress-management technique provides an effective, efficient, and inexpensive approach to health enhancement. As Selye (1975) noted nearly a generation ago, stress management —the conscious raising and lowering of stress—is critical to pursuing the well-lived life. Ideally, kinesiologists and physical educators will teach exercise participants (a) to enjoy physical activity, (b) to use exercise as a stress-management technique that can both raise and reduce ongoing stress levels (specific benefits include mood enhancement.

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increased self-esteem, and reduced psychophysical stress reactivity), (c) to explore the role of physical activity in energy production, and (d) to appreciate the value of exercise in the process of self-discovery at all stages of life. A focus on stress management and personal growth for average and highly skilled exercisers may encourage a larger portion of the population to be physically active. I believe that a major goal of physical education and kinesiology is to encourage e ^ h person to become the Ultimate Athlete in the game of life (Leonard, 1974). Habitual exercise has major implications for the quality, if not for the quantity, of life.

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Note ^Stress is a neutral term that denotes neither desirable nor undesirable states of being. The word distress refers to the negative aspects of stress as illustrated by the title of Hans Selye's (1975) book. Stress Without Distress. In common usage, the word distress is often shortened to the more common stress. Thus, stress and distress will be used interchangeably throughout this discussion.

First International Conference on Prevention ''Prevention, The Key to Health for Life*' October 27-30,1994, Charleston, West Virginia Presented by the Lawrence Frankel Foundation; The Center for the Study of Aging of Albany, NY; Robert C. Byrd Health Sciences Center; West Virginia Schools of Medicine and Osteopathic Medicine; Marshall University School of Medicine; and the World Health Organization. — Papers and Presentations Invited in the Following Areas — Well-Being and the Prevention of Illness; nutrition, exerci^, medicine, community programs, spirituality, self-responsibility, health education and promotion. Medicine; research and clinical practice; Social and Psychological Research and Practice: physical and mental health, exercise, motivation, behavior modification, drugs, group, and individual programs for exercise, sports, and nutrition; Health Assessment of Individuals; Public Policy and Cost Containment: economics of prevention. Deadline for Abstracts: April 15, 1994. Abstracts must be in Enghsh, limited to 5(X) words, and include a summary of salient points to be covered, methodology, results, and conclusions. Mai! to: First International Conference on Prevention, Center for the Study of Aging, 706 Madison Ave., Albany, NY 12208. For more information, call 518/465-6927 or Fax 518/462-1339 at the Center for the Study of Aging of Albany, NY (address above).

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