Journal of Modern Medical

Introduction
Yoga is an ancient practice that originated in India that defines the balance between mind and body. It has been shown to reduce stress, increase resilience, and improve overall well-being in various populations. COVID-19 is a highly contagious and infectious disease and manifests as an acute respiratory syndrome in the early stages. The risk of contracting this disease was much higher among healthcare workers, especially at the beginning of the outbreak, who did not realize the risk of infection. Healthcare workers are exposed to numerous stressors and often experience high levels of work-related stress, which leads to reduced job satisfaction, burnout, and reduced overall mental health. Considering the occurrence of psychological disorders in healthcare workers following the spread of COVID-19 worldwide and the recommendations of international organizations to take the necessary measures to prevent the consequences of psychological disorders in the medical staff, this study aims to determine the effect of yoga on reducing the stress and improving the organizational resilience of nurses during the COVID-19 pandemic.

Methods
This is an open-label controlled randomized clinical trial that was conducted in 2020. The study population consists of 50 nurses from the Corona Ward at Shahid Mohammadi Hospital in Bandar Abbas, southern Iran. Participants were 22 nurses with the highest perceived stress scale (PSS) score who were randomly assigned to two groups of intervention (n=11) and control (n=11). The intervention group participated in four weekly 60-minute yoga sessions provided by a certified yoga instructor. The sessions included breathing exercises, posture training, and meditation technique. The control group received no intervention during the study. 
Both groups completed the PSS and the Connor-Davidson resilience scale in four stages: Before the intervention, 4 weeks after the start of the intervention, 8 weeks after the start of the intervention, and 4 weeks after the end of the intervention. Their demographic characteristics, such as age, marital status, work experience, work shifts, and medication use were also recorded. 

Results
There were no significant differences between the two groups in terms of age (P=0.62), marital status (P=0.29), work experience (P=0.66), work shifts (P=0.13), or medication use (P=0.76). According to Table 1, the mean pre-test score of PSS for all nurses was 28.86 (27.72 in the control group and 30 in the intervention group). There was no significant difference between the two groups in the PSS score at baseline (P=0.58). After 4 yoga sessions, the intervention group reported a significant decrease (16.40) in PSS score compared to the control group (27.18) (P=0.003). According to Table 1, the mean pre-test resilience score for all nurses was 60.77 (62.36 in the control group and 59.18 in the intervention group). After the intervention, the mean score of organizational resilience was 77.72 for the intervention group and 57.18 the control group, which was significantly different from the baseline (P=0.007).




Conclusion
A four-week yoga intervention can significantly reduce perceived stress and improve the resilience in nurses. As an accessible and low-cost intervention, yoga can help improve the mental health of nurses and potentially increase the overall quality of health care. Future studies should examine the long-term effects of yoga on stress and resilience of nurses, as well as the optimal frequency, duration, and type of yoga practice to maximize its benefits.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by Hormozgan University of Medical Sciences (Code: HUMS.IR 2019.249REC).

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

Authors' contributions
Conceptualization: Seyed Hamzeh Seddigh, Farkhonde Mohamadian; Supervision, project management and financing: Seyed Hamzeh Seddigh, and Mehdi Hassani Azad; Methodology and validation: Seyed Hamzeh Seddigh; Analysis and visualization: Mamsoume Mahmoudi;Research and the initial draft preparation: Zahra Javdan, and Mojtaba Salmani Aski; Review and editing: Aidin Derbe.

Conflicts of interest
The authors declared no conflict of interest.




References