What helps with stress: what has been measured, what the GP advises and what a stress scan shows you

In this article you will read exactly what has been measured about what helps with stress: what shifts within a few minutes, what shifts over a few weeks, how much movement and how much time outdoors the figures point to, and what a stress scan can show you. That matters, because stress is common and most of the advice that goes around because of it has never been measured. In the Adult and Elderly Health Monitor 2024, 20.3% of adults aged 18 years and older reported (very) high stress in the past 4 weeks, and between Dutch municipalities that share ranged from 11.2% to 27.8%.⁠⁴ The BioProfile stress scan gives you an indication of where you stand today in this area, as the first of the 11 health areas that the full scan assesses. This is not a diagnosis. It is insight, to see where you stand today, and to help you make better choices in your food and your way of living. What this scan does not do: point to a cause or make a diagnosis. Only a doctor can do that last one.

The fastest step: breathing calmly

Of the 1,842 abstracts screened, 223 studies on deliberate slow breathing were suitable: 172 measuring during the breathing itself, 16 straight after a single session and 49 after a programme of several sessions. Vagally mediated heart rate variability went up in all three situations, and the authors call the technique simple, cheap and unlikely to cause many side effects.⁠²

In plain words: that form of heart rate variability is a reflection of the calming branch of your nervous system, and the value did not move only after weeks of practice but already while people were breathing slowly. So this is the step you can take within a minute, and Thuisarts puts calm breathing on its own self-care list.⁠⁵

What a few weeks of practice does

17 randomised studies with 1,641 non-clinical adults, drawn from research up to and including August 2025, were pooled. Participants who followed a mindfulness programme scored lower on perceived stress afterwards than participants in the control group: SMD -0.53, 95% CI -0.72 to -0.33, p < 0.00001. Within the mindfulness groups the change from start to end was SMD 0.93 (95% CI 0.62 to 1.23), against 0.23 (95% CI 0.00 to 0.46) in the control groups.⁠¹

Progressive muscle relaxation was pooled across 31 randomised studies with 2,277 adults. The scores for sleep quality shifted with an SMD of -1.74 (95% CI -2.14 to -1.34), and on the Pittsburgh Sleep Quality Index the mean difference was -3.79 points. The effect came through at all intervention durations studied, with high heterogeneity between the studies.⁠⁶

For you that means two things. The size of the mindfulness effect is moderate, about 0.5 of a standard deviation: not a turnaround, but a real shift. And the studies on muscle relaxation differed so much from one another that the exact size remains uncertain, while the difference is often something you notice first in your sleep.

How much exercise, and what kind of exercise

Cross-sectional data from 15,688 adults aged 40 to 74 (6,377 men and 9,311 women) in the Japanese Yamagata Cohort Study showed an L-shaped association between moderate to vigorous leisure-time exercise and a high score for perceived stress, with the lowest prevalence ratio at about 5.0 MET-hours per day. Exercise outside leisure time behaved differently: a J-shaped pattern in men, a flattening curve in women, and the authors therefore advise looking at the domain of the activity and not only at the total.⁠⁷

Put simply: movement you choose yourself is linked to experiencing less stress, while being on your feet all day at work is not the same thing, and because the data are cross-sectional this is an association. The Dutch minimum is lower than 5.0 MET hours per day anyway: at least two and a half hours (150 minutes) of moderate movement a week, spread over several days, plus muscle and bone strengthening activities.⁠⁸

Going outside, and the green space around your home

36 city dwellers took a moment outside in nature at least three times a week, each of 10 minutes or longer, over 8 weeks, and chose the time and the place themselves. Salivary cortisol fell fastest when the moment outside lasted between 21 and 30 minutes, a drop of 18.5% per hour on top of the normal daily rhythm. Above 30 minutes the gain kept rising, at a slower pace per minute spent.⁠³

Where you live counts too. A representative sample of 4,529 Dutch respondents from the second National Study of morbidity and interventions in general practice, collected in 2000 to 2002, was linked to the percentage of green space within 1 km and 3 km of the home. The relationship between a stressful life event and both the number of complaints in the past 14 days and self-rated general health was significantly weaker among respondents with a lot of green space within 3 km, and that pattern showed up only at 3 km and not at 1 km, after correcting for age, sex, income, education and urbanicity.⁠⁹

Practical: 20 to 30 minutes outside is a usable dose, rather than an hour you never take,⁠³ and a green area within cycling distance seems to matter more than the one tree in front of your window.⁠⁹

Coffee, alcohol and the hours before bedtime

The European food safety authority holds up to 400 milligrams of caffeine a day as safe for adults in good health, and no more than 200 milligrams at once. A 125 millilitre cup of filter coffee or instant coffee contains about 60 milligrams, so the daily ceiling sits at about 5 cups. For people who are sensitive to caffeine, 100 milligrams at once can already affect sleep duration and the sleep pattern, certainly a few hours or less before bedtime.⁠¹⁰

Alcohol and drugs are on the same list at Thuisarts, and for a reason worth knowing: alcohol and drugs reduce the tension only briefly and make the underlying problem worse.⁠⁵ So the two evening habits that feel like rest are the two that cost you the night.

What helps with stress according to your GP, and when to make an appointment

Thuisarts.nl lists these steps for self-care: move, preferably outdoors; relax; keep structure in your day; spend time in nature; stay in touch with others; worry less; breathe calmly; sleep enough; eat healthily; avoid alcohol and drugs.⁠⁵

Make an appointment with your GP if you cannot bring the stress down on your own and you want help, if complaints get worse such as becoming more anxious or more low, if daily functioning suffers (not working, not getting out of bed, eating badly), if your use of alcohol or drugs increases, or if people around you are seriously worried. Talking to your GP or the practice nurse often helps already: ‘Often it is better after 4 weeks’. Medicines are rarely given for stress.⁠⁵ Those rules carry weight because Thuisarts.nl is made by the Nederlands Huisartsen Genootschap together with the Federatie Medisch Specialisten and Patiëntenfederatie Nederland.⁠⁵

What a stress scan measures and what the scan does not measure

The stress scan asks you questions about the past few weeks, gives each answer points, adds those points up and converts them into a stress score with the reading band the score falls into. Higher is better. The studies in the mindfulness review measured exactly this kind of self-report, a score for perceived stress.⁠¹ Our questions are written in our own words, so your score is not a validated clinical score.

What a questionnaire cannot do is point to the cause of the stress. A hard stretch at work, a slow thyroid, broken sleep and a low mood all read the same way in a list of questions. A stress scan does not make a diagnosis. What you get is a baseline, and if you repeat the scan in two weeks, you have two numbers instead of a memory that flattens out.

In summary

Calm breathing is the step with the fastest measured change, and it costs you nothing. Over a few weeks, a mindfulness programme and progressive muscle relaxation both moved the figures, and you often notice it in your sleep first. With exercise you choose yourself in your free time, perceived stress is lower, and a short moment outside of about twenty to thirty minutes is the dose with the steepest fall in cortisol, helped by green space within a few kilometres of home. Coffee late in the day and alcohol in the evening work against the night. The GP is the place to go if it does not shift under your own steam, if complaints get worse, if your day starts to falter, or if the people around you are worried. And the scan gives you a number to start from. It is not a diagnosis.