Physical fitness: A pathway to health and resilience
Abstract
Various groups representing a number of different perspectives (for example, operational, architectural, community, institutional, and individual resilience) use the term resilience. We define resilience as the ability to withstand, recover, and grow in the face of stressors and changing demands. Physical fitness is one pathway toward resilience because it is associated with many traits and attributes required for resilience. In addition, physical fitness confers resilience because regular exercise and/or physical activity induces positive physiologic and psychological benefits, protects against the potential consequences of stressful events, and prevents many chronic diseases. This article presents a brief historical overview of the health-promoting effects of exercise and physical activity, followed by a discussion on the concept of hardiness and mental toughness and how they relate to resilience and physical fitness; how physical fitness promotes resilience; the clinical implications of a sedentary lifestyle; and the relevance of physical fitness and resilience to Army Medicine's Performance Triad.
24 http://www.cs.amedd.army.mil/amedd_journal.aspx
…physical tness is not only one of the most impor-
tant keys to a healthy body; it is the basis of dynamic
and creative intellectual activity.
President-Elect John F. Kennedy1
Various groups representing a number of different per-
spectives (for example, operational, architectural, com-
munity, institutional, and individual resilience) have
defi ned the term resilience. For the purposes of this
article, we defi ne resilience as the ability to withstand,
recover, and grow in the face of stressors and changing
demands.2
In recent reviews and papers on resilience, one factor
that continues to appear as promoting and/or conferring
resilience is physical fi tness3,4 and regular physical ac-
tivity.5-7 Thus, we focus on the role of physical fi tness
in overall individual resilience. The benefi t of physical
fi tness on resilience is in part based on the recognition
that physical fi tness, achieved through physical activity
and/or regular exercise, can induce positive physiologic
and psychological benefi ts, protect against the poten-
tial consequences of stressful events, and prevent many
chronic diseases.8-11 After a brief historical overview of
the health-promoting effects of exercise and physical ac-
tivity, the following topics are discussed: the concept of
hardiness and mental toughness and how they relate to
resilience and physical fi tness; how physical fi tness pro-
motes resilience; the clinical implications of a sedentary
lifestyle; and the relevance of physical fi tness and resil-
ience to Army Medicine’s Performance Triad. Through-
out this article, the terms physical activity and exercise
are used interchangeably, depending on the literature,
recognizing that exercise represents a planned, struc-
tured, and regular form of physical activity.
HISTORICAL OVERVIEW
The quest for physical fi tness has been unremitting, how-
ever, its importance and application have changed and /
or transitioned over time with both high and low points.
Hunting and gathering for survival were the initial im-
petus for fi tness, which was later followed by the rec-
ognition that selected physical movements and activities
were important for developing the body and preventing
and curing diseases.12-14 In fact, the importance of reg-
ular exercise and physical activity has been touted for
over 7,000 years.12,13 In China, the philosophical teach-
ings of Confucius encouraged participation in regular
physical activity, as physical inactivity was recognized
as associated with certain diseases.12 The Chinese devel-
oped many perspectives on how to achieve and maintain
health, and they deemed exercise essential for increasing
strength, prolonging life, preventing and curing diseas-
es, and minimizing the accumulation of fat.12 Quigong,
Cong fou (later Kung Fu), and Tai-Chi were some of the
gymnastic/movement forms developed in China some-
time around 3,000 BC.12 Among the Greeks, Herodicus
(ci rca 450 BC) was the fi rst to promote physical activ-
ity, and he even considered exercise a form of medicine.
Nonetheless, Hippocrates is usually considered the fa-
ther of exercise and medicine.13 These 2 Greeks were fol-
lowed by Galen (129-210 AD)15 who was perhaps the most
advanced, as he wrote not only about when to exercise,
but he also described various types of exercises, identi-
fi ed qualities of exercise, specifi c places to exercise, and
factors to think about prior to exercise.13 Although the
Physical Fitness:
A Pathway to Health and Resilience
Patricia A. Deuster, PhD, MPH
Marni N. Silverman, PhD
ABSTRACT
Various groups representing a number of different perspectives (for example, operational, architectural, com-
munity, institutional, and individual resilience) use the term resilience. We defi ne resilience as the ability to
withstand, recover, and grow in the face of stressors and changing demands. Physical fi tness is one pathway
toward resilience because it is associated with many traits and attributes required for resilience. In addition,
physical fi tness confers resilience because regular exercise and/or physical activity induces positive physiologic
and psychological benefi ts, protects against the potential consequences of stressful events, and prevents many
chronic diseases. This article presents a brief historical overview of the health-promoting effects of exercise
and physical activity, followed by a discussion on the concept of hardiness and mental toughness and how they
relate to resilience and physical fi tness; how physical fi tness promotes resilience; the clinical implications of a
sedentary lifestyle; and the relevance of physical fi tness and resilience to Army Medicine’s Performance Triad.
October – December 2013 25
importance of exercise and physical fi tness diminished
during various periods of time, such as after the fall of
the Roman empire when the church became the domi-
nant infl uence,16 during the period of industrialization,12
and notably during the 1920s (often called the Roaring
Twe nt ie s) wh e n r el a xa tio n a nd en jo ym en t we re ke y.12
However, the importance of exercise remains widely
recognized. It is interesting to refl ect on the comment of
Edward Stanley, the 15th Earl of Derby, who stated in an
address at Liverpool College on December 20, 1873 that:
Those who think they have not time for bodily exercise
will sooner or later have to fi nd time for illness.14
It is discouraging to realize we have made little progress
over the centuries.
PERSONALITY TRAITS/ATTRIBUTES ASSOCIATED
WITH RESILIENCE
Although the term resilience, as it is used today, emerged
from work on children living under conditions of depri-
vation,17-20 it is now applied to diverse disciplines5-7 and
populations.21-24 Identifying how and why some indi-
viduals are seemingly able to bear up, and sometimes
thrive, under adverse conditions with no observable neg-
ative physical or psychological outcomes, is a continu-
ous quest.5-7,25-33 Personality traits associated with resil-
ience include hardiness and mental toughness.9,3 4- 46 The
term hardiness, as considered by Kobasa et al,34,37-43 was
typifi ed by “interrelated orientations of commitment (vs
alienation), control (vs powerlessness), and challenge
(vs threat).”41 This original characterization was later
refi ned by Maddi,11 who proposed that hardiness is an
attitude (or set of attitudes) and personality trait that
helps an individual restructure stressors into growth op-
portunities rather than allowing them to be or become
catastrophes.
Bartone et al47,48 developed the dispositional hardiness
scale to assess hardiness, and this scale has been used in
a number of studies to relate hardiness characteristics in
persons exposed to challenging occupations and experi-
ences.45,49-52 Bonanno 53 noted that hardiness is one of the
pathways to resilience. Crust et al36 developed the model
of mental toughness by applying the traits of hardiness
to refl ect the unique demands of sports and exercise; the
trait of confi dence was added to control, commitment,
and challenge.35,36,4 4,4 6,5 4,55 As noted by Crust et al36:
Mentally tough individuals are considered to be com-
petitive, resilient to errors or stress, and have high self-
confi dence and low anxiety.
The literature clearly shows that both hardiness and
mental toughness are highly related to resilience.28,56 -58
In addition to the personality traits of hardiness and
mental toughness, other psychological attributes and
social-cognitive variables have been associated with
resilience, including self-esteem, self-effi cacy and mo-
tivation.20,21,59-62 How do these closely associated traits or
attributes relate to physical fi tness and physical activity?
PERSONALITY TRAITS/ATTRIBUTES ASSOCIATED
WITH PHYSICAL FITNESS
Interestingly, regular physical activity and aerobic fi t-
ness have been shown to be associated with specifi c
personality traits and psychological attributes63 -72 asso-
ciated with resilience. For example, anxiety and depres-
sion are inversely related to maximal aerobic capacity, a
primary indicator of physical fi tness.73,74 Moreover, our
unpublished data show a signifi cant positive association
between aerobic capacity and hardiness (r=0.24), and an
inverse relation with perceived stress (r=-0.26) and trait
anxiety (r=-0.17). Of note, Skirka et al10 reported sig-
nifi cantly higher hardiness scores, less perceived stress,
and fewer psychological symptoms in varsity college
athletes than college nonathletes, which further supports
a strong association between regular exercise, aerobic
fi tness, and hardiness. Furthermore, mental toughness,
the personality trait associated with athletes and athletic
competition, has been shown to mitigate the relationship
between high stress and depressive symptoms.57
Two determinants of physical activity, self-esteem and
self-effi cacy, be they enduring traits or modifi able attri-
butes, are essential for resilience.65,66 ,75 Self-effi cacy gen-
erally refl ects how self-confi dent a person is with regard
to undertaking a particular action under challenging
situations,67,72,76,77 and self-esteem signifi es ones sense
of self-worth or personal value.68 Multiple studies have
shown that children and young adults who participate in
regular exercise score higher on measures of self-esteem
and self-effi cacy67,70-72,76,78-80 and competitiveness81 com-
pared to sedentary, untrained controls. Moreover, these
two attributes are improved through regular physical
activity.69,72 Netz et al72 conducted a meta-analysis of 36
studies examining how physical activity interventions
affected well-being in healthy adults. Moderate intensi-
ty aerobic exercise was shown to be most benefi cial and
had a strong effect on self-effi cacy, in addition to con-
ferring improvements in aerobic capacity and strength.
Ekeland et al69 likewise conducted a systematic review
of 12 studies to assess how exercise affected self-esteem
in children and young people. They concluded that ex-
ercise has positive short-term effects on self-esteem and
that it might be an important strategy for improving self-
esteem. Interestingly, one hypothesis as to how physical
activity enhances self-effi cacy and self-esteem is that it
requires the application of self-management strategies
(eg, thoughts, goals, plans, and acts) to achieve a goal.76
26 http://www.cs.amedd.army.mil/amedd_journal.aspx
Self-management strategies require commitment, con-
trol, and motivation, and although each strategy is im-
portant, motivation appears to be key in terms of regular
physical activity.70,78,82-85 Research has shown that mo-
tivation is very important with regard to commencing
and maintaining participation in regular physical exer-
cise.76, 84 According to the literature, motivation is some
force or stimulus that leads an individual to undertake
a particular task or activity in which they have a spe-
cifi c objective or derive personal meaning.78,82,83 Over-
all, these studies strongly suggest that personality traits
(hardiness and mental toughness) and other attributes
(self-esteem, self-effi cacy, motivation, self-manage-
ment strategies) may contribute to the buffering effect
of physical fi tness and how fi tness confers resilience.
Further, one must be motivated to be committed, and
possess self-effi cacy and self-esteem to accept a chal-
lenge. Clearly, strong relationships exist between and
among hardiness or mental toughness, self-effi cacy,
self-esteem, and motivation; all essential resources for
resilience, and all associated with physical fi tness.
PHYSICAL FITNESS AND STRESS RESILIENCE
That physical fi tness is essential for health and well-being
is not in question, as noted in the earlier historical over-
view. However, scientifi c data documenting the essenti-
ality of physical activity for health did not emerge until
the late 1800s and early 1900s when epidemiological
studies demonstrated that sedentary persons were more
likely to have coronary heart disease than those who led
active lifestyles.16,86 -9 0 Since those fi rst studies, the litera-
ture has become replete with evidence that physical fi t-
ness and regular exercise confer resilience and serve as a
resistance resource in a variety of ways, including blunt-
ing stress reactivity in response to both physical and psy-
chosocial stressors, conferring multiple physiologic and
psychological benefi ts, serving as a buffer against stress,
and protecting against stress-related disorders and many
chronic illnesses.57,74,78,91-95 A conceptual model of the
personality traits and attributes associated with physical
fi tness and resilience is presented in the Figure.
Physical Fitness Blunts Stress Reactivity in Response
to Both Physical and Psychosocial Stressors:
Physiologic and Psychological Benefits
The 2 main neuroendocrine/neural systems that medi-
ate the stress response are the hypothalamic-pituitary-
adrenal axis, with the resultant release of cortisol, and
the sympathetic nervous system, which releases the cat-
echolamines epinephrine (adrenaline) and norepineph-
rine. Activation of these stress systems mediates the
fi ght or fl ight response, which entails the rapid mobi-
lization of energy from storage sites to critical muscles
and the brain (getting one ready for action, increasing
alertness/arousal). Moreover, increased heart rate, blood
pressure, and breathing rate facilitate the rapid transport
of nutrients and oxygen to relevant parts of the body. To-
gether, these stress systems orchestrate the physiologic
and behavioral adaptations to stress. However, chronic
activation can lead to dysregulation of multiple physi-
ologic and behavioral systems, leading to maladaptive
stress responses, including anxiety and depression.96,97
Physical fi tness and aerobic fi tness have been related to
a reduction in stress reactivity, physiologically and psy-
chologically, for both physical and mental/psychosocial
stress.65,98-107
Interestingly, neuroendocrine and physiologic responses
to exercise at the same absolute workload are signifi -
cantly lower in physically fi t than unfi t persons.10 8-111 Ad-
ditionally, physically active people show reduced sym-
pathoadrenal reactivity to physical stressors.109,110 When
untrained persons are enrolled in a regular exercise pro-
gram for 8-12 weeks, their response to the same physical
stress prior to beginning exercise training is signifi cant-
ly higher than after the training.112 Thus, when trained
and untrained persons have to work at the same rate,
the untrained person will experience signifi cantly more
stress than someone who is physically fi t and aerobically
trained.108 -110 Therefore, the higher the level of aerobic
fi tness, the greater the ability to tolerate high workloads
and be minimally stressed by low ones.
Physical training also appears to confer protection
against nonphysical stressors, mental and/or psycholog-
ical.98,111,113,114 Rimelle et al115 documented signifi cantly
lower cortisol and heart rate responses to psychosocial
PHYSICAL FITNESS: A PATHWAY TO HEALTH AND RESILIENCE
A conceptual model of the personality traits and attributes as-
sociated with physical fi tness and resilience and how physical
fi tness confers resilience. Physical fi tness confers resilience be -
cause regular exercise/physical activity can protect against the
potential consequences of stressful events and prevent many
chronic and stress-related diseases/disorders.
CVD indicates cardiovascular disease.
Sedentary
Low self-esteem
Low self-effi cacy
Anxious
Depressed
Lethargic
Unsure/uncertain
Timid
Physically Unfi t
(Aerobically unfi t /fat)
Vulnerable
Physically Fit
(Aerobically fi t /lean)
Resilient
Physically active
High self-esteem
High self-effi cacy
Motivated
Hardy/mentally
tough
Committed
Confi dent
Chronic/Stress-related Disorders
anxiety, depression, cognitive
dysfunction, pain and fatigue disorders,
sleep disorders, obesity, CVD, metabolic
syndrome, type 2 diabetes, osteoporosis,
autoimmune disease, cancer
Physical/Mental
Resilience
(-)
(-)
(-)
October – December 2013 27
THE ARMY MEDICAL DEPARTMENT JOURNAL
stress in trained men compared to untrained men. More-
over, signifi cantly greater calmness and better mood,
and a trend toward lower state anxiety were noted in
the trained relative to untrained men. In addition, oth-
ers have noted blunted cortisol responses115 and reduced
cardiovascular responses98 ,99,115 to psychological labora-
tory stressors in physically active as compared to less
active persons. Webb et al111 administered a dual chal-
lenge of physical and mental stress and noted that low-
fi t participants had greater cortisol responses compared
to high-fi t individuals. Importantly, in a meta-review of
34 studies, Crews et al99 reported that aerobically fi t in-
dividuals had reduced responses to psychosocial stress
in comparison to controls. These fi ndings are consistent
with those from the Aerobics Center Longitudinal Study,
which found a signifi cant inverse dose-response rela-
tionship between aerobic fi tness and depressive symp-
tomatology and a positive association between fi tness
and emotional well-being.116
In addition to cross-sectional studies, longitudinal stud-
ies have demonstrated positive effects of exercise train-
ing and regular physical activity, and negative effects
of exercise withdrawal on mood and depressive symp-
toms.68,117-121 Nabkasorn et al117 studied adolescent fe-
males with depressive symptoms and noted signifi cant
decreases in total depressive score, as well as in 24-hour
urinary cortisol and epinephrine excretion, following 8
weeks of physical training (jogging). Importantly, stud-
ies by Berlin et al118 and Weinstein et al121 demonstrated
that when someone who exercises regularly is forced
to withdraw from exercise for 2 weeks, negative mood
increases signifi cantly and correlates with decreases in
fi tness.118,121 In addition, a reduction in parasympathetic
nervous system activity, as measured by heart rate vari-
ability, predicted the development of negative mood after
deprivation of exercise.121 These fi ndings are relevant to
understanding both short-term exercise withdrawal and
exercise initiation, and how they affect overall stress re-
silience and reactivity.
Despite the multiple positive fi ndings, not all are consis-
tent,65,122,123 particularly with regard to catecholamine re-
lease, with both blunted and augmented responses noted
in high- versus low-fi t persons.112,12 3 Along those same
lines, de Geus et al 65 were unable to detect changes in
psychological make-up (for example, personality traits
of neuroticism, introversion, hostility, anger expression)
or acute neurophysiologic reactivity (for example, heart
rate, blood pressure, urinary catecholamine excretion,
or cardiac beta-adrenergic drive) after 4 and 8 months of
training. Thus, although the majority of studies support
positive effects of regular exercise and aerobic fi tness,
not all studies are consistent.
Physical Fitness Serves as a Buffer against Stress and
Stress-Related Disorders
Physical activity may provide a protective effect against
stress-related disorders, as physically fi t persons appear
to be less susceptible to life stressors, in particular with
regard to illnesses: physical fi tness may serve as a buffer
against stress,63,124,125 with stress being highly associated
with various illnesses.20,34,73,124,126,127 A comprehensive re-
view of the literature from 1982 to 2008 in which exer-
cise was examined as a stress-buffer concluded that the
majority of studies, both cross-sectional and prospective,
found exercise to be an effective buffer, but the amount
and type of exercise necessary for protection were not
stated.93 The concept of stress buffering was fi rst pro-
posed by Kobasa et al,34 and later by others9,11 who clearly
showed that regular exercise and hardiness interact to de-
crease illness in the face of serious life stressors.34 Persons
who scored high in hardiness and participated in regular
exercise were usually more healthy than those high only
in hardiness or exercise alone.34 Collectively, the data
suggest that participation in leisure physical activity is
important to the stress-buffering effect of exercise.128
Physical fi tness and regular exercise also appear to buf-
fer against depression 63,68,125,129-134 and anxiety.100,12 5,134 -136
In fact, the benefi cial effects of physical activity on posi-
tive mood are well recognized.83,137 Rethorst et al131 con-
ducted a meta-analysis of all studies investigating the
effects of exercise on depression, and 12 of 16 exercise
treatment groups with clinically depressed patients were
classifi ed as “recovered” or “improved” after the treat-
ment. Similarly, a number of prospective studies have
demonstrated reductions in state anxiety.129,138 Man-
ger et al129 had persons diagnosed with posttraumatic
stress disorder (PTSD) undergo a 12-session aerobic
exercise program and showed signifi cant reductions in
PTSD, anxiety, and depression following the interven-
tion. Moreover, these positive results were stable over 1
month of follow-up.129 Finally, Wipfl i et al135 conducted
a meta-analysis (based on 49 randomized, controlled
trials) examining the effects of exercise on anxiety,
and demonstrated clear reductions in anxiety among
those who exercised compared to the respective control
groups. Of interest was their fi nding that exercise was
more effective in reducing anxiety relative to other anx-
iety-reducing treatments.135
CLINICAL IMPLICATIONS OF A SEDENTARY LIFESTYLE
The short- and long-term consequences of low physical
fi tness and a sedentary lifestyle are clear. Physical inac-
tivity serves a major role in the rising prevalence of obe-
sity, cardiovascular disease (CVD), hypertension, type II
diabetes mellitus (T2DM), metabolic syndrome, insulin
resistance, hyperlipidemia, and breast and colon cancers,
28 http://www.cs.amedd.army.mil/amedd_journal.aspx
to name a few.91,9 4,9 5,116,1 39,140 Of course, excess energy in-
take also contributes to obesity,78 ,94,95, but lack of physi-
cal activity is the leading contributor91,9 4, 95,116 ,139,14 0 and
also the fourth leading cause of death worldwide.95 In
contrast to a sedentary lifestyle, high aerobic fi tness is
inversely related to obesity, metabolic syndrome, CVD,
hypertension, and T2DM.74,141-145
In addition to the major chronic diseases mentioned
above, low aerobic fi tness has been associated with fi bro-
myalgia (FM),146, 147 c h ro n ic f at ig ue sy n d ro me (C FS ), 148,149
osteoarthritis,150 -152 rheumatoid arthritis,150,153,154 and in-
fl ammatory muscle disorders.155,156 Low aerobic fi tness
is also associated with elevations in serum C-reactive
protein (CRP), a well-known marker of infl ammation.
Many studies have shown that maximal aerobic capacity
is inversely related to CRP,142,157 and that exercise inter-
ventions, both aerobic and resistance in nature, reduce
levels of CRP.157-159 However, not all studies showed a
signifi cant effect.160-162 A meta-analytic study by Kelley
et al16 2 of 5 randomized controlled trials reported an ap-
proximately 3% reduction in CRP levels across the ex-
ercise groups, which was not signifi cant. However, the
studies that were negative found other positive benefi ts
of exercise, regardless of its effect on CRP.
With regard to FM, exercise as an intervention has been
shown to be benefi cial, particularly in relation to pain
management. Ellingson et al147 conducted a prospective
study and emphasized how a sedentary lifestyle was like-
ly deleterious for pain regulation in FM. Likewise, Cur-
tis et al16 3 conducted a study wherein women with FM
who engaged in a 75-minute yoga class twice weekly for
8 weeks reported reduced pain and catastrophizing, and
increased acceptance of pain. Chronic fatigue syndrome
is another debilitating disorder characterized by mini-
mal physical activity during daily life and lower muscle
strength and aerobic capacity compared to healthy sed-
entary subjects.149,154 As with FM, when persons with
CFS are entered into a regular exercise program, signifi -
cant benefi ts in terms of physical capacity, quality of life,
fatigue severity, and depressive symptomatology are
reported.164,16 5 Interestingly, Heins et al166 reported that
physical activity is intentionally limited in CFS patients,
possibly because they expect negative bodily symptoms
and catastrophize in such a way as to negatively affect
their performance. This underscores the importance of
the exercise-derived resilience resources self-effi cacy,
self-esteem, and motivation, which, unfortunately, were
not measured in the above studies.
Overall, the clinical implications of a sedentary, physi-
cally inactive lifestyle are profound, and the literature
clearly demonstrates that having a valid measure of
physical fi tness, in particular aerobic fi tness, may be
one of the best indicators of resilience, as well as long-
term health and risk of chronic diseases. Most of the
above mentioned chronic diseases/disorders are also as-
sociated with depression, anxiety, low self-effi cacy, and
other barriers to critical resilience resources. Promoting
regular physical activity in these populations has been
shown to exert profound benefi cial changes, and should
be the key intervention for all such populations who are
able to engage in regular physical activity.
LIMITATIONS AND FUTURE DIRECTIONS
Limitations of studies examining how physical fi tness
contributes to resilience must be acknowledged. First,
many studies examining reactivity to both physical
and psychosocial stress did not quantify aerobic fi tness
or regular physical activity. This is essential for being
able to accurately interpret the results, as they may be
important confounders. Secondly, the intimate rela-
tion between hardiness/mental toughness, and aerobic
capacity/physical activity must be further evaluated to
document their interrelationship. Certainly, the mental
toughness model was specifi cally developed for athletes
who are physically fi t and have self-confi dence, so one
would expect them to have many resilience resources.
However, what happens when they become injured? In
addition, many people with chronic diseases are able to
cope and are physically unfi t (they may be unable to en-
gage in regular exercise), so physical fi tness is important,
but not an absolute.23,24
CONCLUSIONS
Physical fi tness is associated with many traits and attri-
butes required for resilience. As such, it is one pathway
toward resilience. Promoting physical fi tness as a path-
way to resilience is based on solid, scientifi c evidence
as noted in many ancient and current sources showing
that physical fi tness blunts stress reactivity, confers
physiologic and psychological benefi ts, serves as a buf-
fer against stress, and can protect against stress-related
disorders and chronic illness. Perhaps the role of physical
fi tness as a pathway to resilience was most eloquently
stated by then President-Elect John F. Kennedy in 1960
when he said:
…physical fi tness is not only one of the most important
keys to a healthy body; it is the basis of dynamic and
creative intellectual activity. …intelligence and skill can
only function at the peak of their capacity when the body
is healthy and strong; hardy spirits and tough minds usu-
ally inhabit sound bodies.1
RELEVANCE TO THE PERFORMANCE TRIAD
Physical activity is a key component of the Performance
Triad and is clearly essential to optimal performance.
PHYSICAL FITNESS: A PATHWAY TO HEALTH AND RESILIENCE
October – December 2013 29
THE ARMY MEDICAL DEPARTMENT JOURNAL
However, physical activity in the absence of adequate
fueling (ie, healthy dietary patterns, appropriate timing
and types of nutrients) and an adequate quantity and
quality of sleep and recovery is not the solution. Ex-
cessive activity can lead to overtraining, musculoskel-
etal injuries, and similar problems. Only when physical
activity is balanced with a healthy diet and restorative
sleep will the benefi ts described above be realized.
ACKNOWLEDGMENTS
This research was supported by a grant from
Comprehensive Soldier and Family Fitness (CSF2;
HT9404-12-1-0017; F191GJ).
We appreciate the support in preparation and review of
this article by LTC Sharon A. McBride, MS, USA.
REFERENCES
1. Kennedy JF. The soft American. Sports Illus-
trated. 1960;13(26):14-17. Available at: http://
sportsillustrated.cnn.com/vault/article/magazine/
MAG1134750/2/. Accessed August 15, 2013.
2. CJCS Instruction 3405.01: Chairman’s Total Force
Fitness Framework. Washington, DC: Offi ce of the
Chairman, Joint Chiefs of Staff; 2011. Available at:
http://www.dtic.mil/cjcs_directives/cdata/unlim
it/3405_01.pdf. Accessed July 24, 2013.
3. Baker DG, Nash WP, Litz BT, et al. Predictors of
risk and resilience for posttraumatic stress disor-
der among ground combat Marines: methods of
the Marine Resiliency Study. Prev Chronic Dis.
2012;9:E97.
4. Meredith LS, Sherbourne CD, Gaillot S, et al. Psy-
chological Resilience in the U.S. Military. Santa
Monica, CA 90407-2138: Rand Corporation;2011.
5. Perna L, Mielck A, Lacruz ME , et al. Socioeco -
nomic position, resilience, and health behav-
iour among elderly people. Int J Public Health.
2012;57(2):341-349.
6. Skrove M, Romundstad P, Indredavik MS. Resil-
ience, lifestyle and symptoms of anxiety and de-
pression in adolescence: the Young-HUNT study.
Soc Psychiatry and Psychiatr Epidemiol. 8 2012.
7. Wells M, Avers D, Brooks G. Resilience, physical
performance measures, and self-perceived physical
and mental health in older Catholic nuns. J Geriatr
Physical Ther. Jul-2012;35(3):126-131.
8. Acevedo EO, Webb HE, Weldy ML, Fabianke
EC, Orndorff GR, Starks MA. Cardiorespiratory
responses of Hi Fit and Low Fit subjects to men-
tal challenge during exercise. Int J Sports Med.
2006;27(12):1013-1022.
9. Roth DL, Wiebe DJ, Fillingim RB, Shay KA. Life
events, fi tness, hardiness, and health: a simultane-
ous analysis of proposed stress-resistance effects. J
Pers Soc Psychol. 1989;57(1):136-142.
10. Skirka N. The relationship of hardiness, sense
of coherence, sports participation, and gender
to perceived stress and psychological symptoms
among college students. J Sports Med Phys Fitness.
2000;40(1):63-70.
11. Maddi SR. On hardiness and other pathways to re-
silience. Am Psychol. 2005;60(3):261-262; discus-
sion 265-267.
12. Dalleck LC, Kravitz L. The history of fi tness. IDEA
Health and Fitness Source. 2002;20(2):26-33.
13. Berryman JW. Exercise is medicine: a his-
torical perspective. Curr Sports Med Reports.
Jul-2010;9(4):195-201.
14. Fletcher GF. The history of exercise in the practice of
medicine. J Med Assoc Georgia. 1983;72(1):35-40.
15. Berryman JW. The tradition of the “six things non-
natural”: exercise and medicine from Hippocrates
through ante-bellum America. Exerc Sport Sci Rev.
1989;17:515-559.
16. MacAuley D. A history of physical activity, health
and medicine. J R Soc Med. 1994;87(1):32-35.
17. Herrman H, Stewart DE, Diaz-Granados N, Berger
EL, Jackson B, Yuen T. What is resilience? Can
J Psychiatry. Revue canadienne de psychiatrie.
2011;56(5):258-265.
18. Seligman ME. Building resilience. Harv Bus Rev.
2011;89(4):100-106, 138.
19. Ong AD, Bergeman CS, Boker SM. Resilience
comes of age: defi ning features in later adulthood.
J Pers. 2009;77(6):1777-1804.
20. Yi JP, Vitaliano PP, Smith RE, Yi JC, Weinger K.
The role of resilience on psychological adjustment
and physical health in patients with diabetes. Br J
Health Psychol. 2008;13(Pt 2):311-325.
21. Howe A, Smajdor A, Stockl A. Towards an under-
standing of resilience and its relevance to medical
training. Med Educ. 2012;46(4):349-356.
22. Mertens VC, Bosma H, Groffen DA, van Eijk JT.
Good friends, high income or resilience? What
matters most for elderly patients? Eur J Public
Health. 2012;22(5):666-671.
23. Robottom BJ, Gruber-Baldini AL, Anderson KE,
et al. What determines resilience in patients with
Parkinson’s disease? Parkinsonism Relat Disord.
2012;18(2):174-177.
24. West C, Stewart L, Foster K, Usher K. The mean-
ing of resilience to persons living with chronic
pain: an interpretive qualitative inquiry. J Clin
Nurs. 2012;21(9-10):1284-1292.
25. Jeffcott SA, Ibrahim JE, Cameron PA. Resilience in
healthcare and clinical handover. Qual Saf Health
Care. 2009;18(4):256-260.
30 http://www.cs.amedd.army.mil/amedd_journal.aspx
26. Levine SZ, Laufer A, Stein E, Hamama-Raz Y,
Solomon Z. Examining the relationship between
resilience and posttraumatic growth. J Trauma
Stress. 2009;22(4):282-286.
27. Mancini AD, Bonanno GA. Predictors and param-
eters of resilience to loss: toward an individual dif-
ferences model. J Pers. 2009;77(6):1805-1832.
28. Pickering MA, Hammermeister J, Ohlson C, Hol-
liday B, Ulmer G. An exploratory investigation of
relationships among mental skills and resilience in
Warrior Transition Unit cadre members. Mil Med.
2010;175(4):213-219.
29. Pickering RP, Grant BF, Chou SP, Compton WM.
Are overweight, obesity, and extreme obesity asso-
ciated with psychopathology? Results from the na-
tional epidemiologic survey on alcohol and related
conditions. J Clin Psychiatry. 2007;68(7):998-1009.
30. Pietrzak RH, Johnson DC, Goldstein MB, Mal-
ley JC, Southwick SM. Psychological resilience
and postdeployment social support protect against
traumatic stress and depressive symptoms in
soldiers returning from Operations Enduring
Freedom and Iraqi Freedom. Depress Anxiety.
2009;26(8):745-751.
31. R i- Li G, C ha se PJ, Wit kowsk i S, e t al. Obesi ty : as -
sociations with acute mountain sickness. Ann In-
tern Med. 2003;139(4):253-257.
32. Sawka MN, Young AJ, Cadarette BS, Levine L,
Pandolf KB. Infl uence of heat stress and acclima-
tion on maximal aerobic power. Eur J Appl Physiol
Occup Physiol. 1985;53(4):294-298.
33. Taliaz D, Loya A, Gersner R, Haramati S, Chen A,
Zangen A. Resilience to chronic stress is mediated
by hippocampal brain-derived neurotrophic factor.
J Neurosci. 2011;31(12):4475-4483.
34. Kobasa SC, Maddi SR, Puccetti MC. Personality
and exercise as buffers in the stress-illness relation-
ship. J Behav Med. 1982;5(4):391-404.
35. Connaughton D, Wadey R, Hanton S, Jones G. The
development and maintenance of mental tough-
ness: perceptions of elite performers. J Sports Sci.
2008;26(1):83-95.
36. Crust L, Clough PJ. Relationship between mental
toughness and physical endurance. Percept Mot
Skills. 2005;100(1):192-194.
37. Kobasa SC. Stressful life events, personality, and
health: an inquiry into hardiness. J Pers Soc Psy-
chol. 1979;37(1):1-11.
38. Kobasa SC. Personality and resistance to illness.
Am J Community Psychol. 1979;7(4):413-423.
39. Kobasa SC, Maddi SR, Courington S. Personality
and constitution as mediators in the stress-illness re-
lationship. J Health Soc Behav. 1981;22(4):368-378.
40. Kobasa SC, Maddi SR, Kahn S. Hardiness and
health: a prospective study. J Pers Soc Psychol.
1982;42(1):168-177.
41. Kobasa SC, Maddi SR, Puccetti MC, Zola MA. Ef-
fectiveness of hardiness, exercise and social sup-
port as resources against illness. J Psychosom Res.
1985;29(5):525-533.
42. Kobasa SC, Puccetti MC. Personality and social
resources in stress resistance. J Pers Soc Psychol.
1983;45(4):839 -850.
43. Kobasa SC, Spinetta JJ, Cohen J, et al. Social envi-
ronment and social support. Cancer. 1991;67(suppl
3):78 8-793.
44. Mack MG, Ragan BG. Development of the men-
tal, emotional, and bodily toughness inventory in
collegiate athletes and nonathletes. J Athl Train.
2008;43(2):125-132.
45. Ramanaiah NV, Sharpe JP, Byravan A. Hardi-
ness and major personality factors. Psychol Rep.
1999;84(2):497-500.
46. Simpson RJ, Gray SC, Florida-James GD. Physi-
ological variables and performance markers of
serving soldiers from two “elite” units of the Brit-
ish Army. J Sports Sci. 2006;24(6):597-604.
47. Bartone PT. Test-retest reliability of the disposi-
tional resilience scale-15, a brief hardiness scale.
Psychol Rep. 2007;101(3 Pt 1):943-944.
48. Bartone PT, Ursano RJ, Wright KM, Ingraham LH.
The impact of a military air disaster on the health
of assistance workers. A prospective study. J Nerv
Ment Dis. 1989;177(6):317-328.
49. Ford IW, Eklund RC, Gordon S. An examination
of psychosocial variables moderating the rela-
tionship between life stress and injury time-loss
among athletes of a high standard. J Sports Sci.
2000;18(5):301-312.
50. Funk SC. Hardiness: a review of theory and re-
search. Health Psychol. 1992;11(5):335-345.
51. Maddi SR, Harvey RH, Khoshaba DM, Lu JL,
Persico M, Brow M. The personality construct of
hardiness, III: Relationships with repression, inno-
vativeness, authoritarianism, and performance. J
Pers. 2006;74(2):575-597.
52. Britt TW, Adler AB, Bartone PT. Der iv ing benefi ts
from stressful events: the role of engagement in
meaningful work and hardiness. J Occup Health
Psychol. 2001;6(1):53-63.
53. Bonanno GA. Loss, trauma, and human resilience:
have we underestimated the human capacity to
thrive after extremely aversive events? Am Psychol.
2004;59(1):20-28.
54. Gucciardi DF. Measuring mental toughness in
sport: a psychometric examination of the psycho-
logical performance inventory-a and its predeces-
sor. J Pers Assess. 2012;94(4):393-403.
PHYSICAL FITNESS: A PATHWAY TO HEALTH AND RESILIENCE
October – December 2013 31
THE ARMY MEDICAL DEPARTMENT JOURNAL
55. Richardson M. Developing mental toughness. Nurs
Times. 2011;107(45):inside back cover.
56. Gucciardi DF, Jones MI. Beyond optimal perfor-
mance: mental toughness profi les and developmen-
tal success in adolescent cricketers. J Sport Exerc
Psychol. 2012;34(1):16-36.
57. Gerber M, Kalak N, Lemola S, et al. Are adolescents
with high mental toughness levels more resilient
against stress. Stress Health. 2013;29(2):164-171.
58. Miller L. St ress and resilience in law enforcement
training and practice. Int J Emerg Ment Health.
2008;10(2):109-124.
59. Barrow FH, Armstrong MI, Vargo A, Boothroyd
RA. Understanding the fi ndings of resilience-relat-
ed research for fostering the development of Afri-
can American adolescents. Child Adolesc Psychi-
atr Clin N Am. 2007;16(2):393-413, ix-x.
60. Richardson GE. The metatheory of resilience and
resiliency. J Clin Psychol. 2002;58(3):307-321.
61. Richardson GE, Waite PJ. Mental health promotion
through resilience and resiliency education. Int J
Emerg Ment Health. 2002;4(1):65-75.
62. Rutter M. Psychosocial resilience and pro-
tective mechanisms. Am J Orthopsychiatry.
1987;57(3):316-331.
63. Norris R, Carroll D, Cochrane R. The effects of
physical activity and exercise training on psycho-
logical stress and well-being in an adolescent popu-
lation. J Psychosom Res. 1992;36(1):55-65.
64. Rimmele U, Seiler R, Marti B, Wirtz PH, Ehlert
U, Heinrichs M. The level of physical activity af-
fects adrenal and cardiovascular reactivity to
psychosocial stress. Psychoneuroendocrinology.
2009;34(2):190-198.
65. de Geus EJ, van Doornen LJ, Orlebeke JF. Regular
exercise and aerobic fi tness in relation to psycho-
logical make-up and physiological stress reactivity.
Psychosom Med. 1993;55(4):347-363.
66. Delignières D, Marcellini A, Brisswalter J, Legros
P. Self-perception of fi tness and personality traits.
Percept Mot Skills. 1994;78(3 pt 1):843-851.
67. Dzewaltowski DA. Physical activity determinants:
a social cognitive approach. Med Sci Sports Exerc.
1994;26(11):1395-1399.
68. Scully D, Kremer J, Meade MM, Graham R,
Dudgeon K. Physical exercise and psychologi-
cal well being: a critical review. Br J Sports Med.
1998;32(2):111-120.
69. Ekeland E, Heian F, Hagen KB, Abbott J, Nord-
heim L. Exercise to improve self-esteem in chil-
dren and young people. Cochrane Database Syst
Rev [serial online]. 2004(1):CD003683.
70. Kwan BM, Bryan AD. Affective response to exer-
cise as a component of exercise motivation: Atti-
tudes, norms, self-effi cacy, and temporal stability
of intentions. Psychol Sport Exerc. 2010;11(1):71-79.
71. Craft LL, Perna FA, Freund KM, Culpepper L. Psy-
chosocial correlates of exercise in women with self-
reported depressive symptoms. J Phys Act Health.
2008;5(3):469-480.
72. Netz Y, Wu MJ, Becker BJ, Tenenbaum G. Physical
activity and psychological well-being in advanced
age: a meta-analysis of intervention studies. Psy-
chol Aging. 2005;20(2):272-284.
73. Taylor MK, Markham AE, Reis JP, et al. Physical
fi tness infl uences stress reactions to extreme mili-
tary training. Mil Med. 2008;173(8):738-742.
74. Deuster PA, Kim-Dorner SJ, Remaley AT, Poth
M. Allostatic load and health status of Afri-
can Americans and whites. Am J Health Behav.
2011;35(6):641-653.
75. McMurray I, Connolly H, Preston-Shoot M, Wig-
ley V. Constructing resilience: social workers’ un-
derstandings and practice. Health Soc Care Com-
munity. 2008;16(3):299–309.
76. Dishman RK, Motl RW, Sallis JF, et al. Self-man-
agement strategies mediate self-effi cacy and physi-
cal activity. Am J Prev Med. 2005;29(1):10-18.
77. Dishman RK, Saunders RP, Felton G, Ward
DS, Dowda M, Pate RR. Goals and intentions
mediate effi cacy beliefs and declining physi-
cal activity in high school girls. Am J Prev Med.
2006;31(6):475-483.
78. Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJ,
Martin BW. Correlates of physical activity: why
are some people physically active and others not?
Lancet. 2012;380(9838):258-271.
79. Lee LL, Arthur A, Avis M. Using self-effi cacy
theory to develop interventions that help older
people overcome psychological barriers to physi-
cal activity: a discussion paper. Int J Nurs Stud.
2008;45(11):1690-1699.
80. Magnan RE, Kwan BM, Bryan AD. Effects of cur-
rent physical activity on affective response to ex-
ercise: physical and social-cognitive mechanisms.
Psychol Health. 2013;28(4):418-433.
81. Frederick CM. Competitiveness: relations with
GPA, locus of control, sex, and athletic status. Per-
cept Mot Skills. 2000;90(2):413-414.
82. Andrè N, Dishman RK. Evidence for the construct
validity of self-motivation as a correlate of exercise
adherence in French older adults. J Aging Phys Act.
2012;20(2):231-245.
83. Anthony J. Psychologic aspects of exercise. Clin
Sports Med. 1991;10(1):171-180.
84. Dishman RK, Sallis JF, Orenstein DR. The deter-
minants of physical activity and exercise. Public
Health Rep. 1985;100(2):158-171.
32 http://www.cs.amedd.army.mil/amedd_journal.aspx
85. Motl RW, Dishman RK, Felton G, Pate RR. Self-
motivation and physical activity among black
and white adolescent girls. Med Sci Sports Exerc.
2003;35(1):128-136.
86. Morris JN, Chave SP, Adam C, Sirey C, Epstein L,
Sheehan DJ. Vigorous exercise in leisure-time and
the incidence of coronary heart-disease. Lancet.
1973;1(7799):333-339.
87. Chave SP, Morris JN, Moss S, Semmence AM.
Vigorous exercise in leisure time and the death rate:
a study of male civil servants. J Epidemiol Commu-
nity Health. 1978;32(4):239-243.
88. Morris JN, Everitt MG, Pollard R, Chave SP, Sem-
mence AM. Vigorous exercise in leisure-time:
protection against coronary heart disease. Lancet.
1980;2(8206):1207-1210.
89. Paffenbarger RS, Jr., Hyde RT. Exercise in the
prevention of coronary heart disease. Prev Med.
1984;13(1):3-22.
90. Paffenbarger RS Jr, Hyde RT, Wing AL, Hsieh
CC. Physical activity, all-cause mortality, and
longevity of college alumni. N Engl J Med.
1986;314(10):605-613.
91. Pratt M, Norris J, Lobelo F, Roux L, Wang G. The
cost of physical inactivity: moving into the 21st
century. Br J Sports Med. 2012; Nov 7 [epub].
92. Blair SN, LaMonte MJ, Nichaman MZ. The
evolution of physical activity recommenda-
tions: how much is enough? Am J Clin Nutr.
2004;79(5):913S-920S.
93. Gerber M, Puhse U. Review article: do exercise
and fi tness protect against stress-induced health
complaints? a review of the literature. Scand J Pub-
lic Health. 2009;37(8):801-819.
94. Wen CP, Wu X. Stressing harms of physi-
cal inactivity to promote exercise. Lancet.
2012;380(9838):192-193.
95. Kohl HW III, Craig CL, Lambert EV, et al. The
pandemic of physical inactivity: global action for
public health. Lancet. 2012;380(9838):294-305.
96. McEwen BS. Central effects of stress hormones in
health and disease: understanding the protective
and damaging effects of stress and stress mediators.
Eur J Pharmacol. 2008;583(2-3):174-185.
97. Chrousos GP. Stress and disorders of the stress sys-
tem. Nat Rev Endocrinol. 2009;5(7):374-381.
98. Claytor RP. Stress reactivity: hemodynamic adjust-
ments in trained and untrained humans. Med Sci
Sports Exerc. 1991;23(7):873-881.
99. Crews DJ, Landers DM. A meta-analytic review
of aerobic fi tness and reactivity to psychosocial
stressors. Med Sci Sports Exerc. 1987;19(suppl
5):S114-S120.
100. Deboer LB, Tart CD, Presnell KE, Powers MB,
Baldwin AS, Smits JA. Physical activity as a mod-
erator of the association between anxiety sensitivity
and binge eating. Eating Behav. 2012;13(3):194-201.
101. Deuster PA, Petrides JS, Singh A, Chrousos GP,
Poth M. Endocrine response to high-intensity ex-
ercise: dose-dependent effects of dexamethasone. J
Clin Endocrinol Metab. 2000;85(3):1066-1073.
102. Dienstbier RA. Behavioral correlates of sympatho-
adrenal reactivity: the toughness model. Med Sci
Sports Exerc. 1991;23(7):846-852.
103. Horowitz M, Robinson SD. Heat shock proteins
and the heat shock response during hyperthermia
and its modulation by altered physiological condi-
tions. Prog Brain Res. 2007;162:433-446.
104. Lambiase MJ, Dorn J, Chernega NJ, McCarthy TF,
Roemmich JN. Excess heart rate and systolic blood
pressure during psychological stress in relation to
metabolic demand in adolescents. Biol Psychol.
2012;91(1):42-47.
105. McEwen BS. The neurobiology and neuroendocri-
nology of stress. Implications for post-traumatic
stress disorder from a basic science perspective.
Psychiatr Clin North Am. 2002;25(2):469-494, ix.
106. Ribeiro F, Campbell CS, Mendes G, et al. Exercise
lowers blood pressure in university professors dur-
ing subsequent teaching and sleeping hours. Int J
Gen Med. 2011;4:711-716.
107. Steptoe A, Kearsley N, Walters N. Cardiovascular
activity during mental stress following vigorous
exercise in sportsmen and inactive men. Psycho-
physiology. 1993;30(3):245-252.
108. Luger A, Watschinger B, Deuster P, Svoboda T,
Clodi M, Chrousos GP. Plasma growth hormone
and prolactin responses to graded levels of acute
exercise and to a lactate infusion. Neuroendocri-
nology. 1992;56(1):112-117.
109. Luger A, Deuster PA, Kyle SB, et al. Acute hypotha-
lamic-pituitary-adrenal responses to the stress of
treadmill exercise. Physiologic adaptations to phys-
ical training. N Engl J Med. 1987;316(21):1309-1315.
110. Deuster PA, Chrousos GP, Luger A, et al. Hormon-
al and metabolic responses of untrained, moderate-
ly trained, and highly trained men to three exercise
intensities. Metabolism. 1989;38(2):141-148.
111. Webb HE, Rosalky DS, Tangsilsat SE, McLeod
KA, Acevedo EO, Wax B. Aerobic fi tness affects
cortisol responses to concurrent challenges. Med
Sci Sports Exerc. 2013;45(2):379-386.
112. Sothmann MS, Hart BA, Horn TS. Plasma cat-
echolamine response to acute psychological stress
in humans: relation to aerobic fi tness and exercise
training. Med Sci Sports Exerc. 1991;23(7):860-867.
PHYSICAL FITNESS: A PATHWAY TO HEALTH AND RESILIENCE
October – December 2013 33
THE ARMY MEDICAL DEPARTMENT JOURNAL
113. Cox RH. Exercise training and response to stress:
insights from an animal model. Med Sci Sports Ex-
erc. 1991;23(7):853-859.
114. Sothmann MS, Buckworth J, Claytor RP, Cox RH,
White-Welkley JE, Dishman RK. Exercise training
and the cross-stressor adaptation hypothesis. Exerc
Sport Sci Rev. 1996;24:267-287.
115. Rimmele U, Zellweger BC, Marti B, et al. Trained
men show lower cortisol, heart rate and psycho-
logical responses to psychosocial stress compared
with untrained men. Psychoneuroendocrinology.
2007;32(6):627-635.
116. Galper DI, Trivedi MH, Barlow CE, Dunn AL,
Kampert JB. Inverse association between physical
inactivity and mental health in men and women.
Med Sci Sports Exerc. 2006;38(1):173-178.
117. Nabkasorn C, Miyai N, Sootmongkol A, et al. Ef-
fects of physical exercise on depression, neuroen-
docrine stress hormones and physiological fi tness
in adolescent females with depressive symptoms.
Eur J Public Health. 2006;16(2):179-184.
118. Berlin AA, Kop WJ, Deuster PA. Depressive mood
symptoms and fatigue after exercise withdrawal:
the potential role of decreased fi tness. Psychosom
Med. 2006;68(2):224-230.
119. van Gool CH, Kempen GI, Bosma H, van Boxtel
MP, Jolles J, van Eijk JT. Associations between
lifestyle and depressed mood: longitudinal results
from the Maastricht Aging Study. Am J Public
Health. 2007;97(5):887-894.
120. Hamer M, Endrighi R, Poole L. Physical activity,
stress reduction, and mood: insight into immuno-
logical mechanisms. Methods Mol Biol (Clifton,
N.J.). 2012;934:89-102.
121. Weinstein AA, Deuster PA, Kop WJ. Heart rate
variability as a predictor of negative mood symp-
toms induced by exercise withdrawal. Med Sci
Sports Exerc. 2007;39(4):735-741.
122. Jackson EM, Dishman RK. Cardiorespiratory fi t-
ness and laboratory stress: a meta-regression analy-
sis. Psychophysiology. 2006;43(1):57-72.
123. Moyna NM, Bodnar JD, Goldberg HR, Shurin MS,
Robertson RJ, Rabin BS. Relation between aerobic
fi tness level and stress induced alterations in neuro-
endocrine and immune function. Int J Sports Med.
1999;20(2):136-141.
124. Li G, He H. Hormesis, allostatic buffering capac-
ity and physiological mechanism of physical activ-
ity: a new theoretic framework. Med Hypotheses.
2009;72(5):527-532.
125. Steptoe A, Edwards S, Moses J, Mathews A. The
effects of exercise training on mood and perceived
coping ability in anxious adults from the general
population. J Psychosom Res. 1989;33(5):537-547.
126. Morgan CA III, Wang S, Southwick SM, et al. Plas-
ma neuropeptide-Y concentrations in humans ex-
posed to military survival training. Biol Psychiatry.
2000;47(10):902-909.
127. O’Donnell K, Brydon L, Wright CE, Steptoe A.
Self-esteem levels and cardiovascular and infl am-
matory responses to acute stress. Brain Behav Im-
mun. 2008;22(8):1241-1247.
128. Carmack CL, Boudreaux E, Amaral-Melendez M,
Brantley PJ, de Moor C. Aerobic fi tness and leisure
physical activity as moderators of the stress-illness
relation. Ann Behav Med. 1999;21(3):251-257.
129. Manger TA, Motta RW. The impact of an exer-
cise program on posttraumatic stress disorder,
anxiety, and depression. Int J Emerg Ment Health.
2005;7(1):49-57.
130. Southwick SM, Vythilingam M, Charney DS. The
psychobiology of depression and resilience to
stress: implications for prevention and treatment.
Annu Rev Clin Psychol. 2005;1:255-291.
131. Rethorst CD, Wipfl i BM, Landers DM. The anti-
depressive effects of exercise: a meta-analysis of
randomized trials. Sports Med. 2009;39(6):491-511.
132. Paluska SA, Schwenk TL. Physical activity and
mental health: current concepts. Sports Med.
2000;29(3):167-180.
133. Oman RF, Oman KK. A case-control study of
psychosocial and aerobic exercise factors in
women with symptoms of depression. J Psychol.
2003;137(4):338-350.
134. Oeland AM, Laessoe U, Olesen AV, Munk-Jor-
gensen P. Impact of exercise on patients with
depression and anxiety. Nordic J Psychiatry.
2010;64(3):210-217.
135. Wipfl i BM, Rethorst CD, Landers DM. The anx-
iolytic effects of exercise: a meta-analysis of ran-
domized trials and dose-response analysis. J Sport
Exerc Psychol. 2008;30(4):392-410.
136. Fox KR. The infl uence of physical activity on mental
well-being. Public Health Nutr. 1999;2(3A):411-418.
137. Moses J, Steptoe A, Mathews A, Edwards S. The
effects of exercise training on mental well-being in
the normal population: a controlled trial. J Psycho-
som Res. 1989;33(1):47-61.
138. DiLorenzo TM, Bargman EP, Stucky-Ropp R,
Brassington GS, Frensch PA, LaFontaine T. Long-
term effects of aerobic exercise on psychological
outcomes. Prev Med. 1999;28(1):75-85.
139. Blair SN. Physical inactivity: the biggest public
health problem of the 21st century. Br J Sports Med.
2009;43(1):1-2.
140. Goetzel RZ, Pei X, Tabrizi MJ, et al. Ten modifi -
able health risk factors are linked to more than one-
fi fth of employer-employee health care spending.
Health Aff (Milwood). 2012;31(11):2474-2484.
34 http://www.cs.amedd.army.mil/amedd_journal.aspx
141. Zeno SA, Deuster PA, Davis JL, Kim-Dorner SJ,
Remaley AT, Poth M. Diagnostic criteria for meta-
bolic syndrome: caucasians versus African-Ameri-
cans. Metab Syndr Relat Disord. 2010;8(2):149-156.
142. Zeno SA, Kim-Dorner SJ, Deuster PA, Davis JL,
Remaley AT, Poth M. Cardiovascular fi tness and
risk factors of healthy African Americans and cau-
casians. J Natl Med Assoc. 2010;102(1):28-35.
143. Kuo LE, Abe K, Zukowska Z. Stress, NPY and
vascular remodeling: implications for stress-relat-
ed diseases. Peptides. 2007;28(2):435-440.
144. Kim-Dorner SJ, Simpson-McKenzie CO, Poth M,
Deuster PA. Psychological and physiological corre-
lates of insulin resistance at fasting and in response
to a meal in African Americans and whites. Ethn
Dis. 2009;19(2):104-110.
145. Kim-Dorner SJ, Deuster PA, Zeno SA, Remaley
AT, Poth M. Should triglycerides and the triglycer-
ides to high-density lipoprotein cholesterol ratio be
used as surrogates for insulin resistance?. Metabo-
lism. 2010;59(2):299-304.
146. McLoughlin MJ, Stegner AJ, Cook DB. The
relationship between physical activity and
brain responses to pain in fi bromyalgia. J Pain.
2011;12(6):640-651.
147. Ellingson LD, Shields MR, Stegner AJ, Cook DB.
Physical activity, sustained sedentary behavior,
and pain modulation in women with fi bromyalgia.
J Pain. 2012;13(2):195-206.
148. Puetz TW, Flowers SS, O’Connor PJ. A random-
ized controlled trial of the effect of aerobic exercise
training on feelings of energy and fatigue in seden-
tary young adults with persistent fatigue. Psycho-
ther Psychosom. 2008;77(3):167-174.
149. Nijs J, Aelbrecht S, Meeus M, Van Oosterwijck J,
Zinzen E, Clarys P. Tired of being inactive: a sys-
tematic literature review of physical activity, physi-
ological exercise capacity and muscle strength in
patients with chronic fatigue syndrome. Disabil
Rehabil. 2011;33(17-18):1493-1500.
150. Gualano B, Pinto AL, Perondi MB, et al. Thera-
peutic effects of exercise training in patients with
pediatric rheumatic diseases. Rev Bra Reumatol.
2011;51(5):490-496.
151. Semanik PA, Chang RW, Dunlop DD. Aerobic ac-
tivity in prevention and symptom control of osteo-
arthritis. PM R. 2012;4(suppl 5):S37-S44.
152. Stevenson JD, Roach R. The benefi ts and barriers
to physical activity and lifestyle interventions for
osteoarthritis affecting the adult knee. J Orthop
Surg Res. 2012;7:15.
153. Baillet A, Zeboulon N, Gossec L, et al. Effi cacy
of cardiorespiratory aerobic exercise in rheumatoid
arthritis: meta-analysis of randomized controlled
trials. Arthritis Care Res. 2010;62(7):984-992.
154. Weinstein AA, Drinkard BM, Diao G, et al. Explor-
atory analysis of the relationships between aerobic
capacity and self-reported fatigue in patients with
rheumatoid arthritis, polymyositis, and chronic fa-
tigue syndrome. PM R. 2009;1(7):620-628.
155. Lundberg IE, Nader GA. Molecular effects of
exercise in patients with infl ammatory rheu-
matic disease. Nature Clin Pract Rheumatol.
2008;4(11):597-604.
156. Nader GA, Lundberg IE. Exercise as an anti-
infl ammatory intervention to combat infl amma-
tory diseases of muscle. Curr Opin Rheumatol.
2009;21(6):599-603.
157. Thomson RL, Buck ley J D, Moran LJ, et al.
Comparison of aerobic exercise capacity and
muscle strength in overweight women with
and without polycystic ovary syndrome. BJOG.
2009;116(9):1242-1250.
158. Arikawa AY, Thomas W, Schmitz KH, Kurzer MS.
Sixteen weeks of exercise reduces C-reactive pro-
tein levels in young women. Med Sci Sports Exerc.
2011;43(6):1002-1009.
159. Martins RA, Neves AP, Coelho-Silva MJ, Veris-
simo MT, Teixeira AM. The effect of aerobic ver-
sus strength-based training on high-sensitivity C-
reactive protein in older adults. Eur J Appl Physiol.
2010;110(1):161-169.
160. Wong PC, Chia MY, Tsou IY, et al. Effects of a
12-week exercise trai ning programme on aerobic
fi tness, body composition, blood lipids and C-reac-
tive protein in adolescents with obesity. Ann Acad
Med Singapore. 2008;37(4):286-293.
161. Stewart LK, Earnest CP, Blair SN, Church TS. Ef-
fects of different doses of physical activity on C-
reactive protein among women. Med Sci Sports
Exerc. 2010;42(4):701-707.
162. Kelley GA, Kelley KS. Effects of aerobic exercise
on C-reactive protein, body composition, and max-
imum oxygen consumption in adults: a meta-anal-
ysis of randomized controlled trials. Metabolism.
2006;55(11):1500-1507.
163. Curtis K, Osadchuk A, Katz J. An eight-week yoga
intervention is associated with improvements in
pain, psychological functioning and mindfulness,
and changes in cortisol levels in women with fi bro-
myalgia. J Pain Res. 2011;4:189-201.
164. Edmonds M, McGuire H, Price J. Exercise therapy
for chronic fatigue syndrome. Cochrane Database
Syst Rev [serial online]. 2004(3):CD003200.
165. Gordon BA, Knapman LM, Lubitz L. Graduated
exercise training and progressive resistance train-
ing in adolescents with chronic fatigue syndrome:
a randomized controlled pilot study. Clin Rehabil.
2010;24(12):1072-1079.
PHYSICAL FITNESS: A PATHWAY TO HEALTH AND RESILIENCE
October – December 2013 35
THE ARMY MEDICAL DEPARTMENT JOURNAL
166. Heins M, Knoop H, Nijs J, et al. Infl uence of symptom expectancies on stair-climbing performance in chronic fa-
tigue syndrome: effect of study context. Int J Behav Med. 2013;20(2):213-218.
AUTHORS
Dr Deuster is Director and Professor, Consortium for Health and Military Performance, Department of Military and
Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Dr Silverman is Senior Scientist, Human Performance Laboratory, Consortium for Health and Military Performance,
Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda,
Maryland.
- CitationsCitations9
- ReferencesReferences142
- Another pertinent factor may have been the participant's involvement in a new training regime as the start date of the research coincided with the beginning of the competitive season. There is evidence to suggest that physical training fosters the development of MT as well as closely related constructs such as resilience (Deuster & Silverman, 2013 ), and plentiful research highlighting the psychological benefits of exercise (e.g., Edwards, 2015). To substantiate findings, further research should consider measures to help to control the variables.
- A similar parallel has been drawn to the benefits of a common and frequent physical challenge: physical exercise. Physical exercise presents a notable challenge to physiological adaptation (McEwen, 2003), and has been implicated as a promoting factor in resilience in earlier development (Strohle, 2009) and in resilient responses to stress in adults (Deuster & Silverman, 2013). Further, maintenance of physical exercise earlier in life is predictive of greater behavioral engagement in older age, despite the presence of chronic pain (A.
[Show abstract] [Hide abstract] ABSTRACT: Factors contributing to resilience in chronic pain have garnered increased attention in recent years, and research has identified physical and psychosocial characteristics and mechanisms that enhance adaptation to pain, and a host of iatrogenic effects of medications that attempt to end the pain altogether. Ambiguity remains regarding what constitutes resilience to pain, and which factors that influence resilience can be modified by psychosocial interventions. In this chapter we begin by identifying three key components of resilient responses to chronic pain despite pain: (1) recovery from pain-related decrements in functioning, (2) sustainability of purpose in the face of painful episodes, and (3) psychological growth from learning new and more effective ways to respond to recurrent episodes of moderate to severe arthritis pain. We review current research findings of individual differences in successful adaptation with this model of resilience in mind. Further, we introduce time course as a contributing factor to resilient outcomes, incorporating the role of developmental and situational factors in the initial onset of pain through development of and adjustment to chronic pain. Fatigue, a complex and salient barrier for individuals with chronic pain, is examined as an example of a failure of self-regulation and recovery processes in arthritis. Additionally, the role of goal orientation and reward processing in catalyzing resilient responses to pain is reviewed. Finally, the interpersonal context of pain resilience is examined, with specific attention paid to social contributors to positive emotion, social support, and styles of pain expression.- It is also acknowledged to be a resource which appears most often via experiencing serious difficulties and threats under which a person displays signs of positive adaptation (Ogińska-Bulik & Juczyński, 2008a, 2008b). Past research indicates that sportspeople tend to have a higher level of resiliency than people who are not engaged in sport (Cevada et al., 2012;Deuster & Silverman, 2013;Machida, Irwin, & Feltz, 2013). Similarly higher results with regards to resiliency were obtained by police officers and diabetics, i.e. people who struggle with stressful situations everyday, in comparison to office workers (OgińskaBulik & Juczyński, 2008b).
[Show abstract] [Hide abstract] ABSTRACT: Background The aim of this paper is to describe the results of a study concerning the relationship between resiliency and appraisal of a stressful situation, anxiety reactions and undertaken methods of coping among sportsmen. Participants and procedure The research concerned 192 competitors who actively train in one of the Olympic disciplines – individual or team. We used the following instruments: Resiliency Assessment Scale (SPP-25); Stress Appraisal Questionnaire A/B; Reactions to Competition Questionnaire; Coping Inventory for Stressful Situations (CISS); Sport Stress Coping Strategies Questionnaire (SR3S, self-constructed). Results Athletes most frequently apply positive types of stress appraisal, and they cope with stress through a task-oriented style during competitions. There is a relationship between the level of resiliency and the analysed aspects of the process of stress. The higher the resiliency, the more positive is the appraisal of a stressful situation and the more task-oriented are the strategies applied. Similarly, in everyday situations resilient sportspeople positively appraise difficult situations and undertake mostly task-oriented strategies. Resiliency is connected with less frequently experiencing reactions in the form of anxiety. Conclusions The obtained results, similarly to previous research, suggest that resiliency is connected with experiencing positive emotions. It causes more frequent appraisal of stressful situations as a challenge. More resilient people also choose more effective and situation-appropriate coping strategies. Therefore they are more resistant to stress.- Regular exercise and physical activity are key buffers against stress and many chronic and stress-related diseases (Silverman and Sternberg, 2012; Deuster and Silverman, 2013). Studies have shown that regular physical activity/exercise and increased physical fitness can provide a protective effect against development of metabolic (e.g., obesity, cardiovascular disease [CVD], type 2 diabetes and metabolic syndrome) (Gerber and Puhse, 2009; Li and He, 2009; Huang et al., 2013) and psychiatric disorders (e.g., depression, anxiety and cognitive dysfunction) (Rethorst et al., 2009; Herring et al., 2010 Herring et al., , 2012 Gligoroska and Manchevska, 2012).
- Regular exercise and physical activity are key buffers against stress and many chronic and stress-related diseases (Silverman and Sternberg, 2012; Deuster and Silverman, 2013). Studies have shown that regular physical activity/exercise and increased physical fitness can provide a protective effect against development of metabolic (e.g., obesity, CVD, type 2 diabetes and metabolic syndrome) (Gerber and Puhse, 2009; Li and He, 2009; Huang et al., 2013) and psychiatric disorders (e.g., depression, anxiety and cognitive dysfunction) (Rethorst et al., 2009; Herring et al., 2010 Herring et al., , 2012 Gligoroska and Manchevska, 2012).
[Show abstract] [Hide abstract] ABSTRACT: Communication between maternal-fetal immune systems: development of immune tolerance.•Pathways by which immune dysfunction could contribute to neurodevelopmental disorders.•Effects of prenatal/perinatal stress and immune activity on CNS development/function.•Effects of prenatal/perinatal malnutrition on immune and CNS development/function.•Health benefits of physical activity during pregnancy for mother, fetus and infant.- [Show abstract] [Hide abstract] ABSTRACT: Physical fitness, achieved through regular exercise and/or spontaneous physical activity, confers resilience by inducing positive psychological and physiological benefits, blunting stress reactivity, protecting against potentially adverse behavioural and metabolic consequences of stressful events and preventing many chronic diseases. In this review, we discuss the biological mechanisms underlying the beneficial effects of physical fitness on mental and physical health. Physical fitness appears to buffer against stress-related disease owing to its blunting/optimizing effects on hormonal stress responsive systems, such as the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. This blunting appears to contribute to reduced emotional, physiological and metabolic reactivity as well as increased positive mood and well-being. Another mechanism whereby regular exercise and/or physical fitness may confer resilience is through minimizing excessive inflammation. Chronic psychological stress, physical inactivity and abdominal adiposity have been associated with persistent, systemic, low-grade inflammation and exert adverse effects on mental and physical health. The anti-inflammatory effects of regular exercise/activity can promote behavioural and metabolic resilience, and protect against various chronic diseases associated with systemic inflammation. Moreover, exercise may benefit the brain by enhancing growth factor expression and neural plasticity, thereby contributing to improved mood and cognition. In summary, the mechanisms whereby physical fitness promotes increased resilience and well-being and positive psychological and physical health are diverse and complex.
Project
Private Profile
Patricia Deuster
OBJECTIVE(s):
1. To examine the effects of various diets and/or a ketone supplement use on cognition, anxiety, and standard markers of oxidative stress and mitochondrial activity.
2. To examine wh…" [more]
Project
- Private Profile
Lawrence Armstrong- Patricia Deuster
The overall objective of the project is to examine the effects of prolonged exercising in the heat and how it impacts blood homeostasis and the oral microbiome.
Specific aim 1: To determine if cycl…" [more]
Article
Physical fitness, achieved through regular exercise and/or spontaneous physical activity, confers resilience by inducing positive psychological and physiological benefits, blunting stress reactivity, protecting against potentially adverse behavioural and metabolic consequences of stressful events and preventing many chronic diseases. In this review, we discuss the biological mechanisms... [Show full abstract]
Article
This panel discussion, moderated by Dr. Deuster, illustrates the thinking of selected military leaders on the approach that must be taken to ensure the relationship between nutrition and performance. Insights and challenges these leaders face are provided, with consideration of the complex issues relating to sufficient scientific evidence, timing for Department of Defense policy, and the... [Show full abstract]
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