Spiritual walking and stress resilience integrating psychological endocrine and genetic evidence from a longitudinal Iraqi cohort

BACKGROUND: Physical activity benefits stress and anxiety, yet spiritually motivated walking may confer distinct psychobiological advantages compared with competitive sports. While prior studies have been largely cross-sectional, the longitudinal dynamics of psychological, endocrine, and genetic interactions remain underexplored. METHODS: We conducted a mixed cross-sectional and longitudinal study including three hundred adults in Iraq (n = 100 athletes, n = 100 spiritual walkers, n = 100 sedentary controls). Subjects were tracked across four waves: baseline (T0), immediate post-activity (T1), 1-month follow-up (T2), and 3-month follow-up (T3). The results revealed perceived stress (PSS-10), state anxiety (STAI-S), salivary cortisol and DHEA-S (ELISA), and genotyping of BDNF Val66Met (rs6265) and 5-HTTLPR. Analyses used ANOVA/ANCOVA, linear mixed models (LMM), and regression models with FDR correction. RESULTS: Across the waves studied, spiritual walkers consistently showed lower levels of stress and anxiety compared to both athletes and control groups (all p ≤ 0.01). Longitudinal linear mixed models corroborated enduring disparities at T3, wherein the spiritual walkers exhibited the most advantageous psychological profile. Endocrine assessments indicated diminished cortisol levels and increased DHEA-S concentrations in walkers, resulting in a persistently favorable cortisol/DHEA-S ratio relative to the other groups. Genetic analyses indicated that BDNF Met/Met and 5-HTTLPR S/S carriers reported heightened distress; however, these effects were less pronounced among walkers. An integrated model elucidated 51.8% of the variance in anxiety, identifying cortisol (β = 0.42) and DHEA-S (β=-0.35) as the most significant predictors. CONCLUSIONS: Spiritually motivated walking correlated with persistent decreases in stress and anxiety, along with improved regulation of the HPA-axis and a reduction in genetic vulnerability, effects that persisted for up to 3 months following the intervention. These results underscore the practical applicability of culturally relevant, affordable interventions that incorporate spiritual walking into community mental health initiatives, considering biological factors.