The Physiological Effects of Stress in Populations that Exhibit Signs of Chronic Diseases Compared to Athletes

Abstract

Research has collected that stress is the contributing factor to many chronic disease states in our world today. Diabetes, hypertension, and high cholesterol are just a few health conditions in which stress can worsen these disease states for individuals.

Stress is not only seen in people that have a chronic disease but can also appear in anyone dealing with high-performance anxiety, such as student-athletes. Stress does not discriminate in how it can affect people physically, mentally, and emotionally. Even though stress can affect a diverse range of people, there may be some similarities in which different groups affected by stress can learn from each other.

For example, research has shown the overwhelming benefits of exercise on physical health and mental health. Yet, even though athletes train consistently, they can still feel the adverse effects of stress on their mental and emotional health. Many studies reveal the similarities between athletes and those who have a chronic disease about sharing several mental and emotional coping mechanisms for stress. Yet, both groups have vital differences and can learn from one another when dealing with stress.

Introduction-The Physiology of Stress

The physiological link of stress ties into what is known as cortisol. Our brain consists of several regions, some of which include the forebrain, midbrain, and hindbrain. The forebrain contains areas like the frontal cortex, which consists of the diencephalon and the cerebrum. Within the diencephalon are two main areas, which are called the thalamus and hypothalamus. The thalamus is responsible for coding sensory input, while the hypothalamus is a significant region of the brain in which hormones facilitate themselves through different body sites (Castillo-Quan et al. 2007).

The hypothalamus consists of the anterior pituitary and posterior pituitary. The anterior pituitary releases hormones: 

1.  Adrenocorticotropic hormone (ACTH) 
2. Thyroid-stimulating hormone (TSH)
3. Growth hormone (GH)
4. Prolactin
5. Gonadotropin-releasing hormone (GnRH)

These hormones release signals into the blood that circulate to distant areas of the body and cause some response (Castillo-Quan et al. 2007).

Corticotropin-releasing hormone (CRH) is an amino acid peptide released by the hypothalamus. Stressful stimuli release the peptide. This peptide secretes ACTH from the anterior pituitary. The ACTH that secretes from the anterior pituitary releases into capillary beds within the pituitary that eventually gets taken up into the blood and released throughout the body. These hormones find their way into the adrenal cortex (Castillo-Quan et al., 2007).

Finally, cortisol releases within the adrenal cortex from cell bodies known as the zona fasciculate. The cell bodies are named glucocorticoids and responsible for the body’s metabolism. Cortisol is so essential that during times of stress, the body needs to regulate blood glucose. Cortisol assists in increasing glucose metabolism levels during stress through catabolism (Castillo-Quan et al. 2007).

Catabolism is a method used by the body to break down essential fatty acids and glucose for fuel. This increase in regulation and breakdown gives us the energy that we need to carry out a task. The body finds itself in a very original state during catabolism due to other physiological factors taking place, such as increased heart rate from the sympathetic nervous system, leading to higher cardiac output by the heart beating faster. The increase in cardiac output means that more oxygen and nutrients utilize in the body’s tissues. Hormones like epinephrine or norepinephrine allow humans to react quickly to any particular stimulus (Castillo-Quan et al. 2007).

The exciting thing about cortisol is that it can have very beneficial effects in the short term, although the long-term immune function can severely suffer. This effect is most precise for individuals who are already compromised in their immune system or have some chronic diseases such as asthma, diabetes, or cardiovascular disease (Castillo-Quan et al. 2007).

Stress can affect these individuals in several different ways. In my study, a qualitative research analysis will present to patients in the future. The study will analyze stress between a group of chronic disease individuals and compare them with athletes. Both groups will receive a series of questions that would include the history of their disease, how long they have had it, how they have managed it, and how it has affected them mentally or physically.

The characteristics of this experiment will include a longitudinal research design. After observations from the first experiment, it will be essential to follow up with subjects in three-month increments to see how their treatment or therapy reduces their stress level.

Methods- Comparing Stress of Chronic State Individuals to Athletes

This research study will include studies that have measured athletes and diabetic patients using a range of questionnaires and surveys to assess stress. Ethical considerations implore based on anonymity, confidentiality, and informed consent for both patients and athletes.

Once data collects for both groups, categorization can pinpoint the questions’ validity and reliability. There will be one chronic disease group and one group of athletes in a specific sport to mitigate various responses due to different sports or chronic illnesses. Recruitment will prove to be essential. The sample portion will not be too big or too small, 100 subjects, to pinpoint valid results.

For the chronic state group, blood pressure assessment might be relevant to analyze physical displays of stress. The athlete group’s blood pressure can also display as a control group. The mental state of both groups will measure anxiety, depression, or burnout. There may be bias in terms of how the questions reveal results. For validity, it will be necessary to have multiple evaluators understand the realm of tendencies and critically evaluate each question and answer based on the individual’s response.

The purpose of assessing both groups is that their stress levels could implicate measures in which chronic individuals deal with stress relative to how athletes deal with stress. Even though both groups are on the opposite spectrums related to physical fitness, cortisol release can drastically impact both groups in their mental and physical performance. Understanding how stress affects both groups can give mental health counselors solutions to these groups and help them focus on preventing depression, anxiety, or burnout. These could implicate important prevention methods in protecting people that deal with stressful situations and how to best cope with them.

The subjects’ age, gender, and demographic data will be helpful background information in the experiment. Next, residents from both groups will fill out a stress questionnaire. The aim will be to get 50 subjects, both men and women who have type two diabetes, and 50 subjects, both men and women who are collegiate track and field athletes. The questionnaire will have the same questions for both groups. This test is to be an overview before investigating deeper emotional and mental stress.

Stress Questionnaire

Answer all the questions by ticking either yes or no. Answer yes, even if only part of a problem applies to you. Take your time, but please be completely honest with your answers:

  Yes

No

1. Not enough hours in the day to do all the things that I must do

2. I deny or ignore problems in the hope that they will go away

3. I only trust myself to do a job correctly. I do not have faith in people

4. I struggle with balancing my life effectively

5. My self-confidence/ self-esteem is lower than I would like it to be

6. I frequently have a guilty feeling if I relax and do nothing

7. I find myself thinking about problems even when I am supposed to be relaxing.

8. I feel sleepy or tired even when I wake after an adequate sleep

9. I find myself being impatient over small things

10. I tend to always be in a hurry

11. My appetite has changed. I either binge or skip meals

12. I tend to bottle up my feelings when something goes wrong

13. I experience mood swings, difficulty making decisions, concentration, and memory

14. I find fault and rebuke others even when it is undeserved

15. I have trouble listening because I am preoccupied with my thoughts

16. My sex drive is lower

17. I have an increase in muscular aches and pains, especially in the neck, head, shoulders

18. I am unable to perform tasks as well as I used to. My judgment is clouded

19. I have a greater dependency on alcohol, caffeine, nicotine, or drugs

20. I find that I don’t have time for many interests/hobbies outside of work

21. I feel like I lack control in some regions of my life

22. I feel anxious, jittery, and nervous about the future

Questionnaire questions are from the International Stress Management Association, founded in 1974 and known for promoting prevention and reducing human stress through awareness and sound knowledge. The present questionnaire attempts to gather physical, emotional, and mental information to contribute to stress levels. Subjects that check “yes” get one point, and “no,” is zero points (Lovallo, 2016).

ISMA analyzes its results based on three categories. If a subject gets less than 4 points, they are less likely to suffer from stress-related illnesses. If a participant receives 5-13 points, they are more likely to experience stress-related illness, whether physical or mental. Lastly, 14 points or more could be a sign of chronic stress relating to chronic disease or mental illness. Counseling or stress management are helpful recommendations in this category and the 5-13 point category (Lovallo, 2016).

Overall, several standardized tests delve deeper into diagnosing and analyzing, specifically if patients struggle with depression or anxiety. One study used the Zung self-rating depression scale to investigate stress and depression in individuals with chronic disease. This test has a high sensitivity, specificity, and repeatability. It includes items that cover emotional, psychological, and physical symptoms (Gerontoukou et al., 2015).

Results:

It will be imperative to suitable types of tests in this study to analyze the realm and depth of stress from diabetic patients and collegiate athletes. Many results could occur from giving the same test to two groups.

Scenario 1: More chronic state individuals have higher levels of stress and anxiety than athletes.

Scenario 2: More athletes have higher stress and anxiety levels than chronic state individuals.  

Scenario 3: There is no significant increase in stress and anxiety from either group, whether both groups are high or both groups are low.

Scenario 1 may be the most common due to the full range of difficulties that patients have a chronic disease. The authors that used the Zung self-rating test identified several factors that may have influenced their data.

One was that there was a significant correlation between anxiety and education level. Primary education level participants had an 86% likelihood of having an anxiety disorder than higher education graduates. The rates were close to zero. Intermediate education levels were at 68% experiencing stress and anxiety (Gerontoukou et al., 2015).

 Second, unmarried individuals seemed to have an increased likelihood of depression when the study showed 94% of them with marginal symptoms of depression, while participants who were married had a rate of 67% showing borderline depression (Gerontoukou et al., 2015). Third, females developed more anxiety and depression symptoms between genders, 47.5% compared to 31.7% of males (Gerontoukou et al., 2015). Fourth, age was an essential factor in that participants who were 57 years and up had higher rates of depression than those younger than 57 years (48% vs. 33%.) Fifth, there was a difference between smokers and non-smokers. 49% of non-smokers had no signs of acute mental illness compared to 31% of smokers who experienced emotional anxiety and stress (Gerontoukou et al., 2015).

This study included 118 females (57.8%), compared to 86 males (42.2%). The majority of the participants were high school graduates (67%), married (71%), and living in urban areas (53%) (Gerontoukou et al., 2015).

This study included hypertensive patients with hypercholesterolemia, coronary artery disease, and more. The vast number of factors that influence chronic disease could lead to more chronic disease patients having a higher number of stress factors. It is also reasonably probable that an individual could have multiple cases of chronic disease. For example, many patients have couplings of COPD and CAD or other disease combinations since the heart, lung, and renal systems function together to control varying systems in the body.

Scenario 2 of the athletes experiencing higher stress levels would be a lower possibility, seeing as many athletes do not struggle with physical health complications. Other stress tests may be helpful to test the range of anxiety. For example, they use a scale of 1 to 5 for subjects that struggle with anxiety and stress. Therefore, better analyses could reveal better comparisons of the two groups, athletes and chronic disease patients. The limited exposure to chronic disease would most likely present a lower number of athletes with stress-related illnesses.

Regardless, scenario 3 of high numbers of stress from both categories may still be a possibility. Most athletes that are performing at the collegiate level are notable competitors. Seeing as how they are performing at the collegiate level, they most likely have been dealing with stressors for most of their lives when performing different sporting events. However, inadequate coping mechanisms for athletes can be built in earlier stages of their competition; eating disorders, alcohol, tobacco, or drug use with the intention of stress relief. If this behavior is the case, then performing at the collegiate level while balancing homework and work responsibilities may expose athletes to a realm of mental and emotional complications due to the “high stakes” moment of competing in college (Applin, 1986).

The study done in the future would assess both groups and their varying factors. There will be comparisons of both athletes and chronic state individuals who are battling stress and anxiety. Athletes who are not struggling with stress will receive a questionnaire about how they are coping with stress. The same applies to chronic state patients who are not working with stress and anxiety or handle their stress in a manageable way. These tests can be measured as valuable tools when providing therapy possibilities for athletes and chronic state patients having difficulty with stress and anxiety.

Discussion- Effects of Stress on Diabetes:

Type 2 diabetes is a chronic disease that results from an increase in insulin receptors’ lack of sensitivity. Usually, when an individual eats a meal, there is an increase in insulin secretion. This insulin secretion signals to the body that it is in the “fed state.” This result means that the body can utilize the energy from the food and store it in glycogen and other energy stores. This function also means a reduction in glucagon in the blood. The body does not need to increase glucagon or glucose catabolism in the fed state since energy stores also obtain food (Gerontoukou et al., 2015).

However, for people with diabetes, eating food does not signal a decrease in glucagon. Instead, glucose levels remain high after eating, causing the body to be in a state of hyperglycemia. Hyperglycemia is dangerous due to insulin insensitivity and damage to blood vessels. This consistent increase of glucose can result in a risk of heart disease, stroke, kidney disease, vision problems, or even nerve issues (Gerontoukou et al., 2015).

Notably, it is prevalent to see how diabetes can cause an immense amount of physical stress on the body if not managed properly. Studies have discovered that the more complications that arise with diabetes, the more cortisol will increase from the adrenal cortex. As noted earlier, cortisol is a hormone that can stimulate health benefits if secreted short-term. However, due to complications from diabetes, the long-term effects of cortisol release will not only affect the physical organs of the body. Still, they will also lead to mental and emotional stress for the patient.

Metformin is a common drug taken by people with diabetes that helps control blood sugar levels and increase insulin sensitivity in the body. Controlling glucose is the primary factor in which people with diabetes can maintain their health and bodily organ function (Gerontoukou et al. 2015).

Effects of Stress on Athletes:

The second group of individuals analyzed in this study are athletes. Athletes’ body chemistry is undoubtedly different from chronic patients. With all the benefits of exercise, assumptions seem reasonable that athletes do not struggle with stress than regular state individuals. However, studies show that athletes go through their array of pressures.

These stresses regard the type of training they have to endure to be in their peak physical state and perform high standards. Many top collegiate athletes are restricted financially by a fully-funded sports scholarship and perhaps are training to one day perform professionally. For some athletes who come from high-poverty areas, it may be crucial for them to perform at a professional level to take care of their low-income families. There is an incredible amount of stress surrounding collegiate athletes, many of whom are just under the age of twenty-one. This stress can look different, seeing as they may not struggle with chronic diseases such as diabetes or hypertension, but there may be some mental correlations between both groups in how they cope with their stresses (Applin, 1986).        

Perhaps chronic state individuals like diabetic patients have higher physiological adverse effects than athletes who may have more emotional or mental stress due to their peak performance requirement in their sports area. Regardless of the physiological differences, there may be some core similarities related to mental and emotional stress. Perhaps both groups see pressure from the same perspective due to the varying degrees to which stress can affect individuals (Applin, 1986).

Effects of Exercise on Stress:

Exercise is an integral part of many people’s lives that serves multiple health functions to stabilize chronic diseases. The effects of exercise have shown several beneficial health outcomes on different populations. Exercise, whether aerobic or anaerobic, trains the muscles to a higher level of fitness. 

There is the goal of hypertrophy of muscle fibers with resistant training, causing more significant muscle fibers expansion when lifting heavyweights. The development of muscle fibers increases the load potential in which individuals can lift heavier weights. On the other hand, aerobic exercise can serve to raise VO2 max levels in subjects by allowing more ventilation and oxygen to diffuse when exercising. This effect creates a higher cardiac output, which means more blood pumps from the heart for exercise (Paulsen et al., 2012). 

These measures may require a specific type of density in muscle fiber or VO2 max for success related to a particular sport. For example, endurance runners may have a higher VO2 maximum than most people due to the frequency and duration of running. A higher VO2 max causes a lower than average blood pressure of professional runners due to the arteries’ consistent vasodilation, allowing more oxygen to diffuse into tissues. Runners also have more type 1 slow-oxidative fibers known for their high mitochondria capacity and vast ATP stores used by distance runners while running. On the other hand, Sprinters have more type 2 fast-glycolytic fibers, which have a higher amount of phosphagen stores and are excellent for short-duration, high-intensity exercises (Horowitz et al., 1994). 

Research shows that aerobic exercise rather than anaerobic exercise is more effective for people with diabetes. Many people with diabetes report using less medication after a consistent time of exercising. Activity initiates a unique response to glucose. During training, the body is utilizing glucose for ATP. This process means that there is an increase in glucose uptake within the cells. Less glucose within the blood means improved conditions for hyperglycemia. More utilization of type 1 slow-oxidative fibers means a higher carrying capacity for oxygen, which can utilize glucose for ATP and increase insulin sensitivity. 

When exercise becomes a lifestyle, there are remarkable changes not only physically but emotionally and mentally for the body and mind. The unique ability for training to put the body in stimulation mode immediately into relaxation mode gives cells a chance to dissipate long-term cortisol and adrenaline levels. This change leads to counteracting the effects of depression and anxiety for patients. 

The production of endorphins, which are chemicals in the brain that act as the body’s natural painkiller, is responsible for feelings of relaxation and comfort after training. Ultimately, these mental effects can also lead to emotional impacts as patients or athletes become more self-aware of their body, stamina, and strength. Self-image may improve, as well as confidence and renewed energy are positive emotional effects of exercise. 

Effects of Therapy on Diabetics and Athletes:

Noteworthy to mention that many of the studies discussed in this article are using tests that specifically analyze anxiety and depression. This experiment has the primary role of testing for stress. There are many similarities between stress and anxiety. Stress is usually the initial symptom that can lead to anxiety as well as depression. This experiment has its given questionnaires not to diagnose anxiety or depression necessarily but to serve as a function of prevention for subjects that are at high risk for anxiety and depression (White, 2001).

These findings show the complexity of chronic disease patients and the varying factors that influence stress. Studies show a common theme related to athletes as well as chronic disease states. That is talk therapy. Talk therapy, cognitive behavior therapy, or any type of counseling psychology has shown that significant mental health relief can increase from these types of treatment. A study done by Craig White shows that cognitive therapy can manage the psychological aspects of patients that are living with a chronic mental illness. CBT can also manage emotional and psychological disorders in athletes that struggle with stress anxiety related to their sport (White,  2001).

Conclusion:

Studies show that both athletes and chronic disease patients can fall into high stress-related patterns. From the literature, there are patterns shown of chronic disease state patients attributing their stress to mental illness such as depression and anxiety. In comparison, under stress-related conditions, athletes experience several behavior problems such as sexual dysfunction, food disorder, low immune system, and obsessive-compulsive disorder. There is evidence that cortisol levels are high in both groups during these stress-related patterns and contribute to mental illness and behavior issues. However, it is essential to state that subjects’ questions must be neutral and not lead them to an answer that the evaluator anticipates hearing.

Research articles conducted in the format of questions and multiple evaluators’ utilization reduce the risk of bias in interpreting results.

Interestingly to note about both groups, one potential bias assumption is that chronic disease patients tend to relate to severe forms of mental illness. In contrast, athletes tend to relate to more behavioral issues. Data from research studies mention that there may be a pattern of negative behavior from athletes suffering from stress, such as drugs or alcohol. Simultaneously, chronic state patients internalize stress as much more mental and emotional situations like anxiety and depression. Both groups show to suffer from both behavioral and mental illness; however, there may be underlying reasons why both groups have different patterns. Further research will study patterns to gauge whether or not there is general information between how athletes and chronic state individuals respond to stress.

It is essential to mention that athletes are usually much younger than patients with chronic disease. As well, both groups deal with different types of stressors. The elderly state group may deal with life-threatening physiological illnesses that could lead to severe mental and emotional pain. On the other hand, athletes cope with the emotional and mental stresses of sports performance that, when failing, could lead to physical and psychological pain. This study also did not discuss the realms of which medication could benefit specific individuals suffering from mental health or chronic disease. Studies show that mental illness isn’t just an environmental factor but has a legitimate genetic component. Future studies may attempt to find correlations between medication and exercise or medication and talk therapy between athletes and chronic disease patients.

In terms of other beneficial therapies, literature shows that exercises are an immense tool for helping people’s mental stability and emotional happiness. Even though most athletes are consistently exercising due to their sport, they may benefit from other relief areas such as talk therapy, counseling, and sports psychology.

Most patients that have chronic disease utilize some form of therapy, whether talk therapy or clinical psychology. However, it may be even more advantageous to couple that treatment with exercise due to their physical condition.

In summary, both groups deal with different stressors, but the results are often the same. Feelings of stress, anxiety, PTSD, sexual dysfunction, low immune system, and depression are in both groups. Even though athletes benefit from exercise, research shows that combining training with therapy may be the best combination of mental health that people can utilize. In a different light, exercise could prove vitally necessary for chronic disease patients who are already using counseling or talk therapy as a form of controlling their mental health.

More research needs to study the varying ranges of chronic diseases such as hypertension, high cholesterol, renal dysfunction, and other chronic conditions where patients may measure their stress differently. Also, the number of sports that athletes participate in is endless, and each sport contributes to its particular array of stressors and challenges. The diverse variety of sports and chronic illnesses can prove challenging to compare, especially with each person managing their stress in different ways according to the disease or the sport.

The findings of this experiment will continue to contribute to the longitudinal research design. After observations from the first experiment and once subjects receive the help they need, expectations of three and 6-month follow-ups will follow. In the future, the same questionnaire will show if stress has reduced or increased due to the treatment given. The goal is to overtime provide stress relief to these subjects and gather data to measure improvement in either chronic state illness or sports performance. However, after time, the experiment can add different measures, such as other sample groups like basketball collegiate athletes or hypertension patients. Using the same experiment with varying groups of a sample or perhaps slightly different questionnaires can provide validity to the research in proving its results are significant to the public and that the test is repeatable to a larger sample.

Overall, it is remarkable how stress can affect different groups of people in similar but different ways. Stress nowadays is a standard broad issue in any area of life. Thankfully, as mental health awareness has risen, more people utilize multiple therapy methods, such as exercise, yoga, or fitness training. Counseling, talk therapy, hypnosis, and meditation are ways to combat the complexities of stress. The biggest takeaway from this study is that it may be beneficial to utilize multiple forms of treatment like exercise or talk therapy or intentionally use both methods to prevent mental illness and influence positive behavior.

References

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