Abstract
Recent studies have reported that the cortisol awakening response (CAR) is associated with various health risks. The different indices used to represent the CAR include the average cortisol levels in the morning immediately after waking (AVE); the total area under the curve of cortisol levels with respect to ground (AUCg); and the area under the curve of cortisol levels with respect to increase (AUCi). However, it is unclear which physiological phenomenon each index reflects. This study investigated the factors, such as stress, circadian rhythm, sleep, and obesity, affecting the CAR through a marine retreat-based healing program in which the anticipated stress of the participants could be controlled to some degree. Fifty-one menopausal women in their 50s and 60s were included, who performed beach yoga and Nordic walking for four days at an uncontaminated beach. The baseline CAR indices showed that the AVE and AUCg were significantly higher in the high sleep efficiency group than in the low sleep efficiency group. However, the AUCi decreased substantially with increasing age. The changes in the AVE, AUCg, and AUCi were calculated through the program, and it was found that the AVE and AUCg increased significantly more in the obese group than in the normal and overweight groups. The obese group also showed significantly decreased serum triglyceride and BDNF (brain-derived neurotrophic factor) levels compared to the low BMI group. Thus, it was confirmed that AVE and AUCg reflected physiological phenomena affected by factors such as sleep efficiency and obesity, whereas the AUCi was affected by factors such as age. In addition, the marine retreat program can improve the low levels of CAR associated with obesity and aging.