Research & Summaries Question

Received: 16 October 2019
| Revised: 3 January 2020 | Accepted: 2 February 2020
DOI: 10.1111/ppc.12484
ORIGINAL ARTICLE
Effect of yoga?based physical activity on perceived stress,
anxiety, and quality of life in young adults
Gseter Erdo?an YNq
| Gamze Muz2
1
Department of Aged Care, Nevsehir Haci
Bektas Veli University, Nevsehir, Turkey
Abstract
2
Department of Internal Nursing, Nevsehir
Haci Bektas Veli University, Nevsehir, Turkey
Purpose: This study, conducted at a public university in Turkey, sought to determine
the effects of yoga?based physical activity on perceived stress, anxiety, and quality
Correspondence
Gamze Muz, Department of Internal Nursing,
Semra ve Vefa K_+ Faculty of Health
Sciences, Nevsehir Haci Bektas Veli University,
50300 Nevsehir, Turkey.
Email: gamzeucakan@gmail.com
of life in young adults.
Design and Methods: This study was planned as a semiexperimental nonrandomized
study with a control group.
Findings: Yoga?based physical activity decreased the perceived stress and state
anxiety levels, but had no effect on trait anxiety levels and quality of life.
Practical Implications: It is recommended that yoga?based treatment can be included
in nursing interventions for reducing stress and anxiety levels in young adults.
KEYWORDS
anxiety, physical activity, quality of life, stress, yoga
1 | INTRODUCTION
tension, anxiety, insomnia, emotional imbalance, decreased concentration, amnesia, confusion for individuals. These physical and psychologi-
Stress is a multifaceted and global phenomenon with a marked effect on
cal problems decrease individuals1uality of life.2,8,9,11,12,13
public health in this modern age. All causes of change in daily routine
Harmful influences of stress on bodily systems can be decreased
lead to stress.1àYoung adults in particular are constantly under stress
effectively by strengthening adaptive mechanisms that can help us to
because of academic performance expectations, changes in their en-
restore balance. Studies show that mind?body?based applications are
vironment, malnutrition, sedentary lifestyle, economic problems, future
helpful in decreasing anxiety in general population.3,11,13w Yoga,
expectations, problems regarding society’s value systems, personal ex-
one such application, is a psychosomatic?spiritual discipline that
pectations, as well as expectations of family and peers.1,4Êeventually facilitates combination of individual consciousness with
Stress activates limbic system and hypothalamus, which control
universal consciousness to provide mental, bodily, and spiritual sy-
nervous system. The autonomic nervous system has various effects on
nergy and harmony. It originated in India and has been applied for
regulating healthy homeostatic mechanisms of body via hypothalamic?
thousands of years. Yoga is a practice composed of asanas, involving
pituitary?adrenal axis. When this system is stimulated, the amount of
various postures that contribute to flexibility and condition of body;
adrenalin produced by the medulla increases. The increase in adrenalin
pranayama, involving breath control to obtain maximum benefit; and
secretion causes many effects, such as increased heart rate, blood
meditation.11,18,19
1,2,8,9,10
Acute
Mind?body interventions, such as yoga are accessible, highly
stress improves performance by increasing sympathetic discharge over
adaptable practical approaches that can help us to build resilience to
a short period of time. However, chronic stress, which is accepted as a
stress. In the last 25 years, yoga has been subject of many studies due
key component of an unhealthy lifestyle, causes prolonged stimulation
to its positive influences on health and quality of life, rather than due
of sympathetic nervous system. This poses a risk in terms of chronic
to its spiritual influences.11,17,20,21 The influence of yoga on health
diseases, such as coronary heart disease, hypertension, and diabetes
stems from complex biochemical and physiologic mechanisms that
mellitus. Moreover, it leads to many psychological problems, such as
involve decreased activity in sympathetic nervous system and
pressure, blood glucose, and changes in breathing pattern.
This study was presented as a poster presentation at 21st National Congress of Internal Medicine, 9?13 October 2019, Antalya, Turkey.
Perspect Psychiatr Care. 2020;56:697ð4.
wileyonlinelibrary.com/journal/ppc
2020 Wiley Periodicals, Inc.
|
697
698
|
ERDO?AN Y E AND MUZ
antagonistic neuromuscular system, stimulation of the limbic system,
Committee Number: 2019.04.38). In addition, written informed
and increased parasympathetic nervous system activities. Yoga helps
consents were obtained from the volunteer participants, and the
us to improve hormonal balance and feelings of well?being.
study adhered to the tenets of the Helsinki Declaration.
1,2,11,16,17,20,21
Literature has shown that yoga supports spiritual
health, decreases anxiety symptoms, and increases general health
2.2 | Participants and sampling of the study
and psychological wellness.3,10,14v,22,23¹
Cultural differences have led to prejudices against yoga
teachings for a long time. Many studies reported higher levels of
The participants were students studying at Health Services
spirituality orientations among yoga practitioners than general
Vocational School of Nev?ehir Hac? Bekta? Veli University in Turkey.
population.30 The number of studies emphasizing biomedical and
A yoga class was opened, and 65 students were enrolled for this class
therapeutic effects, as well as research emphasizing the basic
in the spring term of the 2018 to 2019 academic year. After in-
spiritual dimensions of yoga, has increased in recent years. Conse-
forming them about the study, 60 students were volunteer to take
quently, yoga has become more widely accepted in various settings
part in. A control group was chosen among the students who were
around the world, particularly in the US and Europe, and it is now
studying at the same college and did not enroll in the yoga class.
increasingly applied as a therapeutic intervention to improve phy-
These students were also informed about the study, and 50 students
sical and psychological health.17,23,30,31 Many studies evaluated
were volunteer participate in the study. Students who consented to
therapeutic effects of yoga, which is used commonly for health
participate in and aged between 18 and 25 years were included in
protection and promotion among diverse groups, such as healthy
the study. Students who had yoga experience, participated in sports
adolescents,
menopausal
regularly, had chronic cardiovascular system, endocrine, or kidney
young
8,10,14,15,17,21
adults,
employees,
and
However, the extent and number of studies
diseases, had neurologic disorder, and/or had any psychiatric dis-
related to application of yoga with a view to protect and develop
order were excluded from the study. Moreover, students who de-
health in young adults are limited. The number of studies on yoga in
sired to quit the study and did not attend the processes and sessions
Turkey has increased in recent years.20,25,32,33 However, no study
regularly were terminated from participation.
women.
has yet investigated the effects of yoga in college students in
There were five students in the yoga group who did not comply
Turkey. Hence, this study sought to reveal the effects of yoga?based
with the study criteria, and they were excluded from the study. Ad-
physical activities on perceived stress, anxiety, and quality of life in
ditionally, three students decided to quit the study, while eight stu-
healthy young adults.
dents were excluded from the study as they did not attend the
processes actively. Moreover, five students in the control group
Research Hypotheses
quitted the study before the last follow?up. Therefore, the study was
completed with 44 students in the yoga group and 45 students in the
Ha0: Yoga, applied 60 minutes every week, for 4 weeks in total, is not
control group, in total 89 students (Figure 1). Post hoc analysis with
effective in reducing stress levels in young adults.
the G?power program indicated that the power of the study was 92%,
Ha1: Yoga, applied 60 minutes every week, for 4 weeks in total, is
and determined an effect size 0.66 in the perceived stress scale (PSS)
effective in reducing stress levels in young adults.
score difference.
Hb0: Yoga, applied 60 minutes every week, for 4 weeks in total, is not
effective in reducing anxiety levels in young adults.
Hb1: Yoga, applied 60 minutes every week, for 4 weeks in total, is
2.3 | Data collection instruments
effective in reducing anxiety levels in young adults.
Hc0: Yoga, applied 60 minutes every week, for 4 weeks in total, is not
2.3.1 | Participant information form
effective in increasing quality of life in young adults.
Hc1: Yoga, applied 60 minutes every week, for 4 weeks in total, is
A participant information form was prepared by the researchers, and
effective in increasing quality of life in young adults.
it included nine questions regarding sociodemographic features, daily
life habits, and health conditions of the participants.
2 | MAT E R I AL S A N D M E TH O DS
2.3.2 | Perceived stress scale
2.1 | Research design
The PSS was developed by Cohen et al34 as a self?assessment scale,
This study was planned as a nonrandomized quasi?experimental
to evaluate how stress levels affect individual’s own lives. The PSS
study to reveal the effects of yoga practiced for 4 weeks, at
has three versions, with 14, 10, or 4 questions, and the 14?question
60 minutes each week, on stress, anxiety, and quality of life in healthy
version was used in this study. These 14 items question to what
young adults. The study was approved by the Clinical Research
extent an individual experience some feelings or thoughts over the
Ethics Committee of the Nev?ehir Hac? Bekta? Veli University (Ethics
past month. Each item is evaluated on a 5?point Likert?scale as (0)
|
ERDO?AN Y E AND MUZ
699
F I G U R E 1 Sample diagram [Color figure
can be viewed at wileyonlinelibrary.com]
never, (1) almost never, (2) sometimes, (3) often, and (4) very often.
subscale.37 In this study, Cronbach’s ? for the SAI is .92 and for the
The lowest score is 0 and the highest is 56; the higher total score
TAI is .84.
means the higher perceived stress level at individual. The reliability
and validity of Turkish version of the scale was reported by Eskin
et al35 Internal consistency by Cronbach’s ? was defined as .84. In
this study, Cronbach’s ? value was .87.
2.3.4 | World Health Organization Quality of Life
Scale Form
World Health Organization Quality of Life Short Form (WHOQOL?
2.3.3 | State and trait anxiety inventory
BREFTR) was developed by World Health Organization and it was
adapted into Turkish by Eser et al38 by conducting reliability and
The state and trait anxiety inventory (STAI) was developed by
validity studies. The scale evaluates bodily, spiritual, social, and en-
Spielberger36 to define state and trait anxiety levels separately, and
vironmental wellness situations. A 5?point Likert?type scale is used to
its translation into Turkish, and reliability and validity analyses were
score 26 items, each with different answering options. When the
conducted by ®er and Le Compte.37 It is an easy scale that can be
Turkish version (the 27th question is a national one) is employed, the
answered by individuals on their own. It is composed of two sub-
environment score is termed environment?Turkey. Points are calcu-
scales with 20 questions each. The first 20 questions form the state
lated between 4 and 20 for each domain, and quality of life is scored
anxiety inventory (SAI), and it defines how individuals feel under
separately. Quality of life increases as points increase. Internal con-
certain conditions. The last 20 questions form the trait anxiety in-
sistency by Cronbach’s ? was defined as .76 for the health dimension,
ventory (TAI). This part defines how individuals feel separate from
.67 for the psychological health dimension, .56 for the social inter-
particular states and conditions. For the SAI, one option among
action dimension, and .74 for the environment dimension, in a heal-
¥ver, some, very much,!nd ïmpletely.eeds to be chosen,
thy group. Test?retest reliability coefficient values were between
according to levels of thoughts and behaviors stated in the items.
0.51 and 0.81.38 In this study, Cronbach’s ? points are .76 for the
Similarly, for the TAI, one option from among ¥ver, sometimes,°hysical health dimension, .74 for the psychological health dimension,
ostly,!nd lways.eeds to be chosen according to levels of
.80 for the social interaction dimension, and .80 for the environment
thoughts and behaviors stated in the items. The scales involve direct
dimension.
and reversed items. In calculating reversed items regarding positive
feelings, 1 point becomes 4 points, and 4 points become 1 point.
Four?point answers indicate high levels of anxiety in negative an-
2.4 | Intervention procedure
swers. The total points obtained from the two scales range between
20 and 80. High scores indicate high levels of anxiety, and vice
Written informed consent forms were gathered from participants before
versa. Cronbach’s ? for internal consistency values are .83 to .87 for
the study after explaining purpose of the study to all participants. The
the state anxiety subscale, and .94 to .96 for trait anxiety
forms and scales applied were completed by the participants after
|
700
ERDO?AN Y E AND MUZ
necessary explanations by the researchers. Yoga sessions were taught by
2.4.2 | Interventions to the control group
an instructor who completed oga Education3uccessfully and had a
oga Tutoring Certificate.”he participant information form, PSS, STAI, and WHOQOL?BREFTR
were completed in the control group at the beginning of the study.
No treatment was conducted on these participants, and the PSS,
2.4.1 | Interventions to the yoga group
STAI, and WHOQOL?BREFTR were reapplied to them at the end of
the study.
The participant information form, PSS, STAI, and WHOQOL?BREFTR
were completed by participants in the yoga group before the first
yoga session. Weekly yoga sessions were organized for these parti-
2.5 | Statistical analysis
cipants by dividing them into groups. Four training sessions were
conducted on 2 days per week between April and June. Each parti-
IBM SPSS 22.0 was used for evaluation of the data. Summary sta-
cipant was requested to participate in these 60?minute sessions at
tistics included the number (n), percentage (%), mean (x? ), and stan-
least once in 4 weeks, at a yoga studio of the university. The content
dard deviation (n ?2 and Fisher’s exact tests were used to evaluate
of the yoga training program is presented in Table 1. PSS, STAI, and
differences between groups in terms of qualitative variables.
WHOQOL?BREFTR were reapplied to participants who had com-
Distribution of numerical variables was calculated using the
pleted 4 weeks of training after the last follow?up.
Shapiro?Wilk normality test, and homogeneity of variances was calculated using the Levene test. The independent?samples t test was
T A B L E 1 Content of the weekly yoga training program
Yoga Training Program
used to compare the two groups, and the paired?samples t test was
Duration,
min
used to compare scores within the groups.
5
3 | RE SU LTS
Warm?up
Sukhasana (relaxed sitting pose), sitting sideways
stretching, sitting forward stretching
Vajrasana (diamond pose), upward stretching, forward
stretching
In this study, 88.6% of the participants in the yoga group were
female, their mean age and income were 20.00 1.25 years and
Marjariasana (cat pose)
$98.41 48.96 per month, respectively. Of these, 47.7% stayed at
Tadasana (mountain pose), standing sideways
stretching, standing spine stretching, stretching at
your foot
Surya namaskar (salute to the sun)
dormitory and 52.5% of them did not smoke. In the control group,
91.1% of the participants were female, their mean age and income
10
52.8% stayed at dormitory and 15.62% of them did not smoke.
Asanas and pranayama
Tadasana (mountain pose)
were 19.77 1.04 years and $98.62 61.69 per month. Of these,
35
Descriptive features of the participants in yoga group and control
group did not differ significantly (P > .05) (Table 2).
Adhama pranayama
The PSS mean score was 27.38 7.56 before the intervention,
Madhyama pranayama (chest breathing)
Adya pranayama (shoulder breathing)
while it was 22.43 6.94 after the intervention in the yoga group. In
Trikonasana (triangular posture)
the control group, the PSS mean score was 26.62 9.11 at baseline
Virabhadrasana I (warrior pose I)
and 26.57 9.49 at completion of the study. While there was a sig-
Virabhadrasana II (warrior pose II)
nificant difference between the PSS mean scores before and after
Uttanasana (bending forward while standing)
intervention in the yoga group (P < .001), there was no significant
Vrksasana (tree pose)
difference between the mean scores of the control group (P > .05). The
Garudasana (eagle pose)
SAI mean score was 41.31 9.54 before intervention and 32.54 9.91
Utkatasana (chair pose)
after intervention in the yoga group. In the control group, the SAI
Dandasana (staff pose)
mean score was 39.46 10.82 at baseline and 42.33 11.29 at study
Paschimottanasana (sitting stretching forward)
completion in the control group. While there was a significant differ-
Janusirasana (bending head leaning against string)
ence between the SAI mean levels before and after intervention in the
Baddha konasana (butterfly pose)
Virasana (hero’s pose)
yoga group (P < .001), there was no significant difference between the
Jathara parivartanasana (horizontal auger pose)
scores of the control group (P > .05). Moreover, the SAI mean score of
Setu bandha sarvangasana (bridge pose)
the yoga group after intervention was significantly lower than that of
the control group (P < .001). The TAI mean score was 46.25 7.82
Deep relaxation and meditation
Savasana (corpse pose)
10
group. The TAI mean score was 45.68 8.74 at baseline and
Purna Pranayama (full yoga breath)
Total
before intervention and 43.40 7.26 after intervention in the yoga
60
46.86 9.13 at study completion in the control group. While there was
a significant difference between the means before and after
|
ERDO?AN Y E AND MUZ
701
T A B L E 2 Comparison of the characteristics of participants in the yoga and control groups.
Groups
Yoga group (n = 44)
Descriptive
characteristics
Control group (n = 45)
n
%
n
%
Statistic
Female
39
88.6
41
91.1
?2 = 0.150
Male
5
11.4
4
8.9
P = .739
Dormitory
21
47.7
26
57.8
?2 = 2.608
With family
9
20.5
9
20.0
With friend
14
31.8
9
20.0
Alone
0
0.0
1
2.2
Sex
Place of residence
P = .451
Smoking status
Still smoking
2
4.5
7
15.6
?= 2.697
Gave up smoking
42
95.5
38
84.4
P = .157
Mean age, y (x? ó)
20.00n25
19.77n04
t = 0.909
P = .366
Income, $ (per month)
98.418.96
98.62±.69
t = 0.018
P = .986
Abbreviations: ? , chi?squared test; t, t test.
2
intervention in the yoga group (P < .05), there was no significant dif-
worldwide trend. For this reason, the research studies focused on
ference between the scores in the control group (P > .05). There was
physical, psychological, social, and cultural effects of yoga on people.
also no significant difference between the scores of the yoga group
Studies revealed the positive influence of yoga on social life, phy-
and the control group after the intervention (P > .05) (Table 3).
For all subcategories of WHOQOL?BREF, the mean scores were
sical and mental health in all age groups.3,10,11,14,15,16,22,24¶,28,31,39 This
study investigated benefits of yoga?based physical activity on stress,
similar between the yoga group and control group at baseline
(P > .05). There was no significant difference in the scores for the
subcategories of the WHOQOL?BREF between groups (P > .05), except for the mean score for the social relationships subcategory.
T A B L E 3 Distributions of perceived stress scale and anxiety scale
points of the individuals in the yoga group and control group baseline
and at last follow?up
While there was an increase in the yoga group’s score for the social
Groups
relationships subcategory after the intervention, there was a decrease in the control group’s score, and the difference between the
groups was statistically significant (P < .05). In the yoga group, the
Scales
difference between before and after the intervention was significant
Yoga
group (n = 44)
Control
group (n = 45)
(x1 ss )
(x1 ss )
Pa
Perceived stress scale
in the scores of physical and psychological health subcategories
(P < .05), and there was no significant difference between the scores
of the control group (P > .05) (Table 4).
Baseline
27.38 7.56
26.62 9.11
.668
Last follow?up
22.43 6.94
26.57 9.49
.021
Pb

Purchase answer to see full
attachment