title: The effects of stress on physical activity and exercise.
abstract: BACKGROUND
  Psychological stress and physical activity (PA) are believed to be reciprocally related; however, most research examining the relationship between these constructs is devoted to the study of exercise and/or PA as an instrument to mitigate distress.
  
  
  OBJECTIVE
  The aim of this paper was to review the literature investigating the influence of stress on indicators of PA and exercise.
  
  
  METHODS
  A systematic search of Web of Science, PubMed, and SPORTDiscus was employed to find all relevant studies focusing on human participants. Search terms included "stress", "exercise", and "physical activity". A rating scale (0-9) modified for this study was utilized to assess the quality of all studies with multiple time points.
  
  
  RESULTS
  The literature search found 168 studies that examined the influence of stress on PA. Studies varied widely in their theoretical orientation and included perceived stress, distress, life events, job strain, role strain, and work-family conflict but not lifetime cumulative adversity. To more clearly address the question, prospective studies (n = 55) were considered for further review, the majority of which indicated that psychological stress predicts less PA (behavioral inhibition) and/or exercise or more sedentary behavior (76.4 %). Both objective (i.e., life events) and subjective (i.e., distress) measures of stress related to reduced PA. Prospective studies investigating the effects of objective markers of stress nearly all agreed (six of seven studies) that stress has a negative effect on PA. This was true for research examining (a) PA at periods of objectively varying levels of stress (i.e., final examinations vs. a control time point) and (b) chronically stressed populations (e.g., caregivers, parents of children with a cancer diagnosis) that were less likely to be active than controls over time. Studies examining older adults (>50 years), cohorts with both men and women, and larger sample sizes (n > 100) were more likely to show an inverse association. 85.7 % of higher-quality prospective research (≥ 7 on a 9-point scale) showed the same trend. Interestingly, some prospective studies (18.2 %) report evidence that PA was positively impacted by stress (behavioral activation). This should not be surprising as some individuals utilize exercise to cope with stress. Several other factors may moderate stress and PA relationships, such as stages of change for exercise. Habitually active individuals exercise more in the face of stress, and those in beginning stages exercise less. Consequently, stress may have a differential impact on exercise adoption, maintenance, and relapse. Preliminary evidence suggests that combining stress management programming with exercise interventions may allay stress-related reductions in PA, though rigorous testing of these techniques has yet to be produced.
  
  
  CONCLUSIONS
  Overall, the majority of the literature finds that the experience of stress impairs efforts to be physically active. Future work should center on the development of a theory explaining the mechanisms underlying the multifarious influences of stress on PA behaviors.
authors.affiliation: Department of Psychiatry, Yale Stress Center, Yale University School of Medicine, 2 Church Street South, Suite 209, New Haven, CT, 06519, USA, matthew.stults-kolehmainen@yale.edu.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Stults-Kolehmainen
authors.forename: Rajita
authors.initials: R
authors.lastname: Sinha
mesh_terms: D015444:Exercise / Q000523:psychology*; D006184:Habits; D015438:Health Behavior; D006801:Humans; D057185:Sedentary Behavior; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology*
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