Can Yoga be an Effective Strategy at the Workplace to Fight Stress and Anxiety amongst the Nursing Staff?

The American College of Physicians guidelines propose that yoga can be prescribed to manage low back pain as a non-pharmacological intervention.[1] Similar to low back pain, yoga may be beneficial for depression, stress symptoms and anxiety also, but the evidence is variable.[2,3] A recently published clinical trial by Mandal et al.[4] is the clue to the efficacy of a non-pharmacological intervention to address the perceived stress and improvement of the professional quality of life (ProQOL). This type of intervention not only will help in the reduction of stress but also will increase coping ability and improve overall health. A high level of both acute and chronic stress can lead to autonomic instability, cardiovascular morbidities, endocrinal disorder, low immunity and mental health disorders.[5] Since, there is no pharmacological intervention available for high stress, mindfulness-based interventions like yoga can be a therapeutic option. Mandal et al. reported the efficacy of structured yoga practice on stress and ProQOL amongst nursing staff working in a tertiary care hospital to see a level of stress and burnout and the effect of yoga on reducing it. This was an open-label, phase-II randomised clinical trial where study participants were randomised (1:1) into a yoga group and wait-list control group. The principal outcome measure was perceived stress level which was measured by the Perceived Stress Scale (PSS) and the secondary outcome was professional quality measured by the ProQOL scale, blood pressure, serum cortisol and high-sensitive C-reactive protein. After the 12 weeks of follow-up the mean PSS, the stress score level was 15.5 (95% confidence interval [CI]: 12.6–18.2, standard deviation [SD]: 5.4) in the yoga group, 20.7 (95% CI: 19.7–21.7, SD: 2.8) in the wait-listed control group (P < 0.0001). This evidence indicates that supervised structured yoga practice has the potential to reduce stress [Table 1].Table 1: Mean change of score of Perceived Stress Scale, Professional Quality of Life Scale and serum stress biomarkers from baseline to post-yoga intervention[ 4 ]There are several published research studies regarding the beneficial role of yoga practice in stress management.[6-14] The unique characteristic of this study is that it assessed the efficacy by conducting the phase II trial in a controlled environment. Moreover, it considered both subjective variables by using a psychometric scale and objective stress biomarkers such as serum cortisol and C-reactive protein. The study findings were consistent with the available pieces of evidence. Although there are several literature available, implementation study can be done to explore further. This type of evidence is not only limited to a usual period but also found to be effective during a pandemic situation. One study done amongst frontline health workers was done during the COVID-19 period, where a similar structured yoga session was provided with significant reduction of stress, anxiety and depression.[15] Another study during the same time also found similar evidence which was done amongst common people of an urban resettlement colony where stress, anxiety and depression reduced significantly.[16] The physiological mechanism of this anti-stress activity of yoga is already known. It involves several parts of our brain controlling the autonomic nervous system and emotional regulatory system.[17] It increases the parasympathetic and vagal tone. There is increased stability of the hypothalamic–pituitary–adrenal cortex, which gets dysregulated on exposure to any acute or chronic stress at a level beyond one's coping ability.[18] Moreover, it increases the positive effect and self-awareness, which help increase the coping ability to tackle day-to-day stressors in a various situation.[18,19] Considering the rising level of stress, burnout and increased vulnerability, the evidence of yoga practice should be translated into practice. There is a higher probability of adoption and positive effect of this healthy practice if made available at academic institutions and workplaces.[20,21] In some countries like the USA, Brazil already started school-based yoga programmes.[22,23] In India, as a part of physical education school students are taught yoga asana and breathing practice but no structured yoga curriculum is present uniformly. A few corporate offices across the globe also promote a yoga practice at the workplace, but there is a lack of structured programme, especially in India. Till now, there are no policy frameworks to adopt yoga practice at a workplace or academic institution. Thus, there is a need for policy related to stress management at workplace. Yoga and meditation can be one such policy undertaking as it has a proven effect on stress. Creating a conducive environment with a flexible timetable will foster the uptake of yoga practice within both academic and professional settings. This will lead to a healthy work environment, reduction of stressors and overall improvement of physical and psychological health resulting in improvement of overall patient care. The rising trend of stress and its implication in our day-to-day life in the context of lifestyle-related diseases, there is a need for a holistic health approach like yoga. There is adequate evidence of its potential to address this issue. In clinical practice, structured supervised yoga can be made available integrating it with the routine duty schedule of health workers.