Pranayama: A Viable Stress Relief Option? A Pilot Study among Pre-exam Dental Students

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1 ORIGINAL RESEARCH Pranayama: A Viable Stress Relief Option? A Pilot Study /jp-journals among Pre-exam Dental Students Pranayama: A Viable Stress Relief Option? A Pilot Study among Pre-exam Dental Students 1 L Nagesh, 2 R Siddana Goud, 3 Shoba Fernandes ABSTRACT Context: Dentists encounter numerous sources of stress beginning in dental school. Exploration of literature did not reveal any studies trying out meditation and pranayama as methods for reducing stress among dental students, especially in the pre-exam period. Aim: To find out the effects of pranayama and meditation in reducing the stress levels as measured by blood pressure and pulse rate among 3rd year exam going dental students. Settings and design: This was a pretest-post-test experimental study conducted to assess the effects of suggested coping strategies on stress as measured by the blood pressure and pulse rate. Materials and methods: A data recording format exclusively designed for collecting all the required and relevant general information was utilized. Pulse rate and blood pressure were recorded using an automated electronic monitor. Statistical analysis used: Student s t-test was applied to the recorded data maintaining significance levels of 0.05 as and confidence intervals were estimated with the 95% level. Results: Enumerated are the findings of this study regarding the effectiveness of meditation upon reduction in stress levels and observable decrease in pulse rates among the study group. Conclusion: The authors recommend inclusion of meditation in academic curriculum would enhance performance, build self confidence leading to academic excellence and superior patient care. Keywords: Stress, Dental students, Meditation, Pranayama, Pulse rate, Coping strategies. How to cite this article: Nagesh L, Goud RS, Fernandes S. Pranayama: A Viable Stress Relief Option? A Pilot Study among Pre-exam Dental Students. J Dent Sci Oral Rehab 2014;5(3): ,3 Professor and Head, 2 Postgraduate Student 1 Department of Public Health Dentistry, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India 2 Department of Public Health Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India 3 Department of Pedodontic and Preventive Dentistry, RKDF Dental College, Bhopal, Madhya Pradesh, India Corresponding Author: R Siddana Goud, Postgraduate Student, Department of Public Health Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India, drsidgoud@gmail.com, vshobasf@gmail.com Source of support: Nil Conflict of interest: None INTRODUCTION Modern day plagues affecting the human race could easily include stress and anxiety. Stress can destroy passion for life and enthusiasm for progress be it academics or careers. Stress affects an individual s memory and concentration. Stress can be defined as the biological reaction to any adverse internal or external stimuli-physical, mental or emotional that disturbs an organism s homeostasis. Although stress is an essential part of our lives, certain amounts or types of stress may inspire a positive response resulting in enhanced performance and improved personality. However if the compensatory reactions are inadequate, disorders like burnout anxiety and depression may result. 1 Dentists encounter numerous sources of stress beginning in dental school. Studies conducted among medical students in Pakistan identified academics and examinations to be most powerful stressors. 2 Other studies have shown psychological stress to be very common among medical students and higher anxiety levels among 3rd year medical students compared to 1st year Previous research has established that students with an active coping style have lower levels of psychological distress. 7 In view of the potential long-term benefits of managing stress in a more effective way, it may be important for students to develop such skills early in their medical career. 12 Coping strategies refer to the specific efforts, both behavioral and psychological, that people employ to master, reduce, tolerate or minimize stressful events. 13 Most approaches proposed for the management of stress involve relaxation and increased self-awareness. These strategies typically involve regular physical exercise, behavioral modifications, psychological exercises, ultimately the development of a Relaxation Response. Other practices involve yoga among Indians, taichi among Chi nese and prayers among Malays. 12 Meditation is a catch phrase of the 21st century. Start meditation and stop medication is the key slogan of holistic medicine. Ten to twenty minutes of deep relaxation through meditation would result in significant reduction of stress. Exploration of literature did not reveal any studies trying out meditation and pranayama as methods for reducing Journal of Dental Sciences and Oral Rehabilitation, July-September 2014;5(3):

2 L Nagesh et al stress among dental students, especially in the pre-exam period. Hence, a study was designed to find out the effects of pranayama and meditation in reducing the stress levels as measured by blood pressure and pulse rate among 3rd year exam going dental students. SUBJECTS AND METHODS This was a pretest-post-test experimental study conducted to assess the effects of pranayama and meditation on stress as measured by the blood pressure and pulse rate in a sample of 34, 3rd year dental students on 3 consecutive days preceding their examination. A data recording format exclusively designed for collecting all the required and relevant general information was utilized. Pulse rate and blood pressure were recorded using an automated electronic monitor (ACON:US FDA approved device). Voluntary informed consent was obtained from the participants before the start of the study. Ethical clearance was sought from the IRB of Bapuji Dental College and Hospital, Davangere. The study was conducted in a well venti lated room on the second floor of the dental college. The investigators were trained in using and recording blood pressure and pulse rate values using the automatic electronic blood pressure monitor. The same examiners measured the parameters in all the participants. Uniform standardization of measurements was ensured by asking examiners to undergo a calibration session. The 34 students who volunteered to participate were selected based on the following criteria. Inclusion Criteria III BDS students who were appearing for the university examinations in that particular month. Exclusion Criteria 1. Students with a history of congenital or acquired neurological disorders and psychological disorders. 2. Students who have respiratory disorders which contraindicate pranayama. 3. Students who are already under regular program of meditation. 4. Student with a known history of hypertension with or without medication. PROCEDURE OF PRANAYAMA AND MEDITA- TION AND MEASURING BLOOD PRESSURE AND PULSE RATE Sample was divided into study and control group with 17 students in each group. The students who belonged to study group were required to practice and perform with supervision of a meditation instructor, to perform pranayama (Rhythmic breathing exercise) followed by meditation from 6 to 6.30 pm, on each day for three consecutive days. Blood pressure and pulse rate were measured by an electronic, automatic blood pressure and pulse recording instrument (Acon) before and after the on each day. The data was recorded in a predesigned data recording format. Pranayama consisted of three methods with each method practiced for 5 minutes one after the other in sequence. 1. Vibhagiya pranayama (Divisive pranayama). 2. Anuloma, Viloma pranayama (Breathing in through one nostril and breathing out by other nostril and again breathing in through that same nostril and breathing out by another as one cycle and approximately 10 rounds performed). 3. Nadishuddi pranayama (Inhalation through one nostril and exhalation through another nostril-approximately 10 rounds). the above pranayama techniques, meditation was practiced for the last 10 minutes. (Sitting comfortably in padmasana, the back is straight but not tense, the right hand is placed in the left hand, palms upward, with the tips of the thumbs slightly raised and gently touching. The hands are held about four fingers width below the navel, then gently turning the attention toward breath, allowing its rhythm to remain normal). In a similar way, the students who belonged to the control group were examined at the same time intervals before 6 pm (Pretest) and after 6.30 pm (post-test). They were not subjected to any. (The subjects in the control group were allowed to continue with their routine studies and blood pressure and pulse rate were recorded wherever they were studying). Statistical Procedures Student s t-test was applied to the recorded data maintaining significance levels of 0.05 as and confidence intervals were estimated with the 95% level. RESULTS The study was undertaken on 34, 3rd year BDS exam going students, aged 20 to 24 years. Among them 17 were male and 17 were female students. Majority of the students belonged to the age group of 21 and 22 years (63%). Among the study group, the mean systolic blood pressure (SBP) on day one showed a statistically significant decrease upon (meditation). On day two the systolic BP decreased after pranayama but it was not statistically significant, whereas on the third day systolic BP did not show much difference after (Table 1). 116

3 Pranayama: A Viable Stress Relief Option? A Pilot Study among Pre-exam Dental Students Table 1: Comparison of before and after systolic BP (SBP) values on 1st, 2nd and among the study group Table 2: Comparison of diastolic BP (DBP) on 1st, 2nd and 3rd day before and after among the study group * Table 3: Comparison of pulse rate values before and after meditation on 1st, 2nd and among the study group Pulse rate (per minute) * * * Table 4: Comparison of pretest and post-test systolic BP (SBP) values on 1st, 2nd and among the control group SBP Pretest Post-test * Pretest Post-test Pretest Post-test Table 5: Comparison of pretest and post-test diastolic BP (DBP) values on 1st, 2nd and among the control group DBP Pretest Post-test * Pretest Post-test Pretest Post-test Table 6: Comparison of pretest and post-test pulse rate (PR) values on 1st, 2nd and among the control group Pulse rate (per minute) Pretest Post-test Pretest Post-test Pretest Post-test * The mean diastolic blood pressure (DBP), post did not demonstrate statistically significant changes on all 3 days (Table 2). There was a statistically significant decrease in the pulse rate values in the subjects after on all the 3 days. The pulse rate decreased to a greater extent after meditation, indicating reduction in stress levels among the study group (Table 3). Among the control group, the mean systolic blood pressure on day one showed a statistically significant difference (p < 0.05) as there was increase in the systolic blood pressure values after the test period. However on the 2nd and, there was no significant difference in the systolic BP values between the test periods (Table 4). Similarly the diastolic BP values showed statistically signi ficant difference only on the first day showing rise in diastolic BP whereas on the 2nd and variation in the values was statistically not significant (Table 5). The pulse rate values among the control group on the first and second day although nonsignificant, a systematic increase in mean values was observed. However, there was statistically significant difference on the indicating increase in stress values as the day progressed (Table 6). DISCUSSION Research has demonstrated that dental students experience considerable stress during their training also that dental Journal of Dental Sciences and Oral Rehabilitation, July-September 2014;5(3):

4 L Nagesh et al students are more anxious than the general population. 18 This high anxiety is disconcerting in its own right, in addition it has been suggested that stress negatively impacts dental students physical and mental health 19,20 and exacerbates patients distress during procedures. 18 Pre-examination stress is a prominent entity among students. Academics and exams have been found to be the most dominant and common stressors among medical students 2,21 with higher anxiety levels among 3rd year students compared to those in 1st year. 22 Although stress has a psychological origin, it affects several physiological processes in the human body. When a person is exposed to a stressor, the autonomic nervous system is triggered: the parasympathetic nervous system is suppressed and the sympathetic nervous system is activated. 23 This results in the secretion of the hormones epinephrine and nor-epinephrine into the blood stream which leads to, for example, vasoconstriction of blood vessels, increased blood pressure, increased muscle tension and a change in heart rate (HR) and heart rate variability. 24 When the stressor is no longer present, a negative feedback system stops cortisol production in the body, and a sympathovagal balance is established through homeostasis between the parasympathetic (vagal) and sympathetic system. Keeping in mind these significant physiological changes, this study assessed two important indicators, such as pulse rate and blood pressure. Significant reduction in the pulse rate manifested each day after the during the study period could be perceived as an indicator of reduction in stress levels. Kang and others reported that a stress coping program based on mindfulness medi tation was an effective for nursing stu dents to decrease their stress and anxiety and could be used to manage stress with students. 25 Previous research showed that students with an active coping style have lower levels of psychological distress. 7 Further our extensive search of literature revealed a paucity of research, evaluating dental students typical coping strategies. However, paralleling the dental student anxiety literature researchers have examined stress management in Medical students. For example, Malathi and Damodaran 26 examined the efficacy of yoga on reducing stress in 1st year Medical students. The researchers reported significant decreases in anxiety following yoga practice and found that students in the yoga group performed better on exams compared to the control group. 27 Considering the second indicator, i.e. the blood pressure, results in the study subjects were varied. There was a statistically significant reduction in systolic blood pressure after performing pranayama and meditation on first the day (p < 0.05). The values on the 2nd and showed numerical reduction though not significant statistically, which is an indicator of reduced levels of stress. In league with above studies which have demonstrated to varying levels effectiveness of various methods of coping, this study has demonstrated that meditation can bring about certain decrease in pre-examination stress levels. Pranayama and medi tation when performed are simple strategies which utilize modest amount of time of a student,` while the reduction in stress would result in improved performance during examinations. The control group subjects demonstrated increased pulse rates at the time of post-test measurement. The probable reason could be that, with the passage of time spent away from exam preparations, caused stress levels to increase ensuing in a concordant elevation in pulse rates. The diastolic pressure values did not show significant variations after meditation among the study group. The authors understand the need for a long-term study in order to be able to demonstrate significant changes in blood pressure through pranayama and meditation. The positive change which resulted in the decreased pulse rate is an excellent indicator of effectiveness of the practiced. For certain, further long-term research with larger sample size would be required to acquire a better understanding of the effects of pranayama and meditation on stress caused by examinations. CONCLUSION Meditations of various types when used as coping strategies have brought about observable decrease in stress levels as shown by reduced pulse rates, implicating physiological health benefits. Although several studies have been conducted relating to managing stress with the help of meditation, few if any like the present study are objective and have used calibrated accurate measurements of physiological indicators to demonstrate significant diminishing of stress levels. The authors would admit study with larger sample size should be conducted. We understand the negative impact of stress on physical and mental health, eventually impairing the academic and professional performance of students. It is hence of utmost importance to recommend inclusion of simple techniques like meditation through workshops which are economical and viable options into the academic curriculum. REFERENCES 1. Rada RE, Leong CJ. Stress, burnout, anxiety and depression among dentists. J Am Dent Assoc 2004;135(6): Shaikh BT, Kahloon A, Kazmi M, Khalid H, Nawaz K, Khan N, Khan S. Students, stress and coping strategies: a case of Pakistani 118

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