Staying Fit and Staying Well: Physical Fitness as a Moderator of Life Stress

Jonathon D. Brown
University of Washington Previous research suggests that physical fitness moderates the adverse effectsof stressful life events. However, a reliance on self-reports of fitness and health may limit the validity of prior investigations. The present research tested the stress-buffering effect of fitness with subjective and objective indicators of exercise, fitness, and physical well-being. For self-reports of health, both self-reports of exercise and objective measures of fitness showed the buffeting effect; however, only objective fitness levels buffered stress when visits to a health facility were considered. Additional evidence indicated that this effect was largely independent of measures of psychological distress. Implications for understanding the link between fitness, stress, and health status are discussed.

Physical fitness plays an important role in health promotion and maintenance. For example, fitness reduces cardiovascular morbidity and mortality (Oberman, 1985), lowers blood pressure (Blair, Goodyear, Gibbons, & Cooper, 1984), and aids in the metabolism of carbohydrates (Lennon et al., 1983) and fats (Rosenthal, Haskell, Solomon, Widstrom, & Reavan, 1983). Fitness also has been linked to numerous psychological benefits. These include improvements in self-concept (Hughes, 1984), mood states (Folkins & Sime, 1981), and cognitive lunG3 tioning (Tomporowski & Ellis, 1986). In short, physical fitness is an important general component of well-being. One benefit of fitness that is receiving increased attention is its ability to moderate the negative effects of stress. In recent years, several laboratory studies have found that high-fit people evidence less physiological reactivity to stress than do those who are less fit. For instance, Holmes and Roth (1985) exposed high-fit and low-fit women to a stressful psychological test. Compared with low-fit subjects, high-fit subjects evinced lower elevations in heart rate. Other researchers have obtained similar evidence that fitness reduces physiological reactivity to experimentally induced stress (Keller & Seraganian, 1984; Light, Obrist, James, & Strogatz, 1987; Sinyor, Golden, Steinert, & Seraganian, 1986). Complementing these laboratory studies are investigations o f fitness and naturally occurring stress. Brown and Siegel (1988) conducted a prospective study of stressful life events, exercise habits, and health status among adolescents. They found that stress and exercise interacted to predict changes in

The preparation of this article was supported by National Science Foundation Grant BNS-8958211. I thank Mike Best and David Watson for their help in the planning and execution of this research. Correspondence concerning this article should be addressed to Jonathon D. Brown, Department of Psychology (NI-25), University of Washington, Seattle, Washington 98195.

self-reported health over time: Although stressful life events were linked to deteriorating health status among subjects who exercised infrequently, they had little negative effect among subjects who exercised on a regular basis. With the results of other studies (Brown & Lawton, 1986; Roth & Holmes, 1985), these findings suggest that fitness mitigates the deleterious effects of life stress (but see also Roth, Wiebe, Fillingim, & Shay, 1989). Before this conclusion can be proffered with any confidence, however, several issues need to be addressed. The first concerns the use of self-report. With one exception (Roth & Holmes, 1985), prior research testing the stress-buffering role of fitness has used subjective reports of exercise and fitness rather than more objective measures. Illness also has been assessed with self-report. Although research supports the validity of self-reports of fitness (Roth & Fillingim, 1988 [cited in Roth et al. 1989]) and health (Davies & Ware, 1981; Kaplan & Camacho, 1983), it is important to determine whether the apparent stressmoderating role of fitness can be replicated with more objective measures. Toward that end, the present research used relatively direct methods of assessing fitness and health status. Expressly, physical fitness was assessed by performance on a submaximal bicycle ergometer test (cf. Roth & Holmes, 1985); health status was indexed by examining subjects' visits to a medical facility for physical illness. Although neither of these measures provides a perfect index of their respective underlying constructs, they are less subject to response biases and other potential confounds (e.g., forgetting) than are self-report measures. A second, and related, issue concerns how to interpret the stress-buffering effect of fitness on health status. People who are physically fit differ from those who are not on a number of dimensions. Only some of these differences are a direct consequence of fitness, per se. Because correlational designs are being used to test the stress-buffering hypothesis, one cannot be certain whether fitness or some third variable is responsible for the stress-buffering effect.

Journal of Personality and Social Psychology, 1991, Vol. 60, No. 4, 555-561 Copyright 1991 by the American Psychological Association, Inc. 0022-3514/91/$3.(30

555

556

JONATHON D. BROWN access to their university health center records. For both the fall and spring semesters, health center personnel recorded the number of visits each subject made to the health center and indicated whether the visit was for illness, injury, or other matters related to physical health (e.g., checkup). Visits for physical illnesses served as the main dependent variable in this research. During the next part of the study, subjects completed a number of self-report measures (described later) at their own pace. A baseline measure of heart rate was then obtained. A Marshall 89 Oscillometric Sphygmomanometer cuff was attached to the subject's nondominant arm, and two pulse readings were taken 30 s apartfl The two readings were averaged to create a measure of resting heart rate. At this point, subjects were asked to doff their shoes in preparation for riding an exercise bike. After being weighed, subjects mounted a Bodyguard 955 Ergocycle. Following a brief warm-up period at no resistance, subjects began pedaling at 50 rpm with the work load set at 300 Kilopond meters/minute. Heart rate was continuouslyrecorded by an Amerec 130 pulsemeter attached to the subjects' left earlobe. If needed, the workload was increased to achieve a target heart rate between 120 and 160 bpm. After the target heart rate had been reached for a 2-min period, subjects continued to ride the ergometer for 2 more minutes. At the end of the final period, final heart rate and work load were used to estimate aerobic capacity.

In theory, the n u m b e r o f potential third variables is infinite. However, one variable stands out as a useful point of departure for examining this issue. This variable is a broad personality variable pertaining to individual differences in self-concept a n d mood states. Some people view themselves negatively a n d experience affective distress across a range o f situations; others view themselves positively a n d typically do not experience affective distress. This construct has been given various names, including neuroticism (Costa & McCrae, 1987), emotionality (Eysenck & Eysenck, 1975), a n d negative affectivity (Watson & Clark, 1984). Following Tessler a n d Mechanic (1978), a more generic term, psychological distress, is used in the present report to describe this constellation of factors. In addition to being characterized by low self-esteem and negative mood states, distressed people also tend to perceive the circumstances in their life as stressful a n d to report a variety of health problems (Costa & McCrae, 1987; Watson, 1989; Watson & Pennebaker, 1989). As a consequence, the relation between self-reported stress a n d subjective indicators o f health can be spuriously inflated if one fails to take this factor into account. For this reason, it is important to examine the role of psychological distress as a possible confound or contaminating variable when investigating the relation between these variables (Costa & McCrae, 1987; Watson & Pennebaker, 1989). The relation between fitness a n d psychological distress also needs to be explored. Physical fitness has been linked to elevations in m o o d states and a favorable self-view (Folkins & Sime, 1981). A l t h o u g h these associations are n o t always observed (Watson, 1989), they admit the possibility that physically fit people may be less distressed than low-fit people. If so, the a p p a r e n t stress-buffering power o f fitness d e m o n s t r a t e d in previous studies may be artifactual. Specifically, the stress-buffering effect may be due to the shared variance between fitness and psychological distress o n the one hand and between psychological distress a n d stress a n d health perceptions o n the other hand. In an attempt to examine this possibility, subjects in the present study completed three personality scales assessing psychological distress. To summarize, the present study had two aims. The first was to determine whether the stress-buffering role o f physical fitness would be found with relatively objective measures o f fitness a n d health status; the second was to determine whether the buffering effect of fitness was independent o f measures o f psychological distress. Method

Measures Exercise. Self-reports of physical exercise were assessed with the Physical Activity Questionnaire (PAQ; Brown, 1989). The PAQ consists of 14 exercise activities. Items include both aerobic (e.g., jogging, swimming, biking) and anaerobic (e.g., weight lifting, yoga, ballet) forms of exercise. 2 Additional space is provided for subjects to enter any other types of exercise they engage in that are not included on the list. For each item, subjects indicate how much time they spend doing the activity each week. A total exercise score is found by summing these values. A slightly modified version of the present scale has been shown to be reliable over a 3-month period (r = .61) and has been used in prior research on exercise and physical well-being (Brown & Siegel, 1988). Life stress. Life stress was measured with the Life Experiences Survey (LES; Samson, Johnson, & Siegel, 1978). The LES is a well-established measure of life events that has been used in numerous investigations of stress and illness. It was chosen for use in the present research because it has a number of items of particular relevance to college students (e.g., moving away from home for the first time). For each of the 60 events on the LES, subjects indicated whether they had experienced the event in the preceding 12-month period and, if so, whether its impact was predominantly negative or positive (-3 = extremely negative; 3 = extremely positive). Additional space was provided for subjects to record any other significant events they had experienced in the previous year. A total stress score was found by summing the number of negative life events)
Blood pressure readings were also taken to identify high-risk subjects prior to the ergometer test. All of the subjects had normal blood pressure readings. 2 Scores for the Aerobic and Anaerobic subscales of the PAQ were highly related in the present sample (p < .0009), making it difficult to empirically distinguish between subjects on this basis. So this distinction is not considered further in this report. 3 Four items from the LES were eliminated before analyzing the data. Two items ("changes in eating habits" and "changes in sleeping habits") were excluded because of their probable relation with psychological distress; one item ("major physical illness") was eliminated to avoid a redundancy between the predictor variable and the outcome

Subjects
The subjects were 37 male and 73 female undergraduates attending a private university. They participated in individual testing sessions during the fall academic semester in exchange for extra credit in their introductory psychology courses. The experiment was conducted by one of three female experimenters.

Procedure
At the start of the experimental session, subjects were told about the nature of the experiment and were asked to sign an informed consent form. They were also asked to sign a release giving the investigators

PHYSICAL FITNESS, STRESS, AND HEALTH STATUS

557

Illness. Self-reportsofillness were assessed with an illness checklist used by Brown and Siegel(1988). This measure is based on the Seriousness of Illness Rating Scale, which was developed and validated by Wyler, Masuda, and Holmes (1968). The present scale was composed of 36 medical conditions and physical illnesses that range in severity from a cold or sore throat to diabetes and cancer. Subjects indicated which of the illnesses they had experienced during the previous 6month period; a total illness score was found by summing the number of items checked. Psychologicaldistress. As used in this report, psychological distress is a rubric for describing a complex of factors pertaining to low self-esteem and depressed affect (of.Costa & McCrae, 1987;Watson & Pennebaker, 1989). Three scales were used to measure this construct in the present investigation. The Rosenberg Self-Esteem Scale (1965) was used to assess perceptions of self-worth. This scale is a widely used measure of self-esteem; many investigations support its validity. The affective constituent of psychological distress was assessed with the Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977). The CES-D is a 20-item, self-report inventory that was developed to assess the presence of depressive symptomatology in the general population. The measure places particular emphasis on the affectivecomponent of depression. The third measure of psychological distress used in this research was a mood measure developed by Watson, Clark, and Tellegen (1988). This measure asks subjects to indicate how often they typically feel each of 10 emotions (e.g., distressed, scared, upset). Subjects completed this measure 3-10 weeks prior to the experimental session in a mass-testing session.
Results

able and valid, albeit approximate, index of aerobic fitness (Astrand & Rodahl, 1977). The mean in the present sample for men was 34.2 (SD = 5.69); for women, the mean was 26.9 (SD = 4.76). These values are comparable to, though somewhat lower than, those found in other research with young adults (Astrand & Rodahl, 1977). Psychological distress. The assumption underlying the use of three personality scales to assess psychological distress is that all tap a common theoretical construct. Two sets of analyses were performed to examine this issue. First, the zero-order correlations among the three scales were examined. Self-esteem was negatively correlated with CES-D scores (r = -.50, p < .001) and with scores on the mood measure of negative affect (r = -.30, p < .005); the CES-D and mood measure were positively correlated (r= .25, p < .025). In a second analysis, the three variables were subjected to a principal-componentsanalysis. A single factor emerged, accounting for 59% of the explained variance. The mood measure and CES-D loaded positively on this factor (.60 and .83, respectively); the Rosenberg Self-Esteem Scale loaded negatively (-.85). In sum, though not identical, the three scales showed a good dealofoverlap. Accordingly, after reversing the scoring for the Rosenberg Self-Esteem Scale, the three measures were standardized and summed to create a single index of psychological distress. (Analyses using each scale separately showed a pattern of results nearly identical to those to be reported in the text.)

Descriptive Data
Table I shows the means, standard deviations, and zero-order correlations among the study variables. Self-reports of exercise were reliably related to physical fitness levels. Moreover, both exercise and fitness were significantly related to resting heart rate. These findings are meaningful as they provide some important validity for the measures of fitness used in this research. Table 1 also reveals that self-reports of neither exercise nor fitness were related to life stress. However, fitness but not self-reports of exercise tended to be related to psychological distress. Finally, neither of these variables was associated with self-reports of health or health center visits.4 As concerns stress and well-being, consistent with a good deal of prior research (Dohrenwend & Dohrenwend, 1974), stressful life events were linked to psychological distress. Life stress also predicted self-reports of health and visits to the health facility. Finally, higher levels of psychological distress were also linked to more health complaints and more frequent visits to the health center. Although the relation between distress and self-reported health is well documented, a link between distress and visits to a medical facility has been observed less frequently (see Watson & Pennebaker, 1989, for a review).

Preliminary Analyses Missing cases. Complete health center records were available for only 90 of the 110 subjects. The percentage of incomplete cases did not vary as a function of subject sex, x 2 (1, N = 110) = 1.91, ns. Incomplete records were primarily due to administrative error, the students' refusal to grant us access to their health center records, or students' dropping out of school before the end of the academic year. Analyses comparing the scores of subjects with missing data with those who had complete data revealed no significant effects for any of the study variables. Rather than using listwise deletion, analyses were performed using all subjects who had available data relevant to that analysis. Degrees of freedom therefore vary somewhat from analysis to analysis. Estimated maximal oxygen uptake. Aerobic fitness was estimated using the procedure outlined by Astrand and Rodahl (1977). Heart rate and work load for the final 2 rain on the ergometer were entered into a standardized nomogram. The resulting estimate of maximal oxygen uptake provides a reli-

variable; another item ("major changes in recreational activities") was discarded to avoid a possible confound between the stress measure and the measure of aerobic fitness. Only negative life events were considered, because prior research on stress and fitness (Brown & Lawton, 1986; Brown & Siegel, 1988;Roth & Holmes, 1985) has focused only on undesirable events. (Consistent with this emphasis, preliminaryanalyses showed that positive life events did not interact with fitness or exercise to affect health status.) Finally, although the data reported in the text are based on a unit weighting of negative events, analyses using subject's 7-point impact ratings yielded a comparable set of results.

Main Analyses
Hierarchical regression analyses (Cohen & Cohen, 1983) were used to examine whether exercise/fitness and stressful life events interact in the prediction of physical health status. 4 Preliminary analyses revealed that students' health center visits were not normally distributed. A log transformation was therefore applied before analyzing these data.

558 Table 1

JONATHON D. BROWN

Means and Zero-Order Correlations Among the Study Variables

Variable 1. Exercise: self-report 2. Physical fitness 3. Resting heart rate 4. Stressful life events 5. Psychological distress 6. Illness: self-report 7. Illness: health center visits 8. Sex M 1 2 3 4 5 6 7 8

.28*** -.22** .09 - . 10 .02 -.16 -.39*** 6.50 3.53 -.41 *** -.03 - . 18* - . 14 -.11 -.58*** 29.30 6.40 .11 .15 .12 .28** .14 72.08 10.32 .23** .37"** .23** .14 3.62 2.64 .22** .21"
13

.37"**
.23***

-.27*** --

SD
* p < .08.

0.07 2.29

5.46 2.81

1.50 1.66

1.66 0.48

Note. Sex is coded as a dummy variable (1 = male; 2 = female).

** p < . 0 5 . ***/7 ~ .01.

Self-reports of health. In the first set o f analyses, self-reports of health served as the dependent variable. Standardized stress and fitness scores (either exercise behavior or fitness level) were entered into the predictive equation. An interaction term (created by calculating the cross product o f the standardized stress and appropriate fitness score) was then entered. In this manner, the variance accounted for by the interaction was determined after controlling for each main effect) Considering first the role o f self-reports o f exercise, the upper-left side of Table 2 shows that stress, but not exercise, was independently related to self-reports o f health. More important for the present research, the addition o f the Stress Exercise interaction term significantly improved the prediction o f health status. Inspection o f the interaction by graphing revealed the predicted stress-buffering effect: Illness reports increased as stress increased for subjects who reported exercising relatively infrequently but not for subjects who reported exercising regularly A similar pattern emerged when the aerobic fitness measure was used (see Table 2). As before, stress predicted health status, whereas fitness did not. Furthermore, the interaction between stress and fitness was once again a reliable predictor of self-reported health status. The form o f the interaction indicated that self-reports o fillness increased under high stress for low-fit subjeets but not for high-fit subjects. Health center visits Comparable analyses to those just reported were performed using subjects' health center visits as the dependent variable. With self-reports of exercise as a predictor variable, only the main effect o f stress achieved significance. Neither the main effect o f exercise nor the Stress Exercise interaction even approached significance (both ps > .20). A different pattern emerged when physical fitness was used as a predictor variable. Here, both the main effect o f stress and the critical Stress Fitness interaction reached significance. Figure 1 contains a schematic representation o f the interaction. 6

In accordance with the claim that fitness buffers the adverse effects o f life stress, the figure shows that stress was linked to increased medical visits only among subjects who scored low in fitness; for physically fit subjects, stress had virtually no negative impact on illness behavior. To summarize, when predicting to self-reports o f health, both self-reports o f exercise and physical fitness appeared to buffer the negative effects o f life stress. However, only fitness buffered stress when more objective measures of illness (ie., health center visits) were examined.

Supplemental Analyses Role of psychological distress. Although the previous results suggest that physical fitness is a moderator o f life stress, a third variable, psychological distress, may carry the effect. To explore this issue, the analyses reported earlier were repeated after controlling for psychological distress. If the stress-buffering effect o f fitness is confounded by psychological distress, the magnitude o f the interaction terms observed earlier should be greatly reduced when this variable is statistically controlled. The results of these analyses are presented in the right side o f Table 2. As concerns self-ratings o f health, the table shows that the interaction between stress and self-reports o f exercise, which was significant in the earlier analysis, is no longer significant when psychological distress is statistically controlled. In
s Because sex was associated with both measures of fitness and with both measures of illness (see bottom row of Table 1), it was entered into the predictive equation before assessing the influence of stress and fitness and the interaction between these variables. 6 The data in Figure I were derived by determining illness scores for subjects scoring in the top and bottom 50% on the measures of stress and fitness. This classification was done only for illustrative purposes, and the variables were treated as continuous in all statistical analyses.

PHYSICAL FITNESS, STRESS, AND HEALTH STATUS Table 2

559

Hierarchical Multiple Regression Analyses

Before controlling for psychological distress Dependent variable Self-report illness Stress Exercise Stress Exercise Stress Fitness Stress Fitness Health center visits Stress Exercise Stress x Exercise Stress Fitness Stress Fitness /~ .3351"** .0669 -.1777"* .3477*** -.0410 -.2071"* .2181"* -.0567 -.1267 .2136** .0384 -.2140"*
R2

After controlling for psychological distress

~

R 2

.3193***
.12"** .03** .12"** .04** .0767 -.1434 .3393*** -.0733 -.1941"* .1681 .0105 -.1283 .1639 .0543 -.1996" .11"** .02 .11"** .04**

.05 .02 .05 .04**

.03 .02 .03 .04*

tress was statistically controlled (/~ = -.2446, p < .05, R 2 change = .06). Because these analyses examine changes in health status over time, they furnish even stronger evidence that physical fitness buffers the adverse effects of life stress. However, the absolute number of visits in this analysis was low, indicating the need for caution when interpreting these findings. General utilization of health services. A final set of analyses was conducted to determine whether stress and fitness interacted to predict visits to the health center for reasons other than physical illness (e.g., checkup, prescription refill; M = .99). No significant effects were found. As in the preceding analysis, caution is indicated when interpreting these findings because the absolute number of visits in this analysis was low. This caveat notwithstanding, these results are of interest because they indicate that stress and fitness were uniquely related to health center visits for physical illness rather than to a tendency to visit the university health facility in general.

Discussion
Prior research suggested that physical fitness may serve to protect people from illness under periods of high stress (Brown & Lawton, 1986; Brown & Siegel, 1988; Roth & Holmes, 1985). However, prior research was potentially limited by (a) relying on either self-reports of fitness or self-reports of health and (b) by failing to consider the influence of possible third variables. The purpose of the present study was to address these possible limitations and thereby provide a stricter test of the stress-buffering hypothesis.

Note. AUanalyses were conducted after controlling for sex o fsubject. Change in R2 for step.
*p<.06. **p<.05. ***p<.01.

contrast, controlling for psychological distress had virtually no effect on the magnitude of the Stress Fitness interaction. Substantively, these findings suggest that psychological distress plays an important role in the stress-buffering effect of self-reported exercise, but does not underlie the stress-buffering power of physical fitness. The results presented in the bottom right side of Table 2 provide additional support for this conclusion. As can be seen, when predicting to health center visits, the magnitude of the Stress x Fitness interaction was virtually unchanged when psychological distress was statistically controlled. Although the interaction term now falls just short of statistical significance (p = .057), as a practical matter controlling for psychological distress had very little effect on the stress-buffering power of physical fitness. Prospective analyses. Several additional analyses were performed to examine further the stress-buffering effect of physical fitness on health center visits. First, a prospective hierarchical regression analysis was conducted to determine whether the Stress Fitness interaction predicted changes in health status over time. The dependent variable for this analysis was subjects' visits to the health facility during the spring academic semester (M = .74). After controlling for health center visits during the fall semester (M = .76), standardized stress and fitness scores were entered into the predictive equation. The cross product term of these latter factors followed. The only effect to achieve significance was the Stress Fitness interaction (~ -- -.2435, p < .05, R 2 change = .06). As in the earlier analyses, stressful life events were more strongly linked to poor health status among low-fit subjects than among high-fit subjects. Moreover, the interaction continued to be a reliable predictor of health outcomes when psychological dis-

LOW FIT

I L L l~ E S 2

HIGH
FIT

Low

High

STRESS
Figure1. Schematic representation of the Stress x Fitness interaction
in the prediction of illness (health center visits).

560

JONATHON D. BROWN tors of the stress-illness relation, such as physical fitness and social support (Cohen, Sherrod, & Clark, 1986). Aspects of the present findings provide support for the continued examination of this issue. Although self-reports of exercise and stress interacted to predict self-reports of health, they did not interact to predict health center visits. Moreover, these variables did not interact to predict self-reports of health after psychological distress was statistically controlled. One way to account for these findings is to assume that selfreports of stress, exercise, and health have both valid and invalid sources of variance (Watson & Pennebaker, 1989). The invalid source of variance derives from the influence of psychological distress. When subjective perceptions of these variables are being considered, researchers would be wise to control for the possible contaminating effects of psychological distress (Watson & Pennebaker, 1989). The need to control for distress appears less critical when more objective indicators of stress, fitness, and health are used. Concluding Remarks To summarize, the present research provided a conservative test of the hypothesis that physical fitness buffers the negative effects of life stress. In accordance with this hypothesis, the findings showed that people who are physically fit are less vulnerable to the adverse effects of life stress than are those who are less fit. Although in the absence of random assignment to conditions, one can never be certain that fitness, per se, is the operative variable, the results are certainly suggestive of that conclusion. At the very least, they provide the most convincing evidence to date that physical fitness serves to protect people from the deleterious effects of life stress. As evidence for the stress-buffering role of fitness continues to mount, research must begin to identify the mechanisms that underlie the effect. Both physiological and psychological variables are very likely involved (Brown & Siegel, 1988). As concerns psychological variables, two mediating mechanisms seem particularly promising. One concerns feelings of perceived control and mastery. Simons, McGowan, Epstein, Kupfer, and Robertson 0985) recently reviewed the relevant literature and concluded that feelings of mastery and self-efficacy increase after regular physical exercise. This finding is important because the belief that one can control events has been shown to reduce stress responsivity (Rodin, 1986). Whether feelings of mastery and self-efficacy underlie the benefits that fitness provides under stress represents a promising topic for future research. Another variable that deserves consideration is attentional focus. Physical fitness training typically turns people's attention away from the stressful circumstances in their life (Bahrke & Morgan, 1978). By providing a temporary respite from life stress, exercise may serve a beneficial restorative function that allows people to deal with stressful circumstances more effectively. In this manner, attentional focus may provide another route through which staying fit is linked to staying well. References Astrand, P., & Rodahl, K. (1977). Textbook of work physiology: Physiological bases of exercise (2nd ed.). New York: McGraw-Hill.

The results were consistent with the claim that physical fitness cushions the deleterious effects of life stress. Life stress was strongly related to illness (health center visits) among subjects whose performance on the bicycle test indicated a relatively low level of physical fitness, but life stress had little ill effect among subjects whose fitness level was relatively high. Moreover, these relations were observed even after indicators of psychological distress were statistically controlled. These data thus suggest that fitness may mitigate the adverse impact of life stress. One's confidence in this conclusion is bolstered further by the findings from the prospective analyses. These analyses examined whether fitness moderates the effects of stress over a 6-month period. By partialing out initial health status, they also tested whether the Stress Fitness interaction predicted changes in health status over time. Fitness continued to buffer the negative effects of life stress in these analyses. Because these analyses examined changes in health status over time, they provide particularly suggestive evidence that stress and fitness affect physical well-being. Of course, one must be circumspect when making this claim because even prospective analyses cannot unequivocally establish causal relations. Other aspects of the current research also indicate a need for caution when interpreting the findings. The measures of fitness and health used in this research possess obvious advantages over self-report measures. Nonetheless, they provide only an approximate index o f their respective underlying constructs. This caveat is particularly pertinent regarding the health measure. Although many people visit a doctor when ill, others do not; thus, health center visits represent only a rough measure of physical well-being. For this reason, a replication of the findings using more precise measures ofiUness is needed. Research using a more objective measure of life stress than the retrospective self-report measure used here is also desirable. More direct measures of fitness (e.g., actual as opposed to estimated maximum oxygen uptake) are also desirable for future research. Another possible limitation of the present research concerns the age of the subjects. The stressful events that college students experience, though subjectively troubling, may be less severe or chronic than the events older adults encounter. College students also tend to be in better health than older adults. Thus, although the illnesses examined in the present research were serious enough to warrant medical attention, they were relatively minor in severity. For these reasons, research is needed to determine whether fitness moderates the effects of stress in older populations. The relative health of subjects in this study may explain why fitness did not have a direct effect on health status. Effects of fitness among young adults may emerge only when health is threatened. In this sense, poor fitness would function as a diathesis in this population; life events function as the stress that activates the vulnerability factor. An important aspect of the present research was an assessment of the potential mediating role of psychological distress. As noted earlier, a number of papers have recently appeared suggesting that the relation between self-reported stress and subjective indicators of health may be spurious insofar as psychological distress may underlie both of these variables (Costa & McCrae, 1987; Watson & Pennebaker, 1989). In theory, this critique applies to variables that have been identified as modera-

PHYSICAL FITNESS, STRESS, AND HEALTH STATUS Bahrke, M. S., & Morgan, W. E (1978). Anxiety reduction following exercise and meditation. Cognitive Therapy and Research, 2, 323333. Blair, S. N., Goodyear, N. N., Gibbons, L. W., & Cooper, K. H. (1984). Physical fitness and incidence of hypertension in healthy normotensive men and women. Journal of the American Medical Association, 252, 487-490. Brown, J. D. (1989). Measuring physical fitness by self-report. Unpublished manuscript, Southern Methodist University, Department of Psychology, Dallas, TX. Brown, J. D., & Lawton, M. (1986). Stress and well-being in adolescence: The moderating role of physical exercise. Journal of Human Stress, 12, 125-131. Brown, J. D., & Siegel, J. M. (1988). Exercise as a buffer of life stress: A prospective study of adolescent health. Health Psychology, 7, 341353. Cohen, J., & Cohen, E (1983). Applied multiple regression~correlation analysis for the behavioralsciences(2nd ed.). Hillsdale, N J: Erlbaum. Cohen, S., Sherrod, D. R., & Clark, M. S. (1986). Social skills and the stress-protective role of social support. Journal of Personality and Social Psychology, 50, 963-973. Costa, E T., Jr., & McCrae, R. R. (1987). Neuroticism, somatic complaints, and disease: Is the bark worse than the bite? Journal of Personality, 55, 299-316. Davies, A., & Ware, J. E., Jr. (1981). Measuring health perceptions in the health insurance experiment (Rep. No. R-2711-HHS). Santa Monica, CA: Rand Corporation. Dohrenwend, B. S., & Dohrenwend, B. E (Eds.). (1974). Stressful life events: Their nature and effects. New York: Wiley. Eysenck, H. J., & Eysenck, S. B. G. (1975). Eysenck Personality Questionnaire Manual. San Diego, CA: Educational and Industrial Testing Service. Folkins, C. H., & Sime, W. E. (1981). Physical fitness training and mental health. American Psychologist, 36, 373-389. Holmes, D. S., & Roth, D. L (1985). Association of aerobic fitness with pulse rate and subjective responses to psychological stress. Psychophysiology, 22, 525-529. Hughes, J. R. (1984). Psychological effects of exercise. PreventiveMedicine, 13, 66-78. Kaplan, G., & Camacho, T. (1983). Perceived health and mortality: Nine-year follow-up of the human population laboratory cohort. American Journal of Epidemiology, 117, 292-304. Keller, S., & Seraganian, E (1984). Physical fitness level and autonomic reactivity to psychosoeial stress. Journal of Psychosomatic Research, 28, 279-287. Lennon, D., Stratman, E W., Shrago, E., Nagle, E J., Hanson, E G., Maddon, M., & Spennetta, T. (1983). Total cholesterol and HDLcholesterol changes during acute, moderate intensityexercise in men and women. Metabolism, 32, 244-249. Light, K. C., Obrist, E A., James, S. A., & Strogatz, D. S. (1987). Cardiovascular responses to stress: II. Relationships to aerobic exercise patterns. Psychophysiology, 24, 79-86. Oberman, A. (1985). Exercise and the primary prevention of cardiovascular disease. American Journal of Cardiology, 55, 10D-20D.

561

Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401. Rodin, J. (1986). Aging and health: Effects of the sense of control. Science, 233, 1271-1276. Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press. Rosenthal, M., Haskeil, W. L., Solomon, R., Widstrom, A., & Reavan, G. M. (1983). Demonstration of a relationship between level of physical training and insulin stimulated glucose utilization in normal humans. Diabetes, 32, 408--411. Roth, D. L., & Holmes, D. S. (1985). Influence of physical fitness in determining the impact of stressful events on physical and psychologic health. Psychosomatic Medicine, 47, 164-173. Roth', D. L., Wiebe, D. J., Fillingim, R. B., & Shay, K. A. (1989). Life events, fitness, hardiness, and health: A simultaneous analysis of proposed stress-resistance factors. Journal of Personality and Social Psychology, 57, 136-142. Sarason, I. G., Johnson, J. H., & Siegel, J. M. (1978). Assessing the impact of life changes: Development of the life experiences survey. Journal of Consulting and Clinical Psychology, 46, 932-946. Simons, A. D., McGowan, C. R., Epstein, L. H., Kupfer, D. J, & Robertson, R. J. (1985). Exercise as a treatment for depression: An update. Clinical Psychology Review, 5, 553-568. Sinyor, D., Golden, M., Steinert, Y.,& Seraganian, E (1986). Experimental manipulation of aerobic fitness and the response to psyehosocial stress: Heart rate and self-report measures. Psychosomatic Medicine, 48, 324-337. Tessler, R., & Mechanic, D. (1978). Psychological distress and perceived health status. Journal of Health and Social Behavior, 19, 254262. Tomporowski, E D., & Ellis, N. R. (1986). Effects of exercise on cognitive processes: A review. PsychologicalBulletin, 99, 338-346. Watson, D. (1989). Intraindividualand interindividualanalyses of positive and negative affect: Their relation to health complaints, perceived stress, and daily activities. Journal of Personality and Social Psychology, 54, 1020-1030. Watson, D., & Clark, L. A. (1984). Negative affeetivity: The disposition to experience aversive emotional states. Psychological Bulletin, 96, 465--490. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063-1070. Watson, D., & Pennebaker, J. W. (1989). Health complaints, stress, and distress: Exploring the role of negative affectivity. PsychologicalReview, 96, 234-254. Wyler, A. R., Masuda, M., & Holmes, T. H. (1968). The Seriousness of Illness Rating Scale. Journal of Psychosomatic Research, 11, 363374. Received November 29, 1989 Revision received May 7, 1990 Accepted August 18, 1990