Psychosomatic Medicine 13:36-50 (1951)
© 1951 American Psychosomatic Society

Life Situations, Emotions, and Exercise Tolerance

¹ Departments of Medicine and Psychiatry of the Cornell Medical College and the New York Hospital, New York, N.Y.

In 35 subjects the circulatory dynamics at rest and after exercise were studied during different emotional states. Included in the study were controls without complaints or evidence of cardiovascular disease, patients with hypertension or various degrees of structural heart disease, and patients without evidence of structural heart disease but having complaints which place them in the group usually designated as neurocirculatory asthenia. Blood pressure, heart rate, stroke volume (ballistocardiograph) and cardiac index were determined in the resting state and at intervals of two, three, five, and ten minutes after a standard two-step exercise (Master).

A close correlation was found between the emotional state and the resting level of cardiac activity. Stressful life situations associated with attitudes of preparedness and feelings of anxiety or resentment were accompained by cardiac hyperactivity, with heart rate and/or cardiac index increased in comparison to the values found during periods of security and relaxation. Situations evoking despair and discouragement were accompanied by cardiac hyperactivity, with heart rate and cardiac index below the usual values.

A similar relationship was observed between the emotional state and the circulatory response to exercise. During periods of anxiety and resentment exercise usually resulted in greater and more prolonged increase in heart rate and/or cardiac index than did the same exercise performed during periods of security and relaxation. This objective evidence of exercise intolerance was commonly accompanied by complaints of dyspnea, palpitations, weakness, or other discomfort on exertion. During mild life stress the resting heart rate and cardiac index were sometimes unchanged but exercise tolerance impaired.

The correlation between emotional state and circulatory dynamics at rest and after exercise was observed in all three groups of subjects. In the healthy controls the fluctuations in emotional state and in circulatory dynamics were relatively small, and symptoms of effort intolerance minimal. The patients with neurocirculatory asthenia exhibited greater variability in emotional state and in cardiac activity, and the association of pronounced anxiety, cardiac hyperactivity at rest, and exercise intolerance was frequently observed. In the subjects with structural heart disease effort intolerance was the product of the fixed structural defect and the variable influence of life stress.

In all patients, both with and without structural heart disease, who presented complaints of exercise intolerance a significant portion of the symptomatology was dependent on anxiety, resentment, and cardiac hyperactivity incident to stressful life situations. With the achievement of a state of relative security and relaxation there was diminution in the cardiac activity at rest and improvement in exercise tolerance.