Effects of Aerobic Zumba Dance on Depression, Anxiety, and Stress Among Female Students: Quasi Experimental Study

INTRODUCTION

Individuals experience varying levels of fulfilment, resilience, and emotional well-being.^[1] Current global epidemiological data consistently report that up to 20% of children and adolescents suffer from disabling mental illness, and suicide is the third leading cause of death among adolescents.^[2-5] Up to 50% of all adult mental disorders have their onset in adolescence.^[3] An unconscious avoidance of something that causes worry or unpleasant emotions in the body is known as a stress reaction.^[2] Anxiety is a typical response to stress, but it can also be a symptom of a more serious anxiety condition.^[6,7] Mental health problems are currently among the greatest global public health challenges and are estimated to affect 13% of children and youth worldwide. Stress and anxiety are common in a student’s life.^[8]

Stress, once it reaches a particular threshold, ceases to be beneficial and begins to harm one’s health, mood, productivity, and quality of life.^[6] Depression, anxiety, heart attack, stroke, hypertension, immune system abnormalities, and sleep disruptions are among the physical and emotional illnesses connected to it.^[7] Somatic symptoms, when associated with emotional distress such as stress, anxiety, or melancholy, are crucial indicators of mental health status, and they frequently coexist. Female youth show a higher prevalence of health complaints than males and experience higher levels of stress and somatic symptoms, which are more likely to be experienced in terms of pain and depressive symptoms.^[8-10]

Adolescence is the period of transition. Depressive disorders often start at a young age; they reduce people’s functioning and are often recurring.^[11] Globally, the reported prevalence rates of mental disorders among children and adolescents range from 1% to 51%. According to the WHO reports, community-based studies reveal a 20% overall prevalence rate for mental disorders in several national and cultural contexts.^[10] Several studies indicate that the prevalence rates of the individual disorders: Depression, anxiety, and stress (DAS) are growing among adolescents.^[11-13] It has been demonstrated that persistent emotional disturbance in youth predicts severe mental illnesses in adulthood; therefore, regardless of co-occurring depression and anxiety, youth need early treatment to address these issues.^[12]

Zumba is basically a dance form that evolved in the 21^st century; it is a perfect blend of fitness and entertainment.^[13] Zumba contains a variety of energetic motions and routines that can release endorphins in the body, which can help lower stress hormones like cortisol and adrenaline.^[14] Several studies have also indicated that taking an active dancing class can improve women’s psychological well-being and quality of life. Zumba enhances fitness and quality of life in young girls.^[14-16] Approximately 15 million people conduct weekly Zumba classes in over 2,00,000 locations right across 180 countries. Dance provides various benefits for the body and mind.^[17-20] Thus, one can learn & practice relaxation techniques through Zumba dance to deal with DAS. Zumba is the perfect workout to get rid of stress, which accumulates throughout the day. These changes will reflect immediately to reduce stress and anxiety, and also improve self-confidence.^[20,21] Therefore, regardless of co-occurring depression and anxiety, early intervention is crucial for addressing these emerging mental health issues in young people.^[12] Physical activity, particularly enjoyable forms like aerobic dance, has emerged as a promising avenue for enhancing mental health outcomes.^[19] Many studies focus on general dance interventions without isolating the specific impact of Zumba. For instance, a meta-analysis demonstrated that dance interventions significantly reduce depression symptoms, stress, and anxiety in adults, but it did not differentiate between dance forms like Zumba and others.^[15,16] This quasi-experimental study investigates the impact of aerobic Zumba dance on depression, anxiety, and stress levels among female students at a selected college in Mangaluru, Karnataka, India.

MATERIAL AND METHODS

A quantitative, quasi-experimental pre-test–post-test control group design was employed to evaluate the effectiveness of aerobic Zumba dance on depression, anxiety, and stress levels among nursing students at a college in Mangaluru, Karnataka. The study was conducted in two phases: Phase One (Screening Phase) and Phase Two (Intervention Phase). The samples in this study consisted of nursing students who experienced mild to moderate levels of DAS and were screened to form the target population. In Phase One, a disproportionate stratified random sampling technique was employed. In Phase Two, subjects who met the inclusion criteria were randomly assigned to the intervention and control groups.

For Phase 1, the population size for a finite population correction factor was 390, and the confidence level was 99%, based on which a sample size of 246 was confirmed [Figure 1]. Design effectives for cluster survey with 0.05 level of confidential limit and the correction finite Sample size is 246 n=[DEFF*Np(1-p)]/[(d2/z2 1α/2*(N-1)+p*(1-p).Phase -2Sample size was calculated by using G*Power for ANOVA. At a 5% level of significance and 90% power with a standard effect size, the total sample size in each group was 55 (based on pilot study results). All female nursing students with mild and moderate DAS scores, aged 18 to 25 years, and participating in Zumba sessions for 20-25 minutes per day in a week for one month, were included in the study. At the same time, those unable to attend at least three times in a week for one month, but involved in other form of activities like yoga, meditation, and physical activities; those with recent trauma or surgery and musculoskeletal disorders like LBA, which limit mobility; and those already under treatment for stress and anxiety disorder were excluded from the study.

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Figure 1:

Consort sample flow diagram.

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RESULTS

DISCUSSION

The findings of this study demonstrate the positive impact of aerobic Zumba dance on reducing DAS levels among female college students in Mangaluru, Karnataka, India. The significant differences observed between the intervention and control groups across the pre- and post-test assessments provide strong evidence that the Zumba dance program was effective in improving these mental health indicators. This aligns with existing literature that supports the benefits of physical activity, and specifically dance-based exercise, for mental well-being.

The present study revealed that, prior to the intervention, the majority fell within the normal category in terms of DAS. However, a substantial proportion of the 246 nursing student participants experienced [48 (19.5%) and 67 (27.3%)] mild to moderate levels of stress. Similarly, 37 (15.04%) and 73 (29.68%) experienced mild to moderate anxiety, while 72(29.2.6%) and 39(15.8%) were found to have mild to moderate depression. These findings highlight the prevalence of these mental health challenges within this population. While direct comparison is difficult due to variations in assessment tools and methodologies, these results align with previous research indicating elevated levels of DAS among nursing students. For instance, a study by Elakya and Shanmugam^[13] also reported significant levels of anxiety among nursing students, with a majority of their participants exhibiting mild to moderate anxiety. Although the specific percentages differ, both studies underscore the vulnerability of this population to mental health concerns.

The results indicate that aerobic Zumba dance is an effective intervention for reducing DAS among nursing students. The statistically significant p-values (p = 0.001) across all three variables confirm the positive impact of Zumba. These findings align with Elakya and Shanmugam^[13], who also found significant anxiety reductions with aerobic exercise (mean difference 13.77, p=0.001), including in participants with diagnosed depression. Similarly, Rao et al.^[10] reported significant reductions in depression symptoms with aerobic exercise (pre-test 16.47 ± 9.19 to post-test 7.13 ± 5.53) compared to a control group, further supporting the benefits of aerobic activity for mental well-being. These convergent findings suggest that aerobic exercise, including Zumba, can be an effective intervention for improving mental health outcomes in student populations

Another study on the effectiveness of Zumba for improving mental well-being is consistent with Thilagavathy et al.[15], who also found significant anxiety reductions with aerobic dance movement therapy (pre-test control 73.2+3.8, experimental 12.30+7.1; post-test control 74.07+4.6, experimental 53.50+4.4; t=0.81, p<0.001). Another similar study conducted by Elakya and Shanmugam^[13] using an independent t-test showed that there was no significant difference in mean anxiety scores between the study and control group. The post-test assessment revealed a significant statistical difference between the two groups, confirming that the intervention was effective in reducing anxiety among the students.

This study suggests that aerobic Zumba dance is a promising intervention for promoting mental well-being among nursing students, offering a practical and engaging approach. However, the study has limitations, including the quasi-experimental design, and the study intervention was limited to only four weeks in a single setting. Future research should address these limitations by using randomised controlled trials and exploring the impact of Zumba on a more diverse student population for a longer duration. Despite these limitations, the major strengths of this study are as follows: the study utilised aerobic Zumba dance, an enjoyable and interactive activity, making it a feasible and appealing mental well-being intervention for nursing students. The findings support the integration of Zumba into college wellness programs, providing a practical approach to managing stress, anxiety, and depression among students.

CONCLUSION

The study concluded that aerobic Zumba dance was effective on DAS among nursing students. Given these findings, incorporating structured Zumba sessions into student wellness programs may be a beneficial strategy for enhancing mental well-being.