Having a sense of control, developing more optimistic thinking, and building social support can help us experience less stress and thus improve our health. Moreover, these factors interrelate: People who have been upbeat about themselves and their future have tended also to enjoy health-promoting social ties (Stinson et al., 2008). But sometimes we cannot alleviate stress and simply need to manage our stress. Aerobic exercise, relaxation, meditation, and spiritual communities may help us gather inner strength and lessen stress effects.

41-6 How effective is aerobic exercise as a way to manage stress and improve well-being?

Aerobic exercise is sustained, oxygen-consuming, exercise—such as jogging, swimming, or biking—that increases heart and lung fitness. It’s hard to find bad things to say about exercise. By one estimate, moderate exercise adds not only to your quantity of life—two additional years, on average—but also to your quality of life, with more energy and better mood (Seligman, 1994; Wang et al., 2011).

Exercise helps fight heart disease by strengthening the heart, increasing bloodflow, keeping blood vessels open, and lowering both blood pressure and the blood pressure reaction to stress (Ford, 2002; Manson, 2002). Compared with inactive adults, people who exercise suffer half as many heart attacks (Powell et al., 1987; Visich & Fletcher, 2009). Exercise makes the muscles hungry for the fats that, if not used by the muscles, contribute to clogged arteries (Barinaga, 1997). In one study of over 650,000 American adults, walking 150 minutes per week predicted living seven more years (Moore et al., 2012). People who avoid sedentary activities, such as watching television, also tend to live longer lives (Veerman et al., 2012; Wilmot et al., 2012).

The genes passed down to us from our distant ancestors were those that enabled the physical activity essential to hunting, foraging, and farming (Raichlen & Polk, 2013). In muscle cells, those genes, when activated by exercise, respond by producing proteins. In the modern inactive person, these genes produce lower quantities of proteins and leave us susceptible to more than 20 chronic diseases, such as type 2 diabetes, coronary heart disease, stroke, Alzheimer’s disease, and cancer (Booth & Neufer, 2005). Inactivity is thus potentially toxic. But physical activity can weaken the influence of some genetic risk factors. In one analysis of 45 studies, the risk of obesity fell by 27 percent (Kilpeläinen et al., 2012).

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Does exercise also boost the spirit? Many studies reveal that aerobic exercise can reduce stress, depression, and anxiety. Americans, Canadians, and Britons who do aerobic exercise at least three times a week manage stress better, exhibit more self-confidence, feel more vigor, and feel less depressed and fatigued than their inactive peers (McMurray, 2004; Mead et al., 2010; Puetz et al., 2006; Smits et al., 2011). Going from active exerciser to couch potato can increase the likelihood of depression—by 51 percent in two years for the women in one study (Wang et al., 2011). And in a 21-country survey of university students, physical exercise was a “strong” and consistent predictor of life satisfaction (Grant et al., 2009).

But we could state this observation another way: Stressed and depressed people exercise less. These findings are correlations, and cause and effect are unclear. To sort out cause and effect, researchers experiment. They randomly assign stressed, depressed, or anxious people either to an aerobic exercise group or to a control group. Next, they measure whether aerobic exercise (compared with a control activity) produces a change in stress, depression, anxiety, or some other health-related outcome. One classic experiment randomly assigned mildly depressed female college students to three groups. One-third participated in a program of aerobic exercise. Another third took part in a program of relaxation exercises. The remaining third (the control group) formed a no-treatment group (McCann & Holmes, 1984). As FIGURE 41.3 shows, 10 weeks later, the women in the aerobic exercise program reported the greatest decrease in depression. Many had, quite literally, run away from their troubles.

Dozens of other experiments confirm that exercise prevents or reduces depression and anxiety (Conn, 2010; Rethorst et al., 2009; Windle et al., 2010). Moreover, exercise is not only as effective as drugs, it may better prevent symptom recurrence (Babyak et al., 2000; Salmon, 2001). When experimenters randomly assigned depressed people to an exercise group, an antidepressant group, or a placebo pill group, exercise diminished depression levels as effectively as antidepressants—and with longer-lasting effects (Hoffman et al., 2011).

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Vigorous exercise provides a substantial and immediate mood boost (Watson, 2000). Even a 10-minute walk stimulates 2 hours of increased well-being by raising energy levels and lowering tension (Thayer, 1987, 1993). How does exercise work its magic? In some ways, exercise works like an antidepressant drug. It increases arousal, thus counteracting depression’s low arousal state. It often leads to muscle relaxation and sounder sleep. It also orders up mood-boosting chemicals from our body’s internal pharmacy—neurotransmitters such as norepinephrine, serotonin, and the endorphins (Jacobs, 1994; Salmon, 2001). And it may foster neurogenesis. In mice, exercise causes the brain to produce a molecule that stimulates the production of new, stress-resistant neurons (Hunsberger et al., 2007; Reynolds, 2009; van Praag, 2009).

On a simpler level, the sense of accomplishment and improved physique and body image that often accompany a successful exercise routine may enhance one’s self-image, leading to a better emotional state. Exercise (at least a half-hour on five or more days of the week) is like a drug that prevents and treats disease, increases energy, calms anxiety, and boosts mood—a drug we would all take, if available. Yet few people (only 1 in 4 in the United States) take advantage of it (Mendes, 2010).

41-7 In what ways might relaxation and meditation influence stress and health?

Knowing the damaging effects of stress, could we learn to counteract our stress responses by altering our thinking and lifestyle? In the late 1960s, some respected psychologists began experimenting with biofeedback, a system of recording, amplifying, and feeding back information about subtle physiological responses, many controlled by the autonomic nervous system. Biofeedback instruments mirror the results of a person’s own efforts, enabling the person to learn which techniques do (or do not) control a particular physiological response. After a decade of study, however, the initial claims for biofeedback seemed overblown and oversold (Miller, 1985). In 1995, a National Institutes of Health panel declared that biofeedback works best on tension headaches.

Simple methods of relaxation, which require no expensive equipment, produce many of the results biofeedback once promised. Figure 41.3 pointed out that aerobic exercise reduces depression. But did you notice in that figure that depression also decreased among women in the relaxation treatment group? More than 60 studies have found that relaxation procedures can also help alleviate headaches, hypertension, anxiety, and insomnia (Nestoriuc et al., 2008; Stetter & Kupper, 2002).

Such findings would not surprise Meyer Friedman and his colleagues. They tested relaxation in a program designed to help Type A heart attack survivors (who are more prone to heart attacks than their Type B peers) reduce their risk of future attacks. They randomly assigned hundreds of middle-aged men to one of two groups. The first group received standard advice from cardiologists about medications, diet, and exercise habits. The second group received similar advice, but they also were taught ways of modifying their lifestyles. They learned to slow down and relax by walking, talking, and eating more slowly. They learned to smile at others and laugh at themselves. They learned to admit their mistakes; to take time to enjoy life; and to renew their religious faith. The training paid off (FIGURE 41.4). During the next three years, those who learned to modify their lifestyle had half as many repeat heart attacks as did the first group. This, wrote the exuberant Friedman, was an unprecedented, spectacular reduction in heart attack recurrence. A smaller-scale British study similarly divided heart-attack-prone people into control and lifestyle modification groups (Eysenck & Grossarth-Maticek, 1991). During the next 13 years, that study also showed a 50 percent reduction in death rate among people trained to alter their thinking and lifestyle. After suffering a heart attack at age 55, Friedman started taking his own behavioral medicine—and lived to age 90 (Wargo, 2007).

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Time may heal all wounds, but relaxation can help speed that process. In one study, surgery patients were randomly assigned to two groups. Both groups received standard treatment, but the second group also experienced a 45-minute relaxation exercise and received relaxation recordings to use before and after surgery. A week after surgery, patients in the relaxation group reported lower stress and showed better wound healing (Broadbent el al., 2012).

Meditation is a modern practice with a long history. In many of the world’s great religions, meditation has been used to reduce suffering and improve awareness, insight, and compassion. Numerous studies have confirmed the psychological benefits of meditation (Goyal et al., 2014; Sedlmeier et al., 2012). Today, it has found a new home in stress management programs, such as mindfulness meditation. If you were taught this practice, you would relax and silently attend to your inner state, without judging it (Kabat-Zinn, 2001). You would sit down, close your eyes, and mentally scan your body from head to toe. Zooming your focus on certain body parts and responses, you would remain aware and accepting. You would also pay attention to your breathing, attending to each breath as if it were a material object.

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Practicing mindfulness may improve many health measures. In one study of 1140 people, some received mindfulness-based therapy for several weeks. Others did not. Levels of anxiety and depression were lower among those who received the therapy (Hofmann et al., 2010). In another study, mindfulness training improved immune system functioning and coping in a group of women newly diagnosed with early-stage breast cancer (Witek-Janusek et al., 2008). Mindfulness practices have also been linked with reductions in sleep problems, cigarette use, binge eating, and alcohol and other substance use disorders (Bowen et al., 2006; Brewer et al., 2011; Cincotta et al., 2011; de Dios et al., 2012; Kristeller et al., 2006). Just 15 minutes of daily mindfulness meditation is enough to improve decision-making performance (Hafenbrack et al., 2014).

So, what’s going on in the brain as we practice mindfulness? Correlational and experimental studies offer three explanations. Mindfulness

Exercise and meditation are not the only routes to healthy relaxation. Massage helps relax both premature infants and those suffering pain. An analysis of 17 experiments revealed another benefit: Massage therapy relaxes muscles and helps reduce depression (Hou et al., 2010).

41-8 What is the faith factor, and what are some possible explanations for the link between faith and health?

A wealth of studies—some 1800 of them in the twenty-first century’s first decade alone—has revealed another curious correlation, called the faith factor (Koenig et al., 2011). Religiously active people tend to live longer than those who are not religiously active. One such study compared the death rates for 3900 people living in two Israeli communities. The first community contained 11 religiously orthodox collective settlements; the second contained 11 matched, nonreligious collective settlements (Kark et al., 1996). Over a 16-year period, “belonging to a religious collective was associated with a strong protective effect” not explained by age or economic differences. In every age group, religious community members were about half as likely to have died as were their nonreligious counterparts. This difference is roughly comparable to the gender difference in mortality.

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How should we interpret such findings? Correlations are not cause-effect statements, and they leave many factors uncontrolled (Sloan et al., 1999, 2000, 2002, 2005). Here is another possible interpretation: Women are more religiously active than men, and women outlive men. Might religious involvement merely reflect this gender-longevity link? Apparently not. One 8-year National Institutes of Health study followed 92,395 women, ages 50 to 79. After controlling for many factors, researchers found that women attending religious services weekly (or more) experienced an approximately 20 percent reduced risk of death during the study period (Schnall et al., 2010). Moreover, the association between religious involvement and life expectancy is also found among men (Benjamins et al., 2010; McCullough et al., 2000, 2005, 2009). A 28-year study that followed 5286 Californians found that, after controlling for age, gender, ethnicity, and education, frequent religious attenders were 36 percent less likely to have died in any year (FIGURE 41.5). In another 8-year controlled study of more than 20,000 people (Hummer et al., 1999), this effect translated into a life expectancy at age 20 of 83 years for frequent attenders at religious services and 75 years for nonattendees.

These correlational findings do not indicate that nonattenders can suddenly add 8 years to their life if they start attending services and change nothing. Nevertheless, the findings do indicate that religious involvement, like nonsmoking and exercise, is a predictor of health and longevity. Can you imagine what intervening variables might account for the correlation? Research points to three possible sets of influences (FIGURE 41.6):

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