Anxiety and Psycho-Physiological Stress Response to Competitive Sport Exercise

Abstract

Introduction: Sport is recognized as beneficial for health. In certain situation of practice, it nevertheless appears likely to induce a stress response. Anxiety is a stress response-modulating factor. Our objective is to characterize the role of anxiety in the stress response induced by a selective physical exercise.
Method: Sixty-three young male military conducted a selective sporting running event (a 8-km commando-walk) and were recorded the day before, the day of the race, and the day after. The variables were psychometric [personality questionnaires, coping and anxious/stress state, and physiological (nocturnal heart rate variability and actigraphy)]. The subjects were classified, using scores on anxiety questionnaires at baseline, into two groups according to their anxious (G ANX) or non-anxious (G N-ANX).
Results: Before the race, the G ANX was characterized by a lower level of self-esteem, higher scores in dysfunctional coping and a greater perceived stress compared to the G N-ANX. Compared to G N-ANX, the stress response to the exercise was higher in G ANX: G ANX exhibited (Selye, 1950) in immediate post-exercise, greater level in activation markers, and mental fatigue associated with a same level of physical fatigue and (Kim et al., 2018) in nocturnal post-exercise, an increase in sympathetic activation associated with a higher sleep fragmentation.
Conclusion: A competition selection sport exercise causes a stress response, particularly for anxious subjects. Anxious status could be involved in the risk of emergence of overtraining in sport practice. These results must be taken into account when sport practice is used for anxiety management.

Full text

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ORIGINAL RESEARCH
published: 27 August 2018
doi: 10.3389/fpsyg.2018.01469
Edited by:
Jean-Eric Blatteau,
Hôpital d’Instruction des Armées
Sainte-Anne, France
Reviewed by:
Roland Seiler,
Universität Bern, Switzerland
Stephane Besnard,
Institut National de la Santé et de la
Recherche Médicale (INSERM),
France
Robert J. Vallerand,
Université du Québec à Montréal,
Canada
*Correspondence:
Marion Trousselard
marion.trousselard@gmail.com
Specialty section:
This article was submitted to
Movement Science and Sport
Psychology,
a section of the journal
Frontiers in Psychology
Received: 21 September 2017
Accepted: 26 July 2018
Published: 27 August 2018
Citation:
Tanguy G, Sagui E, Fabien Z,
Martin-Krumm C, Canini F and
Trousselard M (2018) Anxiety
and Psycho-Physiological Stress
Response to Competitive Sport
Exercise. Front. Psychol. 9:1469.
doi: 10.3389/fpsyg.2018.01469
Anxiety and Psycho-Physiological
Stress Response to Competitive
Sport Exercise
Gaelle Tanguy1,2 , Emmanuel Sagui1,2,3 , Zagnoli Fabien2,4 , Charles Martin-Krumm2,5,6,7 ,
Frédéric Canini2,5 and Marion Trousselard2,5,7,8*
1Service de Neurologie, Hôpital d’Instruction des Armées Laveran, Marseille, France, 2Ecole du Val de Grâce, Paris, France,
3Fed 3C, LNC, UMR 7291, Aix Marseille Université, Marseille, France, 4Service de Neurologie, Hôpital d’Instruction des
Armées Clermont-Tonnerre, Brest, France, 5Unité de Neurophysiologie du Stress, Département de Neurosciences et
Contraintes Opérationnelles, Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France, 6Laboratoire
de Psychologie de l’Ecole de Psychologues Praticiens de Paris, Paris, France, 7APEMAC, EA 4360, EPSaM, Université
de Lorraine, Nancy, France, 8Chaire Mindfulness, Bien-être au Travail et Paix Économique, Grenoble Ecole de Management,
Grenoble, France
Introduction: Sport is recognized as beneficial for health. In certain situation of practice,
it nevertheless appears likely to induce a stress response. Anxiety is a stress response-
modulating factor. Our objective is to characterize the role of anxiety in the stress
response induced by a selective physical exercise.
Method: Sixty-three young male military conducted a selective sporting running event
(a 8-km commando-walk) and were recorded the day before, the day of the race, and
the day after. The variables were psychometric [personality questionnaires, coping and
anxious/stress state, and physiological (nocturnal heart rate variability and actigraphy)].
The subjects were classified, using scores on anxiety questionnaires at baseline, into
two groups according to their anxious (G ANX) or non-anxious (G N-ANX).
Results: Before the race, the G ANX was characterized by a lower level of self-esteem,
higher scores in dysfunctional coping and a greater perceived stress compared to the
G N-ANX. Compared to G N-ANX, the stress response to the exercise was higher
in G ANX: G ANX exhibited (Selye, 1950) in immediate post-exercise, greater level in
activation markers, and mental fatigue associated with a same level of physical fatigue
and (Kim et al., 2018) in nocturnal post-exercise, an increase in sympathetic activation
associated with a higher sleep fragmentation.
Conclusion: A competition selection sport exercise causes a stress response,
particularly for anxious subjects. Anxious status could be involved in the risk of
emergence of overtraining in sport practice. These results must be taken into account
when sport practice is used for anxiety management.
Keywords: anxiety management, stress, selective physical exercise, special forces, overtraining
INTRODUCTION
Stress is a non-specific and complex response of a human body submitted to a stressor, which
responds to an adaptive function. It is described as the general adaptation syndrome (GAS) (Selye,
1950) and is divided into three stages: an initial alarm stage, followed by a resistance stage to the
stressor, which lasts and to which the human body has to adapt to, and lastly a recovery stage.
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The stressor characterizes any situation activating the stress
pathway, regardless its nature, its depth and its duration
(Selye, 1950). It can be external to the subject, imposed by an
environmental change, or auto-generated by affects or negative-
valence thoughts, especially anxious thoughts.
From a physiological point of view, if we can artificially
consider all the stress players separately in regard to their very
nature, it is important to consider them within their dynamics
and their interactions. Strictly speaking, stress corresponds to
the activation of the catabolic mechanisms: the activation of the
corticotropic axis and of the sympathetic autonomic nervous
system (ANS) and withdrawal of the parasympathetic ANS.
The sympathetic ANS prepares the body to action when facing
a stressor thanks to an increased mobilization of the energy
resources of the body in order to support the alert reaction
(flight or fight) and attention to the world. The corticotropic
axis facilitates the availability of the body energy resources
over time. Recovery is possible through anabolic pathways
entailing in particular sleep and activation of the parasympathetic
ANS. These pathways represent the link between the central
nervous system and the periphery, allowing the body to act in
a coordinated and adjusted manner. They allow the rating of
the level of stress response of a body by peripheral physiological
measurements.
The heart rate variability dynamically informs about the
regulation of the balance between the sympathetic and the
parasympathetic ANS (Task Force of the European Society
of Cardiology and the North American Society of Pacing
and Electrophysiology, 1996;Kim et al., 2018). When it is
well-regulated (eustress), the stress expresses a physiological
mechanism managing acute and chronic biological costs.
A burnout situation will result if the stressor is too intensive
and/or too long, or else if the stressed individual’s response
capacities are not adapted (distress). There is a strong inter-
individual variability in the psychobiological reaction to a
stressor, and it is identical within the same individual for
the physical or psychic stressors (McEwen, 2007). The stress
response, whatever the stressor, forms part of an earthly body
whose limits are influenced by the genome and the history of
the subject. These factors inherent to each subject constitute
an endogenous limitation, which expresses the more or less big
efficiency of the biological systems to cope with the demands
imposed by the stressors. This biological efficiency is modulated
by the psyche that is going to deal with an event as a
stressor as soon as it is perceived as new, unpredictable, or
else uncontrollable. As soon as an individual assigns one or
several of these characteristics to an event, he perceives his/her
resources as inappropriate to the perception he has of the
coercion (Lazarus, 1993). The psychological factors participating
in this inter-individual variability belong to two main categories:
the moderators, which determine whether or not the response
to stress will emerge (the most studied are the personality
traits) (Baron and Kenny, 1986), and the mediators, which are
going to modulate this response once it is implemented (we
also speak about adjusting factors). Among these psychological
factors, anxiety plays a major part. As for any psychic dimension,
the trait (personality, moderator factor) must be distinguished
from the state and the mood (mediator factor; Bolmont and
Abraini, 2001). The anxiety trait is considered as a relatively stable
emotional disorder that characterizes a personality manifesting
through a sense of insecurity (Spielberger and Smith, 1966). The
anxiety-state is a fear characterized by behavioral, physiological,
and cognitive responses, which encompass those of stress
but do not stop at them. The individuals with an anxious
personality are particularly sensitive to emotional stimuli with
a negative valence, which contribute to the risk of developing
anxious pathologies. This sensitivity contributes to reducing the
adaptation of anxious individuals to stressors. The anxiety trait
is therefore considered as a moderator fostering the emergence
of important and repeated stress reactions. The anxiety-state
reflects a time period focused to anxious feeling relatively to
a present or future meaningful context (Hainaut and Bolmont,
2006). So, if the anxious trait empirically allows to prejudge
an anxious state, the opposite is less systematic as a result of
the anxious state depending on its context. The anxiety context
would express a dynamic emotional process that could include
an anxious emotion or an anxious mood depending on its
intensity and duration. The anxious state is considered as a
stress reaction mediator positioning the perception of context
as a per se actor of the dynamic to stress response. Numerous
managements of anxiety do exist in terms of prevention and/or
treatment. Practicing a physical activity, aerobic or anaerobic,
has been put forward for a long time as an ecological method
to reduce the anxiety-state whatever the level of anxiety-trait
(Petruzzello et al., 1991;Anderson and Shivakuvar, 2013).
Furthermore, the physical activity is of undeniable interest for
the prevention and treatment of mental diseases in relation
to anxiety (Anderson and Shivakuvar, 2013;Kumar, 2017).
Beyond this, somatic benefits do exist, especially cardiovascular
effects are benefits (Paffenbarger et al., 1986). It also plays a
beneficial role on the stress-related diseases. These benefits are
all the more important when the practice is regular (Petruzzello
et al., 1991). The WHO recommendations suggest to practice
a moderate activity (at least 3 h a week) or an intense activity
(at least 20 min three times a week). However, some sport
activities generate deleterious stress responses. In the context of
a compulsory practice, the physical activity turns up to act as a
stressor for the individual. Preclinical studies on rats undergoing
rehabilitation show a stress response, which delays recovery when
the rehabilitation exercises are compulsorily done (Ke et al.,
2011). As far as humans are concerned, a compulsory sport
practice also triggers a stress reaction (Nicolas, 2009;Ke et al.,
2011). In the context of a regular practice, 13% of the sportsmen
develop a state ranging from exhaustion to overtraining, and
7.8% of the military are addicted to sport (Tello et al., 2011).
A need for performing a more-and-more frequent and more-
and-more intense physical activity is observed, particularly
among sportsmen characterized by a high anxiety-trait level
(Cook and Hausenblas, 2008). In the context of competition,
an anxiety is often present following a sports contest (Shabnam
Hamidia, 2010). It is fostered by the existence of an anxiety-
trait, -state and/or -mood and of a strong social desirability
(Craft et al., 2003;Shabnam Hamidia, 2010). Finally, after a
competitive effort, compared to a similar effort in a training
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context, a longer physiological recovery is observed, resulting
in the persistence of a high sympathetic tone (Foster, 1998).
Thus, practicing a physical activity in the context of an external
and/or internal compulsory practice induces a stress response
likely to be potentiated among the anxious sportsmen. This
response could have consequences in terms of recovery among
these patients. These data suggest that certain sport practices
conditions might not be beneficial to the health, especially among
anxious patients.
The military environment provides a model to explore these
issues. As part of the army forces retention, the military
institution imposes a regular physical activity practice to
its staff for a minimum of 8 h a week. In this sense,
soldiers are professional sportsmen. The purpose of this
training is twofold: toughening the soldiers for the future
struggles, but also preparing them to sports events selection,
among which the commando march is the most common
selection procedure used. This paradigm characterizes a selective
physical exercise, intense in duration and in “intensity,”
which forms part of well-codified regular practice. It is
legitimate under these elements to consider that the military
sports selection is similar to competitions) and that it
constitutes a practice setting likely to generate a stress response,
especially among anxious staff members. We wish to study the
psycho-physiological stress response in the military individual
compelled to a selective commando march. The purpose of
this study is to assess the impact of the anxious status
on the dynamic of stress response following the commando
march.
MATERIALS AND METHODS
Participants
Sixty-three voluntary French male soldiers (age: 20.3 ±2 years;
BMI 23.4 ±2.3) were included in a prospective study. All were
in initial training for the fusilier commando specialty, a French
navy special force unit. The data collection was carried out on
four commando training-courses that took place between May
2012 and January 2013. Three individuals were excluded from the
analysis due to missing data; the individuals had not completed
the submitted questionnaires. Chart 1 sums up the characteristics
of these training-courses. This study was agreed by the Ouest six
persons protection comity under the reference 2011-A01660-41.
All the prospective subjects were informed about the conduct
of this study and gave their written consent prior to their
participation.
Physical Test
The experimental paradigm is an 8-km commando march in
the minimum amount of time. This physical test specific to the
military environment consists in a race dressed in combat gear
with “rangers” type of shoes carrying an 11-kg backpack. As
regards a qualifying event, the subjects were to perform the best
possible time, the time for this event interfering in their ranking
and in their final selection for the fusilier commando specialty.
None of the subjects had already the experience of this event.
Physiological Variables
Night Heart Rate Variability
The heart rate was measured, thanks to a heart rate monitor
(ActiHeart R
, CE). It is a small (35 mm ×35 mm ×15 mm), light
(16 g) self-adhesive device placed on the chest and connected
to two self-adhesive ECG electrodes causing no discomfort.
To isolate specifically the responsiveness of the sympathovagal
balance, the calculation of the LF/HF (Low Frequency/High
Frequency) ratio, was chosen as variable of interest (KubiosR

software). The higher the value is, the more important the
sympathetic activation is.
The Quality of Sleep
The quality of sleep is assessed thanks to a wrist actimeter
(Wellness Wireless Watch VIVAGO EU644534000). The devices
are light watches causing no inconvenience for the activities.
The processed variables are the time asleep, the sleep efficiency,
the sleep onset latency, and the sleep fragmentation (Wellness
Wireless VIVAGOR
software).
Psychological Variables
Three questionnaires have assessed the psychological dispositions
(trait). The anxious personality was assessed by the anxiety-
trait Spielberger questionnaire (State-Trait-Anxiety Inventory;
STAI Y-B) (Spielberger, 1983). This self-assessment questionnaire
consists of 20 items. For each item, the subject must indicate if he
characterizes his usual anxious feeling from a Likert scale ranging
from 1 (no) to 4 (yes). The average value is 41.9 ±9.5 in a French
population. A score greater than or equal to 47 is considered as
being pathological (Bruchon-Schweitzer and Paulhan, 1993).
The self-esteem has been measured, thanks to the Rosenberg
Self Esteem Scale (SES) (Rosenberg, 1979). This self-assessment
scale measures, thanks to 10 items, the opinion one has about
oneself, in a non-specific way. For each of the items, the subject
must indicate if he characterizes his feeling from a Likert scale
ranging from 1 (totally disagree) to 4 (totally agree). A score
of less than 15 is considered as assessing a low self-esteem; a
score between 15 and 25 is considered as assessing a normal
self-esteem.
The stress adjustment, or “coping,” has been measured by
the Coping Inventory of Stressful Situations (CISS) (Endler and
Parker, 1999). This questionnaire assesses via 48 items the way
the subject usually copes with stresses. It allows to assess the
subject in the three types of coping: the task focused coping,
the emotion focused coping, and the passive coping (avoidance,
social distraction, and diversion). The average value in the
population is of 58.6 ±10 for the task focused coping, 39.2 ±11.5
for the emotion focused coping, 38.1 ±9 for the avoidance
focused coping, 17.5 ±5.5 for the distraction focused coping, and
13.3 ±4.1 for the social diversion type coping (Trousselard et al.,
2010).
Three Questionnaires Assess the Psychological State
The anxious state was assessed through the Spielberger’s
state-anxiety questionnaire (STAI Y-A). This self-questionnaire
includes 20 items. For each of these items, the subject must
indicate if he characterizes his anxious feeling while filling in
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the questionnaire from a Likert’s scale ranging from 1 (no) to 4
(yes). The average value is of 35.7 ±10.3 in a French population.
An equal or higher score than 41 is considered as being high
(Bruchon-Schweitzer and Paulhan, 1993).
The subject’s mood was measured by the Profile of Mood
State (POMS) (Shacham, 1983). This self-questionnaire
assesses, by the means of 37 adjectives, the different states
of mood of a subject and their fluctuation (repetition of
questionnaires). The subject must indicate how this adjective
reflects his state from a Likert’s scale ranging from 1 (not
at all) to 4 (extremely). The adjectives gather in six factors
defining six states of mood, which are anxiety, depression,
confusion, anger, fatigue, and vigor. This questionnaire,
assessing the state of mood of a subject at the moment
when he answers the different items, has a transitional
value.
The perceived stress was assessed through Cohen’s perceived
stress scale [Perceived Stress Scale (PSS)] (Cohen et al., 1983). This
self-questionnaire includes 14 items. For each of the items, the
subject must indicate his perception of stress while filling it in
from a Likert’s scale ranging from 1 (never) to 4 (often).
Experimental Procedure
Each of the trainings followed an identical protocol including
four sessions and was organized around the commando march
challenge, which systematically started at 10 a.m. Figure 1
sums up the experimental protocol with the distribution of
the four sessions over time: at 5 p.m. on the day before
the challenge (inclusion session; D-1), in the morning just
before the challenge (pre-challenge session; prechallenge D1),
at the end of the challenge (post-challenge session; post-
challenge D1), and at 9 a.m. on the day after the challenge
(recovery session; D+1).
All fusilier commando training, participants benefited
from a medical examination during the week before the
beginning of the training assessing their medical fitness
to do it. On D-1, the subjects filled in the following
questionnaires: socio-biographic and sports practice, self-
esteem (EES), anxiety-trait and -state (STAI Y-A and-B),
mood (POMS), coping (CISS), perceived stress (PSS).
During the D1 pre-challenge and post-challenge sessions
and D+1, the subjects filled in the anxiety-state and mood
questionnaires.
The heart rate variability and actimetrics data were collected
in N−1 and N+1 on a recording time of 6 h for all subjects.
This period was established within an 11 p.m. to 5 a.m. timetable
corresponding to the moments when the subjects were all in bed.
Statistical Analysis
The data were registered under Excel 2010 (Microsoft R
,
Redmond, WA, United States) and analyzed with Statistica
V7.1 (Statsoft R
, France). The discrete variables were compared
through the Chi2test or through the Fisher’s exact test when
the conditions for the Chi2use were not completed. The
continuous variables, presented by their average ±standard
deviation, were compared by variance analyses (ANOVAs).
A principal components analysis pre-treatment was conducted
in order to assess the relevance of the anxiety psychometric
data reduction collected in the inclusion (anxiety-trait, -
state, -mood baselines) with less descriptors. The results of
the analysis isolate one single factor of own value above
1 (λ= 2.22) and which explains 73.9% of the variance.
The three variables used have a positive force on this
factor, meaning that they have the same meaning: the
most anxious subjects express high scores in the three
anxiety questionnaires taken into account. The pre-treatment
FIGURE 1 | Experimental protocol with the distribution of the four sessions: day before the challenge (inclusion session; D−1), morning just before the challenge
(pre-challenge session; pre-challenge D1), end of the challenge (post-challenge session; post-challenge D1), and day after the challenge (recovery session; D+1).
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performed was complemented by a distribution of subjects
relatively to the anxiety-trait, -state, -mood variables, collected
in the inclusion, through the clustering technic (K-mean)
in two groups allowing to characterize an anxious group
(G ANX) composed of 17 subjects and a non-anxious
group (G N-ANX) composed of 47 subjects. In all cases,
we considered that a difference was significant as soon as
p<0.05.
RESULTS
Study Population
Table 1 sums up the bio-demographic characteristics of the
subjects. The night-time physiological data collected in N−1
are summed up in Table 2. No difference was found between the
trainings on each of the physiological variables. The psychological
profile in the inclusion is summed up in Table 3. No difference
is found between the trainings on the psychological variables
collected.
Effect of the Commando March on the
Population
All the trainees completed the commando march. The average
performance was of 54.71 (±8.85) minutes. The psycho-
physiological responses to the commando march show a post-
challenge stress reaction. Physiologically, a post-challenge night-
time sympathic activation is noticed: comparatively to N−1, the
LF/HF index in N+1 is higher (F= 6.77; p= 0.01), and the
objective sleep is of less good quality in terms of sleep quality
(F= 11.03; p= 0.002), and of sleep onset latency (F= 6.02;
p= 0.02). Psychologically, we notice that the anxiety-state is
the highest in the D1 post-challenge (F= 11.54; p<0.001)
and that the negative moods scores are the highest [fatigue
(F= 7.32; p<0.001); depression (F= 7.59; p<0.001); and
anger (F= 11.48; p<0.001)]. In D +1, these scores are
not different from the values collected in D −1 and D1 pre-
challenge.
TABLE 1 | Sociodemographic characteristics of the subjects.
Mean age in year (standard deviation) 20(±2)
Military seniority (months) 1 [1 −2]∗
Educational level (%)
- Undergraduate studies 32
- Graduate studies 60
- Post-graduate studies 5
Reported stressfull event (%) 10
Levels of sport (%):
- Recreational 49
- Regional 14
- National 10
Monthly hours of sport practice 9 [1, 75–20]∗
∗For non-Gaussian distribution values, the description is presented by the median
(first–second interquartile).
TABLE 2 | Nocturnal physiological data collected in N −1 session.
Variables Inclusion
Nocturnal Mean (±SD) sleep duration (min) 407(±42)
Actimetry Micro-awakening duration (min) 45
Sleep efficiency index (%) 89
Sleep fragmentation index (%) 30
Mean (±SD) easiness to go to sleep (min) 2
Mean (±SD) nocturnal heart rate variability (LF/HF) 1.32(±0.77)
SD, standard deviation; Min, minutes; LF/HF, low frequency/high frequency.
TABLE 3 | Psychological scores in the inclusion session (D−1).
Variables M(±SD)
Self-esteem 32.8 (±5.5)
Coping:
– Task 57.4 (±9.3)
– Avoidance 37.2 (±10.7)
– Emotion 43.7 (±12.3)
– Distraction 17.9 (±6.8)
– Social diversion 16.6 (±5.4)
Anxiété:
– Trait 33.8 (±8.6)
– Etat 30.5 (±8.1)
Perceived stress 31.5 (±5.9)
Mood:
– Tension/anxiety 3.1 (±3.6)
– Activity/vigor 12.3 (±5.2)
– Fatigue 2.4 (±2)
– Depression 0.7 (±1.3)
– Angor 1.3 (±2.2)
– Confusion 1.2 (±1.8)
M(±SD), mean (±standard deviation).
Anxious Cluster Effect in the Inclusion
(G-ANX vs. G N-ANX) Onto the
Psycho-Physiological Responses to the
Commando March
Anxious Cluster Effect Onto the Inclusion
Psycho-Physiological Variables
No difference is found between both groups neither in terms
of average age, marital status, school level, nor in terms of
hours of sports training during the previous month (p>0.05).
The G-ANX trainees revealed more stress events throughout
their life than the G N-ANX trainees (X2= 5.45; p= 0.02).
No difference is found in the inclusion (N−1) neither on the
nocturnal actimetrics variables, nor on the nocturnal heart rate
variability. No difference is found between both groups in terms
of performance (p>0.05). Table 4 sums up the differences
observed in psychological terms between both groups.
Anxious Cluster Effects Onto the Physiological
Responses of the Commando March
Regarding the LF/HF heart rate variability index, there is a session
effect [LF:HF is higher at N+1 (recovery) comparatively to
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TABLE 4 | Differences observed in mean psychological scores between both groups in the inclusion session (D−1).
Variables G ANX M(±SD) G N-ANX M(±SD) p
Population size 17 43
Self-esteem 30.3 (±6.1) 33.8 (±5) 0.03
Coping CISS task 54.2 (±10.9) 58.4 (±8.7) 0.15
CISS emotion 48.2 (±9.6) 33.6 (±8.5) 0.00
CISS avoidance 49.5 (±12) 41.5 (±11.9) 0.03
CISS distraction 20.2 (±6.5) 17 (±6.9) 0.13
CISS social diversion 18.2 (±6.8) 15.9 (±4.7) 0.16
Perceived stress 36.7 (±4.2) 29.4 (±5.2) 0.00
Mood Vigor 10.9 (±6) 12.7 (±4.9) 0.24
Fatigue 2.9 (±1.6) 2.2 (±2.1) 0.21
Depression 1.8 (±1.8) 0.3 (±0.7) 0.00
Anger 2.6 (±2.5) 0.8 (±1.9) 0.00
Confusion 2.4 (±2.4) 0.6 (±1) 0.00
G-ANX, anxious group; G N-ANX, non-anxious; M, mean; SD, standard deviation; CISS, Coping Inventory Stress Scale.
N−1; F= 25.68; p<0.001] without any effect on the anxious
status (F= 0.73; p= 0.39]. The significant interaction between
the session factor and the anxiety status shows that the LF/HF
index is higher at N+1 for the G ANX comparatively to the G
N-ANX (F= 13.45; p<0.001). Regarding the quality of sleep,
it is noticed that the fragmentation index is higher at N+1
(recovery) comparatively to N−1 (F= 8.5; p= 0.006). The
significant interaction between the session factor and the anxiety
status shows that the fragmentation index is higher at N+1 for
the G ANX comparatively to the G N-ANX (F= 5.64; p= 0.02).
Anxious Cluster Effects Onto the Psychological
Responses Following the Commando March
Regarding the anxiety-state, there is an effect of the session
(F= 5.97; p<0.001) with an anxiety-state score higher at D1
post-challenge comparatively to the other sessions. There is an
anxious status effect (G ANX et G N-ANX; F= 41.95; p= 0.39)
with an anxiety-state score higher for the G ANX comparatively
to the G N-ANX. The significant interaction between the session
factor and the anxious status shows that the anxiety-state score is
higher in D1 post-challenge comparatively to the other sessions
for the G N-ANX (F= 4.17; p= 0.006).
Regarding the tension-anxiety mood, there is an effect of the
session (F= 6.79; p= 0.002) with a tension-anxiety score higher
in D+1 (recovery) comparatively to the other sessions. There is
an effect of the anxious status (G ANX et G N-ANX; F= 18.67;
p<0.001) with a tension-anxiety score higher for the G ANX
comparatively to the G N-ANX. No interaction between the
factors is noticed (F= 1.75; p= 0.15).
Regarding the activity-vigor mood, there is an effect of the
session with a lower activity-vigor score at D1 post-challenge
comparatively to the other sessions (F= 10.09; p<0.001) and an
anxious status effect with an activity-vigor score lower for the G
ANX comparatively to the G N-ANX (F= 4.02; p= 0.04). A trend
toward an anxious session–status interaction is noticed (F= 2.1;
p= 0.1). For the G ANX, the activity-vigor score tends to be stable
between the sessions whereas for the G N-ANX, it is lower at D1
post-challenge comparatively to the other sessions.
Regarding the fatigue mood, there is a session effect with a
higher score in D1 post-challenge comparatively to the other
sessions (F= 10.09; p<0.001), without any effect of the anxious
status (F= 2.17; p= 0.14), and without any interaction between
the session factor and the anxious status (F= 0.25; p= 0.85).
Regarding the depression mood, we notice that the score is
higher in D1 post-challenge comparatively to the other sessions
(F= 8.09; p<0.001), and that it is higher for the G ANX
comparatively to the G N-ANX (F= 13.06; p<0.001).
Regarding the anger mood, we notice that the score is higher in
D1 post-challenge comparatively to the other sessions (F= 9.87;
p<0.001) and that it is higher for the G ANX comparatively to
the G N-ANX (F= 8.67; p= 0.004).
Regarding the confusion mood, the score is higher in D1
post-challenge comparatively to the other sessions (F= 11.03;
p<0.001). The score is higher for the G ANX (F= 28.75;
p<0.001). A trend toward an interaction is observed between
the session factors and the anxious status (F= 2.1; p= 0.1). For
the G N-ANX, the confusion score tends to be stable between
the sessions whereas for the G ANX, it is higher in D1 post-
challenge comparatively to the other sessions. Figure 2 sums
up the differences between the groups over the mood variables
during the different sessions (D-1, D1 pre-challenge, D1 post-
challenge, and D+1).
DISCUSSION
The purpose of this study was to assess the reaction to stress
induced by a sports challenge with a strong commitment and
the recovery the day after the challenge according to the
subjects’ anxious status. First, it confirmed the stressor role
of the selecting challenge played by the commando march.
The increase of the activation psychological markers (anxiety,
anger moods) was associated with physical fatigue (fatigue
mood) and mental fatigue (depression mood). The psychological
recovery was observed the very next day after the exercise.
The night that followed the exercise allowed to assess the
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FIGURE 2 | Differences between the groups over the mood variables during the different sessions. (A) D−1inclusion, (B) D1pre-challenge, (C) D1post-challenge,
(D) D+1recovery. G-ANX, anxious group; GN-ANX, non-anxious group.
recovery. A night-time parasympathetic rebound (Myllymaki
et al., 2012) and a quality of sleep with few awakenings reflect
the quality of the anabolic response of the sleep in the post-
exercise recovery (Schall et al., 2013). The results show that
the sleep was not restorative as shown by the night-time
heart rate variability and the deterioration of the sleep quality.
These observations contrast with the data showing that the
isolated or regular physical exercise practice is an important
factor to promote the sleep (Youngstedt et al., 1999). The
disruption of the post-exercise night-time recovery is all the
more important to consider that the subjects enrolled in the
study are characterized by a protective psychological profile:
high level of self-esteem and low level of anxiety-trait. The
adjustments strategies show an adaptive pattern relatively to
the general population, the subjects being characterized by a
high level of on-task coping, and a moderate level of emotional
coping.
Second, in our study, the population was segregated into two
subgroups according to the anxious status and by taking into
account both the anxious personality and the dynamic process
induced by the commando march (anxiety-state and -mood).
This segregation showed that the subjects of the anxious group
were characterized by a lower level of self-esteem and a higher
level of coping focused on emotion and avoidance. It also had
implications on the stress response at different steps of the
exercise. Before the challenge, the anxious subjects expressed
a higher level of perceived stress as well as an increase of the
activation psychological markers (anxiety, anger moods) and of
mental fatigue (depression and confusion moods) for a same
level of physical fatigue (fatigue mood). If this state reflects
an anticipatory anxiety in relation to previous experiences, this
reactivity before the exercise raises questions the memorization
of previous physical exercises (Stranahan et al., 2008) and the
way he anticipates the level of constraint (Dishman et al., 2000).
A neurobiological profile with an increase of reactivity to a
stressor was put forward (Pruessner et al., 2005). It combines a
reduction of the hippocampus volume in a functional MRI, an
increase of the reactivity of the corticotropic axis, and a reduction
of the self-esteem. The pertinence of this profile requests to be
assessed within the frame of an excessive reaction to stress when
facing a sport event with a strong commitment. Immediately
after the exercise, the anxious status was characterized by the
maintenance of the psychological markers of activation (anxiety,
anger) and of mental fatigue (depressive and confused mood)
at a higher level than the non-anxious status. However, the
anxious status did not have any impact neither onto the physical
performance nor onto the fatigue.
Lastly, the night-time recovery is of less good quality in the
anxious subjects than in the subjects with a non-anxious status.
Hughes et al. (2006) have shown that the existence of depressive
symptoms were slowing down the recovery after an exercise.
Thus, the stress activation excess in peri-exercise was associated
with an anomaly of its extinction in the recovery phase. In the
end, these data suggest that in subjects with an anxious status,
practicing an implying activity generates an inadequate stress
reaction. This excessive reactivity concerns on the one hand
the modalities of sports practice in the treatment of anxiety.
The physical activity modalities in these treatments must focus
on promoting a practice without generating neither an internal
nor an external obligation in the anxious subjects. On the
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other hand, the excessive reactivity questions in the longer term
about the consequences of a repeated and constraint physical
activity onto these subjects’ psychological and physical health.
In particular, it questions the role that the anxious status could
have in the risk of emergence of an overtraining syndrome.
This syndrome, which is characterized by a performance level
decrement without any modification of the investment in the
sports practice, is clinically expressed in very different ways:
anxiety, depression, fatigue, anger, lack of confidence, insomnia
(Kentta and Hassmen, 1998). The absence of any clinical
sign pathognomonic for an overtraining state, is associated
with a difficulty to extract specific biological signs from it
(Lee et al., 2017). However, the repetition of excessive stress
reactions was put forward as contributing to a risky sports
practice (Angeli et al., 2004). The repeated stress would induce
a functional problem likely to lead to a dysfunction. The
overtraining could be considered as a stress pathology expressing
the impossibility for an individual to manage his stress response
to the minimum required by the demand. These costs fall within
the framework of the allostasis theory, which characterizes the
recovery process or not of the homeostasis in the presence
of constraint (Charney, 2004). The evaluation of the anxious
status would allow to improve the detection of subjects at
highest risk complementary to the overtraining questionnaire.
The latter does not allow the systematic detection of the most
motivated subjects who are the most vulnerable (Maso et al.,
2005): these subjects, who barely listen to the body alarm
signals, will meet any decrease of performance by an increase
of training. This description fits in with the absence of impact
of the anxious status onto the physical fatigue experienced
after the commando march. Taking this status into account
could be necessary to determinate the training programs for
regular sportsmen. These data are all the more important that
the consequences of overtraining can be dramatic for a sports
career.
This study has shown two main limitations. Even though
no difference in the main variables was observed over the four
training sessions organized in different seasons, an impact of the
seasonality onto the mood cannot be excluded (Kurlansik and
Ibay, 2012). Then, the study has only included male subjects,
which implies reproducing these results in a female population.
CONCLUSION
The commando march constitutes a military paradigm of
sport under constraint that can be transposed to the civilian
environment within the frame of a selective or competitive sports
practice. The results obtained have applications for the health
of both civilian and military sportsmen. They clearly raise the
question of taking into account the anxiety in the sports practice
programming. When the anxiety is taken into account, the
modalities must detect any practice under constraint. For regular
sportspeople, the modalities must integrate the anxious status in
the programs of the sessions’ repetition. These results highlight
the interest for coupling the physical activity to stress and anxiety
management techniques whether on the occasional sportsman,
the regular sportsman or the competitor.
AUTHOR CONTRIBUTIONS
ES, ZF, FC, and MT were involved in the conception and trial
design. GT, ES, CM-K, and MT wrote the draft of the article. ES,
ZF, FC, CM-K, and MT contributed to the refinement of the study
protocol and provided expert insight. ES and FC were responsible
for the ethics committee. All the authors were involved in final
approval of the manuscript.
ACKNOWLEDGMENTS
The authors wish to thank the soldiers from fusilier commando
of Lorient (France) and the physicians for their support.
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Conflict of Interest Statement: The authors declare that the research was
conducted in the absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.
The reviewer RV declared a past co-authorship with one of the authors CM-K to
the handling Editor.
Copyright © 2018 Tanguy, Sagui, Fabien, Martin-Krumm, Canini and Trousselard.
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