Annals of Behavioral Medicine

, Volume 51, Issue 6, pp 799–809 | Cite as

Does Stress Result in You Exercising Less? Or Does Exercising Result in You Being Less Stressed? Or Is It Both? Testing the Bi-directional Stress-Exercise Association at the Group and Person (N of 1) Level

  • Matthew M. BurgEmail author
  • Joseph E. Schwartz
  • Ian M. Kronish
  • Keith M. Diaz
  • Carmela Alcantara
  • Joan Duer-Hefele
  • Karina W. Davidson
Original Article



Psychosocial stress contributes to heart disease in part by adversely affecting maintenance of health behaviors, while exercise can reduce stress. Assessing the bi-directional relationship between stress and exercise has been limited by lack of real-time data and theoretical and statistical models. This lack may hinder efforts to promote exercise maintenance.


We test the bi-directional relationship between stress and exercise using real-time data for the average person and the variability—individual differences—in this relationship.


An observational study was conducted within a single cohort randomized controlled experiment. Healthy young adults, (n = 79) who reported only intermittent exercise, completed 12 months of stress monitoring by ecological momentary assessment (at the beginning of, end of, and during the day) and continuous activity monitoring by Fitbit. A random coefficients linear mixed model was used to predict end-of-day stress from the occurrence/non-occurrence of exercise that day; a logistic mixed model was used to predict the occurrence/non-occurrence of exercise from ratings of anticipated stress. Separate regression analyses were also performed for each participant. Sensitivity analysis tested all models, restricted to the first 180 days of observation (prior to randomization).


We found a significant average inverse (i.e., negative) effect of exercise on stress and of stress on exercise. There was significant between-person variability. Of N = 69, exercise was associated with a stress reduction for 15, a stress increase for 2, and no change for the remainder. We also found that an increase in anticipated stress reported the previous night or that morning was associated with a significant 20–22% decrease (OR = 0.78–0.80) in the odds of exercising that day. Of N = 69, this increase in stress reduced the likelihood of exercise for 17, increased the odds for 1, and had no effect for the remainder. We were unable to identify psychosocial factors that moderate the individual differences in these effects.


The relationship of stress to exercise can be uni- or bi-directional and varies from person to person. A precision medicine approach may improve exercise uptake.


Stress Exercise 


Compliance with Ethical Standards

Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards

Karina Davidson is the co-owner of MJBK, a small business that provides mhealth technology solutions to consumers and the co-owner of IOHealthWorks, a small consulting services company. No other potential conflicts of interest relevant to this article were reported.


This work was supported by a grant from the National Institutes of Health (R01HL115941) to Drs. Burg and Davidson.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© The Society of Behavioral Medicine 2017

Authors and Affiliations

  • Matthew M. Burg
    • 1
    Email author
  • Joseph E. Schwartz
    • 2
    • 3
  • Ian M. Kronish
    • 3
  • Keith M. Diaz
    • 3
  • Carmela Alcantara
    • 4
  • Joan Duer-Hefele
    • 3
  • Karina W. Davidson
    • 3
  1. 1.Department of Internal MedicineYale University School of MedicineNew HavenUSA
  2. 2.Department of Psychiatry and Behavioral ScienceStony Brook UniversityStony BrookUSA
  3. 3.Center for Behavioral Cardiovascular HealthColumbia University Medical CenterNew YorkUSA
  4. 4.Columbia School of Social WorkColumbia UniversityNew YorkUSA

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