Telerehabilitation-Based Yoga Versus Yoga-Pranayama in University Students

Overview

This study will compare two online exercise programs for university students: yoga alone and yoga combined with breathing exercises called pranayama. Participants will be randomly assigned to one of the two groups and will attend online sessions three times a week for four weeks. The study will examine whether these programs reduce anxiety and improve the mechanical properties of the neck muscles. Muscle tone, stiffness, and elasticity will be measured using the MyotonPRO device. Anxiety and neck-related problems will also be assessed before and after the program. The study will also investigate whether adding pranayama breathing exercises provides greater benefits than yoga alone.

The university years are a period characterized by increased stress and anxiety due to academic pressure, concerns about the future, and social transitions. These psychological burdens may negatively affect physical health by altering muscle tone and elasticity through the autonomic nervous system. While yoga improves physical flexibility and body awareness, pranayama (breath control) promotes relaxation by activating the parasympathetic nervous system. Although the individual benefits of these interventions are well established, the effects of their combination on objective physiological parameters, such as muscle elasticity, remain insufficiently investigated. Furthermore, for a population highly integrated with technology, telerehabilitation offers a critical alternative by improving accessibility and cost-effectiveness. However, evidence-based studies comparing telerehabilitation-delivered yoga interventions with combined yoga-pranayama programs are limited. Therefore, this study aims to compare the effects of telerehabilitation-based yoga and combined yoga-pranayama interventions on stress, anxiety, and muscle elastic properties in university students. The findings are expected to contribute to the physiotherapy literature by providing evidence for holistic and digitally delivered intervention models. Participants will be randomly allocated into two groups using a simple randomization method: a yoga group and a yoga-pranayama group. The intervention will last four weeks, with sessions conducted three times per week. The yoga group will participate in 30-minute exercise sessions, whereas the yoga-pranayama group will receive 40-minute sessions consisting of 30 minutes of yoga followed by 10 minutes of pranayama. The yoga-pranayama intervention will include yoga exercises targeting mobility and flexibility in combination with diaphragmatic breathing and alternate nostril breathing techniques. The yoga group will perform diaphragmatic breathing, thoracic expansion exercises, and postural correction exercises, including scapular retraction, chin tuck, and core activation. Muscle mechanical properties will be assessed using a Myoton device. Stress and anxiety levels will be evaluated using the State Anxiety Inventory (STAI-I), and neck-related functional status will be assessed using the Neck Disability Index (NDI). All outcome measures will be collected before and after the intervention. The data will be analyzed using appropriate statistical methods to determine within-group and between-group differences. This study is expected to clarify the effects of telerehabilitation-based yoga interventions on the psychological and physical health of university students and to determine the additional benefits of incorporating pranayama techniques. Objective: The primary objective of this study is to comparatively evaluate the effectiveness of a telerehabilitation-based yoga program and a conventional yoga-pranayama combination on psychometric outcomes (stress and anxiety) and biomechanical outcomes (muscle elasticity and mechanical properties) in university students. Methods This study is designed as a randomized controlled trial to investigate the effects of telerehabilitation-based yoga and yoga-pranayama interventions in university students. The study population will consist of healthy young adults enrolled at a university. The sample will include volunteers who meet the predefined inclusion and exclusion criteria, and the required sample size will be determined by an a priori power analysis (α = 0.05, power = 0.80). Participants will be randomly allocated to one of two groups using a simple randomization method. Muscle mechanical properties will be assessed using the MyotonPRO device. Anxiety levels will be evaluated using the State Anxiety Inventory (STAI-I), and neck-related functional status will be assessed using the Neck Disability Index (NDI). Muscle mechanical properties will be measured objectively and non-invasively using the MyotonPRO device. Measurements will be performed on the upper trapezius and sternocleidomastoid (SCM) muscles in the cervical region. During the assessments, participants will be positioned comfortably in either a supine or seated position according to a standardized protocol. Measurement sites will be identified using anatomical landmarks, and all measurements will be obtained from the same locations for each participant. For the upper trapezius muscle, the midpoint between the acromion and the spinous process of the C7 vertebra will be used as the reference point. For the sternocleidomastoid muscle, measurements will be taken from the midpoint of the muscle belly where it is most prominent. At each measurement site, the probe of the MyotonPRO device will be positioned perpendicular to the skin surface, and a brief mechanical impulse will be applied to record the viscoelastic properties of the muscle. Participants will be instructed to remain completely relaxed during the measurements. Multiple measurements will be obtained at each site, and the average value will be used for analysis. The recorded muscle mechanical parameters will include muscle tone (Hz), stiffness (N/m), and elasticity (logarithmic decrement). To ensure measurement reliability, all assessments will be performed by the same trained researcher under standardized environmental conditions. All outcome assessments will be conducted by a researcher who has received standardized training in the measurement procedures. The telerehabilitation interventions will be delivered through an online platform, whereas all outcome assessments will be performed face-to-face. The interventions will be administered three times per week for four weeks. Participants in the yoga group will complete a 30-minute exercise session, whereas those in the yoga-pranayama group will receive a 40-minute intervention consisting of 30 minutes of yoga followed by 10 minutes of pranayama. Statistical analyses will be performed using appropriate parametric or non-parametric tests depending on data distribution. Paired statistical tests will be used for within-group comparisons, while independent-sample tests will be used for between-group comparisons. Statistical significance will be set at p \< 0.05. To minimize bias, participants will be randomly allocated to intervention groups, the outcome assessor will be blinded to group allocation, and all measurement procedures will be standardized. In addition, participants will be monitored regularly throughout the study to minimize missing data. Sample Size The sample size was calculated using G\*Power version 3.1 based on an a priori power analysis. A repeated-measures analysis of variance (ANOVA) model with a group × time interaction was used for the calculation. Based on previous studies evaluating cervical muscle viscoelastic properties using the MyotonPRO device, a moderate effect size (f = 0.30) was assumed. The significance level was set at α = 0.05, with a statistical power of 1 - β = 0.95. The analysis indicated that a minimum sample size of 44 participants was required. Considering a potential 20% dropout rate, a total of 52-56 participants will be recruited. Inclusion Criteria * University students aged 18-30 years * Sedentary or lightly physically active individuals * Ability to participate in online intervention sessions * Willingness to provide informed consent Exclusion Criteria * Diagnosed psychiatric disorders * Current use of psychotropic medications * Acute musculoskeletal injury * Advanced experience in yoga or meditation Literature Summary: The literature confirms that the university years represent one of the most stressful periods in an individual's life. Academic demands and social adaptation continuously stimulate the hypothalamic-pituitary-adrenal (HPA) axis, resulting in sustained cortisol secretion. These endocrine changes trigger a protective increase in musculoskeletal tension, leading to increased muscle stiffness, reduced biomechanical elasticity, and the development of myofascial pain. Yoga and pranayama are well-established somatic interventions that regulate autonomic nervous system function. Evidence suggests that yoga enhances parasympathetic activity through vagal stimulation, while pranayama (breathing control) techniques reduce anxiety symptoms by modulating amygdala activity. At the physiological level, yoga improves tissue hydration and muscle elasticity by optimizing collagen fiber alignment through static stretching and isometric contractions. Following the COVID-19 pandemic, digitalization in healthcare has accelerated, making telerehabilitation an important alternative because of its accessibility and cost-effectiveness. Previous studies have demonstrated that remotely supervised exercise programs can achieve clinical outcomes comparable to those of face-to-face interventions. For university students, who generally possess a high level of digital literacy, telerehabilitation represents a promising approach for improving adherence to therapeutic interventions. Although existing studies have primarily focused on the psychological benefits of yoga, its effects on objective biomechanical parameters, such as muscle elasticity, have received comparatively little attention. Furthermore, evidence comparing telerehabilitation-based yoga with combined yoga-pranayama protocols remains limited. Therefore, the present study aims to address this gap by investigating the effectiveness of digital mind-body interventions on both psychological and biomechanical outcomes.