As a business owner, Kate Trnka of Alternatives Holistic Health and Wellness Center in Appleton makes plenty of decisions. But there's one she deems more important than most — the decision to be grateful.

While Trnka admits that doing so is easier on some days than others, she asserts that practicing gratitude is always possible, regardless of circumstance.

"We take so much for granted every day," she said. "I think we need to stop and live in this moment. That's really all we have. ... We can hope that we have 10 minutes from now or tomorrow or the next day, but it's really a gift, and (gratitude for it) is a choice."

What's more, Trnka said, those who make that choice experience benefits beyond improved mental state: "They work out more. They eat the right foods. They get regular exams because their health is important to them."

It seems science backs her belief that appreciating the gifts life has to offer can make a measurable difference in your physical health.

"Positive people on average live longer, happier, healthier lives. The research is clear on that," said Jon Gordon, author of "The Energy Bus: 10 Rules to Fuel Your Life, Work and Team with Positive Energy" (Wiley, 2007) and "The No Complaining Rule: Positive Ways to Deal with Negativity at Work" (Wiley, 2008).

Indeed, a 2003 study by Dr. Robert A. Emmons of the University of California-Davis and Dr. Michael E. McCullough of the University of Miami demonstrated some of gratitude's more tangible effects. Participants in the study who kept gratitude journals on a weekly basis exercised more regularly, reported fewer physical symptoms and felt better about their lives than those who recorded hassles or neutral life events.

"The more we take on and acknowledge in a negative way, that physically impacts us," Trnka said.

Letting go of negativity and stress to embrace gratitude may be good for us, but it's not simple, according to Dr. Albert Bellg, cardiac psychologist with the Appleton Heart Institute. Unlike humor or simple cheerfulness, he said, "gratitude is in some ways a more nitty-gritty challenge.

"It doesn't come easily, but it's worth fighting for."

Here, some suggestions for developing your own sense of gratitude and improving your health as a result:

Know your leanings toward or away from gratitude

Understanding your own openness to gratitude is a good first step toward cultivating it in your life.

"We're all born with a positivity set point," Gordon said. "Through gratitude, you can change your physiological state and mental state and, through habit, can make that more your natural state."

That may prove more difficult for men than for women. Bellg cited a psychological study out of George Mason and Hofstra universities that showed that men were less likely to feel and express gratitude and derived fewer benefits from it, instead perceiving gifts as a source of obligation to another.

Beyond gender, faith also can impact predisposition toward gratitude — though how its effect plays out varies from individual to individual. "People who are spiritual or religious in nature may already have an awareness of (gratitude) and why it's the right thing to do," Trnka said.

However, that's not universally the case, according to Bellg. "There are some religions where the cultivation of gratitude is very much a part of the religious viewpoint. Sad to say, there are some religions where the opposite is true, where guilt, where the basic wrongfulness of people, is the focus."

Instead of being based in faith alone, gratitude can stem from something more personal — namely, self-esteem. As an example, Bellg has counseled patients brought back from massive heart attacks who struggle with why they deserve the gift of life.

"What gratitude does in a way that no other concept does is it allows you to accept a gift like that without having to merit it. … You simply have to be willing to benefit from it, accepting your own self-worth."

Document gratefulness

One of the initial steps Trnka took to cultivate her own practice of gratefulness was keeping a gratitude journal. "When I first started, I said, 'I'm going to write until I can't think of anything else.'"

And she did — right down to running water. "When you go to that level of even very simple things, you can't help but be happy," she said.

Connie Krumrai, parish nurse at First Presbyterian Church in Neenah, also writes at least three things for which she's grateful in her journal each night. The practice, she said, "helps keep me focused on all the blessings in my life despite whatever else may be going on."

Bellg has seen how such journaling correlates to patient outcomes. "There are times when I've had patients keep journals of things that are going well in their lives and things they're grateful for.

"If they come back with a journal of three good things that have happened to them in a week and nothing they're grateful for, that gives us something to work for."

Conversely, he said, for a patient who comes back with a lengthy gratitude list, "this is someone that's going to be coping much, much better" — even if the individual's medical prognosis is bleak.

Take a thank-you walk

If writing is not your thing, Gordon suggests walking your gratitude as an alternative.

"This has been the one habit that changed my life," he said. "It's like a garden. You have to weed the negative and feed the positive."

During his one-hour daily constitutional, he prays, visualizes his future and mentally lists things for which he's thankful.

"It's a walk that energizes you physically and, while you're walking, you're practicing gratitude," Gordon said.

Trnka, too, combines her gratitude practice with physical activity, escaping for a stroll in a natural setting when she notices stress taking hold.

"I think we don't spend enough time outside just breathing the fresh air, and if you can actually take that a step further and go out into nature and just be present there and see and feel and touch, I think it reconnects us to who we really are. It helps us heal in that more profound way than just taking an aspirin or putting a Band-Aid on it."

Regardless of your chosen approach to developing a sense of gratitude, expect the habit to take some time to stick.

"Gratitude is not simple — not something you just flip on like you might try to do with being happy," Bellg said.

Neither is it a Pollyanna state of mind. Said Gordon, "It's not saying you shouldn't ever get down. It's not saying you shouldn't feel negative emotions. We'll all be tested.

"It's about knowing how to respond to these tests. It's about giving yourself these strategies to turn it around."