THE EFFECTS OF ACCUMULATED VS. CONTINUOUS EXERCISE SESSIONS ON EVENING CORTISOL CONCENTRATION AND PERCEIVED MOOD STATE

Abstract

Background: Exercise has amassed much evidence as a significant buffer for stress,

Full text

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THE EFFECTS OF ACCUMULATED VS. CONTINUOUS EXERCISE SESSIONS ON
EVENING CORTISOL CONCENTRATION AND PERCEIVED MOOD STATE
Submitted to the Graduate Education Faculty of
The Clinical Exercise Physiology Program
of the University of Mary
In partial fulfillment of the requirements
for the degree of
Master of Science in Clinical Exercise Physiology
By
Jared Joseph Rogers
April 2022
Bismarck, North Dakota
Key words: [Accumulated, Continuous, Cortisol, Mood State, Perceived Mood State]

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ABSTRACT
Background: Exercise has amassed much evidence as a significant buffer for stress,
using both objective biochemical and subjective psychological assessments. Previous
research has demonstrated that cortisol serves as a biomarker for stress and correlates
with perceived stress. The Sleep-waking cycle is modulated in part by cortisol, marked
by elevated levels during the morning hours and lower levels at night, reaching its nadir
during the later sleep cycles. Insomnia can be contributed to if cortisol does not meet a
natural nadir by the onset of sleep. Purpose: The purpose of this study was to identify
any differences in evening cortisol levels and mood state between accumulated (AC) and
continuous (CO) exercise. Methods: Participants consisted of college-aged students
between the ages of 18-25 (n=8). Preintervention consisted of heart rate reserve and 5
repetition maximum assessments to determine loads for aerobic and resistance exercise,
and Profile of Mood States Short Form survey (POMS SF-36). Results: Of the 8 adults
who participated, 8 completed the intervention, 8 were available for cortisol collection,
while 7 of 8 POMS were collected. The post-treatment POMS scores on both intervention
days were lower compared to the control day, yet these were shown to not be significant
(p=.088). Mean salivary cortisol concentration was lower on the continuous day (x
=.08)
than on the accumulated day (
x
=.10). Effect size was d = .36, r=.18 for cortisol
collection. Conclusion: While differences in the means were noted for all variables, from
control to intervention days in the POMS SF-36, and in the salivary cortisol from
accumulated and continuous days, these differences were found to be not significant.

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However, further research should be done in this area using larger sample/effect sizes to
increase chances of statistical significance.

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THE EFFECTS OF ACCUMULATED VS. CONTINUOUS EXERCISE ON EVENING
CORTISOL CONCENTRATION AND PERCEIVED MOOD STATE
By
Jared Joseph Rogers
A thesis study submitted in partial fulfillment
of the requirements for the degree
Of
Master of Science in Clinical Exercise Physiology
___________________________ _____________________________
Chairperson Thesis Committee Member Thesis Committee
Clinical Exercise Physiology Clinical Exercise Physiology
University of Mary University of Mary
___________________________ ____________________________
Member Thesis Committee Member Thesis Committee
Clinical Exercise Physiology Clinical Exercise Physiology
University of Mary University of Mary
UNIVERSITY OF MARY
Bismarck, North Dakota
Wednesday, April 25, 2022

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STATEMENT OF PERMISSION TO COPY
In presenting this thesis/dissertation in partial fulfillment of the requirements for a
Master’s/Doctorate in Education degree at the University of Mary, I agree that the
Welder Library shall make it freely available for inspection. I further agree that the
Welder Library Director may grant permission for extensive copying of this
document for scholarly purposes. It is understood that any copying or publication of
this thesis/dissertation for financial gain shall not be allowed without my written
permission. It is also understood that due recognition shall be given to me and to the
University of Mary in any scholarly use which may be made of any material in my
thesis/dissertation.
Signature Date

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ACKNOWLEDGEMENTS
The author expresses sincere gratitude to Dr. Henry Lang, who served as the
thesis/dissertation committee chair of my committee for his tireless work in this
thesis preparation. I also want to thank my data collection members Kyle Cacho,
and Gerardo Jaime, Anna Adcox, Christian Hanson, Kyle Cacho, Jonathan Prokop,
Gerardo Jaime, for their time and effort. I want to thank Dr. Jill Nustad who
assisted me in proofreading and approving the study. I gratefully acknowledge my
family for all their understanding and support. while I dedicated my time and efforts
to create this scholarly work.

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TABLE OF CONTENTS
ABSTRACT……………………………………………………………………………i
LIST OF TABLES…………………………………………………………………...viii
LIST OF APPENDICES……………………………………………………………...ix
LIST OF TERMS AND ABBREVIATIONS…………………………………………x
RESUME……………………………………………………………………………,,,xi
CHAPTER I – INTRODUCTION TO THE STUDY………………………………….1
Problem Statement……………………………………………………………4
Purpose .............................................................................................................4
CHAPTER II – REVIEW OF LITERATURE………………………………………...5
Introduction………………………………………………………………..5
Biological Mechanisms of Stress………………………………………….6
Cortisol as a Biomarker of Stress………………………………….6
Cortisol and the Sleep-Wake Cycle…………………………….....7
Cortisol Reactivity in Relation to Perceived Stress……………………….8
The Cross-Stressor Hypothesis……………………….…………...8
Effects of Exercise on Perceived Stress and Serum Cortisol……………...9
Perceived Mood…………………………………………………...9
Effects of Exercise on Cortisol Behavior Throughout the Day.....10
High-frequency exercise versus high duration (accumulated vs.
continuous) ………………………………………………………………11

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CHAPTER III – METHODOLOGY AND DESIGN………………………………...13
Experimental Design……………………………………………………………..13
Participants……………………………………………………………………….14
Five Repetition Maximum Testing……………….…………………………………..14
Exercise Protocol…………………………………………………………………15
Saliva Collection……………………………………………………………….…16
Profile of Mood States Short Form – 36………………………………………….16
Heart Rate and Anthropometrics…………………………………………………17
Data Analysis……………………………………………………………………..17
CHAPTER IV – RESULTS……………………………………………………….….18
CHAPTER V – DISCUSSION………………………………………….…...……….20
REFERENCES………………………………………………………………………..23
ta
APPENDICES
Appendix A: Recruitment materials……………………………………….……33
Appendix B: Health history questionnaire ……………………………………….35
Appendix C: Profile of mood states short form-36……………...…………….....38
Appendix D: Exercise Program………………………………………...………...39

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LIST OF TABLES
Table 1: Participant Descriptive Characteristics and Demographics.............................14
Table 2: Repeated Measures ANOVA for POMS SF-36..................................................19

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LIST OF APPENDICES
APPENDIX A: Recruitment materials………………………………….........................33
APPENDIX B: Health history questionnaire ………………………………………….…35
APPENDIX C: Profile of mood states short form-36………………………………….....38
APPENDIX D: Exercise Program…………………………………………………….…..39

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LIST OF TERMS AND ABBREVIATIONS
• HPAA – Hypothalamus-pituitary-adrenal-axis
• CO – Continuous Exercise
• AC – Accumulated Exercise
• HDL – High-density lipoprotein
• LDL – Low-density lipoprotein
• ACTH – Adrenocorticotropic Hormone
• PSS – Perceived Stress Scale
• POMS – Profile of Mood State
• POMS SF=36 – Profile of Mood State Short Form
• HRR – Heart Rate Reserve
• 1 Repetition Maximum (1RM)
• 5RM – 5 Repetition Maximum (1RM)

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RESUME
Education
1. University of Mary Bismarck, ND
Degree: Masters of Science Expected Graduation:
Major: Clinical Exercise Physiology May 2022
1. University of Wisconsin - Eau Claire Eau Claire, WI
Degree: Bachelors of Science Graduated May 2020
Major: Kinesiology - Human Performance
Volunteering
St. Peter’s Catholic Church Vacation Bible School Cameron, WI
● Led children ages 4 - 11 through lessons July 2016 - July 2019
● Performed educational skits 35+ hours of service
Mayo Clinic Cancer Center Eau Claire, WI
● Keep the waiting and treatment areas Jan. 2018 - May 2018
● Fax patient lunch orders 30+ hours of service
● Deliver patient appointment schedules
Campus Involvement
Newman Catholic Student Association Sept. 2018 – May 2020
● Bible Study Leader
Teaching Assistant for UWEC Kinesiology Department Sept. 2018 – Dec. 2019
● Assisted students in anatomical labs
● Entered Grades for assignments and exams
● Created study materials and supervised lab hours
Relevant Experience
Cardiac Rehab Intern at HSHS St. Joseph’s Hospital Chippewa Falls, WI
• Admitted and prescribed exercise to patients Sept. 2021 – March 2022
• Completed ITP reviews, discharges, and reports 600+ hours

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• Shadowed phase I cardiac rehab
• Assessed vitals and ECGs
Intern at Marshfield Medical Center Rice Lake, WI
● Assisted in Cardiac Rehab at the hospital May 2019 - Sept. 2019
● Built working relationships with patients 400+ hours
● Assessed blood pressure, ECG, RPE
● Entered, analyzed, and interpreted patient data
References (Available Upon Request)
● Steph Fleming – Internship Mentor
● Sarah Bourget – Internship Supervisor
● Olivia Steinmetz – Internship Mentor

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CHAPTER I
INTRODUCTION TO THE STUDY
Stress, both in a biological and perceived sense, is a relevant topic for modern
society. In a recent meta-analysis of 17 studies, Salari et al. (2020) estimated that 29.6%
of individuals experience consistent stress overload and an increase thereof in 2020 due
to the pandemic. That meta-analysis delved into perceived stress which was measured in
the current study as well. Yet, measuring physiological stress is also important and
correlates with the degree of perceived stress (Knight et al., 2021). It can be measured in
several ways, but cortisol is one of the most established biomarkers for stress
(Hellhammer et al., 2018; Bozovic et al., 2013). This is because Cortisol is a
corticosteroid that increases metabolism and is one of the ending products of the hormone
cascade in the Hypo-Pituitary Adrenal Axis (HPAA), helping to create the “fight or
flight” response (Boudarene et al., 2002). Previous research has also demonstrated an
increase in cortisol levels due to perceived emotional stress (Do Yup Lee et al., 2015).
Additionally, cortisol is involved in the sleep-waking cycle (Weitzman et al.,
1983; Follenius, et al., 1992). Cortisol awakens cell response and metabolism in the
morning and then follows a circadian rhythmic pattern, reaching its lowest point
before/near sleep onset and the rapid eye movement stage of sleep (Bush & Hudson,
2010). Research suggests that at least 30% of college students do not meet sleep
recommendations, leading to elevated cortisol, and subsequently stress, throughout the

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day (Suen et al., 2010; Pensuksan et al., 2016; Masalamany et al., 2017;
Nurismadiana et al., 2018; Hanawi et al., 2020).
To elaborate further, sleep and stress are inversely related (Herawati and Gayatri,
2019), with sleep being directly correlated to perceived mental and emotional health
(Munezawa et al., 2011; Tzischinsky & Shochat, 2011; Matamura et al., 2014. Perceived
stress, while related to cortisol, is a different and important variable. Poor sleep quality
and quantity have been linked to increased perceived stress in a variety of demographics,
including college students (McCanlies et al., 2012; Matamura et al., 2014). A lack of
exercise is also associated with poor sleep patterns and stress (Yang et al., 2017).
As for potential solutions to these issues, much evidence has been accrued that
supports the idea of exercise being an effective buffer for stress - both in a biochemical
and abstract psychological sense. Exercise seems to positively impact mood, mutually
reducing stress reactivity, lowering resting cortisol levels when the body is in a resting
state (Lichtman & Poser, 1983; Raglin, 1990; Yeung, 1996; Hansen et al., 2001; Peluso
& Andrade, 2005; Chase & Hutchinson, 2015; Polenakovic et al., 2017). Furthermore,
evidence suggests that exercise garners better same-day cortisol reduction towards
achieving the cortisol nadir (low point in a 24 hour period) for the evening to aid in sleep
onset, as opposed to not exercising that day (Hackney & Viru, 1999; Daly et al., 2004;
Nabkasorn et al., 2006).
Due to sleep’s relation to stress and cortisol, exercise may therefore affect sleep
quality in a favorable manner as well. A wide breadth of research has suggested that, if
controlled for extraneous variables like time management, preferred mode of exercise,

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etc., exercise has widespread positive effects on mood and typically shows significant
reductions in perceived stress (Matamura et al., 2014; Bartholomew et al., 2005;
Guszkowska & Sionek, 2009; McDonald & Hodgdon, 1991; Osei-Tutu & Campagna,
2005). In addition, evidence suggests that exercise garners better same-day cortisol
reduction - achieving a lower concentration for the evening, as opposed to not exercising
that day, which may aid sleep onset. (Hackney & Viru, 1998; Daly et al., 2005;
Nabkasorn et al., 2006.) Furthermore, sleep and stress are inversely related.
There exist certain variables that may be more advantageous than others in
treating stress and sleep-related issues. Previous findings suggest that, if controlled for
extraneous variables like time management, preferred mode of exercise, etc. exercise has
widespread positive effects on mood and typically shows significant reductions in
perceived stress (Matamura et al., 2014; Bartholomew et al., 2005; Guszkowska &
Sionek, 2009; McDonald & Hodgdon, 1991; Osei-Tutu & Campagna, 2005). One way
that time during exercise may be managed to fit an individual’s lifestyle more
appropriately and/or schedule, is to alter the style of a continuous exercise session (CO)
to that of accumulated exercise (AC) sessions. For example, if one’s goal is to attain 30
minutes of exercise in a day, they would perform three sessions of 10 minutes each, as
opposed to one 30-minute session.
Most research has reported similar health benefits between AC and CO (Murphy
et al., 2019). Yet, some differences in outcomes between the two styles in variables such
as high-density lipoprotein (HDL), low-density lipoprotein (LDL) cholesterol and body
composition (Mestek, et al., 2006; Murphy et al., 2019). Addressing the topic at hand

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(stress and cortisol concentration), it is not evident whether cortisol concentration differs
between individuals who participate in the AC or CO. In the topic of perceived mood, a
small sample of data shows CO positively affecting mood over AC (Osei-Tutu &
Campagna, 2005). This is an important and practical consideration in exercise
prescription that may have many implications for psychological and lifestyle factors.
Under 10 studies have explored AC and CO in relation to psychological factors. No
studies have considered both mood state and salivary cortisol concentration in relation to
the two styles of exercise.
Problem Statement
A gap in the research exists when addressing whether accumulated or continuous
exercise exhibits different effects on cortisol levels corresponding to mood state. This
study was done to further specify, if possible, what variables in exercise contribute to the
benefits discussed. This study addresses the question if either AC or CO modes have
advantages over the other when addressing mood state and cortisol levels in the evening,
and therefore benefits towards sleep state.
Purpose
The primary purpose of this study was to identify any differences in evening
cortisol levels and mood state between AC and CO. This study will contribute to the
relatively unexplored topic of the benefits of accumulated versus continuous exercise.
The hypothesis was that AC and CO would show significant differences in their effects
on salivary cortisol control and perceived mood state.

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CHAPTER II
REVIEW OF LITERATURE
Introduction
Stress and the treatment/prevention thereof is an ever-growing topic in modern
society, especially in college-aged individuals. Gallup polls taken from 1994 to 2017
report that more individuals 18 years of age and older experience stress frequently each
year (Jones & Saad, 2017). In 2017 that value hit an all-time high, with 44% of
individuals reporting substantial stress. In 2009, Cohen and Janicki-Deverts concluded
that those of lower socioeconomic status or those (particularly men) faced with possible
unemployment experience higher stress. The researchers also reported that younger
individuals experience greater stress than their older counterparts (Cohen and Janicki-
Deverts, 2009). The Gallup polls also assessed whether individuals felt they had adequate
amounts of time to complete their desired tasks, with 41% reporting a perceived lack of
time (Cohen and Janicki-Deverts, 2009). It is important to note that, by nature, treatment
cannot exacerbate the problem. Because a consistently recognized barrier to exercise is
time, or the perception of inadequate time to exercise, this must be addressed if exercise
is to be used to attenuate stress in college students.
These variables – perceived stress, specific stressors (time, unemployment, and
finances, etc.), biological indicators of those (hormones, namely cortisol), and modalities
of exercise, will be discussed to point potential research in the direction that would
provide the most applicable information to attenuate stress in college-aged students.

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Biological Mechanisms of Stress
Emotions, at their biological roots, serve as survival mechanisms - especially ones
of distress. Phenomena such as the “fight or flight” response are well-known cases of
stress as a mechanism to aid in survival. In this mechanism, the sympathetic nervous
system presides over bodily response, yet hormonal changes also take place. Namely
activation of the HPAA, releasing the trigger point peptide hormone Corticotropin-
Releasing Factor (Faravelli et al., 2012). Ultimately Adrenocorticotropic Hormone
(ACTH) and other peptide hormones and active substances are released from
corticotropes in the anterior pituitary gland (Faravelli et al., 2012). From there, plasma
levels of adrenocorticotropic hormone and additional hormones may rise by 2 to 5 times
above baseline (Ranabir & Reetu, 2011). It is well established that resting serum levels of
cortisol correlate with “perceived stress” in humans (Walvekar et al. 2015). In 2015,
Walvekar et al. reported a positive correlation between cortisol and scores on the
Perceived Stress Scale.
Cortisol as a Biomarker of Stress
The use of cortisol as a biomarker of stress has been validated in the literature (Do
Yup Lee et al., 2015). However, a more accessible and cost-effective method of
measuring cortisol is through saliva. Hellhammer et al. (2018) noted that as long
researchers remain aware of possible covariance between cortisol and stress (due to the
complex involvement of multiple compounds in the HPAA), salivary cortisol is a useful
biomarker in stress research. Furthermore, consistent reports of a high correlation in
salivary cortisol levels and unbound free cortisol levels in blood plasma is evident in
research (correlations ranged between (r= 0.71) and (r= 0.96) (Levine et al., 2007;

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Hellhammer et al., 2009). It is important to note that “unbound free cortisol” is different
from cortisol in the serum released from the HPAA, which dissipates during circadian
cycles and extraneous circumstances while the former stays elevated in those situations.
Yet, if the researcher is aware of this and times testing accordingly, this is useful
evidence that measuring cortisol through saliva is a valid method. Furthermore, Bozovic
et al. (2013) assert this method is preferable to measuring blood cortisol because of an
extraneous stress response to blood draws that skews results. Salivary cortisol is backed
by evidence as a valid and reliable measure of stress and correlates with perceived stress
measured via the perceived stress scale (PSS), which has also shown to have positive face
validity, internal consistency, reliability,” while Reis et al. (2010) reported that, “The
test-retest reliability scores were 0.83 (Factor 1), 0.68 (Factor 2) and 0.86 (Total Score).”
The Profile of Mood States (POMS) and short form (POMS SF-36) have also shown
moderate correlations in multiple categories to salivary cortisol (Shibuya et al. 2014).
Cortisol and the Sleep-Wake Cycle
Cortisol is a corticosteroid that awakens cell response and metabolism. Therefore,
serum cortisol levels follow a circadian rhythmic pattern, dropping at night for sleep
onset. Cortisol concentrations then increase during the sleep cycles in preparation for the
ensuing day. HPAA, and therefore cortisol, activity reaches its nadir or lowest
concentration in each 24-hour period, typically around the midnight hour (Bush &
Hudson, 2010). Sleep onset occurs approaching or at the nadir of the HPAA and cortisol
activity. Bush and Hudson (2010) report that sleep deprivation is associated with HPAA
activity, while other sleep-related issues may cause HPAA dysregulation at nighttime –
which may further increase insomnia. Therefore, decreasing the climactic hormone of the

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HPA axis – cortisol – may garner benefits in either of those cases, making steps toward
restoring a regular circadian and sleep rhythm. Nicolaides et al. (2020) report that sleep,
especially in the later cycles, such as rapid eye movement, inhibits HPAA activity.
Therefore, HPAA axis activation can induce “arousal and sleeplessness,” and a 24-hour
net increase of namely ACTH and cortisol is shown to associate with insomnia
(Nicolaides et al., 2020).
Cortisol Reactivity in Relation to Perceived Stress
The POMS has also shown correlations in multiple categories to salivary cortisol
(O’Connor et al., 1989; Shibuya et al., 2014). In an overtraining study, female swimmers
decreased mood scores via the POMS was significantly correlated with rises in salivary
cortisol (r=.50; p<0.05) (O’Connor et al., 1989). Shibuya et al. 2014 reported, Tension-
Anxiety (r = 0.418; p < 0.05), Depression-Dejection (r = 0.467; p < 0.05), Fatigue
(r = 0.482; p < 0.05) and Confusion (r = 0.572; p < 0.01) all having moderate positive
correlations to salivary cortisol concentration. Therefore, these may present as useful
outcomes/dependent variables in the investigation of an intervention such as exercise.
The Cross-stressor Hypothesis
First coined and outlined by Sothmann (2006), the cross-stressor hypothesis
proposes that improvements in the management of stressors via the HPAA and cortisol
reactivity can be seen if an individual intentionally introduces external stimuli (a cross-
stressor). These can be grouped together and generalized as stress reactivity can be
observed. The most relevant cross-stressor here is exercise. A 12-week endurance
program performed by participants under Klaperski et al. (2014) was correlated with a
lower cortisol response to psychosocial stress. However, the literature on the interplay

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between exercise, stress reactivity, and perceived mood leaves much ambiguity to be
sorted through, and more data on the mutual relationship of these three variables could
help progress to an answer.
Effects of Exercise on Perceived Stress and Cortisol
Perceived Mood
According to Jackson (2013), consistent findings that people report feeling calmer
after a bout of aerobic exercise between 20 to 30 minutes in duration. However, research
in relation to exercise and stress relief has typically centered around aerobic exercise,
with little consideration of many training variables. A limited number of studies exist
examining different modalities of exercise and their respective effects on perceived
stress. One such study performed by Berger and Owen (Berger & Owen, 1987),
suggested that mode of exercise and requirements of the proposed taxonomy affect the
stress reduction benefits of the exercise. The study examined stress outcomes via several
different self-guided stress surveys across participants in different modes of exercise
(fencing, body conditioning, yoga, and swimming). This serves as grounds for suspicion
of variance of training variables having different effects on stress reduction, yet Berger
and Owen did not focus their investigation on these (time, frequency, volume, etc.).
This gap in the literature has not been addressed to the researcher’s knowledge
and has potentially led to discrepancies in academia in this conversation. However,
Goldin et al. (2012) found that aerobic exercise was not as effective as mindfulness-based
perceived stress reduction in managing stress in participants with social anxiety disorder.
The discrepancy between these two studies is most likely attributed to the specificity of

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each, and the difference in disciplines. Each one examined two different subsets of the
population (fibromyalgia versus social anxiety disorder patients). Lastly, they both
examined exercise in an exclusively aerobic modality.
Findings concerning exercise’s consequences on stress and mental distress could
be more appropriately applied if a more generalized sample of the population (such as
college students) were examined after each being given specific training variables and
compared them to each other. The most appropriate exercise parameters need to be
identified first before they are applied to specific patient populations. Many measurement
tools exist for perceived mood; however, the POMS is widely used in research and has
been examined for the effect exercise has on the scores of it (Petrowski et al., 2021;
Berger & Motl, 2000). In a selective review by Berger and Motl (2000), it was reported
that many studies have shown both acute and chronic advantages in improving POMS
scores.
Effects of Exercise on Cortisol Behavior Throughout the Day
It has been observed that exercise causes an acute increase in cortisol and
adrenocorticotropin to meet metabolic and physical demands. However, this seems to
benefit stress control in two ways. Firstly, Chen et al. (2017) demonstrated the
phenomenon of a concurrent rise in dopamine levels triggered directly by physical
activity. Secondly, multiple studies have recorded lower cortisol baseline levels from pre-
post-light to moderate exercise, typically about the 24th hour after said planned physical
activity. Hackney and Viru (2006) included 17 trained athletes in a program consisting of
a control day involving no exercise, and 2 separate training days – 1 including 2 sessions
of moderate exercise intensity, and 1 of high intensity. Hourly monitored cortisol showed

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that cortisol levels in participants for the 24th hour of recovery were substantially lower
after training sessions compared to the control, especially following the moderate-
intensity day (Daly et al., 2005).
In Daly et al. (2005) a total of 22 male endurance-trained athletes ran on a
treadmill until volitional fatigue. Cortisol was monitored in these participants during
post-exercise recovery, at 24-hour post-exercise termination, serum cortisol levels were
much lower than baseline pre-exercise samples (Daly et al. 2005). As for perceived mood
state, in 1996 Nabkasorn et. Al. showed a decrease in depressive moods after an eight-
week exercise program versus an eight-week program consisting of daily living activities.
This study also documented early evidence of baseline cortisol management after
exercise, as urinal cortisol levels were lower at 24 hours of post-exercise recovery
compared to those of pre-exercise. Cortisol can achieve lower levels after exercise than
baseline in as little as 240 minutes (Hackney & Viru, 1999; Daly et al., 2004; Nabkasorn
et al., 2006).
While there seems to be an established link between improved management and
recovery of stress reactivity after exercise, a lack of literature exists addressing different
modes of exercise and whether that affects the magnitude of cortisol and mood state
improvement post-exercise.
High-frequency exercise versus high duration (accumulated vs. continuous)
According to a meta-analysis by Murphy et al. (2009) 16 studies had been
published that distinguished accumulated or continuous exercise and examined outcomes
on health variables. Murphy et al. (2019), included 3 more studies in another meta-
analysis 10 years later. The analysis across the studies showed that better improvements

12
in HDL and LDL cholesterol, through the AC group were noted, while continuous
exercise seemed to elicit greater reductions in body fat percentage (Murphy et al. 2009;
Murphy et al. 2019). As for psychological outcomes among AC and CO, the research is
scarce (Murphy et al. 2009; Murphy et al. 2019). Only 3 studies were available to be
referenced for analysis on psychological outcomes, and CO exercise showed the only
significant positive effects on mood state in the CO group, but it was shown that the AC
group showed a trend in the same direction (Murphy et al. 2009; Murphy et al. 2019;
Osei-Tutu & Campagna, 2005). Blood pressure showed significant improvements in both
AC and CO groups, with no significant difference between them (Murphy et al. 2009;
Murphy et al. 2019).
Conclusion
Stress can refer to both the process by which the cells are acted on by hormones in
the HPA axis to increase metabolism or perceived stress (Faravelli et al., 2012). Cortisol
is a biomarker of stress that correlates with perceived mood measured by the POMS
O’Connor et al., 1989; Shibuya et al., 2014; Do Yup Lee et al., 2015). Evidence suggests
exercise can lead to favorable outcomes in both cortisol and POMS score outcomes
(Berger & Motl, 2000). However, a lack of research exists examining the possibility of
differences in how AC and CO affect cortisol and mood state (Hackney & Viru, 2006;
Murphy et al. 2019). This study was conducted to address that gap in the literature.

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CHAPTER III
METHODOLOGY AND DESIGN
Experimental Design
This was a single group cross-over design study (n=8). The sample group
consisted of students at the University of Mary in Bismarck, ND. Participants completed
an initial screening and 2 days of exercise with evening post-exercise lab assessments.
Upon recruitment, participants were assigned to complete an accumulated or continuous
exercise protocol, followed by completing the other protocol during their second exercise
session. Day 0: participants were asked to refrain from structured exercise 24 hours prior
to day 0 through the duration of the study. An informed consent, Health History
Questionnaire (HHQ), and Profile Mood State Short Form (POMS SF) were completed.
Height, weight, and estimated heart rate max (HRmax) were collected, and participants
were taken to the student wellness center for an explanation of the exercise protocols.
Participants then completed one set of 5 repetitions for 6 different strength exercise and
their 1-repetition maximum (1RM) was estimated for each exercise. Day one: 72 hours
following day 0, participants either completed the continuous protocol (exercise session
at 11am) or the accumulated protocol 20-minute exercise bouts at 8am, 11am, and 2pm).
Participants reported to the lab in the evening to complete a salivary cortisol collection
and a POMS SF. Day 2: 48 hours after the first session, participants returned to complete
the other exercise protocol. Participants returned the evening after the

14
exercise session for saliva collection and to complete the POMS SF.
Participants
Participants were recruited via email, word of mouth, and poster advertisements
around the University of Mary Campus. Inclusion criteria required participants to be 18
to 25 years of age. Participants were excluded due to any contraindications as shown on
the HHQ. Participant data was not included in the analysis if they did not complete all
exercise sessions. Potential risks and benefits were provided to the participants via the
informed consent form. The descriptive and demographic characteristics can be seen in
table 1. Potential risks and benefits were provided to the participants via the informed
consent form.
Table 1.
Participant Descriptive Characteristics and Demographics
n=8
Mean
± SD
Age
Resting Heart Rate
Heart Rate Reserve (HRR)
Height
Weight
21.13
75.38
117.01
66.59
151.51
0.44
5.30
5.30
1.50
11.88
Five Repetition Maximum Testing
Participants arrived at the fitness center and reported their estimated 5RM for the
leg press, row, chest press, lat pulldown, leg curl, and overhead shoulder press machines.

15
All participants then performed a generalized warm-up followed by 5 Repetition Max
(5RM) testing on the leg press, row, chest press, lat pulldown, leg curl, and overhead
shoulder press machines. Each test began with 10 repetitions at 30% of the reported
5RM. Participants then completed 5 reps at 60%, five reps at 70%, 3 reps at 90%. Two to
3 minutes of rest was allotted between each warm-up set. (Brzycki 1993; Abdul-Hameed
et al. 2012). Following the warmup, participants will attempt up to four 5RM trials with 3
to 5 minutes between each trial. The greatest weight achieved was used to estimate 1RM
and prescribe weight for the exercise sessions
Exercise Protocol
Participants completed the exercise interventions in a crossover manner. Volume
was determined from three studies, Crewther et al. (2011), Leite et al. (2011), and Volek
et al. (1997), in which volumes of 3-5 sets and 8-12 reps elicited positive changes in
cortisol, while one of the studies examined and determined that no significant hormonal
changes in low volume - high load resistance exercise was present. Treadmill exercise
was completed on a Runner-up SoleF80 for each, and resistance training exercises were
completed using Life Fitness machines. Timing for each day and time of data collection
was determined through studies by Hackney & Viru (1999), and Hackney (2006).The
intervention consisted of the two different modes/styles of exercise, continuous and
accumulated.
Each participant completed one of the workouts the morning of day 1 and then
returned to do whichever workout they had not yet completed on the morning of day 2.
The continuous exercise session consisted of 21 straight minutes on the treadmill at
intervals of two minutes operating at a low intensity and five minutes at a moderate

16
intensity, with resistance training immediately following for a total of 60 minutes. The
accumulated design consisted of 3 separate 20-minutes sessions, each congruent to the
other in the aerobic phase, but containing two different resistance training exercises from
the others. Each session required the participants to complete 7 minutes on the treadmill
with 2 minutes being at a low intensity and 5 minutes at a high intensity. The first
accumulated session’s resistance exercises were the leg press and seated row, the second
was the chest press and lat pull down, third was the leg curl and overhead press. Low-
intensity aerobic exercise was prescribed as 40-59% of heart rate reserve (HRR) derived
from age-predicted HRmax and moderate-intensity as 64-76% of HRR per the ACSM.
The intensity of each resistance exercise was 85% of each participant’s five repetition
maximum (5RM), and volume was prescribed at three sets of eight repetitions.
Saliva Collection
Salimetrics salivary cortisol test kit (©2021 Salimetrics, Carlsbad, California) was
used to collect the saliva using the Salimetrics passive drool method which has been
validated with oral swabs (Fisher et al., 2015) and ELISA immunoassays (Izawa and
Suzuki, 2017). Participants were instructed to allow saliva to pool in the mouth. Then,
with the head tilted forward, they gently guided saliva through the SalivaBio Collection
Aid into the vial until 1.8mL had been collected. Salivary samples were stored in a
freezer at -20 degrees Celsius. All samples were sent to Salimetrics for analysis.
Profile of Mood States Short Form - 36
POMS SF-36 is an abbreviated version of the Profile of Mood States and has been
validated against the POMS (full form) (Grove & Prapavessis, 1992; Bourgeois, LeUnes,
& Meyers, 2010). The questionnaire consists of prompts regarding mood state. Each

17
prompt listed a mental/emotional state or characteristic, followed by Likert scale response
options (0 = Not at all, to 4 = extremely).
Heart Rate and Anthropometrics
Height and weight were measured using the Health-O-Meter 400KL Mechanical
Beam Scale (Pelstar® LLC / Health o meter® Professional Scales, St. McCook, IL
60525-7110 USA). Estimated HRmax was calculated using the equation 207 beats per
minute – (age x0.7) (Robergs and Landwehr, 2002).
Data Analysis
Data were collected from November 2021 to January 2022. Statistical analysis
was completed with Statistical Package for Social Sciences (SPSS) and Microsoft Excel
to assess variance in the cortisol value means, and a repeated-measures t-test was run. A
paired sample t-test was used to compare mean differences between AC and CO for
cortisol values from the salivary analysis. A repeated measured ANOVA without
replication was run to determine any differences between the 3 POMS SF-36 means, with
a subsequent test for sphericity. Two correlations were run to determine the relationship
between evening cortisol levels and the POMS SF-36 after AC and CO.

18
CHAPTER IV
RESULTS
All 8 participants completed the intervention and saliva collection. Only 7 of 8
participants successfully completed the POMS SF-36 due to one participant not
completing the survey. All participants self-reported adherence to study protocols. To
compare mean scores between the 3 sample pools, a repeated-measures ANOVA was
used (Table 2).. No difference was found between CO mean salivary cortisol (x
=.08) and
AC salivary cortisol (x
=.1) (t(7)=1.25, p=.25, d= 0.53), with medium effect size.. A
nonsignificant negative moderate correlation between CO POMS SF-36 and CO salivary
cortisol was found (p=.24, r=-.51). A nonsignificant negative strong correlation between
AC POMS SF-36 and AC salivary cortisol was found (p=.07, r=-.72).

19
Table 2.
Repeated Measures ANOVA for POMS SF-36
ANOVA
SS
df
MS
F
P-value
F crit
η2p
POMS SF-
36
254.38
2
127.19
3.00
.09
3.89
0.45
Error
508.952
12
42.41
Total
5054.95
20

20
CHAPTER V
DISCUSSION
The purpose of this study was to identify any differences in evening cortisol
levels and mood state between accumulated and continuous exercise. The hypothesis was
that AC and CO would show significant differences in their effects on salivary cortisol
control and perceived mood state. A paired-samples t-test was conducted to check for
differences in salivary cortisol each evening after both AC and CO. A repeated-measures
ANOVA was conducted to determine differences in POMS SF-36 scores across baseline,
AC, and CO days.
No differences were found between AC and CO exercise in salivary cortisol
concentration the evening after the intervention. To the knowledge of the researchers, no
other study has examined salivary cortisol after the two types of exercise. However, other
biochemical markers have been shown to be modulated more by AC than CO, such as
HDL and LDL cholesterol (Mestek, et al., 2006; Murphy et. al., 2019). In Mestek, et. al.
(2006), blood lipid differences were found 48 hours post-exercise when implementing
AC as opposed to 24 hours when utilizing CO. However, this is not a consideration in
cortisol concentration, as significant evidence suggests cortisol concentration dropping in
as little as 3 hours after exercise (Hackney & Viru 1999). Since cortisol and other
hormonal biomarkers of stress have not been examined for outcome differences between
AC and CO, further research could be conducted to identify the advantages of one over
the other in biochemical/hormonal outcomes. Likewise, the repeated measures ANOVA

21
did not show any differences in the baseline, AC, and CO POMS SF-36 scores. To the
researcher’s knowledge, only two other studies have examined AC, CO, and the effects
of POMS (full form) scores (Murphy et. al., 2002; Osei-Tutu & Campagna, 2005). Osei-
Tutu and Campagna (2005) showed CO positively impacting mood state with AC not
significantly impacting mood but showing a trend towards it in the POMS (full form)
scores. However, participants in Murphy et al. (2002) and Osei-Tutu & Campagna (2005)
only performed aerobic exercise in the form of walking. Also, Osei-Tutu and Campagna
(2005) did not control for intensity. So, neither study included resistance training, and
one of them did not prescribe intensity, unlike the current study which utilized resistance
training and prescribed intensity for all exercises. A suggestion for future research on this
topic would be to include aerobic and resistance training in a longitudinal design to
increase sample data for each participant.
An interesting non-significant negative correlation between POMS SF-36 and
salivary cortisol in both styles of exercise. A strong negative correlation was found in the
AC results and a moderate negative correlation in the CO results. This is contrary to what
previous research would indicate in terms of cortisol concentration positively correlating
with perceived stress and mood state. (O’Connor et al., 1989; Filaire et al., 2001; Do Yup
Lee et al., 2015; Gerber et al., 2020). The results shift the focus to the question of the
reliability of the POMS SF-36 in measuring mood state and correlating appropriately
with cortisol activity. Specific to this study, a worthwhile consideration is the findings
regarding concurrent and internal validity of the POMS (full form) in Gibson (1997).
These findings suggested higher validity in older adults (defined as 60-100 years of age),
with decreasing validity as age decreased. As the population in the current study is

22
college-aged individuals, the suggestions of Gibson (1997) are important, because they
bring into question the ability to generalize all forms of the POMS across all age
demographics and experiences. In addition, further research in the validation of all forms
of the POMS shows extraneous variability inherent in the nature of the questions asked in
the survey (Nyenhuis et al., 1999; Terry et al., 2003). Future research in mood state
should aim to build a measurement that considers variables for the specific age range and
other specific demographic variables, to control for participant experiences and their
effect on the perception of mood.
None of the findings support the hypothesis, with statistically non-significant
differences in all dependent variables. Significant findings in the previous research
support that, in general, exercise modulates cortisol concentration towards a nadir
favoring functional sleep cycles. This research does not provide any evidence that the
type of exercise alters the cortisol concentration trend in the evening.
Primary considerations for future research in which this study was limited would
be a larger sample size and intensity. High-intensity training may elicit a stronger effect
on salivary cortisol reduction than moderate intensity (Hackney & Viru, 1999).
Therefore, employing high intensity may help increase effect size and distinguish the data
from each sample, possibly increasing validity. Additionally, a longitudinal design or
repeating intervention and data collection for each participant. Lastly, considering
demographic and lifestyle factors specific to participants that may alter the perception of
mood is important for assured validity in future research. The topics of this study can
help spur much more exploration into the biological and psychological ramifications of
accumulated vs. continuous exercise modes, employing the considerations discussed.

23
REFERENCES
Abdul-Hameed, U., Rangra, P., Shareef, M. Y., & Hussain, M. E. (2012). Reliability of
1-repetition maximum estimation for upper and lower body muscular strength
measurement in untrained middle aged type 2 diabetic patients. Asian journal of
sports medicine, 3(4), 267.
Bartholomew, J. B., Morrison, D., & Ciccolo, J. T. (2005). Effects of acute exercise on
mood and well-being in patients with major depressive disorder. Medicine and
science in sports and exercise, 37(12), 2032.
Berger, B. G., & Motl, R. W. (2000). Exercise and mood: A selective review and
synthesis of research employing the profile of mood states. Journal of applied sport
psychology, 12(1), 69-92.
Berger, B. G., & Owen, D. R. (1987). Anxiety reduction with swimming: relationships
between exercise and state, trait, and somatic anxiety. International Journal of Sport
Psychology.
Boudarene, M., Legros, J. J., & Timsit-Berthier, M. (2002). Study of the stress response:
role of anxiety, cortisol and DHEAs. L'encephale, 28(2), 139-146.
Bozovic, D., Racic, M., & Ivkovic, N. (2013). Salivary cortisol levels as a biological
marker of stress reaction. Med Arch, 67(5), 374-377.
Brzycki, M. (1993). Strength testing—predicting a one-rep max from reps-to-
fatigue. Journal of physical education, recreation & dance, 64(1), 88-90.

24
Brzycki, M. (1998). Quality REPS: The REPS prescription simplifies basic strength
training movements. FITNESS MANAGEMENT, 44-47.
Chase, R., & Hutchinson, J. (2015). The effects of acute aerobic exercise versus
resistance exercise on mood state. J Multidisciplinary Res, 7(2), 15-16.
Chen, C., Nakagawa, S., An, Y., Ito, K., Kitaichi, Y., & Kusumi, I. (2017). The exercise-
glucocorticoid paradox: How exercise is beneficial to cognition, mood, and the brain
while increasing glucocorticoid levels. Frontiers in neuroendocrinology, 44, 83-102.
Chida Y., & Hamer M. (2008). Chronic psychosocial factors and acute physiological
responses to laboratory-induced stress in healthy populations: A quantitative review
of 30 years of investigations. Psychol. Bull, 134(6), 829–885. doi: 10.1037/a0013342
Chong CSM, Tsunaka M, Tsang HWH, Chan E.P., & Cheung W.M. (2011). Effects
of yoga on stress management in healthy adults: a systematic review. Altern Ther
Health Med, 17(1), 32–8.
Cohen, S., & Janicki-Deverts, D. (2009). Who’s stressed? Distributions of psychological
stress in the united states in probability samples from 1983, 2006, 2009. 42(6), 1320-
1334
Crewther, B. T., Heke, T., & Keogh, J. W. (2011). The effects of training volume and
competition on the salivary cortisol concentrations of Olympic weightlifters. The
Journal of Strength & Conditioning Research, 25(1), 10-15.
Daly, W., Seegers, C. A., Rubin, D. A., Dobridge, J. D., & Hackney, A. C. (2005).
Relationship between stress hormones and testosterone with prolonged endurance
exercise. European journal of applied physiology, 93(4), 375-380.

25
Dishman, R. K., & Sallis, J. F. (1994). Determinants and interventions for physical
activity and exercise.
Do Yup Lee, E. K., & Choi, M. H. (2015). Technical and clinical aspects of cortisol as a
biochemical marker of chronic stress. BMB reports, 48(4), 209.
Faravelli, C., Lo Sauro, C., Lelli, L., Pietrini, F., Lazzeretti, L., Godini, L., ... & Ricca, V.
(2012). The role of life events and HPA axis in anxiety disorders: a review. Current
pharmaceutical design, 18(35), 5663.
Filaire, E., Bernain, X., Sagnol, M., & Lac, G. (2001). Preliminary results on mood state,
salivary testosterone: cortisol ratio and team performance in a professional soccer
team. European journal of applied physiology, 86(2), 179-184.
Follenius, M., Brandenberger, G., Bandesapt, J. J., Libert, J. P., & Ehrhart, J. (1992).
Nocturnal cortisol release in relation to sleep structure. Sleep, 15(1), 21-27.
Gerber, M., Imboden, C., Beck, J., Brand, S., Colledge, F., Eckert, A., ... & Hatzinger, M.
(2020). Effects of aerobic exercise on cortisol stress reactivity in response to the trier
social stress test in inpatients with major depressive disorders: A randomized
controlled trial. Journal of clinical medicine, 9(5), 1419.
Gibson, S. J. (1997). The measurement of mood states in older adults. The Journals of
Gerontology Series B: Psychological Sciences and Social Sciences, 52(4), P167-
P174.
Goldin, P. R., Ziv, M., Jazaieri, H., Werner, K., Kraemer, H., Heimberg, R. G., & Gross,
J. J. (2012). Cognitive reappraisal self-efficacy mediates the effects of individual
cognitive-behavioral therapy for social anxiety disorder. Journal of consulting and
clinical psychology, 80(6), 1034.

26
Guszkowska, M., & Sionek, S. (2009). Changes in mood states and selected personality
traits in women participating in a 12-week exercise program. Human
Movement, 10(2), 163-169.
Hackney, A. C., & Viru, A. (1999). Twenty-four-hour cortisol response to multiple daily
exercise sessions of moderate and high intensity. Clinical physiology (Oxford,
England), 19(2), 178-182.
Hansen, C. J., Stevens, L. C., & Coast, J. R. (2001). Exercise duration and mood state:
How much is enough to feel better?. Health Psychology, 20(4), 267.
Hellhammer, D.H., Wust, W., & Kudielka, B.M. (2009). Salivary cortisol as a biomarker
in stress research. Psychoneuroendocrinology, 34(2), 163-171.
Herawati, K., & Gayatri, D. (2019). The correlation between sleep quality and levels of
stress among students in Universitas Indonesia. Enfermeria clinica, 29, 357-361.
Hudson T., & Bush, B. (2010). The Role of Cortisol in Sleep. Nat Medi J, 2, 6.
Ising M., Horstmann S., Kloiber S., Lucae S., Binder E.B., Kern N., Künzel H.E.,
Pfenning A., Uhr M., & Holsboer F. (2007). Combined dexamethasone/corticotropin
releasing hormone test predicts treatment response in major depression-a potential
biomarker? Biol. Psychiatry. 62(1), 47-54. doi: 10.1016/j.biopsych.2006.07.039.
Jackson, E. M. (2013). Stress relief: The role of exercise in stress management. ACSM's
Health & Fitness Journal, 17(3), 14-19.
Jones, J., & Saad, L. (2017, December 20) Eight in 10 Americans Inflicted by Stress.
Gallup. https://news.gallup.com/poll/224336/eight-americans-afflicted-stress.aspx
Klaperski, S., von Dawans, B., Heinrichs, M., & Fuchs, R. (2014). Effects of a 12-week
endurance training program on the physiological response to psychosocial stress in

27
men: a randomized controlled trial. Journal of behavioral medicine, 37(6), 1118-
1133.
Knight, E. L., Jiang, Y., Rodriguez-Stanley, J., Almeida, D. M., Engeland, C. G., &
Zilioli, S. (2021). Perceived stress is linked to heightened biomarkers of inflammation
via diurnal cortisol in a national sample of adults. Brain, Behavior, and Immunity, 93,
206-213.
Leite, R. D., Prestes, J., Rosa, C., De Salles, B. F., Maior, A., Miranda, H., & Simao, R.
(2011). Acute effect of resistance training volume on hormonal responses in trained
men. Journal of Sports Medicine and Physical Fitness, 51(2), 322.
Levine, A., Zagoory-Sharon, O., Feldman, R., Lewis, J. G., & Weller, A. (2007).
Measuring cortisol in human psychobiological studies. Physiology & behavior, 90(1),
43-53.
Lichtman, S., & Poser, E. G. (1983). The effects of exercise on mood and cognitive
functioning. Journal of psychosomatic Research, 27(1), 43-52., The Effects of
Perceived Stress, Traits, Mood States, and Stressful Daily Events on Salivary Cortisol
Raglin J. S. (1990). Exercise and mental health. Beneficial and detrimental effects. Sports
medicine (Auckland, N.Z.), 9(6), 323–329.
McCanlies, E. C., Slaven, J. E., Smith, L. M., Andrew, M. E., Charles, L. E., Burchfiel,
C. M., & Violanti, J. M. (2012). Metabolic syndrome and sleep duration in police
officers. Work, 43(2), 133-139.
McDonald, D. G., Beckett, M. B., & Hodgdon, J. A. (1991). Psychological predictors of
physical performance and fitness in US Navy personnel. Military Psychology, 3(2),
73-87.

28
Munezawa, T., Kaneita, Y., Osaki, Y., Kanda, H., Minowa, M., Suzuki, K., ... & Ohida,
T. (2011). The association between use of mobile phones after lights out and sleep
disturbances among Japanese adolescents: a nationwide cross-sectional
survey. Sleep, 34(8), 1013-1020.
Matamura, M., Tochigi, M., Usami, S., Yonehara, H., Fukushima, M., Nishida, A., ... &
Sasaki, T. (2014). Associations between sleep habits and mental health status and
suicidality in a longitudinal survey of monozygotic twin adolescents. Journal of Sleep
Research, 23(3), 292-296.
Masalamany, K., Ngu, S. T., Abd Manan, N., & Adam, S. K. (2017). Sleep quality
among pre-clinical medical students in Universiti Putra Malaysia and University
Malaya, Malaysia. Education in Medicine Journal, 9(3).
Mestek, M. L., Garner, J. C., Plaisance, E. P., Taylor, J. K., Alhassan, S., & Grandjean, P.
W. (2006). Blood lipid responses after continuous and accumulated aerobic
exercise. International journal of sport nutrition and exercise metabolism, 16(3), 245-
254.
Mikkelsen, K., Stojanovska, L., Polenakovic, M., Bosevski, M., & Apostolopoulos, V.
(2017). Exercise and mental health. Maturitas, 106, 48–56.
Murphy, M. H., Lahart, I., Carlin, A., & Murtagh, E. (2019). The effects of continuous
compared to accumulated exercise on health: a meta-analytic review. Sports
Medicine, 49(10), 1585-1607.
Murphy, M. H., Nevill, A. M., Neville, C., Biddle, S., & Hardman, A. E. (2002).
Accumulating brisk walking for fitness, cardiovascular risk, and psychological health.

29
Nabkasorn, C., Miyai, N., Sootmongkol, A., Junprasert, S., Yamamoto, H., Arita, M., &
Miyashita, K. (2006). Effects of physical exercise on depression, neuroendocrine
stress hormones and physiological fitness in adolescent females with depressive
symptoms. European journal of public health, 16(2), 179–184.
https://doi.org/10.1093/eurpub/cki159
Nahas, M. V., Goldfine, B., & Collins, M. A. (2003). Determinants of physical activity in
adolescents and young adults: The basis for high school and college physical
education to promote active lifestyles. The Physical Educator, 60(1).
Nicolaides, N. C., Vgontzas, A. N., Kritikou, I., & Chrousos, G. (2020). HPA axis and
sleep. In Endotext [Internet]. MDText. com, Inc.
Nurismadiana, I., & Lee, K. (2018). Factors associated with sleep quality among
undergraduate students at a Malaysian public university. International Journal of
Public Health and Clinical Sciences, 5(6), 373-391.
Nyenhuis, D. L., Yamamoto, C., Luchetta, T., Terrien, A., & Parmentier, A. (1999).
Adult and geriatric normative data and validation of the profile of mood
states. Journal of clinical psychology, 55(1), 79-86.
O'Connor, P. J., Morgan, W. P., Raglin, J. S., Barksdale, C. M., & Kalin, N. H. (1989).
Mood state and salivary cortisol levels following overtraining in female
swimmers. Psychoneuroendocrinology, 14(4), 303-310.
Osei-Tutu, K. B., & Campagna, P. D. (2005). The effects of short-vs. long-bout exercise
on mood, VO2max., and percent body fat. Preventive medicine, 40(1), 92-98.

30
Peluso, M. A. M., & Andrade, L. H. S. G. D. (2005). Physical activity and mental health:
the association between exercise and mood. Clinics, 60, 61-70.. Health
Psychology, 20(4), 267. .
Perna, F. M., Antoni, M. H., Kumar, M., Cruess, D. G., & Schneiderman, N. (1998).
Cognitive-behavioral intervention effects on mood and cortisol during exercise
training. Annals of Behavioral Medicine, 20(2), 92-98.
Petrowski, K., Albani, C., Zenger, M., Brähler, E., & Schmalbach, B. (2021). Revised
short screening version of the Profile of Mood States (POMS) from the German
general population. Frontiers in psychology, 12, 1937.
Pensuksan, W. C., Lertmaharit, S., Lohsoonthorn, V., Rattananupong, T., Sonkprasert, T.,
Gelaye, B., & Williams, M. A. (2016). Relationship between poor sleep quality and
psychological problems among undergraduate students in the Southern
Thailand. Walailak journal of science and technology, 13(4), 235.
QuARTERLY, R. (1988). Stress reduction and mood enhancement in four exercise
modes: swimming, body conditioning, hatha yoga, and fencingº. Stress, 59(2), 148-
159.
Ranabir, S., & Reetu, K. (2011). Stress and hormones. Indian journal of endocrinology
and metabolism, 15(1), 18–22. https://doi.org/10.4103/2230-8210.77573
Hanawi, S. A., Saat, N. Z. M., Zulkafly, M., Hazlenah, H., Taibukahn, N. H.,
Yoganathan, D., ... & Low, F. J. (2020). Impact of a Healthy Lifestyle on the
Psychological Well-being of University Students. International Journal of Pharmaceutical
Research & Allied Sciences, 9(2).
Salari, N., Hosseinian-Far, A., Jalali, R., Vaisi-Raygani, A., Rasoulpoor, S., Mohammadi,
M., ... & Khaledi-Paveh, B. (2020). Prevalence of stress, anxiety, depression among

31
the general population during the COVID-19 pandemic: a systematic review and
meta-analysis. Globalization and health, 16(1), 1-11.
Shambrook, P., Kingsley, M., Taylor, N., & Gordon, B. (2018). Accumulated or
continuous exercise for glycaemic regulation and control: a systematic review with
meta-analysis. BMJ open sport & exercise medicine, 4(1), e000470.
Shibuya, I., Nagamitsu, S., Okamura, H., Ozono, S., Chiba, H., Ohya, T., ... & Matsuishi,
T. (2014). High correlation between salivary cortisol awakening response and the
psychometric profiles of healthy children. BioPsychoSocial Medicine, 8(1), 1-4.
Siqueira Reis, R., Ferreira Hino, A. A., & Romélio Rodriguez Añez, C. (2010). Perceived
stress scale: reliability and validity study in Brazil. Journal of health
psychology, 15(1), 107-114.
Sothmann, M. S. (2006). The Cross-Stressor Adaptation Hypothesis and Exercise
Training.
Suen, L. K., Tam, W. W., & Hon, K. L. (2010). Association of sleep hygiene-related
factors and sleep quality among university students in Hong Kong. Hong Kong Med
J, 16(3), 180-5.
Terry, P. C., Lane, A. M., & Fogarty, G. J. (2003). Construct validity of the Profile of
Mood States—Adolescents for use with adults. Psychology of sport and
exercise, 4(2), 125-139.
Tzischinsky, O., & Shochat, T. (2011). Eveningness, sleep patterns, daytime functioning,
and quality of life in Israeli adolescents. Chronobiology international, 28(4), 338-
343.

32
Volek, J. S., Kraemer, W. J., Bush, J. A., Incledon, T., & Boetes, M. (1997). Testosterone
and cortisol in relationship to dietary nutrients and resistance exercise. Journal of
Applied Physiology.
Walvekar, S. S., Ambekar, J. G., & Devaranavadagi, B. B. (2015). Study on serum
cortisol and perceived stress scale in the police constables. Journal of clinical and
diagnostic research: JCDR, 9(2), BC10.
Weitzman, E. D., Zimmerman, J. C., Czeisler, C. A., & Ronda, J. (1983). Cortisol
secretion is inhibited during sleep in normal man. The Journal of Clinical
Endocrinology & Metabolism, 56(2), 352-358.
Yang, Y., Shin, J. C., Li, D., & An, R. (2017). Sedentary behavior and sleep problems: a
systematic review and meta-analysis. International Journal of Behavioral
Medicine, 24(4), 481-492.
Yeung, R. R. (1996). The acute effects of exercise on mood state. Journal of
psychosomatic research, 40(2), 123-141.

33
APPENDIX A
Recruitment Materials
Hello,
The University of Mary Department of Clinical Exercise Physiology is seeking current
college students who are between 18-25 years of age to participate in a research study.
The purpose of this study is to examine the effects exercising in one session of 60
minutes (called “continuous” exercise) as opposed to three sessions of 20 minutes
(“accumulated” exercise) on the outcome of one’s mood state and cortisol levels.
Participation in this study involves:
• A time commitment of approximately 4 hours over 7 days
• Treadmill and resistance exercise
• Completion of an evaluation of mood
• Collection of saliva for testing cortisol levels
This is a great opportunity to gain exposure to scientific research and systematic
exercise testing and training completed with professional lab equipment.
For more information about this study, please contact the principal investigator, Jared
Rogers 1st year MSCEP graduate student, at jjrogers1@umary.edu or by phone at (715)-
418-9167.
Thank you,
Jared Rogers
Principal Investigator
Study Title: Effects of Accumulated vs. Continuous Exercise On Evening Cortisol and
Mood State

34
New Study
We Want You!
EXERCISE ON
CORTISOL AND MOOD
Effects of Accumulated vs. Continuous Exercise on
Evening Cortisol
Participants will complete the assessments listed on the upper right, as
well as two different exercise sessions to help us determine if one 60-
minute session and three 20-minute session result in different cortisol
levels and mood at night.
WHAT’S INCLUDED:
RESISTANCE AND
AERBIC EXERCISE
ASSESMENT OF
CORTISOL LEVELS
COMPLETION OF
MOOD SURVEYS
A HEALTH HISTORY
QUESTIONAIRE
FOR MORE
INFORMATION
CONTACT
Jared Rogers
jjrogers1@umary.edu
Phone: 715-418-9167

35
APPENDIX B
Health History Questionnaire (HHQ)
Health History Questionnaire
Name:
Date of birth:
Date:
Address:
City:
State:
Zip:
Phone (Cell):
(Work):
Email
address:
In case of emergency, whom may we contact?
Name:
Phone
(Cell):
Relationship:
(Home):
Health Care Provider:
Name:
Phone:
Fax:
Present/Past History
Have you had, or do you presently have any of the following? (Check if yes.)
❑
Heart attack
❑
Any kind of heart disease or heart surgery
❑
Diabetes
❑
Prediabetes

36
❑
High blood pressure
❑
Low blood pressure
❑
Kidney disease
❑
High Cholesterol
❑
Lung disease
❑
Seizures
❑
Cancer
❑
Rheumatic fever
❑
Recent operation
❑
Other (please describe):
❑
Fainting or dizziness
❑
Chest pains
❑
Palpitations or tachycardia (unusually strong or
rapid heartbeat)
❑
Known heart murmur
❑
Muscle or joint problems (e.g., back, knee)
❑
Edema (swelling of ankles)
❑
Pain, discomfort in the chest, neck, jaw, arms, or
other areas
❑
Unusual fatigue or shortness of breath at rest or
with light activity
❑
Temporary loss of clear vision or speech or short-
term numbness or weakness in one side, arm, or leg
of
your body
❑
Shortness of breath while lying down, at night or
that comes on suddenly
❑
Intermittent claudication (calf cramping)
Family History
Have any of your first-degree relatives (parent, sibling, or child) experienced the following conditions? (Check if
yes.)
In addition, please identify at what age the condition occurred.
❑
Heart attack
❑
Congenital heart disease
❑
High blood pressure
❑
High cholesterol
Explain checked items:
❑
Heart surgery
❑
Diabetes
❑
Other major illness:
Activity History
1.
Why have you decided to seek exercise guidance at this time? (Please be specific.)
2.
Were you referred to this program?
❑
Yes
By whom:
3.
Have you ever worked with a personal trainer before?
❑
Yes
❑
No
4.
Date of your last physical examination performed by a physician:
5.
Do you participate in a regular exercise program currently?
❑
Yes
❑
No
If
yes, briefly describe:
6.
Can you currently walk 2 miles briskly without fatigue?
❑
Yes
❑
No
7.
Have you ever performed strength training exercises in the past?
❑
Yes
❑
No
❑
No

37
8.
Do you have injuries (bone/muscle disabilities) that may interfere with exercising?
❑
Yes
❑
No
If yes, briefly describe:
9.
Do you smoke?
❑
Yes
❑
No
If yes, how much per day and what was your age when you started?
10.
What is your
body weight
now?
What
was it one
year ago?
At age 21?
11.
How tall are you?
12.
Do you follow, or have you recently followed any specific dietary intake plan and, in general,
how do you feel
about your nutritional habits?
13.
List the medications you are presently taking.
14.
What are your personal health or fitness goals?
Copyright © 2019 Exercise is Medicine

38
APPENDIX C
Profile of Mood States - Short Form 36 (POMS SF 36)
“The Profile of Mood States (POMS; P. M. McNair et al, 1981) is a commonly used measure of
psychological distress. The length of this scale (65 items) may limit its use with physically ill or
otherwise impaired populations or prevent its inclusion in multi-instrument assessment protocols.
This study evaluated the psychometric properties of a shorter, 37-item version of the POMS
developed by S. Shacham (1983; POMS SF-36). Data were provided by 600 respondents
representing five different clinical samples and one sample of healthy adults. For all samples,
internal consistency estimates for the POMS SF-36 subscales were very comparable to those for
the original POMS. Furthermore, correlations between total mood disturbance and subscale
scores on the POMS SF-36 and those from the original POMS all exceeded .95. The POMS SF-
36 is considered an excellent alternative to the original POMS when a brief measure of
psychological distress is desired. (PsycINFO Database Record (c) 2016 APA, all rights
reserved).”
Curran, S. L., Andrykowski, M. A., & Studts, J. L. (1995). Short Form of the Profile of Mood
States (POMS-SF): Psychometric information. Psychological Assessment, 7(1), 80–
83. https://doi.org/10.1037/1040-3590.7.1.80
The POMS-SF can be accessed here: psycnet.apa.org/record/1995-27722-001

39
APPENDIX D
Exercise Program
Continuous
Session Time
60 minutes
Treadmill
Time
21 minutes
Intensity
2min low
7min mod
2min low
7min mod
2min low
7min mod
Resistance
Volume
3x8
Intensity
85% 5rm
Exercise
Leg Press
Seated row
Chest press
Lat pull down
Leg curl
Overhead press
Accumulated
Session Time
20 minutes
20 minutes
20 minutes
Treadmill
Treadmill
Treadmill
Time
7 minutes
7 minutes
7 minutes
Intensity
2min low
5min mod
2min low
5min mod
2min low
5min mod
Resistance
Volume
3x8
3x8
3x8
Intensity
85% 5rm
85% 5rm
85% 5rm
Exercise
Leg Press
Seated row
Chest press
Lat pull down
Leg curl
Overhead press