International Journal of Research in Medical Sciences

Tiwari VK et al. Int J Res Med Sci. 2018 Feb;6(2):581-584

www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012

DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20180302
Original Research Article

Is yoga an effective modality of stress reduction within medical

population; a qualitative study within MBBS students of BRD medical
college, Gorakhpur
Vikash K. Tiwari1, Vinay Singh1*, Devesh Kumar1, Mahim Mittal2, A. B. Asthana1

1
Department of Physiology, 2Department of Medicine, BRD Medical College, Gorakhpur, Uttar Pradesh, India

Received: 18 November 2017

Accepted: 21 December 2017

*Correspondence:
Dr. Vinay Singh,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Stress is very common in medical professionals. Stress begins in the first year of medical school and
increases with subsequent years of medical life. Stress decreases overall performance and had a multitude of health-
related adverse effect. Yoga has been tried as a stress reduction technique in different populations. In present study
yoga was performed in the 1st year MBBS students and impact on stress reduction was studied using PSS-10 stress
scale.
Methods: Study groups, yoga and control contained 26 and 27 subjects respectively. The yoga group practiced
selected yogic asana, pranayama, and yoga nidra 1hour daily 6days a week for 3months. Control group kept in touch
and allowed their usual activity as before. The PSS-10 scale used to measure the level of stress in both groups pre and
post study.
Results: There was a highly significant reduction in the PSS-10 Score (stress level) in the yoga group (P Value
<0.0001) but there was no significant change in the PSS-10 Score of control group (P Value = 0.2930).
Conclusions: Yoga is an effective modality of stress reduction technique in 1st year medical students. Therefore,
yoga should be introduced as a part of the curricula in the first year of medical school. This may be taken as the 1st
step in implantation of healthy lifestyle in future health care providers.

Keywords: Medical students, PSS-10, Stress, Yoga

INTRODUCTION There appear to be high rates of mental health problems

in young doctors. A wealth of researches conducted
Stress is a mental status when individual perceives that worldwide suggests that doctors have high rates of mental
environmental demands exceed his or her adaptive health problems, including depression, anxiety, addiction
capacity. Chronic stress exposure is more likely to result to alcohol or drugs, misuse of prescription drugs, and
in long-term or permanent changes in the emotional, emotional exhaustion. Suicide levels are also high for
physiological, and behavioral responses.1 Exposure to doctors, particularly female doctors. Recent findings from
intense and chronic stressors has long-lasting studies of young doctors suggest that their own health
neurobiological effects and puts one at increased risk of care is poor and that doctors with addiction problems in
anxiety and mood disorders, aggressive problems, hypo- later life tend to manifest vulnerabilities at medical
immune dysfunction, medical morbidity, structural school.3 In the current scenario the prevalence of
changes in the CNS, and early death.2 perceived stress is very high among medical students,

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 Tiwari VK et al. Int J Res Med Sci. 2018 Feb;6(2):581-584

which directly affects not only their academic physical inability to practice yoga, any other disease
performances but all aspects of health too. This stress can condition,
lead to depression, daytime sleepiness, sleep deprivation
and overweight. Study at Medical school is indeed a time • Any addiction (excluding nicotine).
of significant psychological distress for the budding
physicians. Stress increases as MBBS student go in first First year medical students were counseled and motivated
to second and then third year of study. So, the first year for taking part in the study. All first-year medical
of medical education is the beginning point of the students showing interest in Yoga were assessed using
stressful medical carrier and it increases with time.4 PSS-10 scale and students showing a score of the high
Factors contributing to high levels of stresses in medical stress group were included in the study. They were
colleges could be highly competitive curriculum, intense informed about study. Informed consent was taken on
academic competition, and excessive demands on coping paper. Each participant was interviewed for health history
abilities in physical, intellectual, emotional, financial and and demographic details before start of the study. The
social terms.5 Thus stress and anxiety along with participants (N=60, including male and female) were
substance abuse develop early in medical training and randomized in two group (Yoga group and Control
may increase with time. Until and unless our students group) by computer generated list of random numbers.
themselves practice health promotional measures, they There were 30 (20 Male and 10 Female) participants in
are very less likely to guide and motivate their patients Yoga group and 30 (19 Male and 11 Female) in control
and the community to do so.6 group. Yoga instructor taught yoga group a specific yoga
module 1hours/day, 6day a week for 3months. Subjects in
There are several well-known effects of yoga practice control group received no specific intervention but kept
such as an enhanced sense of wellbeing, better physical in touch for final evaluation. All participating medical
endurance, as well as definite changes suggestive of students were assessed again at end of 3months using
stress reduction.7 Practicing yoga and meditation as a PSS-10 scale. There were 4 drop out in yoga and 3 in
means to manage and relieve both acute and chronic control group.
stress helps individuals overcome stress and leads to
increased quality of life. Yoga is able to increase Yoga module included asana for 35 minutes (preliminary
relaxation and induce a balanced mental state and preparation, surya namaskar, pawan muktasana,
improves sleep quality and insomnia. Furthermore, shankasana, supt vajrasana, setu bandhasana, chakrasana,
participation in yoga classes improved self-reported sarvangasana, halasana), pranayama for 15minutes
quality-of-life as well as measures of physical function (bhastrika, kapalbhati, bahya pranayama, anuloma
among an elderly population.8 viloma, bhramari, udgeeth), and yognidra for
10minutes.9-14
It is very clear from the above discussion that yoga can
be useful to reduce the stress among medical students. The Perceived Stress Scale (PSS) is the most widely used
Thus, this study aims to pave a path towards stress psychological instrument for measuring the perception of
reduction techniques for future health care providers, stress. The items are easy to understand, and the response
what even now remains the minimally touched issue. alternatives are simple to understand. Furthermore, the
questions are of general in nature, and hence, are
METHODS relatively free of content specific to any subpopulation
group. The questions in the PSS-10 scale ask about
This study was conducted in Yoga lab of Physiology feelings and thoughts during the last month. In each case,
Department, BRD Medical College, Gorakhpur for period respondents are asked how often they felt a certain way in
of 3 months between March and June 2016. a series of 10 questions regarding their recent personal
stress perceptions, using a four-point frequency scale viz.
Inclusion criterion Never (0), Almost never (1), Sometimes (2), Fairly often
(3) Very often (4). Minimum score is 0 and maximum is
• Willing to participate and continue the yoga 40. Higher the degree and longer the duration of self-
practice, perceived stress, indicated by a higher score. Scores
• Physically able to do yoga practice, around 13 are considered average. High stress groups
• Normal health status. usually have a stress score of around 20 points. Scores of
20 or higher are considered high stress.
Exclusion criterion
Data was obtained as mean ±SD of PSS-10 scale. Data
• Practicing yoga in past, was compared before and after yogic practices and
• Presence of stroke, seizure, vertigo, hypertension, analyzed using SPSS V-20. Data related to yoga and
coronary artery disease, congenital heart diseases, control groups were compared using t-test and p value
history of status asthamaticus, peptic ulcer disease, <0.05 was considered statistically significant. Figures
spondylitis, joint pain, disc prolapse, CSOM, hernia, were prepared using GraphPad Prism 6 and tables by
Microsoft office 2010.

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 Tiwari VK et al. Int J Res Med Sci. 2018 Feb;6(2):581-584

RESULTS 14.60±5.64 and in 6 (23%) participants increased from

22.66±4.22 to 26.33±4.41. Pre and post study PSS-10
Table 1, 2, 3 and Figure 1 summarizes findings of the score in the control group was 23.48±2.65 and
present study. Higher PSS-10 score is associated with 22.25±6.66 respectively (P Value = 0.2930). There were
high stress level. Pre and post study PSS-10 score in the 12 (44%) participants in control group in whom score
yoga group was 24.19±3.74 and 17.30±7.31 respectively decreased from 23.16±3.09 to 16.33±5.14 and in 15
(P Value <0.0001). There were 20 (77%) participants in (56%) participants increased from 23.73±2.31 to
yoga group in whom score decreased from 24.65±3.57 to 27.00±2.72.

Table 1: Distribution of PSS-10 score in yoga group (N=26).

Yoga group Pre-study (mean ± SD) Post-study (mean ±SD) Percentage change in PSS-10 score
Total sample (n=26) 24.19 ± 3.74 17.30 ± 7.31 28.48% decrease
Decreasing pattern (n=20) 24.65 ± 3.57 14.60 ± 5.64 40.77% decrease
Increasing pattern (n=6) 22.66 ± 4.22 26.33 ± 4.41 16.20 % increase

Table 2: Distribution of PSS-10 score in control group (N=27).

Control group Pre-study (mean ±SD) Post-study (mean ±SD) Percentage change in PSS-10 score
Total sample (n=27) 23.48 ± 2.65 22.25 ± 6.66 5.24% decrease
Decreasing pattern (n=12) 23.16 ± 3.09 16.33 ± 5.14 29.49% decrease
Increasing pattern (n=15) 23.73 ± 2.31 27.00 ± 2.72 13.78% increase

Table 3: Relative change in PSS-10 score in yoga and control groups.

Yoga group Control group

Sample size 26 participants 27 participants
Decreasing pattern 77% participants (n=20) 44% participants (n=12)
Increasing pattern 23% participants (n=6) 56% participants (n=15)
Overall change in pss-10 score 28.48% decrease (p value < 0.0001) 5.24% decrease (p value = 0.2930)

DISCUSSION one study involving young Iranian women that yoga

decrease the PSS-10 score.19 Sudarshan Kriya Yogic
We can see that there were 77% participants in yoga breathing alleviated everyday stress, post-traumatic
group where PSS-10 score decreased hence stress, while stress, and stress-related medical illnesses in a study
increased in only 23% participants. Overall there was conducted by Brown RP, et al.20
decrease in PSS-10 score in yoga group, which was
statistically significant (P Value <0.0001). In control
group there were 56% participants where PSS-10 score
increased and in 44% participants decreased. Overall
observed difference in control group was not statistically
significant (P Value = 0.2930).

A study conducted by Lin SL et al concluded that mental

health professionals experienced a reduction in work-
related stress and an increase in autonomic nerve activity
in a weekly yoga program for 12 weeks.15 In 2015 Oron
G, et al found in their one study that yoga program
decreases stress in women waiting for IVF.16
Mindfulness-based stress reduction (MBSR) reduced
anxiety in veterans in a study conducted by Serpa JG, et
al.17 Gard T, et al also concluded in their one study that
yoga-based intervention decreases the perceived stress in Figure 1: Change in PSS-10 score in yoga and control
young adults.18 Messripour M, et al concluded in their group.

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 Tiwari VK et al. Int J Res Med Sci. 2018 Feb;6(2):581-584

He described the mechanisms contributing to a state of 5. Malathi A, Damodaran A. Stress due to exam in
calm alertness include increased parasympathetic drive, medical students-Role of Yoga. Indian J Physiol
calming of stress response systems, neuroendocrine Pharmacol. 1999;43(2):218-24.
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clear that many studies conducted earlier in different short term yoga intervention on mental well-being of
population shows reduction in stress and cortisol level. medical students posted in Community Medicine: A
Similar result came in this study in medical students. pilot study. Ind J Community Med. 2013;38(2):105-8.
7. Telles S, Bhat R. Yoga. Physiology and Application in
therapy and rehabilitation. In: Tandon OP, Tripathi Y,
Strength-All subjects (male and female) included in study
editors. Best and Taylor's physiological basis of
were staying within hostel of college. They all were 1st medical practice. 13th ed. Gurgaon: Lippincott
year MBBS students with age ranging from 18 to 22 Williams and Wilkins;2012.
years. Subject with any confounding factor were 8. Woodyard C. Exploring the therapeutic effects of Yoga
excluded from study. Study was started almost after 6 and its ability to increase quality of life. Int J Yoga.
months of their entry in medical college, thereby in 2011;4(2):49-52.
equilibrium with medical college life. Thus, all subjects 9. Ramdev S. Pranayama rahashya. 2nd ed. Haridwar:
were almost similar and were facing similar social and Divya prakashan;2009.
academic stress within college premises. 10. Saraswati SS. Asana pranayama mudra bandh. 4th ed.
Munger:Yoga publication trust;2012.
Limitations of the study was the sample size and duration 11. Iyengar BKS. Light on Yoga. Noida: Harpers
of study was small. PSS-10 was introduced only at start Collins;2014.
and end of study, so trend of change during study can’t be 12. Iyengar BKS. Light on Pranayama. India: Harpers
predicte. Element;2014.
13. Tandon OP, Tripathi Y. Best and Taylor’s
CONCLUSION physiological basis of medical practice. 13th ed.
Gurgaon: Wolter Kluver (India) Pvt Ltd;2012.
14. Bijlani RL, Manjunatha S. Understanding Medical
This study concludes that yoga is an effective modality of
Physiology: A Textbook for Medical Students. India:
stress reduction techniques in 1st year MBBS students. Jaypee Brothers Publishers;2010.
Introducing yogic stress reduction techniques early in 15. Lin SL, Huang CY, Shiu SP, Yeh SH. Effects of Yoga
Medical Schools may lead to production of minimally on Stress, Stress Adaption, and Heart Rate Variability
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Recommendations 16. Oron G, Allnutt E, Lackman T, Sokal-Arnon T, Holzer
H, Takefman J. A prospective study using Hatha Yoga
This study should be conducted with bigger sample size for stress reduction among women waiting for IVF
and at multiple medical institutions. Study should be treatment. Reprod Biomed Online. 2015;30(5):542-8.
carried forward in subsequent years of medical training. 17. Serpa JG, Taylor SL, Tillisch K. Mindfulness-based
Biochemical parameters should be measured in detail stress reduction (MBSR) reduces anxiety, depression,
making study more quantitative. and suicidal ideation in veterans. Med Care.
2014;52(12 Suppl 5):S19-24.
Funding: No funding sources 18. Gard T, Brach N, Hölzel BK, Noggle JJ, Conboy LA,
Conflict of interest: None declared Lazar SW. Effects of a yoga-based intervention for
Ethical approval: The study was approved by the young adults on quality of life and perceived stress:
The potential mediating roles of mindfulness and self-
Institutional Ethics Committee
compassion. J Positive Psychol. 2012;7(3):165-75.
19. Messripour M, Shohreh S. Psycho-biological
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