Universidade Federal de São Paulo, Dept Prevent Med, Ctr Mindfulness & Hlth Promot, São Paulo, BrazilWashington Univ, Sch Med, Div Cardiol, Heart Rate Variabil Lab, St Louis, MO USAUniversidade Federal de São Paulo, Dept Prevent Med, Ctr Mindfulness & Hlth Promot, São Paulo, BrazilWeb of Scienc

Demarzo, Marcelo Marcos Piva

Stein, Phyllis K.

English

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Marcelo Marcos Piva Demarzo

Phyllis K. Stein

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Frontiers in Physiology

Mental Stress and Exercise Training Response: Stress-sleep Connection may be Involved

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Demarzo, Marcelo Marcos Piva [UNIFESP]

Repositório Institucional UNIFESP

General Commentarypublished: 06 June 2012doi: 10.3389/fphys.2012.00178Mental stress and exercise training response: stress-sleep connection may be involvedMarcelo Marcos Piva Demarzo1* and Phyllis K. Stein 21 Department of Preventive Medicine, Center for Mindfulness and Health Promotion, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil2 Division of Cardiology, Heart Rate Variability Laboratory, Washington University School of Medicine, Saint Louis, MO, USA*Correspondence: marcelokele@yahoo.com.br2011). For this reason, as previously pointed by other investigators (Lonsdale et al., 2009; Birrer and Morgan, 2010; Kristiansen and Roberts, 2010), we also believe that psycho-logical skills training will be progressively more relevant in future athletic training, with a special focus on balancing self-deter-mined motivation, psychological demands, skills and techniques, social support, and a good coach-athlete relationship in order to optimally enhance performance.REFERENCESAzboy, O., and Kaygisiz, Z. (2009). Effects of sleep depri-vation on cardiorespiratory functions of the runners and volleyball players during rest and exercise. Acta Physiol. Hung. 96, 29–36.Bambaeichi, E., Reilly, T., Cable, N. T., and Giacomoni, M. (2005). Influence of time of day and partial sleep loss on muscle strength in eumenorrheic females. Ergonomics 48, 1499–1511.Basishvili, T., Eliozishvili, M., Maisuradze, L., Lortkipanidze, N., Nachkebia, N., Oniani, T., Gvilia, I., and Darchia, N. (2011). Insomnia in a displaced population is related to war-associated remembered stress. Stress Health. doi: 10.1002/smi.1421. [Epub ahead of print].Birrer, D., and Morgan, G. (2010). Psychological skills training as a way to enhance an athlete’s performance in high-intensity sports. Scand. J. Med. Sci. Sports 20(Suppl. 2), 78–87.Dattilo, M., Antunes, H. K., Medeiros, A., Mônico Neto, M., Souza, H. S., Tufik, S., and de Mello, M. T. (2011). Sleep and muscle recovery: endocrinological and molecular basis for a new and promising hypothesis. Med. Hypotheses 77, 220–222.Dattilo, M., Antunes, H. K., Medeiros, A., Mônico-Neto, M., Souza Hde, S., Lee, K. S., Tufik, S., and de Mello, M. T. (2012). Paradoxical sleep deprivation induces muscle atrophy. Muscle Nerve 45, 431–433.Dorrian, J., Paterson, J., Dawson, D., Pincombe, J., Grech, C., and Rogers, A. E. (2011). Sleep, stress and compen-satory behaviors in Australian nurses and midwives. Rev. Saude. Publica 45, 922–930.Erlacher, D., Ehrlenspiel, F., and Schredl, M. (2011). Frequency of nightmares and gender significantly predict distressing dreams of German athletes before competitions or games. J. Psychol. 145, 331–342.Fietze, I., Strauch, J., Holzhausen, M., Glos, M., Theobald, C., Lehnkering, H., and Penzel, T. (2009). Sleep quality in pro-fessional ballet dancers. Chronobiol. Int. 26, 1249–1262.Heffner, K. L., Ng, H. M., Suhr, J. A., France, C. R., Marshall, G. D., Pigeon, W. R., and Moynihan, J. A. (2012). Sleep disturbance and older adults’ inflam-Sleep is widely known to be an impor-tant component of recovery from train-ing (Leeder et al., 2012) and new data continue to elucidate the association between sleep disturbances and muscle pathophysiology. For example, Dattilo et al. (2011) hypothesized that sleep debt could, paradoxically, provoke loss of muscle mass after damage induced by exercise, hindering muscle recovery. The same research group (Dattilo et al., 2012) showed in an animal model that sleep deprivation induces a catabolic hor-mone profile (enhanced plasma corticos-teroids and reduced serum testosterone levels) leading to muscle atrophy. Studies in athletes also have demonstrated simi-lar results, showing that sleep deprivation is associated with reductions in: muscle glycogen and sprint performance per-ceptual stress (Skein et al., 2011); exer-cise performance by decreasing exercise minute ventilation and time to exhaus-tion (Azboy and Kaygisiz, 2009); anaer-obic performance (Souissi et al., 2008; Taheri and Arabameri, 2012); and with enhance sports-related overtraining and acute injuries (Luke et al., 2011). Those data cannot be directly extrapolated to the general population, but is reasonable to expect that some similar processes are occurring.Finally, the stress-sleep-training response connection has potential implication for ath-letic performance and should be addressed by coaches and researchers. Symptoms of chronic stress, sleep disturbances, burnout, depression, anxiety, overtraining, and addic-tion are prevalent among athletes (Fietze et al., 2009; Lonsdale et al., 2009; Resch, 2010). Further, athletes showed poorer markers of sleep quality than a matched non-athletic control group (Leeder et al., 2012), and disrupted sleep and disturbed dreaming are common forms of sleep deprivation in athletes the night before important competi-tions (Bambaeichi et al., 2005; Erlacher et al., A commentary onSelf rated mental stress and exercise train-ing response in healthy subjectsby Ruuska, P. S., Hautala, A. J., Kiviniemi, A. M., Mäkikallio, T. H., and Tulppo, M. P. (2012).  Front. Physio. 3:51. doi: 10.3389/fphys.2012.00051Ruuska et al. (2012) showed that individual responses to exercise training may vary as a function of the baseline self-rated men-tal stress among healthy volunteers after a highly controlled aerobic training interven-tion. The changes in fitness were poor or absent in the subjects who reported their psychological resources as low and reported having a lot of stressors in their lives prior to the intervention. The authors presented some potential mechanisms that could explain their findings, highlighting the role of stress-related hormonal changes in the training response. Our brief comment aims to contribute to the discussion by adding a complementary explanation that could help to clarify these interesting findings. Our hypothesis is that the connection between sleep disturbance and mental stress could also be involved in the results from Ruuska et al. (2012).It is well known that sleep quantity and quality are associated with mental stress and vice versa (Basishvili et al., 2011; Dorrian et al., 2011; Heffner et al., 2012; Kachikis and Breitkopf, 2012; Kashani et al., 2012). Thus, it is possible that sleep deprivation lowers the psychological threshold for the per-ception of stress from cognitive demands (Minkel et al., 2012). Recently, Kashani et al. (2012) suggested that the stress-sleep con-nection may be an important mechanistic mediator of the association between stress and cardiovascular disease. In the same way, we hypothesize that stress-sleep connection may be an important mechanism in the relationship between mental stress and the exercise training response.www.frontiersin.org June 2012 | Volume 3 | Article 178 | 1M., Philpott, J., and Smith, A. (2011). Sports-related injuries in youth athletes: is overscheduling a risk fac-tor? Clin. J. Sport Med. 21, 307–314.Minkel, J. D., Banks, S., Htaik, O., Moreta, M. C., Jones, C. W., McGlinchey, E. L., Simpson, N. S., and Dinges, D. F. (2012). Sleep deprivation and stressors: evi-dence for elevated negative affect in response to mild stressors when sleep deprived. Emotion. [Epub ahead of print].Resch, M. (2010). The psychological factors affecting athletic performance. Orv. Hetil. 151, 815–821.Ruuska, P. S., Hautala, A. J., Kiviniemi, A. M., Mäkikallio, T. H., and Tulppo, M. P. (2012). Self-rated mental stress and exercise training response in healthy subjects. Front. Physio. 3:51. doi: 10.3389/fphys.2012.00051Skein, M., Duffield, R., Edge, J., Short, M. J., and Mündel, T. (2011). Intermittent-sprint performance and mus-cle glycogen after 30 h of sleep deprivation. Med. Sci. Sports Exerc. 43, 1301–1311.Souissi, N., Souissi, M., Souissi, H., Chamari, K., Tabka, Z., Dogui, M., and Davenne, D. (2008). Effect of time matory responses to acute stress. Am. J. Geriatr. Psychiatry. [Epub ahead of print].Kachikis, A. B., and Breitkopf, C. R. (2012). Predictors of sleep characteristics among women in Southeast Texas. Womens Health Issues 22, e99–e109.Kashani, M., Eliasson, A., and Vernalis, M. (2012). Perceived stress correlates with disturbed sleep: a link connecting stress and cardiovascular disease. Stress 15, 45–51.Kristiansen, E., and Roberts, G. C. (2010). Young elite ath-letes and social support: coping with  competitive and organizational stress in “Olympic” competition. Scand. J. Med. Sci. Sports 20, 686–695.Leeder, J., Glaister, M., Pizzoferro, K., Dawson, J., and Pedlar, C. (2012). Sleep duration and quality in elite athletes measured using wristwatch actigraphy. J. Sports Sci. 30, 541–545.Lonsdale, C., Hodge, K., and Rose, E. (2009). Athlete burnout in elite sport: a self-determination perspec-tive. J. Sports Sci. 27, 785–795.Luke, A., Lazaro, R. M., Bergeron, M. F., Keyser, L., Benjamin, H., Brenner, J., d’Hemecourt, P., Grady, of day and partial sleep deprivation on short-term, high-power output. Chronobiol. Int. 25, 1062–1076.Taheri, M., and Arabameri, E. (2012). The effect of sleep deprivation on choice reaction time and anaerobic power of college student athletes. Asian J. Sports Med. 3, 15–20.Received: 15 May 2012; accepted: 16 May 2012; published online: 06 June 2012.Citation: Demarzo MMP and Stein PK (2012) Mental stress and exercise training response: stress-sleep connec-tion may be involved. Front. Physio. 3:178. doi: 10.3389/fphys.2012.00178This article was submitted to Frontiers in Clinical and Translational Physiology, a specialty of Frontiers in Physiology.Copyright © 2012 Demarzo and Stein. This is an open-access article distributed under the terms of the Creative Commons Attribution Non Commercial License, which permits non-commercial use, distribution, and reproduc-tion in other forums, provided the original authors and source are credited. Piva Demarzo and Stein Training response-stress-sleep connectionFrontiers in Physiology | Clinical and Translational Physiology  June 2012 | Volume 3 | Article 178 | 2

Mental stress and exercise training response: stress-sleep connection may be involved

Phyllis K Stein

Directory of Open Access Journals

General Commentary
published: 06 June 2012
doi: 10.3389/fphys.2012.00178
Mental stress and exercise training response: stress-sleep 
connection may be involved
Marcelo Marcos Piva Demarzo1* and Phyllis K. Stein 2
1 Department of Preventive Medicine, Center for Mindfulness and Health Promotion, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
2 Division of Cardiology, Heart Rate Variability Laboratory, Washington University School of Medicine, Saint Louis, MO, USA
*Correspondence: marcelokele@yahoo.com.br
2011). For this reason, as previously pointed 
by other investigators (Lonsdale et al., 2009; 
Birrer and Morgan, 2010; Kristiansen and 
Roberts, 2010), we also believe that psycho-
logical skills training will be progressively 
more relevant in future athletic training, 
with a special focus on balancing self-deter-
mined motivation, psychological demands, 
skills and techniques, social support, and a 
good coach-athlete relationship in order to 
optimally enhance performance.
REFERENCES
Azboy, O., and Kaygisiz, Z. (2009). Effects of sleep depri-
vation on cardiorespiratory functions of the runners 
and volleyball players during rest and exercise. Acta 
Physiol. Hung. 96, 29–36.
Bambaeichi, E., Reilly, T., Cable, N. T., and Giacomoni, 
M. (2005). Influence of time of day and partial sleep 
loss on muscle strength in eumenorrheic females. 
Ergonomics 48, 1499–1511.
Basishvili, T., Eliozishvili, M., Maisuradze, L., 
Lortkipanidze, N., Nachkebia, N., Oniani, T., Gvilia, 
I., and Darchia, N. (2011). Insomnia in a displaced 
population is related to war-associated remembered 
stress. Stress Health. doi: 10.1002/smi.1421. [Epub 
ahead of print].
Birrer, D., and Morgan, G. (2010). Psychological skills 
training as a way to enhance an athlete’s performance 
in high-intensity sports. Scand. J. Med. Sci. Sports 
20(Suppl. 2), 78–87.
Dattilo, M., Antunes, H. K., Medeiros, A., Mônico Neto, 
M., Souza, H. S., Tufik, S., and de Mello, M. T. (2011). 
Sleep and muscle recovery: endocrinological and 
molecular basis for a new and promising hypothesis. 
Med. Hypotheses 77, 220–222.
Dattilo, M., Antunes, H. K., Medeiros, A., Mônico-Neto, 
M., Souza Hde, S., Lee, K. S., Tufik, S., and de Mello, 
M. T. (2012). Paradoxical sleep deprivation induces 
muscle atrophy. Muscle Nerve 45, 431–433.
Dorrian, J., Paterson, J., Dawson, D., Pincombe, J., Grech, 
C., and Rogers, A. E. (2011). Sleep, stress and compen-
satory behaviors in Australian nurses and midwives. 
Rev. Saude. Publica 45, 922–930.
Erlacher, D., Ehrlenspiel, F., and Schredl, M. (2011). 
Frequency of nightmares and gender significantly 
predict distressing dreams of German athletes before 
competitions or games. J. Psychol. 145, 331–342.
Fietze, I., Strauch, J., Holzhausen, M., Glos, M., Theobald, C., 
Lehnkering, H., and Penzel, T. (2009). Sleep quality in pro-
fessional ballet dancers. Chronobiol. Int. 26, 1249–1262.
Heffner, K. L., Ng, H. M., Suhr, J. A., France, C. R., 
Marshall, G. D., Pigeon, W. R., and Moynihan, J. A. 
(2012). Sleep disturbance and older adults’ inflam-
Sleep is widely known to be an impor-
tant component of recovery from train-
ing (Leeder et al., 2012) and new data 
continue to elucidate the association 
between sleep disturbances and muscle 
pathophysiology. For example, Dattilo 
et al. (2011) hypothesized that sleep 
debt could, paradoxically, provoke loss 
of muscle mass after damage induced 
by exercise, hindering muscle recovery. 
The same research group (Dattilo et al., 
2012) showed in an animal model that 
sleep deprivation induces a catabolic hor-
mone profile (enhanced plasma corticos-
teroids and reduced serum testosterone 
levels) leading to muscle atrophy. Studies 
in athletes also have demonstrated simi-
lar results, showing that sleep deprivation 
is associated with reductions in: muscle 
glycogen and sprint performance per-
ceptual stress (Skein et al., 2011); exer-
cise performance by decreasing exercise 
minute ventilation and time to exhaus-
tion (Azboy and Kaygisiz, 2009); anaer-
obic performance (Souissi et al., 2008; 
Taheri and Arabameri, 2012); and with 
enhance sports-related overtraining and 
acute injuries (Luke et al., 2011). Those 
data cannot be directly extrapolated to 
the general population, but is reasonable 
to expect that some similar processes are 
occurring.
Finally, the stress-sleep-training response 
connection has potential implication for ath-
letic performance and should be addressed 
by coaches and researchers. Symptoms of 
chronic stress, sleep disturbances, burnout, 
depression, anxiety, overtraining, and addic-
tion are prevalent among athletes (Fietze 
et al., 2009; Lonsdale et al., 2009; Resch, 
2010). Further, athletes showed poorer 
markers of sleep quality than a matched non-
athletic control group (Leeder et al., 2012), 
and disrupted sleep and disturbed dreaming 
are common forms of sleep deprivation in 
athletes the night before important competi-
tions (Bambaeichi et al., 2005; Erlacher et al., 
A commentary on
Self rated mental stress and exercise train-
ing response in healthy subjects
by Ruuska, P. S., Hautala, A. J., Kiviniemi, 
A. M., Mäkikallio, T. H., and Tulppo, M. P. 
(2012).  Front. Physio. 3:51. doi: 10.3389/
fphys.2012.00051
Ruuska et al. (2012) showed that individual 
responses to exercise training may vary as 
a function of the baseline self-rated men-
tal stress among healthy volunteers after a 
highly controlled aerobic training interven-
tion. The changes in fitness were poor or 
absent in the subjects who reported their 
psychological resources as low and reported 
having a lot of stressors in their lives prior 
to the intervention. The authors presented 
some potential mechanisms that could 
explain their findings, highlighting the role 
of stress-related hormonal changes in the 
training response. Our brief comment aims 
to contribute to the discussion by adding a 
complementary explanation that could help 
to clarify these interesting findings. Our 
hypothesis is that the connection between 
sleep disturbance and mental stress could 
also be involved in the results from Ruuska 
et al. (2012).
It is well known that sleep quantity and 
quality are associated with mental stress and 
vice versa (Basishvili et al., 2011; Dorrian 
et al., 2011; Heffner et al., 2012; Kachikis and 
Breitkopf, 2012; Kashani et al., 2012). Thus, 
it is possible that sleep deprivation lowers 
the psychological threshold for the per-
ception of stress from cognitive demands 
(Minkel et al., 2012). Recently, Kashani et al. 
(2012) suggested that the stress-sleep con-
nection may be an important mechanistic 
mediator of the association between stress 
and cardiovascular disease. In the same way, 
we hypothesize that stress-sleep connection 
may be an important mechanism in the 
relationship between mental stress and the 
exercise training response.
www.frontiersin.org June 2012 | Volume 3 | Article 178 | 1
M., Philpott, J., and Smith, A. (2011). Sports-related 
injuries in youth athletes: is overscheduling a risk fac-
tor? Clin. J. Sport Med. 21, 307–314.
Minkel, J. D., Banks, S., Htaik, O., Moreta, M. C., Jones, 
C. W., McGlinchey, E. L., Simpson, N. S., and Dinges, 
D. F. (2012). Sleep deprivation and stressors: evi-
dence for elevated negative affect in response to mild 
stressors when sleep deprived. Emotion. [Epub ahead 
of print].
Resch, M. (2010). The psychological factors affecting 
athletic performance. Orv. Hetil. 151, 815–821.
Ruuska, P. S., Hautala, A. J., Kiviniemi, A. M., 
Mäkikallio, T. H., and Tulppo, M. P. (2012). Self-
rated mental stress and exercise training response 
in healthy subjects. Front. Physio. 3:51. doi: 10.3389/
fphys.2012.00051
Skein, M., Duffield, R., Edge, J., Short, M. J., and Mündel, 
T. (2011). Intermittent-sprint performance and mus-
cle glycogen after 30 h of sleep deprivation. Med. Sci. 
Sports Exerc. 43, 1301–1311.
Souissi, N., Souissi, M., Souissi, H., Chamari, K., Tabka, 
Z., Dogui, M., and Davenne, D. (2008). Effect of time 
matory responses to acute stress. Am. J. Geriatr. 
Psychiatry. [Epub ahead of print].
Kachikis, A. B., and Breitkopf, C. R. (2012). Predictors 
of sleep characteristics among women in Southeast 
Texas. Womens Health Issues 22, e99–e109.
Kashani, M., Eliasson, A., and Vernalis, M. (2012). 
Perceived stress correlates with disturbed sleep: a 
link connecting stress and cardiovascular disease. 
Stress 15, 45–51.
Kristiansen, E., and Roberts, G. C. (2010). Young elite ath-
letes and social support: coping with  competitive and 
organizational stress in “Olympic” competition. 
Scand. J. Med. Sci. Sports 20, 686–695.
Leeder, J., Glaister, M., Pizzoferro, K., Dawson, J., and 
Pedlar, C. (2012). Sleep duration and quality in elite 
athletes measured using wristwatch actigraphy. J. 
Sports Sci. 30, 541–545.
Lonsdale, C., Hodge, K., and Rose, E. (2009). Athlete 
burnout in elite sport: a self-determination perspec-
tive. J. Sports Sci. 27, 785–795.
Luke, A., Lazaro, R. M., Bergeron, M. F., Keyser, L., 
Benjamin, H., Brenner, J., d’Hemecourt, P., Grady, 
of day and partial sleep deprivation on short-term, 
high-power output. Chronobiol. Int. 25, 1062–1076.
Taheri, M., and Arabameri, E. (2012). The effect of sleep 
deprivation on choice reaction time and anaerobic 
power of college student athletes. Asian J. Sports Med. 
3, 15–20.
Received: 15 May 2012; accepted: 16 May 2012; published 
online: 06 June 2012.
Citation: Demarzo MMP and Stein PK (2012) Mental 
stress and exercise training response: stress-sleep connec-
tion may be involved. Front. Physio. 3:178. doi: 10.3389/
fphys.2012.00178
This article was submitted to Frontiers in Clinical and 
Translational Physiology, a specialty of Frontiers in 
Physiology.
Copyright © 2012 Demarzo and Stein. This is an open-
access article distributed under the terms of the Creative 
Commons Attribution Non Commercial License, which 
permits non-commercial use, distribution, and reproduc-
tion in other forums, provided the original authors and 
source are credited. 
Piva Demarzo and Stein Training response-stress-sleep connection
Frontiers in Physiology | Clinical and Translational Physiology  June 2012 | Volume 3 | Article 178 | 2


accepted: 16

Athlete burnout in elite sport: a self-determination perspective.

Effect of time matory responses to acute stress.

Effects of sleep deprivation on cardiorespiratory functions of the runners and volleyball players during rest and exercise.

Frequency of nightmares and gender significantly predict distressing dreams of German athletes before competitions or games.

Influence of time of day and partial sleep loss on muscle strength in eumenorrheic females.

Insomnia in a displaced population is related to war-associated remembered stress. Stress Health. doi: 10.1002/smi.1421. [Epub ahead of print].

Mental stress and exercise training response: stress-sleep connection may be involved.

of day and partial sleep deprivation on short-term, high-power output.

Paradoxical sleep deprivation induces muscle atrophy.

Perceived stress correlates with disturbed sleep: a link connecting stress and cardiovascular disease.

Piva Demarzo and Stein Training response-stress-sleep connection Frontiers

Predictors of sleep characteristics among women in Southeast Texas.

Psychological skills training as a way to enhance an athlete’s performance in high-intensity sports.

Selfrated mental stress and exercise training response in healthy subjects.

Sleep and muscle recovery: endocrinological and molecular basis for a new and promising hypothesis.

Sleep deprivation and stressors: evidence for elevated negative affect in response to mild stressors when sleep deprived. Emotion. [Epub ahead of print].

Sleep disturbance and older adults’ inflamSleep is widely known to be an important component of recovery from training

Sleep duration and quality in elite athletes measured using wristwatch actigraphy.

Sleep quality in professional ballet dancers.

Sleep, stress and compensatory behaviors in Australian nurses and midwives.

Sports-related injuries in youth athletes: is overscheduling a risk factor?

The effect of sleep deprivation on choice reaction time and anaerobic power of college student athletes.

The psychological factors affecting athletic performance.

Young elite athletes and social support: coping with competitive and organizational stress in “Olympic” competition.

http://doaj.org/search?source=%7B%22query%22%3A%7B%22bool%22%3A%7B%22must%22%3A%5B%7B%22term%22%3A%7B%22id%22%3A%22dd504d6baa4e4017a19a543c1736fb81%22%7D%7D%5D%7D%7D%7D

Mental Stress and Exercise Training Response: Stress-sleep Connection may be Involved

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