Research Article

Effect of Aerobic Dance Movement Therapy on Anxiety among

First Year B. SC. (N) Students
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Tamil Elakiya1, Shankar Shanmugam2

1
Tutor, Department of Mental Health Nursing, Saveetha College of Nursing, SIMATS, 2Associate Professor, College of Nursing, Madras Medical College,
Chennai, Tamil Nadu, India
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Abstract
Anxiety disorders are becoming one of the most common mental health problems on college campuses worldwide. It is estimated that 1 in 13
people suffer from anxiety. Newly admitted college students are more anxious due to their transition to a new environment and a probable lack
of proficiency in technology. Researchers reported that the anxiety levels among nursing students are high with a poor impact on their health
and academic status. This study evaluated the effectiveness of aerobic dance movement therapy (ADMT) on anxiety level and to associate
post‑test level of anxiety with selected demographic variables among B.Sc. (N) first‑year students. A Quasi‑experimental non‑randomised
control group design was used. 60 students were selected by purposive sampling technique with 30 students in each group. Zung Self Rating
Anxiety Scale was used. After pre‑test, intervention was given to students in the study group for 45 min on alternate days for 4 weeks followed
by post‑test in both groups. In pre‑test, the mean anxiety score in the study group and control group were 55.93 and 55.27. After administration
of ADMT, the post‑test mean anxiety score was 42.17 and 54.43 in the study and control group, respectively. The mean difference in the study
group is 13.77 and found to be statistically significant (t = 13.63, P = 0.001). Variables such as age, type of family, area of residence and type
of attending college were significantly associated with post‑test anxiety level (P ≤ 0.05). ADMT was found to be cost‑effective, appropriate
and feasible to implement in all settings that would help the students to manage anxiety and improve their academic performance effectively.

Keywords: Aerobic dance movement therapy, anxiety, nursing students

Introduction the prevalence of anxiety disorder among adolescents aged

Adolescent life is the period of transition. It is the period that
has both extremes of happiness and stress. The later part of
adolescence is spent mostly in colleges. College life is one
of the most sparkling experiences for them with a vivacious
environment, a company of friends and academic life. Newly
admitted college students may be more anxious due to their
transition to a new environment and a probable lack of
proficiency in technology. Anxiety is a normal human emotion.
In a normal or moderate amount, it acts as catalyst if it exceeds
a normal limit it causes harm to the individual.[1]
WHO report states that 3.6% of individuals suffer from
anxiety.[2] In the United States, 40 million of adults suffer
from anxiety disorder in which 75% experience their first
episode within the age of 22.[3] According to Programme for
International Students Assessment (PISA) report, 72% of
students from the United Kingdom reported anxiety while
taking a test even after adequate preparation.[4] In India,
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between 13 and 18 years was found to be about 31.9%, in which
8.3% had severe impairment, with the highest prevalence noted
in females (38%) than males (26.1%).[5] In Tamil Nadu, the
highest suicidal rate was reported due to academic pressure
among adolescents. It is found that failure in examination led
to 2413 suicides among students in 2016 or accounting for 25%
of student suicides and necessitates the need to understand the
factors contributing anxiety among students.[6]
Anxiety can be related to stress. In stressful situations, body
releases a hormone called adrenaline. This adrenaline rush
Address for correspondence: Dr. Shankar Shanmugam,
College of Nursing, Madras Medical College,
Chennai ‑ 600 003, Tamil Nadu, India.
E‑mail: shankarshaki@yahoo.com
Submitted: 12‑Sep‑2020 Revised: 20‑Dec‑2020
Accepted: 16-Apr-2021 Published: 07-Jul-2021
This is an open access journal, and articles are distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non‑commercially, as long as appropriate credit
is given and the new creations are licensed under the identical terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com

DOI: How to cite this article: Elakiya T, Shanmugam S. Effect of aerobic dance
10.4103/IJCN.IJCN_75_20 movement therapy on anxiety among first year B. SC. (N) students. Indian
J Cont Nsg Edn 2021;22:57-63.

© 2021 Indian Journal of Continuing Nursing Education | Published by Wolters Kluwer - Medknow 57
 Elakiya and Shanmugam: Aerobic Dance Movement on Anxiety
helps the body to prepare and deal with stressors and it is
referred to as ‘fight or flight response’. However when the
individual constantly runs in an emergency mode, the mind
and body must pay the price.[7]
Stress and anxiety are notably woven into nursing student’s
educational experience internationally and has an impact
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on their health as well as their academic and clinical
performance.[8] A student nurse’s first year of professional
experience lays the foundation for long‑term professional
satisfaction. Many nursing students move away from home
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for the first time, leaving all previously learned support
systems and have difficulties in adjusting to more academic
expectations such as fear of failure due to language problems
and differing cultures and beliefs which provoke anxiety.[9] A
study revealed that 96.9% of first‑year nursing students had
moderate anxiety and 3.1% had low anxiety. Studies revealed
that anxiety affects 30% of nursing students and has detrimental
effects on academic performance and student success.[10]
Aerobic dance movement therapy (ADMT) is a smoother
exercise program that combines physiological activity
with psychological components that has positive effects on
health‑related psychological outcomes.[11] Aerobic exercise
in form of dance is most beneficial in improving social
relationship among individuals and boosting up mood.[12]
Research shows that regular exercise of 30 min for 3–5 days
a week can alleviate anxiety as much as anxiety medications
and effects of exercise may last longer than those of drugs.
During exercise adrenaline is expelled, muscles relax and
heartbeat slows down all of which are associated with a sense of
well‑being and reduction in anxiety.[13] Thus Aerobic exercise
is a powerful tool to enhance physical and mental health.
Anxiety is considered a major obstacle during student’s college
life that has an impact on their health as well as on academic
outcomes. Students are unaware of coping methods to address
their anxiety effectively. Therefore, psychiatric nurse educator
should act as a liaison between students, community and
educational institutions for managing anxiety and intervention
aimed at facilitating positive mental health outcome among
students.
Objectives
The present study was undertaken with the following
objectives.
• To evaluate the effectiveness of ADMT on anxiety levels
among I‑year BSc nursing students
• To determine the association of post‑test level of anxiety
with selected demographic variables.
Methods
A Quasi‑experimental non‑randomised control group research
design was used to recruit B. Sc (N) I year students for the
study. Nursing students who were differently‑abled or with
chronic illness were excluded from the study as they may
have different levels of anxiety. Initially, a sampling frame was
58 Indian Journal of Continuing Nursing Education ¦ Volume 22 ¦ Issue 1 ¦ January-June 2021
created with list of private nursing colleges, based on feasibility
and availability of subjects, two nursing colleges were selected
purposively. Each college had an annual intake of 50 students.
Formal approval was obtained from the Principal of both the
selected Nursing colleges in the Chennai district. 36 students
from one college who met the inclusion criteria and who gave
informed consent were selected as study group and the other
college (34 students) was selected as control group with the
same inclusion criteria.
Tools
Section A
The demographic data of the students included their age, type
of family, breadwinner of family, education and occupation
of the head of the family, family monthly income, area of
residence, selection of nursing course, medium of instruction,
type of attending college, previous academic performance
in school, exposure to hostel life and duration of hostel life,
sleeping hours, previous experience of any relaxation therapies
and form of recreational activities.
Section B
Zung Self Rating Anxiety Scale is a self‑administered
standardised tool with 4 points consisting of 20 questions
based on four domains such as cognitive, autonomic, motor
and CNS symptoms. The reliability of the tool was found to
be 0.84 by Cronbach’s alpha method.[14] Permission for using
the scale in the study was obtained.
Scoring interpretation
Table 1.
Ethical consideration
Ethical approval was obtained from the College Ethical
Committee. During the initial interview, the purpose of the
study and data collection procedure was explained to the
participants. Written informed consent was obtained from
the study participants and informed them that participation
is voluntary and they can withdraw from the study at any
time. Confidentiality with the information was achieved by
maintaining the anonymity of the participants.
Data collection procedure
The investigator collected data for 4 weeks from February 04,
2019 to March 04, 2019. Followed by pre‑test, the samples
in the study group were divided into four groups with 9
members in each group. ADMT was given on alternate days
for 45 min (35 min of aerobic exercises including dance
movements and 10 min for employing coping phrases) in
each group for 4 weeks. After 7 days of the last session of
Table 1: Interpretation of Zung self Rating Anxiety Scale
Score Interpretation
20‑44 Absence of anxiety (normal range)
45‑59 Mild level of anxiety
60‑74 Moderate level of anxiety
75‑80 Severe level of anxiety
 Elakiya and Shanmugam: Aerobic Dance Movement on Anxiety

intervention, post‑test was conducted for both groups using However in the post‑assessment, the study group 46.67% of
the same tool. Booklets about aerobic exercises and coping the students were having normal, 43.33% had mild and 10%
phrases were given to the control group after post‑test as had moderate level of anxiety. None of the students had severe
an ethical consideration. 6 samples from study group and level of anxiety. Among the control group, none of the students
4 samples from the control group dropped out at the time of had normal and severe levels of anxiety. 63.33% of them had
intervention and post‑test, so sample size reduced to 60 with mild and 36.67% had moderate levels of anxiety.
30 in each group. Analysis of the collected data was done using
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Domain‑wise comparison of pre‑ and post‑test level of anxiety

SPSS version 21 [SPSS Statistics for Windows, Version 21.0.
in study group and control group were as follows: At pre‑test
Armonk, NY: IBM Corp].
the mean scores for each of the four domains were similar. The
autonomic symptom score was highest at pre‑test in both groups.
Results
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While there were significant differences in the mean scores in all

Table 2 indicates 46.67% of students in the study group and the domains in the study group after the intervention, the scores
40% of students in the control group were in the age group remained same for control group [Figure 1].
of 18 years of age. 56.67% of students in the study group Based on cognitive symptoms, pre‑ and post‑test score in the
and 70% of students in control group were living in the study group were 14.90 and 11.90 score and difference was 3.0
nuclear family. 50% of students in the study group and 60% and it was statistically significant. In the control group, during
of students in the control group were in the income group pre‑ and post‑test score were 14.30 with nil difference and it
of Rs. 5001–10,000.50% of students in the study group and was not statistically significant. Based on autonomic symptoms,
43.33% of students in the control group were residing in rural pre‑ and post‑test score in the study group were 23.0 and 14.47
area. About 53.33% of students in the study group had selected and the difference was 8.60 and it was statistically significant.
courses by self‑choice and 53.33% of students in the control In the control group, pre‑ and post‑test score were 23.06 and
group had selected the course with recommendations from 22.23 score. The difference is 0.83 and it was not statistically
parents. About 66.67% of students in the study group and significant. Based on motor symptoms, pre‑ and post‑test anxiety
56.67% of students in the control group had Tamil as medium score in the study group were 11.47 and 10.27, respectively.
of instruction. 46.67% of students in the study group and Difference is 1.20 and it was statistically significant. In the
73.33% of students in control group were from hostel. About control group, pre‑  and post‑test score were 11.90 with nil
56.67% of students in study group and 46.67% of students in difference and it is not statistically significant. Based on CNS
the control group had recreational activities like listening to symptoms, pre‑ and post‑test score in study group were 6.50
music. The groups were similar in their association of baseline and 5.52 score. The Difference was 0.98 and it was statistically
characteristics. significant. In control group, pre‑ and post‑test score were 6.00
In the present study, pre‑test assessment in the study group with nil difference and it was not statistically significant.
showed that 43.33% of them had mild level of anxiety and Table 3 shows the paired t‑test comparison of pre‑ and post‑test
56.67% of them had moderate level of anxiety. Among control level of anxiety score among B. Sc (N) Ist year students.
group, 50% of them mild and rest 50% of them had moderate Considering the study group, the pre‑test mean and standard
level of anxiety. In both groups, none had normal or severe deviation were 55.93 and 5.54 and the post‑test mean and
levels of anxiety. standard deviation were 42.17 and 9.67, the difference of
13.77 was statistically significant (P < 0.001). In the control
PRETEST AND POSTTEST MEAN ANXIETY group, the difference in mean score 0.83 was not statistically
SCORE
23.07

23.08
22.23

Pretest
25
MEAN ANXIETY SCORE

Posttest
20
14.47
14.9

14.3
14.3
11.47
11.9

10.27

11.9
11.9

15

10
5.52
6.5

6
6

0
Autonomic symptoms

Autonomic symptoms
Motor symptoms

Motor symptoms
Cognitive symptoms

Cognitive symptoms
CNS symptoms

CNS symptoms

Study group Control group

Figure 1: Domain wise comparison of pre‑ and post‑test anxiety score Figure 2: Simple bar diagram with 2 standard error compares the student’s
of B.Sc. (N) I year students pre‑ and post‑test anxiety score

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 Elakiya and Shanmugam: Aerobic Dance Movement on Anxiety

Table 2: Frequency and percentage distribution of demographic variables of B.Sc (N) year students in study group and
control group (n=60)
Demographic variables Group Chi‑square
test (χ2, P)
Study (n=30), n (%) Control (n=30), n (%)
Age (years)
17 8 (26.67) 11 (36.67) 0.71, 0.86
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18 14 (46.67) 12 (40.00)
19 6 (20.00) 5 (16.67)
20 2 (06.67) 2 (06.67)
Type of family
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Joint family 11 (36.67) 6 (20.00) 2.09, 0.35

Nuclear family 1‑7 (56.67) 21 (70.00)
Extended family 2 (06.67) 3 (10.00)
Family monthly income (Rs.)
5001‑10,000 15 (50.00) 18 (60.00) 0.80, 0.67
10,001‑15,000 10 (33.33) 7 (23.33)
15,001‑above 5 (16.67) 5 (16.67)
Area of residence
Urban 13 (43.33) 11 (36.67) 2.31, 0.32
Rural 15 (50.00) 13 (43.33)
Semi urban 2 (06.67) 6 (20.00)
Selection of nursing course
By self 16 (53.33) 7 (23.33)
Recommendation from parents 10 (33.33) 16 (53.33)
Recommendation from relatives 4 (13.33) 7 (23.33)
Any other 0 0
Medium of instruction in school
Tamil 20 (66.67) 17 (56.67) 5.72, 0.06
English 10 (33.33) 13 (43.33)
Other languages 0 0
Previous academic performance in school
80% ‑ 90% 12 (40.00) 15 (50.00)
<80% 18 (60.00) 15 (50.00)
Type of attending college
From hostel 14 (46.67) 22 (73.33) 4.44, 0.11
From home with parents 10 (33.33) 5 (16.67)
From home with relatives 6 (20.00) 3 (10.00)
As paying guest 0 0
Sleeping hours at night (h)
7‑8 17 (56.67) 16 (53.33)
>8 13 (43.33) 14 (46.67)
Previous experience of any relaxation therapies
Yes 2 (6.67) 6 (20.00) 2.30, 0.12
No 28 (93.33) 24 (80.00)
Form of recreational activities
Reading books 4 (13.33) 4 (13.33) 2.30, 0.12
Watching videos 7 (23.33) 11 (36.67)
Listening music 17 (56.67) 14 (46.67)
Others 2 (6.67) 1 (3.33)

significant. Figure 2 depicts the range of anxiety scores for
both groups at pre and post‑test.
Independent t‑test showed that there was no significant
difference in mean anxiety scores between the study and
control group. The post‑test assessment showed a significant
statistical difference between the two groups again revealing
that the intervention was effective in reducing anxiety in the
students [Table 4].
Table 5 shows the association between post‑test level of anxiety
reduction score and their selected demographic variables in

60 Indian Journal of Continuing Nursing Education ¦ Volume 22 ¦ Issue 1 ¦ January-June 2021

 Elakiya and Shanmugam: Aerobic Dance Movement on Anxiety

the study group. Older students (19–20 years), living in the
nuclear family, and urban area and attending college from
home reported normal anxiety scores than others.
Discussion
The evidence of anxiety among B. Sc (N) Ist year students under
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nurse researcher carried out the study using Zung Self Rating
Anxiety Scale. Pre‑test assessment in the present study showed
about half the proportion of students had mild or moderate
levels of anxiety in both groups. In contrast in another study
by Hiremathet et al. in which he investigated prevalence of
depression, anxiety and stress among 72 first baccalaureate
nursing students it was found that 36% had mild levels of

the context of different domains was an evolving scenario. Due

to the paucity of literature regarding the effect of ADMT on anxiety, 18% had moderate and 4% had severe level of anxiety
anxiety among nursing students in the Indian population, the among students.[15] Another study examined anxiety and
academic achievement among 440 female nursing students and
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identified that 70.9% had low, 19.3% had moderate and 9.8%
Table 3: Comparison of overall mean pretest and posttest had severe level of anxiety with a correlation between female
anxiety score among B.Sc (N) 1 year students (n=60) nursing student’s satisfaction and anxiety score significant
at P = 0.005 level.[16] A Srilankan based study investigated
Anxiety Pretest Posttest Mean Paired
difference t‑test
depression, anxiety and stress among 92 undergraduate nursing
Mean score SD Mean score SD students and found that 59.8% had anxiety symptoms with
Study 55.93 5.54 42.17 9.67 13.77 13.63* the distribution of anxiety symptoms were 40.2% had normal
Control 55.27 6.11 54.43 5.70 0.83 1.71 (NS) range of anxiety, 9.8% had mild level, 21.7% had moderate
*P<0.001. SD: Standard deviation, NS: Not significant
level, 12% had severe and 16.3% had extremely severe level of
anxiety.[17] Compared to most of the study in the present study
Table 4: Difference in mean anxiety scores between there were more who had moderate level of anxiety at baseline.
control and study groups at pre‑ and post‑ tests In the post‑assessment majority had normal or mild anxiety in
Mean (SD) t the study group when there were none in normal anxiety levels
Control group Study group in the control group. In this study, it was also found that the
Pretest 55.27 (6.11) 55.93 (5.54) 1.5 (NS) anxiety scores were not statically different at pre‑assessment.
Posttest 54.43 (5.70) 42.17 (9.67) 5.89* The paired test showed a significant reduction in anxiety scores
*P<0.001. SD: Standard deviation, NS: Not significant in the study group. These results show that the ADM was

Table 5: Association between posttest level of anxiety reduction score and their demographic variables in study group
Demographic variables Posttest level of anxiety n Chi‑square
test (χ2, P)
Normal, n (%) Mild, n (%) Moderate,
n (%)
Age (years)
17 2 (25.0) 3 (37.5) 3 (37.5) 8 12.62, 0.04*
18 5 (35.7) 9 (64.3) 0 14
19 5 (83.3) 1 (16.7) 0 6
20 2 (100) 0 0 2
Type of family
Joint family 2 (18.2) 7 (63.6) 2 (18.2) 11 9.76, 0.05*
Nuclear family 12 (70.6) 5 (29.4) 0 17
Extended family 0 1 (50.0) 1 (50.0) 2
Family income (Rs.)
10,001‑15,000 5 (50.0) 3 (30.0) 2 (20.0) 10
15,001‑above 3 (60.0) 2 (40.0) 0 5
Area of residence
Urban 10 (76.9) 3 (13.1) 0 13 10.82, 0.03*
Rural 4 (26.7) 8 (53.3) 3 (20.0) 15
Semi urban 0 250.0) 0 2
Type of attending college
From hostel 4 (28.6) 7 (50.0) 3 (21.4) 14 9.27, 0.05*
From home (staying with parents) 8 (80.0) 2 (20.0) 0 10
From home with relatives 2 (33.3) 4 (66.7) 0 6
As paying guest 0 0 0 0
*P<0.05

Indian Journal of Continuing Nursing Education ¦ Volume 22 ¦ Issue 1 ¦ January-June 2021 61

 Elakiya and Shanmugam: Aerobic Dance Movement on Anxiety
effective in reducing anxiety in nursing students. The above
study finding was consistent with other studies which looked at
the effect of dance movement in reducing anxiety and depression
in different groups of population. A study based in Korea
examined an effect of dance movement therapy on depression,
anger and psychotic symptoms among schizophrenic clients.
The results revealed a significant decrease in state anger (F [1,
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36] =2.26, P < 0.05), depression (F [1, 36] =5.92, P < 0.01) and
negative psychotic symptoms and significant increase in anger
control (F [1, 36] =5.12, P < 0.01).[18] It was also supported by
another study which revealed that dance movement therapy
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was beneficial in the treatment of depressed adults with
statistical significance (χ2 = 7.07, df = 1, P < 0.01).[19] Current
findings are augmented by an Iranian study where the effect
of short‑term movement therapy on academic stress among
female students was observed. The study results showed a
statistically significant reduction in stress levels among female
students (F = 26.20, P < 0.01).[20]
The results of the present study were also supported by the
studies conducted by Shokri et al. who investigated the effect
of 8 weeks aerobic exercise on depression, anxiety and sleep
disorders among 60 middle‑aged women. The results showed
that significant impact on reducing depression, anxiety and
improving the quality of life with pre‑  and post‑test value
of anxiety were 5.88 and 4.32 at P = 0.005.[21] A study based
at Malaysia investigated the effect of low‑intensity aerobic
dance exercise on hostility, anxiety and depression among
40 sedentary overweight women. The results revealed a
statistically significant differences between intervention group
and control group (F = [4, 35] =20.79, P < 0.01, η =0.790) with
positive findings concerning physical health and psychological
well‑being among sedentary women in intervention group.[22]
Our present study findings showed association between post‑test
level of anxiety with their selected demographic variables. In
the study group, older students, students living in the nuclear
family, students residing in urban area and students attending
college from home with parents have reduced anxiety score than
others. None of the demographic variables in the control group
were significantly associated with post‑test level of anxiety.
EvangeliaGiourou et al. found that higher age (P = 0.014),
females, ignorance of support services, reduction in income,
area of residence at P < 0.001 were significantly associated with
anxiety among students.[23] Another study found that locality
of staying (χ2 = 0.2057, P < 0.05), family members relation
with nursing profession (χ2 = 2.73, P < 0.05) and students
willingness to join nursing profession (χ2 = 0.6231, P < 0.05)
were significantly associated with stress and anxiety.[15]
Limitations
The study has some limitations. The researcher could not
generalize the study findings as the sample size was relatively
small and limited to 60 student nurses. Only first‑year B. Sc (N)
students were included into the study. Another limitation was
the lack of random allocation of the groups. This was overcome
by checking the association of demographic variables which
62 Indian Journal of Continuing Nursing Education ¦ Volume 22 ¦ Issue 1 ¦ January-June 2021
were not different between groups. The anxiety level among
students can differ based on their cultural differences and
background. The current study has only a few supportive
studies in Indian population due to the paucity of literature.
Conclusion
The results of the present study showed the anxiety levels
among nursing students and also evidenced that ADMT is a
safe and cost‑effective intervention to alleviate anxiety among
nursing students. The psychiatric nurse educators should
assess, guide, educate and empower students by alleviating
anxiety and promote health and well‑being among nursing
students in an earlier stage and conduct activities to empower
students for achieving positive health outcomes. ADMT can be
an interesting activity powerful in reducing anxiety in students.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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