Running on Empty
Should you stop exercising due to stress?
For decades, the wellness industry has promoted movement and exercise as a cornerstone of mental and physical health. Whilst the benefits of physical activity are unequivocal and well documented, including everything from prevention of chronic disease to improving bone health, statistics reveal that many females are far exceeding public health recommendations [1].
In the UK, current public health guidelines for physical activity are relatively moderate, encouraging adults to do at least 150 minutes of moderate-intensity activity weekly, including resistance-based activities on two days for muscle and bone strengthening [2].
So, is there a psychological benefit in over-shooting these recommendations? And, if you are feeling stressed or burnt-out, will exercise be harmful or helpful?
This is a question I had to answer myself in my journey as I was overusing exercise to manage my stress levels, and didn’t know this was, in fact, delaying my recovery. I always assumed exercise was good for you so the more the better, especially if it helped manage stress.
There is a lot of messaging around eating more and moving less to manage HA symptoms, especially on social media. From my clinical experience, I don’t think this does justice to the nature and complexity of the female ‘HPO axis’ (hypothalamic-pituitary-ovarian axis). My approach is usually not to halt exercise completely but to investigate all the underlying contributors to missing periods, alongside optimising nutritional status following the right testing. I may recommend changing up the volume, timing or type of exercise instead of asking women to stop it altogether. In certain circumstances, complete cessation of exercise may increase stress, which is counterproductive to healing. In other cases, it may be best to stop all exercise for a period of time. In all cases, it’s important to ensure you are medically safe to exercise before doing so.
So, should you exercise more or less due to stress? Let’s take a deeper dive into the science…
What is stress?
Essentially, the stress response is responsible for our survival. It gives us the energy and focus we need to react quickly to hazardous situations. All animals have a stress response - even insects. If you have a central nervous system that can detect threats, you have a built-in stress response.
Although many of us think of stress as an emotional experience, it is primarily a physiological response, causing the release of hormones including adrenaline and cortisol in reaction to a perceived threat. These hormones ‘prime’ the body for action by increasing the energy available for ‘fight or flight’ from danger. Heart rate accelerates, breathing rate increases, blood is diverted away from the digestive tract and the body releases blood sugar, giving your muscles the fuel they need to move quickly and strongly whether fighting or fleeing.
Unfortunately, our body is unable to differentiate between different types of stressors… and in modern-day society, we are experiencing these stressors far more frequently than ever before!
Some of us face a cascade of ‘microdoses’ of stress daily. With endless emails, an ever-growing workload and the traffic that just won’t budge on the motorway, our stress response can become repeatedly activated and over-recruited, never having a chance to calm down.
Persistent stimulation of the stress response can lead to a ‘chronic stress state’. With time, elevated stress hormones can cause an array of problems including low energy levels, brain fog, immune system and ovulatory dysfunction, high inflammation, poor sleep, low sex drive and more.
Can exercise help with stress?
There is a large body of research suggesting that exercise can be beneficial for managing symptoms of mild stress and anxiety disorders. Exercise can serve as a break from daily stressors, bring an isolated experience of stress to its physiological conclusion, help improve self-confidence and resilience and may provide an opportunity for social interaction and time outdoors [3].
However, we still have very limited evidence examining the impact of exercise on the chronically stressed.
Here’s what we do know…
Exercise in itself is a stressor
During exercise, there is an increased demand on our muscles for energy and nutrients. What’s more, research has shown that moderate to high-intensity exercise can increase the levels of circulating cortisol in the body [4].
A 2017 study [5] concluded that exercise was an effective tool for decreasing symptoms of anxiety and stress disorders… but there were several limitations. Notably, the researchers were unable to distinguish between the effects of the frequency, intensity, and type of exercise on the outcomes observed. The therapeutic benefits of exercise were likely dose-dependent, and thus the study concluded that recommendations for exercise for anxiety/stress symptom management should concur with the current public health prescription of 150 minutes per week.
Interestingly, another study that focused specifically on patients suffering from burnout was unable to find any significant evidence of symptom relief following exercise [6]. The researchers concluded that there remains a large gap in the literature when it comes to high-quality research surrounding exercise and chronic stress states.
To put it simply, we just don’t have the evidence to support an increased exercise prescription as a treatment for people with chronic stress.
In fact, given that we know exercise elevates cortisol and increases energy expenditure, we could assume that it would be ill-advised to place an already stressed, burnt out and depleted system through an additional rigorous exercise regime.
If you are experiencing symptoms of chronic stress or burnout, know that the notion that ‘the more exercise we do, the less stressed we will feel’ is just not supported by science.
Exercise and Hypothalamic Amenorrhoea (HA)
It is perhaps unsurprising that exercise is discouraged during recovery from HA, given that HA is often attributed to stress, over-exercising, and under-fuelling. Treatment guidelines for HA currently recommend correcting energy imbalances to improve HPA axis function [7], which may require a reduction in exercise or even stopping exercise altogether.
It is also crucial to remember that some individuals with HA may have a lived experience (past or present) of disordered eating and/or compulsive exercise. Unmodified exercise or re-introduction at the wrong times could threaten psychological recovery as well as place an additional strain on an undernourished body, whilst increasing the risk of injury.
The reality is that everybody is different and there is no ‘one size fits all’ approach to HA recovery. Some people may find exercise enjoyable, and some may feel stress relief from keeping active. The physiology of exercise as stress management in recovery from HA is complex. However, if you’re coming from a history of compulsive exercise – why not try some gentler forms of movement such as yoga, stretching, mat Pilates or walking? From my own experience, modifying exercise intensity in the short term, yoga and walking helped rebalance my energy and I was able to recover more quickly by making changes to my exercise habits.
Check out this blog post for some more ideas.
Fuelling movement
If you do want to exercise (and you have the green light from medical professionals to do so), it is important to ensure that you are fuelling yourself correctly to protect your hormones, energy levels and prevent depletion of nutrients. Here are some tips:
Ensure you are eating enough calories to sustain the total work you require of your body. This includes exercise, non-exercise-specific activities, alongside optimal bodily functioning. Food is fuel after all!
Try to avoid 'fasted', training especially in the morning. This has been shown to elevate cortisol among females.
Carb up! Carbohydrates are the body’s favoured fuel source and depleted carbohydrates have been linked with increased cortisol (8). A snack containing at least 30g of carbohydrates prior to exercise is advised. Many of us are a bit ‘carb phobic’ thanks to the wellness industry so do what you can to reframe carbohydrates as healthy fuel.
Re-fuel soon after exercise. Aim to eat a meal or snack containing carbohydrates, fats and protein. This helps to replenish glycogen (carbohydrate) stores, provides muscles with the nutrients they need for repair and a supply of essential amino acids required for optimal brain function.
Don’t forget to look out for your bones too. Ensure you are eating enough calcium (three servings per day is recommended), alongside vitamin K2, magnesium and mineral-rich foods and take your daily vitamin D supplement.
Take-home message
Currently, there is no evidence to support an increased exercise prescription to manage stress.
Adding an intense exercise regime to an already depleted system could cause more harm than good.
If you are frequently exercising as a coping mechanism whilst feeling run-down, fatigued, overwhelmed and/or burnout, it may be time to take a step back and honour your body with the rest it deserves.
If you are worried about giving up exercise completely, there are other options you can explore - it doesn’t need to be ‘all or nothing’
An important reminder
Exercise should never be used as a form of punishment or to ‘earn or burn’ food. If you find yourself using language like I ‘need to exercise’, or ‘I have to exercise’, this may be a sign to take a step away and seek support to work on your relationship with exercise. Exercise should be an enjoyable experience, and that looks different for everyone.
If you are having issues with your mental health and/or have lost your period, please reach out for support. If you would like help with what dietary and lifestyle changes may be appropriate for you, you are welcome to get in touch.
You can book a free call, where I can get to know you, your journey, any struggles (past or present) and we can chat about the best way forward for you. You can also ask any questions you have about working with me.
REFERENCES
1. Ipsos MORI Social Research Institute. Active Lives Survey: Year 1 Technical Report [Internet]. 2017 May [cited 2023 Aug 25]. Available from: http://doc.ukdataservice.ac.uk/doc/8223/mrdoc/pdf/8223_technical_report_active_lives_survey_year_1.pdf
2. Department of Health & Social Care. UK Chief Medical Officer’s Physical Activity Guidelines [Internet]. 2009 Sept [cited 2023 Aug 25]. Available from: https://www.citethisforme.com/cite/journal/autocite?q=doi.org%2F10.5255
3. Peluso MA, Guerra de Andrade LH. Physical activity and mental health: the association between exercise and mood. Clinics (Sao Paulo) [Internet]. 2005 Feb [cited 2023 Aug 25]; 60 (1): 61-70. Available from: https://pubmed.ncbi.nlm.nih.gov/15838583/ doi: 10.1590/s1807-59322005000100012.
4. Hill EE, Zack E, Battaglini C, Viru M, Viru A, Hackney AC. Exercise and circulating cortisol levels: the intensity threshold effect. J Endocrinol Invest [Internet]. 2008 Jul [cited 2023 Aug 25]; 31 (7): 587-91. Available from: https://pubmed.ncbi.nlm.nih.gov/18787373/ doi: 10.1007/BF03345606.
5. Stubbs B, Vancampfort D, Rosenbaum S, Firth J, Cosco T, Veronese N, Salum GA, Schuch FB. An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. Psychiatry Res [Internet]. 2017 Mar [cited 2023 Aug 25]; 249: 102-108. Available from: https://pubmed.ncbi.nlm.nih.gov/28088704/ doi: 10.1016/j.psychres.2016.12.020.
6. Ochentel O, Humphrey C, Pfeifer K. Efficacy of Exercise Therapy in Persons with Burnout. A Systematic Review and Meta-Analysis. J Sports Sci Med [Internet]. 2018 Aug 14 [cited 2023 Aug 25]; 17 (3): 475-484.
7. Endocrine Society. Hypothalmic Amenorrhoea Clinical Practice Guideline [Internet]. 2017 Mar [cited 2023 Aug 25]. Available from: https://www.endocrine.org/clinical-practice-guidelines/hypothalamic-amenorrhea#3
8. Seimon RV, Hostland N, Silveira SL, Gibson AA, Sainsbury A. Effects of energy restriction on activity of the hypothalamo-pituitary-adrenal axis in obese humans and rodents: implications for diet-induced changes in body composition. Horm Mol Biol Clin Investig [Internet]. 2013 Sep [cited 2023 Aug 25]; 15 (2): 71-80. Available from: https://pubmed.ncbi.nlm.nih.gov/25436734/ doi: 10.1515/hmbci-2013-0038
This article was researched and written with the help of Emily Boorman (BSc Human Nutrition), a Band 4 Dietetic Assistant Practitioner and a wonderful intern at Holly Dunn Nutrition.
DISCLAIMER:
All content found on this website has been created for informational and educational purposes only. It is not a substitute for individual medical or mental health advice, diagnosis or treatment.
Always seek the advice of your doctor or another qualified health provider with any questions you may have regarding a medical condition or eating disorder recovery. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
Remember that we are all unique and what works for one person may not work for another.