Diaphragmatic Breathing Exercises on Stress and Exam Anxiety in High School Seniors: A Randomized Study

This study will be conducted in the city of Iğdır, Türkiye, and will involve final-year high school students currently enrolled in educational institutions in the region. Necessary permissions will be obtained from the Iğdır Provincial Directorate of National Education prior to the study.

The project is supported by TÜBİTAK 2209-A - University Students Research Projects Support Program.

Parental meetings will be organized, during which detailed information about the study will be provided to the families. The study will begin six weeks prior to the national university entrance examination.

After obtaining informed consent from both students and their families, demographic data including age, height, weight, and socio-cultural background will be recorded.

Oxygen saturation levels will be measured using a pulse oximeter.

To assess exam anxiety levels, the Tex Anxiety Inventory (TAI) will be used. This scale, developed by Spielberger and adapted into Turkish, consists of 20 items and two subscales: Worry (8 items) and Emotionality (12 items). Each item is rated on a 4-point Likert scale ranging from "almost never" to "always". The inventory evaluates the level of anxiety and its components experienced by individuals (References 8, 9).

To measure perceived stress levels, the Perceived Stress Scale (PSS) will be administered. The PSS assesses the degree to which individuals perceive situations in their lives as stressful. It consists of 14 items scored on a 5-point Likert scale ranging from 0 (never) to 4 (very often), with total scores ranging from 0 to 56. Higher scores indicate higher perceived stress levels (Reference 10).

Following initial evaluations, participants will be randomly assigned to either an intervention group or a control group. The intervention group will receive training in diaphragmatic breathing, relaxation techniques, and respiratory exercises, including respiratory muscle training using a spirometer (References 4, 11).

These training sessions will be conducted once a week for 4 consecutive weeks, with each session lasting approximately 20 minutes. Oxygen saturation will be measured with a pulse oximeter before and after each session.

At the end of the 4-week intervention period, both the Test Anxiety Inventory and Perceived Stress Scale will be re-administered to assess changes in stress and anxiety levels. Statistical analyses will be conducted accordingly.

This is a randomized controlled trial (RCT). Students in the control group will undergo assessments but will not receive any training during the study period. However, to prevent ethical concerns, the same respiratory training will be offered to the control group participants after the completion of the study.

Inclusion criteria

• Participant and their parent/legal guardian must provide informed consent.
• Must be a final-year high school student preparing for the national university entrance exam.
• Must be in good general health.No chronic illnesses that pose a risk for participation.
• Aged between 16 and 19 years.

Exclusion criteria

• Participant and/or their parent/legal guardian do not provide informed consent.
• Failure to fully complete data collection tools (questionnaires, forms, etc.).
• Inability to actively participate in the exercise sessions.
• Presence of chronic health conditions that contraindicate participation in respiratory exercises.