Having a sense of control, nurturing an optimistic outlook, building our social support, and finding meaning can help us experience less stress and thus improve our health. What do we do when we cannot avoid stress? At such times, we need to manage our stress. Aerobic exercise, relaxation, meditation, and active spiritual engagement may help us gather inner strength and lessen stress effects.

It’s hard to find a medicine that works for most people most of the time. But aerobic exercise—sustained activity that increases heart and lung fitness—is one of these rare near-perfect “medicines.” Estimates vary, but moderate exercise adds to your quantity of life—two additional years, on average—as well as to your quality of life, with more energy, better mood, and stronger relationships (Flueckiger et al., 2016; Hogan et al., 2015; Seligman, 1994; Wang et al., 2011).

Throughout this book, we have revisited one of psychology’s basic themes: Heredity and environment interact. Physical activity can weaken the influence of genetic risk factors for obesity. In one analysis of 45 studies, that risk fell by 27 percent (Kilpeläinen et al., 2012). Exercise also helps fight heart disease. It strengthens your heart, increases bloodflow, keeps blood vessels open, lowers overall blood pressure, and reduces the hormone and 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).

Many studies suggest that aerobic exercise reduces stress, depression, and anxiety. People who exercise at least 30 minutes, three times a week manage stressful situations better, have more self-confidence and energy, and feel less depressed and anxious than their inactive peers (Rebar et al., 2015; Smits et al., 2011). In one study of over 650,000 American adults, walking 150 minutes per week predicted living seven more years (Moore et al., 2012). Going from active exerciser to couch potato can increase risk for depression—by 51 percent in two years for the women in one study (Wang et al., 2011). But we could state these observations another way: Stressed and depressed people exercise less. It’s that old correlation problem again—cause and effect are not clear.

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To sort out cause and effect, researchers experiment. They randomly assign people either to an aerobic exercise group or to a control group. Next, they measure whether aerobic exercise (compared with a control activity that doesn’t involve exercise) produces a change in stress, depression, anxiety, or some other health-related outcome. In one such experiment (McCann & Holmes, 1984), researchers randomly assigned mildly depressed female college students to one of three groups:

As FIGURE 10.7 shows, 10 weeks later the women in the aerobic exercise program reported the greatest decrease in depression. Many of them had, quite literally, run away from their troubles.

Another experiment randomly assigned depressed people to an exercise group, an antidepressant group, or a placebo pill group. Again, exercise diminished depression levels. And it did so as effectively as antidepressants, with longer-lasting effects (Hoffman et al., 2011). Aerobic exercise counteracts depression in two ways. First, it increases arousal. Second, it does naturally what some prescription drugs do chemically: It increases the brain’s serotonin activity.

More than 150 other studies have confirmed that exercise reduces depression and anxiety. What is more, toned muscles filter out depression-causing toxins (Agudelo et al., 2014). Aerobic exercise has therefore taken a place, along with antidepressant drugs and psychotherapy, on the list of effective treatments for depression and anxiety (Arent et al., 2000; Berger & Motl, 2000; Dunn et al., 2005).

Sit with your back straight, getting as comfortable as you can. Breathe a deep, single breath of air through your nose. Now exhale that air through your mouth as slowly as you can. As you exhale, repeat a focus word, phrase, or prayer—something from your own belief system. Do this five times. Do you feel more relaxed?

Why Relaxation Is Good

Like aerobic exercise, relaxation can improve our well-being. Did you notice in FIGURE 10.7 that women in the relaxation treatment group also experienced reduced depression? More than 60 studies have found that relaxation procedures can also provide relief from headaches, high blood pressure, anxiety, and insomnia (Nestoriuc et al., 2008; Stetter & Kupper, 2002).

Researchers have even used relaxation to help Type A heart attack survivors reduce their risk of future attacks (Friedman & Ulmer, 1984). They randomly assigned hundreds of these 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 lifestyle. 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 spectacularly (FIGURE 10.8). During the next three years, the lifestyle modification group had half as many repeat heart attacks as did the first group. A British study supported this finding. Lifestyle modification cut the risk of heart attack in half over 13 years for heart-attack-prone people (Eysenck & Grossarth-Maticek, 1991).

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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 second group reported lower stress and showed better wound healing (Broadbent el al., 2012).

Learning to Reflect and Accept

Meditation is a modern practice with a long history in a variety of world religions. Meditation was originally used to reduce suffering and improve awareness, insight, and compassion. Numerous studies have confirmed the psychological benefits of meditation (Goyal et al., 2014; Rosenberg et al., 2015; Sedlmeier et al., 2012), including mindfulness meditation, which has today found a new home in stress management programs. 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 in 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.

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 abuse (Bowen et al., 2006; Brewer et al., 2011; Cincotta et al., 2011; de Dios et al., 2012; Kristeller et al., 2006).

So, what’s going on in the brain as we practice mindfulness? Correlational and experimental studies offer three explanations for how mindfulness helps us make positive changes:

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Exercise and meditation are not the only routes to healthy relaxation. Massage helps relax both premature infants (Chapter 3) and those suffering pain (Chapter 5), and it also helps reduce depression (Hou et al., 2010).

A wealth of studies has revealed another curious correlation, called the faith factor (Koenig et al., 2012). Religiously active people tend to live longer than those who are not religiously active. In one 16-year study, researchers tracked 3900 Israelis living in one of two groups of communities (Kark et al., 1996). The first group contained 11 religiously orthodox collective settlements. The second group contained 11 matched, nonreligious collective settlements. The researchers found that “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 those in the nonreligious community.

How should we interpret such findings? Remember that correlation does not mean causation. What other factors might explain these protective effects? Here’s one possibility: Women are more religiously active than men, and women outlive men. Does religious involvement reflect this gender-longevity link? No. Although the spirituality-longevity correlation is stronger among women, it also appears among men (McCullough et al., 2000; McCullough & Laurenceau, 2005). In study after study—some lasting 28 years, and some studying more than 20,000 people—the faith factor holds (Chida et al., 2009; Hummer et al., 1999; Schnall et al., 2010). And it holds after researchers control for age, sex, race, ethnicity, education, and region. In one study, this effect translated into a life expectancy of 83 years for those who regularly attended religious services, and only 75 years for nonattenders (FIGURE 10.9).

Does this mean that nonattenders who start attending services and change nothing else will live longer? Again, the answer is No. But we can say that religious involvement predicts health and longevity, just as nonsmoking and exercise do. Religiously active people have demonstrated healthier immune functioning, fewer hospital admissions, and, for people with AIDS, fewer stress hormones and longer survival (Ironson et al., 2002; Koenig & Larson, 1998; Lutgendorf et al., 2004).

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Can you imagine why religiously active people might be healthier and live longer than others? Here are three factors that help explain the correlation:

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Let’s summarize what we’ve learned so far: Sustained emotional reactions to stressful events can be damaging. However, some qualities and influences can help us cope with life’s challenges by making us emotionally and physically stronger. These include a sense of control, an optimistic outlook, relaxation, healthy habits, social support, a sense of meaning, and spirituality (FIGURE 10.11).

In the remainder of this chapter, we’ll take a closer look at our pursuit of happiness and how it relates to our human flourishing.