Objective Our study objective is to evaluate whether gender differences in both perceived and biological stress levels will alter resting heart rates. Hypothesis We hypothesize that females will experience higher levels of perceived and biological stress which will translate to a higher resting heart rate compared to males. Methods 19 first‐year medical students participated in this study. Participants wore Fitbits to collect heart rate data throughout the course of the academic year. During exam weeks (the “stressor”), participants filled out a standard psychometric questionnaire to assess perceived stress levels and saliva samples were collected to measure cortisol and alpha‐amylase concentrations. Results Our study showed that females have higher resting heart rates than males (65.8±6.8 bpm vs 57.7±4.34 bpm, p<0.001). Females recorded having higher perceived stress levels than males (7.9±4.6 vs. 2.12±5.27, p<0.001), as well as having higher salivary alpha‐amylase concentrations than males (33.95±29.50 U/mL vs. 75.4±76.44 U/mL p=0.001). No difference in salivary cortisol concentrations between females and males are seen (0.44±0.25 ug/dL vs. 0.39±0.24 ug/dL, p= 0.3). In females, there is a weak positive correlation between RHR and perceived stress level (0.22), as well as with amylase (0.26). In males, there is a moderate negative correlation between RHR and perceived stress level (‐0.48) and a weak positive correlation between RHR and cortisol (0.26). There was no relationship between RHR and amylase. Conclusion Females have higher levels of perceived stress levels which is in agreement with their higher levels of alpha‐amylase, a marker of psychosocial stress via the sympatho‐adrenal‐medullary system. As salivary alpha‐amylase has been suggested to reflect catecholaminergic reactivity, it seems likely that this is responsible for the increased resting heart rate. This relationship is not consistent in males where perceived stress is associated with a decrease in RHR. However, in males a relationship was seen between biological markers of stress (cortisol via the hypothalamic‐pituitary‐adrenal axis) and RHR. This study suggests that the relationship between biological measures of stress and heart rate vary with gender and that females experience an increased level of perceived stress overall.
Stress in medical students is higher than the general population and burnout among those in the healthcare field is becoming a rising concern. Exercise has been shown to decrease anxiety and stress via a role in the oxidative stress and inflammatory pathways and could contribute to combating the increase in burnout and stress among medical students. We hypothesized that there would be an inverse correlation between activity level and perceived stress among medical students. Exercise activity of first‐year medical students at Cooper Medical School of Rowan University were monitored using FitBits throughout the course of the academic year and the data were uploaded to Fitabase, a comprehensive data management platform. Data such as heart rate, steps, activity level, calories and distance were collected throughout the year. During baseline and exam weeks, participants filled out a standard psychometric questionnaire to assess perceived stress levels. Students were divided into two groups based off their resting heart rates: high activity (HA) level (resting HR less than and including 60 beats per minute) and low activity (LA) level (resting heart rate greater than 60 beats per minute). Students were also categorized into high, moderate, and low stress groups based off their perceived stress scores. Those in the HA group had lower self‐reported stress scores throughout the entire school year during the week of the exam than those in the LA category (p=.014). There was a significant correlation between steps taken during the block (pre‐exam) and steps taken the week of the exam in each of the system blocks (p < 0.001). Furthermore, the HA groups consistently increased steps taken the week of the exam while the LA group decreased steps taken. Our data also indicated that the HA group performed more “very active” activity per day than the LA group, while “fairly active” and “lightly activity” did not differ between groups. Our results suggest a strong relationship between higher activity levels and a reduced perceived stress levels throughout the first year of medical school.
Medical students experience higher than average levels of burnout and stress as they learn to adapt to the rigors of medical school. Due to the demanding structure of medical education, students may forego exercise, healthy diets, social interactions, and sleep. Healthy habits such as sleep, diet, and exercise have been shown to impact academic performance and future functions as physicians. In addition, as exercise training has been shown to reduce oxidative stress, it is through this pathway that the cortisol‐induced stress response may be blunted. We hypothesize that exercise can reduce the self‐perceived levels of stress in second‐year medical students. Fitbits were distributed to second‐year medical students and were used to monitor the activity, steps, and heart rate during the second half of the year as well as during their United States Medical Licensure Exam (USMLE) Step 1 dedicated test preparation period. Each person was also given a stress survey to fill out during the week of their exam, as well as during the week of their USMLE Step 1. Students self‐reported whether they were a low, moderate, or high exercise activity person, which coincided with their resting heart rates, as confirmed by literature. Our results showed that students who had self‐reported low exercise activity had higher stress scores in the Women’s Health, Ears‐Nose‐Throat, and one of two Neurology‐psychiatry blocks, as well as during the USMLE Step 1 detected test preparation period. Stress levels in general increased as the year progressed to the Step 1 exam. There was also a significant negative correlation between sleeping hours and stress levels. In conclusion, these results demonstrate that those students who perform higher levels of physical activity report lower levels of stress, which could possibly occur via a reduction in the oxidative stress‐induced cortisol response. In addition, the reduction of sleep time may have altered the circadian cycle‐responding stress hormone, cortisol, resulting in the perceived level of increased stress that the students reported.
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