Effect of 4-7-8 Breathing Exercise on Anxiety in University Students: A Quasi-Experimental Controlled Study

Abstract

Background: Anxiety is common among university students and may negatively affect academic performance and psychological well-being. Simple, safe, and self-administered non-pharmacological interventions are therefore needed, one of which is the 4-7-8 breathing exercise.
Objective: To examine the effect of the 4-7-8 breathing exercise on anxiety levels among undergraduate physiotherapy students.
Methods: This quasi-experimental pretest–posttest study with a non-randomized control group was conducted in October 2025 at a physiotherapy undergraduate program. A total of 110 students were recruited using purposive sampling and allocated into an experimental group (n=55) and a control group (n=55). The experimental group performed the 4-7-8 breathing exercise for 14 days with a duration of 2 minutes per session, while the control group received no intervention. Anxiety levels were assessed using the Zung Self-Rating Anxiety Scale. Data were analyzed using Wilcoxon signed-rank and Mann–Whitney U tests with a significance level of p<0.05.
Results: The experimental group showed a significant reduction in anxiety scores, with the median decreasing from 47 (IQR 45–51) at baseline to 30 (IQR 22–45) post-intervention (Z=−6.230; p<0.001; r=0.84). No significant change was observed in the control group (p=0.108). Post-intervention anxiety scores were significantly lower in the experimental group than in the control group (Z=−6.846; p<0.001; r=0.65).
Conclusion: The 4-7-8 breathing exercise is effective in reducing anxiety among university students and may serve as a practical non-pharmacological strategy for anxiety management in academic settings.