regular exercise helps stress management essay

Essay on Stress Management

500 words essay on stress management.

Stress is a very complex phenomenon that we can define in several ways. However, if you put them together, it is basically the wear and tear of daily life. Stress management refers to a wide spectrum of techniques and psychotherapies for controlling a person’s stress level, especially chronic stress . If there is effective stress management, we can help one another break the hold of stress on our lives. The essay on stress management will throw light on the very same thing.

Identifying the Source of Stress

The first step of stress management is identifying the source of stress in your life. It is not as easy as that but it is essential. The true source of stress may not always be evident as we tend to overlook our own stress-inducing thoughts and feelings.

For instance, you might constantly worry about meeting your deadline. But, in reality, maybe your procrastination is what leads to this stress than the actual deadline. In order to identify the source of stress, we must look closely within ourselves.

If you explain away stress as temporary, then it may be a problem. Like if you yourself don’t take a breather from time to time, what is the point? On the other hand, is stress an integral part of your work and you acknowledging it like that?

If you make it a part of your personality, like you label things as crazy or nervous energy, you need to look further. Most importantly, do you blame the stress on people around you or the events surrounding you?

It is essential to take responsibility for the role one plays in creating or maintaining stress. Your stress will remain outside your control if you do not do it.

Strategies for Stress Management

It is obvious that we cannot avoid all kinds of stress but there are many stressors in your life which you can definitely eliminate. It is important to learn how to say no and stick to them.  Try to avoid people who stress you out.

Further, if you cannot avoid a stressful situation, try altering it. Express your feelings don’t bottle them up and manage your time better. Moreover, you can also adapt to the stressor if you can’t change it.

Reframe problems and look at the big picture. Similarly, adjust your standards and focus on the positive side. Never try to control the uncontrollable. Most importantly, make time for having fun and relaxing.

Spend some time with nature, go for a walk or call a friend, whatever pleases you.  You can also try working out, listening to music and more. As long as it makes you happy, never give up.

Get the huge list of more than 500 Essay Topics and Ideas

Conclusion of the Essay on Stress Management

All in all, we can control our stress levels with relaxation techniques that evoke the relaxation response of our body. It is the state of restfulness that is the opposite of the stress response. Thus, when you practice these techniques regularly, you can build your resilience and heal yourself.

FAQ of Essay on Stress Management

Question 1: What is the importance of stress management?

Answer 1: Stress management is very efficient as it helps in breaking the hold which stress has on our lives. Moreover, you can also become happy, healthy and more productive because of it. The ultimate goal should be to live a balanced life and have the resilience to hold up under pressure.

Question 2: Give some stress management techniques.

Answer 2: There are many stress management techniques through which one can reduce stress in their lives. One can change their situation or their reaction to it. We can try by altering the situation. If not, we can change our attitudes towards it. Remember, accept things that you cannot change.

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Exercise: 7 benefits of regular physical activity.

You know exercise is good for you, but do you know how good? From boosting your mood to improving your sex life, find out how exercise can improve your life.

Want to feel better, have more energy and even add years to your life? Just exercise.

The health benefits of regular exercise and physical activity are hard to ignore. Everyone benefits from exercise, no matter their age, sex or physical ability.

Need more convincing to get moving? Check out these seven ways that exercise can lead to a happier, healthier you.

1. Exercise controls weight

Exercise can help prevent excess weight gain or help you keep off lost weight. When you take part in physical activity, you burn calories. The more intense the activity, the more calories you burn.

Regular trips to the gym are great, but don't worry if you can't find a large chunk of time to exercise every day. Any amount of activity is better than none. To gain the benefits of exercise, just get more active throughout your day. For example, take the stairs instead of the elevator or rev up your household chores. Consistency is key.

2. Exercise combats health conditions and diseases

Worried about heart disease? Hoping to prevent high blood pressure? No matter what your current weight is, being active boosts high-density lipoprotein (HDL) cholesterol, the "good" cholesterol, and it decreases unhealthy triglycerides. This one-two punch keeps your blood flowing smoothly, which lowers your risk of heart and blood vessel, called cardiovascular, diseases.

Regular exercise helps prevent or manage many health problems and concerns, including:

• Metabolic syndrome.
• High blood pressure.
• Type 2 diabetes.
• Depression.
• Many types of cancer.

It also can help improve cognitive function and helps lower the risk of death from all causes.

3. Exercise improves mood

Need an emotional lift? Or need to lower stress after a stressful day? A gym session or brisk walk can help. Physical activity stimulates many brain chemicals that may leave you feeling happier, more relaxed and less anxious.

You also may feel better about your appearance and yourself when you exercise regularly, which can boost your confidence and improve your self-esteem.

4. Exercise boosts energy

Winded by grocery shopping or household chores? Regular physical activity can improve your muscle strength and boost your endurance.

Exercise sends oxygen and nutrients to your tissues and helps your cardiovascular system work more efficiently. And when your heart and lung health improve, you have more energy to tackle daily chores.

5. Exercise promotes better sleep

Struggling to snooze? Regular physical activity can help you fall asleep faster, get better sleep and deepen your sleep. Just don't exercise too close to bedtime, or you may be too energized to go to sleep.

6. Exercise puts the spark back into your sex life

Do you feel too tired or too out of shape to enjoy physical intimacy? Regular physical activity can improve energy levels and give you more confidence about your physical appearance, which may boost your sex life.

But there's even more to it than that. Regular physical activity may enhance arousal for women. And men who exercise regularly are less likely to have problems with erectile dysfunction than are men who don't exercise.

7. Exercise can be fun — and social!

Exercise and physical activity can be fun. They give you a chance to unwind, enjoy the outdoors or simply do activities that make you happy. Physical activity also can help you connect with family or friends in a fun social setting.

So take a dance class, hit the hiking trails or join a soccer team. Find a physical activity you enjoy, and just do it. Bored? Try something new, or do something with friends or family.

Exercise to feel better and have fun

Exercise and physical activity are great ways to feel better, boost your health and have fun. For most healthy adults, the U.S. Department of Health and Human Services recommends these exercise guidelines:

Aerobic activity. Get at least 150 minutes of moderate aerobic activity. Or get at least 75 minutes of vigorous aerobic activity a week. You also can get an equal combination of moderate and vigorous activity. Aim to spread out this exercise over a few days or more in a week.

For even more health benefits, the guidelines suggest getting 300 minutes a week or more of moderate aerobic activity. Exercising this much may help with weight loss or keeping off lost weight. But even small amounts of physical activity can be helpful. Being active for short periods of time during the day can add up and have health benefits.

• Strength training. Do strength training exercises for all major muscle groups at least two times a week. One set of each exercise is enough for health and fitness benefits. Use a weight or resistance level heavy enough to tire your muscles after about 12 to 15 repetitions.

Moderate aerobic exercise includes activities such as brisk walking, biking, swimming and mowing the lawn.

Vigorous aerobic exercise includes activities such as running, swimming laps, heavy yardwork and aerobic dancing.

You can do strength training by using weight machines or free weights, your own body weight, heavy bags, or resistance bands. You also can use resistance paddles in the water or do activities such as rock climbing.

If you want to lose weight, keep off lost weight or meet specific fitness goals, you may need to exercise more.

Remember to check with a health care professional before starting a new exercise program, especially if you have any concerns about your fitness or haven't exercised for a long time. Also check with a health care professional if you have chronic health problems, such as heart disease, diabetes or arthritis.

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• AskMayoExpert. Physical activity (adult). Mayo Clinic; 2021.
• Physical Activity Guidelines for Americans. 2nd ed. U.S. Department of Health and Human Services. https://health.gov/our-work/physical-activity/current-guidelines. Accessed June 25, 2021.
• Peterson DM. The benefits and risk of aerobic exercise. https://www.uptodate.com/contents/search. Accessed June 24, 2021.
• Maseroli E, et al. Physical activity and female sexual dysfunction: A lot helps, but not too much. The Journal of Sexual Medicine. 2021; doi:10.1016/j.jsxm.2021.04.004.
• Allen MS. Physical activity as an adjunct treatment for erectile dysfunction. Nature Reviews: Urology. 2019; doi:10.1038/s41585-019-0210-6.
• Tips for starting physical activity. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/weight-management/tips-get-active/tips-starting-physical-activity. Accessed June 25, 2021.
• Laskowski ER (expert opinion). Mayo Clinic. June 16, 2021.

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The Role of Physical Activity in Stress Management: Strategies for a Balanced Lifestyle

Tuesday, May 9, 2023 | Activity , Lifestyle

Stress is an inevitable part of life, and while it can be a motivator, it can also have negative impacts on both physical and mental health. In fact, chronic stress has been linked to a number of health conditions, including anxiety, depression, heart disease, and obesity. Physical activity is an effective way to reduce stress and can help individuals achieve a balanced lifestyle . This article will explore the role of physical activity in stress management and provide strategies for incorporating physical activity into a busy lifestyle.

Understanding the role of physical activity in stress management

Other lifestyle factors that impact stress management, physical activities beneficial for stress management, strategies for incorporating physical activity into a busy lifestyle, precautions.

Physical activity can have a significant impact on stress levels. Stress is a natural response to the challenges and demands of life, and it can be beneficial in small doses. However, chronic stress can have negative effects on both physical and mental health. Here’s how physical activity can help:

• Reduces stress hormones: Physical activity can reduce the levels of stress hormones, such as cortisol and adrenaline, in the body. This can help to lower feelings of anxiety and tension.
• Releases endorphins: Exercise can also stimulate the release of endorphins, which are feel-good chemicals that can improve mood and reduce feelings of pain and stress.
• Improves sleep: Regular physical activity can improve sleep quality, which can help to reduce stress levels.
• Provides a healthy distraction: Physical activity can provide a healthy distraction from stressful thoughts and situations, allowing you to focus on something positive and enjoyable.
• Boosts self-esteem: Regular physical activity can improve self-esteem and confidence, which can help to reduce feelings of stress and anxiety.

It’s important to note that while physical activity can be beneficial in reducing stress, it should not be used as the sole method of managing chronic stress. Other stress management techniques such as relaxation techniques, time management, and social support can also be helpful. As with any new physical activity routine, it’s always best to check with a healthcare provider to ensure it is safe and appropriate for your individual needs.

In addition to physical activity, there are other lifestyle factors that impact stress management. One such factor is sleep. It is important to get enough high-quality sleep, as lack of sleep can increase stress levels and make it harder to manage stress. Strategies for improving sleep quality include establishing a regular sleep schedule, creating a relaxing bedtime routine, and avoiding electronic devices before bed.

Nutrition also plays a role in stress management. A healthy diet can provide the nutrients necessary for the body to manage stress, while a poor diet can worsen stress symptoms. A diet that is high in fruits, vegetables, whole grains, lean proteins, and healthy fats is recommended for stress management.

Mindfulness practices, such as meditation, deep breathing, and yoga, can also help manage stress. Mindfulness involves paying attention to the present moment without judgment, and has been shown to reduce stress and anxiety. Incorporating mindfulness into daily life can be as simple as taking a few deep breaths before a stressful meeting or practicing a few minutes of meditation before bed.

• Aerobic exercise : Aerobic exercise, such as running, cycling, or swimming, can be effective in reducing stress levels. It increases heart rate and circulation, releases endorphins, and helps to clear the mind.
• Yoga : Yoga combines physical postures with deep breathing and relaxation techniques, making it an excellent stress management tool. It can improve flexibility, reduce muscle tension, and calm the mind.
• Tai Chi : Tai Chi is a gentle form of exercise that involves slow, flowing movements and deep breathing. It can help to reduce stress levels, improve balance, and increase overall relaxation.
• Strength training : Strength training can improve overall health and reduce stress levels. It can help to increase muscle mass, boost metabolism, and improve sleep quality.
• Dancing : Dancing can be a fun and enjoyable way to relieve stress. It can also improve mood, increase energy levels, and provide a healthy social outlet.

Any physical activity that you enjoy and that gets you moving can be beneficial for managing stress. It’s important to find activities that you enjoy and that fit into your schedule. Aim for at least 30 minutes of moderate-intensity physical activity most days of the week to reap the benefits of stress reduction.

Incorporating physical activity into a busy lifestyle can be challenging, but it’s essential for weight loss and overall health. Here are some strategies that can help women to integrate physical activity into their busy lives:

• Schedule it in: One of the best ways to ensure that you get physical activity into your busy schedule is to schedule it in. Make it a priority and treat it like an appointment. Block out time in your calendar and stick to it.
• Find activities you enjoy: If you don’t enjoy the type of physical activity you’re doing, you’re less likely to stick with it. Experiment with different activities until you find something you enjoy. It could be anything from dancing to hiking, to swimming or playing a sport.
• Make it social: Exercising with friends or family can make it more enjoyable and hold you accountable. Join a fitness class, or a sports team or find a workout buddy. You can also go for a walk or a hike with a friend. The Healthi app has a bustling community of like-minded individuals that are on varying legs of the same journey. By connecting with them, you can find your own support system that can empathize with you, while also exchanging tips and tricks to stay on track.
• Break it up: Physical activity doesn’t have to be done all at once. You can break it up into smaller chunks throughout the day. For example, take a 10-minute walk during your lunch break, do a 15-minute workout in the morning, and a 15-minute walk after dinner.
• Make it a part of your routine: Incorporating physical activity into your daily routine can make it easier to stick with. For example, take the stairs instead of the elevator, park further away from your destination, or walk or bike to work instead of driving.
• Use technology: The Healthi app doubles as a food journal and a progress tracker, monitoring your intake, while also allowing you to pinpoint areas on which you need to work. Likewise, since it tracks your progress, it can also help highlight what you’re doing well, thereby encouraging you as well. The Healthi app is also an excellent tool to help you stay on track with a balanced diet plan. It will create custom meal plans for you, while also providing you with recipes that you can try to mix things up. To help you make better, more informed food choices, the Healthi app uses BITES – prescribed numerical values to food items – that can also help you monitor your consistency and progress.

While physical activity is generally safe for most people, there are some precautions to keep in mind to prevent injury or other negative effects. Here are some precautions to consider:

• Consult with your healthcare provider: Before starting any new physical activity program, it’s important to consult with your healthcare provider, especially if you have any underlying health conditions or injuries.
• Start slow: If you’re new to physical activity, start with low-intensity exercises and gradually increase the intensity and duration over time. This will help prevent injuries and allow your body to adjust to the new demands.
• Warm-up and cool-down: Always warm up before exercising and cool down afterwards. This can help prevent injury and reduce muscle soreness.
• Stay hydrated: Drink plenty of water before, during, and after physical activity to stay hydrated.
• Wear appropriate clothing and shoes: Wear comfortable, breathable clothing that allows for movement and supportive shoes that fit well.
• Listen to your body: Pay attention to any pain, discomfort, or fatigue during physical activity. Stop or modify the activity if necessary.
• Take rest days: Allow your body to rest and recover between workouts. This can help prevent injuries and improve overall performance.

Physical activity is a key component of a balanced lifestyle and can play an important role in stress management. Incorporating physical activity into a busy schedule may seem challenging, but there are strategies that can make it easier. Additionally, other lifestyle factors, such as sleep, nutrition, and mindfulness, can also impact stress management. By prioritizing physical activity and other healthy habits, individuals can manage stress and improve their overall health and well-being.

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Physical activity, stress reduction, and mood: insight into immunological mechanisms

Affiliation.

• 1 Psychobiology Group, Department of Epidemiology and Public Health, University College London, London, UK. [email protected]
• PMID: 22933142
• DOI: 10.1007/978-1-62703-071-7_5

Psychosocial factors, such as chronic mental stress and mood, are recognized as an important predictor of longevity and wellbeing. In particular, depression is independently associated with cardiovascular disease and all-cause mortality, and is often comorbid with chronic diseases that can worsen their associated health outcomes. Regular exercise is thought to be associated with stress reduction and better mood, which may partly mediate associations between depression, stress, and health outcomes. The underlying mechanisms for the positive effects of exercise on wellbeing remain poorly understood. In this overview we examine epidemiological evidence for an association between physical activity and mental health. We then describe the exercise withdrawal paradigm as an experimental protocol to study mechanisms linking exercise, mood, and stress. In particular we will discuss the potential role of the inflammatory response as a central mechanism.

Publication types

• Research Support, Non-U.S. Gov't
• Affect* / physiology
• Depression / epidemiology*
• Depression / immunology
• Exercise* / physiology
• Exercise* / psychology
• Inflammation / epidemiology
• Inflammation / immunology
• Mental Health
• Mood Disorders / epidemiology*
• Mood Disorders / immunology
• Stress, Psychological / immunology*
• Stress, Psychological / psychology

Grants and funding

• FS/09/049/27874/BHF_/British Heart Foundation/United Kingdom
• RG/10/005/28296/BHF_/British Heart Foundation/United Kingdom

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Articles & Advice > Student Life > Articles

Working Out Your Mental Health: 3 Benefits of Regular Exercise for Students

Enhance your mental health as a student with exercise! Here's a look at why it's important and how working out improves your mental health.

by Kelly Koeppel Author and Digital Marketing Specialist

Last Updated: Jun 24, 2023

Originally Posted: Jun 24, 2023

College life can be a whirlwind of academic pressures, social transitions, and newfound responsibilities—all of which can take a toll on a student’s mental well-being. Amid these challenges, finding time and space to prioritize mental health becomes crucial. When it comes to maintaining good mental health, it’s essential to ensure your mind and body are in sync. By incorporating exercise into your daily routine, you can proactively boost your mental health, alleviate stress, and cultivate a positive mindset to thrive academically and emotionally in college.

Why exercise is important to mental health

Physical activity has been shown to positively affect mental well-being because your mind and body are inextricably linked. Exercise can help alleviate stress, reduce anxiety and depression, and improve overall mood and emotional health. That’s because regular exercise increases the production of endorphins, the body's natural feel-good chemicals. Regular exercise can also help improve the quality of your sleep, which can have a major effect on mental health. In particular, aerobic exercise such as running, cycling, and swimming significantly benefits mental health. These activities increase your heart and breathing rates, thus increasing oxygen delivery to the brain. This boost in oxygen helps improve brain function, leading to better mental clarity and focus.

Exercise can also be a great way to socialize and spend time with friends, which is important for your overall mental health. College students might find that regular exercise helps them expand their social circles and connect with others who share similar interests. Although that leads to one barrier to regular exercise: time management. It's crucial to find an exercise routine that works for you and fits into your busy schedule . This could involve taking a yoga class on campus, joining a sports team, or finding a workout buddy to exercise with regularly. Whatever your chosen activity, it's important to make exercise a regular part of your routine to reap the mental health benefits.

Related: 6 Ways to Live a Healthy Lifestyle in College

Benefits of exercise on your mental health

Exercise is often touted for its many physical benefits, such as weight loss and improved cardiovascular health. But it also has extensive mental health benefits. Here’s a closer look at these positive effects. 

Reduced stress and anxiety levels

Stress and anxiety are common in today's fast-paced world. Many factors can contribute to heightened anxiety levels, including academic pressure, social expectations, financial stress, and more. While there are many strategies for managing stress , regular exercise has been shown to be one of the most effective. Stress and anxiety can also be a detriment to your cognitive functioning if unchecked for too long. Exercising regularly has been shown to improve cognitive function—including memory, attention span, and processing speed—partly due to increased blood flow and oxygen to the brain. In addition to exercise, other lifestyle strategies can help you release some tension, such as eating a healthy diet, getting enough sleep, and practicing mindfulness and relaxation techniques. By paying attention to your physical and mental health in college, you’ll lead a more balanced life and have healthy habits established when you transition to the real world.

Related: Our Best Advice for Dealing With Stress as a Student

More daily energy

One of the most significant benefits of exercise is improved energy levels, which are crucial for staying focused and motivated in school and everyday life. Regular exercise has been shown to improve cardiovascular health and increase blood flow and oxygen to the body and brain. This is especially important for college students who lead demanding lives that leave them feeling drained and fatigued. Aerobic exercise and strength training are good routines to start with . By upping your heart rate and building muscle mass, you can improve your overall physical fitness, which translates into greater stamina and energy throughout the day. Upper-body exercises are also beneficial for students who spend long hours sitting at desks and studying to counteract muscle tension and stiffness.

It's also essential to fuel your body with healthy foods and snacks. Eating a balanced diet that includes plenty of fruits, vegetables, and whole grains gives your body the nutrients it needs to stay energized throughout the day and get through your workouts. Additionally, staying hydrated by drinking plenty of water is crucial for keeping your energy levels high.

Better mood and emotional stability

College life can be both exciting and challenging. For many, it’s the first time living away from home and navigating a new environment. The academic workload can also be overwhelming, making it challenging to balance academics with a social life. All these factors can lead to stress, which we know takes a toll on your mental health —but it also affects your emotional resilience. Regular exercise is an effective way to improve your mood and build emotional resilience; even 30 minutes of moderate exercise daily can make a big difference in how you feel. In addition to releasing endorphins, exercising when stressed teaches you how to release tension through a healthy outlet. It also involves challenging yourself and your abilities, which can help you develop emotional strength and mental toughness. This translates into improved self-esteem, confidence, and body image perception, which you can use in other areas of life such as academic or personal challenges. You can draw upon this newfound resilience to persevere through difficult times.

Practicing mindfulness and meditation is another effective way to build emotional resilience. These practices involve bringing awareness to the present moment and cultivating a non-judgmental attitude toward one's thoughts and emotions. Doing this regularly can help you develop skills for managing difficult emotions and building emotional resilience.

Related: How to Be More Confident Freshman Year of College

These are just a few of the many benefits of exercise for mental health. It's worth noting that everyone's experience with exercise will be different, and it's important to find a type of exercise that you enjoy and feels good to you. As long as you’re having fun and getting your body moving, you’re already on your way to a better mindset.

Need a good exercise routine to get you started? Check out Your Mini Dorm Room Workout right here!

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Home — Essay Samples — Nursing & Health — Physical Exercise — The Effects Of Regular Exercising On Everyday Life

The Effects of Regular Exercising on Everyday Life

• Categories: Physical Exercise

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Published: Apr 2, 2020

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How to Relax in Stressful Situations: A Smart Stress Reduction System

Yekta said can.

1 Computer Engineering Department, Bogazici University, 34342 Istanbul, Turkey; [email protected] (N.C.); [email protected] (D.E.); rt.ude.nuob@yosre (C.E.)

Heather Iles-Smith

2 Leeds Teaching Hospitals NHS Trust/University of Leeds, Leeds LS1 3EX, UK; [email protected]

Niaz Chalabianloo

Javier fernández-Álvarez.

3 General Psychology and Communication Psychology, Catholic University of Milan, 20123 Milan, Italy; [email protected] (J.F.-Á.); [email protected] (C.R.); [email protected] (G.R.)

Claudia Repetto

Giuseppe riva.

Stress is an inescapable element of the modern age. Instances of untreated stress may lead to a reduction in the individual’s health, well-being and socio-economic situation. Stress management application development for wearable smart devices is a growing market. The use of wearable smart devices and biofeedback for individualized real-life stress reduction interventions has received less attention. By using our unobtrusive automatic stress detection system for use with consumer-grade smart bands, we first detected stress levels. When a high stress level is detected, our system suggests the most appropriate relaxation method by analyzing the physical activity-based contextual information. In more restricted contexts, physical activity is lower and mobile relaxation methods might be more appropriate, whereas in free contexts traditional methods might be useful. We further compared traditional and mobile relaxation methods by using our stress level detection system during an eight day EU project training event involving 15 early stage researchers (mean age 28; gender 9 Male, 6 Female). Participants’ daily stress levels were monitored and a range of traditional and mobile stress management techniques was applied. On day eight, participants were exposed to a ‘stressful’ event by being required to give an oral presentation. Insights about the success of both traditional and mobile relaxation methods by using the physiological signals and collected self-reports were provided.

1. Introduction

Stress constitutes a complex process that is activated by a physical or mental threat to the individuals’ homeostasis, comprising a set of diverse psychological, physiological and behavioral responses [ 1 ]. Although it is usually considered a negative response, stress actually constitutes a key process for ensuring our survival. However, when a stress response is repeatedly triggered in the absence of a challenging stimulus, or if there is constant exposure to challenging situations, stress can become harmful. Evidence suggests that, in either of these two contexts, stress is a persistent factor for the development of psycho-pathological conditions [ 2 , 3 ].

When faced with stressful events, people make autonomic and controlled efforts to reduce the negative impact and maximize the positive impact that every specific situation may provoke. Generally, this process is denominated as emotion regulation, formally defined as the process by which individuals can influence what emotions they have, when they have them and how they experience and express those emotions [ 4 ]. It has been suggested that the term emotion regulation can be understood as a broad tag that comprises the regulation of all responses that are emotionally charged, from basic emotions to complex mood states as well as regulation of everyday life [ 5 ].

Failure to address triggers of stress has been shown to lead to chronic stress, anxiety and depression, and attributed to serious physical health conditions such as cardiovascular disease [ 6 ]. The World Health Organization concluded that psychological stress is one of the most significant health problems in the 21st-century and is a growing problem [ 7 ]. There are various interventions to minimize stress based on individual preferences and requirements. Stress management techniques including ancient practices such as Tai Chi [ 8 ] and yoga [ 9 ] as well as other physical activities [ 10 ] are often cited as being helpful in combating stress. Likewise traditional meditation, mindfulness [ 11 ] and cognitive behavioural therapy (CBT) [ 12 ] all have established benefits. These techniques are not applicable in office or social environments, or during most daily routines. Therefore, a smart device based stress management application may be of benefit. Recently, smartphone applications such as Calm, Pause, Heartmath and Sway have been developed for indoor environments. However, these applications are not individualized nor do they include biofeedback and studies that validate their effects are limited [ 13 ].

In this study, we used the stress level detection scheme using physiological signals and added a physical activity based context analyzer. When the user experiences a high stress level, the system suggests appropriate stress reduction methods (traditional or mobile). We further compare the effects of traditional and mobile stress alleviation methods on physiological data of 15 international Ph.D. students (participants) during eight days of training. In addition, 1440 h of physiological signals from Empatica E4 smart bands were collected in this training event. Stress management techniques based on the emotion regulation model of James Gross [ 4 ] were applied to reduce participant stress levels. To the best of our knowledge, this work is the first one suggesting appropriate stress reduction methods based on contextual information and comparing both traditional and mobile stress management interventions in the real-life environment using a commercial smart-band based automatic stress level detection system that eliminates motion artifacts. Using such a system is essential because these offline stress level detection algorithms could be used in real-time biofeedback apps.

Application of our stress level detection algorithm, in a real world context, could allow individuals to receive feedback regarding high stress levels along with recommendations for relaxation methods. Additional continued monitoring may also enable the individual to better understand the effectiveness of any stress reduction methods. However, for our stress detection algorithm to be applied in daily life, the smart device should be unobtrusive (i.e., should not be comprised of cables, electrodes, boards). Our system works on smart-bands which are perfect examples of this type of unobtrusive wearable device.

This paper describes emotion regulation in the context of stress management and how yoga and mindfulness can be used for regulating emotions ( Section 2 ). Methods of detecting stress and analyzing context based on physical activity are described ( Section 3 ) and data are presented related to our method for stress level detection with the use of smart-bands ( Section 4 ). Experimental results and discussion are also presented ( Section 5 ) and we present the conclusions and future works of the study ( Section 6 ).

The major research contributions of this study are the following:

• Developing a physical activity based context analyzer and relaxation method suggestion system
• Comparison of stress reduction methods (mobile mindfulness, traditional mindfulness and yoga) and their effectiveness in the context of stress management with the use of an unobtrusive smartwatch based stress level detection system
• Application of James Gross’s prominent emotion regulation model in the context of stress management and measuring the physiological component with smart bands.

2. Background

2.1. emotion regulation in the context of stress management.

Stress is a normal part of daily life. However, its effects often vary across individuals and despite similar circumstances, some people do not feel under strain while others may be severely affected. Multiple reasons exist for these differences between individuals, including how people perceive reality and how they respond to the numerous stimuli to which they are exposed. When a person believes that a certain situation surpasses their available coping mechanisms, it is referred to as perceived stress. Thus, perceived stress varies from person to person depending on the value that an individual gives to a situation and their self-recognition of the resources to deal with it.

Numerous psychological scientists have investigated perceived stress. Individuals who display a mismatch between contextual demands and perceived resources constantly (rather than during a specific moment in time) are referred to as experiencing chronic stress. Chronic stress has not only been shown to be very relevant in people’s well-being and quality of life, but also important in the appearance and maintenance of several physical and mental diseases [ 14 ].

As a consequence, mounting research has focused on the mechanisms that people implement in order to alleviate the physical and cognitive burden associated with that perceived stress. Coping styles, stress management techniques, self-regulation, or emotion regulation techniques are different labels that define the way people implement certain behavioral, cognitive, or emotional strategies to maintain allosteric load [ 15 ]. In other words, every living organism needs to vary among plasticity and stability in order to survive. Human beings are not the exception to the rule and the complex system that applies to every single person and the necessity of reaching a constant level of regulation permits the individuals to pursue their goals.

Specifically, emotion regulation has been defined as the study of “the processes by which we influence which emotions we have when we have them, and how we experience and express them” [ 4 ]. A large body of evidence has shown that there are very different consequences depending on the effectiveness people achieve to regulate their emotions. Naturally, both at an implicit or explicit level, people regulate emotions in order to maintain those allosteric levels previously mentioned. Therefore, when there are specific stressors that demand a particular cognitive or physical response, the emotional reactivity may be stronger and the need for a proper regulation more relevant. Indeed, emotion regulation has shown to be a transdiagnostic factor that is present at a wide range of mental disorders. In other words, the way people initiate, implement and monitor their emotional processes, in order to reach more desirable states, has a significant impact on the stress levels. Some emotion regulation (ER) strategies have shown to be correlated with mental health issues. Among these strategies, cognitive reappraisal, problem-solving, or acceptance shall be mentioned as strategies that are negatively correlated with psychopathology, while rumination, experiential avoidance, or suppression are positively correlated with psychopathology [ 16 ]. In this regard, hinging on the different ER strategies deployed, ER can constitute a protective factor to face stress responses that all individuals experience after minor or major stressors [ 17 ]. Additionally, an adaptive regulation of emotions, by managing stress, may also be beneficial for clinical populations, such as people suffering from affective disorders [ 18 , 19 ].

Therefore, from whole psychotherapeutic treatments to single self-applied applications, studies in the literature have focused on how people can better regulate their emotions and manage their stress levels. Among many other techniques, cognitive behavioral therapy, autogenic training, biofeedback, breathing exercises, relaxation techniques, guided imagery, mindfulness, yoga, or Tai-Chi, are some of the stress management interventions that have received attention from researchers [ 20 , 21 ].

2.2. Yoga and Mindfulness: As Tools for Emotion Regulation

2.2.1. yoga.

Yoga is an ancient Eastern practice that developed more than 2000 years ago. Although its original creator and source are uncertain, the earliest written word ‘Yoga Sutra’ describes the philosophy of yoga focussing on growing spirituality, regulating emotions and thoughts. Initially, the focus was on awareness of breathing and breathing exercises ‘pranayama’ to calm the mind and body, ultimately reaching a higher state of consciousness.

As yoga evolved, physical movement in the form of postures was included and integrated with yogic breathing ‘prana’ and elements of relaxation. The underlying purpose is to create physical flexibility, reduce pain and unpleasant stimuli and reduce negative thoughts and emotions to calm the mind and body, thereby improving well-being. In the healthcare literature, the benefits are reported to be far-reaching both for mental and physical health conditions such as anxiety, depression, cardiovascular disease, cancer and respiratory symptoms. It is also reported to reduce muscular-skeletal problems and physical symptoms through increasing the awareness of the physical body.

Yoga has become a global phenomenon and is widely practiced in many different forms. Generally, all types of yoga include some elements of relaxation. Additionally, some forms include mainly pranayama and others are more physical in nature. One such practice is vinyasa flow which involves using the inhale and exhale of the breathing pattern to move through a variety of yoga postures; this leads to the movement becoming meditative. The practice often includes pranayama followed by standing postures linked together with a movement called vinyasa, (similar to a sun salutation) which helps to keep the body moving and increases fitness, flexibility and helps maintain linkage with the breath. The practice also often includes a range of seated postures, an inversion (such as headstand or shoulder stand) and final relaxation ‘savasana’.

2.2.2. Mindfulness

Mindfulness involves being more present at the moment by acknowledging the here and now, often referred to as ‘being present’ rather than focussing on the past or future [ 8 ]. Being present may include being aware of our surroundings and the environment, or of what we are eating and drinking and physical sensations such as the sun or wind on our skin.

Acknowledging the thoughts and body are also aspects of mindfulness. Each day humans experience thousands of thoughts, the majority being of no consequence. In some instances, these thoughts are repetitive and negative in nature which can lead to increased stress and the related unpleasant physical symptoms such as feeling anxious, nausea and tension headaches. Being mindful includes an awareness of our thinking and whether we are caught up with our thoughts rather than being aware of the moment. Additionally, on a daily basis, awareness of the physical body may be minimal; being mindful includes increasing this awareness through becoming more connected with the sensations in the body. This might include experiencing the legs moving when walking, or feeling the ground under the feet or the natural way of the body whilst standing.

Mindfulness has been shown to be of benefit to physical and mental health. It is currently recommended by the National Institute for Clinical Excellence [ 22 ] as adjunctive therapy to Cognitive Behavioural Therapy (CBT) for the prevention of relapse depression.

However, it may be challenging for some individuals to do this with a multitude of distractions around them and, therefore, they may choose to identify a particular time and place when and where they can sit in a comfortable position to start to become aware of their breathing and bodily sensations.

2.2.3. Mobile Mindfulness Inspired By Tai-Chi—Pause

Tai-Chi is an internal Chinese martial art practiced for both its defense training, its health benefits and meditation. There is good evidence of benefits for depression, cardiac and stroke rehabilitation and dementia [ 23 ]. The term Tai-Chi refers to a philosophy of the forces of yin and yang, related to the moves. An iPhone application Pause inspired by Tai-Chi is used for guided mindfulness which draws upon the principles of mindfulness meditation to trigger the body’s rest and digest response, quickly restoring attention [ 24 ].

3. Related Work

Researchers have created the ability to detect stress in laboratory environments with medical-grade devices [ 25 , 26 , 27 , 28 ]; smartwatches and smart bands started to be used for stress level detection studies [ 29 , 30 , 31 ]. These devices provide high comfort and rich functionality for the users, but their stress detection accuracies are lower than medical-grade devices due to low signal quality and difficulty obtaining data in intense physical activity. If data are collected for long periods, researchers have shown that their detection performance improves [ 32 ]. During movement periods, the signal can be lost (gap in the data) or artifacts might be generated. Stress level detection accuracies for 2-classes by using these devices are around 70% [ 29 , 30 , 33 , 34 ].

After detecting the stress level of individuals, researchers should recover from the stressed state to the baseline state. To the best of our knowledge, there are very few studies that combine automatic stress detection (using physiological data) with recommended appropriate stress management techniques. Ahani et al. [ 35 ] examined the physiological effect of mindfulness. They used the Biosemi device which acquires electroencephalogram (EEG) and respiration signals. They successfully distinguished control (non-meditative state) and meditation states with machine learning algorithms. Karydis et al. [ 36 ] identified the post-meditation perceptual states by using a wearable EEG measurement device (Muse headband). Mason et al. [ 37 ] examined the effect of yoga on physiological signals. They used PortaPres Digital Plethtsmograph for measuring blood pressure and respiration signals. They also showed the positive effect of yoga by using these signals. A further study validated the positive effect of yoga with physiological signals; researchers monitored breathing and heart rate pulse with a piezoelectric belt and a pulse sensor [ 21 ]. They demonstrated the effectiveness of different yogic breathing patterns to help participants relax. There are also several studies showing the effectiveness of mobile mindfulness apps by using physiological signals [ 20 , 38 , 39 ]. Svetlov et al. [ 20 ] monitored the heart rate variability (HRV), electrodermal activity (EDA), Salivary alpha-amylase (sAA) and EEG values. In other studies, EEG and respiration signals were also used for validating the effect of mobile mindfulness apps [ 38 , 39 ]. When the literature is examined, it could be observed that the effect of ancient relaxation methods and mobile mindfulness methods are examined separately in different studies. Ancient methods generally require out of office environments that are not suitable for most of the population, since, in the modern age, people started to spend more time in office-like environments. On the other hand, some smartphone applications such as Pause, HeartMath and Calm do not require extra hardware or equipment and be applicable in office environments. Hence, an ideal solution depends on the context of individuals. A system that monitors stress levels, analyzes the context of individuals and suggests an appropriate relaxation method in the case of high stress will benefit society. Furthermore, mobile methods along with the ancient techniques should be applied in stressful real-life events and their effectiveness should be compared by investigating physiological signals. When the literature is examined, there is not any study comparing the performance of these methods in real-life events (see Table 1 ). Another important finding is that these methods should be compared with unobtrusive wearable devices so that they could be used for a biofeedback system in daily lives. Individuals may be reluctant to use a system with cables, electrodes and boards in their daily life. Therefore, a comparison of different states with such systems could not be used in daily life. There is clearly a need for a suggestion and comparison of ancient and mobile meditation methods by using algorithms that could run on unobtrusive devices. An ideal system should detect high stress levels, suggest relaxation methods and control whether users are doing these exercises right or not with unobtrusive devices. Our algorithm is suitable to be embedded in such daily life applicable systems that use physiological signals such as skin temperature (ST), HRV, EDA and accelerometer (ACC). In this paper, we present the findings of our pilot study that tested the use of our algorithm during general daily activities, stress reduction activities and a stressful event.

Comparison of our work with the studies applying different types of meditation techniques for stress management in the literature.

4. Methodology

4.1. unobtrusive stress detection system with smart bands.

Our stress detection system developed in [ 32 ] allows users to be aware of their stress levels during their daily activities without creating any interruption or restriction. The only requirement to use this system is the need to wear a smart band. Participants in this study wore the Empatica E4 smart band on their non-dominant hand. The smart band provides Blood Volume Pressure, ST, EDA, IBI (Interbeat Interval) and 3D Acceleration. The data are stored in the memory of the device. Then, the artifacts of physiological signals were detected and handled. The features were extracted from the sensory signals and fed to the machine learning algorithm for prediction. In order to use this system, pre-trained machine learning models are required. For training the models, feature vectors and collected class labels were used.

4.1.1. EDA Preprocessing Artifact Detection and Removal Methods

The body sweats when emotional arousal and stress are experienced and, therefore, skin conductance increases [ 40 ]. This makes EDA a promising candidate for stress level detection. Intense physical activity and temperature changes contaminate the SC (Skin Conductance) signal. Therefore, affected segments (artifacts) should be filtered out from the original signal. In order to detect the artifacts in the SC signal, we used an EDA toolkit [ 41 ] which is 95% accurate on the detection of the artifacts. While developing this tool, technicians labeled the artifacts manually. They trained a machine learning model by using the labels. In addition to the SC signal, 3D acceleration and ST signals were also used for artifact detection. We removed the parts that this tool detected as artifacts from our signals. We further added batch processing and segmentation to this tool by using custom software built-in Python 2.7.

4.1.2. EDA Feature Extraction Methods

After the artifact removal phase, features were extracted from the EDA signal. This signal has two components phasic and tonic; features from both components were extracted (see Table 2 ). The cvxEDA tool [ 42 ] was used for the decomposition of the signal into these components. This tool uses convex optimization to estimate the Autonomic Nervous System (ANS) activity that is based on Bayesian statistics.

EDA features and their definitions.

Tonic Component Features

The tonic component in the EDA signal represents the long-term slow changes. This component is also known as the skin conductance level. It could be regarded as the indicator of general psychophysiological activation [ 43 ].

Phasic Component Features

The phasic component represents faster (event-related ) differences in the SC signal. The Peaks of phasic SC component as a reaction to a stimulus is also called Skin Conductance Response [ 43 ]. After we decompose the phasic component from the EDA signal, peak related features were extracted.

4.1.3. Heart Activity Preprocessing (Artifact Detection and Removal) and Feature Extraction Methods

Heart activity (or, more specifically, HRV) reacts to changes in the autonomic nervous system (ANS) caused by stress [ 44 ] and it is, therefore, one of the most commonly used physiological signal for stress detection [ 40 ]. However, vigorous movement of subjects and improperly worn devices may contaminate the HRV signal collected from smartwatches and smart bands. In order to address this issue, we developed an artifact handling tool in MATLAB programming language [ 45 ] that has batch processing capability. First, the data were divided into 2 min long segments with 50% overlapping. Two-minute segments were selected because it is reported that the time interval for stress stimulation and recovery processes is around a few minutes [ 46 ]. The artifact detection percentage rule (also employed in Kubios [ 47 ]) was applied after the segmentation phase. In this rule, each data point was compared with the local average around it. When the difference was more than a predetermined threshold percentage, (20% is commonly selected in the literature [ 48 ]), the data point was labeled as an artifact. In our system, we deleted the inter-beat intervals detected as the artifacts and interpolated these points with the cubic spline interpolation technique which was used in the Kubios software [ 47 ]. The time-domain features of HRV are calculated. In order to calculate the frequency domain features, we interpolated the RR intervals to 4 Hz. Then, we applied the Fast Fourier Transform (FFT). These time and frequency domain features (see Table 3 ) were selected because these are the most discriminative ones in the literature [ 30 , 49 , 50 ].

HRV features and their definitions [ 32 ].

4.1.4. Accelerometer Feature Extraction Methods

Research has shown that movements of the human body and postures can indeed be employed as a means to detect signs of different emotional states. The dynamics of body movement were investigated by Castellano et al. who used multimodal data to identify human affective behaviors. Specific movement metrics, such as the amount of movement, intensity and fluidity, were used to help deduct emotions, and it was found that the amount of movement was a major factor in distinguishing different types of emotions [ 51 ]. Melzer et al. investigated whether movements comprised of collections of Laban movement components could be recognized as expressing basic emotions [ 52 ]. The results of their study confirm that, even when the subject has no intention of expressing emotions, particular movements can assist in the perception of bodily expressions of emotions. Accelerometer sensors may be used to detect these movements and different types of affect. The accelerometer sensor data are used for two different purposes in our system. Firstly, we extracted features from the accelerometer sensor, for detecting stress levels. We also selected the features to be used as described in Table 4 [ 53 ] and, as mentioned above, this sensor was also employed to clean the EDA signal in the EDAExplorer Tool [ 41 ].

ACC features and their definitions.

4.1.5. Skin Temperature

A skin temperature signal is used for the artifact detection phase of the EDA signal in the EDAExplorer Tool [ 41 ]. After we divide our data into segments, different modalities were merged into one feature vector. The heart activity signal started with a delay (to calculate heartbeats per minute at the start) and all signals were then synchronized. We included start and end timestamps for each segment, and each modality was merged with a custom Python script.

4.1.6. Machine Learning Classifier Algorithms

The Weka machine learning toolkit [ 54 ] is used for identifying stress levels. The Weka toolkit has several preprocessing features before classification. Our data set was not balanced when the number of instances belonging to each class was considered. We solved this issue by removing samples from the majority class. We selected random undersampling because it is the most commonly applied method [ 55 ]. In this way, we prevented classifiers from biasing towards the class with more instances. In this study, we employed five different machine learning classification algorithms to recognize different stress levels: MultiLayer Perceptron (MLP), Random Forest (RF) (with 100 trees), K-nearest neighbors (kNN) ( n = 1–4), Linear discriminant analysis (LDA), Principal component analysis (PCA) and support vector machine (SVM) with a radial basis function. These algorithms were selected because they were the most commonly applied and successful classifiers for detecting stress levels [ 30 , 48 ]. In addition, 10-fold stratified cross-validation was then applied and hyperparameters of the machine learning algorithms were fine-tuned with grid search. The best performing models have been reported.

4.1.7. Dimensionality Reduction

We applied correlation-based feature selection (CBFS) technique which is available in the Weka machine learning package for combined signal [ 56 ]. The CBFS method removes the features that are less correlated with the output class. For every model, we selected the ten most important features. This method is applied for MLP, RF, kNN and LDA. In order to create an SVM based model, we applied PCA based dimensionality reduction where the covered variance is selected as 0.95 (the default setting).

4.1.8. Insights from the Feature Selection Process

The CBFS method computes the correlation of features with the ground truth label of the stress level. Insights about the contribution of the features to the stress detection performance can be obtained from Figure 1 and Figure 2 . Three of the best features (over 0.15 correlation) are frequency domain features. These features are high, low and very-low frequency components of the HRV signal (see Figure 1 ). When we examine the EDA features, peaks per 100 s feature are the most important and distinctive feature by far. Since the EDA signal is distorted under the influence of the stimuli, the number of peaks and valleys increases. Lastly, when the acceleration signal is investigated, the most discriminative feature is mean acceleration in the z -axis (see Figure 2 b). This could be due to the nature of hand and body gestures which are caused by stressed situations.

Top-ranking features selected for the HRV signal.

Top-ranking features selected for the EDA and ACC signals.

4.2. Relaxation Method Suggestion by Analyzing the Physical Activity-Based Context

Context is a broad term that could contain different types of information such as calendars, activity type, location and activity intensity. Physical activity intensity could be used to infer contextual information. In more restricted environments such as office, classrooms, public transportation and physical activity intensity could be low, whereas, in outdoor environments, physical activity intensity could increase. Therefore, an appropriate relaxation method will change according to the context of individuals.

For calculating physical activity intensity, we used the EDAExplorer tool [ 41 ]. The stillness metric is used for this purpose. It is the percentage of periods in which the person is still or motionless. Total acceleration must be less than a threshold (default is 0.1 [ 41 ]) for 95 percent of a minute in order for this minute to count as still [ 41 ]. Then, the ratio of still minutes in a session can be calculated. For the ratio of still minutes in a session, we labeled sessions below 20% as still, above 20% as active and suggested relaxation method accordingly (see Figure 3 ).

The whole system diagram is depicted. When a high stress level is experienced, by analyzing the physical activity based context, the system suggests the most appropriate reduction method.

4.3. Description of the Data Collection Procedure

The proposed stress level monitoring mechanism, for real-life settings, was evaluated during an eight day Marie Skłodowska-Curie Innovative Training Network (ITN) training event in Istanbul, Turkey, for the AffecTech project. AffecTech is a program funded by Horizon 2020 (H2020) framework established by the European Commission. The AffecTech project is an international collaborative research network involving 15 PhD students (early stage researchers (ESR)) with the aim of developing low-cost effective wearable technologies for individuals who experience affective disorders (for example, depression, anxiety and bipolar disorder).

The eight-day training event included workshops, lectures and training with clearly defined tasks and activities to ensure that the ESR had developed the required skills, knowledge and values outline prior to the training event. At the end of the eight-day training, ESRs were required to deliver a presentation about their PhD work to two evaluators from the European Union where they received feedback about their progress (see Figure 4 for raw physiological signals at the start of the presentation). For studying the effects of emotion regulation on stress, yoga, guided mindfulness and mobile-based mindfulness, sessions were held by a certified instructor.

Sample data belong to a presentation session. The increase in EDA, ST and IBI could be observed when the subject started the presentation.

During the training, physiological and questionnaire data were collected from the 16 ESR participants (9 men, mean age 28); 15 ESRs and one of the AffecTech project academics, all of whom gave informed consent to participate in the study. Participants were from different countries with diverse nationalities (two from Iran, two from Spain, two from Italy, one from Argentina, one from Pakistan, one from China, one from Switzerland, one from Belarus, one from France, one from England, one from Barbados, one from Turkey and one from Bulgaria). Due to the fault of one of the Empatica E4 devices, it was not possible to include data from one participant. The remaining 15 participants completed all stages of the study successfully.

During the eight days of training and presentations, psychophysiological data were collected from 16 participants during the training event from Empatica E4 smart band while they are awake. For studying the effects of emotion regulation on stress, yoga, guided mindfulness and mobile-based mindfulness sessions were held by a certified instructor. The timeline of the event is shown in Figure 5 .

Time-line depicting eight days of the training event. Presentations, relaxations and lectures are highlighted.

4.3.1. Physiological Stress Data

The psychophysiological signal data were collected using the Empatica E4 smart band whilst participants were awake throughout the eight days of the AffecTech training. Physiological data included IBI, EDA, ACC (Accelerometer) and ST and stored in different csv files. In addition, 27.39% of the data are obtained from free times (free day and after training until subjects slept 5:00 p.m.–10:00 p.m.), 43.83% of the data comes from lectures in the training, 11.41% is the presentation session and relax sessions consist of 17.35% of the data. As mentioned previously, we randomly undersampled (most commonly applied method [ 55 ] ) the data to overcome the class imbalance problem. The participants’ blood pressure (BP) was also recorded using CE(0123) Harvard Medical Devices Ltd. automated sphygmomanometer prior to and after each stress reduction event (yoga and mindfulness), in order to demonstrate whether the participants stress levels were modified. On each occasion that the participants’ BP was recorded, the mean of three recordings was used as the final BP. A reduction in the participants’ blood pressure and/or pulse rate may be seen, which demonstrates a reduction in stress level.

4.3.2. Ethics

The procedure used in this study was approved by the Institutional Review Board for Research with Human Subjects of Boğaziçi University with the approval number 2018/16. Prior to data acquisition, each participant received a consent form describing the experimental procedure and its benefits and implications to both the society and the subject. The procedure was also explained verbally to the subject. All of the data are stored anonymously.

4.3.3. Questionnaire Self-Report Stress Data

A session-based self-report questionnaire comprised of six questions based on the Nasa Task Load Index (NASA-TLX) [ 57 ]. The frustration scale was specifically used to measure perceived stress levels [ 32 ]. We asked the following question to the participants for each session:

How irritated, stressed and annoyed versus content, relaxed and complacent did you feel during the task?

Questionnaires were completed daily (at the end of the day) and, after each presentation, lecture and stress reduction event (such as yoga and mindfulness).

4.3.4. Stress Management Scheme Using Yoga and Mindfulness

During the eight day training, it is assumed that the participants’ stress levels are likely to have increased day by day because they were required to give a presentation (perceived as a stressful event) reporting their PhD progress to the EU project evaluators at the end of the training.

Underpinned by James Gross’s Emotion Regulation model (see Figure 6 ) [ 4 ], we modified the situation to help the participants to reduce their thoughts of the end of the training presentation. To help participants manage their stress levels, we applied Yoga and mindfulness sessions on two separate days (day three and day four, respectively). These sessions lasted approximately 1 h and, throughout the sessions, participants wore an Empatica E4 smartband. In addition to the physiological signals coming from the Smartbands, participants’ blood pressure values were also recorded before and after the yoga and mindfulness sessions.

Application of James Gross’s Emotion Regulation model [ 4 ] in the context of stress management.

5. Experimental Results and Discussion

5.1. statistical data analysis, 5.1.1. validation of different perceived stress levels by using the self-reports.

In order to validate that the participants experienced different perceived stress levels in different contexts (lecture, relaxation, presentation), we used the Frustration item (see Section 4.5) from the NASA-TLX [ 57 ]. The distribution of answers is demonstrated in Figure 7 . Our aim is to show that the perceived stress levels (obtained from self-report answers) differ in relaxation sessions considerably when compared to the presentation session (high stress). To this end, we applied the t -test (in R programming language) to the perceived stress self-report answers of yoga versus presentation, mindfulness versus presentation and pause (mobile mindfulness) versus presentation session pairs. The paired t -test is used to evaluate the separability of each session. The degree of freedom is 15. We applied the variance test to each session tuple; we could not identify equal variance in any of the session tuples. Thus, we selected the variance as unequal. We used 99.5% confidence intervals. The t -test results’ ( p -values and test statistics) are provided in Table 5 . For all tuples, the null hypothesis stating that the perceived stress of the relaxation method is not less than the presentation session is rejected. The perceived stress levels of participants for all meditation sessions are observed to be significantly lower than the presentation session (high stress).

Visual representation of the frustration scores collected in different types of sessions.

T -test results for session tuple comparison of perceived stress levels using self-reports.

5.1.2. Before and After Physiological Measurements for Evaluating Performance of Yoga and Mindfulness with Blood Pressure

In this section, we compared the effect of stress management tools such as yoga and mindfulness on blood pressure. It is expected that blood pressure sensors will be part of unobtrusive wrist-worn wearable sensors soon. We plan to integrate a blood pressure (BP) module to our system when they are available. Therefore, by using the measurements of a medical-grade blood pressure monitor, we provided insights about how stress reaction affects BP. We further applied and tested the prominent emotion regulation model of James Gross by analyzing these measurements in the context of stress management. We measured the diastolic and systolic BP and pulse using a medical-grade blood pressure monitor before and after the yoga and mindfulness sessions. In order to ensure that the participants were relaxed and that an accurate BP was recorded, BP was measured three times with the mean as the recorded result. A one-sample t -test was applied to the difference between mean values. The results are shown in Table 6 .

The difference between the mean diastolic blood pressure, the mean systolic blood pressure and the mean pulse, before and after sessions of guided mindfulness and guided yoga. (* p < 0.05).

Mindfulness decreased the systolic BP, –1.13% (ns), increased diastolic BP, +1.75% ( p < 0.05) and decreased the pulse –5.75% ( p < 0.05). Medicine knows that systolic blood pressure (the top number or highest blood pressure when the heart is squeezing and pushing the blood around the body) is more important than diastolic blood pressure (the bottom number or lowest blood pressure between heartbeats) because it gives the best idea of the risk of having a stroke or heart attack. In this view, the significant reduction of systolic BP after mindfulness is an important result.

Moreover, the difference between systolic and diastolic BP is called pulse pressure. For example, 120 systolic minus 60 diastolic equals a pulse pressure of 60. It is also known that a pulse pressure greater than 60 can be a predictor of heart attacks or other cardiovascular diseases, while a low pulse pressure (less than 40) may indicate poor heart function. In our study, pulse pressure was lower after mindfulness (we had both a significant reduction in systolic BP and an increase in diastolic BP), but its value was higher than 40 (42.69 mean difference before the mindfulness and 40.48 mean difference after the mindfulness), suggesting that this result can also be considered clinically positive.

During yoga, there was a decrease in systolic BP by −5.81% ( p < 0.05), diastolic BP by −1.93% (ns) and increase in pulse +8.06% ( p < 0.05). Yoga appears to be more effective than mindfulness at decreasing systolic and diastolic blood pressure, although mindfulness seems to be more effective than yoga for decreasing the pulse due to the activity involved in yoga.

5.2. Physiological Stress Level Detection with Wearables by Using Context Labels as the Class Label

We tested our system by using the known context labels of sessions as the class label. We used Lecture (mild stress), Yoga and Mindfulness (relax) and Presentation in front of the board of juries (high stress) as class labels by examining perceived stress self-report answers in Figure 6 . We investigated the success of relaxation methods, different modalities and finding the presenter.

5.2.1. Effect of Different Physiological Signals on Stress Detection

We evaluated the effect of using the interbeat-interval, the skin conductance and the accelerometer signals separately and in a combined manner on two and three class classification performance. These classes are mild stress, high stress and relax states from mindfulness and yoga sessions. The results are shown in Table 7 , Table 8 and Table 9 . For the three-class classification problem, we achieved a maximum accuracy of 72% by using MLP on only HRV features and 86.61% with only accelerometer features using the Random Forest classifier and 85.36% accuracy combination of all features with LDA classifier (see Table 7 ). The difficulty in this classification task is a similar physiological reaction to relax and mild stress situations. However, since the main focus of our study is to discriminate high stress from other classes to offer relaxation techniques in this state, it did not affect our system performance. We also investigated high-mild stress and high stress-relax 2-class classification performance. For the discrimination of high and mild stress, HRV outperformed other signals with 98% accuracy using MLP (see Table 8 ). In the high stress-relax 2-class problem, only HRV features with RF achieved a maximum accuracy of 86%, whereas ACC features with MLP achieved a maximum of 94% accuracy. In this problem, the combination of all signals with RF achieved 92% accuracy which is the best among all classifiers (see Table 9 ). For all models, EDA did not perform well. This might be caused by the loose contact with EDA electrodes in the strap due to loosely worn smartbands.

Effect of different modalities and their combination on the system performance. Note that the number of classes is fixed at 3 (high stress, mild stress and relax).

Effect of different modalities and their combination on the system performance. Note that the number of classes is fixed at 2 (high stress and mild stress).

Effect of different modalities and their combination on the system performance. Note that the number of classes is fixed at 2 (high stress and relax).

5.2.2. Effectiveness of Yoga, Mindfulness and Mobile Mindfulness (Pause)

We applied three different relaxation methods to manage stress levels of individuals. In order to measure the effectiveness of each method, we examined how easily these physiological signals in the relaxation sessions can be separated from high stress presentations. If it can be separated from high stress levels with higher classification performance, it could be inferred that they are more successful at reducing stress. As seen in Table 10 and Table 11 , mobile mindfulness has lower success in reducing stress levels. Yoga has the highest classification performance with both HR and EDA signals.

The classification accuracy of the relaxation sessions using stress management methods and stressful sessions using EDA.

The classification accuracy of the relaxation sessions using stress management methods and stressful sessions using HRV.

6. Conclusions

In this study, by using our automatic stress detection system with the use of Empatica-E4 smart-bands, we detected stress levels and suggested appropriate relaxation methods (i.e., traditional or mobile) when high stress levels are experienced. Our stress detection framework is unobtrusive, comfortable and suitable for use in daily life and our relaxation method suggestion system makes its decisions based on the physical activity-related context of a user. To test our system, we collected eight days of data from 16 individuals participating in an EU research project training event. Individuals were exposed to varied stressful and relaxation events (1) training and lectures (mild stress), (2) yoga, mindfulness and mobile mindfulness (PAUSE) (relax) and (3) were required to give a moderated presentation (high stress). The participants were from different countries with diverse cultures.

In addition, 1440 h of mobile data (12 h in a day) were collected during this eight-day event from each participant measuring their stress levels. Data were collected during the training sessions, relaxation events and the moderated presentation and during their free time for 12 h in a day, demonstrating that our study monitored daily life stress. EDA and HR signals were collected to detect physiological stress and a combination of different modalities increased stress detection, performance and provided the most discriminative features. We first applied James Gross ER model in the context of stress management and measured the blood pressure during the ER cycle. When the known context was used as the label for stress level detection system, we achieved 98% accuracy for 2-class and 85% accuracy for 3-class. Most of the studies in the literature only detect stress levels of individuals. The participants’ stress levels were managed with yoga, mindfulness and a mobile mindfulness application while monitoring their stress levels. We investigated the success of each stress management technique by the separability of physiological signals from high-stress sessions. We demonstrated that yoga and traditional mindfulness performed slightly better than the mobile mindfulness application. Furthermore, this study is not without limitations. In order to generalize the conclusions, more experiments based on larger sample groups should be conducted. As future work, we plan to develop personalized perceived stress models by using self-reports and test our system in the wild. Furthermore, attitudes in the psychological field constitute a topic of utmost relevance, which always play an instrumental role in the determination of human behavior [ 58 ]. We plan to design a new experiment which accounts for the attitudes of participants towards relaxation methods and their effects on the performance of stress recognition systems.

Acknowledgments

We would like to show our gratitude to the Affectech Project for providing us the opportunity for the data collection in the training event and funding the research.

Author Contributions

Y.S.C. is the main editor of this work and made major contributions in data collection, analysis and manuscript writing. H.I.-S. made valuable contributions in both data collection and manuscript writing. She was the yoga and mindfulness instructor in the event and contributed the related sections regarding traditional and mobile methods. She also led the blood pressure measurement efforts before and after relaxation methods. D.E. and N.C. contributed equally to this work in design, implementation, data analysis and writing the manuscript. J.F.-Á., C.R. and G.R. contributed the experiment design and provided valuable insights into both emotion regulation theory. They also contributed to the related sections in the manuscript. C.E. provided invaluable feedback and technical guidance to interpret the design and the detail of the field study. He also performed comprehensive critical editing to increase the overall quality of the manuscript. All authors have read and agreed to the published version of the manuscript.

This work has been supported by AffecTech: Personal Technologies for Affective Health, Innovative Training Network funded by the H2020 People Programme under Marie Skłodowska-Curie Grant Agreement No. 722022. This work is supported by the Turkish Directorate of Strategy and Budget under the TAM Project number DPT2007K120610.

Conflicts of Interest

The authors declare no conflict of interest.

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How can I plan what to eat or drink when I have diabetes?

How can physical activity help manage my diabetes, what can i do to reach or maintain a healthy weight, should i quit smoking, how can i take care of my mental health, clinical trials for healthy living with diabetes.

Healthy living is a way to manage diabetes . To have a healthy lifestyle, take steps now to plan healthy meals and snacks, do physical activities, get enough sleep, and quit smoking or using tobacco products.

Healthy living may help keep your body’s blood pressure , cholesterol , and blood glucose level, also called blood sugar level, in the range your primary health care professional recommends. Your primary health care professional may be a doctor, a physician assistant, or a nurse practitioner. Healthy living may also help prevent or delay health problems  from diabetes that can affect your heart, kidneys, eyes, brain, and other parts of your body.

Making lifestyle changes can be hard, but starting with small changes and building from there may benefit your health. You may want to get help from family, loved ones, friends, and other trusted people in your community. You can also get information from your health care professionals.

What you choose to eat, how much you eat, and when you eat are parts of a meal plan. Having healthy foods and drinks can help keep your blood glucose, blood pressure, and cholesterol levels in the ranges your health care professional recommends. If you have overweight or obesity, a healthy meal plan—along with regular physical activity, getting enough sleep, and other healthy behaviors—may help you reach and maintain a healthy weight. In some cases, health care professionals may also recommend diabetes medicines that may help you lose weight, or weight-loss surgery, also called metabolic and bariatric surgery.

Choose healthy foods and drinks

There is no right or wrong way to choose healthy foods and drinks that may help manage your diabetes. Healthy meal plans for people who have diabetes may include

• dairy or plant-based dairy products
• nonstarchy vegetables
• protein foods
• whole grains

Try to choose foods that include nutrients such as vitamins, calcium , fiber , and healthy fats . Also try to choose drinks with little or no added sugar , such as tap or bottled water, low-fat or non-fat milk, and unsweetened tea, coffee, or sparkling water.

Try to plan meals and snacks that have fewer

• foods high in saturated fat
• foods high in sodium, a mineral found in salt
• sugary foods , such as cookies and cakes, and sweet drinks, such as soda, juice, flavored coffee, and sports drinks

Your body turns carbohydrates , or carbs, from food into glucose, which can raise your blood glucose level. Some fruits, beans, and starchy vegetables—such as potatoes and corn—have more carbs than other foods. Keep carbs in mind when planning your meals.

You should also limit how much alcohol you drink. If you take insulin  or certain diabetes medicines , drinking alcohol can make your blood glucose level drop too low, which is called hypoglycemia . If you do drink alcohol, be sure to eat food when you drink and remember to check your blood glucose level after drinking. Talk with your health care team about your alcohol-drinking habits.

Find the best times to eat or drink

Talk with your health care professional or health care team about when you should eat or drink. The best time to have meals and snacks may depend on

• what medicines you take for diabetes
• what your level of physical activity or your work schedule is
• whether you have other health conditions or diseases

Ask your health care team if you should eat before, during, or after physical activity. Some diabetes medicines, such as sulfonylureas  or insulin, may make your blood glucose level drop too low during exercise or if you skip or delay a meal.

Plan how much to eat or drink

You may worry that having diabetes means giving up foods and drinks you enjoy. The good news is you can still have your favorite foods and drinks, but you might need to have them in smaller portions  or enjoy them less often.

For people who have diabetes, carb counting and the plate method are two common ways to plan how much to eat or drink. Talk with your health care professional or health care team to find a method that works for you.

Carb counting

Carbohydrate counting , or carb counting, means planning and keeping track of the amount of carbs you eat and drink in each meal or snack. Not all people with diabetes need to count carbs. However, if you take insulin, counting carbs can help you know how much insulin to take.

Plate method

The plate method helps you control portion sizes  without counting and measuring. This method divides a 9-inch plate into the following three sections to help you choose the types and amounts of foods to eat for each meal.

• Nonstarchy vegetables—such as leafy greens, peppers, carrots, or green beans—should make up half of your plate.
• Carb foods that are high in fiber—such as brown rice, whole grains, beans, or fruits—should make up one-quarter of your plate.
• Protein foods—such as lean meats, fish, dairy, or tofu or other soy products—should make up one quarter of your plate.

If you are not taking insulin, you may not need to count carbs when using the plate method.

Work with your health care team to create a meal plan that works for you. You may want to have a diabetes educator  or a registered dietitian  on your team. A registered dietitian can provide medical nutrition therapy , which includes counseling to help you create and follow a meal plan. Your health care team may be able to recommend other resources, such as a healthy lifestyle coach, to help you with making changes. Ask your health care team or your insurance company if your benefits include medical nutrition therapy or other diabetes care resources.

Talk with your health care professional before taking dietary supplements

There is no clear proof that specific foods, herbs, spices, or dietary supplements —such as vitamins or minerals—can help manage diabetes. Your health care professional may ask you to take vitamins or minerals if you can’t get enough from foods. Talk with your health care professional before you take any supplements, because some may cause side effects or affect how well your diabetes medicines work.

Research shows that regular physical activity helps people manage their diabetes and stay healthy. Benefits of physical activity may include

• lower blood glucose, blood pressure, and cholesterol levels
• better heart health
• healthier weight
• better mood and sleep
• better balance and memory

Talk with your health care professional before starting a new physical activity or changing how much physical activity you do. They may suggest types of activities based on your ability, schedule, meal plan, interests, and diabetes medicines. Your health care professional may also tell you the best times of day to be active or what to do if your blood glucose level goes out of the range recommended for you.

Do different types of physical activity

People with diabetes can be active, even if they take insulin or use technology such as insulin pumps .

Try to do different kinds of activities . While being more active may have more health benefits, any physical activity is better than none. Start slowly with activities you enjoy. You may be able to change your level of effort and try other activities over time. Having a friend or family member join you may help you stick to your routine.

The physical activities you do may need to be different if you are age 65 or older , are pregnant , or have a disability or health condition . Physical activities may also need to be different for children and teens . Ask your health care professional or health care team about activities that are safe for you.

Aerobic activities

Aerobic activities make you breathe harder and make your heart beat faster. You can try walking, dancing, wheelchair rolling, or swimming. Most adults should try to get at least 150 minutes of moderate-intensity physical activity each week. Aim to do 30 minutes a day on most days of the week. You don’t have to do all 30 minutes at one time. You can break up physical activity into small amounts during your day and still get the benefit. 1

Strength training or resistance training

Strength training or resistance training may make your muscles and bones stronger. You can try lifting weights or doing other exercises such as wall pushups or arm raises. Try to do this kind of training two times a week. 1

Balance and stretching activities

Balance and stretching activities may help you move better and have stronger muscles and bones. You may want to try standing on one leg or stretching your legs when sitting on the floor. Try to do these kinds of activities two or three times a week. 1

Some activities that need balance may be unsafe for people with nerve damage or vision problems caused by diabetes. Ask your health care professional or health care team about activities that are safe for you.

Stay safe during physical activity

Staying safe during physical activity is important. Here are some tips to keep in mind.

Drink liquids

Drinking liquids helps prevent dehydration , or the loss of too much water in your body. Drinking water is a way to stay hydrated. Sports drinks often have a lot of sugar and calories , and you don’t need them for most moderate physical activities.

Avoid low blood glucose

Check your blood glucose level before, during, and right after physical activity. Physical activity often lowers the level of glucose in your blood. Low blood glucose levels may last for hours or days after physical activity. You are most likely to have low blood glucose if you take insulin or some other diabetes medicines, such as sulfonylureas.

Ask your health care professional if you should take less insulin or eat carbs before, during, or after physical activity. Low blood glucose can be a serious medical emergency that must be treated right away. Take steps to protect yourself. You can learn how to treat low blood glucose , let other people know what to do if you need help, and use a medical alert bracelet.

Avoid high blood glucose and ketoacidosis

Taking less insulin before physical activity may help prevent low blood glucose, but it may also make you more likely to have high blood glucose. If your body does not have enough insulin, it can’t use glucose as a source of energy and will use fat instead. When your body uses fat for energy, your body makes chemicals called ketones .

High levels of ketones in your blood can lead to a condition called diabetic ketoacidosis (DKA) . DKA is a medical emergency that should be treated right away. DKA is most common in people with type 1 diabetes . Occasionally, DKA may affect people with type 2 diabetes  who have lost their ability to produce insulin. Ask your health care professional how much insulin you should take before physical activity, whether you need to test your urine for ketones, and what level of ketones is dangerous for you.

Take care of your feet

People with diabetes may have problems with their feet because high blood glucose levels can damage blood vessels and nerves. To help prevent foot problems, wear comfortable and supportive shoes and take care of your feet  before, during, and after physical activity.

If you have diabetes, managing your weight  may bring you several health benefits. Ask your health care professional or health care team if you are at a healthy weight  or if you should try to lose weight.

If you are an adult with overweight or obesity, work with your health care team to create a weight-loss plan. Losing 5% to 7% of your current weight may help you prevent or improve some health problems  and manage your blood glucose, cholesterol, and blood pressure levels. 2 If you are worried about your child’s weight  and they have diabetes, talk with their health care professional before your child starts a new weight-loss plan.

You may be able to reach and maintain a healthy weight by

• following a healthy meal plan
• consuming fewer calories
• being physically active
• getting 7 to 8 hours of sleep each night 3

If you have type 2 diabetes, your health care professional may recommend diabetes medicines that may help you lose weight.

Online tools such as the Body Weight Planner  may help you create eating and physical activity plans. You may want to talk with your health care professional about other options for managing your weight, including joining a weight-loss program  that can provide helpful information, support, and behavioral or lifestyle counseling. These options may have a cost, so make sure to check the details of the programs.

Your health care professional may recommend weight-loss surgery  if you aren’t able to reach a healthy weight with meal planning, physical activity, and taking diabetes medicines that help with weight loss.

If you are pregnant , trying to lose weight may not be healthy. However, you should ask your health care professional whether it makes sense to monitor or limit your weight gain during pregnancy.

Both diabetes and smoking —including using tobacco products and e-cigarettes—cause your blood vessels to narrow. Both diabetes and smoking increase your risk of having a heart attack or stroke , nerve damage , kidney disease , eye disease , or amputation . Secondhand smoke can also affect the health of your family or others who live with you.

If you smoke or use other tobacco products, stop. Ask for help . You don’t have to do it alone.

Feeling stressed, sad, or angry can be common for people with diabetes. Managing diabetes or learning to cope with new information about your health can be hard. People with chronic illnesses such as diabetes may develop anxiety or other mental health conditions .

Learn healthy ways to lower your stress , and ask for help from your health care team or a mental health professional. While it may be uncomfortable to talk about your feelings, finding a health care professional whom you trust and want to talk with may help you

• lower your feelings of stress, depression, or anxiety
• manage problems sleeping or remembering things
• see how diabetes affects your family, school, work, or financial situation

Ask your health care team for mental health resources for people with diabetes.

Sleeping too much or too little may raise your blood glucose levels. Your sleep habits may also affect your mental health and vice versa. People with diabetes and overweight or obesity can also have other health conditions that affect sleep, such as sleep apnea , which can raise your blood pressure and risk of heart disease.

NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for healthy living with diabetes?

Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of healthy living for people with diabetes, such as

• how changing when you eat may affect body weight and metabolism
• how less access to healthy foods may affect diabetes management, other health problems, and risk of dying
• whether low-carbohydrate meal plans can help lower blood glucose levels
• which diabetes medicines are more likely to help people lose weight

Find out if clinical trials are right for you .

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials for healthy living with diabetes are looking for participants?

You can view a filtered list of clinical studies on healthy living with diabetes that are federally funded, open, and recruiting at www.ClinicalTrials.gov . You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe for you. Always talk with your primary health care professional before you participate in a clinical study.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

NIDDK would like to thank: Elizabeth M. Venditti, Ph.D., University of Pittsburgh School of Medicine.