Table 2.
Progressive Muscle Relaxation (PMR)
| No | Author (Year)/ Country | Duration (Minutes/ Length) | Frequency Per Week | Participants | Study Design | Research Instrument | Components/ Content of PMR | Outcome Measures (with Effect Size Where Available) | Key Finding | Quality of the Article | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EXP | Pre-test | Post- test | F-Up | ||||||||||
| 1 | Avants et al34 (1990) United States | 20m at laboratory/ 1 session | 1 session only | 40 university students (PMR: 20, CG: 20) S: Laboratory DO: 0% | QED | / | / | STAI | Use Jacobson’s PMR exercise by Bernstein, Borkovec.35 | Anxiety | PMR did not significantly reduce (=) anxiety among the participants. | High | |
| 2 | Battaglini et al36 (2022) Brazil | 30–40m at classroom / 12 sessions | Once or twice/ week | 59 athletes (PMR: 29, CG: 30) S: Classroom DO: 0% | QED | / | / | CSAI-2, RESTQ-Sport | Use the adapted Jacobson’s PMR exercise by Sándor.37 | Stress (d=0.29), Anxiety (d=1.30) | There is a significant decrease (↓) in cognitive anxiety score and specific stress score in IG compared to CG. | High | |
| 3 | Chaudhuri et al38 (2014) India | 20m at home/ 12 weeks | 7 days/ week | 64 female healthcare workers (PMR: 64→57) S: At home DO: 10.9% |
QED | / | / | PSS | Use Jacobson’s PMR exercise protocol by Varvogli, Darviri.39 | Stress (d=4.12) | There is a significant decrease (↓) in stress scores at the post-test compared to the pretest. | High | |
| 4 | Chellew et al40 (2015) Spain | 5 45m session/ 1 week. | 5 days/ week | 101 university students (APMR: 101) S: N/A DO: 0% |
QED | / | / | SRLE | Use the abbreviated Jacobson’s PMR exercise by Bernstein, Borkovec.35 | Stress (d=0.38) | There is a decrease (↓) in stress score and cortisol secretion level at post-test compared to pretest in IG. | High | |
| 5 | Silveira et al41 (2020) Brazil | 10–15min at classroom/ 8 weeks | Once/ week | 16 nurses (PMR: 16) S: Classroom DO: 0% | QED | / | / | WSS | Use the Jacobson’s PMR exercise. | Stress (d=0.36) | There is a decrease (↓) in stress score at post-test compared to pretest. | High | |
| 6 | Dolbier & Rush42 (2012) United States | 20m at laboratory/ 1 session | 1 session only | 128 university students (APMR: 66, CG: 62) S: Laboratory DO: 0% |
QED | / | / | EMAS-S | Use the abbreviated Jacobson’s PMR exercise. | Anxiety (d=0.25) | There is a significant decrease (↓) in anxiety score in post-test compared to pretest in both IG & CG. | High | |
| 7 | Ganjeali et al43 (2022) Iran | 20m at home / 2 weeks + 2–60m classroom | 7 days/ week | 46 nurses (PMR: 23, CG: 23) S: Classroom & at home DO: 0% |
RCT | / | / | DASS-21 | Use the Jacobson’s PMR exercise by Toqan, Malak, Ayed, Fashafsheh, Salameh, Sarhan, Azizeh, Batran.44 | Stress (d=1.47), Anxiety (d=1.61) | There is a decrease (↓) in stress and anxiety score at post-test compared to pretest in the IG. | High | |
| 8 | Gao et al45 (2018) China | 5m at home/ 12 weeks | 7 days/ week | 78 university participants (students and employees) (PMR: 47→25→14F-Up, CG: 31→25) S: At home DO: 35.9% |
QED | / | / | / (1 month) | PSS | Use the Jacobson’s PMR exercise. | Stress (d=0.42) | There is a significant decrease (↓) in stress score at post-test compared to pretest in the IG. | High |
| 9 | Gustainiene et al46 (2015) Lithuania | 6 sessions at laboratory/ 4 weeks | Once or twice/ week | 95 university students (PMR: 47, CG: 48) S: Laboratory DO: N/A |
QED | / | / | PSS | Use the Jacobson’s PMR exercise. | Stress (d=0.31) | There is a decrease (↓) in stress score at post-test compared to pretest in IG. | High | |
| 10 | Hayati et al47 (2020) Iran | 15m /4 weeks + 2 sessions | Twice a day for 7 days /week | 76 elders (PMR: 38, CG: 38) S: N/A DO: 0% | QED | / | / | GDS | Use the PMR audio file validated by Yousefi, Taraghi, Mousavinasab48 | Depression (d=1.49) | There is a significant decrease (↓) in depression score in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG). | High | |
| 11 | Jermaina et al49 (2022) Indonesia | 30–60m/ 10 weeks | N/A | 20 beginner athletes (PMR: 20) S: Classroom DO: 0% | QED | / | / | SAS | N/A | Anxiety | PMR did not significantly reduce (=) anxiety for beginner athletes. | High | |
| 12 | Murphy50 (1983) United States | 20m at small room and at home/ 2 weeks | 5 days/ week | 26 nurses (PMR: 17→9→8 F-Up, CG: 9→8 F-Up) S: Small room and at home DO: 30.8% |
QED | / | / | / (3 months) | Trait-anxiety scale of STAI | Use the Jacobson’s PMR exercise by Bernstein, Borkovec.35 | Anxiety | There is a significant decrease (↓) in trait anxiety score in post-test compared to pretest in both IG and CG. | High |
| 13 | Mustafa et al51 (2021) Pakistan | 4 sessions/ 4 weeks | N/A | 10 female nurses (PMR: 10) S: N/A DO: 0% | QED | / | / | DASS-21 | N/A | Stress (d=2.45), anxiety (d=0.53), depression (d=1.95) | There is a significant decrease (↓) in stress and depression score but not in anxiety at post-test compared to pretest in IG. | High | |
| 14 | Palkar et al52 (2021) India | 45m at home/ 4 weeks + 3 sessions at seminar hall | 7 days/ week | 114 medical students (PMR: 43, CG: 71) S: Seminar Hall & at home DO: 0% | QED | / | / | PSS, TAS | N/A | Stress (d=0.45), Anxiety (d=0.35) | There is a significant decrease (↓) in stress and anxiety score at post-test compared to pretest in IG. | High | |
| 15 | Prakash Jha et al53 (2020) India | 30m/ 2 weeks | 7 days/ week | 30 elderlies (PMR: 30) S: N/A DO: 0% | QED | / | / (twice) | GDS | N/A | Depression | There is a significant decrease (↓) in depression score at post-test compared to pretest. | High | |
| 16 | Yilmaz et al54 (2018) Turkey | 28m at home/ 8 weeks | 3 days/ week | 65 caregivers of elders (PMR: 33→23, CG: 32→21) S: At home DO: 32.3% |
RCT | / | / | BDS | Use the “Relaxation Exercises” (prepared by the Turkish Psychologists Association)55 | Depression (d=0.86) | There is a significant decrease (↓) in depression score at post-test compared to pretest in IG. | High | |
| 17 | Zargarzadeh & Shirazi56 (2014) Iran | At home/ 6 weeks + 4 30m sessions at classroom | Twice a day for 7 days/ week | 50 nursing students (PMR: 25→24, CG: 25) S: At home and classroom DO: 2.0% |
QED | / | / | STAS | N/A | Anxiety (d=2.54) | There is a significant decrease (↓) in anxiety score in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG). | High | |
| 18 | Zhang et al57 (2022) China | 30m classroom/ 6 weeks | Once/ week | 90 medical students (PMR: 45→42, CG: 45) S: Classroom DO: 6.7% | RCT | / | / | / (2 months) | TAS | Use standardized version of PMR by Bernstein, Borkovec.35 | Anxiety (d=2.07) | There is a significant decrease (↓) in test anxiety score at post-test and at follow up compared to pretest in the IG. | High |
| 19 | Allison et al58 (2020) United States | 10m at classroom /1 session | 1 session only | 124 veterinary students (PMR: 124→101) S: Classroom DO: 18.5% |
QED | / | / | SRSI3 | N/A | Stress (d=0.93) | There is a decrease (↓) in stress scores at the post-test compared to the pretest. | Moderate | |
| 20 | Barling & Raine59 (2005) Australia | At home /3 weeks + 1 60m session | 7 days/ week | 30 volunteers (PMR: 15, CG: 15) S: At home DO: 0% | RCT | / | / | DASS | N/A | Stress, anxiety, depression | There is a significant decrease (↓) in 1. IG compared to CG at post-test (anxiety). 2. stress, anxiety and depression scores in the post-test compared to the pretest in IG. | Moderate | |
| 21 | Çapacı et al60 (2022) Turkey | 30m at home/ 8 weeks | 4 days/ week (2 days with researchers, 2 days on their own) | 36 caregivers of elders (PMR: 18→10), CG: 18→10) S: At home DO: 44.4% |
RCT | / | / | BDI | Use the “Relaxation Exercises CD Sound Records” and “PMR Information Guide” (prepared by the Turkish Psychologists Association). | Depression (d=0.58) | There is a decrease (↓) in depression score in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG). | Moderate | |
| 22 | Gökşin & Aşiret61 (2021) Turkey | 28m at home/ 8 weeks | 3 days/ week | 58 elderly women (PMR: 24→21, CG: 34→28) S: At home DO: 15.5% |
RCT | / | / | GDS-15 | N/A | Depression (d=0.91) | There is a significant decrease (↓) in depression score in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG). | Moderate | |
| 23 | İnangil et al62 (2020) Turkey | 15m at practice room/ 2weeks | 3 days/ week | 60 nursing students (PMR: 30→28, CG: 30→28) S: Practice room DO: 6.7% | RCT | / | / | STAI | Use the “Relaxation Exercises” (prepared by the Turkish Psychologists Association)63 | Anxiety (d=0.62) | There is a significant decrease (↓) in state anxiety score in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG). | Moderate | |
| 24 | Khasky & Smith64 (1999) United States | 25m / 1 session | 1 session only | 76 university students (PMR: 20, CG: 56) S: N/A DO: 0% | RCT | / | / | SQST | Use the Jacobson’s PMR exercise script by Smith.65 | Stress (d=1.07) | There is a significant decrease (↓) in stress score in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG). | Moderate | |
| 25 | Korkut et al66 (2021) Turkey | 15m + 15m at laboratory/ one session | Twice in one session only. | 88 nursing students (PMR: 44→41, CG: 44) S: laboratory DO: 3.4% |
RCT | / | / | STAI | Use the Jacobson’s PMR exercise. | Anxiety (d=0.49) | There is a decrease (↓) in anxiety score at post-test compared to pretest in IG. | Moderate | |
| 26 | Kurian et al67 (2021) India | N/A | N/A | 30 non-teaching staff (PMR: 30) S: N/A DO: 0% |
QED | / | / | JSS | N/A | Stress (d=4.31) | There is a significant decrease (↓) in stress score at post-test compared to pretest. | Moderate | |
| 27 | Robb68 (2000) United States | 15m at laboratory/ 1 session | 1 session only | 15 university students (PMR: 15) S: Laboratory DO: 0% | RCT | / | / | State-anxiety scale of STAI Form Y-1 | Use the Jacobson’s PMR exercise. | Anxiety (d=1.65) | There is a significant decrease (↓) in anxiety score in post-test compared to pretest in IG. | Moderate | |
| 28 | Toqan et al69 (2022) Palestine | 45m Lab room+ 10–15m at home/ 2 weeks | 5 days/ week | 60 nursing students (PMR: 60) S: Lab room and at home DO: 0% |
QED | / | / | State-anxiety scale of STAI Form Y-1 | Use the Jacobson’s PMR exercise by Ramasamy, Panneerselvam, Govindharaj, Kumar, Nayak.70 | Anxiety (d=4.20) | There is a decrease (↓) in anxiety score at post-test compared to pretest. | Moderate | |
| 29 | Toqan et al71 (2022) Palestine | 45m Lab room+ 10–15m at home/ 2 weeks | 5 days/ week | 90 nursing students (PMR: 90) S: Lab room and at home DO: 0% |
QED | / | / | State-anxiety scale of STAI Form Y-1 | Use the Jacobson’s PMR exercise by Ramasamy, Panneerselvam, Govindharaj, Kumar, Nayak.70 | Anxiety (d=4.57) | There is a decrease (↓) in anxiety score at post-test compared to pretest. | Moderate | |
| 30 | Toqan et al44 (2022) Palestine | 45m Lab room+ 10–15m at home/ 2 weeks | 5 days/ week | 48 male nursing students (PMR: 48) S: Lab room and at home DO: 0% |
QED | / | / | State-anxiety scale of STAI Form Y-1 | Use the Jacobson’s PMR exercise by Ramasamy, Panneerselvam, Govindharaj, Kumar, Nayak.70 | Anxiety (d=0.90) | There is a decrease (↓) in anxiety score at post-test compared to pretest. | Moderate | |
| 31 | Vaughn et al72 (1989) United States | 15m at home/ 4 weeks + 1 session at lunch room | 3 days/ week | 20 female clerical workers (PMR: 10→8, CG: 10) S: At home and Lunch Room DO: 10.0% |
QED | / | / | SRI | Use the Jacobson’s PMR exercise by Jacobson.18 | Stress | There is a significant decrease (↓) in stress score in IG compared to CG at post-test. | Moderate | |
Abbreviations: PMR, Progressive Muscle Relaxation; EXP, Experiment; F-Up, Follow up; S, Setting; DO, Dropouts; RCT, Randomized control trial; QED, Quasi-experimental design; IG, Intervention group; CG, Control group; d, Cohen’s d; TAS, Test anxiety scale; STAI, State-trait anxiety inventory; SAS, Zung Self-Rating Anxiety Scale; DASS, Depression; anxiety; stress scale; BDI, Beck Depression Inventory; CSAI-2, Competitive State Anxiety Inventory-2; RESTQ-Sport, Recovery-Stress Questionnaire for Athletes; PSS, Perceived Stress Scale; JSS, Job Stress Scale; GDS, Geriatric Depression Scale; WSS, Work Stress Scale; SRSI3, Smith Relaxation States Inventory 3; BDS, Beck Depression Scale; SRLE, Survey of Recent Life Experiences; STAS, Sarason test anxiety scale; EMAS-S, Endler Multidimensional Anxiety Scale—State; SQST, Smith Quick Stress Test; SRI, Stress Response Index.