nursing students are constantly under various stressors such as 
 academic performance , isolation from the group , change in environment , change in food type , 
 irregular diet , clinical challenges , economic problems , future prospects , problems with the 
 value system of current society , self - expectations , and expectations from family and peers 
 etc1,2,3,4,5,6 . if 
 these stressors are not managed properly , they can have negative effects on the physical and 
 psychological health of nursing students1,2,3 . 

furthermore , these problems can cause academic failure and/or limited growth as a valuable 
 employee2 , 4 , 
 7 .
therefore , it is necessary to put in 
 place various activities and behaviors to prevent and reduce life stress in nursing 
 students4 , 6,7 .
all these stressors have adverse effects on the autonomic nervous system , pineal and 
 hypothalamic - pituitary - adrenal axis that interrupt the healthy operation of the homeostatic 
 mechanisms of the body8 .
this has damaging 
 effects on various parameters of the body , and one of the common parameters is blood 
 glucose2 . it is observed that stress 
 increases both short - term and long - term blood glucose levels , and if it increases one or 
 both of them beyond the normal limits , stress can cause persistent high blood glucose 
 levels , resulting in diabetes mellitus2 .
yoga , which integrates 
 various postures , breathing exercises , and meditation , is beneficial in reducing stress .
the 
 mechanisms by which yoga influences well - being are likely complex biochemical and 
 physiological mechanisms consisting of reduced sympathetic nervous tone , activation of 
 antagonistic neuromuscular systems , and stimulation of the limbic system9 .
that is to say , breathing exercises during yoga practice 
 reduce sympathetic tone , increases parasympathetic activity , and help to reduce stress in 
 yoga practictioners10 .
meditation also 
 brings about a hypometabolic state and reduces stress induced by sympathetic 
 overactivity11 . also , yogic exercise has a direct influence on pancreatic secretion by rejuvenation of the 
 pancreatic cells through alternate abdominal contractions and relaxation12 , 13 , and yogic exercise reduces blood glucose levels due to muscular 
 exercise and relaxation12 , 13 .
the dynamic stretching of the body during yoga asanas is 
 postulated to rejuvenate pancreatic cells , increase insulin secretion , and hence correct the 
 impaired insulin secretion in chronic diabetes14 .
ultimately , yoga practice has been proven to affect mental balance 
 of an individual by allying apprehension and stress and bringing about hormonal balance and 
 feelings of well - being2 . in previous studies
, researchers have indicated that yoga intervention played an effective 
 role in decreasing stress and improving general well - being in medical students2 , 15 . 
 in spite of its known positive effects on physical and psychological variables ,
no studies 
 have been conducted with yogic programs to manage nursing students life stress .
hence , the 
 purpose of this randomized controlled trial study was to evaluate the effect of yogic 
 exercises on life stress and biochemical markers of stress such as blood glucose levels in 
 nursing students .
the subjects of this study were 27 healthy 
 female undergraduate nursing students aged 2023 years with no medical diseases , no history 
 of drug abuse , and no experience with yoga exercise .
all participants received detailed information on the purpose and usefulness of this study 
 and were provided a written consent form .
after the participants signed the informed consent 
 form , they were randomly assigned by a random permuted block design using a random number 
 table , to 1 of 2 groups , either the yoga exercise ( n=15 ) or control group ( n=15 ) . 

twenty - seven subjects completed the entire study , 12 in the yoga exercise group and 15 in 
 the control group .
three subjects dropped out of the study before completing the posttest 
 due to personal reasons .
demographic information , life stress scale , and postprandial blood 
 glucose levels were measured as pretest data .
the life stress scale and postprandial blood 
 glucose levels were also measured as posttest data .
this instrument consisted of 50 items scored using a 
 4-point likert scale ( 0=never , 3=very often ) measuring sources of life stress in 8 
 subscales - economy , lover , faculty , family , the future , values , grades , and friends .
a higher 
 score indicates a higher level of perceived stress . in this study ,
the internal consistency 
 ( cronbach s alpha ) of the life stress scale was 0.93 . after completing life stress scale surveys ,
measurements were taken from the participants both before 
 commencement of the study and also after the yogic intervention was over .
postprandial blood 
 glucose levels were measured with a digital glucometer ( accu - chek . sr .
yogic exercises were conducted for about one hour , once a week for 12 weeks .
cyclic form yoga exercises were chosen because of the 
 availability of scientific studies on this type of yoga17 , 18 .
also yoga nidra , 
 which means  psychic sleep ,  is a specific yogic relaxation and meditation practice19 .
the cyclic yoga performed in this study 
 consisted of the following practices ( table 
 1table 1.yogic exercise processstep 1 : surya namaskara ( 20  min/10 cycles)step 2 : shavasana ( 5  min)step 3 : yoga nidra ( 35  min/1 cycle)(postures and breathing exercise)(relaxation)(meditation and relaxation)1 .
pranamasana ( prayer pose ) ) . under the guidance and supervision of the yoga expert , after practicing 10 
 cycles of surya namaskara for 20 minutes , the subjects performed the shavasana pose for 5 
 minutes of relaxation . finally , the subjects performed yoga nidra .
it has several steps , such as resolve , rotation of consciousness , 
 awareness of the breath , feeling and sensation , visualization , and ending the practice with 
 resolve .
a t test was used to test for the homogeneity of 
 demographic and clinical characteristics between the exercise and control group .
the level of statistical significance 
 was considered to be a probability value of less than 0.05 .
no significant differences in age were found between the yoga group and the control group 
 ( table 2table 2.homogeneity test for age , life stress , and blood glucose level between the 
 experimental and control groupvariablesexperimental groupmean  sdcontrol groupmean  sdage ( years)21.0  0.221.0  0.3life stress ( score)1.6  0.31.6  0.3economy1.6  0.51.7  0.5lover1.3  0.41.4  0.4faculty1.2  0.81.3  0.8family1.3  0.41.2  0.4future2.0  0.41.9  0.3value1.8  0.61.9  0.5grades2.4  0.42.2  0.5friend1.3  0.41.1  0.3ppg ( mg / dl)90.0  11.589.6  9.9ppg : postprandial blood glucose , sd : standard deviation ) . there were no significant differences in the pre - intervention life stress 
 scale score or pre - intervention postprandial blood glucose level between the two groups 
 ( table 2 ) .
ppg : postprandial blood glucose , sd : standard deviation the life stress score significantly differed between the 2 groups ( yoga group vs. control 
 group , p<0.001 ) and over time ( pretest vs. posttest , p<0.001 ) . for the yoga group ,
the 
 mean post - intervention life stress score ( mean  sd , 0.77  0.49 ) was significantly 
 decreased compared with the mean pre - intervention life stress score ( mean  sd , 1.6  0.3 ) . 
 of the life stress subscales ,
the life 
 stress subscale scores of economy , lover , family , the future , values , grades , and friends 
 were decreased significantly in the yoga group after the yogic exercises , respectively 
 ( table 3table 3.effects of yogic exercises on life stress and postprandial blood glucose 
 levelgrouppretestposttestdifference ( posttest - pretest)mean  sdmean  sdmean  sdlife stress ( score)yoga1.6  0.30.7  0.4***0.8  0.6***control1.6  0.31.7  0.20.1  0.3economyyoga1.6  0.50.6  0.5***1.0  0.6***control1.7  0.51.9  0.50.1  0.5loveryoga1.2  0.40.5  0.5**0.7  0.7**control1.4  0.41.5  0.60.1  0.7facultyyoga1.1  0.70.1  0.2***1.0  0.7control1.2  0.80.6  0.70.6  1.1familyyoga1.2  0.30.5  0.5**0.7  0.6***control1.2  0.41.4  0.40.1  0.4futureyoga2.0  0.31.1  0.7**0.8  0.8***control1.8  0.32.1  0.30.2  0.4valuesyoga1.8  0.50.7  0.6***1.0  0.7***control1.9  0.52.2  0.30.2  0.6gradesyoga2.4  0.41.6  0.7*0.7  0.8***control2.2  0.52.6  0.30.3  0.5friendsyoga1.2  0.30.6  0.5**0.6  0.6***control1.1  0.31.2  0.30.1  0.3ppg ( mg / dl)yoga90.0  11.481.3  8.7**8.7  7.5***control89.6  9.9103.4  8.2**13.8  13.7*p<0.05 ; * * p<0.01 ; * * * p<0.001 ; ppg : postprandial blood glucose level , sd : 
 standard deviation ) .
* p<0.05 ; * * p<0.01 ; * * * p<0.001 ; ppg : postprandial blood glucose level , sd : 
 standard deviation the postprandial blood glucose level significantly differed between the 2 groups ( yoga 
 group vs. control group , p<0.001 ) and over time ( pretest vs. posttest , p<0.05 ) . for 
 the yoga group , the mean post - intervention postprandial blood glucose level ( mean  sd , 81.3 
  8.7 ) was significantly decreased compared with the mean pre - intervention postprandial 
 blood glucose level ( mean  sd , 90.0  11.4 ) . for the control group , the mean 
 post - intervention postprandial blood glucose level
( mean  sd , 103.4  8.2 ) was 
 significantly increased compared with the mean pre - intervention postprandial blood glucose 
 level ( mean  sd , 89.6  9.9 ) ( table 3 ) .
as shown in the study results , after 12 weeks of yogic exercises , life stress scale scores 
 were significantly decreased compared with those before starting yoga practice . 
 additionally , nursing students in the yoga exercise group had a significant decrease in 
 their stress levels over this 12-week period , while those in the control group had an 
 increase in their stress levels .
these findings are similar to the findings of simard and 
 henry , who found that perceived stress scale levels significantly decreased from baseline to 
 mid - term , an improvement that persisted to the end of the intervention15 .
they assessed the impact of a short yoga intervention on 
 female medical students health for a 16-week period .
they also pointed out that a yoga 
 intervention may be effective in decreasing stress and improving general well - being in 
 medical students .
besides , the findings of beets & mitchell indicated that despite short 
 yoga program exposure , acute changes in mental health indicators such as stress were 
 observed20 .
similarly , the findings of 
 yoshihara et al . suggested that yoga can improve mental health status and has implications 
 for the prevention of psychosomatic symptoms in healthy women17 .
in addition , sharma systematically reviewed 17 articles related to 
 yoga for stress management8 .
as a result , 
 they reported that of the 17 studies , 12 demonstrated positive changes in psychological or 
 physiological outcomes related to stress .
like the previous studies , the present study also 
 supports the paradigm that yoga exercise can have beneficial effects in reducing 
 psychological problems such as stress in nursing students . of the life stress
this 
 result is inconsistent with the concept that academic factors are a greater perceived cause 
 of stress in nursing students1 , 5 , 6 . over the past 2 
 decades
, many forms of intervention have been suggested to help nursing students with their 
 stress .
most recently , one researcher recommended biofeedback , humor , peer instructors , 
 mentors , and mindfulness training interventions for stress centered around academic 
 challenges in nursing students2 , 5 , 6 , 21,22,23 .
however , no recent studies have been conducted with a new 
 generation of yoga exercises to help reduce nursing students stress . ultimately , these 
 findings suggest that the nursing students in the yoga exercise group were able to control 
 the same level of stress over the 12-week period even though they experienced more stressors 
 and demands from their academic conditions .
it is very important for nurse educators to help 
 nursing students manage their stress in order to prevent additional problems . in the present study ,
fasting blood sugar levels could not be checked because of the time of 
 the yoga class as the participants personal situations .
after practicing yoga for 12 weeks , postprandial blood glucose levels were significantly 
 decreased in the yoga group .
this finding is similar to that of shende et al . , who found 
 that both fasting and postprandial blood glucose levels were significantly improved in the 
 yoga group , whereas there was no significant improvement in the postprandial blood glucose 
 levels in their control group not practicing yoga pranayama4 .
they assessed the effect of pranayama on the blood glucose level of 
 60 medical students and found that a short - term intervention of yogic exercise helps in 
 reducing the stress in medical students , which is reflected by improvement in both fasting 
 and postprandial blood glucose levels .
they also emphasized that the beneficial effects of 
 yoga on fasting and postprandial blood glucose levels are well documented .
as stated , most 
 of these studies have been done on patients with known diseases .
however , there is very 
 little data available on the effect of yoga exercise composed of surya namaskara ( which 
 means sun salutations ) and yoga nidra ( which means psychic sleep ) on the blood glucose 
 levels in healthy subjects .
the findings of the present study also support those of jensen , 
 stevens , and kenny , who stated that yoga nidra is related to psycho - neuro - physiological 
 parameters24 .
numerous studies have 
 shown yoga to have an immediate downregulating effect on both the pineal and 
 hypothalamic - pituitary - adrenal axis responses to stress12,13,14,15 .
the performance of asana 
 led to increased sensitivity of the b cells of the pancreas to the glucose signal .
it also 
 increased the sensitivity of the progressive long - term effect of asanas .
therefore , it was 
 also found that brief yoga - based relaxation training normalizes the functions of the 
 autonomic nervous system15 .
as shown in 
 previous studies , the findings of the present study suggest that yogic exercises can improve 
 stress and stress biomarkers in nursing students .
however , follow - up studies will be needed 
 to evaluate the effect on biochemical parameters of stress such as cortisol and blood 
 glucose in nursing students . to my knowledge , this is the first study to demonstrate the 
 effect of yoga exercise on the blood glucose level of healthy nursing students .
use of only female subjects meant that we could not 
 make comparisons between males and females .
the participants were not on a strict and 
 uniform diet plan , and this may have influenced the study results . despite these 
 limitations , these findings suggest that cyclic yoga exercise can improve not only the score 
 of life stress , but also the postprandial blood glucose level in nursing students .
 [ purpose ] this study was performed to investigate the effects of yogic exercises on life 
 stress and blood glucose levels in nursing students . [ subjects and methods ] the study was 
 a randomized controlled trial . 
 twenty - seven undergraduate nursing students were randomly 
 selected , with 12 assigned to an exercise group and 15 assigned to a control group . 
 the 
 yogic exercises intervention was undertaken for 60 minutes one day a week for 12 weeks . 
 it 
 consisted of physical exercise ( surya namaskara ) combined with relaxation and meditation 
 ( shavasana and yoga nidra ) . 
 life stress was measured by the life stress scale for college 
 students , and postprandial blood glucose levels were measured with a digital glucometer . 
 
 [ results ] the exercise group measurements were significantly decreased in both life stress 
 and postprandial blood glucose levels compared with the control group . 
 [ conclusion ] these 
 findings indicate that yogic exercises would reduce life stress and lower postprandial 
 blood glucose levels in nursing students . 