The Role of Exercise in Stress Management
Regular exercise can help you complete the stress response cycle and help your body return to homeostasis. The stress response system is a mechanism that is triggered by a threat to one’s well-being or survival, causing a cascade of protective physiological responses that prepare the individual to combat the threat or flee from it. While this is helpful in response to an acute stressor, a chronic stress response can have detrimental effects on your physical and mental health, contributing to disease, chronic pain, and anxiety. Exercise helps you complete the stress cycle by engaging your body in movement, which completes the flight response your body prepares for when encountering a stressor. Exercise can also be used therapeutically to help calm the chronic stress response and reduce chronic pain through graded low-impact exercise.
How the Stress Response System Works
Stress can be defined as experiences that are emotionally and physically challenging and pose a threat to homeostasis within your body. As humans, we function on a neurological continuum between the sympathetic nervous system and the autonomic nervous system. The sympathetic nervous system is activated in response to a stressor, causing the flight or fight response; promoting tissue breakdown and fat metabolism to mobilize glucose for energy; and supporting arousal, alertness, motivation, and goal-directed behavior.
The autonomic nervous system is the “rest and digest” state, promoting healing, repair, immunity, and anabolic growth that is required to restore energy reserves and longevity. There is a delicate balance between the sympathetic and autonomic (or parasympathetic) nervous system. Once the body responds to a stressor using the sympathetic nervous system, it is essential for the body to return to homeostasis and return to the autonomic nervous system state.
The stress response system is a mechanism that is triggered by a threat, whether real or perceived, to one’s well-being or survival. The stress response system is characterized by a cascade of protective physiological responses that prepare the individual to combat the threat or flee from it. The amygdala of the brain responds to the stress (fear or danger) by initiating an immediate sympathetic response, releasing norepinephrine and epinephrine, which increase heart rate, blood pressure, and respiration and stimulate sweat secretion and dilation of the pupils.
This is followed by a neuroendocrine response to promote survival in which the hypothalamus and HPA axis are signaled to release corticotropin-releasing hormone (CRH) and then cortisol from the adrenal cortex. Within 15 minutes of the onset of stress, cortisol levels rise systemically and remain elevated for several hours. Cortisol surges during the stress response to provide energy to cope with and respond to the stressor. While a stress-induced increase in cortisol is adaptive and helpful in the short term, excessive or prolonged cortisol secretion due to chronic stress can have crippling effects on the person, both physically and psychologically.
The Connection between Chronic Stress & Chronic Pain
Nearly one-third of the world’s population reported being chronically stressed in 2020 in a survey completed prior to the pandemic; chronic stress levels have likely continued to escalate over the last 3 years. Chronic stress is strongly correlated to a number of chronic diseases and mental health conditions, such as cardiovascular disease, stroke, hypertension, diabetes, certain cancers, sleep and digestive issues, upper respiratory issues, immune suppression, mood swings, anxiety, and depression.
Chronic stress causes dysregulation of the autonomic nervous system due to the sustained release or repeated surges of cortisol in response to the chronic stressor, causing a constant state of fight or flight and a disruption of the body’s homeostasis. This leads to exhaustion of the HPA axis and significant cortisol dysfunction as well as uncontrolled inflammatory responses throughout the body that can cause oxidative stress, free radical damage, tissue degeneration, inflammation, and pain.
The chronic stress response intensifies cortisol secretion and can prolong the experience of pain in the body, augmenting a cycle of chronic pain and increased sensitization of the painful area. Studies have revealed that chronic stress-induced cortisol dysfunction are linked to pain somatization disorders like fibromyalgia, chronic fatigue syndrome, chronic pelvic pain, and temporomandibular disorder. The chronic pain itself is a stressor that may reactivate a proinflammatory stress response, now uncontrolled due to cortisol dysfunction from chronic stress, and contribute to increased sensitization in the painful area.
The Role of Exercise in Stress Management & Chronic Pain Treatment
Regular exercise can help you complete the stress response cycle and help your body return to homeostasis and balance. Exercise helps you to complete the stress cycle by engaging your body in movement, which completes the flight response your body prepares for when encountering a stressor. Aerobic exercise, like walking, jogging, swimming, cycling, or dancing, is the fastest way to get the stress-busting benefits of exercise as aerobic exercise elevates your heart rate and releases endorphins. Exercise helps you decrease your reactive response to stress over time. Exercise mimics the physical effects of the stress response, like a rapid heartbeat and sweating, which can reduce your sensitivity to actual stressful events and help you cope more easily.
Exercise has many benefits for stress relief:
Exercises boosts your endorphins, which are the brain’s feel-good neurotransmitters, and improves your mood.
Exercise can be “meditation in motion,” helping you to take your focus off the stressor and instead focus on the rhythm of your movement and be present to the moment, not lost in fear or worry over the stressor.
Exercise also improves your cardiovascular health which can be negatively impacted by chronic stress. Regular exercise lowers your blood pressure and decreases your heart rate over time.
Exercise can decrease anxiety and symptoms of depression and improve your sleep.
Exercise can decrease fatigue and increase mental alertness and energy.
Exercise improves your overall physical health, strengthening your bones and muscles, improving your immunity, boosting good cholesterol levels in the blood, and improving blood circulation.
Exercise can make you more resilient both physically and emotionally to stressors. A randomized control trial study assessed the effect of exercise training on men’s physiological response to stress. Those participants who underwent a 12-week endurance exercise training program had significantly reduced stress reactivity to a psychosocial stressor as measured by cortisol, heart rate, and heart rate variability responses. Those participants who underwent a 12-week relaxation technique training program demonstrated reductions in cortisol stress reactivity only, whereas the wait list group who received no intervention showed no changes or improvements in stress reactivity.
Another study showed regular exercise have a protective effect against stress. Twenty-two elite sportsmen had lower cortisol and heart responses as well as better mood, greater calmness, and lower state anxiety to a psychosocial stressor compared with 22 untrained men. A 2014 study of 111 participants compared the effects of a stressful task with those of a non-stressful task among those who exercised regularly vs. those that are sedentary. In those who exercised regularly, stress caused a smaller decline in mood, whereas those that were sedentary experienced a larger decline in mood after a stressor.
Therapeutic graded exercise with a physical therapist can play a pivotal role in addressing chronic pain that is exacerbated by the chronic stress response. Chronic pain, like low back pain or pelvic pain, can be a source of chronic stress in the body, reactivating a proinflammatory stress response and contributing to increased sensitization in the painful area. To desensitize the painful area and calm the body’s stress response to the area of pain, the physical therapist uses low impact, graded aerobic exercise. The graded exercise program helps the patient not only slowly increase their aerobic ability, improve mobility and coordination, and reduce stress in the body, but also allows the affected body part (the source of the chronic pain) to move gently and safely. This trains the brain to sense the problem area without eliciting and increasing hyper-sensitive pain messaging. Over time, the chronic pain area can be moved without a hypersensitive response and the chronic stress response to the pain is calmed, allowing the body to come to a place of homeostasis and decreased chronic pain.
