The Journal for Nurse Practitioners
Volume 5, Issue 6 , Pages 408-413, June 2009

The Effects of Exercise on Stress in Working Women

  • Patricia A. Coulter

      Affiliations

    • Patricia A. Coulter, MSN, ANP, is an adult nurse practitioner at Jeanie Schmidt Free Clinic in Herndon, VA.
    • ,
  • Kathy Dickman

      Affiliations

    • Kathy Dickman, MSN, CFNP, is a family nurse practitioner at the same clinic and an instructor in the nurse practitioner program at George Mason University in Fairfax, VA.
    • ,
  • Ann Maradiegue

      Affiliations

    • Ann Maradiegue, PhD, MSN, BC-FNP, is an assistant professor at George Mason University.

Article Outline

Abstract 

Working women distribute their time between career and family, leaving little time and energy for personal health. Proven links exist between chronic stress and disease, which can be alleviated through regular exercise. Focused efforts by employers and advanced practice nurses can promote exercise as an effective tool to reduce stress, resulting in disease prevention and reduced health care costs. The coaching model is proposed as a method for health care professionals to encourage working women to develop a daily physical activity plan.

Keywords:  counseling , effects , exercise , sedentary lifestyle , stress , stressors , women , working mothers

 

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Introduction 

Workplace pressure that becomes excessive or unmanageable leads to stress.1 Although increased levels of stress can help motivate people to achieve incredible feats, chronic or traumatic stress is destructive and can lead to physical and mental health disorders.2 Continued stress can compromise health and the ability to function effectively. One third of Americans are living with extreme stress and 48% of Americans believe that their stress has increased over the past 5 years.3

To reduce the effects of stress and promote health, the U.S. Preventive Services Task Force recommends regular physical activity.4 About 23% of adults in the United States report regular, vigorous physical activity that involves large muscle groups in dynamic movement for 20 minutes or longer 3 or more days per week.5 An additional 15% of adults report physical activity for 5 or more days per week for 30 minutes or longer, and another 40% do not participate in any regular physical activity.5 Healthy People 2010 asserts that approximately 43% of women are not involved in physical activity, and research suggests that moderate physical activity can have significant health benefits, including stress relief.5

Stress reduction is important to managing and reducing many health problems.5 While there are various lifestyle and coping strategies for reducing stress, such as socialization, meditation, and leisure time, exercise is a natural means to have a positive effect on health. Integrating exercise into working women's daily routine is a crucial step toward prevention of health problems and improved lifestyle. This article examines the effects of stress on working women and the benefits of exercise in reducing tension and stress-related illnesses.

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Literature Review 

A search was conducted for articles evaluating exercise, stress, and the working woman. The data bases CINAHL, Pub-Med, OVID, Pro-Quest, Medline, and ERIC were searched with the key words: exercise, stress and stressors, counseling, effects, working mothers, and sedentary lifestyle.

Over the past several decades, women's participation in the labor force has increased, particularly among married women with children.6 Currently, participation of women in the labor force is at 46.3%.7 More women are projected to enter the workforce, and proactive measures to reduce stress and to promote preventive health care strategies will have a better end result for employers and families.

A 2006 survey, conducted by the American Psychological Association, found that stress affects more women than men.8 In the United States, female workers accounted for the majority of stress-related cases during 1992-2001.9 Stress has reached epidemic proportions, with approximately 80% of all non-traumatic deaths caused by a stress-related illness.2 A survey in the new European Member States found that 90% of the respondents thought that stress is a major cause of disease in their countries.10 A Scandinavian study reported women perceived themselves to have a higher level of stress than men.11

Job stressors are objective conditions in the work environment that tax an individual's emotional, physical, and cognitive stores, potentially leading to health problems.12 In the workplace, these stressors facilitate a response people may have when presented with work demands and pressures that are not matched to their knowledge and abilities and challenge their ability to cope.1 Stress can lead to reduced work effectiveness and ultimately increased employment absenteeism, health compromise, increased health expenses, and decreased income. Annual costs to U.S. employers for lost productive time amount to over $250 billion.13

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Stress 

Stress is a risk factor for a variety of illnesses, ranging from metabolic and cardiovascular disorders to mental illness.14 Stress can be compounded by family life, workplace environment, and the social arena whenever the human body attempts to defend itself. The stress response is the body's natural defense mechanism to life's challenges.15 Each individual responds to stress differently and this response is based on the severity of the stressor. What is perceived as stressful to one individual may be considered insignificant to another individual. The manner in which a person responds to stress is central to their overall sense of well-being.

A short-term stress response is normal during a crisis situation, such as a threat to a person's life. In times of crisis, an increase in cardiac perfusion and respiratory rate occur to provide oxygen and nutrients to the brain and other stressed sites. Fuel to the aroused brain triggers more focused attention to react appropriately to the stressor, causing the “fight or flight” response.2, 16 Flushed face, sweating, vomiting, and diarrhea are common responses to stress. At the end of a stressful event, the body returns to a resting state with no further demands to the body's defenses.

Chronic stress has been associated with health-related illnesses including suppressed immunity, elevated blood glucose levels, hyperlipidemia, and atherosclerosis, leading to the risk for heart disease, diabetes, and an accelerated aging process.17 Improper stress response may have adverse consequences on physiologic functions, such as growth, metabolism, circulation, reproduction, psychiatric, and inflammatory/immune response.16

Inadequate or excessive and/or prolonged physiologic response to stress can affect personality development and behavior. Currently in the U.S. population, due to workplace, lifestyle, and family demands, chronic stress is not uncommon, which can lead to illness and affect daily functioning. The demands of modern life, along with poor eating habits and a sedentary lifestyle, affect the activation of the stress system. Prolonged stress has hazardous, even lethal effects on the body, increasing risk of obesity, heart disease, depression, and a variety of other illnesses.18 Symptoms of chronic stress usually include difficulty sleeping, changes in appetite, prolonged healing time, muscle tenderness and soreness, susceptibility to viral infections, and feelings of sadness or worthlessness.19

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Working Women 

Women's stress levels are greater when employment hours are longer and there are heavier job responsibilities.20 Combined with family responsibilities, working women are more prone than their male counterparts to home-related pressures and the negative impact on quality of life and health outcomes.21 Longer employment hours and home-related pressures weigh heavily on the working woman. Health care professionals need to be sensitive to the high stress levels and the potential detriment to the health of their female patients.

Women with multiple roles of wife, mother, and employee balance family and social relationships as well as career choices. Stress is compounded within these roles when working women are responsible for managing professional and family decisions. The term “second shift phenomenon” describes the workload working mothers' confront once their own career day is over — combining parenthood with paid employment.22 Significant time is spent on caring for family and performing household chores. The increase in work demand can lead to feeling of loss of control, social withdrawal, irritability, and anger, feelings of inferiority, depression, and stress. Single mothers experience the same stress when dealing with everyday challenges, except to a greater degree.20

The workplace environment can impact employee morale and potentially job performance. Employee burn-out leads to performance levels that are often unacceptable to both the employee and employer.23 Stress can be circular, with job stress leading to anxiety, obesity, and depression, resulting in a change in activity level and eating patterns.12

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Sedentary Behavior 

More women have a sedentary lifestyle than men.5 Healthy People 2010 report that women, more than men, report no regular exercise routine. This is especially prevalent among African-American and Hispanic women. Also, as women age, their activity levels decline.5

Sedentary behavior contributes to an increase in obesity and with obesity comes associated health problems.24 According to the Centers for Disease Control (CDC), overweight individuals are at risk for hypertension, osteoarthritis, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, sleep apnea, respiratory problems, forms of cancer, and reproductive disorders in women.25 Working women need to recognize how exercise favorably affects multiple systems, including reducing the risk for obesity, preventing disease, and decreasing stress.

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Benefits of Exercise 

Regular exercise has been shown to reduce stress, anxiety, and depression.26 Incorporating exercise training into a regular daily regimen is associated with a decreased risk for many of the diseases linked to chronic stress.27 Women who exercised expressed feelings of mental well-being and the immediate easing of personal stress levels.28 Evidence indicates that a single bout of activity can improve mood and sleep quality, as well as positively affect a sense of mental well-being.29 Accordingly, an important variable in employee satisfaction and motivation is health and fitness.23 Considering the health benefits of exercise, it is important to understand why more women are not exercising as a means of reducing stress and improving overall health.

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Barriers and Recommendations 

Research has shown that the most common barriers to exercise are time and energy.30 Tending to family and professional careers leaves little time for working women to focus on personal health. The first step toward resolving this dilemma is acknowledging that there is a relationship between stress and personal health. Understanding poor health outcomes of chronic stress is a strong motivator to change. If more working women understood the effects of stress on their health, the time factor may be overcome as a prime consideration in delaying exercise therapy.

Recommendations for overcoming stress-reduction barriers have been identified in previous research.8, 19, 21, 28, 31 Structured programs with personal attention and encouragement motivates women toward participation.31 Because time is a primary barrier for working women, starting out slowly and gradually increasing the frequency and duration of physical activity is the key to successful behavior change.5

Integrating an incentive program designed to meet specific exercise targets is a positive approach that can motivate change. Employee incentives can include time off from work, free childcare, gift certificates for logging in miles walked, reduced insurance costs, or having a housekeeper for a day. Healthy People 2010 suggest employers design employee benefit packages that include coverage for fitness club membership fees and community-based fitness classes.5

Companies that encourage physical fitness provide motivation for their employees to participate in health promotion measures and understand the importance of exercise on time management, health promotion, cost effectiveness and job retention. As working women continue to have more time constraints in the home setting, incorporating exercise at work is vital for their overall well-being.

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Nurse Practitioner's Role 

Nurse practitioners (NPs) play a central role in educating women on health and fitness issues. Physical activity counseling has been shown to have a positive effect on the motivation to exercise.32 Recent studies recommend NPs use a different kind of communication to motivate patients.33 The coaching model is suggested to encourage behavioral change. The term “coach” is meant to emphasize the role of the NP as a facilitator of a process rather than monitor of minimal performance standards.34 In other words, for the NP to effectively counsel on physical activity, he/she should assume various roles to assist the client in becoming an “independent, creative, self-supervising learner.”34

All women should be routinely screened for physical activity. An exercise screening questionnaire can be developed and, to save time, completed by the patient before seeing the NP. This physical screening tool can eventually be incorporated into the patient's electronic medical records for easy access by the NP.

This initial assessment guides the NP in developing a plan, including an individualized exercise program. A fact sheet can be made available to each patient covering fundamental exercise routines; these fact sheets will include space to develop individual exercise requirements and calendar. Assessing for supportive networks, accountability partners, nutritional screening, and motivation for change aid in the screening process as well.

Women should engage in moderate physical activity for at least 30 minutes per day. Weekly physical activity resulting in the expenditure of 1000 calories translates into a weight loss of roughly one-sixth to one-third pound per week and has significant health benefits, especially for persons who are sedentary.5 Choosing activities that best fit into a working woman's schedule creates a program that is attainable, relevant and timely. Basic suggestions include:

•Walk during work breaks

•Walk or bike to and from work

•Park farther away from job entrance site

•Use stairs instead of elevators

•Have an accountability partner to ensure motivation and completion of exercise tasks

•Use a pedometer to log miles walked

NPs should keep in mind that working women have the added burden of childcare expense in the home setting. Without arranging adequate childcare, they may not have the opportunity to tend to their personal health. Knowing local support groups and resources can provide the means necessary toward successful change. A supportive network of working mothers, family members, and friends encourages opportunities for exercising.

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Case Study 

Rachel is a 34-year-old paralegal who starts her day at 6 in the morning by waking her 2 boys and preparing them for preschool. She begins her workday at 8 AM and works between 8 and 10 hours, never leaving work before her boss. Once home, she prepares dinner for her family, cleans the kitchen, bathes her 2 boys, puts them to bed, then tidies up around her house before she organizes her next day's schedule. She notices her weight is steadily rising and she is always tired. Rachel is a prime example of how working women, especially working mothers, juggle career and home life. Rachel's recurrent stress has long-term physiological implications for her health that can be measured in her physiologic response.

Rachel works 8 to 10 hours per day before assuming her responsibilities as a mother and housewife, with little time left over to care for herself. The NP assists Rachel in developing a comprehensive healthy lifestyle plan by first reviewing her exercise screening questionnaire. In keeping with the coaching model, the NP explores the issues that prevent Rachel from engaging in health-promoting behaviors and the important considerations when evaluating an intervention.35 The NP keeps in mind that Rachel is the expert about her own life and has the answers to her own life questions. The NP's role, as a coach, is to assist Rachel in accessing the answers.35

Establishing an effective NP-client relationship is crucial for positive change. As a coach, the NP needs to practice self-management, which requires putting aside personal beliefs and respecting the client's ideas.35 The expression used in this method is “staying over there” right with the client and his/her perspective.35

First, the NP establishes whether Rachel desires to become physically fit and whether she places value on taking the initiative to change. Taking the time to explore what is important to Rachel provides an opportunity for the coach to honor Rachel's values.35 Rachel needs to choose activities that she determines will promote change and is included in the decision-making process as part of the coaching technique. A short-term goal for Rachel may be walking 20 minutes/day, 3 times/week. Increasing to 30 minutes daily is a long-term goal. Women should include muscular strength, endurance, and flexibility training. Examples of these activities include weight training, resistance activities using elastic bands or dumbbells, and stretching exercises, such as static stretching, yoga, or T'ai Chi Chuan.5 Rachel's exercise program is specific, measurable, and attainable to promote positive change and is organized in her fact sheet as a guide for her to follow.

The coach is responsible for encouraging the client. If Rachel is hesitant to continue with her exercise regime, the NP cheers her on. Championing by a coach requires supporting clients when they are hesitant about their abilities.35 The coach's role challenges a client to engage in his or her desired behavior; champion the client, reminding him/her of past successes, reflecting on why the client can succeed and nudging them forward into action. Rachel agrees to follow-up monthly at the office and to report her progress with weekly e-mails. The NP acknowledges Rachel's efforts.

Monitoring and evaluating are key components to a successful exercise program. The tools discussed in this case study offer positive reinforcement and aid in promoting change.

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Conclusion 

Working women often forgo their own health needs to provide for the needs of their family. Sedentary behavior, due to job requirements plus consumption of high-fat foods, increases the risk for stress-induced illnesses. Over time, this pattern can lead to feelings of depression, stress, fatigue and, ultimately, compromised health. Considering the work environment and “second-shift phenomenon,” finding the time to exercise and relieve stress is critical for working women to function at an optimal level.

All health care practitioners have a responsibility to assist women to identify stress as well as educate them on a healthier lifestyle. In doing so, it is essential to bear in mind that each woman requires an individualized exercise program. Due to time constraints during the initial visit, it may be necessary to schedule a subsequent visit to discuss exercise management. Time constraints and lifestyle challenges may also impede regular follow-up office visits; in these instances, the NP can reinforce behavior in the patient's goals through e-mail and phone calls. Consistent, regular exercise is a significant intervention to healthy outcomes, and educating working women to maintain lifelong healthy choices should be at the forefront of health care change. Assisting working women to overcome personal barriers is a part of ensuring overall care.

Nurses are challenged to define the standard for practice as they become more intimately involved in the field of workplace health promotion and wellness.36 It is important for advanced practice nurses to keep abreast of current policy issues regarding preventive health measures and to adequately educate and implement change as new standards for practice arise. Collaboration between nurses, policymakers, and employers can aid in implementing preventive health measures, especially exercise programs for working women in the workplace setting. Consequently, health care costs will be decreased by diminishing the risk for illness, and ultimately improving health and well-being of women in the workforce.

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References 

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 CE credit is available online without charge at www.npjournal.com or by mail for $10 per credit hour.In compliance with national ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.

PII: S1555-4155(08)00306-1

doi:10.1016/j.nurpra.2008.05.008

The Journal for Nurse Practitioners
Volume 5, Issue 6 , Pages 408-413, June 2009

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