An Intervention to Improve Mental and Physical Health of Undergraduate Nursing Students

Student summary

Why This Research Matters

Nursing school is demanding, and research consistently shows nursing students carry heavier mental and physical health burdens than students in other health disciplines. This Canadian study, published in the Canadian Journal of Nursing Research by Sylwia Ciezar Andersen, Tavis Campbell, Deborah White, and Kathryn King-Shier (University of Calgary), tested whether a low-cost, flexible intervention — an asynchronous online yoga program — could improve nursing students' depression, anxiety, stress, self-compassion, and physical core endurance.

The researchers recruited undergraduate nursing students from six Alberta post-secondary institutions between January and December 2021. Students were excluded if they already exercised moderately-to-vigorously three or more times a week, had recent yoga experience, or had an acute illness — the goal was to reach students who were relatively sedentary and might benefit most. Of the students who initially consented, 68 completed the full six-week program (a completion rate the authors describe candidly as modest, driven mainly by time constraints, with most dropouts occurring around week three).

The intervention itself was designed by a certified yoga instructor (RYT-200, more than 20 years of experience) and delivered as pre-recorded classes hosted on yogiapproved.com, free of charge. Sessions blended Hatha, Iyengar, and Vinyasa styles and ran between 25 and 67 minutes (mode 45 minutes, mean about 40 minutes). Participants were asked to complete three classes per week, with a rest day in between. Classes were low to moderate in intensity and progressed from beginner to more intermediate poses (held for 30 to 60 seconds), combining physical postures (asana) with breathwork (pranayama) and meditation. (The study reports that a certified instructor designed the program to appeal to novices with limited time, but does not publish a class-by-class outline.)

To measure change, the team used a single-group pre/post design — comparing each participant's scores before and after the program, without a separate comparison group. Mental health symptoms were measured with the Depression, Anxiety, and Stress Scale (DASS), self-compassion with the Self-Compassion Scale (SCS), and physical core endurance with the Mackenzie Core Endurance Test (MCET), a timed test of core stability.

The results were striking: every measure improved significantly (p<0.001), with large effect sizes across the board. Mean depression scores dropped from about 11.9 to 4.0; anxiety fell from about 11.8 to 5.3; stress dropped from about 18.7 to 9.1; self-compassion rose from about 2.75 to 3.57; and core endurance time rose by roughly 60%, from about 68 seconds to about 109 seconds. Looking at it another way, the proportion of students in the "high" symptom range for anxiety fell from 74% to 12%, and for stress from 63% to 15%.

For nursing students, this study is a reminder that structured, low-barrier wellness interventions — ones that don't require a studio, a fee, or a fixed class time — can meaningfully shift how you feel and how your body functions, at least in the short term. It's also a useful example of how a single-group pre/post design works, and why that design, while encouraging, cannot on its own prove that yoga caused the improvements: with no comparison group, some of the change could reflect natural fluctuation over the semester, other coping strategies, or simply the passage of time. The authors are explicit that nearly half the sample dropped out before finishing, mostly citing lack of time — a completion problem you should weigh against the promising results. As you read studies like this, practice separating the specific, source-supported findings (the actual scores, the specific program structure, the stated limitations) from broader context about nursing student wellbeing, so you build sound critical appraisal skills you'll use throughout your career.

Faculty notes

Educational Relevance

This article, published in the Canadian Journal of Nursing Research (2024), reports a single-group pre/post pilot study evaluating an asynchronous online yoga intervention for undergraduate nursing students, conducted by Ciezar Andersen, Campbell, White, and King-Shier at the University of Calgary. It is a useful teaching example for discussing pilot/feasibility designs, self-selected samples, and the interpretation of large effect sizes in the absence of a control group.

Students were recruited from six Alberta post-secondary institutions (January–December 2021). Exclusion criteria removed students already exercising ≥3 times weekly, with recent yoga experience, or acute illness, targeting a relatively sedentary population. An a priori power calculation indicated 64 participants were needed (effect size 0.357, α=0.05, power=0.80), with recruitment targeting ~77 to allow for 20% attrition. Actual attrition was considerably higher than anticipated: of participants who initially consented, only 68 completed the program (44% attrition: 54 of the 122 who consented did not finish, and 68 of the 114 who provided baseline data completed), with most withdrawals occurring around week three and time constraints cited as the primary reason.

The intervention was a six-week, pre-recorded video program (Hatha/Iyengar/Vinyasa blend, 25–67 minutes per session, three sessions weekly) designed by a certified (RYT-200) instructor and delivered free via a commercial platform. Outcomes were measured with the DASS (depression, anxiety, stress subscales), the Self-Compassion Scale, and the Mackenzie Core Endurance Test, analyzed with paired t-tests.

All five outcomes improved significantly (p<0.001) with large effect sizes (Cohen's d approximately 1.0–1.3): depression (11.90→4.03), anxiety (11.84→5.31), stress (18.74→9.09), self-compassion (2.75→3.57), and core endurance time (68.19s→108.51s). Categorical shifts were equally notable — e.g., high-anxiety prevalence fell from 74% to 12%, and below-average core endurance fell from 86.8% to 41.2%. The demographic profile (94% female, 74% aged 17–25, 60% in first/second year) should be foregrounded in any classroom discussion of generalizability, alongside the sample's relative homogeneity.

For teaching purposes, this study offers rich material on several fronts. First, it is an accessible case for discussing why a single-group pre/post design — despite statistically significant, large-effect findings — cannot establish causation: regression to the mean, maturation across a semester, co-occurring stressors (e.g., exam timing), and the placebo/expectancy effects of volunteering for a wellness study are all plausible alternative explanations the authors themselves acknowledge. Second, the near-50% attrition, occurring disproportionately early (week three) and attributed to time constraints, is a strong prompt for discussing feasibility and implementation science in student-facing interventions — what would need to change (session length, synchronous accountability, academic-calendar timing) to improve retention. Third, the authors' explicit call for a large-scale RCT is a good springboard for asking students to design the next-phase study: what control condition, randomization approach, and follow-up interval would be appropriate. Discussion should also address the self-selected, mostly female, younger sample, and the absence of longer-term follow-up data beyond the six-week endpoint, both of which the authors name directly as limitations. Overall, the study is best framed to students as promising pilot-level evidence supporting further, more rigorous investigation of low-cost, flexible wellness programming for nursing students — not as confirmed practice guidance on its own.