Anxiety and heart rate under psychological stress: The effects of exercise-training

Smartphone Photoplethysmography Pulse Rate Covaries With Stress and Anxiety During a Digital Acute Social Stressor

OBJECTIVE

Heart rate is a transdiagnostic correlate of affective states and the stress diathesis model of health. Although most psychophysiological research has been conducted in laboratory environments, recent technological advances have provided the opportunity to index pulse rate dynamics in real-world environments with commercially available mobile health and wearable photoplethysmography (PPG) sensors that allow for improved ecologically validity of psychophysiological research. Unfortunately, adoption of wearable devices is unevenly distributed across important demographic characteristics, including socioeconomic status, education, and age, making it difficult to collect pulse rate dynamics in diverse populations. Therefore, there is a need to democratize mobile health PPG research by harnessing more widely adopted smartphone-based PPG to both promote inclusivity and examine whether smartphone-based PPG can predict concurrent affective states.

METHODS

In the current preregistered study with open data and code, we examined the covariation of smartphone-based PPG and self-reported stress and anxiety during an online variant of the Trier Social Stress Test, as well as prospective relationships between PPG and future perceptions of stress and anxiety in a sample of 102 university students.

RESULTS

Smartphone-based PPG significantly covaries with self-reported stress and anxiety during acute digital social stressors. PPG pulse rate was significantly associated with concurrent self-reported stress and anxiety ( b = 0.44, p = .018) as well as prospective stress and anxiety at the subsequent time points, although the strength of this association diminished the farther away pulse rate got from self-reported stress and anxiety (lag 1 model: b = 0.42, p = .024; lag 2 model: b = 0.38, p = .044).

CONCLUSIONS

These findings indicate that PPG provides a proximal measure of the physiological correlates of stress and anxiety. Smartphone-based PPG can be used as an inclusive method for diverse populations to index pulse rate in remote digital study designs.

An examination of bidirectional associations between physical activity and mood symptoms among individuals diagnosed and at risk for bipolar spectrum disorders

OBJECTIVES

Activation, a construct including energy and activity, is a central feature of Bipolar Spectrum Disorders (BSDs). Prior research found motor activity is associated with affect, and this relationship may be stronger for individuals with BSDs. The aims of this study were to investigate bidirectional relationships between physical activity and mood and evaluate whether bipolar risk status moderated potential associations.

METHODS

Young adults at low-risk, high-risk, and diagnosed with BSD participated in a 20-day EMA study in which they wore an actiwatch to measure physical activity and sleep/wake cycles. They also reported depressive and hypo/manic symptoms three times daily. Multilevel linear models were estimated to examine how bipolar risk group moderated bidirectional relationships between physical activity and mood symptoms at within-day and between-day timescales.

RESULTS

Physical activity was significantly associated with subsequent mood symptoms at the within-day level. The relationship between physical activity and depressive symptoms was moderated by BSD risk group. An increase in physical activity resulted in a greater reduction of depressive symptoms for the BSD group compared to the low-risk and high-risk groups.

CONCLUSIONS

Interventions targeting activity like behavioral activation may improve residual inter-episode mood symptoms.

The effects of exercise on transdiagnostic treatment targets: A meta-analytic review

BACKGROUND

The present study meta-analytically reviewed the effects of exercise on four transdiagnostic treatment targets: anxiety sensitivity (AS), distress tolerance (DT), stress reactivity (SR), and general self-efficacy (GSE).

METHODS

We conducted systematic searches of peer-reviewed studies in bibliographical databases (Cochrane Library, psychINFO, PubMed) before April 1, 2018. Only randomized controlled trials (RCT) evaluating the effect of exercise on AS, DT, SR, or GSE using at least one validated outcome instrument in a sample of adolescents (≥13 years old) or adults were selected. We employed a meta-analysis of effects using random-effects pooling modeling for each treatment target.

RESULTS

The systematic search yielded 28 RCTs meeting eligibility criteria. Exercise interventions had a large effect on reducing AS (six studies, Hedges's g = 0.72, p = .001), a medium effect on increasing GSE (eight studies, Hedges's g = 0.59, p < .001), and a small effect on reducing SR (ten studies, Hedges's g = 0.32, p < .001). Evidence from four studies suggested that exercise interventions had a small but non-significant effect on increasing DT (Hedges's g = 0.21, p = .26).

CONCLUSIONS

This meta-analysis provides preliminary evidence exercise can engage certain transdiagnostic targets. Further research is required to optimize exercise intervention parameters to achieve the strongest effects on these important mechanistic variables.

Exercise as a buffer against difficulties with emotion regulation: A pathway to emotional wellbeing

Though exercise is associated with emotional health, it remains unclear what psychological processes account for this relationship. The present study explores emotional recovery from and responses to stress as links. It extends prior research by exploring whether poor response tendencies, such as a ruminative response style, could mediate the relationship between regular exercise and clinical symptoms, and whether acute exercise facilitates emotional recovery from a stressor in a heterogeneous sample comprising sedentary as well as active individuals and those reporting mood and anxiety symptoms. Participants completed questionnaires, performed 30 min of cycling or stretching, and underwent a stressful speech task. State affect and difficulties with emotion regulation and rumination were measured at various time points. Minimal regular exercise predicted more depression, anxiety, and stress, and cross-sectional data suggest that poor stress response tendencies (more habitual rumination and low coping self-efficacy) could partially mediate these relationships. Relative to stretching, prior exercise did not affect initial reactions to the stressor or reports of struggling to regulate one's emotions. However, it attenuated the effects that rumination and difficulties with emotion regulation had on delaying emotional recovery. Results suggest that enhanced emotional resilience to the prolonged effects of stress accounts, at least in part, for the emotional benefits of regular exercise. There appear to be benefits afforded by even single sessions of exercise and cumulative benefits from regular activity for coping with stress.

Diminished heart rate complexity in adolescent girls: a sign of vulnerability to anxiety disorders?

BACKGROUND AND OBJECTIVES

Diminished heart rate variability has been found to be associated with high anxiety symptomatology. Since adolescence is the period of onset for many anxiety disorders, this study aimed to determine sex- and anxiety-related differences in heart rate variability and complexity in adolescents.

METHODS

We created four groups according to sex and anxiety symptomatology: high-anxiety girls (n = 24) and boys (n = 25), and low-anxiety girls (n = 22) and boys (n = 24) and recorded their cardiac function while they performed regular school activities. A series of two-way (sex and anxiety) MANOVAs were performed on time domain variability, frequency domain variability, and non-linear complexity.

RESULTS

We obtained no multivariate interaction effects between sex and anxiety, but highly anxious participants had lower heart rate variability than the low-anxiety group. Regarding sex, girls showed lower heart rate variability and complexity than boys.

CONCLUSIONS

The results suggest that adolescent girls have a less flexible cardiac system that could be a marker of the girls' vulnerability to developing anxiety disorders.

Acute aerobic exercise helps overcome emotion regulation deficits

Although colloquial wisdom and some studies suggest an association between regular aerobic exercise and emotional well-being, the nature of this link remains poorly understood. We hypothesised that aerobic exercise may change the way people respond to their emotions. Specifically, we tested whether individuals experiencing difficulties with emotion regulation would benefit from a previous session of exercise and show swifter recovery than their counterparts who did not exercise. Participants (N = 80) completed measures of emotion response tendencies, mood, and anxiety, and were randomly assigned to either stretch or jog for 30 minutes. All participants then underwent the same negative and positive mood inductions, and reported their emotional responses. Analyses showed that more perceived difficulty generating regulatory strategies and engaging in goal-directed behaviours after the negative mood induction predicted more intense and persistent negative affect in response to the stressor, as would be expected. Interactions revealed that aerobic exercise attenuated these effects. Moderate aerobic exercise may help attenuate negative emotions for participants initially experiencing regulatory difficulties. This study contributes to the literature on aerobic exercise's therapeutic effects with experimental data, specifically in the realm of emotional processing.

Does a 20-week aerobic exercise training programme increase our capabilities to buffer real-life stressors? A randomized, controlled trial using ambulatory assessment

PURPOSE

The cross-stressor adaptation hypothesis suggests that regular exercise leads to adaptations in the stress response systems that induce decreased physiological responses to psychological stressors. Even though an exercise intervention to buffer the detrimental effects of psychological stressors on health might be of utmost importance, empirical evidence is mixed. This may be explained by the use of cross-sectional designs and non-personally relevant stressors. Using a randomized controlled trial, we hypothesized that a 20-week aerobic exercise training does reduce physiological stress responses to psychological real-life stressors in sedentary students.

METHODS

Sixty-one students were randomized to either a control group or an exercise training group. The academic examination period (end of the semester) served as a real-life stressor. We used ambulatory assessment methods to assess physiological stress reactivity of the autonomic nervous system (heart rate variability: LF/HF, RMSSD), physical activity and perceived stress during 2 days of everyday life and multilevel models for data analyses. Aerobic capacity (VO2max) was assessed pre- and post-intervention via cardiopulmonary exercise testing to analyze the effectiveness of the intervention.

RESULTS

During real-life stressors, the exercise training group showed significantly reduced LF/HF (β = -0.15, t = -2.59, p = .01) and increased RMSSD (β = 0.15, t = 2.34, p = .02) compared to the control group.

CONCLUSIONS

Using a randomized controlled trial and a real-life stressor, we could show that exercise appears to be a useful preventive strategy to buffer the effects of stress on the autonomic nervous system, which might result into detrimental health outcomes.

Effects of a 12-week endurance training program on the physiological response to psychosocial stress in men: a randomized controlled trial

The present study experimentally tested the cross-stressor adaptation hypothesis by examining whether endurance exercise training leads to reductions in the physiological stress response to a psychosocial stressor. We randomly assigned 149 healthy men to a 12-week exercise training, relaxation training, or a wait list control group. Before and after intervention we assessed the groups' physical fitness (lactate testing) and compared their physiological stress responses to the Trier Social Stress Test for Groups in terms of salivary free cortisol, heart rate (HR) and heart rate variability (HRV); the final sample consisted of 96 subjects. As hypothesized, the exercise training significantly improved fitness and reduced stress reactivity in all three parameters; however, it only improved stress recovery in terms of HR. The relaxation program reduced only cortisol, but not HR or HRV reactivity; no changes emerged for the control group. The findings suggest that the cross-stressor adaptation hypothesis is valid for cardiovascular as well as endocrine stress reactivity.

Aerobic exercise for alcohol recovery: rationale, program description, and preliminary findings

Alcohol use disorders are a major public health concern. Despite the demonstrated efficacy of a number of different treatments for alcohol dependence, relapse remains a major problem. Healthy lifestyle changes may contribute to long-term maintenance of recovery, and interventions targeting physical activity, in particular, may be especially valuable as an adjunct to alcohol treatment. In this article, the authors discuss the rationale and review potential mechanisms of action whereby exercise might benefit alcohol dependent patients in recovery. They then describe the development of a 12-week moderate-intensity aerobic exercise program as an adjunctive intervention for alcohol dependent patients in recovery. Preliminary data from a pilot study (N=19) are presented, and the overall significance of this research effort is discussed.

Cardiorespiratory fitness and laboratory stress: a meta-regression analysis

We performed a meta-regression analysis of 73 studies that examined whether cardiorespiratory fitness mitigates cardiovascular responses during and after acute laboratory stress in humans. The cumulative evidence indicates that fitness is related to slightly greater reactivity, but better recovery. However, effects varied according to several study features and were smallest in the better controlled studies. Fitness did not mitigate integrated stress responses such as heart rate and blood pressure, which were the focus of most of the studies we reviewed. Nonetheless, potentially important areas, particularly hemodynamic and vascular responses, have been understudied. Women, racial/ethnic groups, and cardiovascular patients were underrepresented. Randomized controlled trials, including naturalistic studies of real-life responses, are needed to clarify whether a change in fitness alters putative stress mechanisms linked with cardiovascular health.

Perceived health is associated with visiting natural favourite places in the vicinity

Visiting favourite natural settings may serve as a resource for regulating negative feelings and coping with perceived stress. The authors investigated the association between perceived health, the selection and experiential qualities of favourite places in four residential areas; 211 respondents (average age 40 years) responded to the questionnaire. Respondents with a certain amount of health complaints, such as headaches, chest or stomach pains, and faintness or dizziness, were more likely to select natural favourite places than those with few complaints. Respondents with health complaints benefited more in emotional terms from their visits to the favourite place although they did not visit their places more frequently than others. The change toward positive feelings was associated in particular with natural favourite places and relaxing in them. The results give impetus to research on the self-regulation of mood and neighbourhood context in health.

Comparison of two exercise programs on general well-being of college students

Responses to life stressors are associated with negative behaviors that may increase risk for illness and injury. The effect of high intensity exercise in reducing reactivity to psychological stress has been well documented among older people. The purpose of this study was to ascertain the effect of weight-training versus aerobic dance on psychological stress in college students. 45 students participated in a weight-training course, 35 students participated in aerobic dance classes, and 34 students served as a control group. The Survey of Recent Life Experiences was used to appraise stressfulness of current experiences before and after exercise intervention. On immediate retest after 8 wk. of weight-training perceived stress was significantly reduced when compared with an 8-wk. aerobic dance program, but there were no significant differences between the control group and the weight-training group or the aerobic dance group. These results suggest that a regular routine of low intensity exercise such as weight-training may reduce perceived stress on an immediate test.

The decade 1989-1998 in Spanish psychology: an analysis of research in basic psychological processes, history of psychology, and other related topics

This article presents a review of research published by Spanish Faculty from the area of basic psychology in the decade 1989-1998. It provides information about research on basic psychological processes commonly studied under the labels of experimental and cognitive psychology, plus a number of topics from other research areas, including some applied psychology issues. The review analyzes the work of 241 faculty members from 27 different Spanish universities, as reflected in 1,882 published papers, book chapters, and books. The analyses carried out in this report include a description of the main research trends found in each area, with some representative references of the published materials, and statistics showing the distribution of this research work in various relevant publications (both Spanish and foreign), with figures that reveal the impact of this work both at a national and international scale.

Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory

Until recently, claims for the psychological benefits of physical exercise have tended to precede supportive evidence. Acutely, emotional effects of exercise remain confusing, both positive and negative effects being reported. Results of cross-sectional and longitudinal studies are more consistent in indicating that aerobic exercise training has antidepressant and anxiolytic effects and protects against harmful consequences of stress. Details of each of these effects remain unclear. Antidepressant and anxiolytic effects have been demonstrated most clearly in subclinical disorder, and clinical applications remain to be exploited. Cross-sectional studies link exercise habits to protection from harmful effects of stress on physical and mental health, but causality is not clear. Nevertheless, the pattern of evidence suggests the theory that exercise training recruits a process which confers enduring resilience to stress. This view allows the effects of exercise to be understood in terms of existing psychobiological knowledge, and it can thereby provide the theoretical base that is needed to guide future research in this area. Clinically, exercise training continues to offer clinical psychologists a vehicle for nonspecific therapeutic social and psychological processes. It also offers a specific psychological treatment that may be particularly effective for patients for whom more conventional psychological interventions are less acceptable.