"The Effect of Combined Mental & Physical Stress on Biomarkers of Stress and Perceived Anxiety" by Nathan M. Sutton, Stephanie Uriegas et al.
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Abstract

High Stress occupations are subject to significant health risk due to the exposure to a variety of stressors, specifically the exposure to concurrent stressors (i.e., combined mental and physical stress). Exposure to concurrent stressors has been shown to exacerbate the stress response, potentially resulting in cardiovascular strain, immune suppression, and inflammation. PURPOSE: The purpose of this study was to examine the effect of a concurrent stress challenge (CSC) on markers of stress, as well as perceived anxiety. METHODS: This study utilized a randomized control trial, in which fifty-four subjects (n=54) were randomly assigned to perform either exercise alone (EA), or a CSC. The EA condition consisted of the Ruffier squat test (30 squats in 45 seconds), while the CSC included the exercise immediately followed by a virtual reality active shooter drill previously demonstrated to elicit a significant stress biomarker response. A saliva sample, heart rate (HR) measurement, and state anxiety inventory (SAI) survey were collected four times throughout the study: 1) 30 minutes prior to exercise 2) immediately prior to exercise 3) 5 minutes following exercise, and 4) 30 minutes following exercise. Saliva samples were analyzed for concentrations of stress biomarkers: salivary alpha amylase (sAA) and secretory immunoglobulin-A (SIg-A). RESULTS: No treatment x time interactions were noted for sAA, SIg-A, and HR; however, immediately post-stress all variables were significantly higher as compared to all other time-points. With respect to SAI, a significant (p < 0.05) interaction was noted. Post hoc analysis indicated no significant changes from pre to post stress challenge in EA; however, a significant increase in SAI was found from pre to immediately post stress in the CSC condition. CONCLUSION: This study found that following stress, the EA and CSC conditions resulted in significant increases in physiological markers of stress. Moreover, the CSC condition resulted in increased SAI post stress compared to EA. In conclusion, it can be determined that adding mental stress to physical stress results in increases in perceived anxiety. These findings provide implications that high stress occupations may be at an increased risk to health complications due to the exposure to concurrent stress.

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