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Diet, Exercise, Mindfulness, and Relaxation_Stress Management and Stress Reduction

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Recognizing the growing problem of chronic stress in the United States, this paper explores the utility of diet, exercise, and mindfulness-based stress reduction to stress management and protection against periods of stress. A review of research relating diet and stress implicates poor nutrition and excess consumption of fat as increasing stress reactivity while a Mediterranean diet and supplementation with anti-oxidant vitamins, minerals and Omega-3 provide stress protection. The literature exploring the impact of exercise on stress affirms the positive role of vigorous or aerobic exercise in improving response to stress, protecting against the adverse health effects of stress, and reducing stress experienced by individuals dealing with chronic disease. Finally, studies evaluating the effectiveness of mindfulness-based stress reduction identify the practice as successful in lowering perceived stress, improving regulation of stress hormones, reducing hostile and impulsive behavior in young people, and leaving a positive state of mindfulness with low emotionality, contentment, and new life perspective. Key words: stress, stress management, diet, exercise, mindfulness
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Diet, Exercise, Mindfulness, and Relaxation: Stress Management and Stress Reduction
Frederick H. Navarro
August, 2011
Walden University
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Abstract
Recognizing the growing problem of chronic stress in the United States, this paper explores the
utility of diet, exercise, and mindfulness-based stress reduction to stress management and
protection against periods of stress. A review of research relating diet and stress implicates poor
nutrition and excess consumption of fat as increasing stress reactivity while a Mediterranean diet
and supplementation with anti-oxidant vitamins, minerals and Omega-3 provide stress
protection. The literature exploring the impact of exercise on stress affirms the positive role of
vigorous or aerobic exercise in improving response to stress, protecting against the adverse
health effects of stress, and reducing stress experienced by individuals dealing with chronic
disease. Finally, studies evaluating the effectiveness of mindfulness-based stress reduction
identify the practice as successful in lowering perceived stress, improving regulation of stress
hormones, reducing hostile and impulsive behavior in young people, and leaving a positive state
of mindfulness with low emotionality, contentment, and new life perspective.
Key words: stress, stress management, diet, exercise, mindfulness
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Diet, Exercise, Mindfulness, and Relaxation: Stress Management and Stress Reduction
In August of 2010 the American Psychological Association conducted a study of stress in
the United States (APA, 2010) and concluded that the US population as a whole is over-stressed.
Exasperated by several years of economic downturn, those in the US are finding it difficult to
focus on health given the needs of work and the needs of family. Thus, coping with stress is
having a deleterious effect on their physical and emotional health (APA, 2010). For example, the
report notes that too much stress over an extended time can impair an individual’s ability to
engage in normal living by increasing fatigue, disrupting concentration, and heightening negative
mood (APA, et al).
Families are also adversely impacted by stress. According to the APA, a sizable
percentage of parents (32%) are suffering from extreme levels of stress which they recognize as
potentially detrimental to their health and disruptive to the family and children. They are correct
in this assessment as research has shown that perceived stress is associated with increased
severity of premenstrual syndrome (Gollenberg, Hediger, Mumford, Whitcomb, Hovey,
Wactawski-Wende, & Schisterman, 2010) and the susceptibility of children to disease later in
life (Miller, Chen, & Parker, J. 2011).
Stress, Workplace, and Ethnicity
There are other factors besides those related to the economy that contribute to stress, such
as workplace and ethnic/radical factors. With respect to workplace stress, Chandola, Heraclides,
and Kumari (2009) reviewed studies investigating plasma catecholamines, variability of heart
rate, and cortisol levels after walking and concluded that employment stress is associated with
higher levels of physiological stress markers consistent with greater activation of the sympathetic
adrenal-medulla (SAM) and hypothalamic-pituitary-adrenocortical (HPA) axes. Examination of
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stress associated with race/ethnicity has shown that Hispanic and African-American young
people do in fact possess a flatter cortisol signature relative to Caucasians, and this flatter cortisol
is a marker of higher risk of future ill health (DeSantis, Adam, Doane, Mineka, Zinbarg, &
Craske, 2007). Interestingly, DeSantis, et al. (2007) found stress in Hispanic and African-
American youth associated with patterns of negative emotion as opposed to socioeconomic status
or environment.
Stress, Illness, and Disease
It is well understood that stress and perceived stress in adults contribute to a wide range
of disorders including hypertension and elevated plasma cortisol (Esler, Eikelis, Schlaich,
Lambert, Alvarenga, Dawood, et al., 2008), cardiac and cardiovascular disease (Stanley &
Burrows, 2008; Sarkar & Mukhopadhyay, 2008), inflammatory bowel syndrome (Jordan, 2010),
Type II diabetes (Heraclides, Chandola, Witte, & Brunner, 2009), and reduced quality of life
among those suffering with cancer (Hansen & Sawatzky, 2008; Kreitler, Peleg, & Ehrenfeld,
2007; van de Wiel, Geerts, & Hoekstra-Weebers, 2008).
Reducing Stress and Stress Management Approaches
Given the adverse consequences of stress or perceived stress on both health and quality of
life, the importance of both managing and reducing the effects of stress is self-evident.
Fortunately, stress management has proven successful in reducing stress. For example, Storch,
Gaab, Küttel, Stüssi, and Fend (2007) evaluated the long-term effectiveness of training in stress
management on cortisol and the appraisal of stress and found reductions in salivary cortisol
levels as well as reduced levels of appraised stress. Phillips, Antoni, Lechner, Llabre, Avisar,
Gluck, et al. (2008) showed reduction in stress and lower cortisol levels in female cancer patients
after completing a ten week stress management intervention focusing on cognitive-behavioral
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factors. Finally, Daubenmier, Weidner, Sumner, Mendell, Merritt-Worden, Studley, and Ornish
(2007) examined the triple effect of lowering the consumption of fat, increasing exercise, and
providing stress management over a three month period on the risk of coronary heart disease and
other psychosocial issues. Daubenmier, et al. (2007) found that both reductions in fat intake and
exercise interacted to lower weight, lower cholesterol, and bring down levels of perceived stress.
Also, reductions associated with stress management were associated with reduction in other
physiological markers (e.g., triglycerides, A1c) and psychosocial markers (e.g., hostile behavior).
Thus, stress management is an important tool in reducing stress and in altering the physiological
effects of stress.
Stress Management Approaches
This paper will follow the approach of Daubenmier, et al. (2007) and take an extended
look at three stress management interventions: diet, exercise, and mindfulness, and their role in
stress reduction. The discussion will focus first on the relationship between diet and stress.
Diet and Stress
High Fat Diet and Stress Response. Noting that improper poor diet and elevated stress
act to disturb the balance of energy in the body and contribute to ill health and disease, Kitraki,
Soulis, and Gerozissis (2004) described an animal study using Wister rats investigating the
effects of a diet high in polyunsaturated fat (e.g., corn oil) and deceased consumption of
carbohydrates and reduced intake of protein over seven days on both energy consumption and a
subsequent stress reaction to a short stressor (e.g., swimming). Comparing levels of stress
hormones in the high fat/low protein/low carbohydrate diet rats and normally fed rats, Kitraki, et
al. (2004) found that the levels of corticosterone in both sets of rats were not different during the
stressor. Additionally, corticosterone concentrations appeared to not be effected by the different
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diets. However, further analysis of blood stains showed elevated levels of glucocorticoid
receptors within the hypothalamic area of the rats fed normally while lower glucocorticoid
receptors levels were found in the high fat/low protein/low carbohydrate diet fed rats. According
to Kitraki, et al., the results highlight how quickly an improper diet with high fat intake and lack
of other nutrients can adversely impact the balance of stress hormones as evidenced by lower
glucocorticoids receptors in the hypothalamus known to mediate the effects of cortisol (Manary,
Muglia, Vogt, & Yarasheski, 2006).
Omega-3 and Perceived Stress. Bradbury, Myers, and Oliver (2004) sought to
determine if perceived levels of stress can be lowered through consumption of the omega-3 three
fatty acid docosahexaenoic acid (DHA). For the study, participants employed at a university
scoring high on a scale of perceived stress were randomly assigned to either a group taking fish
oil supplements containing DHA or a group (e.g., placebo group) taking supplements of olive oil
over a six-week period. For the analysis both the fish oil group and the olive oil placebo group
were contrasted with each other as well as against a larger control population of individuals
making up a cross-sectional sample. Following the six-week trial, analysis showed that perceived
stress levels were significantly lower among both the fish oil and olive oil placebo groups.
When comparing perceived stress levels between the fish oil group and the larger population, the
fish oil group had significantly lower perceived stress. Yet, further analysis showed that there
were no significant differences in perceived stress level between the fish oil and olive oil placebo
group, and no significant difference in perceived stress level between the olive oil placebo group
and the cross sectional control group. Overall, only the fish oil group showed significant
reductions in perceived stress relative to the control sample consistent with the conclusion that
omega-3 acts to attenuate perceived stress.
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Omega-3 and Posttraumatic Stress Disorder Prevention. According to Matsuoka
(2011), preventing the development of posttraumatic stress disorder (PTSD) among individuals
following an accident is critical as up to 23% of individuals experience PTSD within 12 months
of an injury due to an accident. Also, several risk factors contribute to a greater incidence of
PTSD following an accident including factors such as being female, already suffering from
depression, being admitted to an ICU as a result of the accident, being prescribed
benzodiazepine, seeing the accident as life-threatening, and so on (Matsuoka, et al.) As a
symptom of PTSD is intrusive memories and re-experiencing the accident, Matsuoka focused on
how traumatic memories are formed following an accident, and that recent research has shown
that the formation of traumatic memories following an accident do not become permanent at the
time of the accident but sometime later as the memories are consolidated. Thus, focusing on the
neurogenesis that occurs in the hippocampus (Kempermann, 2002), and noting that memory
consolidation must involve interaction between the areas of the brain involved with fear (e.g.,
amygdala) and short-term memories (e.g., hippocampus), Matsuoka attempted to stimulate
hippocampus neurogenesis using Omega-3 to assess its impact on the development of PTSD.
Using 15 individuals who had recently experienced an injury due to an accident, Matsuoka gave
the individuals Omega-3 (e.g., DHA, eicosapentaenoic acid) for 12 weeks. Measuring the
individuals with a validated scale for assessing PTSD symptoms at the close of the intervention,
Matsuoka found PTSD symptoms in only 6.7% of the original 15 indicating a reduction in PTSD
progression. Though Matsuoka’s research is preliminary, the findings indicate that giving
accident survivors omega-3 fatty acid following injury from an accident may decrease their risk
for developing PTSD.
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Diet, Stress, and Inflammation. Inflammation is a biomarker of stress. According to
Hänsel, Hong, Cámara, and von Känel (2010) situations such as work-related stress, stress
associated with living in poor socioeconomic conditions, stressful events suffered in childhood,
and stress associated with caring for another all contribute to chronic stress and influences the
function of the immune system. Further, Hänsel, et al. (2010) describe how chronic stress
impacts the HPA axis as well as the autonomic nervous system (ANS) resulting in increased
levels of inflammation. Galland (2010) describes how research exploring the impact of nutrition
and patterns of food consumption have identified associations with immunologic indicators of
inflammation (e.g., interleukin-6, tumor necrosis factor alpha, C-reactive protein). Of those
studies evaluating the effects of diet on inflammatory response, results indicate that changes in
diet have affected levels of fiber, the mix of fatty acids, levels of magnesium, and other nutrient
compositions (Galland, 2010). Further, Galland associates healthier, anti-inflammatory
influences with food consumption patterns that result in a greater monounsaturated fat to
saturated fat ratio, a greater Omega-3 to Omega-6 ratio, and greater levels of vegetable, fruit,
whole grain, and legume consumption.
Bakker, van Erk, Pellis, Wopereis, Rubingh, Cnubben, et al. (2010) conducted a rigorous
experiment to see if dietary changes could reduce moderate levels of chronic inflammation in
individuals identified as being overweight. Bakker, et al. (2010) gave a sample of men who were
overweight but healthy a mix of nutrients known to deliver anti-inflammatory effects (e.g.,
vitamin C, omega-3, extracts derived from green tea and tomatoes) for five weeks. Measures
were taken of blood plasma, fat tissue, metabolic enzymes, and so on. At the end of the five
weeks there were no changes in measures of inflammation (e.g., C-reactive protein). Yet, there
were a wide range of very small alterations indicating some attenuation of inflammation in fatty
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tissues as indicated by improved performance of endothelial tissue and oxidation of fatty acids in
the liver. The outcomes indicate that adopting a diet high in anti-inflammatory and antioxidant
properties can have beneficial impacts on inflammation and oxidative stress.
Vitamins and Stress. Supplementation with vitamins can reduce stress and improve
overall mood. The benefit of vitamin supplementation in reducing stress and improving mood
and mental performance was demonstrated by Kennedy, Veasey, Watson, Dodd, Jones, Maggini,
and Haskell (2010) in a sample of working males between the ages of 30 and 55. These males
were required to visit a laboratory at the beginning and end of the experimental trial where they
filled out a questionnaire measuring their mood state, a questionnaire measuring their perceived
stress, and a questionnaire assessing their overall health. A measurement of cognitive
functioning, mood change, and fatigue were also assessed during one hour battery of cognitive
tests. The men where then randomly assigned to an experimental or control group. For over 30
days the men in the experimental group received direct supplements of vitamins and minerals.
During the last day of the trial all men were asked to walk on a treadmill as they where engaged
in a test of cognitive function. Analysis showed that the men who received supplements of
vitamins and minerals exhibited improved cognitive performance, lower rated stress, improved
mental functioning, and heartiness.
A study conducted by Mishra, McNaughton, O'Connell, Prynne, & Kuh (2009) further
demonstrates how insufficient amounts of vitamins, specifically B vitamins, can contribute
distressed mood. Mishra, et al. (2009) assessed the impact of vitamin levels (e.g., vitamins B6,
B12, niacin, folate, etc.) taken as a child and taken as an adult on women’s psychological state
during adulthood. Using a standardized questionnaire to assess levels of psychological distress
and a memory recall session to assess patterns of food consumption and vitamin intake during
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childhood, Mishra, et al. collected food intake information from a sample of women going as far
back as age 4 and later ages leading to adulthood. Upon analysis, Mishra, et al. found that only
deficient levels of vitamin B12 taken at their current adult age had an association with higher
reporting of psychological distress.
Exercise and Stress
Exercise, Stress, and Health. Seeking to investigate if exercises’ benefit to health is due
to its moderation of stress response, Gerber and Pühse (2009) conducted an in-depth review of
research studies as far back as 1982 which evaluated the potential role of exercise on stress. Of
the studies identified only half identified partial relationships between exercise, stress, and
health. For example, Gerber, et al. (2009) noted that individuals in the studies who engaged in
regular vigorous exercise showed minimal adverse health effects during periods of stress.
Applying an analysis methodology in an attempt to tease out causality, Gerber, et al. identified
consistent results with respect to the role of exercise in reducing the effects of stress even though
various studies employed different research methods and analysis procedures. Gerber, et al.
concluded that exercise is a valuable asset to those working to improve public health. Future
research questions posed by Gerber, et al. include the need to understand the level of exercise
required to achieve stress moderation, and the kinds of exercise which deliver this affect most
efficiently.
Exercise and Breast Cancer. Hughes, Leung, and Naus (2008) observed that few
women who are Hispanic show regular engagement in regular exercise, and by coincidence
cancer rates and higher instances of mortality from cancer are found among them relative to
other ethnic groups. Stress among Hispanics increases the risk of several adverse health
conditions such as impaired immune function, impaired healing of injuries, and psychosocial
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problems (Hughes, et al.). Using a research methodology that allowed for analyses by group and
within the individual, Hughes, et al. conducted a study using Hispanic women who had survived
cancer and not received treatment for six months or more. Of the measures to assess outcomes,
Hughes, et al. assessed physical attributes such as cardiovascular functioning, percentage of body
fat, and flexibility. Hughes, et al. also included a measure of self-reported health status (e.g., SF
36) that included subscales measuring physical status and mental status, and a standardized
measure of perceived stress. Finally, the authors used measures of nocturnal salivary cortisol to
measure the stress response. All participants were subjected to a five-week tailored exercise
intervention involving 60 min. of aerobic and strength training exercise. At the group level,
Hughes, et al. found that all measures of physical fitness showed improvement and levels of
salivary cortisol decreased according to levels of participation. Analysis of exercise impacts at
the individual level revealed reduction of body fat, improve physical fitness, and lower levels of
stress but some raising of quality of life.
Exercise, Stress, and Telomere Chromosome Length. According to Puterman, Lin,
Blackburn, O’Donovan, Adler and Epel (2010) the adverse effects on health that follow chronic
stress may be related to advanced aging processes in the cells evidenced by reduced lengths of
chromosome telomeres (e.g., endings). Noting that chromosome telomeres with reduced length
are not found in all individuals suffering from stress, Puterman, et al. (2010) conducted a study
to see if exercise can moderate stress and reduce the impact of stress on chromosome telomere
length. Using a sample of 63 older but otherwise healthy females, Puterman, et al. drew blood
from the participants after they had engage in fasting to assess chromosome telomere lengths.
Additionally, the participants completed a standardized assessment of perceived stress, and were
asked to report the number of minutes they engaged in a vigorous exercise over the course of
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three days. Puterman, et al. used the exercise data to divide participants into an active group and
a sedentary group, and assessed the association of chromosome telomere lengths with perceived
stress levels and average number of minutes of vigorous exercise per day controlling for age,
body mass index (BMI) and educational level. Consistent with other research, analysis conducted
by Puterman, et al. showed that exercise has an attenuating affect on stress. Further, Puterman, et
al. found that, among the participants in the sedentary group, every unit that perceived stress
increased raised the odds of shorter chromosome telomeres by 15 times. In contrast, Puterman, et
al. found no such relationship among the participants in the exercise group. Puterman, et al.
concluded that those who engage in regular physical exercise appear to be protected from the
effects of stress on chromosome telomere length.
Mental Stress, Physical Stress, and Stress Response. An interesting dynamic
investigated by Webb, Weldy, Fabianke-Kadue, Orndorff, Kamimori, and Acevedo (2008) is the
responsiveness of the heart and respiratory system, and hormones associated with the stress,
under conditions of physical stress in the context of mental stress. Participants in the study were
assessed for their respiratory capacity and then involved in two experimental treatments.
According to Web, et al. (2008), in the first condition participants were asked to ride a stationary
bike for just over a half hour at 60% of the respiratory capacity while simultaneously engaging in
a computer-based mental exercise representing a condition where both physical and mental
faculties were being exerted. In the second control treatment, participants performed the same
physical activity without the exertion of mental faculties. Analysis by Web, et al. over the
duration of the physical activity found increases in heart and respiration activity, and aeration
indicative of both physical stress and mental stress. The assessment of stress hormones (e.g.,
norepinephrine, cortisol) found significantly elevated levels associated with the physical
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activity/mental activity treatment in contrast to the physical activity treatment alone. Web, et al.
interpreted this as evidence of that involvement with a stress provoking mental activity while
engaging in physical activity can worsen the stress response resulting in greater secretion of
stress hormones known to adversely impact immune function, metabolism, and heart health.
Inflammatory Bowel Disease. According to Jordan (2010), perceived stress has been
shown to exacerbate intestinal inflammation in individuals suffering from inflammatory bowel
disease (IBD). According to Packer, Hoffman-Goetz, and Ward (2010), several studies
investigating the influence of exercise/physical activity on IBD have identified positive
outcomes. For example, in a review of seven published articles, Packer, et al. identified four that
reported improvements in IBD sufferer’s quality of life, and two that identified reductions in
IBD symptoms. These studies certainly support the use of exercise/physical activity as an
additional therapeutic approach to improve quality of life for those suffering from IBD.
Physical Activity and Crohn’s Disease. . While Crumbock, Loeb, and Fick (2009) note
that physical activity is an effective method of managing stress in the context of many diseases,
their research was designed to study how both stress and physical activity influence Crohn’s
disease. Crumbock, et al., (2009) recruited a small sample of individuals with Crohn’s disease
and had them complete assessments of their level of physical activity, their perceived level of
stress, their current experience with Crohn’s disease, and their perceived quality of life.
Evaluating the associations of the various assessments, Crumbock, et al. only identified
associations between physical activity and quality of life, and stress and quality of life. The
association was positive between physical activity and quality of life, but negative between stress
and quality of life. Thus, physical activity improved quality of life among the Crohn’s disease
sample while stress reduced it.
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Diet and Exercise
Kelley (2009), recognizing the adverse effects of chronic stress on the body signified by
disruption in the balance of stress hormones (e.g., catecholamines, cortisol) and immune
function, discussed the role of both exercise and diet in reducing stress. With respect to forms of
exercise which have beneficial effects on stress, Kelly describes a half hour of aerobic exercise,
strength training, or stretching (i.e., yoga) as beneficial to stress reduction. Also, Kelly stresses
the benefits of engaging in exercise in areas outside where there is plenty of fresh air and natural
sunlight. According to Kelly, brain function is helped by exercise due to its affect on improved
blood flow, oxygen transport, and neurogenesis involved the maintenance of neural plasticity in
the maintenance of many neurochemicals (e.g., dopamine, serotonin). Additionally, Kelly
describes how exercise may also serve to weaken those neural mechanisms involve the stress
response resulting in lower sympathetic nervous system activity in response to perceived stress.
With respect to diet and stress, Kelly focuses on the stress reducing benefits of the Mediterranean
diet mainly associated with reducing intake of foods containing saturated fats, increasing
consumption of food with high concentrations of monounsaturated fats, and increasing intake of
foods high in fiber. Kelly describes the Mediterranean diet as consisting of high consumption of
“fruits, vegetables, bread and other cereals, potatoes, beans, nuts and seeds” (p 38); olive oil;
moderate consumption of fish, poultry, but lower consumption of red meats (e.g., steak); weekly
consumption of up to four eggs, and occasional wine. Kelly also recommends the use of
supplements including multivitamin supplements, the intake of B complex vitamins, particularly
vitamin B12; supplemental intake of calcium, magnesium, sodium, manganese, omega-3 fatty
acids, vitamins E and C, and finally supplementation with zinc, selenium, and copper. Kelly
notes that following recommended levels of physical activity and patterns of nutrition consistent
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with the Mediterranean diet along with recommended supplements can provide a preventive
effect against the adverse results of chronic stress.
Khubchandani, Nagy, Watkins, Nagy, and Balls (2009) provide an interesting example of
how high and low levels of stress, specifically work related stress, and perceived health status are
associated with patterns of diet and exercise. Khubchandani , et al. (2009) conducted a study to
find employees with elevated perceived stress and a coping style dominated by emotion focused
coping and employees with lower perceived stress and a coping style characteristic of problem
focused coping and compare the two groups across various health measures (e.g., BMI, self-
reported health status, patterns of diet and exercise, perceived barriers to practicing a good diet
and healthy levels of exercise). Analysis showed that employees who rated themselves high in
work related stress included a higher proportion of those overweight, more employees who rated
their health either fair or poor, more employees who reported low levels of exercise, and more
employees who reported unbalanced diet and greater consumption of junk food relative to those
employees with low levels of perceived work-related stress. While only associational, these
findings are in agreement with Kelley (2009): Employees who reported better eating patterns and
regular engagement of exercise reported lower levels of perceived work-related stress.
Diet, Exercise, and Cardiovascular Disease. The objective of the research conducted
by Ignarro, Balestrieri, and Napoli (2007) targeted the establishment of evidence-based support
for the benefits of exercise and nutritional diet to cardiovascular disease, as well as to adverse
conditions deriving from atherosclerosis in the context of impairment in the functioning of
endothelial cells due to oxidative stress. Ignarro, et al. (2007) discuss findings indicating that
deficiencies in the availability of nitric oxide as a result of oxidative stress appears to be a typical
impairment of molecular function encompassing atherosclerosis related cell damage. Further,
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according to Ignarro, et al., it only takes expending approximately 1000 kcal per week, about the
same as energy used to walk for one hour or five days, to obtain real positive impacts on health.
Also, similar positive benefits can be obtained from engaging in short periods of physical
activity (i.e., as short as 10 min.) throughout the week. With respect to diet and cardiovascular
disease, Ignarro, et al. describe the findings of recent studies indicating an association between
elevated instances of cardiovascular impairment, unstable angina, and stroke due to plaque with
insufficient consumption of fruits and vegetables. Further, Ignarro, et al. indicate that a wide
range of nutrients found in fruits and vegetables may work independently or together to deliver
lower risk for cardiovascular disease, and also report on, consistent with previously discussed
research, the positive benefits of antioxidants, fibers, omega-3, vitamins, minerals, and
specialized herbs in the reduction, prevention, and management of cardiovascular disease.
Diet, Exercise and Coronary Heart Risk. While independent lifestyle interventions
such as reducing unhealthy fat intake, engaging in more physical activity, or practicing stress
management exercises have been shown to lower the risk of coronary heart disease, Daubenmier,
Weidner, Sumner, Mendell, Merritt-Worden, Studley, & Ornish, 2007) conducted research to
examine the effectiveness of multi-component effectiveness of lifestyle interventions in
preventing coronary heart disease. Focusing on three interventions - diet, exercise, and different
forms of stress management, Daubenmier, et al. (2007) sought to examine the way the various
interventions interacted and contributed to reducing coronary heart disease risk by way of
changes in blood pressure, total cholesterol, and exercise capacity as well as affects on other
issues such as reported levels of depression, hostility, and perceived stress. A large sample of
both males and females were recruited to the program and required to participate in learning
sessions about cooking, an hour of exercise, and an hour of stress management. Participants were
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also required to eat a meal following dietary guidelines, and take part in all interventions two
times per week for three weeks. Measurements were taken before and at the completion of the
intervention. A direct comparison of baseline measures with measures collected at the end of the
intervention identified a wide range of reductions including reduced percentage of dietary fat,
and reductions in a range of coronary risk factors including weight, diastolic blood pressure, total
cholesterol, triglycerides, and hemoglobin A1 C. Additionally, significant increases in hours of
stress management coincided with reductions in depressive symptoms, hostility, and perceived
stress. With respect to the multi-component contribution of all interventions on reduction of
coronary heart risk, depressive symptoms, hostility, and perceived stress, Daubenmier, et al.
found that stress management, dietary intervention focused on reduced fat intake, and exercise
all contributed significant main effects additively contributing to reducing coronary heart disease
risk factors. Examining psychological variables, stress management was the only intervention
successful in reducing levels of hostility while both exercise and reduced fat intake contributed
to the reduction of perceived stress.
Mindfulness and Mindfulness-based Stress Reduction
Mindfulness is characterized as “a state of active, open attention on the present
(Mindfulness, 2011). In a state of mindfulness where attention is only focused on the Now of the
moment an individual is able to observe thoughts objectively, without emotional engagement,
and without judging these thoughts as either good or bad, or positive and negative. Mindfulness
is also identified with five “skills” assessed by the Five Facet Mindfulness Questionnaire
consisting of “observing, describing, acting with awareness, non-judging of inner experience,
and non-reactivity to inner experience” (Baer, Smith, Lykins, Button, Krietemeyer, Sauer, et al.,
2008 [Abstract]). Recent examination of the effect of mindfulness from a neuroscience
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perspective has found that extended periods of mindfulness practice appears to affect the neural
circuitry between the prefrontal cortex and the amygdala resulting in negatively correlated
patterns of response to affective content (Creswell, Way, Eisenberger, & Lieberman, 2007). This
negative correlation of the neural response link between the prefrontal cortex and the amygdala
following mindfulness practice suggests an important impact on stress given that the amygdala is
a key component of those neural centers involved with the stress response (Dedovic, Duchesne,
Andrews, Engert, & Pruessner, 2009) and also influences concentrations of cortisol in the blood
(van Stegeren, Wolf, Everaerd, Scheltens, Barkhof, & Rombouts, 2007).
Mindfulness, Stress Reduction, Psychological Well-Being, and Cancer. Bränström,
Kvillemo, Brandberg, and Moskowitz (2010) conducted research to examine how training in
mindfulness-based stress reduction might be useful in lowering levels of stress and improving
areas of psychological performance among a sample of 70 males and females with an average
age of 52 years and a prior diagnosis of cancer. In addition, Bränström, et al. (2010) sought to
examine if the development of mindfulness skills played a role in mediating the outcomes
obtained. For the experiment, participants were randomly assigned to either mindfulness training
or a control group. Those assigned to mindfulness training received eight weeks of training. In
the experimental group and the control group were compared across measures of perceived
stress, avoidance of symptoms consistent with posttraumatic stress, and positive mental state.
According to Bränström, et al., the participants who received the mindfulness training reported
elevated levels of the mindfulness skills as assessed by the Five Facet Mindfulness Questionnaire
in contrast to the controls. Further analysis also demonstrated that elevated mindfulness skills
played a mediating role in the effectiveness of the mindfulness-based intervention to lower
perceived stress, reduce symptoms of avoidance to posttraumatic stress, but improve positive
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mental state. Based on the results, Bränström, et al., concluded that the positive benefits of
mindfulness-based stress reduction training on measures of psychological function and stress are
due to elevated levels of a mindfulness dispositional state.
Mindfulness-based Stress Reduction, Cancer, and Cortisol. Matousek, Pruessner, and
Dobkin, (2011) conducted a study to examine the impact of mindfulness-based stress reduction
on cortisol levels found during the awakening cortisol response (ACR) (Hanson & Chen, 2008)
among a sample of 33 breast cancer patients. For the study, Matousek, et al. (2007) asked the
breast cancer patients to report on stress levels, depressive symptoms, and health related
symptoms both before and after the mindfulness-based stress reduction intervention. ACR was
also assessed twice in the same way. According to Matousek, et al., three days following the
mindfulness-based stress reduction practice ACR levels were found to have increased. In
addition, Matousek, et al found positive changes in reported stress, depression, and health
symptoms. Interestingly, Matousek, et al also found the reduction in stress, depression, and
health systems were negatively correlated improvements in the ACR. The authors concluded that
ACR is a good marker of stress among breast cancer patients which response to mindfulness-
based stress reduction.
Mindfulness-based stress reduction and School Teacher Stress. Recognizing that
individuals making a living as teachers are subject to ill effects on health and psychological
issues due to stress, Gold, Smith, Hopper, Herne, Tansey, and Hulland (2010) conducted
research to test the effectiveness of mindfulness-based stress reduction in reducing stress among
individuals teaching elementary school. For the intervention, teachers participated in a training
program where mindfulness-based stress reduction techniques were learned and practiced. To
evaluate the effectiveness of the mindfulness-based practice teachers completed assessments of
RUNNING HEAD: Diet, Exercise, Mindfulness
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self-reported anxiety, depressive symptoms, and perceived stress both before and after the
mindfulness-based practice. As found with Matousek, et al, the comparison of pre-intervention
and post-intervention measures identified significant reductions in reported anxiety, stress less,
and depressive symptoms. Thus, Gold, et al. demonstrated that mindfulness-based stress
reduction is an effective and affordable method for reducing stress levels in teachers and
potentially reducing the rates of teachers departing from the field.
Mindfulness-based Stress Reduction and Urban Youth. The studies reviewed above
demonstrate the benefits of mindfulness-based training on adults. In an attempt to expand the
reach of mindfulness-based stress reduction, Sibinga, Kerrigan, Stewart, Johnson, Magyari, and
Ellen (2011) examined the impact of mindfulness-based stress reduction training on adolescents
and young adults at risk or diagnosed with HIV living in an urban environment. The research
was conducted to assess how well mindfulness-based stress reduction is accepted among this
population as well as the impact of mindfulness training on psychological issues such as
hostility, adverse physical issues, and emotional issues. For the study, Sibinga, et al. (2011)
recruited participants ranging in age from 13 years old to 21 years old from a nearby urban
clinic. Participants completed psychological assessments prior to mindfulness-based stress
reduction training as well as an assessment of quality of life. Participants were asked to take part
in four different mindfulness-based training groups consisting of one weekly session per week
over nine weeks. At the completion of all mindfulness-based training sessions Sibinga, et al.
(2011) carried out an analysis which included the examination of participant attendance as a
gauge of acceptability, examination of the psychological (e.g., hostility, emotional) issues and
quality of life; and also conducted personal interviews with available participants. The analyses
conducted by Sibinga, et al. included pre-and post-comparisons of the psychological measures
RUNNING HEAD: Diet, Exercise, Mindfulness
21
and an in-depth review of the information obtained to the personal interviews. An analysis of
mindfulness-based stress reduction training participation showed that of participants beginning
the training nearly 80% showed consistent attendance. This final set of participants included only
African-Americans who were mainly of female. According to Sibinga, et al, post-intervention
analysis of the psychological measures revealed significant decreases in the measures of a
hostility, discomfort, and emotional issues. Additionally, analysis of qualitative information
collected from the personal interviews by Sibinga, et al, revealed that participants perceived
benefits following the mindfulness-based stress reduction training including improved
relationships with friends, improve performance in school, improvements in health, and lower
levels of stress. Sibinga, et al. interpreted the results of the research is indicating that training
urban youths in mindfulness-based stress reduction is feasible and has been shown to yield
positive results with respect to psychosocial issues such as hostility, relationships, school
performance, and improvements in health.
An additional study investigating the utility of mindfulness-based stress reduction on
urban youths was conducted by Kerrigan, Johnson, Stewart, Magyari, Hutton, Ellen, and Sibinga
(2011) who executed the same qualitative interview methodology carried out by Sibinga, et al.
(2011) on a subset of same participants researched by Sibinga, et al. For this study, Kerrigan, et
al. (2011) utilized personal interviews to examine how the urban youth and young adults
responded to the experience of mindfulness-based stress reduction participation. Qualitative
analysis showed that participants experience the benefits from the mindfulness-based training as
well as improved levels of personal self-awareness. Differences in perceptual and self-
reorienting changes were also identified as illustrated by reduced responsiveness to stress and
significant changes in the way participants approached life and experienced greater contentment.
RUNNING HEAD: Diet, Exercise, Mindfulness
22
Thus, Kerrigan, et al. provided demonstrated that the effects of mindfulness-based stress
reduction extend beyond stress reduction.
Mindfulness and Symptom Reduction. Affirming the growing recognition of the
effectiveness of mindfulness-based stress reduction in improving health and psychological
issues, Dobkin and Zhao (2011) sought investigate the mechanisms by which such outcomes are
obtained by exploring the association between growing levels of mindfulness and positive patient
results. In addition, Dobkin, et al. attempted to uncover the aspects of mindfulness-based training
responsible for post-intervention results. A sample of 83 participants diagnosed with chronic
illness was recruited for the research. All participants provided pre-and posttest assessments of
mindful attention, depression, medical symptoms, perceived stress, sense of coherence, and
engagement in various components of mindfulness (e.g., frequency of mindfulness engagement,
time spent meditating, awareness of breath, benefit of breath awareness, and importance of the
mindfulness-based stress reduction training). Comparison of measures pre-and post-mindfulness
training showed reduction in depression, perceived stress, and reported medical conditions as
measures of mindfulness and sense of coherence increased, thus demonstrating an inverse
correlation between increasing levels of mindfulness and decreasing levels stress, depression,
and medical problems. Unfortunately, the data did not indicate the components of mindfulness
responsible for the observed outcomes sought by the researchers.
Mindfulness-based Stress Reduction and Glycemic Control. Noting that significant
levels of distress is experienced by diabetics due to glycemic control problems, Rosenzweig,
Reibel, Greeson, Edman, Jasser, McMearty, and Goldstein (2007) sought to investigate the
effects of mindfulness-based stress reduction on glycemic control, arterial blood pressure,
weight, depressive symptoms, anxiety levels, degree of somatization, and reductions in overall
RUNNING HEAD: Diet, Exercise, Mindfulness
23
severity among a sample of diabetic patients. One month following the end of mindfulness-
based training, Rosenzweig, et al. found no changes in weight but observed reductions in all the
other measures of interest including hemoglobin A1c, average arterial blood pressure, and all the
psychological measures (e.g., distress, depression, anxiety). Thus, Rosenzweig, et al. provided
evidence that mindfulness-based stress reduction is a useful intervention to help diabetics gain
better control of blood glucose levels.
Relaxation and Stress Reduction
Having provided an overview of the effectiveness of mindfulness-based stress reduction
in treating stress and improving psychological and physical function, this paper will close with a
brief look at relaxation therapy and its role in stress reduction.
Ali and Hasan (2010) sought to demonstrate the relevance of relaxation therapy in
treating anxiety by presenting a case study of a female plagued by both pain and fatigue which
impaired her occupational performance and disrupted her everyday life. Psycho diagnosis
identified her as suffering from clinical anxiety. Having failed to receive benefit from treatments
she had previously attempted, she was treated with relaxation therapy within a clinical
psychological environment which also included a breathing exercise and visualization of perfect
vacation conditions and perfect relaxation. Measures of anxiety and depressive symptoms were
obtained before and after the relaxation/visualization. After experiencing the various elements of
relaxation therapy she was able to apply the techniques by herself. According to Ali, et al.
significant reductions are obtained in reported anxiety levels and depressive symptoms.
Additional changes reported by patient included less tension in the muscles, improved sleep,
fewer instances of disturbed sleep, and elimination of impairments to occupational and social
performance.
RUNNING HEAD: Diet, Exercise, Mindfulness
24
Seeking to improve on the repertoire of interventions that can be applied to adolescent
males with high levels of hostile action, Gaines and Barry (2008) conducted research to examine
the efficacy of a relaxation intervention that involved deep breathing in improving levels of
impulse control as measured by the use of foul language, decreasing instances of disruptive
behavior in a juvenile management setting, and increasing levels of voluntary self-monitoring
among adolescents with respect to user file language and aggressive behavior in an independent
living situation. The research involves six adolescents who were individually tracked over the
course of the study. All six adolescents were exposed to the relaxation/deep breathing
intervention twice with a gap between the first and second exposure. The primary outcome
measures were frequency of using foul language, frequency of inappropriate aggressive
behavior, and a measure of self-monitoring. Upon analysis divergent results are obtained with
only two of the six adolescents showing improved impulse control, improved behavior, and
approve self-monitoring.
Conclusions
Recognizing the growing problem of stress in society and its deleterious impact on health
with respect to the stress hormone imbalance (e.g., cortisol) and inflammation, this paper has
examined effectiveness of diet, exercise, and mindfulness-based stress reduction in reducing
stress.
With respect to diet, improper nutritional balance, insufficient vitamin intake, and excess
consumption of fat have been shown to exacerbate the stress response and create unhealthy
balances of stress hormones in the brain and body. The dietary patterns shown to create positive
protective effects against stress and inflammation are consistent with the Mediterranean diet
consisting of increased levels of vegetables, fruit, whole-grain, nuts, seeds, beans, potatoes, eggs
RUNNING HEAD: Diet, Exercise, Mindfulness
25
and higher levels of fiber along with lower levels of steak and other red meats. Stress reduction
is also aided by supplementation with vitamins and minerals including magnesium, calcium,
manganese, B vitamins, and vitamin C and E. Additional stress protection can come through the
intake of omega-3 fatty acids, particularly DHA from fish oil, and increasing the ratio of
monounsaturated fats (e.g., omega-3) to saturated fats (e.g., Omega 6).
Regular vigorous or aerobic exercise is protective against stress as it has been shown that
negligible undesirable health effects follow stressful situations among individuals who regularly
engage in this type of exercise. Even regular short periods of exercise can deliver positive health
benefits. Exercise has been shown to be an effective stress reduction approach among
individuals with a variety of health conditions including cancer, inflammatory bowel syndrome,
and Crohn's disease. Exercise also been shown to have positive health benefits beyond stress
reduction including improve physical fitness, the maintenance of healthy levels of cortisol,
reduction in body fat, and improved quality of life. Interestingly, regular vigorous exercise has
also been shown to slow the aging process associated with stress at the genetic level!
The combination of diet and exercise has been shown to have similar effects on stress
reduction in the general population and to deliver other positive health effects including lower
weight and reductions in diastolic blood pressure, cholesterol, hemoglobin A1 C, symptoms of
depression, hostile attitude, and perceived stress.
Finally, a review of the research exploring the practice of mindfulness-based stress
reduction as a stress management approach has reported consistent patterns of reduced stress and
improved cortisol regulation among cancer patients, reduced stress and lower rates of burnout
among school teachers, and reductions in levels of hostility, impulse control, and emotional
issues among urban youth. These effects have also proven consistent with studies in
RUNNING HEAD: Diet, Exercise, Mindfulness
26
neuroscience showing reduced levels of interactivity between awareness centers and emotional
centers in the brain. Additionally, the resultant state of mindfulness following an extended
period of mindfulness-based stress reduction practice has also been shown to change life
perspective, decrease emotional reactivity, and increase levels of contentment.
Building Adoption
The key ingredient to reducing and managing stress through diet, exercise, and
mindfulness-based practice is doing them. Individuals must consistently engage in these
practices for them to benefit health, well-being, and keep stress low. Unfortunately, the fact is
that's only a minority of individuals adopt one or more of these stress reduction options. In the
2010 APA study of stress, the report included statistics on the importance and achievement of
issues relevant to well-being as reported by parents in the chart, “Aspects of Well-Being” (p 9).
The chart lists seven different issues identified by parents as relevant to well-being. The second
issue listed is managing stress. And while 69% of participants classified stress management as
important, only 32% reported achieving it. The bottom three issues identified as relevant to
well-being include eating healthy, getting sufficient sleep, and being healthy and physically fit.
Looking at the responses for eating healthy, 64% of participants identified the issue as important
but only 30% reported achieving it. With respect to being healthy and physically fit (which
requires regular exercise), 60% of participants identified the issue as important, and only 29%
reported achieving it. Data such as this indicate that the challenge before diet, exercise, and
mindfulness as stress management approaches is getting individuals to adopt them and sustain
their practice through life. Understanding why some individuals adopt health-focused lifestyles
that protect against stress and others do not is an area of research I would like to develop post-
doctorally.
RUNNING HEAD: Diet, Exercise, Mindfulness
27
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... Providing care to older community-dwelling adults may also adversely impact the caregiver's diet quality. There is growing empirical evidence that links such behaviors as healthful eating, regular physical activity, and stress reduction to well-being [10][11][12][13][14][15]. The absence of these recommended health behaviors combined with frequent caregiving responsibilities could lead to obesity, hypertension, diabetes, cardiovascular disease, and an array of chronic diseases among caregivers. ...
Article
Full-text available
Objective: We investigated cross-sectional and longitudinal associations of diet quality with middle-aged caregiver status. Methods: Caregiving in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (57.7% women, 62% African American (AA)) was measured at waves 3 (2009-2013) and 4 (2013-2017) (mean follow-up time 4.1 years). Diet quality was assessed by the Healthy Eating Index 2010 (HEI-2010) derived from two separate 24 h diet recalls. Multivariable ordinary least square regression was performed for cross-sectional analyses of the association of wave 4 caregiving with wave 4 HEI-2010. Wave 3 caregiving was examined both cross-sectionally and with annual rate of change in HEI using mixed-effects linear regression Models. Multivariable models were adjusted for age, sex, and poverty status. Results: Cross-sectional analyses at wave 4 demonstrate an inverse association of frequent caregiving ("Daily or Weekly" vs. "Never") for grandchildren with HEI-2010 total score (i.e., lower diet quality) among Whites (β = -2.83 ± 1.19, p = 0.03, Model 2) and AAs (β = -1.84 ± 0.79, p = 0.02,). The "cross-sectional" analysis pertaining to grandchildren caregiving frequency suggested that frequent caregiving (i.e., "Daily or Weekly" vs. "Never" (β = -2.90 ± 1.17, p = 0.04)) only among Whites was inversely related to HEI-2010 total score. Total HEI-2010 score was also related to caring (Model 1), for the elderly over "5 years vs. Never" among Whites (-7.31 ± 3.54, p = 0.04, Model 2). Longitudinally, we found slight potential improvement in diet quality over time ("Daily or Weekly" vs. Never by TIME interaction: +0.88 ± 0.38, p = 0.02) with frequent caregiving among Whites, but not so among AAs. Conclusions: Frequent caring for grandchildren had an inverse relationship with the diet quality of White and AA urban middle-aged caregivers, while caring for elderly was inversely linked to diet quality among Whites only. Longitudinal studies should address the paucity of research on caregivers' nutritional quality.
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