Beneficial Effects of Yoga in medical students under stress – a preliminary study

Dr. Ruchi Kothari1, Akshay Yadav*, Pradeep Bokariya2

Introduction:
There is substantial evidence for the place of mind body medicine in the treatment of stress induced disorders. Excessive stress leads to maladaptive behaviour. It is often considered to be the major contributor of unhealthy lifestyle that results  significantly in not only psychiatric but also many other systemic disorders.
Extremes of stress may also result in deteriorating performance of an individual.
It has been documented that medical students experience significant stress during various levels of their course [1,2]. This stress develops early in medical training and may increase over a period of time [3-5]. Several studies both from the West [1, 6,7] and from Asia [2] have reported that medical training is highly stressful particularly for those who are entering in their medical education.
It is for sure that any student under stress will not be able to perform to his or her best. A plethora of contributory factors have been implicated like soaring levels of stresses in medical students could be due to highly competitive curriculum, intense academic competition, excessive demands on coping abilities in physical, emotional, intellectual, financial and social terms.
Benefits of Yoga:
As an ancient holistic system of wellness, Yoga is a scientifically validated, time tested and socially acceptable health promotional technique developed thousands of years ago in our own country 8,9. Yoga can safeguard the individual by bringing harmony between mind and body, modulating stress responses and also improving mental faculties such as attention, memory, learning efficiency and positive attitude to life. [10-12]
Stress is known to modulate the activity of autonomic nervous system and central nervous system in a way so as to cope up with the stress to get adapted to it.
Yogic relaxation can check sympathetic over activity.[12,14] In stressful states with preponderance of sympathetic activity, yogic asanas and pranayama can lead to a state of reduced sympathetic activity shifting the autonomic balance towards relative parasympathetic dominance.[15,16,17] The objective manifestations of anxiety are a racing heart, palpitations, tremors, sweating, increased blood pressure, dry mouth, avoidance behavior, signs of restlessness, and heightened responsiveness decrease. Prior studies have also reported a significant reduction in the scores of trait anxiety following meditation18 and breathing exercises19 and in anxiety following muscle relaxation techniques.[20]

Total growth of personality at physical, mental, intellectual and social level can result with the regular practice of yoga.10 At physical level regular practice of asanas, pranayama bestows a proportionate, flexible, normally relaxed body with an ability to withstand stress efficiently.[14] At critical times necessary energy gets evoked to deal with the stressful state.[21] A calm still mind can bring forth the best performance even when one is under stress states like exams and helps in the development of one’s personality. At intellectual level yoga can sharpen memory, concentration, decrease anxiety levels.[10,14] At spiritual level yoga creates an awareness to look for happiness from within oneself and to be at peace with oneself.
With the above facts in mind the relevance of yoga in medical education is thought to be evaluated. The health of those students who are going to be the future doctors should be promoted first. Until and unless our students themselves practice health promotional measures, they are very less likely to guide and motivate their patients and the community to do so.
Can yoga be of benefit in stress induced effects in medical students? This was the question that triggered us to delve into this intricate issue bothering hundreds of medical students across the country.
A pilot research project based on Yoga at Arogyadham-
A total of thirty MBBS students of Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha within the age group of 17-25 years were recruited for a Yoga based research project where research proved Asanas, Pranayama and Meditation technique were taught to the students and followed for two months. The study was carried out in the Department of Physiology of MGIMS, in collaboration with Arogyadham Health care and research project of Kasturba Health Society, Sevagram.
The yoga classes were conducted by a trained yoga therapist at Arogyadham.
Before initiating yoga practices the students were shown the published research work done on yoga and health in the leading Indian and western medical institutions. Their doubts and apprehension about yoga were cleared by thorough discussion. Timing of yoga practice was kept in evening daily and it was ensured that yoga practice did not affect the regular teaching program. Anonymous feedback was also taken at the end of intervention to understand students’ experience of yoga.
The study protocol was submitted to the institutional ethics committee for IRB approval. The study commenced only after getting the ethical clearance. Written informed consent was obtained from all the students following a description of the procedures and risks, and participants will have the opportunity to ask questions before their enrolment in this study.
Intervention
The students were given 45 minutes for yoga practice every day in the evening from 5 to 6 pm for a period of one month which began with Starting prayer and sukshmavyaama (Joints’ movement) followed by Surya Namaskar and crocodile posture. Various asanas were also included in the session which were in different positions like Standing (Tadasana, Trikonasana); Sitting (Vajarasana, Gomukhasana, Mandukasana, Shashankansana); Supine (Pawanmuktasana, wind relieving pose, Leg rising, Rotation, Setubhandhasana, bridge) as well as Prone position (Shalabhasana, Bhujangasana, Cobra pose, Tiriap Bhujangasana, Dhanurasana). Pranayam / breathing practices like Kapalbhati, Anulom-Vilom, Suryabhedan, Chandrabhedan, Bhramari (honeybee sound) during expiration; Relaxation in the form of Shavasana played a crucial role in our Yogic session. The session used to conclude with the chanting of OM Shanti Mantra and a closing prayer.
After the scheduled period of yogic practice session it was observed by the investigators that the stress levels of students reduced to a significantly low value.
                Apart from the improvement observed in mental well being score, the students also reported other beneficial effects of yoga in their anonymous feedback such as better sleep, improved concentration in studies, Better control of anger and other negative symptoms, More relaxed and activeness throughout the day and an increased overall work output. Some students also reported increased level of muscle tone, weight loss and positive energy at the beginning of their day.
                All the students appreciated this yoga intervention in their feedback and found it to be interesting and hence, many of them also volunteered for continuing this Yoga practice as a part of their daily routine and wish to pursue it for long.
Discussion
Our study at the institute revealed a definite reduction in the magnitude of stress There was a statistically highly significant difference (p<0.001) in the pre test and post test scores of thirty participants. The total reduction was about 30%. We found significant improvement in the mental well being of medical students following short term yoga intervention. The results obtained are consistent with other studies on yoga among medical students like the one of Simard and Henry [22] showed improvement in overall health, perceived stress and depressive symptoms following the 16 week yoga intervention among fourteen 1st year medical students assessed by perceived stress scale and centre for epidemiology depression scale.
Another study by Malathi, Damodaran11 also showed a statistically significant reduction in anxiety among 50 first year medical students following yoga practices.
A recent study by Bansal et al [23] was conducted on 82 MBBS students of 3rd semester in the age group of 18‑23 years. The students were assessed after specific yoga intervention by using General Health Questionnaire‑28 GHQ‑28 and they reported significant improvement in general and mental well being following the intervention that again corroborates with our findings.
Since it was for the first time yoga was introduced in the college we also tried to ascertain whether the students relished the yoga sessions. 96% reported to have thoroughly enjoyed the sessions while 4% enjoyed it to some extent. If given an opportunity to join yoga classes when arranged in future whether they would like to join the classes, an overwhelming response of 100% was received.
Various opinions expressed by the students regarding yoga were:

  • It should be a continuous on-going activity
  • Yoga should be included as a part of the curriculum.
  • It should be started from the time of admission into professional colleges so as to benefit one in the long run.

Yoga with physical, emotional, mental, personality developmental and holistic understanding offers to cope with stressful states. To meet the modern lifestyle full of challenges, stress and tensions an all round personality development has become mandatory especially for the medical students. The aspect of relaxation and detachment is lacking in our education process and it is this new dimension that needs to be added to the curriculum. Thus yoga can be beneficial in achieving a tranquil state of mind during routine activities and yet providing the concentration and arousal essential in demanding or stressful situations like examinations.
Conclusion
The enhancement in parameters like better sense of well being, feeling of relaxation, improved concentration, self confidence, improved efficiency, good interpersonal relationship, increased attentiveness, lowered irritability levels, and an optimistic outlook in life were some of the beneficial effects experienced and shared by the yoga group. The study is proposed to be followed up throughout the completion of medical course of the enrolled participants in order to assess the long term beneficial effects of yoga and meditation to medical students.
Acknowledgement:
The authors are extremely grateful to Prof. BC Harinath, Director, JBTDRC & Coordinator, BIC & Arogyadham and would like to put on record the tremendous support and guidance bestowed upon us without which this study would not have seen the light of the day. We also thank Mr. Chetan Dandade, Yoga Therapist at Arogyadham for his support.

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1Department of Physiology and

2Department of Anatomy, Mahatma Gandhi Institute of Medical Sciences, Sevagram

*Mr. Akshay Yadav, 2nd yr MBBS student at MGIMS was awarded 2nd prize for this paper along with a cash prize of 3000/- at National level undergraduate students’ conference, SIMSCON 2016, Puducherry, July 28-30, 2016.

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