INTRODUCTION:

Everyone feels anxious from time to time. Stressful situations such as meeting tight deadlines or important social obligations often make us nervous or fearful. Experiencing mild anxiety may help a person become more alert and focused on facing challenging or threatening circumstances. But individuals who experience extreme fear and worry that does not subside may be suffering from an anxiety disorder.

The frequency and intensity of anxiety can be overwhelming and interfere with daily functioning. (Kerstin Wickstorm, 2001) Anxiety disorders may be caused by genetics, brain chemistry, substance abuse, medical factors, environmental factors, or a combination of these. It is most commonly triggered by the stress in our lives.It has been suggested by some researchers that a family history of anxiety increases the likelihood that a person will develop it. That is, some people may have a genetic predisposition that gives them a greater chance of suffering from anxiety disorders.Research has shown that people with abnormal levels of certain neurotransmitters in the brain are more likely to suffer from generalized anxiety disorder. When neurotransmitters are not working properly, the brain's internal communication network breaks down and the brain may react in an inappropriate way in some situations. This can lead to anxiety. Anxiety is associated with medical factors such as anaemia, asthma, infections, and several heart conditions. Some medically-related causes of anxiety include: stress from a serious medical illness, side effects of medication, symptoms of a medical illness, lack of oxygen from emphysema or pulmonary embolism. It is estimated that about half of patients who utilize mental health services for anxiety disorders such as GAD, panic disorder, or social phobia are doing so because of alcohol or benzodiazepine dependence. More generally, anxiety is also know to result from: intoxication from an illicit drug, such as cocaine or amphetamines, withdrawal from an illicit drug, such as heroin or from prescription drugs like vicodin, benzodiazepines or barbiturates. Environmental factors that are known to cause several types of anxiety include: trauma from events such as abuse, victimization or the death of a loved one, stress in a personal relationship, marriage, friendship and divorce, stress at work, stress from school, stress about finances and money, stress from a natural disaster, lack of oxygen in high altitude areas. People with anxiety disorders present a variety of physical symptoms in addition to non-physical symptoms that characterizes the disorders such as excessive, unrealistic worrying. Many of these symptoms are similar to those exhibited by a person suffering general illness, heart attack or stroke and this tends to further increase anxiety.

The following is a list of physical symptoms associated with GAD: trembling, churning stomach, nausea, diarrhoea, headache, backache, heart palpitations, numbness or "pins and needles" in arms, hands or legs, sweating/flushing, restlessness, easily tired, trouble concentrating, irritability, muscle tension, frequent urination, trouble falling or staying asleep, being easily startled. Those suffering from panic disorders may experience similar physical symptoms to those with GAD. They also may experience chest pains, a sense of choking, shortness of breath and dizziness.²²Aerobic exercise is the type of moderate-intensity physical activity that can sustain for more than just a few minutes with the objective of improving cardio respiratory fitness and health. "Aerobic" means "in the presence of oxygen."¹⁷Calories burned by aerobic exercise: Below is a list of aerobic activities with the approximate number of calories burned per hour for a 150-pound individual. Aerobics class: 450-500, Bicycling (outdoor): 540-620, Bicycling (stationary): 480-540, Cross-country skiing: 530-630, Dancing: 300-350, Gardening: 270-300, Hiking: 400-480, Jogging: 530-630, Jumping rope: 650-800, Running: 650-750, Skating: 470-550, Swimming: 400-480, Tennis: 470-550, Volleyball: 200-240, Walking (regular pace): 150-200, Walking (fast pace): 250-300. ¹⁸Many health and fitness benefits are acquired when regular aerobic exercise is performed. Here's a partial list: burns calories, improves endurance, reduces the risk of chronic diseases like heart disease and diabetes, lowers moderately high blood pressure, improves bone density reduces the risk of certain cancers, improves the likelihood of surviving a heart attack, alleviates symptoms of depression, reduces body fat, can improve balance and performance of activities of daily living, can reduce the pain and swelling of arthritis, increase HDL cholesterol, decreased blood triglycerides, improve weight control, improve glucose tolerance and reduce insulin. ²³Rehabilitation s a place where the patients admitted after recovering from acute stage of illness.

OBJECTIVES OF THE STUDY:

Ø To assess the pre-test levels of anxiety among samples at selected psychiatric rehabilitation centre.

Ø To implement the aerobic exercises.

Ø To assess the post-test levels of anxiety among samples at selected psychiatric rehabilitation centre.

Ø To compare the pre-test and post-test levels of anxiety among samples at selected psychiatric rehabilitation centre.

Ø To find out the association between the post-tests levels of anxiety among samples with their selected demographic variables. (Age, Educational status, Occupational status, Monthly income of family, Marital status, Type of family, type of substance abuse, Duration of substance abused).

HYPOTHESIS:

H₁ :

There will be a significant difference between the pre-test and the pos-test levels of anxiety among samples at selected psychiatric rehabilitation centre.

H₂:

There will be a significant association between the post-test level of anxiety with their selected demographic variables (Age, Type of family, Educational status, Occupational status, Monthly income of family, Marital status, Type of family, Duration of substance abused).

RESEARCH METHODOLOGY:

DESCRIPTION OF THE TOOL:

A Modified Anxiety Rating Scale is used to measure the level of anxiety among substance abuse patients in selected psychiatric rehabilitation centre, Dehradun.

Part-A:

Questionnaire related to demographic variables to associate the pretest and post-test knowledge with certain demographic variables. It consists of age, gender etc.

Part-B:

A Modified Anxiety Rating Scale to assess the level of anxiety in patient in the selected psychiatric rehabilitation centre

Scoring:

Scoring interpretation was classified into four levels based on the score as follows:- the minimum score was 30 and maximum score was 120. The respondents were classified based on the levels of anxiety as:-

Level of anxiety	Score
Mild	30
Moderate	31- 60
Severe	51–75
Extreme	91 – 120

DATA COLLECTION PROCEDURE:

The duration of the data collection for the main study was one month. The study was conducted in the selected Psychiatric Rehabilitation Centre, Dehradun, after obtaining permission from the Academic section and Director of the selected Rehabilitation Centre . 40 patients who were admitted in the selected Psychiatric Rehabilitation Centre were included in the study. Standardized tools were used for collection of data. Patients were explained about the purpose of the study and got a written consent from them and Non Probability Convenient Sampling Technique was used. A Modified Anxiety Rating Scale was given to them to get information about their baseline data. Data was collected with the help of Semi Structured Interview Technique. Samples were divided into two groups. After this, aerobic exercises (selected nursing interventions) were taught to the groups up to ten days and post tests were conducted on the 11th day of pre-test.

SECTION – I: FREQUENCY AND PERCENTAGE DISTRIBUTION OF SOCIO-DEMOGRAPHIC VARIABLES AMONG SAMPLES

Table 1: Frequency and percentage distribution of socio demographic variables among samples N=40

Sl. no.

Demographic variable

Frequency

Percentage (%)

Age

15-20 years

21-25 years

26-30 year

31-35 year

36 years and above

Gender

Male

Female

Educational status

Illiterate

Primary education

Secondary education

Graduation

Post graduation

Occupational status

Unemployed

Self employed/business

Government employee

Professional

Family monthly income

Less than Rs. 10,000/-

Rs. 10,001 to 15,000/-

Rs.15,001 to 20,000/-

Rs.20,000 and above

Marital status

Single

Married

Separated

Family type

Broken

Divorced

Joint family

Nuclear family

Extended family

Type of substance use

Alcohol

Opioids

Cannabis

Smoking

Other

Duration of substance abuse

Less than 5 year

6-10year

11-15year

More than 16year

100

7.5

27.5

42.5

2.5

17.5

12.5

82.5

2.5

37.5

2.5

27.5

2.5

62.5

12.5

SECTION II -: FREQUENCY AND PERCENTAGE DISTRIBUTION OF LEVELS OF ANXIETY AMONG SAMPLES

TABLE – 2: Frequency and percentage distribution of levels of anxiety among samples N=40

Anxiety levels	Pre-test		Post-test
Anxiety levels	Frequency	%	Frequency	%
Mild anxiety	0	0.0	0	0.0
Moderate anxiety	6	15.0	35	87.5
Severe anxiety	27	67.5	5	12.5
Extreme anxiety	7	17.5	0	0.0
Total	40	100	40	100

SECTION - IV: - ASSOCIATION BETWEEN THE POST-TEST LEVELS OF ANXIETY WITH THEIR SELECTED DEMOGRAPHIC VARIABLES.

Table – 4: Chi-square value for post-test levels of anxiety with their age.

S. No	Demographic variable	df	c²
1.	Age	2	4.28****
2.	Educational status	4	4.730**
3.	Occupational status	3	6.000 **
4.	Family monthly income	3	1.536 **
5.	Marital status	2	5.064 **
6.	Family type	4	0.532 **
7.	Type of substance abuse	4	2.140**
8.	Duration of substance abuse	3	8.261 *

(** - Not Significant at > 0.05 level) ; (* - Significant at > 0.05 level)

RESULTS:

Majority 85% of subjects were aged between 15-20 years, all were males, 30% of the patients had been completed primary education and secondary education, 45% of subjects were self employed/ doing business, 45% of subjects had family income less than Rs.10000, 82.5% of the subjects were unmarried, 55% of subjects were living in joint family, 35% of the subjects had the habit of opioids consumption, 62.5% of the subjects uses substance for less than 5 years. The pre-test mean anxiety score was 74.45 (62.04%) with the standard deviation of 14.38 indicating the severe anxiety. The post-test mean anxiety score of the patients was 50.13 (41.77%) with the standard deviation 8.562 indicates the moderate anxiety among patients. The obtained "t" value 11.53 is greater than the table value at a.05 level of significance. There is no significant association between the levels of anxiety with their age, gender, educational status, occupational status, monthly income of family, marital status, type of family, type of substance abuse. Analysis of the eighth objective of the study revealed that there is significant association between the levels of anxiety with their duration of substance abuse.

CONCLUSION:

The assessment of effectiveness of aerobic exercise in reducing anxiety of samples at selected rehabilitation centre revealed, that the anxiety reduction after intervention having mean difference is 24.325 and effective level is 11.53 at P<0.05 using modified anxiety rating scale. Hence it is inferred that there is significant reduction in the anxiety of the patients.

RECOMMENDATIONS:

· A similar study can be done to assess the knowledge, attitude and practice of student nurses in relation to provision of aerobic exercise for patient.

· A similar study may be conducted to find out the effectiveness in reducing pain among rehabilitation centre patient.

· A similar study can be under taken on large scale.

· A similar study may be conducted to find out the effectiveness in reducing anxiety having control group and experimental group.

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Received on 13.09.2016 Modified on 23.12.2016

Int. J. Nur. Edu. and Research. 2017; 5(1): 77-82.

DOI: 10.5958/2454-2660.2017.00017.5

Sl. No.	Anxiety aspects	Mean	S D	Mean difference	t Value	df	Inference
1	Pre-test	74.45	14.38	24.325	11.53	39	S
2	Post-test	50.13	8.562	24.325	11.53	39	S