Anxiety is a normal response to specific stress. It is a state of uneasiness and apprehension of fear. Medical s tudent s usually experience anxiety during viva examin ation, seminars & presentation s as they are the main focus of attention. Such a nxiety affects the ir confidence level, performance in the oral exam and ability to focus during the exam.

To evaluate the effect of alternate nostril breathing exercise on pre exam anxiety in Healthy Physiotherapy students.

Materials and method

132 healthy male and female physiotherapy students were asked to fill beck anxiety inventory before and after a session of alternate nostril breathing exercise during their oral examination. Difference in score was documented and studied. Considerable reduction in the anxiety levels were found after performing alternate nostril breathing exercise just before the oral exam .

Conclusion

Study concludes that alternate nostril breathing exercise helps in reduc ing pre exam anxiety levels in P hysiotherapy students.

Keywords: Beck anxiety inventory, Alternate nostril breathing exercise, Anxiety.

Aims and objectives

Aim

To study the effect of Alternate Nostril Breathing Exercise on Pre-exam Anxiety in Healthy Physiotherapy students.

Objectives

MATERIALS AND METHOD

MATERIALS

Methodology

Selection criteria

Inclusion criteria

Exclusion criteria

METHOD

The study participants were first to final year undergraduate physiotherapy students. Students were provided preliminary information about this study which involved a demonstration of performing an alternate nostril breathing exercise. Then they were asked to fill up the Beck Anxiety Inventory. It was then followed by alternate nostril breathing session & again they were asked to fill up the Beck Anxiety Inventory.

Procedure of Alternate nostril breathing exercise (ANB)

Instructions and demonstration for the practice of ANB [Alternate Nostril Breathing] was given to the students. It was followed by its practice session and clarification of any doubts regarding the procedure was done. The students were instructed to close their eyes and focus their attention on the breath throughout the exercise. The students were asked to sit comfortably with back straight. ANB exercise started with 3 to 4 cycles of normal inhalation and exhalation. It was followed by inhaling slowly and deeply through left nostril while closing the right nostril with the thumb of right hand. Then students were asked to hold breath for 2-3 seconds. And at the end, they were asked to exhale through the right nostril while closing the left nostril with the index finger of right hand. Later the similar exercise was repeated by beginning it with the opposite nostril. This exercise was done 12 times with the same procedure. Then students were asked to fill up the beck anxiety inventory (BAI).

Beck Anxiety Inventory ( BAI )

It was used in this study to assess the anxiety levels in students. The beck anxiety inventory was moderately correlated with the revised Hamilton anxiety rating scale⁵¹ and mildly correlated with the Hamilton depression rating scale²⁵ It is a twenty item scale with the total score sixty three. The scale is divided in three grades – mild anxiety (score 0-21), moderate anxiety (score 22-35), potentially concerning level of anxiety (score 36 and above). Students were asked to fill this scale before and after performing ANB. The score was calculated and data analysis was done.

DATA ANALYSIS AND RESULT

Table 1: G ender wise distribution of participants

Interpretation

Table no.1 shows that 81% were females & 19% were males out of total study population.

Table 2: Distribution of Beck anxiety inventory according to grades.

Interpretation

Table no.2 shows that students had low anxiety, 39 students had moderate anxiety & 7 students had potentially concerning level of anxiety before performing ANB. But it also shows that these students (132 ) experienced mild anxiety after performing ANB.

Table 3: C omparison of mean BAI score of males & females before & after ANB.

Interpretation

Table no.3 shows that mean BAI score in males before ANB is 15.48 & after ANB is 5.56.Mean BAI score in females before ANB is 19.93 & after ANB is 5.57. Indicating significant reduction in anxiety after ANB.

Table 4 : Comparison of mean BAI score of Nervousness before & after ANB.

Males

Females

* p value less than 0.05, shows the significant difference in the means.

Interpretation

Table no. 4 shows that shows the considerable lowering of nervousness among both the genders.

Table 5 : Comparison of mean BAI score of Unsteadiness before & after ANB.

Males

Females

* P value less than 0.05, shows the significant difference in the means.

Interpretation

Table no.5 shows that mean BAI score in male and female before & after ANB was 1.24 & 0.32 and 1.36& 0.22 respectively. Indicating that students are quite steady and focused after performing ANB exercise.

Table 6 : Comparison of mean BAI score of student’s inability to relax.

Males

Females

*p value less than 0.05, shows the significant difference in the means.

Interpretation

In table no.6 both male & female students were found to be considerably relaxed after doing ANB as significant difference was found in the scores before & after doing ANB.

Table 7 : Comparison of mean BAI score of heart pounding symptom in students.

Males

Females

* p value less than 0.05, shows the significant difference in the means.

Interpretation

Table no.7 shows that mean BAI score in males before ANB is 1.52& after ANB is 0.48. Mean BAI score in females is reduced from 1.57 to 0.39. This indicates that students experienced lesser heart pounding and they also felt calm.

DISCUSSION

It was observed that out of total study population 86 students had low anxiety, 39 students had moderate anxiety& 7 students had severe anxiety just before giving oral exam. After performing alternate nostril breathing all students experienced that the anxiety was reduced( table 2) . This shows that anxiety levels were significantly lower after alternate nostril breathing³. N.K. Subbalakshmi, S.K. Saxena etal also shows that there is significant decline in heart rate ( P<0.0001) and systolic blood pressure (P<0.0001)in study population after 20 minutes of alternate nostril breathing¹.

Table 3.shows that mean BAI score of males and females before ANB was 15.48 and 19.93 respectively. But after performing it was found to be reduced to 5.56. and 5.57 respectively. This indicates that there is significant reduction in mean BAI score in both gender after performing Alternate Nostril Breathing exercise⁶.B. Pahwa, S. Goyal etal,in their study found the difference in mean baseline and pre exam anxiety was more in females than in males, indicating greater anxiety levels in females⁸. In the present study gender wise comparison was not possible because of unequal number of male and female students. Female students were more in number.

It was found that Alternate Nostril Breathing exercise has a strong tendency of improving or balancing the Autonomic nervous system through enhanced activation of parasympathetic nervous system. Breathing through right nostril causes sympathetic dominance by increasing the release of serotonin and left nostril breathing causes parasympathetic dominance by decreasing the release of adrenaline & hence decrease in heart rate, respiratory rate, blood pressure².

Anxiety shows different symptoms in every individual. In our study, majority of students were found to be nervous because of the fear of the oral exam.

Table no. 4 showed that the mean score of male & female who were nervous before and after ANB was 1.24 & 0.56 and 1.72 & 0.66, this shows significant reduction in nervousness after alternate nostril breathing⁸

Table 5 showed significant improvement in unsteadiness of students after performing ANB both in males as well as females. This indicate that student were more stable after performing alternate nostril breathing¹⁰.

In table no.6 showed that subjects felt much relaxed and was able to concentrate more after performing alternate nostril breathing. Similar results were found by Upadhyay-Dhunge K, et al who explained that slow breathing pranayamic exercises has tendency to create a sense of relaxation and well being in subjects².

Table no. 7 showed that the the feeling of heart pounding/ racing was considerably reduced and students did not feel affected by it while giving the exam after performing alternate nostril breathing exercise^5,13.

It was observed that Alternate Nostril Breathing Exercise increases the supply of oxygen to brain increases which in turn increases the efficiency of Autonomic Nervous System. Some recent studies also found increase in oxygenated hemoglobin and total hemoglobin and decrease in deoxygenated hemoglobin levels¹⁵.

CONCLUSION

This study concludes that the Practice of alternate nostril breathing can considerably reduce the pre exam anxiety levels of students. A few minutes of practice just before the oral exam may help them in performing better in the exam. The daily practice could also be included as a part of lifestyle modification programs in maintaining better physical and mental health.

Limitation

Future scope

REFERENCES