Sports Medicine

, Volume 48, Issue 11, pp 2607–2622 | Cite as

Influence of Regular Physical Activity and Fitness on Stress Reactivity as Measured with the Trier Social Stress Test Protocol: A Systematic Review

  • Manuel MückeEmail author
  • Sebastian Ludyga
  • Flora Colledge
  • Markus Gerber
Systematic Review



Psychosocial stress is associated with multiple health complaints. Research to date suggests that regular physical activity (PA) and higher cardiorespiratory fitness may reduce stress reactivity and therefore contribute to a reduction of stress-related risk factors. While previous reviews have not differentiated between stressors, we focus on psychosocial stress elicited with the Trier Social Stress Test (TSST).


Our objective was to examine the effect of regular PA and cardiorespiratory fitness on stress reactivity, with a particular focus on the TSST. The TSST is the laboratory task most widely used to induce socio-evaluative stress and elicits stronger stress reactions than most other cognitive stressor tasks.


A systematic search within various databases was performed in January 2018. The following outcomes were considered: cortisol, heart rate, psychological stress reactivity, and potential moderators (age, sex, exercise intensity, assessment mode, and psychological constructs).


In total, 14 eligible studies were identified. Cortisol and heart rate reactivity were attenuated by higher PA or better fitness in seven of twelve studies and four of nine studies, respectively. Two of four studies reported smaller increases in anxiety and smaller decreases in calmness in physically active/fitter participants. Three of four studies found that higher PA/fitness was associated with more favorable mood in response to the TSST.


About half of the studies suggested that higher PA/fitness levels were associated with an attenuated response to psychosocial stress. Currently, most evidence is based on cross-sectional analyses. Therefore, a great need for further studies with longitudinal or experimental designs exists.


Compliance with Ethical Standards


No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Manuel Mücke, Sebastian Ludyga, Flora Colledge, and Markus Gerber have no conflicts of interest relevant to the content of this review.


  1. 1.
    Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. JAMA. 2007;298:1685–7. Scholar
  2. 2.
    Holmes ME, Ekkekakis P, Eisenmann JC. The physical activity, stress and metabolic syndrome triangle: a guide to unfamiliar territory for the obesity researcher. Obes Rev. 2010;11:492–507. Scholar
  3. 3.
    Thoits PA. Stress and health: major findings and policy implications. J Health Soc Behav. 2010;51(Suppl):S41–53. Scholar
  4. 4.
    Middlebrooks JS, Audage NC. The effects of childhood stress on health across the lifespan. Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2008.Google Scholar
  5. 5.
    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;583:174–85. Scholar
  6. 6.
    Kivimäki M, Virtanen M, Elovainio M, Kouvonen A, Väänänen A, Vahtera J. Work stress in the etiology of coronary heart disease: a meta-analysis. Scand J Work Environ Health. 2006;32:431–42.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Booth J, Connelly L, Lawrence M, Chalmers C, Joice S, Becker C, Dougall N. Evidence of perceived psychosocial stress as a risk factor for stroke in adults: a meta-analysis. BMC Neurol. 2015;15:233. Scholar
  8. 8.
    Bergmann N, Gyntelberg F, Faber J. The appraisal of chronic stress and the development of the metabolic syndrome: a systematic review of prospective cohort studies. Endocr Connect. 2014;3:R55–80. Scholar
  9. 9.
    Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull. 2004;130:601–30. Scholar
  10. 10.
    Redmond N, Richman J, Gamboa CM, Albert MA, Sims M, Durant RW, et al. Perceived stress is associated with incident coronary heart disease and all-cause mortality in low- but not high-income participants in the Reasons for Geographic And Racial Differences in Stroke study. J Am Heart Assoc. 2013;2:e000447. Scholar
  11. 11.
    Ludyga S. Sportaktivität, Stress und das Gehirn. In: Fuchs R, Gerber M, editors. Stressregulation und sport. Heidelberg: Springer; 2017. p. 275–91.Google Scholar
  12. 12.
    Pines AM, Keinan G. Stress and burnout: the significant difference. Pers Individ Differ. 2005;39:625–35. Scholar
  13. 13.
    Bauman AE. Updating the evidence that physical activity is good for health: an epidemiological review 2000–2003. Zs Sportpsychol. 2004;7:6–19. Scholar
  14. 14.
    Biddle SJH, Asare M. Physical activity and mental health in children and adolescents: a review of reviews. Br J Sports Med. 2011;45:886–95. Scholar
  15. 15.
    Netz Y, Wu M-J, Becker BJ, Tenenbaum G. Physical activity and psychological well-being in advanced age: a meta-analysis of intervention studies. Psychol Aging. 2005;20:272–84. Scholar
  16. 16.
    Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: the evidence. CMAJ. 2006;174:801–9. Scholar
  17. 17.
    Gerber M, Holsboer-Trachsler E, Pühse U, Brand S. Exercise is medicine for patients with major depressive disorders: but only if the “pill” is taken! Neuropsychiatr Dis Treat. 2016;12:1977–81. Scholar
  18. 18.
    Gerber M, Pühse U. Review article: do exercise and fitness protect against stress-induced health complaints? A review of the literature. Scand J Public Health. 2009;37:801–19. Scholar
  19. 19.
    Klaperski S, Seelig H, Fuchs R. Sportaktivität als Stresspuffer. Zs Sportpsychol. 2012;19:80–90. Scholar
  20. 20.
    Sothmann MS. The cross-stressor adaptation hypothesis and exercise training. In: Acevedo EO, Ekkekakis P, editors. Psychobiology of physical activity. Champaign: Human Kinetics; 2006.Google Scholar
  21. 21.
    Kjaer M. Regulation of hormonal and metabolic responses during exercise in humans. Exerc Sport Sci Rev. 1992;20:161–84.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Luger A, Deuster PA, Kyle SB, Gallucci WT, Montgomery LC, Gold PW, et al. Acute hypothalamic–pituitary–adrenal responses to the stress of treadmill exercise. Physiologic adaptations to physical training. N Engl J Med. 1987;316:1309–15. Scholar
  23. 23.
    Gerber M. Physiologische Wirkmechanismen des Sports unter Stress. In: Fuchs R, Gerber M, editors. Stressregulation und Sport. Heidelberg: Springer; 2017.Google Scholar
  24. 24.
    Foley P, Kirschbaum C. Human hypothalamus–pituitary–adrenal axis responses to acute psychosocial stress in laboratory settings. Neurosci Biobehav Rev. 2010;35:91–6. Scholar
  25. 25.
    Childs E, de Wit H. Regular exercise is associated with emotional resilience to acute stress in healthy adults. Front Physiol. 2014;5:401. Scholar
  26. 26.
    Jayasinghe SU, Lambert GW, Torres SJ, Fraser SF, Eikelis N, Turner AI. Hypothalamo-pituitary adrenal axis and sympatho-adrenal medullary system responses to psychological stress were not attenuated in women with elevated physical fitness levels. Endocrine. 2016;51:369–79. Scholar
  27. 27.
    Strahler J, Fuchs R, Nater UM, Klaperski S. Impact of physical fitness on salivary stress markers in sedentary to low-active young to middle-aged men. Psychoneuroendocrinology. 2016;68:14–9. Scholar
  28. 28.
    Klaperski S, von Dawans B, Heinrichs M, Fuchs R. Effects of a 12-week endurance training program on the physiological response to psychosocial stress in men: a randomized controlled trial. J Behav Med. 2014;37:1118–33. Scholar
  29. 29.
    Gerber M, Ludyga S, Mücke M, Colledge F, Brand S, Pühse U. Low vigorous physical activity is associated with increased adrenocortical reactivity to psychosocial stress in students with high stress perceptions. Psychoneuroendocrinology. 2017;80:104–13. Scholar
  30. 30.
    Klaperski S, von Dawans B, Heinrichs M, Fuchs R. Does the level of physical exercise affect physiological and psychological responses to psychosocial stress in women? Psychol Sport Exerc. 2013;14:266–74. Scholar
  31. 31.
    Rimmele U, Zellweger BC, Marti B, Seiler R, Mohiyeddini C, Ehlert U, Heinrichs M. Trained men show lower cortisol, heart rate and psychological responses to psychosocial stress compared with untrained men. Psychoneuroendocrinology. 2007;32:627–35. Scholar
  32. 32.
    Chida Y, Steptoe A. Greater cardiovascular responses to laboratory mental stress are associated with poor subsequent cardiovascular risk status: a meta-analysis of prospective evidence. Hypertension. 2010;55:1026–32. Scholar
  33. 33.
    Forcier K, Stroud LR, Papandonatos GD, Hitsman B, Reiches M, Krishnamoorthy J, Niaura R. Links between physical fitness and cardiovascular reactivity and recovery to psychological stressors: a meta-analysis. Health Psychol. 2006;25:723–39. Scholar
  34. 34.
    Jackson EM, Dishman RK. Cardiorespiratory fitness and laboratory stress: a meta-regression analysis. Psychophysiology. 2006;43:57–72. Scholar
  35. 35.
    Dickerson SS, Kemeny ME. Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. Psychol Bull. 2004;130:355–91. Scholar
  36. 36.
    Boutcher SH, Hamer M. Psychobiological reactivity, physical activity and cardiovascular health. In: Acevedo EO, Ekkekakis P, editors. Psychobiology of physical activity. Champaign: Human Kinetics; 2006. p. 161–76.Google Scholar
  37. 37.
    Kirschbaum C, Pirke KM, Hellhammer DH. The ‘Trier Social Stress Test’: a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology. 1993;28:76–81. Scholar
  38. 38.
    Buske-Kirschbaum A, Jobst S, Wustmans A, Kirschbaum C, Rauh W, Hellhammer D. Attenuated free cortisol response to psychosocial stress in children with atopic dermatitis. Psychosom Med. 1997;59:419–26. Scholar
  39. 39.
    von Dawans B, Kirschbaum C, Heinrichs M. The Trier Social Stress Test for Groups (TSST-G): a new research tool for controlled simultaneous social stress exposure in a group format. Psychoneuroendocrinology. 2011;36:514–22. Scholar
  40. 40.
    Allen AP, Kennedy PJ, Dockray S, Cryan JF, Dinan TG, Clarke G. The Trier Social Stress Test: principles and practice. Neurobiol stress. 2017;6:113–26. Scholar
  41. 41.
    Kudielka BM, Hellhammer DH, Kirschbaum C. Ten years of research with the trier social stress test revisited. In: Harmon-Jones E, Winkielman P, editors. Social neuroscience. New York: The Guilford Press; 2007. p. 56–83.Google Scholar
  42. 42.
    Kudielka BM, Hellhammer DH, Wüst S. Why do we respond so differently? Reviewing determinants of human salivary cortisol responses to challenge. Psychoneuroendocrinology. 2009;34:2–18. Scholar
  43. 43.
    Kudielka BM, Kirschbaum C. Sex differences in HPA axis responses to stress: a review. Biol Psychol. 2005;69:113–32. Scholar
  44. 44.
    Hackney AC. Stress and the neuroendocrine system: the role of exercise as a stressor and modifier of stress. Expert Rev Endocrinol Metab. 2006;1:783–92. Scholar
  45. 45.
    Bibbey A, Carroll D, Roseboom TJ, Phillips AC, de Rooij SR. Personality and physiological reactions to acute psychological stress. Int J Psychophysiol. 2013;90:28–36. Scholar
  46. 46.
    Connor-Smith JK, Flachsbart C. Relations between personality and coping: a meta-analysis. J Pers Soc Psychol. 2007;93:1080–107. Scholar
  47. 47.
    Houston JM, Carter D, Smither RD. Competitiveness in elite professional athletes. Percept Mot Skills. 2016;84:1447–54. Scholar
  48. 48.
    Harrison LK, Denning S, Easton HL, Hall JC, Burns VE, Ring C, Carroll D. The effects of competition and competitiveness on cardiovascular activity. Psychophysiology. 2001;38:601–6.CrossRefPubMedCentralPubMedGoogle Scholar
  49. 49.
    Thayer JF, Lane RD. A model of neurovisceral integration in emotion regulation and dysregulation. J Affect Disord. 2000;61:201–16.CrossRefPubMedCentralGoogle Scholar
  50. 50.
    Brosschot JF, Pieper S, Thayer JF. Expanding stress theory: prolonged activation and perseverative cognition. Psychoneuroendocrinology. 2005;30:1043–9. Scholar
  51. 51.
    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097. Scholar
  52. 52.
    Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1. Scholar
  53. 53.
    Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;349:g7647. Scholar
  54. 54.
    Rohleder N, Beulen SE, Chen E, Wolf JM, Kirschbaum C. Stress on the dance floor: the cortisol stress response to social-evaluative threat in competitive ballroom dancers. Pers Soc Psychol Bull. 2007;33:69–84. Scholar
  55. 55.
    Sjörs A, Larsson B, Dahlman J, Falkmer T, Gerdle B. Physiological responses to low-force work and psychosocial stress in women with chronic trapezius myalgia. BMC Musculoskelet Disord. 2009;10:63. Scholar
  56. 56.
    Sommer M, Braumann M, Althoff T, Backhaus J, Kordon A, Junghanns K, et al. Psychological and neuroendocrine responses to social stress and to the administration of the alpha-2-receptor antagonist, yohimbine, in highly trained endurance athletes in comparison to untrained healthy controls. Pharmacopsychiatry. 2011;44:129–34. Scholar
  57. 57.
    Jayasinghe SU, Torres SJ, Hussein M, Fraser SF, Lambert GW, Turner AI. Fitter women did not have attenuated hemodynamic responses to psychological stress compared with age-matched women with lower levels of fitness. PLoS One. 2017;12:e0169746. Scholar
  58. 58.
    Dockray S, Susman EJ, Dorn LD. Depression, cortisol reactivity, and obesity in childhood and adolescence. J Adolesc Health. 2009;45:344–50. Scholar
  59. 59.
    Martikainen S, Pesonen A-K, Lahti J, Heinonen K, Feldt K, Pyhälä R, et al. Higher levels of physical activity are associated with lower hypothalamic–pituitary–adrenocortical axis reactivity to psychosocial stress in children. J Clin Endocrinol Metab. 2013;98:E619–27. Scholar
  60. 60.
    Rimmele U, Seiler R, Marti B, Wirtz PH, Ehlert U, Heinrichs M. The level of physical activity affects adrenal and cardiovascular reactivity to psychosocial stress. Psychoneuroendocrinology. 2009;34:190–8. Scholar
  61. 61.
    Wood CJ, Clow A, Hucklebridge F, Law R, Smyth N. Physical fitness and prior physical activity are both associated with less cortisol secretion during psychosocial stress. Anxiety Stress Coping. 2017. Scholar
  62. 62.
    Wyss T, Boesch M, Roos L, Tschopp C, Frei KM, Annen H, La Marca R. Aerobic fitness level affects cardiovascular and salivary alpha amylase responses to acute psychosocial stress. Sports Med Open. 2016;2:33. Scholar
  63. 63.
    Puterman E, O’Donovan A, Adler NE, Tomiyama AJ, Kemeny M, Wolkowitz OM, Epel E. Physical activity moderates effects of stressor-induced rumination on cortisol reactivity. Psychosom Med. 2011;73:604–11. Scholar
  64. 64.
    Pruessner JC, Kirschbaum C, Meinlschmid G, Hellhammer DH. Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology. 2003;28:916–31. Scholar
  65. 65.
    Hellhammer DH, Wüst S, Kudielka BM. Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology. 2009;34:163–71. Scholar
  66. 66.
    Levine A, Zagoory-Sharon O, Feldman R, Lewis JG, Weller A. Measuring cortisol in human psychobiological studies. Physiol Behav. 2007;90:43–53. Scholar
  67. 67.
    Wolfram M, Bellingrath S, Feuerhahn N, Kudielka BM. Cortisol responses to naturalistic and laboratory stress in student teachers: comparison with a non-stress control day. Stress Health. 2013;29:143–9. Scholar
  68. 68.
    Campbell J, Ehlert U. Acute psychosocial stress: does the emotional stress response correspond with physiological responses? Psychoneuroendocrinology. 2012;37:1111–34. Scholar
  69. 69.
    Roy MP. Patterns of cortisol reactivity to laboratory stress. Horm Behav. 2004;46:618–27. Scholar
  70. 70.
    Zanstra YJ, Johnston DW. Cardiovascular reactivity in real life settings: measurement, mechanisms and meaning. Biol Psychol. 2011;86:98–105. Scholar
  71. 71.
    Gerber M. Sportliche Aktivität und Stressreaktivität: ein Review [Exercise and stress reactivity: a review]. Dt Zs Sportmed. 2008;59:168–74.Google Scholar
  72. 72.
    Lovallo WR. Do low levels of stress reactivity signal poor states of health? Biol Psychol. 2011;86:121–8. Scholar
  73. 73.
    Phillips AC, Ginty AT, Hughes BM. The other side of the coin: blunted cardiovascular and cortisol reactivity are associated with negative health outcomes. Int J Psychophysiol. 2013;90:1–7. Scholar
  74. 74.
    de Geus EJC, Stubbe JH. Aerobic exercise and stress reduction. In: Fink G, editor. Encyclopedia of stress. 2nd ed. New York: Academic Press; 2007. p. 73–8.CrossRefGoogle Scholar
  75. 75.
    Armbruster D, Mueller A, Strobel A, Lesch K-P, Brocke B, Kirschbaum C. Predicting cortisol stress responses in older individuals: influence of serotonin receptor 1A gene (HTR1A) and stressful life events. Horm Behav. 2011;60:105–11. Scholar
  76. 76.
    Kajantie E, Phillips DIW. The effects of sex and hormonal status on the physiological response to acute psychosocial stress. Psychoneuroendocrinology. 2006;31:151–78. Scholar
  77. 77.
    Kirschbaum C, Kudielka BM, Gaab J, Schommer NC, Hellhammer DH. Impact of gender, menstrual cycle phase, and oral contraceptives on the activity of the hypothalamus–pituitary–adrenal axis. Psychosom Med. 1999;61:154–62.CrossRefPubMedGoogle Scholar
  78. 78.
    Hollanders JJ, van der Voorn B, Rotteveel J, Finken MJJ. Is HPA axis reactivity in childhood gender-specific? A systematic review. Biol Sex Differ. 2017;8:23. Scholar
  79. 79.
    Lustyk MKB, Olson KC, Gerrish WG, Holder A, Widman L. Psychophysiological and neuroendocrine responses to laboratory stressors in women: implications of menstrual cycle phase and stressor type. Biol Psychol. 2010;83:84–92. Scholar
  80. 80.
    Glynn LM, Christenfeld N, Gerin W. The role of rumination in recovery from reactivity: cardiovascular consequences of emotional states. Psychosom Med. 2002;64:714–26. Scholar
  81. 81.
    Linden W, Earle TL, Gerin W, Christenfeld N. Physiological stress reactivity and recovery: conceptual siblings separated at birth? J Psychosom Res. 1997;42:117–35. Scholar
  82. 82.
    Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to meta-analysis. Chichester: Wiley; 2009.CrossRefGoogle Scholar
  83. 83.
    Boutcher SH. Physical activity and stress reactivity. Oxford: Oxford University Press; 2017.CrossRefGoogle Scholar
  84. 84.
    Hoogendoorn WE, van Poppel MNM, Bongers PM, Koes BW, Bouter LM. Systematic review of psychosocial factors at work and private life as risk factors for back pain. Spine. 2000;25:2114–25. Scholar
  85. 85.
    Roozendaal B, McEwen BS, Chattarji S. Stress, memory and the amygdala. Nat Rev Neurosci. 2009;10:423–33. Scholar
  86. 86.
    Fuchs R, Klaperski S, Gerber M, Seelig H. Messung der Bewegungs- und Sportaktivität mit dem BSA-Fragebogen. Zs Gesundheitspsychol. 2015;23:60–76. Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Division of Sport and Psychosocial Health, Department of Sport, Exercise and HealthUniversity of BaselBaselSwitzerland
  2. 2.Division of Sport and Health Pedagogy, Department of Sport, Exercise and HealthUniversity of BaselBaselSwitzerland

Personalised recommendations