Yoga: A Strategy to Cope up Stress and Enhance Wellbeing Among Medical Students.

Dear Editor, Stress, burnout, and coping strategies in preclinical medical students by Fares et al.[1] made for an interesting read. I would like to compliment the authors for the commanding effort to put together a burning issue of psychological and physical stress and burnout among the medical students. The issue is often neglected both by the vulnerable population of students as well as the health-care community itself. The article definitely brings attention on the need for coping strategies and also puts together various methods for the physical and psychological wellbeing of the doctors-in-making. Yoga, a mind-body practice of ancient Indian origin has gained significance in recent times due to its health benefits. Various practices of yoga have been found beneficial to attenuate stress and enhance functionality among medical students. Despite an array of coping strategies, yoga practices are found to reduce perceived stress,[2,3,4,5] anxiety,[4,6,7,8] markers of stress such as cortisol,[9] improved general health and well-being,[5,10,11] physical and physiological health,[6,12,13] improve cognition[14] as well as cultivation of positive emotions[2,3,7] such as empathy, compassion, and self-regulation. There is evidence of a reduction in work-related stress and better autonomic balance with the practice of yoga in health professionals.[15] The studies indicate not just the psychological benefits of yoga, but the physical benefits such as better autonomic balance, enhanced respiratory endurance, auditory and visual reaction times as well as muscle strength.[13] Few research studies showing the beneficial effects of yoga among medical students are listed in Table 1. Table 1 Findings of research studies on yoga for medical students One of the most important stressors among medical students is the examination. Malathi and Damodaran and Malathi et al.[8,12] have found yoga to be beneficial in modulating the response to stress during the examination. In addition, studies indicate that yoga could enhance the examination performance and reduce anxiety.[16] Another important area of concern brought out by Fares et al. is the lack of self-care behavior among medical students.[1] Yoga and mindfulness-based practices have demonstrated beneficial impact on the self-care behavior in counselors, who encounter similar health issues of that of medical students.[17] From the review of existing scientific literature on the application of yoga in medical students, it is evident that yoga is a self-practiced, low cost, safe, efficacious as well as acceptable tool benefitting the target population. There are positive outcomes for the medical students in their physical, psychosocial, and emotional health. The practices that are safely used in the wellbeing of student community include asana (physical postures), pranayama (breathing practices), dhyana (meditation), mindfulness-based stress relaxation, and mind sound resonance technique (MSRT).[2,3,4,5,6,7,8,9,10,11,12,13,14,18] These techniques were used either as standalone modality in a combination or even as an adjunct program within the frame of medical curricula. The possible mechanisms involved with the beneficial effects of yoga among medical students include autonomic balance, relaxation, better emotional status, and self-care behavior. There is scope to evaluate the effects of yoga further among the medical students through rigorous clinical studies, wherein these mechanisms could be tested. Considering the current evidence in the field, which indicates the beneficial effects of yoga on the physical, psychological, emotional, spiritual, and overall well-being of medical students, it could be recommended to incorporate yoga into the medical curricula for the health benefits of the doctors-in-making, medical fraternity, and community at large. The possible inclusions in such program could be the practice of simple asana, pranayama, meditation, and mindfulness-based relaxation. The following module is proposed to be incorporated for medical students keeping in mind the existing literature on yoga for medical students: Shithilikarana vyayama (loosening exercises) - 5 min Suryanamaskara (sun salutation) - 5 min Asana (physical postures) - 15 min. Ardhakatichakrasana (lateral bend pose) Ardhachakrasana (backward bend pose) Padahastasana (standing forward bend pose) Sarvangasana (shoulder stand pose) Matsyasana (fish pose) Bhujangasana (serpent pose) Padmasana (lotus pose) Savasana (corpse pose). Pranayama (breathing practices) – 10 min Kapalabhati (illuminating forehead breath) Nadisuddhi (alternate nostril breath) Ujjayi (the psychic breath) Bhramari (humming bee breath) Meditation/relaxation – 10 min Mindfulness-based relaxation/yoga nidra (psychic sleep) MSRT or cyclic meditation – once a week. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.