Impact of Progressive Muscle Relaxation Therapy on Anxiety Levels among Elderly People in Mehsana District, Gujarat

Abstract

Background:

Anxiety is common among elderly people and can negatively affect sleep, daily functioning, treatment adherence, and overall quality of life.

Methods:

A quantitative, quasi-experimental one-group pre-test—post-test design was adopted. A total of 100 elderly participants (≥60 years) were selected using non-probability convenience sampling.

Results:

The mean pre-test anxiety score was 12.6 ± 3.8, which decreased to 7.1 ± 3.6 in the post-test, showing a mean reduction of 5.5 points. The difference was statistically significant (paired t = 18.33, P < 0.001). Category-wise improvement was also observed, with the proportion of severe anxiety reducing from 30 to 6%, and minimal anxiety increasing from 6 to 28% after progressive muscle relaxation (PMR) therapy. PMR can be recommended as a feasible, low-cost nursing intervention for community-based geriatric mental health promotion.

INTRODUCTION

Anxiety is a common but often under-recognized mental health concern in older adults, arising from age-related transitions such as declining physical capacity, and chronic illnesses.[1] Persistent anxiety in later life can aggravate somatic symptoms, impair sleep, reduce adherence to medical treatment, limit social participation, and ultimately diminish quality of life.[2] Community-dwelling elderly people may be particularly vulnerable because day-to-day coping relies heavily on family support, neighborhood networks, and access to primary care services—factors that can be inconsistent or limited in many settings.[3] Consequently, practical, low-cost, and easily teachable interventions that can be delivered at community level are increasingly important in geriatric mental health care.[4]

PMR, originally developed by Edmund Jacobson, is a structured technique involving sequential tensing and relaxing of major muscle groups, while maintaining slow, controlled breathing.[5] The core rationale is that reducing muscle tension helps downregulate physiological arousal and sympathetic activation.[6] More specifically, systematic reviews of PMR indicate clinically meaningful reductions in anxiety and related psychological distress.[7] Studies among elderly residents in nursing homes reported decreases in anxiety following Jacobson’s PMR sessions.[8] Similar findings have been reported in quasi-experimental studies conducted in old-age home settings using standardized anxiety measures (e.g., Hamilton Anxiety Rating Scale).[9] PMR has also been evaluated in medically vulnerable older populations (e.g., hip-fracture hospitalizations), where anxiety and sleep disturbance often coexist, and PMR was associated with improved psychological outcomes.[10] Beyond elderly-focused studies, controlled trials demonstrate that PMR can reliably increase relaxation and reduce stress responses, supporting its physiological plausibility and transferability to community programs.[11] Therefore, it is of interest to evaluate the effectiveness of Progressive Muscle Relaxation Therapy on anxiety levels among elderly people in Mehsana District, Gujarat.

METHODOLOGY

A quantitative, quasi-experimental one-group pre-test–post-test design was conducted in Mehsana district, Gujarat among 100 elderly people (≥60 years) using non-probability convenience sampling. Anxiety levels were measured at baseline (pre-test), the PMR intervention was administered, and anxiety was re-assessed after the intervention (post-test) in the same participants. Data were collected using structured socio-demographic and health profile form [Tables 1 and 2] a standardized anxiety assessment scale, GAD-7, to quantify anxiety severity. The same anxiety scale was used for both pre-test and post-test assessment to ensure comparability.

Table 1.

Demographic and clinical profile of elderly participants (n=100)

Variable	Category	Frequency (n)	Percentage (%)
Age (years)	60–69	52	52
	70–79	34	34
	≥80	14	14
Gender	Male	44	44
	Female	56	56
Marital status	Married	62	62
	Widowed/Widower	34	34
	Single/Separated	4	4
Education	No formal education	28	28
	Primary	33	33
	Secondary	24	24
	Higher secondary and above	15	15
Living arrangement	With spouse/family	84	84
	Alone	16	16
Chronic illness	Yes	71	71
	No	29	29

Table 2.

Comparison of pre-test and post-test anxiety scores (GAD-7) among elderly (n=100)

Outcome (GAD-7)	Pre-test mean±SD	Post-test mean±SD	Mean difference	Test used	Test value	P
Anxiety score	12.6±3.8	7.1±3.6	5.5	Paired t-test	18.33	<0.001

Baseline socio-demographic data were recorded and pre-test anxiety was assessed. PMR therapy was provided using a standardized protocol, for 15–20 min per session, once daily, for 14 consecutive days. After completion of the intervention period, post-test anxiety was assessed.

Data were summarized using descriptive statistics and PMR effectiveness was tested using paired t-test (or Wilcoxon signed-rank test), with P < 0.05.

RESULT

Table 1 shows the demographic and clinical profile of elderly participants (N = 100).

Table 2 compares pre-test and post-test anxiety scores (GAD-7) after PMR therapy (N = 100). The mean anxiety score reduced from 12.6 ± 3.8 to 7.1 ± 3.6 (mean difference = 5.5). This indicates an overall mean decrease of 5.5 points, reflecting improvement in anxiety levels after the intervention. The change was statistically significant (paired t = 18.33, P < 0.001).

DISCUSSION

The present study evaluated the effectiveness of PMR therapy on anxiety among elderly people in a selected community area of Mehsana district. The results showed a clear improvement after the intervention: the mean anxiety score reduced from 12.6 ± 3.8 (pre test) to 7.1 ± 3.6 (post test), and the change was statistically significant (paired t = 18.33, P < 0.001) the levels of anxiety reducing from 30 to 6% and minimal anxiety increasing from 6 to 28% [Graph 1]. This finding supports PMR as an effective non pharmacological approach to reduce anxiety in older adults, especially in community settings where access to specialist psychological services may be limited.[1]

Graph 1.

Pre and Post test mean anxiety scores

The improvement observed in this study aligns closely with published evidence among institutionalized older adults. For example, Tapeh et al. found that Jacobson’s PMR significantly reduced anxiety in older adults living in nursing homes, also reporting benefits in emotional wellbeing.[12] Similar results were reported by Ghodela et al., where PMR reduced anxiety (and depressive symptoms) among elderly participants, indicating that structured relaxation methods are useful in geriatric mental health nursing.[13] Evidence from elderly nursing-home based research also indicates that progressive relaxation can reduce anxiety among older residents, supporting consistency of effect across settings.[14]

A plausible explanation for the effectiveness is PMR’s ability to reduce physiological arousal: systematic muscle release and controlled breathing can decrease sympathetic activation and enhance perceived control over bodily tension, thereby lowering anxiety.[15] This mechanism is supported by broader clinical research, including a large evidence base showing PMR increases relaxation, and improves psychological states.[16] In addition, a recent systematic review by Khir et al. concluded that PMR is effective for reducing anxiety (along with stress and depression) across adult populations, strengthening the general evidence base for PMR delivery.[17]

The findings are also consistent with randomized controlled evidence in medically vulnerable groups where anxiety is common. For instance, a 2024 randomized trial in hip fracture patients reported that PMR reduced anxiety, and improved sleep quality post-operatively.[18]

Although results are promising, the one-group pre–post design without a control group may allow influences such as testing effects or attention effects. Future studies should use controlled designs with follow-up assessments to test sustainability in community elderly populations.

CONCLUSION

The present study concludes that PMR therapy was effective in reducing anxiety among elderly people in the selected community. A significant decline was observed in the mean anxiety score indicating a marked improvement after the intervention. The results suggest that PMR is a simple, safe, and cost-effective non-pharmacological technique that can be implemented at community level.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.