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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Stress-Induced Changes in Autonomic Activity and Fascia Hydration: A Cross-Recurrence Quantification Analysis in a Naturalistic Exam Paradigm

  • Andreas Brandl1,2
  • Lea Overmann3
  • Robert Schleip1,4
  • Glen Farrugia5
  • Tobias Nowy5
  • Christian Helmrich6
6 affiliations
  1. 1Conservative and Rehabilitative Orthopedics, TUM School of Medicine and Health, Technical University of Munich, 80333 Munich, Germany
  2. 2Department of Health and Social Sciences, Hochschule Fresenius, 20148 Hamburg, Germany
  3. 3Association for Fascia Research, 80799 Munich, Germany
  4. 4Department for Medical Professions, Diploma Hochschule, 37242 Bad Sooden-Allendorf, Germany
  5. 5School of Health and Psychology, Triagon Academy, MRS 1331 Marsa, Malta
  6. 6Department of Psychology, SRH Fernhochschule, 88499 Riedlingen, Germany
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Abstract

Background: The autonomic nervous system is increasingly recognized as a key regulator of fascial physiology. Interventions that modulate autonomic activity, including breathing techniques, relaxation strategies, and movement-based therapies, have therefore been proposed to influence tissue hydration and mechanics, as well as functional outcomes, yet evidence under real-life stress conditions remains limited. This study examined the effects of acute exam stress on autonomic activity, lumbar tissue hydration and their dynamic interaction. Methods: Eighteen students (9 female, 9 male; 36.1 ± 11.6 years) were assessed in front of peers and an examiner as part of an osteopathic medical school training (exam condition) and again after a four-week recovery period (control condition). Heart rate variability (HRV) and local bioelectrical impedance analysis (BIA) of the lumbar region were recorded. Subjective stress over the past four weeks was measured using the Perceived Stress Scale (PSS-10). Interactions between HRV and BIA were analyzed using cross-recurrence quantification analysis (CRQA). Results: Compared to the control condition, the exam condition showed significantly increased CRQA values (0.38 ± 0.44 vs. −0.33 ± 1.27; p = 0.037), indicating stronger system coupling. HRV was significantly reduced (716 ± 141 ms vs. 813 ± 105 ms; p < 0.001), reflecting increased autonomic activation. BIA values were also significantly lower (24.55 ± 9.28 Ω vs. 30.25 ± 9.77 Ω; p = 0.015), suggesting altered tissue hydration. PSS-10 scores were significantly higher during the exam condition (22.63 ± 5.46). Conclusions: Acute psychosocial stress appears to induce measurable changes in autonomic regulation and lumbar tissue properties and enhances their dynamic interaction. These findings provide initial indication for the concept of autonomic-fascial coupling and emphasize the relevance of integrative, biopsychosocial approaches in clinical physical therapy.

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Cite

BibTeXRIS
BibTeX
@article{brandl2026stressinduced,
  title = {{Stress-Induced Changes in Autonomic Activity and Fascia Hydration: A Cross-Recurrence Quantification Analysis in a Naturalistic Exam Paradigm}},
  author = {Andreas Brandl and Lea Overmann and Robert Schleip and Glen Farrugia and Tobias Nowy and Christian Helmrich},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15207839},
  url = {https://www.mdpi.com/2077-0383/15/20/7839},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Stress-Induced Changes in Autonomic Activity and Fascia Hydration: A Cross-Recurrence Quantification Analysis in a Naturalistic Exam Paradigm
AU  - Andreas Brandl
AU  - Lea Overmann
AU  - Robert Schleip
AU  - Glen Farrugia
AU  - Tobias Nowy
AU  - Christian Helmrich
PY  - 2026
DA  - 2026/10/01
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15207839
UR  - https://www.mdpi.com/2077-0383/15/20/7839
AB  - Background: The autonomic nervous system is increasingly recognized as a key regulator of fascial physiology. Interventions that modulate autonomic activity, including breathing techniques, relaxation strategies, and movement-based therapies, have therefore been proposed to influence tissue hydration and mechanics, as well as functional outcomes, yet evidence under real-life stress conditions remains limited. This study examined the effects of acute exam stress on autonomic activity, lumbar tissue hydration and their dynamic interaction. Methods: Eighteen students (9 female, 9 male; 36.1 ± 11.6 years) were assessed in front of peers and an examiner as part of an osteopathic medical school training (exam condition) and again after a four-week recovery period (control condition). Heart rate variability (HRV) and local bioelectrical impedance analysis (BIA) of the lumbar region were recorded. Subjective stress over the past four weeks was measured using the Perceived Stress Scale (PSS-10). Interactions between HRV and BIA were analyzed using cross-recurrence quantification analysis (CRQA). Results: Compared to the control condition, the exam condition showed significantly increased CRQA values (0.38 ± 0.44 vs. −0.33 ± 1.27; p = 0.037), indicating stronger system coupling. HRV was significantly reduced (716 ± 141 ms vs. 813 ± 105 ms; p < 0.001), reflecting increased autonomic activation. BIA values were also significantly lower (24.55 ± 9.28 Ω vs. 30.25 ± 9.77 Ω; p = 0.015), suggesting altered tissue hydration. PSS-10 scores were significantly higher during the exam condition (22.63 ± 5.46). Conclusions: Acute psychosocial stress appears to induce measurable changes in autonomic regulation and lumbar tissue properties and enhances their dynamic interaction. These findings provide initial indication for the concept of autonomic-fascial coupling and emphasize the relevance of integrative, biopsychosocial approaches in clinical physical therapy.
SN  - 2077-0383
ER  -