Lower cumulative stress is associated with better health for physically active adults in the community

Figures & data

Table 1. Participant characteristics for demographics, exercise, health, adverse life events and lifetime incidence of psychological disorders.

Characteristics	All (n = 395)	Women (n = 219)	Men (n = 176)
Age	29.42 (8.95)	29.5 (9.2)	29.4 (8.7)
Ethnicity (% Caucasian)	64.2	61.1	68.1
Ethnicity (% African American)	26.1	23.6	19.2
Ethnicity (% Asian)	4.6	4.4	5.0
Race (% Hispanic; Latino/Latina)	7.3	8.3	6.0
Education (% ≥12 grade)	85.3	86.3	84.1
BMI (kg/m^2)	27.28 (5.61)	27.30 (5.83)	27.24 (5.34)
Smoker (%)	20.0	19.0	21.0
Smokers: cigarettes/day	9.01 (7.00)	9.59 (7.11)	8.32 (6.92)
Exercise frequency^a	2.32 (1.50)	2.29 (1.49)	2.36 (1.51)
Exercise duration (min)^a	43.60 (18.26)	42.83 (17.94)	44.55 (18.70)
Exercise min/week^b	114.11 (83.02)	110.11 (81.21)	119.16 (85.43)
Cornell Medical: Total	16.39 (14.92)	19.34 (16.20)	12.73 (12.25)***
Cornell Medical: Physical	10.76 (9.20)	12.37 (9.99)	8.77 (7.69)***
Cornell Medical: Cardiovascular^c	0.94 (1.34)	1.12 (1.46)	0.71 (1.13)*
Cornell Medical: Musculoskeletal^c	0.31 (0.78)	0.37 (0.86)	0.24 (0.67)
Cornell Medical: Psychological	5.68 (7.18)	3.94 (5.65)	7.07 (7.95)***
CALE^d	10.70 (6.43)	10.92 (6.62)	10.46 (6.21)
MLE	2.09 (1.77)	2.32 (1.90)	1.79 (1.55)**
Traumatic events	5.83 (4.02)	5.64 (3.75)	6.07 (4.32)
RLE	2.78 (2.45)	2.95 (2.60)	2.57 (2.24)
Lifetime mood disorder	15.8	19.1	11.5*
Lifetime anxiety disorder^e	3.2	4.8	1.1*
Lifetime eating disorder^f	0.01	0.02	0.01
Lifetime alcohol or drug dependence	10.0	8.7	11.5

Values represent mean (SD) or percent of n. ^aTransformed values (see text for category values); ^bvalue is computed score derived from frequency and duration; ^csubset of the physical health complaints portion of the Cornell Medical Index; ^dtotal adverse events = sum of events subscales, which are standardized values; ^eincludes post-traumatic stress disorder; ^fincludes anorexia, bulimia and eating disorders not otherwise specified (including binging). Gender differences assessed using Student’s t-tests for continuous data and χ² for categorical data (***p < 0.0001, **p < 0.001,*p < 0.01).

Table 2. Correlations between exercise, BMI, adverse life events and health problems.

No.	Characteristics	1	2	3	4	5	6	7	8	9	10
1	Exercise (min/week)
2	BMI (kg/m^2)	−0.078
3	CALE	−0.076	0.179*
4	MLE	−0.096	0.182*	0.667*
5	RLE	−0.051	0.043	0.679*	0.250*
6	Traumatic life events	−0.048	0.181*	0.894*	0.475*	0.367*
7	Total health problems	−0.138*	0.193*	0.431*	0.331*	0.407*	0.297*
8	Physical health problems	−0.167*	0.260*	0.401*	0.289*	0.382*	0.284*	0.934*
9	Cardiovascular health problems	−0.145*	0.260*	0.234*	0.148*	0.259*	0.152*	0.627*	0.712*
10	Musculoskeletal health problems	−0.130*	0.200*	0.210*	0.150*	0.203*	0.147*	0.503*	0.608*	0.407*
11	Psychological health problems	−0.072	0.067	0.380*	0.317*	0.356*	0.253*	0.885*	0.659*	0.392*	0.266*

Values are Pearson’s product moment correlations. *p < 0.01.

Table 3. Moderation of the MLE-health problems (complaints) relationship by exercise and gender^a.

				MLE									MLE (adjusted models)^b,c
Model	Outcome	r^2 (adj.)	Predictors	B	SE	β	p	TC	VIF	Model	r^2 (adj.)	Predictors	B	SE	β	p	TC	VIF
1a	Total health problems	0.166	Stress^d	0.298	0.046	0.312	0.000	0.95	1.10	1b	0.181	Stress	0.294	0.047	0.308	0.000	0.92	1.09
			Exercise^e	−0.102	0.045	−0.106	0.025	0.99	1.01			Exercise	−0.089	0.045	−0.093	0.050	0.99	1.02
			Gender^f	−0.174	0.046	−0.181	0.000	0.96	1.04			Gender	−0.180	0.046	−0.186	0.000	0.96	1.04
			Stress × exercise	0.120	0.050	0.114	0.017	0.98	1.02			Stress × exercise	0.119	0.050	0.113	0.017	0.97	1.03
2a	Physical problems	0.142	Stress	0.233	0.041	0.279	0.000	0.95	1.05	2b	0.173	Stress	0.220	0.041	0.263	0.000	0.92	1.09
			Exercise	−0.106	0.040	−0.126	0.009	0.99	1.01			Exercise	−0.091	0.040	−0.108	0.023	0.99	1.02
			Gender	−0.140	0.041	−0.166	0.001	0.96	1.04			Gender	−0.149	0.040	−0.176	0.000	0.96	1.04
			Stress × exercise	0.090	0.044	0.097	0.043	0.98	1.02			Stress × exercise	0.086	0.044	0.094	0.049	0.97	1.03
3a	Cardiovascular	0.067	Stress	0.084	0.040	0.149	0.037	0.97	1.03	3b	0.248	Stress	0.047	0.037	0.083	0.215	0.93	1.08
	problems		Exercise	−0.118	0.041	−0.203	0.005	0.97	1.03			Exercise	−0.067	0.039	−0.116	0.089	0.91	1.10
			Gender	−0.013	0.041	−0.023	0.746	0.98	1.03			Gender	−0.037	0.038	−0.064	0.332	0.95	1.06
			Stress × exercise	0.114	0.046	0.178	0.013	0.96	1.40			Stress × exercise	0.094	0.044	0.148	0.032	0.88	1.14
4a	Musculoskeletal problems	0.028	Stress	0.101	0.039	0.133	0.010	0.97	1.03	4b	0.078	Stress	0.061	0.39	0.079	0.125	0.92	1.09
			Exercise	−0.081	0.039	−0.105	0.038	0.99	1.01			Exercise	−0.058	0.039	−0.075	0.133	0.97	1.03
			Gender	−0.033	0.039	−0.043	0.400	0.97	1.03			Gender	−0.043	0.039	−0.055	0.269	0.97	1.03
5a	Psychological	0.115	Stress	0.288	0.055	0.295	0.000	0.97	1.04	5b	0.176	Stress	0.310	0.061	0.312	0.000	0.84	1.19
	problems		Exercise	−0.061	0.057	−0.060	0.284	0.99	1.01			Exercise	−0.063	0.058	−0.062	0.278	0.97	1.03
			Gender	−0.139	0.058	−0.135	0.017	0.97	1.03			Gender	−0.145	0.059	−0.143	0.014	0.96	1.04
			Stress × exercise	0.128	0.061	0.119	0.037	0.96	1.04			Stress × exercise	0.151	0.061	0.143	0.014	0.95	1.05

^aNon-significant interaction terms have been trimmed from the models; ^bmodels statistically adjusted for age, BMI, years of education, smoking (cigarettes/day), marital status (married, not married), employment status (employed, unemployed), household income, ethnicity (Caucasian, non-Caucasian); ^cnon-significant covariates were trimmed from adjusted models; ^dstress is run as a z-score; ^eexercise is run as a z-score; ^ffemale = −1, male = 1 (all models).

Table 4. Moderation of the CALE-health problems (complaints) relationship by exercise and gender^a.

				CALE^b									CALE (adjusted models)^c,d
Model	Outcome	r^2 (adj.)	Predictors	B	SE	Β	p	TC	VIF	Model	r^2 (adj.)	Predictors	B	SE	β	p	TC	VIF
6a	Total health problems	0.196	Stress^e	0.339	0.044	0.354	0.000	1.00	1.01	6b	0.226	Stress	0.381	0.047	0.398	0.000	0.87	1.15
			Exercise^f	−0.106	0.044	−0.110	0.017	0.99	1.01			Exercise	−0.116	0.045	−0.120	0.010	0.97	1.04
			Gender^g	−0.214	0.044	−0.222	0.000	0.99	1.01			Gender	−0.226	0.044	−0.234	0.000	0.99	1.01
7a	Physical	0.196	Stress	0.282	0.040	0.336	0.000	0.94	1.06	7b	0.233	Stress	0.300	0.041	0.358	0.000	0.86	1.16
	Problems		Exercise	−0.117	0.039	−0.139	0.003	0.98	1.02			Exercise	−0.109	0.039	−0.129	0.005	0.97	1.03
			Gender	−0.172	0.039	−0.204	0.000	0.98	1.02			Gender	−0.185	0.039	−0.219	0.000	0.98	1.02
			Stress × exercise	0.035	0.039	0.042	0.369	0.97	1.04			Stress × Exercise	0.040	0.039	0.047	0.305	0.96	1.04
			Exercise × sex	−0.036	0.039	−0.042	0.364	0.98	1.02			Exercise × Sex	−0.007	0.039	−0.008	0.865	0.95	1.05
			Stress × sex	−0.035	0.040	−0.042	0.379	0.95	1.06			Stress × Sex	−0.023	0.039	−0.028	0.551	0.94	1.06
			Stress × exercise × sex	−0.086	0.039	−0.103	0.029	0.97	1.03			Stress × Exercise × Sex	−0.088	0.039	−0.104	0.026	0.95	1.06
8a	Cardiovascular	0.080	Stress	0.130	0.038	0.238	0.001	1.00	1.00	8b	0.269	Stress	0.111	0.037	0.204	0.003	0.91	1.10
	problems		Exercise	−0.115	0.040	−0.197	0.005	1.00	1.00			Exercise	−0.074	0.038	−0.129	0.055	0.95	1.05
			Gender	−0.031	0.040	−0.054	0.442	1.00	1.00			Gender	−0.058	0.038	−0.100	0.133	0.97	1.03
9a	Musculoskeletal	0.051	Stress	0.153	0.038	0.201	0.000	0.99	1.01	9b	0.093	Stress	0.150	0.039	0.199	0.000	0.95	1.06
	problems		Exercise	−0.080	0.038	−0.104	0.038	0.99	1.01			Exercise	−0.080	0.039	−0.105	0.039	0.99	1.01
			Gender	−0.042	0.038	−0.055	0.267	0.99	1.01			Gender	−0.063	0.039	−0.083	0.105	0.99	1.01
10a	Psychological	0.158	Stress	0.357	0.054	0.360	0.000	1.00	1.00	10b	0.192	Stress	0.389	0.055	0.395	0.000	0.93	1.07
	problems		Exercise	−0.050	0.055	−0.049	0.367	1.00	1.00			Exercise	−0.065	0.055	−0.064	0.240	0.98	1.02
			Gender	−0.175	0.056	−0.170	0.002	1.00	1.00			Gender	−0.180	0.055	−0.176	0.001	1.00	1.01

^aNon-significant interaction terms have been trimmed from the models, except in models 7a and 7b; ^bcumulative adverse events = sum of MLE, RLE and traumatic life events/experiences; ^cmodels statistically adjusted for age, BMI, years of education, smoking (cigarettes/day), marital status (married, not married), employment status (employed, unemployed), household income, ethnicity (Caucasian, non-Caucasian); ^dnon-significant covariates were trimmed from adjusted models; ^estress is run as a z-score; ^fexercise is run as a z-score; ^gfemale = −1, male = 1 (all models).

Figure 1. Moderation by moderate or vigorous exercise (MV exercise) of the MLE and self-reported health relationships for (a) total, (b) cardiovascular and (c) psychological problems as measured by the Cornell Medical Index. Higher levels of stress (MLE score) were associated with poorer health for both total and psychological problems in both adjusted and non-adjusted models (p < 0.001). Stress was associated with cardiovascular health in non-adjusted models (p = 0.037) but there was no association in adjusted models (p = 0.083). Interactions between exercise and stress emerged such that at increasing levels of exercise this linear effect became more marked (p values = 0.017, 0.013 and 0.037, respectively). Associations were tested by hierarchical multiple linear regression (n = 395). Stress is shown at 1 SD below and above the mean MLE score. MV exercise is shown at the mean (114 min) and 1 SD below and above the mean (31 and 197 min). For cardiovascular complaints, stress was not associated with exercise at 31 and 114 min (p > 0.05). Values for health outcomes are log transformed.

Figure 2. Moderation by moderate or vigorous exercise (MV exercise) of relationships between CALE score with self-reported physical health as measured by the Cornell Medical Index. The three-way interaction between stress, exercise and sex was significant in both non-adjusted and adjusted models (p values = 0.029 and 0.026, respectively). Associations were tested by hierarchical multiple linear regression (n = 381). All slopes were significantly different from 0 (p < 0.05), except the slope for women at high stress (simple slopes tests). This same slope was different from all other slopes, which did not differ from each other (slopes differences tests). Stress (CALE score) is shown at 1 SD below and above the mean as is MV exercise (31 and 197 min). Values for health problems are log transformed.