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Edmund O. Acevedo and Aaron L. Slusher

The relationship between stress and disease, in particular cardiovascular disease, has long been recognized, whereas the study of the physiological mechanisms that explain this link has only more recently received attention. The acute response to stress is generally thought to be a critically important adaptation designed to activate the system in preparation to cope with the stressor. However, prolonged stimulation of the system (acute and chronic) can lead to deleterious adaptations including the release of inflammatory cytokines (small proteins important in cell signaling) that play a critical role in the development of atherosclerosis. Scientists have therefore used a breadth of protocols and methods to identify the complexity of our fight-or-flight response and demonstrate the synergy between perception, the stress response, physical activity, and health. In addition, the critical assessment of cellular health, the gut microbiome, and genetic polymorphisms have further advanced our understanding of additional therapeutic targets against CVD.

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Guro Strøm Solli, Espen Tønnessen, and Øyvind Sandbakk

of the overtraining syndrome: clues from depression and psychoneuroimmunology . Sports Med . 2002 ; 32 ( 3 ): 185 – 209 . PubMed ID: 11839081 doi:10.2165/00007256-200232030-00003 11839081 10.2165/00007256-200232030-00003 14. Fry RW , Morton AR , Keast D . Overtraining in athletes. An

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Thomas Sawczuk, Ben Jones, Mitchell Welch, Clive Beggs, Sean Scantlebury, and Kevin Till

 al . Consensus statement: immunonutrition and exercise . Exerc Immunol Rev . 2017 ; 23 : 8 – 50 . PubMed ID: 28224969 28224969 33. Irwin MR . Why sleep is important for health: a psychoneuroimmunology perspective . Annu Rev Psychol . 2015 ; 66 : 143 – 172 . PubMed ID: 25061767 doi:10.1146/annurev

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Sarah K. Keadle, Eduardo E. Bustamante, and Matthew P. Buman

). Ongoing work focuses on allostatic load (i.e., the wear and tear of the body in response to chronic stress; McEwen, 1998 ), psychoneuroimmunology (i.e., the interaction between psychology and the nervous and immune systems; Kiecolt-Glaser et al., 2002 ), and gut microbiome (i.e., the microorganisms

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Kizzy Antualpa, Marcelo Saldanha Aoki, and Alexandre Moreira

. Salivary sIgA and cortisol concentrations in response to music therapy in patients with cancer . Psychoneuroimmunology research society meeting , Galveston, Texas . 1999 ; 6 : 224 . 23. Hucklebridge F , Clow A , Evans P . The relationship between salivary secretory immunoglobulin A and cortisol

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Daniel Birrer

Psychiatric Publishing . Armstrong , L. E. , & VanHeest , J. L. ( 2002 ). The unknown mechanism of the overtraining syndrome—Clues from depression and psychoneuroimmunology . Sports Medicine, 32 ( 3 ), 185 – 209 . PubMed ID: 11839081 doi: 10.2165/00007256-200232030-00003 10

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Natashia Swalve, Brianna Harfmann, John Mitrzyk, and Alexander H. K. Montoye

:10.1093/sleep/29.3.299 10.1093/sleep/29.3.299 Irwin , M.R. ( 2015 ). Why sleep is important for health: a psychoneuroimmunology perspective . Annual Review of Psychology, 66 , 143 – 172 . PubMed ID: 25061767 doi:10.1146/annurev-psych-010213-115205 10.1146/annurev-psych-010213-115205 Jo , H

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Richard Tahtinen, Hafrun Kristjansdottir, Daniel T. Olason, and Robert Morris

? Psychiatric Services, 68 ( 7 ), 724 – 726 . PubMed ID: 28292224 doi:10.1176/appi.ps.201600320 10.1176/appi.ps.201600320 Moriarity , D. , & Alloy , L.B. ( 2020 ). Beyond diagnoses and total symptom scores: Diversifying the level of analysis in psychoneuroimmunology research . Brain, Behavior, and