Appendices

A. Consent Form

Title of the study: “A study on effect of music therapy and meditation on performance in

professional shooters”.

Invitation to Participation;

You are invited to participate in this research study investigating the efficacy of music therapy

and meditation on performance in professional shooters.

Basis for Subject selection;

You are eligible to participate in this study because you fulfill all the inclusion and exclusion

criteria required for the study. You will be one of the approximately 200 professional shooters to

participate in this study.

Procedure;

You will undergo a non-invasive evaluation procedure and will be asked to undergo the training

protocol allotted to you. It is anticipated that your time commitment will be 5 days /week for 5

weeks from the time of your participation.

Potential risks;

There are minimal perceivable risks associated with your involvement in this research study.

However, you may ask about any doubts regarding the study, if any while you are participating.

Potential benefits;

The potential benefits to you for participating in this research study are-

This study may show increase in overall shooting performance, increase activeness and decrease

pre competition stress/anxiety.

Guarantee of Confidentiality;

All the information about you would be kept confidential and limited to me and my project

supervisors and will not be shared with person who is not a part of this research. At no time will

your name appear on any materials or reports of the research findings (including web-site

postings of the results, conference presentations, or professional publications). Your signed

consent form will be stored separately from your data to insure complete confidentiality.

Withdrawal from Participation;

Participation in this study is voluntary. If you decide to dropout, you are free to withdraw your

consent and to discontinue your participation at any time with impunity.

Offer to Answer Any Questions;

If you have any questions about the procedures at any time, please do not hesitate to ask. If you

think of questions later, please feel free to contact Shaji John (+91 9560223344,

johnsphysio@gmail.com). All questions about the procedures and this study in general will be

answered. However, some questions may not be answered until after you have completed the

procedures to insure that your responses will not be affected by your knowledge of the research.

Participant’s Statement;

I am voluntarily making the decision to participate, and I am at least eighteen years of age. My

signature certifies that I have read and understood the aforementioned information. My signature

also certifies that I have had an adequate opportunity to discuss this study with the research

investigator and have had all my questions answered to my satisfaction. I understand that by

signing this document, I waive no legal rights. I also know that I shall receive a copy of this

consent form for my records.

Participant’s Name:……………………….………………Signature/Date: ……………….

Confidential Code:………Address:.........................................................................................

Contact no: ……………………e-mail: ……………………………………………………..

Research Investigator’s Statement;

In my judgment, the aforementioned participant is voluntarily and knowingly giving informed

consent and possesses the legal capacity to do so.

Research Investigator’s Name: Shaji John Signature/Date………………………

Contact No: +91-9560223344, e-mail: johnsphysio@gmail.com

B. Subjective Data Form

Group: - A B C D

Demographic data;

1. Conf. Code: ……………………………..Age/Sex: ……yrs./M: F: Date:…./..…/……..

2. Weight (kg): ……………. Height (cm): ……………. BMI: ……………

3. HR:……./ bpm RR:……../ rpm BP: ……/…… mm of Hg

Shooting History;

4. Level of shooters: International: National: State: District: Recreational:

5. Participation in competitive shooting for: <1 yr: <2 yrs: <5 yrs: >10 yrs:

6. Categories of shooting: Pistol: Rifle: Specification:……………………..

7. For pistol shooters specify range: 10m: 25m 50m:

8. Average duration of shooting training / practice:… …….. hrs/day …...………. days/week

9. Average duration for fitness training:…….…………….. hrs/day……………….days/week

Medical History;

10. Have you been diagnosed of any medical problem last 6 months: Yes: No:

11. Are you on any medication: Yes: No:

12. If ‘Yes’ for 10 and 11 specify in detail:.………………………………………………………

13. Do you feel stressed during: Training: : Yes: No: Pre-competition: Yes: No:

Competition Yes: No: Post-competition: Yes: No: Always Yes: No:

Intervention Specific;

14. Are you interested in listening to music: Yes: No:

15. If ‘Yes’ type of music: Classical: Hindi Film: Western: Instrumental:

Fast: Melodious: Any: Specification: …………………………………...

16. Have you listened to any music daily more than 10 minutes in last 1 week:

Yes: No:

17. Are you interested in meditation: Yes: No:

18. Are you practicing any form of Meditation for last 6 months: Yes: No:

19. Have you ever practiced any form of relaxation therapies? Yes: ..………..…… No:

Personal History;

20. Are you alcoholic: Yes: No: Daily: <week: <month: occasional:

21. Are you a Smoker: Yes: No: Daily: <week: <month: occasional:

22. Do you feel it is necessary during Training, Pre-competition, Competition: Yes:No:

23. Are you able to follow the instructions given to you till the end of the study: Yes:No:

Subject Data Chart

S# Variables 0 Days / Pre test 29 days / Post Test 36 Days / Follow up

2

SDNNi

5

nHF

6

nLF

8

S. Cortisol

9

P. Score

C. Songs Table

1 Ab Kahan Jayen Ham

Ujala 1959 Darbari

Kanada

Kaherava

Shankar Jaikishan Manna Dey

2 Ab Mori Vinti Suno

Bhagwaan

Taj 1956 Darbari

Kanada

Kaherava

Hemant Kumar

Mohd. Rafi

3 Agar Mujhse Muhobbat Hai,

Mujhe Sab Apne Gam De

Do

Aap Ki Parchhaiyan 1964 Darbari

Kanada

Dadra

Madan Mohan Lata Mangeshkar

4 Basti Basti Parbat Parbat

Railway Platform 1955 Darbari

Kanada

Kaherava

Madan Mohan Mohd. Rafi

5 Chandi Ki Divar Na Todi

Vishvaas 1969 Darbari

Kanada

Kaherava Kalyanji, Anandji Mukesh

6 Aiya Re Daiya Laj Mohe

Lage

Leader 1964 Darbari

Kanada

Kaherava Naushad Asha Bhosle

7 Dekha Hai Pehli Baar

Saajan 1991

Darbari

Kanada

Dadra Laxmikant, Pyarelal Alka Yagnik,

S.P.

Balsubramaniam

8 Dil Jalta Hai To Jalane De Pahli Nazar

1945 Darbari

Kanada

Kaherava

Anil Biswas

Mukesh

9 Duniya Badal Gayi

Babul 1950 Darbari

Kanada

Dadra

Naushad Talat Mehmood,

Shamshad

Begum

10 Ghoonghat Ke Pat Khol Re Jogan 1950 Darbari Kanada

Kaherava

Bulo C Rani Geeta Roy

11 Guzre Hain Aaj Ishq Men,

Dil Diya Dard Liya

1966 Darbari

Kanada

Dadra

Naushad

Mohd. Rafi

12 Ham Tujh Se Muhabbat Kar Ke

Awara 1951

Darbari Kanada

Kaherava

Shankar Jaikishan Mukesh

13 Ham Tum Se Juda Ho Ke Ek Sapera Ek

Lutera

1965

Darbari

Kanada

Kaherava

Usha Khanna Mohd. Rafi

14 Hangama Hai Kyon Barpa

non-film song 1994 Darbari

Kanada

Kaherava

Ghulam Ali

Ghulam Ali

15 Jhanak Jhanak Tori Baje Payeliya

Mere Huzur

1968

Darbari Kanada

Tintal

Shankar, Jaikishan Manna Dey

16 Jogi Aaya Black & White

2008 Darbari

Kanada

Kaherava Sukhwinder Singh

Sukhwinder

Singh

17 Kabhi Dil Dil Se Takarata

To Hoga

Anokhi Ada

1948 Darbari

Kanada

Kaherava Naushad

Shamshad

Begum

18 Kitna Hasin Hai Mausam

Azad

1955 Darbari

Kanada

Kaherava C. Ramchandra Lata

Mangeshkar, C. Ramchandra

19 Koi Matwala Ayaa Mere

Dware

Love In Tokyo 1966 Darbari

Kanada

Sitarkhani Shankar, Jaikishan Lata Mangeshkar

20 Main Nigahen Tere Chehare

se Hataun Kaise

Aap ki Parchaiyyan 1964 Darbari

Kanada

Dadra

Madan Mohan Mohd. Rafi

21 Mere Mehboob Shayad Aaj Kuchh

Kitne Paas Kitne Door

1976 Darbari Kanada

Kaherava Chand Pardesi

Chandrani Mukherji

22 Mitava Laut Aye Ri

Sangeet Samrat Tansen

1962

Darbari Kanada

-- S.N. Tripathi

Manna Dey

23 Muhabbat Ki Jhuthi Kahani

Pe Roye

Mughal-e-Azam

1960

Darbari

Kanada

Kaherava Naushad

Lata Mangeshkar

24 Mujhe Tum Se Kuch Bhi Na

Chahie

Kanhaiya 1959 Darbari

Kanada

Rupaktal Shankar, Jaikishan Mukesh

25

Nain Se Nain Milaye

Rakhne Ko

Waada

1957 Darbari

Kanada

Ektal Rashid Atre Ustad Fateh Ali

Khan and Zahida

R

a

g

a

D

a

r

b

a

r

i

b

a

s

e

d

m

u

s

i

c

u

s

e

d

f

o

r

M

usic Therapy (www.chandrakantha.com)

Perveen

26 Nainheen Ko Raah Dikha Prabhu

Bhakta Surdaas

1942 Darbari Kanada

Kaherava Gyan Dutt

K.L. Saigal

27 O Duniya Ke Rakhavale

Baiju Bawra

1952 Darbari

Kanada

Kaherava Naushad

Mohd. Rafi

28 Pag Ghoongroo Bandh

Meera Naachi Thi

Namak Halal

1982 Darbari

Kanada

Kaherava Bappi Lahari Kishore Kumar

29 Pyar Ki Aag Men Tan

Badan

Ziddi 1964 Darbari

Kanada

Kaherava S.D. Burman Manna Dey

30 Raha Gardishon Men

Haradam

Do Badan

1966 Darbari

Kanada

Kaherava Ravi Mohd. Rafi

31 Sarfaroshi Ki Tammana Shaheed

1965 Darbari

Kanada

Dadra Prem Dhawan

Mohd. Rafi,

Manna Dey,

Rajendra Mehta

32 Satyam Shivam Sundaram

Satyam Shivam Sundaram

1978 Darbari Kanada

Kaherava Laxmikant, Pyarelal

Lata Mangeshkar

33 Shairana Si Hai Zindagi Ki Faza

Phir Teri Kahani Yaad Ayi

1993 Darbari Kanada

Dadra Anu Malik Alka Yagnik

34 Suhani Chaandni Raaten

Hamen Sone Nahin Deti

Mukti 1977 Darbari

Kanada

Dadra R.D. Burman Mukesh

35 Tere Dar Pe Ayaa Hun,

Kuchh Karke Jaunga

Laila Majnu

1976 Darbari

Kanada

Kaherava Madan Mohan Mohd. Rafi

36 Teri Duniya Mein Dil Lagta

Nahin

Baware Nain 1950 Darbari

Kanada

Kaherava Roshan Mukesh

37 Tora Man Darpan Kahalay

Kaajal

1965 Darbari

Kanada

Kaherava Ravi Asha Bhosle

38 Woh Mohabbat Woh Wafaayen

Noor Jahan

1967 Darbari Kanada

Dadra Roshan Mohd. Rafi

39 Tu Jo Nahin Hai to Kuch Bhi Nahin Hai

Wo Lamhe

2006 Darbari Kanada

Kaherava Pritam Glenn John

40 Tu Pyar Ka Sagar Hai

Seema 1955 Darbari Kanada

Kaherava Shankar Jaikishan Manna Dey

41 Tumhe Zindagi Ke Ujale

Mubarak

Poornima 1965 Darbari

Kanada

Jhaptal Kalyanji, Anandji Mukesh

42 Tumse Hi Ghar Ghar

Kahalaya

Bhabhi Ki

Chudiyaan

1961 Darbari

Kanada

Kaherava Sudhir Phadke

Mukesh

43 Tuthe Hue Khvabon Ne

Madhumati

1958 Darbari

Kanada

Kaherava Salil Chowdhury Mohd. Rafi

44 Ud Ja Bhanwar Maya Kamal

Ka

Rani Roopmati 1959 Rupaktal S.N. Tripathi Manna Dey

D. Abstract

A STUDY ON EFFECT OF MUSIC THERAPY AND MEDITATION ON

PERFORMANCE IN PROFESSIONAL SHOOTERS Shaji John

1, S. K Verma

2, G. L Khanna

3

1PhD Scholar, Punjabi University, India,

2Supervisor, Department of Sports Sciences, Punjabi University, India,

3Co-Supervisor, Faculty of Applied Medical Sciences, Manav Rachna International University, India.

E-mail:johnsphysio@gmail.com, Tel.: +919560223344

Background: Little has been known about the Hypothalamic Pituitary Adrenal (HPA) axis

response and Autonomic Nervous System (ANS) activity to Pre-Competition Stress (PCS) and

its response to relaxation therapies such as of Music Therapy (MT) and Mindfulness Meditation

Therapy (MMT) on sports population. Studies have been performed on the psychophysiological

responses of music and meditation on normal and diseased persons, but little has been done on

its combination and individual responses on sports population especially in shooters.

Objective: The purpose of this study was to estimate the contribution of MT, MMT and its

Combination Therapy (CT) on PCS, by psychophysiological basis and its effect on Shooting

Performance.

Methods: 200 professional elite male shooters with mean age of 29.5 ± 4.3years were examined

in four groups (n= 50 ±3) in each group. Group A, B, C and D; MT, MMT, CT and as a Control

(C) groups respectively. Total duration of the study was 5weeks, 4weeks of interventional and

1week study to determine the follow-up effect. Pre, post and follow-up data of quantitative

phenotypic markers of ANS activity by Heart Rate Variability (HRV), HPA- Axis by Salivary

Cortisol (SC) and Performance Score (PS) were analyzed.

Results: All three interventional groups have shown positive correlation, but CT group has

shown highly significant (p<0.0001) post-intervention and in follow-up (p<0.0001) in SDNNi,

nHF, nLF, SC and in PS. Ultimately resulted in reduction of PCS level and increase in PS.

Comparatively MT and MMT, MT group shown marginal improvement than MMT. Whereas

the control group has been shown non-significant result compare to interventional groups

(p<0.05).

Conclusions: It is concluded that relaxation therapies such as MT and MMT interventions along

with routine sports specific training may decrease PCS and will enhance PS and found CT is

more effective than MT and MMT alone and also found MT has been shown better effectiveness

than MMT in four weeks of training.

Key words: ANS, HPA, HRV, Cortisol, Pre competition Stress, Music, Meditation, Shooting.

Manuscript

Introduction:

In shooting the requirement of good physical and psychological condition as well as

technical perfection is highly demanded. The important use of vision for shooting necessitates,

leading to compensation through subconscious postural mechanisms based on proprioceptive and

vestibular information, such as a less elevation of pre-shot heart rate and blood pressure, a lower

sweating and a more appropriate preparatory brain activity (Tremayne and Barry, 2001). Pistol

shooting is a static activity requiring a strict control of body segments and posture to align the

rear sight aperture and the foresight through proprioceptive feedback and gaze fixation either on

the target directly or between the target and the weapon and, therefore, to increase precision of

the shot (Mononen et al., 2007). Air pistol shooting is an Olympic sport requiring extreme

mental concentration and movement precision for success. Compared to that of rifle shooting,

there are very little literatures related to pistol shooting. In this work, we investigated pistol

shooting and several of the psychophysiological factors that affect the shooting performance.

While a number of studies have examined both psychological and physiological factors related to

shooting performance, to our knowledge, this is the first study to determine the efficacy of MT

and MMT on HRV and SC in professional shooters.

Stress is most often used to describe an unpleasant emotional state or condition which is

characterized by subjective feelings of tension, apprehension, and worry. In sports context it is

commonly known as PCS or anxiety. Further, researches indicated that anxiety has a negative effect

on these sport outcomes (Terry and Slade, 1995). Research on how athletes cope with sport-related

stress has been recognized for both its practical and its theoretical importance because of the

debilitating effects that stress may have on athletic performance (Smith et al., 1998). Stephen et

al., (2009), findings suggest that, prior to competing, sport performers encounter more stressors

pertinent to performance, these observations highlight that all the athletes should be considered

when preparing and implementing interventions to manage competition stress. PCS is a widely

prevalent condition that exists among athletes of all levels and within every sport. Its relationship

to performance has been studied both in and out of the sport context through test anxiety research

and anxiety research with athletes (Chamberlain and Hale, 2007; Kais and Raudsepp, 2005).

Despite the large body of research on pre-competition anxiety, our understanding of its

relationship to performance remains elusive. Researchers have been conducted to discover or

identify the sources of stress in various competitive sports, including basketball (Madden et al.,

2004), figure skating (Scanlan et al., 1989), college baseball (Anshel et al., 1978), golf (Cohn,

1990), and wrestling (Gould et al., 1988). Anxiety and stress decreases the concentration and

performance level of sports persons (Solberg and Bergulund,, 1996). A recent meta-analysis

examined the effects of competitive anxiety and self-confidence on athletic performance (Craft et

al., 2003), it is concluded that a weak relationship appears to exist between competitive anxiety,

self-confidence, and athletic performance. Pre competition and during competition stress rises in

today’s sports world.

Research findings comparing the physiological and psychological markers of stress have

been equivocal (Filaire et al., 2001). Acute stress may affect cardiac function by shifting

autonomic cardiac regulation in favor of the sympathetic nervous system. Environmental

conditions that evoke behavioral or physiological responses may be considered stressors.

Neurobiological responses are stressor-specific (Pacak and Palkovits, 2001) thus, it is important

to study responses to relevant stressors.

Cortisol is a hormonal response to acute stress and has been measured to be higher before

competition than at resting conditions (Salvador et al., 2003). Researchers have found that

athletes produce higher levels of Cortisol before games than before non-competition situations

(Filaire et al., 2007; Filaire et al., 2001; Haneishi et al., 2007; Salvador et al., 2003). The result

supports previous findings that athletes are more anxious before games than during off days,

because Cortisol is secreted as a result of a threatening stimulus, and sports competition is

considered an anxiety-arousing situation (Salvador et al., 2003).

Decreased HRV has often been reported during physically or emotionally stressful

events. The majority of the studies concluded that the reduction in overall variability is induced

by the withdrawal of the highly frequent vagal activity. High vagal tone has been linked to

efficient autonomic regulatory activity which allows an organism to enhance its sensitivity and

response to physiological and environmental challenges (Friedman and Thayer, 1998). In

previous research, HRV was found to serve as a physiological index of self-regulatory strength

(Segerstrom and Solberg, 2007). Empirical evidence strongly supports these assumptions,

indicating that HRV co varies with processes that are involved in self regulation, such as emotion

regulation (Appelhans and Luecken, 2006), constructive coping (Fabes and Eisenberg, 1997),

and the pursuit of goals (Geisler and Kubiak, 2009). More specifically, researches have indicated

that HRV is associated with behaviors that require executive functioning.

In applied sport psychology, its efforts to enhance the competitive performance of

athletes, has traditionally utilized cognitive behavioral methods and techniques with an emphasis

on developing self-control of internal states, commonly referred to as psychological skills

training (Whelan et al., 1991). Relaxation techniques have been used in sports primarily to

enhance recovery from training and competition, manage anxiety and improve performance

(Solberg et al., 1996).

Studies support previous researches that found music to be an effective tool for

improving athletic performance (Copeland and Franks, 1991; Ferguson et al., 1994;

Karageorghis et al., 1996). Evidence for the positive effect of music on performance demon-

strated that karate players attained superior performances with the use of asynchronous

background music during performance (Ferguson et al., 1994). Likewise, performance

improvements were observed in treadmill running tasks under conditions of asynchronous music

(Copeland and Franks, 1991). Additionally, Studies that have investigated the stimulative or

energising effects of music have also noted benefits in the performance of physical tasks

(Karageorghis et al., 1996) Furthermore, (Jackson et al., 1992) reported that pre-performance

mood was a key antecedent of flow among elite figure skaters.

The techniques of MMT which focus on awareness to develop a detached observation of

the contents of consciousness may represent a powerful cognitive behavioural coping strategy

for transforming the ways in which we respond to life events (Astin, 1997). Even though many

studies on MMPs have been criticized for the lack of scientific rigor, including the lack of high

quality randomized controlled studies designed to differentiate between the specific (i.e.

specifically related to repeated sitting meditation practice) and the non specific (i.e. related to

benefits' expectations) effects of such practices (Chiesa and Serretti, 2010). The frequent use of

self report instruments as measures of clinical improvements following mindfulness training

(Chambers, et al, 2008); overall available studies provide preliminary evidence for the clinical

usefulness of such interventions. Further, as it has been suggested that the use of mindfulness

techniques may lead to the development of greater self-awareness, habitual ways of responding

to external cues can be more easily identified, which may result in enhanced behavioural

flexibility in response to athletic demands. Mindfulness-Based Cognitive Therapy for use with

an athletic population.

The present study focused on the relation of physiological response to skilled sport

performance, and investigated the relevance of relaxation therapies in PCS. For this purpose,

physiological variables, including Heart Rate Variability (HRV) and Salivary Cortisol (SC) were

recorded during the pre and post-competition and follow-up phases of real shooting competition.

Materials and Methods

Subjects: A total of 220 healthy male elite level shooters with mean age of (29.5±4.3years)

voluntarily recruited from Indian shooting team were selected for the present study; permission

was obtained from chief coach and officials. Questionnaires administered prior to the experiment

were indicated that no volunteers are included as per exclusion criteria such as any physical or

mental illness, hearing impairment, and have been undergoing neither meditation nor music

therapies for last 3 months. All subjects were nonsmokers, medication-free and not habitual

drinkers. The procedures involved and potential risks of the study were explained to the subjects,

and the written consent was obtained prior to the study.

The program consisted of three primary components: (1) Music Therapy (MT) (2)

Mindfulness Meditation Therapy (MMT), and (3) Combination of both (CT). 220 Participants

were randomly allocated into four groups, 55 in each group; MT, MMT, CT, and Control (C)

groups by multiple blocked randomization, after the dropout 200 (50±3) subjects could complete

the study. Heart Rate (70±3bpm), Respiratory Rate (15±2rpm), BMI (24±1.04kg/cm2) and Blood

Pressure (119±4/79±4 mm of Hg) were the mean values of recruited in this study. Intervention

trial was conducted to the respective subjects 1week prior to the study. Concerning impediments

to effective practice, subjects were monitored by the researcher and experts during the

interventions. The interventions were provided over the course of 4 weeks and 1week follow-up,

group sessions with a maximum of 8 participants each, 20 minutes session per day, 6 days a

week and one day was off. Participants were asked not to consume caffeine or alcoholic

beverages for 12 h, and not to exercise for 12 h prior to the experiment especially during testing.

They were requested to refrain from eating and drinking for at least 3 h prior to the experiment.

Procedure: The all participants of each batch reported to the laboratory at 08:00AM, each

session conducted in the morning (between 8 AM and 10 AM) and The subject changed into

loose fitting clothing, and shoes removed then the participants were instructed to lie in the supine

position on the floor mat in a quiet, light-attenuated room with the temperature between 24 and

28 °C with their eyes closed.

Interventions:

Music Therapy: CD of 30-40 music of Raga Darbari based Hindi songs given to the subject (in

MT and CT Groups) one week prior to the study and asked them to select 5-10 songs according

to their choice from 40 songs given , After selection of music, made separate folder for each

subjects. This music was delivered on SonyTM

MP3 player by headphone with volume of 60-70

dB, 60 to 70 beats per minute. The MT group was encouraged to assume a comfortable position

in supine position on a floor mat during delivery of the music intervention, Advised subjects to

clear their minds and allow their muscles to relax throughout the training session. The

participants left the room after 20 minutes of session.

Mind Fullness Meditation Therapy: The first step in performing a meditation is to adopt a

posture that ensures an erect spine and shoulder resting on the mat, with the hands should be

placed on the upper position of the abdomen, the position of head kept slightly foreword with the

support of small towel roll. The eyes closed, and were given 1 minutes of adaptation period. As a

meditation condition progress, subjects were asked to undergo 3 minutes for stabilization by

Shavasana, For Shavasana training the technique recommended by (Coulter, 2001) was used.

The subjects were asked to relax, performed meditation comprising a Pranayam for 4 min while

situated as in the control condition (in the supine position with the eyes closed and respiration at

a constant frequency of 0.2 Hz in tempo with the sound of a metronome (i.e., 5 breaths/min for 4

min)). Then the participants were instructed mindfulness by body scan i.e. focusing attention on

various joints of body by simply focuses on the way each part of body feels without labeling the

sensations as either “good” or “bad” in a sequence from distal to proximal and for 4 minutes

Pranayam. Finally ended with 3 minutes of Shavasana again.

Due to inexperience, drowsiness might cause during the performance of the meditation,

therefore tried to eliminate drowsiness by checking the participant’s eye movement and

respiration rates. Subjects were informed to raise their hands during any discomfort while doing

meditation and if so they were asked to immediately stop the session. Subsequently, the

participants left the room after 20 minutes of session.

Combination Therapy: This group was given a combination of both music and

meditation. Started with posture stabilization done by subjects during 1 minutes of adaptation

period, The music was delivered on MP3 player by headphone for 10 minutes of individual

choice and after the music session in same supine position meditation training started, they

performed meditation comprising all steps as MMTgroup, but the duration has been reduced to

10 minutes consists of Adaptation period for 1minutes, Shavasana for 1 minutes, Pranayam for 2

minutes, mind fullness for 3 minutes, 2 minutes of Pranayam and finally ended with Shavasana

for 1 minute. Subsequently, the participants left the room after 20 minutes of session.

Testing: The testing sessions were conducted between 8 am and 12 pm and the same researcher

tested all subjects. Measurement day scheduled one day prior to beginning the 1st week, 29

th day

and 36th

day, subjects were assessed for pre-test, post-test and follow-up data respectively,

except Performance Test, in a quiet controlled room with ambient temperature (24–280C). The

performance score calculated by pre-scheduled a competition in a internationally standard

shooting range on one day prior to beginning the 1st week, and on 29

th day, subjects were

assessed for pre-test, post-test Performance Score respectively.

All Participants were instructed to avoid consuming stimulant beverages, tea, and coffee;

exercising, in the 12 hours previous to the examination. The all participants of each batch

reported to the laboratory at 08:00AM, measurement procedure started between 09:00 am and

12:00 pm, to control as much as possible for circadian variations. Prior to testing, Participants

attended a detailed briefing session where they received full verbal instructions regarding the

procedures of the testing. SC samples were taken between 9:00 am -10:00 am. And HRV data

were taken between 10:00 am-12:00pm, all subjects were tested individually.

Salivary Cortisol; For obtaining the free, unbound, biologically active moiety of cortisol,

saliva samples were collected. To rid the mouth of contaminates, subjects rinsed thoroughly with

water ten minutes before saliva collection. Subjects sat in a comfortable chair with lumbar

support, Subjects were then allowed to relax for five minutes, the experimenter then began each

test session and collected minimum of 2 ml of saliva by tilting the head forward, allowing the

saliva to pool on the floor of the mouth, then passing the saliva through a short straw into a

polypropylene vial. The Salivary samples were labelled and sealed and refrigerated in an ice box

within 30 minutes. After all procedures the sealed sample sends to the laboratory on the same

day by 2:00 h to store under-15 degree centigrade to the laboratory for later analysis,

Free cortisol level data from the samples of saliva were analyzed in the laboratory by

using SalimetricsTM

salivary cortisol kit. On day of assay, samples brought at room temperature

and thaw completely, and centrifuge at 1500 x g (@3000 rpm for 15 minutes before adding to

assay plate and cortisol was assessed in via enzyme-linked immunosorbent assay as per

manufacturer (SalimetricsTM

) instructions.

Heart Rate Variability; For HRV testing, after fixation of equipments, subjects were then

instructed to lie down on the lounge for 5 minutes as an adaptation period, then the participants

were instructed to lie in the supine position on the floor mat with their eyes closed and the

subjects were asked to remain awake and relaxed, but the depth and rate of breathing were not

controlled. A continuous 5-minute resting data were collected and saved for HRV analysis.

HRV data were obtained using a cardio-recorder (i.e. Polar RS 800 CX ®—Polar electro Oy,

Kempele, Finland). For the Polar monitor, the series were automatically recorded by a receptor

belt and captured and stored by a wrist sensor unit, and this individual files containing normal

HRV data were transferred and saved to the computer via Infra Red port. Stored data processed

on a computer to calculate the following time and frequency domain indices of HRV according

to the recommendations of the Task Force of the European Society of Cardiology and the North

American Society of Pacing and Electrophysiology (1996); by dedicated software analyzed with

the polar HRV software (Polar Precision Performance TM

Software). Heart rate variability was

assessed in two ways: (1) time domain analysis and (2) frequency domain analysis, the power

was divided into two components: low frequency (LF, 0.04 Hz-0.15 Hz), and high frequency

(HF, 0.15-0.40 Hz).

In time domain analysis Standard Deviation of all R-R intervals (SDNNi) was obtained.

In frequency domain analysis, HF (is a marker of solely parasympathetic activity) and LF (is

mainly a measure of sympathetic activity with some influence from the parasympathetic nervous

system) were obtained. All these components were expressed in ms2

and then converted to

normalised units (n.u) (i.e. nHF, nLF), as recommended by the Task Force of European Society

of Cardiology (Task-Force, 1996).

Performance score: Measure of shooting accuracy, shooting score was calculated from the

standard shooting scoring board and the final result of competition obtained from the chief coach

after the completion of competition, in order to test shooting performance.

Data Obtained: Descriptive statistics (mean and SD) were used to describe all the study (Age,

BMI, HR, RR, BPD, BPS) and outcome variables (HRV (SDNNi, nHF, nLF), SC, PS). The

within group comparison of mean values of outcome variables (SDNNi, nHF, nLF, and SC) at

the baseline, 29th

day and at 36th

day was done using one-way analysis of variance followed by

Tukey’s post hoc multiple comparison tests and between 4 groups (MT, MMT, CT, C)

comparison of study and outcome variables was also carried out similar statistical tests (Table-10

and 11). And the main outcome variable performance score was compared before and after

intervention by using student’s t-test for paired samples. The 95% confidence intervals were

calculated for difference of mean of all outcome variables.

Result:

The comparison of base line mean values of study variables (Table-1) and outcome

variables (Table-2-5) among the 4 study groups, that is shooters who had interventions: as MT,

MMT, CT and C, showed a statistically non-significant difference in the mean values of Age( F=

1.15; p= 0.332), HR( F= 0.10;p=0.961), RR(F=2.44;p=0.066),BPD(F=0.42;p=0.736), and BPS

(F=1.11;p=0.347) among these groups. But there is a statistically significant difference in the

mean values of BMI (F= 3.57; p=0.015). In outcome variables showed a statistically non-

significant difference in the mean values in SDNNi (F= 0.29; p = 0.829), nHF (F= 1.68; p =

0.172), SC (F= 0.02; p = 0.995), PS (F= 0.40; p = 0.756). But there is a statistically significant

difference in the mean values of nLF (F= 10.18; p <0.0001) among these groups.

SDNNi: There is highly statistically significant difference in the mean values of SDNNi across

the 4 study groups at 29th

day (F= 905.76; p <0.0001) and at 36th

day (F= 796.73; p <0.0001).

The pair wise comparison of mean values indicates the group CT subjects mean values of

SDNNi were statistically significantly higher at 29th

day and 36th

day ( 56.78; 55.57) when

compared the mean values of study subjects of MT group at 29th

day and 36th

day (54.48; 53.87),

of MMT group (52.91; 52.70) and of C group ( 48.03; 48.20). Among the 4 groups the mean

values of SDNNi at 29th

and 36th

day were statistically significantly lower in C group i.e.

shooters who did not had any intervention. And among the 3 intervention groups, the mean

values of MMT group were significantly lower than the mean values of MT group and CT group.

nHF: Analysis showed a highly statistically significant difference in the mean values of nHF

across the 4 study groups at 29th

day (F= 3.26; p <0.0001) and at 36th

day (F= 2.16; p <0.0001).

The pair wise comparison of mean values indicates the CT group subjects mean values of nHF

were statistically significantly higher at 29th

day and 36th

day ( 45.53;44.44) when compared the

mean values of study subjects of MT group at 29th

day and 36th

day (43.42;41.56), of MMT

group (44.53;42.24) and of C group ( 33;33.95). Among the 4 groups the mean values of nHF at

29th

and 36th

day were statistically significantly lower in control group. And among the 3

intervention groups, the mean values of MT group were significantly lower than the mean values

of MMT group and CT group.

nLF: The pair wise comparison of mean values indicates the CT group subjects mean values of

nLF were statistically significantly lower at 29th

day and 36th

day ( 54.47; 55.56) when compared

the mean values of study subjects of MT group at 29th

day and 36th

day (56.58;58.44), of MMT

group (55.47;57.76) and of C group ( 70;66.05). Among the 4 groups the mean values of nLF at

29th

and 36th

day were statistically significantly higher in control group. And among the 3

intervention groups, the mean values of MT group were significantly higher than the mean

values of MMT and CT groups.

SC: Analysis showed a highly statistically significant difference in the mean values of SCO

across the 4 study groups at 29th day (F= 5.25; p <0.0001) and at 36th

day (F= 986.7; p <0.0001).

The pair wise comparison of mean values indicates the CT group subjects mean values of SCO

were statistically significantly lower at 29th

day and 36th

day ( 0.33;0.45) when compared the

mean values of study subjects of MT group at 29th

day and 36th

day (0.53;0.91), of MMT group

(0.66;0.93) and of C group ( 1.95;1.60). Among the 4 groups the mean values of SCO at 29th

and

36th

day were statistically significantly higher in control group. And among the 3 intervention

groups, the mean values of MMT group were significantly higher than the mean values of MT

and CT groups.

PS: Analysis showed a highly statistically significant difference in the mean values of

performance score across the 4 study groups at 29th

day (F= 13.69; p <0.0001) .The pair wise

comparison of mean values indicates the CT group subjects mean values of performance score

were statistically significantly higher at 29th

day (549.72) when compared the mean values

performance score of study subjects of MT group (544.31), of MMT group (541.69) and of C

group (518.04) at 29th

day. Among the 4 groups the mean values of PS at 29th

day was

statistically significantly lower in control group. And among the 3 intervention groups, the mean

values of PS of MMT group were significantly lower than the mean values of MT and CT

groups.

Discussion:

In the current study, used Heart Rate Variability (HRV) and Salivary Cortisol (SC) as

two physiological markers and Performance Score (PS) as one subjective marker to assess the

changes with different interventions in three groups and also assessed changes in control group

during the same duration. These parameters are very much reliable to provide true picture of

changes in pre competition anxiety or stress. This fact is supported by (Filarie et al., 2007 and

Hanesishi et al., 2007) and also supported by research findings comparing the physiological and

psychological markers of stress have been equivocal (Filaire et al., 2001). Since the salivary

cortisol assay has been proposed as the method of choice for assessing adrenocortical

(endocrine) function and responses to competitive stress, autonomic nervous system requires a

complex a dynamic interplay between SNS and PNS, Thus in this study also included HRV as a

physiological marker.

Time Component (SDNNi): The result of study showed that in HRV, SDNNi component value

from 0-29 day (Pre and Post Intervention) demonstrated significant difference in all groups

(F=905.76; p<0.0001) and also in 29th

- 36th

day (Follow-up) (F=796.73; p<0.0001). When

comparing in groups CT group (Combination) has shown 13.2% increase (56.78) during post

interventions and a follow up difference of 2.4% (55.57). When compared to MT and MMT (i.e.

Music and Meditation alone), Both groups also have been showed an increase in SDNNi value,

but MT group showed more increase of SDNNi than MMT group in post intervention i.e. 8.3%

(54.48) and 5.7 % (52.91) and a follow up effect of 1.2 % (53.87) and .4% (52.70) respectively.

These values showed there is an increase in SDNNi value in all groups where as CT group is

more than MT and MT group is more than MMT group. But in C group showed decrease of

4.5% (48.03) and 0.3% (48.20) during pre and post competition (Table-6).

Frequency Component (nHF): The result of this study showed that in nHF component of HRV

from 0-29 day (pre and Post Intervention) demonstrated significant difference in all groups

(F=3.26; p<0.0001) and also in 29th

- 36th

day (Follow-up) (F=2.16; p<0.0001). Pair wise

comparison of mean values indicates CT has shown 24% increase (45.53) during post

interventions and a follow up difference of 3% (44.44). MMT showed increase of 24% (44.53)

and follow up effect of 6% (42.24). In MT showed an increase of 18% (43.42) during

intervention and 5% (41.56) of increase during follow up effect. This result indicates MT has

less value of intervention effect in comparison with CT and MMT groups. But comparing CT

and MMT groups, MMT showed more follow up effect than CT and MT groups. Whereas C

group showed a decrease of 10% (33) during pre competition and 3% (33.95) of decrease during

post competition (Table-7).

Frequency Component (nLF): The result of the current study also supported the previous

researches, showed during intervention the nLF component decreased in all three groups of

intervention and follow up (F=3.26; p<.001; F=2.16; p<0.001). CT group decreased 14% (54.47)

during intervention and follow up decrease of 2% (55.56), MMT group decreased 12% (55.47)

and 4% (57.76) during intervention and follow up respectively. But in MT group there is a

decrease of 11% (56.58) and 3% (58.44) during intervention and follow up respectively. These

results showed that during intervention CT group is showed more decrease than MMT and MT

groups, and MMT group showed more follow up effect than both group MT and CT, whereas C

group showed an increase of 11% (70) and 6% (66.05) during pre and post competition period

(Table-8).

Salivary Cortisol: Result have been proved, during intervention of relaxation therapies, the

cortisol level in saliva decreased in all three groups of intervention and follow up (F=5.25;

p<0.0001 ; F=986.7; p<0.0001). In our result CT group has shown more decrease during

intervention and MT group showed more carryover effect in comparison with CT and MMT, and

there is decrease in pre competition. Whereas CT 75% (.33), MT 60% (.53) and MMT 50% (.66)

and as follow up carry over decrease MT 29% (.91), MMT 20% (.93) and CT 9% (.45) groups

respectively. Whereas C group showed an increase of 47% 1.95 and 26% 1.60 pre-competition

and post competition respectively (Table-9).

Performance Score: This study showed the pre and post competition PS of all three

interventions were increased (F=13.69; p<000.0001) whereas C group showed a decrease of PS.

In Group CT has shown more increase of PS in comparison with MT and MMT groups, whereas

MT showed an increase of PS than Group B. percentage values are 3%(544), 2.6% (542), 4.5%

(550) and 0.9% (518) for Groups A, B ,C, and D respectively (Graph1-4).

The result of the study indicated that there is an increase in post-intervention and follow-

up values in all interventional groups and combination was showing more effective, whereas the

control groups it was highly insignificant result. The reason for these changes might be

supported by studies on competition stress have been observed (Stephen et. al., 2009), supported

that, prior to competing, sport performers encounter more stressors pertinent to performance. The

level of anxiety automatically narrows perception restricting the focus of attention (Ashcraft and

Krause, 2007). Thus result of this study indicated that there is a decrease in control group and

increase in post intervention PS in all interventional groups; the reason for these changes might

be due to decrease in PCS.

Acute stress may affect cardiac function by shifting autonomic cardiac regulation in favor

of the sympathetic nervous system (Pacak and Palkovits 2001) thus during stress or anxiety the

nLF component of HRV increases. Cortisol is a hormonal response to acute stress and has been

measured to be higher before competition than at resting conditions (Salvador et al., 2003). SC

has been shown to reliably reflect levels of unbound cortisol in the blood and raised levels have

been found to be associated with stress in normal subjects (Kirschbaum and Hellhammer, 1994).

supported by studies on competition stress have been observed to decrease HRV, and alter the

power spectrum by decreasing the high frequency (HF) component, increasing the low frequency

(LF) component (Isowa et al. 2006). Based on these facts if any intervention is effective to

reduce competition stress then we observed the reversibility in behaviour of these markers that

will get an increase in HF and decrease in LF components of HRV and increase in SDNNi

component of HRV. The same phenomena observed with three different interventional groups

after receiving interventions.

Further, suggesting that relative increases in sympathetic nervous system activity during

stressful events (Sloan et al. 1994). It is also proved that there is an increase in parasympathetic

activity due to interventions of this study. Malfatto et al., (1996) explained the results regarding

elevation of SDNNi, the strongest prognostic HRV markers, have been supported with an

explanation. Thus in this study SDNNi component showed elevation from their baseline values

after interventions. McCraty et al., (1995) also supported that the positive emotions resulting

from relaxation therapies may significantly augment the HF component of a power spectrum

whereas the opposite occurs with negative emotions that happens with competition stress.

Therefore, HRV analysis provides a means of assessing the rhythmical changes that occur in

instantaneous heart rate (R-R intervals) in response to alterations in sympathovagal balance. By

relaxing music increases in parasympathetic activity decrease heart rate and increase HRV

(White, 1999). Current study also supports the increase of nHF and decrease of nLF in all music

interventional groups.

Music affects a reduction in sympathetic nervous control and therefore a reduction in

heart and respiration rates, metabolism, oxygen consumption, muscle tension, (Lee et al., 2005).

Reduced heart and respiration rates lead to less anxiety and can promote relaxation. These

studies support the reduction of nLF component in groups involved with music.

Listening to classical music increases heart rate variability, whereas listening to noise or

rock music decreases heart rate variability (reflecting greater stress) (Chuang et al., 2010).

Current study also given music therapy based on classical music that might have increased HRV

in groups which have under gone music interventions.

As repeated listening to music affects people's preference for it as well as their

physiological responses to it (Knight and Rickard, 2001), the HF component of HRV might be

increased with repeated listening. Music appears to exert direct physiological effects through the

autonomic nervous system. In the current study have given 20 minutes session for 4 weeks this

could supports the more effect of meditation in frequency components than music.

During guided relaxation, there was a reduction in the power of the low-frequency (LF)

component of the HRV spectrum and an increase in the power of the high-frequency (HF)

component, which suggested a reduction in sympathetic nervous system activity (Vempati and

Telles, 2002). HRV can be influenced by different patterns of breathing, breathing patterns

investigated in parallel to HR to determine the role of lengthening or shortening R-R interval in

the decision making process to pull the trigger. Thus in our study we included meditation

training. One of the aims of this experiment was to show the effects of paced breathing at 0.2 Hz

in meditation, compared to uncontrolled breathing, on time and frequency domain measures of

heart rate variability. The results showed a significant trend for paced breathing at 0.2 Hz to

increase HRV in the time domain, measured by SDNNi, and to shift sympathovagal balance,

measured by LF/HF spectral power, toward greater sympathetic activity. Because of the

respiration-related variability (respiratory sinus arrhythmia) of electrocardiogram inter-beat (RR)

intervals, the necessity of controlling respiratory frequency during measurements of HRV has

been demonstrated, several mechanisms have been attributed to this observation, e.g., the

respiratory sinus arrhythmia might be amplified due to increased tidal volume (De Meersman et

al. 1995). Tidal volume is also reported to be a modulator of the heart rate variability spectrum

by increasing high frequency power (Grossman et al. 2004) and 0.2 Hz paced breathing usually

increases tidal volume (Pinna et al. 2006). The activity of the vagal nerve endings increases

during exhalation, and the activity of sympathetic fibers increases during inhalation, causing the

“respiratory modulation” (RM) or “sinus arrhythmia”, i.e., during inhalation the heartbeat

intervals shorten and during exhalation they stretch. The oscillation in vagal action is responsible

for most of the RM, because it is faster than the sympathetic action. In summary, these factors

could have been helped to enhance further improvement nHF and nLF component of HRV in

MMT than MT alone training.

The combination effect supported by MT studies also indicate that music and

progressive muscle relaxation has effective outcomes in controlling muscle tension, anxiety,

sleep quality, and reducing stress (Hernandez-Ruiz, 2005). In addition, lower anxiety is expected

to promote psychological well being by decreasing plasma norepinephrine and cortisol (Mockel

et al., 1994) and enhancing relaxation and calmness. Therefore, soothing music was expected to

have a therapeutic effect on relaxation.

Meditation has been shown to decrease cortisol levels in populations of healthy

volunteers, but the effect of MMT program in PCS and release of SC levels has not previously

been evaluated in sports population. However, there has been some investigation of the effects of

psychosocial intervention on cortisol levels in normal and patient population. Tang et al., (2007)

supported by participants who meditated had better attentional processing on alerting function as

well as better mood, lower cortisol, and better immune function, allowing to conclude that

randomly assigned short-term intensive meditation causes immediate benefits. Studies reported

long-term endocrinologic changes in cortisol in subjects practicing transcendental meditation

(TM). Walton et al., (1995) found low concentrations of the blood levels of cortisol in TM

practitioners, in comparison with nonpracticing subjects. Music listening may influence

cognitive functioning via alternate pathways by helping to better organize cortical brain

transmissions (Rauscher et al., 1993), this might have improved performance.

These observations highlight that all the demands faced by athletes should be considered

when preparing and implementing interventions to manage competition stress. Result of the

current study showed all interventional groups have been shown some amount of follow up

effects even after one week of intervention this is supported by studies such as, (Caine, 1992)

found evidence that playing recorded music for infants in the neonatal intensive care unit

increased weight gain and shortened lengths of stay. Moreover, a follow-up study of the infants

that participated in Caine's music listening study indicated that infants who participated in the

music intervention were rated as calmer by their mothers at 6 months of age compared to infants

without music intervention. The results concerning the affective component of symptom changes

showed that the effect of music therapy was sustained. One week after the discontinuation of

sessions. Crocker et al., (1988) found evidence that post meditation there was significant com-

petitive performance improvements, and these improvements were maintained at 6-month

follow-up.

Future Research

The neuroendocrine scientific studies of music and meditation is clearly still in its

infancy, but the initial findings reviewed earlier promise both to reveal the mechanisms by which

such training might exert its effects on relaxation that underlie complex regulatory mental

functions. It seems that music and meditation can exert physiological effects through the

autonomic nervous system, but the factors directly involved are still unknown. These findings

will need to be supplemented with more data, most crucially from longitudinal studies examining

changes over time within the same individuals randomized either to music or meditation training

or to an active control group. The impact of relaxation or mental training on peripheral biological

processes that are important for physical health and illness is not yet clear. Although several

clinical studies have reported changes in, there are no data that mechanistically link changes in

the brain that might be produced by music or meditation, and alterations in peripheral processes,

further study is required to enable music and meditation related interventions to be accepted by

the sports science community on the basis of strong empirical evidence. Specifically, now that

the benefits of music and meditation have been repeatedly demonstrated in laboratory settings,

more ecologically valid and group-based research methods would serve to bolster the knowledge

base. Further work is needed to investigate subjects, measurement indicators, and experimental

conditions to clarify the relationship between physiological changes and emotional responses

produced by music or meditation.

Conclusion

To our knowledge, the HRV and SC have been little evaluated in young athletes and, in

such conditions of pre-competitive stress and post relaxation therapies. This work was made

possible to find out the changes on the neuroendocrine (ANS and HPA axis) activity during

intervention, or changes induced in PCS. The past empirical evidence has lent support to the

view that psychophysiological recordings may even provide insight into the skill related aspects

of a shooter's psychomotor strategies and determinants of successful shooting performance.

Studies examined whether sports capacity or performance of the shooters is related to the

alteration in scaling exponents derived from short-term HRV by relaxation trainings. The result

current study further concluded that relaxation therapies such as MT and MMT

interventions along with routine sports specific training may decrease PCS and will

enhance PS and found CT is more effective than MT and MMT alone and also found MT

has been shown better effectiveness than MMT in four weeks of training. Which reflects the

underlying control mechanism of the ANS on the heart beats in such a unique situation.

Therefore, professional shooting athletes may have been developing a better autonomic cardiac

control due to intensive training and in competition.

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Graphs and Tables

Graph 1: Bland and Altman plot—Comparison of pre and post performance values of

study subjects who had MT as intervention

350 400 450 500 550 600

8

6

4

2

0

-2

-4

-6

AVERAGE of Score29 and Score0

(Sco

re2

9 -

Sco

re0

) /

Ave

rag

e %

Mean

2.9

-1.96 SD

-1.3

+1.96 SD

7.2

460 480 500 520 540 560 580 600

10

8

6

4

2

0

-2

-4

-6

-8

-10

AVERAGE of Score29 and Score0

(Sco

re2

9 -

Sco

re0

) /

Ave

rag

e %

Mean

2.6

-1.96 SD

-2.4

+1.96 SD

7.6

Graph 2: Bland and Altman plot—Comparison of pre and post performance values of

study subjects who had MMT as intervention

Graph 3: Bland and Altman plot—Comparison of pre and post performance values of

study subjects who had combination of CT as intervention

480 500 520 540 560 580 600

20

15

10

5

0

-5

AVERAGE of Score29 and Score0

(Sco

re2

9 -

Sco

re0

) /

Ave

rag

e %

Mean

4.5

-1.96 SD

-2.5

+1.96 SD

11.5

Graph 4: Bland and Altman plot—Comparison of pre and post performance values of

study subjects who had no intervention

Table 1: Study variables comparison in all groups

MT Group MMT Group CT Group C Group

Mean ± SD SD Mean SD Mean SD Mean SD

Age 28.67 4.24 29.4 4.08 29.38 3.16 30.2 4.68

BMI 24.27 1.11 23.65 0.76 24.04 1.18 23.8 1

HR 69.54 4.14 69.67 5.89 69.64 4.21 70.02 4.12

RR 15.46 1.73 14.69 1.99 15.21 1.83 15.61 1.58

BPD 119.42 4.38 118.67 5.96 118.77 3.48 119.41 3.2

BPS 78.58 3.92 78.74 5.09 79.36 3.9 79.93 3.3

Table 2: Outcome variables comparison in MT Group

Outcome

Variables

0 Day 29th Day 36th Day

Mean SD Mean SD Mean SD

SDNNi 50.32 1.58 54.48 0.59 53.87 0.58

nHF 36.72 0.6 43.42 0.34 41.56 0.34

400 450 500 550 600

12

10

8

6

4

2

0

-2

-4

-6

AVERAGE of Score0 and Score29

(Sco

re0

- S

co

re2

9)

/ A

ve

rag

e %

Mean

1.0

-1.96 SD

-5.2

+1.96 SD

7.2

nLF 63.44 0.26 56.58 0.34 58.44 0.34

SC 1.33 0.06 0.53 0.07 0.91 0.11

PS 528.52 29.1 544.31 30.64

Table 3: Outcome variables comparison in MMT Group

Outcome

Variables

0 Day 29th Day 36th Day

Mean SD Mean SD Mean SD

SDNNi 50.05 1.42 52.91 0.56 52.7 0.3

nHF 35.79 4.85 44.53 0.15 42.24 0.12

nLF 63.33 0.27 55.47 0.15 57.76 0.12

SC 1.33 0.06 0.66 0.07 0.93 0.11

PS 528.04 25.26 541.69 25.11

Table 4: Outcome variables comparison in CT Group

Outcome

Variables 0 Day 29th Day 36th Day

Mean SD Mean SD Mean SD

SDNNi 50.15 0.57 56.78 1.21 55.57 1.16

nHF 36.74 1.1 45.53 0.01 44.44 0.21

nLF 63.02 0.68 54.47 0.01 55.56 0.21

SC 1.33 0.15 0.33 0.07 0.45 0.08

PS 525.87 25.89 549.72 18.66

Table 5: Outcome variables comparison in C Group

Outcome

Variables

0 Day 29th Day 36th Day

Mean SD Mean SD Mean SD

SDNNi 50.28 2.38 48.03 0.89 48.2 0.76

nHF 36.67 0.21 33 0.25 33.95 0.05

nLF 63.33 0.21 70 0.25 66.05 0.05

SC 1.33 0.06 1.95 0.08 1.6 0.11

PS 522.96 31.14 518.04 28.1

Table 6: Outcome variable-SDNNi comparison in all Groups

SDNNi

Variable

MT Group MMT Group CT Group C Group

Mean SD Mean SD Mean SD Mean SD

SDNNi-0 50.32 1.58 50.05 1.42 50.15 0.57 50.28 2.38

SDNNi-29 54.48 0.59 52.91 0.56 56.78 1.21 48.03 0.89

SDNNi-36 53.87 0.58 52.7 0.3 55.57 1.16 48.2 0.76

Table 7: Outcome variable-nHF comparison in all Groups

nHF

Variable

MT Group MMT Group CT Group C Group

Mean SD Mean SD Mean SD Mean SD

nHF-0 36.72 0.6 35.79 4.85 36.74 1.1 36.67 0.21

nHF-29 43.42 0.34 44.53 0.15 45.53 0.01 33 0.25

nHF-36 41.56 0.34 42.24 0.12 44.44 0.21 33.95 0.05

Table 8: Outcome variable-nLF comparison in all Groups

nLF

Variable

MT Group MMT Group CT Group C Group

Mean SD Mean SD Mean SD Mean SD

nLF-0 63.44 0.26 63.33 0.27 63.02 0.68 63.33 0.21

nLF-29 56.58 0.34 55.47 0.15 54.47 0.01 70 0.25

nLF-36 58.44 0.34 57.76 0.12 55.56 0.21 66.05 0.05

Table 9: Outcome variable-SC comparison in all Groups

SC

Variable

MT Group MMT Group CT Group C Group

Mean SD Mean SD Mean SD Mean SD

SC-0 1.33 0.06 1.33 0.06 1.33 0.15 1.33 0.06

SC-29 0.53 0.07 0.66 0.07 0.33 0.07 1.95 0.08

SC-36 0.91 0.11 0.93 0.11 0.45 0.08 1.6 0.11

One way Analysis of Variance

Table 10: Comparison of mean values of study variables at 3 stages in male shooters among

the 4 study groups

Sum of

Squares

df Mean Square F Sig.

Age- Between Groups

Within Groups

Total

56.59

3208.61

3265.21

3

195

198

18.86

16.45

1.15

.332

BMI- Between Groups

Within Groups

Total

11.12

202.37

213.50

3

195

198

3.71

1.04

3.57 .015

HR- Between Groups

Within Groups

Total

6.34

4190.76

4197.10

3

195

198

2.11

21.49

.10 .961

RR- Between Groups

Within Groups

Total

23.51

626.91

650.42

3

195

198

7.84

3.22

2.44 .066

BPD- Between Groups

Within Groups

Total

24.36

3737.79

3762.15

3

195

198

8.12

19.17

.42 .736

BPS- Between Groups

Within Groups

Total

55.93

3280.06

3335.99

3

195

198

18.64

16.82

1.11 .347

One way Analysis of Variance

Table 11: Comparison of mean values of outcome variables at 3 stages in male shooters of 4 study

groups

Sum of Squares df Mean Square F Sig.

SDNNi 0- Between Groups

Within Groups Total

2.27

493.97 496.24

3

195 198

.76

2.53

.29 .827

SDNNi 29- Between Groups

Within Groups

Total

1998.61

143.43

2142.04

3

195

198

666.20

.74

905.76 .000

SDNNi 36- Between Groups

Within Groups

Total

1435.73

117.13

1552.86

3

195

198

478.58

.601

796.73 .000

nHF 0- Between Groups

Within Groups

Total

30.76

1187.33

1218.09

3

195

198

10.25

6.09

1.68 .172

nHF 29- Between Groups

Within Groups

Total

4790.12

9.57

4799.69

3

195

198

1596.71

.05

3.26 .000

nHF 36- Between Groups

Within Groups

Total

2989.13

9.00

2998.13

3

195

198

996.38

.05

2.16 .000

nLF 0- Between Groups

Within Groups

Total

5.19

33.15

38.34

3

195

198

1.73

.17

10.18 .000

nLF 29- Between Groups

Within Groups

Total

4790.12

9.57

4799.69

3

195

198

1596.71

.05

3.26 .000

nLF 36- Between Groups

Within Groups

Total

2989.13

9.00

2998.13

3

195

198

996.38

.05

2.16 .000

SC 0- Between Groups

Within Groups

Total

.00

1.65

1.65

3

195

198

.000

.008

.02 .995

SC 29- Between Groups

Within Groups

Total

76.74

.95

77.69

3

195

198

25.58

.01

5.25 .000

SC 36- Between Groups

Within Groups

Total

32.81

2.16

34.97

3

195

198

10.94

.01

986.67 .000

PS 0- Between Groups

Within Groups

Total

923.33

151648.89

152572.21

3

195

198

307.78

777.69

.40 .756

PS 29- Between Groups

Within Groups

Total

28100.54

133436.06

161536.59

3

195

198

9366.85

684.29

13.69 .000

Mindfulness Meditation on HPA-Axis

The Effect of Mindfulness Meditation on HPA-Axis in Pre-Competition Stress in Sports Performance of Elite Shooters

Dr. Shaji John*, Dr. S. K Verma**, Dr. G. L Khanna***

*Researcher, College of Applied Medical Sciences, King Saud University, KSA, **Professor, Department of Sports Sciences, Punjabi University, India, ***Professor, Faculty of Applied Medical Sciences, Manav Rachna International University, India.

Abstracts: Background: Little has been known about the Hypothalamic Pituitary Adrenal (HPA) axis response to pre-competition stress (PCS) and its response to relaxation therapies such as of Mindfulness Meditation Therapy (MMT) on sports population. In shooting sports good physical as well as psychological condition is highly demanded. Researchers have been performed on the psychophysiological responses of MMT on normal and diseased persons, but little has been done on sports population especially in shooters. Objective: The purpose of current study was to estimate the contribution of MMT on Salivary Cortisol (SC), a reliable physiological marker of HPA- axis response in reducing PCS, and its effect on shooting performance (PS). Methods: 96 male elite Shooters, with mean age of 29.5±4.3years were examined as in experimental and control (48 in each). Total duration of the study was five weeks, four weeks of experimental and one week study to determine the follow-up effect. Pre, post and follow-up data of quantitative phenotypic markers of HPA-Axis activity by analysis of SC and PS were analyzed. Results: Compare to control, experimental group has shown significant result, post-intervention (p<0.001) and in follow-up (p<0.001) in SC and in PS. Resulted in reduction of PCS level and increase in PS, whereas the control group has been shown non-significant result (p<0.05).Conclusions: Results indicated that relaxation therapies such as MMT may decrease PCS and will enhance PS. It is concluded that in four weeks of MMT has an effect on HPA-Axis by decreasing the level of SC as a reliable physiological marker of PCS. [ John S NJIRM 2011; 2(3) : 15-21] Key Words: HPA, Cortisol, Pre competition Stress, Meditation, Shooting.

Author for correspondence: Shaji John, Researcher, College of Applied Medical Sciences, King Saud University, P O Box;10219, Riyadh 11433, KSA., E-mail:johnsphysio@gmail.com

Introduction: Air pistol shooting is an Olympic sport requiring extreme mental concentration and movement precision for success. Pistol shooting is a static activity requiring a strict control of body segments and posture to align the rear sight aperture and the foresight through proprioceptive feedback and gaze fixation either on the target directly or between the target and the weapon and, therefore, to increase precision of the shot1. Compared to that for rifle shooting, there is very little literature related to pistol shooting. In this work, we investigated pistol shooting.

Stress is most often used to describe an unpleasant emotional state or condition which is characterized by subjective feelings of tension, apprehension, and worry. In sports context it is commonly known as pre-competition stress or anxiety. Further, research indicated that anxiety has a negative effect on these sport outcomes2. Research findings suggest that, prior to competing; sport performers encounter more stressors pertinent to

NJIRM 2011; Vol. 2(3). July- September

performance3. These observations highlight that all the demands faced by athletes should be considered when preparing and implementing interventions to manage competition stress. Pre-competition anxiety is a widely prevalent condition that exists among athletes of all levels and within every sport 4 , 5 , 6. Despite the large body of research on pre-competition anxiety, our understanding of its relationship to performance remains elusive.

Cortisol is a hormonal response to acute stress and has been measured to be higher before competition than at resting conditions7. Some researchers have found that athletes produce higher levels of Cortisol before games than before non-competition situations 8 , 9 , 1 0 , 7. The results support previous findings that athletes are more anxious before games than during off days1 1. Research findings comparing the physiological and psychological markers of stress have been equivocal9.

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Relaxation techniques have been used in sports primarily to enhance recovery from training and competition, manage anxiety and improve performance12. The techniques of mindfulness meditation which focus on awareness to develop a detached observation of the contents of consciousness may represent a powerful cognitive behavioural coping strategy for transforming the ways in which we respond to life events1 3. Even though many studies on MMT have been criticized for the lack of scientific rigor, including the lack of high quality randomized controlled studies designed to differentiate between the specific (i.e. specifically related to repeated sitting meditation practice) and the non specific (i.e. related to benefits' expectations) effects of such practices14, and the frequent use of self report instruments as measures of clinical improvements following MMT 1 5 .

The present study focused on examining the relation of physiological response to skilled sport performance, and investigating the relevance of MMT in pre-competition anxiety. For this purpose, Salivary Cortisol (SC) were recorded during the training and pre-competition phase of actual shooting.

Material and Methods: Subjects: A total of 110 healthy male elite level shooters with mean age of (29.5±4.3years) selected for the study. Subjects were voluntarily recruited from national shooting team; permission was obtained from officials. Questionnaires administered prior to the experiment were indicated that no volunteers are included as per exclusion criteria such as any physical or mental illness, hearing impairment, and have been undergoing meditation therapies for last 3 months. All subjects were nonsmokers, medication-free and not habitual drinkers. The aims of the present study, the procedures involved and potential risks of the study were explained carefully to subjects, and the written consent was obtained prior to the study. The study and all protocols were approved by research ethical committee of Punjabi University.

Participants were randomly allocated into two groups; experimental (MMT) and Control by multiple blocked random sampling of 55 in each

NJIRM 2011; Vol. 2(3). July- September

group, after the dropout 96 subjects could complete the study in each group. The baseline values of Heart Rate (70±3bpm), Respiratory Rate (15±2rpm), BMI (24±1.04kg/cm2) and Blood Pressure (119±4/79±4 mm of Hg) were documented. For the better understanding of Interventions a sample trial was conducted to the experimental subjects one week prior to the study. Concerning impediments to effective practice, subjects were monitored by the researcher and experts during the interventions. The intervention was provided over the course of four weeks and one week follow-up, group sessions with a maximum of 8 participants each, 20 minutes session per day, 6 days a week and one day was off per week. Participants were asked not to consume caffeine or alcoholic beverages for 12 h, and not to exercise for 12 h prior to the experiment especially during testing.

Procedure: The all participants of each batch reported to the laboratory at 08:00AM, each session conducted in the morning (between 8 AM and 10 AM) and The subject changed into loose fitting clothing, and shoes removed then the participants were instructed to lie in the supine position on the floor mat in a quiet, light-attenuated electrically shielded room with the temperature between 24 and 28 °C with their eyes closed.

Interventions; Mindfulness Meditation Therapy (MMT): The first step in performing a MMT is to adopt a posture that ensures an erect spine and shoulder resting on the mat, with the hands should be placed on the upper position of the abdomen, the position of head kept slightly foreword with the support of small towel roll. The eyes may be fully closed, or the upper lids may be dropped and was given 1 minutes of adaptation period. As a meditation condition progress, subjects were asked to undergo 3 minutes for stabilization by Shavasana, For Shavasana training the technique recommended by Coulter was used 2 8. The subject was asked to relax , after this, they performed meditation comprising a Pranayam for 4 min while situated as in the control condition (in the supine position with the eyes closed and respiration at a constant frequency of 0.2 Hz in tempo with the sound of a metronome (i.e., 5 breaths/min for 4

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Mindfulness Meditation on HPA-Axis

min)). Then the participants were instructed mindfulness by body scan i.e. focusing attention on various joints of body by focuses on the each joint from proximal to distal as described and feels without labeling the sensations as either "good" or "bad" in a sequence from distal to proximal. Once they completes again for 4 minutes Pranayam at a constant frequency of 0.2 Hz in tempo with the sound of a metronome and ended with 3 minutes of Shavasana. Subjects were informed to raise their hands during any discomfort while doing meditation and if so they were asked to immediately stop the session. Subsequently, the participants left the room after 20 minutes of session.

Testing; The testing sessions were conducted between 8 am and 10 am and the same researcher tested all subjects. Measurement day scheduled one day prior to beginning the 1 s t week, 29 t h day and 36 t h day, subjects were assessed for pre-test, post-test and follow-up data respectively, except Performance Test, in a quiet controlled room with ambient temperature (24-280C). The performance score calculated by pre-scheduled a competition in a internationally standard shooting range on one day prior to beginning the 1 s t week, and on 29 t h

day, subjects were assessed for pre-test, post-test Performance score respectively.

All Participants were instructed to avoid consuming stimulant beverages, tea, and coffee; exercising, in the 12 hours previous to the examination. The all participants of each batch reported to the laboratory at 08:00AM, measurement procedure started between 09:00 am and 10:00 am, to control as much as possible for time of day, to avoid circadian variations. Prior to testing, Participants attended a detailed briefing session where they received full verbal instructions regarding the procedures of the study. SC samples were taken been 9:00 am -10:00 am to minimize time of day effects. All subjects were tested individually.

Salivary Cortisol; For obtaining the free, unbound, biologically active moiety of cortisol, saliva samples were collected. To rid the mouth of contaminates, subjects rinsed thoroughly with water ten minutes before saliva collection. Subjects sat unrestrained

NJIRM 2011; Vol. 2(3). July- September

in a comfortable chair with lumbar support, Subjects were then allowed to relax for five minutes, the experimenter then began each test session and collected minimum of 2 ml of saliva by tilting the head forward, allowing the saliva to pool on the floor of the mouth, then passing the saliva through a short straw into a polypropylene vial. The Salivary samples were labeled and sealed and refrigerated in an ice box within 30 minutes. After all procedures the sealed sample sends to the laboratory on the same day by 2:00 h to store under-15 degree centigrade to the laboratory for later analysis,

Free cortisol level data from the samples of saliva were analyzed in the laboratory by using Salimetric s T M salivary cortisol kit. On day of assay, samples brought at room temperature and thaw completely, vortex, and centrifuge at 1500 x g (@3000 rpm) for15 minutes before adding to assay plate and cortisol was assessed in via enzyme-linked immunosorbent assay as per manufacturer (SalimetricsTM) instructions.

Performance score; Measure of shooting accuracy or shooting score was calculated from the standard shooting scoring board and the final result of competition obtained from the chief coach after the completion of competition, in order to test shooting performance.

Result: Descriptive statistics of study and outcome variables measured in 48 subjects each in experimental and control group. The comparison of base line mean values of study variables (Table-1) and outcome variables (Table-2 ) among the 2 study groups, that is male shooters who had interventions: as MMT and control, shows a non statistically significant difference in the mean values of Age( F= 1.15; p= 0.332), BMI (F= 3.57; p=0.015), heart rate (HR)( F= 0.10;p=0.961), respiratory rate (RR)(F=2.44;p=0.066), diastolic blood pressure (BPD)(F=0.42;p=0.736), and systolic blood pressure (BPS) (F=1.11;p=0.347) and SC(F= 0.02; p = 0.995),,PS (F= 0.40; p = 0.756).

In MMT group, the mean values of Salivary Cortisol (SC) had statistically significantly decreased from the baseline value of 1.33 to 0.66 at 29 t h day and 0.93 at 36 t h day which is statistically significant

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Mindfulness Meditation on HPA-Axis

(F=834.6;p<0.001).The post hoc pair wise comparison of these values indicates highly statistically significant difference among the values. From this it can be infer that the effect of meditation in this group has decreased the SC values significantly from their base line values. The mean value of performance score has statistically significantly increased from 528 to 544(t-value=-6.85, p<0.001) (Graph-1).

Table:1 Mean values of Study variables in comparison between MMT and Control groups

Study Variables

MMT Control Study Variables Mean ±SD Mean ±SD

Age 29.40 4.08 30.2 4.68

BMI 24 .8 24 1

HR 70 6 70 4

RR 15 2 16 2

BPD 119 6 119 3

BPS 79 5 80 3

Table:2 : Comparison of mean values of outcom variables at 3 stages in male shooters of study

Outcome Variable

MM T Group Control Group Outcome Variable Mean ±SD Mean ±SD

SC-0Day 1.33 0.06 1.33 0.06

SC-29th Day 0.66 0.07 1.95 0.08

SC-36th Day 0.93 0.11 1.6 0.11

PS-0Day 528 13 524 2

PS-29th Day 542 13 518 16

Graph- 1: Bland and Altman plot—Comparison of pre and post performance values of study subjects who had meditation as intervention

10

8

6

4

2

0

-2

-4

-6

-8

-10

O O Q O O O O C

7.6

Mean 2.6

-1.96 SD -2.4

460 480 500 520 540 560 580 A V E R A G E of Score29 and Score0

600

In control group, the mean values of Salivary Cortisol (SC) had statistically significantly increased

NJIRM 2011; Vol. 2(3). July- September

from the baseline value of 1.33 to 1.95 at 29 t h day and 1.60 at 36 t h day which is statistically significant (F=577.48;p<0.001).The post hoc pair wise comparison of values indicates highly statistically significant difference among the values. From this it can be infer that the effect of no meditation intervention in this group has increased the SC values significantly from their base line values. The mean value of performance score has statistically significantly decreased from 524 to 522 (t-value=0.65, p<0.001)(Graph-2).

Graph-2: Bland and Altman plot—Comparison of pre and post performance values of study subjects who had no intervention

-5.2,

450 500 550

A V E R A G E of Sco re0 and Score29

eISSN:

Discussion: In the current study, used Salivary Cortisol (SC) as physiological marker and Performance Score (PS) as subjective marker to assess the changes in groups. These parameters are very much reliable to provide true picture of changes and also susceptible for changes in pre competition anxiety or stress. This fact is supported by 8 , 1 0 and also supported by research findings comparing the physiological and psychological markers of stress have been equivocal9. Since the salivary cortisol assay has been proposed as the method of choice for assessing adrenocortical (endocrine) function. Thus in this study included SC as a physiological marker.

The result of the study indicated that there is an increase in post intervention and follow up values in MMT group whereas the control group, it was highly insignificant result. In MMT group, the cortisol level in saliva decreased in post-intervention and follow up. i.e. 50% (.66) and as follow up carry over decrease of 20% (.93). Whereas control group showed an increase of 47% (1.95) and 26% (1.60) pre-competition and post

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+1.96 S D 7.2

Mean

1.0

-1.96 S D

400 600

+1.96 SD

Mindfulness Meditation on HPA-Axis

competition respectively. In performance score experimental group showed an increase of 2.6% (542) from base line (528), whereas control group showed decrease of 0.9% (518) from base line (524). The reason for these changes supported by studies on competition stress, supported that, prior to competing, sport performers encounter more stressors pertinent to performance3. The level of anxiety automatically narrows perception restricting the focus of attention 1 6 , 1 7 , 1 8 , 1 9 . Thus result of this study indicated that there is an decrease in control group and increase in post intervention performance score in all interventional groups; the reason for these changes might be due to decrease in pre competition anxiety.

Cortisol is a hormonal response to acute stress and has been measured to be higher before competition than at resting conditions7. In recent years, however, salivary cortisol has been shown to reliably reflect levels of unbound cortisol in the blood and raised levels have been found to be associated with stress in normal subjects20. Based on these facts if any intervention is effective to reduce competition stress then we observed the reversibility in behaviour of this marker. These observations highlight that all the demands faced by athletes should be considered when preparing and implementing interventions to manage competition stress.

Meditation has been shown to decrease cortisol levels in populations of healthy volunteers21 , but the effect of meditation training program in pre competition stress and release of cortisol levels has not previously been evaluated in Sports population. However, there has been some investigation of the effects of psychosocial intervention on cortisol levels in normal and patient population. Study supported by participants who meditated had better attentional processing on alerting function as well as better mood, lower cortisol, and better immune function, allowing to conclude that randomly assigned short-term intensive meditation causes immediate benefits. This might have improved performance22.

Result of the current study showed intervention group has been shown some amount of follow up

NJIRM 2011; Vol. 2(3). July- September

effects even after one week of intervention this is supported by studies such as, found evidence that post meditation there was significant competitive performance improvements, and these improvements were maintained at 6-month follow-up 2 3.

Conclusion: The past empirical evidence has lent support to the view that psychophysiological recordings may even provide insight into the skill related aspects of a shooter's psychomotor strategies and determinants of successful shooting performance. Results of this study showed positive correlation in MMT than controlled group in one month duration training. It has shown improvement in dependent variables such as decrease salivary cortisol and Performance score of individual shooter. As previous studies the long term training may enhance the further in experimental group. It is suggested that the intensity of improvement and follow-up effect shall be analyzed and compared in long duration interventional training i.e. more than a month. To our knowledge until HPA- Axis has been little evaluated in young athletes, especially in such conditions of pre-competitive stress and efficacy of post relaxation therapies. This work was made possible to find out the changes on the endocrine (HPA axis) activity during intervention, or changes induced in pre-competition stress. Although short-term activations of the HPA axis are adaptive and necessary for everyday functioning, extreme, frequent or chronic activation of this system are associated with negative health outcomes. Existing research has implicated the HPA axis in the development of a variety of sub-clinical and clinical conditions including metabolic syndrome2 4, depression2 5, risk for cardiovascular disease26 and cognitive decline2 7.

References: 1. Mononen K, Konttinen N, Viitasalo J, Era P.

Relationships between postural balance, rifle stability and shooting accuracy among novice rifle shooters. Scand J Med Sci Sports. 2007; 17:180-5.

2. Terry, P. C., & Slade, A. Discriminate effectiveness of psychological state measures in predicting performance outcome in karate

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competition. Perceptual and Motor Skills. 1995; 81(i): 275-286.

3. Stephen D Mellalieu, Richard Neil, Sheldon Hanton, David Fletcher. Competition stress in sport performers: Stressors experienced in the competition environment. Psychology of sport and exercise. 2009; 27 (7): 729-736.

4. Chamberlain, S. T., & Hale, B. D. Competitive state anxiety and self-confidence: Intensity and direction as relative predictors of performance on a golf putting task. Anxiety, Stress, and Coping. 2007; 20: 197-207.

5. Kais, K., & Raudsepp, L. Intensity and direction of competitive state anxiety, self-confidence and athletic performance. Kinesiology. 2005; 37: 13-20.

6. Swain, A., & Jones, G. Explaining performance variance: The relative contribution of intensity and direction dimensions of competitive state anxiety. Anxiety, Stress, and Coping. 1996; 9: 1¬18.

7. Salvador, A., Suay, F., Gonzalez-Bono, E., & Serrano, M. A. Anticipatory Cortisol, testosterone and psychological responses to judo competition in young men. Psychoneuroendocrinology. 2003; 28: 264-375.

8. Filaire, E., Alix, D., Rouveix, M., & Le Scanff, C. Motivation, stress, anxiety, and Cortisol responses in elite paragliders. Perceptual and Motor Skills. 2007; 104: 1271-1281.

9. Filaire, E., Sagnol, M., Ferrand, C, Maso, F., & Lac, G. Psychophysiological stress in judo athletes during competitions. Journal of Sports Medicine and Physical Fitness. 2001; 41: 263¬268.

10. Haneishi, K., Fry, A. C, Moore, C. A., Schilling, B. K., & Li, Y. Cortisol and stress responses during a game and practice in female collegiate soccer players. Journal of Strength and Conditioning Research. 2007; 21: 583-588.

11. Filaire, E., Alix, D., Ferrand, C, Verger, M. Psychophysiological stress in tennis players during the first single match of a tournament. Psychoneuroendocrinology. 2009; 34 (1):150-7.

12. E E Solberg, F Ingjer, A Holen. Reviews of the literature, Recovery from a standardized exercise bout: a study on 31 runners practicing relaxation technique. British Journal of Sports Medicine. 2000; 34:268-272.

13. Astin JA. Stress reduction through mindfulness meditation: Effects on psychological symtomatology, sense of control and spiritual expe-riences. Psychotherapy and Psychosomatics. 1997; 66(2): 97-106.

14. Chiesa A and A. Serretti. A systematic review of neurobiological and clinical features of mindfulness meditations, Psychological Medicine. 2010; 40: 1239-1252.

15. Chambers, R., Lo, B. C. Y., & Allen, N. B. The impact of intensive Mindfulness training on attentional control, cognitive style and affect. Cognitive Therapy & Research. 2008; 32: 303¬22.

16. Ashcraft, M . H. , & Krause, J. A . Working memory, math performance, and math anxiety. Psychonomic Bulletin & Review. 2007; 14: 243-248.

17. Curry, D. G., Meyer, J. E., & McKnney, J. M. Seeing versus perceiving: What you see isn't always what you get. Professional Safety. 2006; 57(6): 28-34.

18. Fredrickson, B. L., & Branigan, C. Positive emotions broaden the scope of attention and thought-action repertoires. Cognition & Emotion. 2005; 19(3): 313-332.

19. Most, S. B., Scholl, B. J., Clifford, E. R., & Simons, D. J. What you see is what you set: Sustained in attentional blindness and the capture of awareness. Psychological Review. 2005; 112(1): 217-242.

20. Kirschbaum C & Hellhammer DH. Salivary cortisol in psychoneuroendocrine research: recent developments and applications. Psychoneuroendocrinology. 1994; 19: 313-333.

21. MacLean, C.R., Walton, K.G., Wenneberg, S.R., Levitsky, D.K., Mandarino, J.P., Waziri, R., Schneider, R.H. Altered responses of cortisol, GH, TSH and testosterone to acute stress after four months' practice of transcendental meditation (TM). Ann. N. Y. Acad. Sci. 1994; 746: 381-384.

22. Tang, Y., Ma, Y., Wang, J., Feng, S., Yu, Q., Rothbart, M. K., et al. Short-term meditation training improves attention and self-regulation. PNAS Proceedings of the National Academy of Sciences of the United States of America. 2007 ; 104: 17152-17156.

23. Crocker, R R. E, Alderman, R. B., & Smith, M. R. Cognitive-affective stress management training

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Mindfulness Meditation on HPA-Axis

with high performance youth volleyball players: Effects on affect, cognition, and performance. Journal of Sport and Exercise Psychology. 1988; 10:448-460.

24. Brunner, E.J., Hemingway, H., Walker, B.R., Page, M., Clarke, P., Juneja, M., Shipley, M.J., Kumari, M., Andrew, R., Seckl, J.R., Papadopoulos, A., Checkley, S., Rumley, A., Lowe, G.D.O., Stansfeld, S.A., Marmot, M.G. Adrenocortical, autonomic, and inflammatory causes of the metabolic syndrome. Circulation. 2002; 106: 2659—2665.

25. Belmaker R.H., Agam G. Major depressive disorder. N. Engl. J. Med. 2008; 358: 55- 68.

26. Smith, G.D., Ben-Shlomo, Y., Beswick, A., Yarnell, J., Lightman, S., Elwood, P. Cortisol, testosterone, and coronary heart disease: prospective evidence from the Caerphilly study. Circulation. 2005; 112: 332—340.

27. Seeman, T.E., McEwen, B.S., Singer, B.H., Albert, M.S., Rowe, J.W. Increase in urinary cortisol excretion and memory declines: MacArthur studies of successful aging. J. Clin. Endocrinol. Metab. 1997;82: 2458—2465.

28. Coulter, H.D. (Ed.).Relaxation and meditation. In: Anatomy of Hatha Yoga: Body and Breath, first ed. Inc. Honesdale, 2001; 547-557.

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Journal of Exercise Science and Physiotherapy, Vol. 6, No. 2: 70-77, 2010

70

The Effect of Music Therapy on Salivary Cortisol as a Reliable

Marker of Pre Competition Stress in Shooting Performance

John1, S., Verma

2, S. K., Khanna

3, G. L.

1Department of Sports Sciences, Punjabi University, Patiala, Punjab, India, email:johnsphysio@gmail.com,

2Professor,

Department of Sports Sciences, Punjabi University, Patiala, Punjab, India, Email: satishsk1@rediffmail.com

3Professor & Dean,

Faculty of Applied Medical Sciences, Manav Rachna International University, Faridabad, Haryana, India.

Introduction

In shooting the requirement of

good physical and psychological condition as well as technical perfection is

highly demanded (Antal et al., 1994).

Pistol shooting is a static activity requiring a strict control of body segments

and posture to align the rear sight aperture

and the foresight through proprioceptive

feedback and gaze fixation either on the target directly or between the target and

the weapon and, therefore, to increase

precision of the shot (Mononen et al., 2007). Air pistol shooting is an Olympic

sport requiring extreme mental

concentration and movement precision for success. Compared to that for rifle

shooting, there is very little literature

related to pistol shooting. To our

knowledge, this is the first study to

determine the efficacy of Music Therapy

(MT) on Salivary Cortisol (SC) in professional shooters. Stress is most often

used to describe an unpleasant emotional

state or condition which is characterized by subjective feelings of tension,

apprehension, and worry. In sports

context it is commonly known as pre-

competition stress or anxiety. Further, researches indicate that anxiety has a

negative effect on these sport outcomes

(Terry & Slade, 1995). Research on how athletes cope with sport-related stress has

been recognized for both its practical and

its theoretical importance because of the debilitating effects that stress may have

on athletic performance (Smith et al.,

1998). Findings of Mellalieu et al (2009)

Abstract

Studies have been performed on the psychophysiological responses of Music Therapy (MT) in

normal and diseased, but little has been done on pre-competition stress (PCS) and Hypothalamic

Pituitary Adrenal (HPA) axis response on sports population. The purpose of the current study was to estimate the contribution of MT on Salivary Cortisol (SC) in reducing PCS, and its effect

on shooting performance (PS). One hundred male shooters between the age range of

29.5±4.3years were examined as experimental (N=50, MT along with the routine sports specific

training) and control (N=50, only with the routine sports specific training). Duration of the study

was 5 weeks, 4 weeks of interventional and 1 week study to determine the follow-up effect. Pre,

post and follow-up data of quantitative phenotypic markers of HPA-Axis by SC and PS were

analyzed. Compared to the control, experimental group has shown significant result, post-

intervention (p<0.001) and in follow-up (p<0.001) in SC and in PS. Experimental group

demonstrated in reduction of PCS level and increase in PS, whereas the control group showed

non-significant result. Results indicated that relaxation therapies such as MT may decrease PCS

and therefore enhance PS. It is concluded that four weeks of MT has an effect on HPA-Axis by

decreasing the level of SC as a reliable physiological marker of PCS.

Key Words: HPA, Cortisol, Pre competition Stress, Music, Shooting.

The Effect of Music Therapy on Salivary Cortisol as a Reliable Marker of Pre Competition Stress in Shooting Performance

– John, S. et al

71

suggest that, prior to competing; sport performers encounter more stressors

pertinent to performance. These

observations highlight that all the

demands faced by the athletes should be considered when preparing and

implementing interventions to manage

competition stress. Pre-competition anxiety is a widely prevalent condition

that exists among athletes of all levels and

within every sport. Its relationship to

performance has been studied both in and out of the sport context through test

anxiety research (Liebert & Morris, 1967)

and anxiety research with athletes (Swain & Jones, 1996; Kais & Raudsepp, 2005;

Chamberlain & Hale, 2007). Despite the

large body of research on pre-competition anxiety, our understanding of its

relationship to performance remains

elusive.

Cortisol is a hormonal response to acute stress and has been measured to be

higher before competition than at resting

conditions (Salvador et al., 2003). Some researchers have found that athletes

produce higher levels of cortisol before

games than before non-competition situations (Salvador et al., 2003; Filaire

et al., 2007; Haneishi et al.,2007). The

results support previous findings of

Filaire et al (2009) that athletes are more anxious before games than during off

days. Because cortisol is secreted as a

result of a threatening stimulus, and sports competition is considered an anxiety-

arousing situation (Salvador et al., 2003).

Research findings comparing the

physiological and psychological markers of stress have been equivocal (Filaire et

al., 2001).

Applied sport psychology, in its efforts to enhance the competitive perfor-

mance of athletes, has traditionally

utilized cognitive behavioral methods and techniques with an emphasis on

developing self-control of internal states,

commonly referred to as psychological

skills training (Whelan et al., 1991). Relaxation techniques have been used in

sports primarily to enhance recovery from

training and competition, manage anxiety and improve performance (Solberg et al.,

2000). One mechanism through which

music may impact on flow is by

enhancing pre-performance mood. Indeed, in a recent review, presented a strong case

for the mood-enhancing effects of music

in a sport context. (Vlachopoulos et al., 2000). Studies support previous research

that found music to be an effective tool

for improving athletic performance ( Karageorghis et al., 1996).

The present study focused on

examining the relation of physiological

response to skilled sport performance, and investigating the relevance of music

therapy in pre-competition stress. For this

purpose, physiological variable such as Salivary Cortisol (SC) were recorded

during the training and pre-competition

phase of actual shooting.

Materials and Methods

Subjects: A total of 110 healthy

male elite level shooters aged

(29.5±4.3years) selected for the study. Subjects were voluntarily recruited from

national shooting team; permission was

obtained from officials. Questionnaires administered prior to the experiment were

indicated that no volunteers are included

as per exclusion criteria such as any

physical or mental illness, hearing impairment, and have been under going

music therapies for last 3 months. All

subjects were nonsmokers, medication-free and not habitual drinkers. The aims

of the present study, the procedures

Journal of Exercise Science and Physiotherapy, Vol. 6, No. 2: 70-77, 2010

72

involved and potential risks of the study were explained carefully to subjects, and

the written consent was obtained prior to

the study. The study and all protocols

were approved by research ethical committee of Punjabi University.

Participants were randomly

allocated into two groups; experimental (Music Therapy) and Control by multiple

blocked random sampling of 55 in each

group, after the dropout 100 (50±3)

subjects could complete the study in each group. Heart Rate (70±3bpm),

Respiratory Rate (15±2rpm), BMI

(24±1.04kg/cm2) and Blood Pressure

(119±4/79±4 mm of Hg) were recruited to

participate in this study. Intervention trial

was conducted to the experimental subjects one week prior to the study.

Concerning impediments to effective

practice, subjects were monitored by the

researcher and experts during the interventions. The intervention was

provided over the course of four weeks

and one week follow-up, group sessions with a maximum of 8 participants each,

20 minutes session per day, 6 days a week

and one day was off per week. Participants were asked not to consume

caffeine or alcoholic beverages for 12 h,

and not to exercise for 12 h prior to the

experiment especially during testing.

Procedure: The all participants of

each batch reported to the laboratory at

08:00AM, each session conducted in the morning (between 8 AM and 10 AM) and

The subject changed into loose fitting

clothing, and shoes removed then the

participants were instructed to lie in the supine position on the floor mat in a quiet,

light-attenuated electrically shielded room

with the temperature between 24 and 28 °C with their eyes closed.

Interventions:

Music Therapy: CD of 30-40 music of Raga Darbari based Hindi songs

given to the experimental subjects one

week prior to the study and asked them to

select 5-10 songs according to their choice from the songs given, after

selection of individual choice of music

made separate folder for each subjects. The music was delivered on Sony

TM MP3

player by headphone with volume of 60-

70 dB, 60 to 70 beats per minute.

The music therapy group was encouraged to assume a comfortable

position in supine position on a floor mat

during delivery of the music intervention, Advised subjects to clear their minds and

allow their muscles to relax throughout

the training session. The participants left the room after 20 minutes of session.

Experimental group underwent music

therapy along with the routine sports

specific training and control group only with the routine sports specific training.

Testing: The testing sessions were

conducted between 8 am and 10 am and the same researcher tested all subjects.

Measurement day scheduled one day prior

to beginning the 1st week, 29

th day and

36th day, subjects were assessed for pre-

test, post-test and follow-up data

respectively, except Performance Test, in

a quiet controlled room with ambient temperature (24–28

0C). The performance

score calculated by pre-scheduled a

competition in a internationally standard shooting range on one day prior to

beginning the 1st week, and on 29

th day,

subjects were assessed for pre-test, post-

test Performance score respectively.

All the participants were

instructed to avoid consuming stimulant

beverages, tea, and coffee; exercising, in the 12 hours previous to the examination.

All the participants of each batch reported

The Effect of Music Therapy on Salivary Cortisol as a Reliable Marker of Pre Competition Stress in Shooting Performance

– John, S. et al

73

to the laboratory at 08:00AM, measurement procedure started between

09:00 am and 10:00 am, to control as

much as possible for time of day, to avoid

circadian variations. Prior to testing, Participants attended a detailed briefing

session where they received full verbal

instructions regarding the procedures of the study. Salivary Cortisol samples were

taken been 9:00 am -10:00 am to

minimize time of day effects. All subjects

were tested individually.

Salivary Cortisol: For obtaining

the free, unbound, biologically active

moiety of cortisol, saliva samples were collected. To rid the mouth of

contaminates, subjects rinsed thoroughly

with water ten minutes before saliva collection. Subjects sat unrestrained in a

comfortable chair with lumbar support,

Subjects were then allowed to relax for

five minutes, the experimenter then began each test session and collected minimum

of 2 ml of saliva by tilting the head

forward, allowing the saliva to pool on the floor of the mouth, then passing the saliva

through a short straw into a polypropylene

vial. The Salivary samples were labelled and sealed and refrigerated in an ice box

within 30 minutes. After all procedures

the sealed sample sends to the laboratory

on the same day by 2:00 h to store under-15 degree centigrade to the laboratory for

later analysis,

Free cortisol level data from the samples of saliva were analyzed in the

laboratory by using SalimetricsTM

salivary

cortisol kit. On day of assay, samples

brought at room temperature and thaw completely, vortex, and centrifuge at 1500

x g (@3000 rpm) for 15 minutes before

adding to assay plate and cortisol was assessed in via enzyme-linked

immunosorbent assay as per manufacturer (Salimetrics

TM) instructions.

Performance score: Measure of

shooting accuracy or shooting score was

calculated from the standard shooting scoring board and the final result of

competition obtained from the chief coach

after the completion of competition, in order to test shooting performance.

Results

Table: 1 Comparison of mean values of study

variables in male shooters of study groups

Study Variable

Music Therapy

Control Group

Mean ± SD Mean ± SD

Age 28.67 4.24 30.2 4.68

BMI 24.27 1.11 23.8 1

HR 69.54 4.14 70.02 4.12

RR 15.46 1.73 15.61 1.58

BPD 119.42 4.38 119.41 3.2

BPS 78.58 3.92 79.93 3.3

Table: 2 Comparison of mean values of outcome

variables at 3 stages in male shooters of study groups

Outcome Variable

Music Therapy Control

Group

Mean ± SD Mean ± SD

SC-0Day 1.33 0.06 1.33 0.06

SC-29th Day 0.53 0.07 1.95 0.08

SC-36th Day 0.91 0.11 1.6 0.11

PS-0Day 528 29 544 30

PS-29th Day 522 31 518 28

Table: 3 Comparison of mean values of outcome

variables at 3 stages in male shooters of study groups

(One way Analysis of Variance) Sum of

Squares

df Mean

Square

F Sig.

SC 0-

Between

Groups

Within

Groups

Total

0.00

1.65

1.65

3

195

198

0.000

0.008

0.02 0.995

SC 29-

Between

Groups

Within

Groups

Total

76.74

0.95

77.69

3

195

198

25.58

0.01

5.25 0.000

SC 36-

Between

Groups

32.81

2.16

34.97

3

195

198

10.94

0.01

986.67 0.000

Journal of Exercise Science and Physiotherapy, Vol. 6, No. 2: 70-77, 2010

74

Within

Groups

Total

PS 0-

Between

Groups

Within

Groups

Total

923.33

151648.89

152572.21

3

195

198

307.78

777.69

0.40 0.756

PS 29-

Between

Groups

Within

Groups

Total

28100.54

133436.06

161536.59

3

195

198

9366.85

684.29

13.69 0.000

Descriptive statistics of study and

outcome variables measured in 52 and 48 subjects in experimental and control

group respectively. The comparison of

base line mean values of study variables

(Table-1) and outcome variables (Table-2 ) among the two study groups, that is

male shooters who had interventions: as

music and control, shows a non statistically significant difference in the

mean values of Age (F= 1.15; p= 0.33),

BMI (F= 3.57; p=0.02), heart rate (HR) ( F=0.10; p=0.96), respiratory rate (RR)

(F=2.44;p=0.07), diastolic blood pressure

(BPD) (F=0.42; p=0.74), and systolic

blood pressure (BPS) (F=1.11; p=0.35) and SC(F=0.02; p=0.99), PS (F=0.40; p=

0.756).

In Experimental group, the mean values of Salivary Cortisol (SC) had

statistically significantly decreased from

the baseline value of 1.33 to 0.53 at 29th

day and 0.91 at 36th day which is

statistically significant (F=1.20;p<0.001).

The post hoc pair wise comparison of

these three values indicates highly statistically significant difference among

the three values. From this it can be infer

that the effect of music in this group has decreased the SC values significantly

from their base line values. The mean

value of performance score has

statistically significantly increased from 528 to 544(t-value=-9.67, p<0.001).

In control group, the mean values of Salivary Cortisol (SC) had statistically

significantly increased from the baseline

value of 1.33 to 1.95 at 29th day and 1.60

at 36th day which is statistically

significant (F=577.48; p<0.001). The post

hoc pair wise comparison of these three

values indicates highly statistically significant difference among the three

values. From this it can be infer that the

effect of no music intervention in this

group has increased the SC values significantly from their base line values.

The mean value of performance score has

statistically significantly decreased from 524 to 522 (t-value=0.65, p<0.001).

Discussion

In the current study, used Salivary Cortisol (SC) as physiological markers

and Performance Score (PS) as one

subjective marker to assess the changes

with music intervention group and also assessed changes in control group during

the same duration. These parameters are

very much reliable to provide true picture of changes and they are also very much

susceptible for changes in pre competition

anxiety or stress. This fact is supported by (Filarie et al., 2007 and Hanesishi et al.,

2004) and also supported by research

findings comparing the physiological and

psychological markers of stress have been equivocal (Filaire et al., 2001). Since the

salivary cortisol assay has been proposed

as the method of choice for assessing adrenocortical (endocrine) function and

responses to competitive stress Thus in

this study also included SC as a

physiological marker.

Result have been proved, during

intervention of music therapy, the cortisol

level in saliva decreased in music group post-intervention 60% (.53) and follow-up

29% (.91). Whereas control group showed

The Effect of Music Therapy on Salivary Cortisol as a Reliable Marker of Pre Competition Stress in Shooting Performance

– John, S. et al

75

an increase of 47% 1.95 and 26% 1.60 pre-competition and post competition

respectively. Study also showed the pre

and post competition performance score

of experimental group has increased 3% (544) whereas control group showed a

decrease of performance score 0.9%

(518).

The result of the study indicated

that there is an increase in post

intervention and follow up values in

experimental group was showing more effective whereas the control groups it

was highly insignificant result. The reason

for these changes might be supported by studies on competition stress have been

observed (Stephen D Mellalieu et. al.,

2009), supported that, prior to competing, sport performers encounter more stressors

pertinent to performance. The level of

anxiety automatically narrows perception

restricting the focus of attention (Fredrickson & Branigan, 2005; Most et

al., 2005; Curry et al., 2006; Ashcraft &

Krause, 2007). Thus result of this study indicated that there is an decrease in

control group and increase in post

intervention performance score in music therapy group; the reason for these

changes might be due to decrease in pre

competition stress.

supported by studies on cortisol have been observed, Cortisol is a

hormonal response to acute stress and has

been measured to be higher before competition than at resting conditions

(Salvador et al., 2003). In recent years,

however, salivary cortisol has been shown

to reliably reflect levels of unbound cortisol in the blood and raised levels

have been found to be associated with

stress in normal subjects (Kirschbaum and Hellhammer, 1994).

Music affects a reduction in sympathetic nervous control and therefore

a reduction in heart and respiration rates,

metabolism, oxygen consumption, muscle

tension, (Lee et al 2005). Listening to classical music increases heart rate

variability helps in stress reduction,

whereas listening to noise or rock music decreases heart rate variability (reflecting

greater stress) (Chuang et al., 2010).

Also supported by reductions in

autonomic activity and self-reported tension and improved performance of

surgeons (Allen and Blaskovich, 1994). In

the current study music therapy has also been given based on classical music that

might have increased relaxation in groups

which have under gone music interventions.

As repeated listening to music

affects people's preference for it as well as

their physiological responses to it (Knight and Rickard, 2001), Music appears to

exert direct physiological effects through

the autonomic nervous system (Rakel et. al., 2003). In our study we have given 20

minutes session for 4 weeks this could

supports the more effect of music. In addition, lower anxiety is expected to

promote psychological well being by

decreasing plasma norepinephrine and

cortisol (Mockel et al., 1994) and enhancing relaxation and calmness.

Therefore, soothing music was expected

to have a therapeutic effect on relaxation.

Result of the current study

showed in experimental group have been

shown some amount of follow up effects

even after one week of intervention this is supported by studies such as, (Caine,

1992) found evidence that playing

recorded music for infants in the neonatal intensive care unit increased weight gain

and shortened lengths of stay. Moreover,

Journal of Exercise Science and Physiotherapy, Vol. 6, No. 2: 70-77, 2010

76

a follow-up study of the infants that participated in Caine's music listening

study indicated that infants who

participated in the music intervention

were rated as calmer by their mothers at 6 months of age compared to infants

without music intervention. The results

concerning the affective component of symptom changes showed that the effect

of music therapy was sustained. One

week after the discontinuation of sessions

(Guetin et al., 2009).

Conclusion

The neuroendocrine scientific

studies of music is clearly still in its infancy, but the initial findings reviewed

earlier promise both to reveal the

mechanisms by which such training might exert its effects on relaxation that

underlie complex regulatory mental

functions. Results of this study indicated

that relaxation therapies such as music therapy may decrease pre-competition

stress and will enhance sports

performance. It is concluded that in four weeks of music training has an effect on

HPA-Axis by decreasing the level of

salivary cortisol as a reliable physiological marker of pre-competition

stress.

The past empirical evidence has

lent support to the view that psychophysiological recordings may even

provide insight into the skill related

aspects of a shooter's psychomotor strategies and determinants of successful

shooting performance.

To our knowledge, the salivary

cortisol has been little evaluated in young athletes and, in such conditions of pre-

competitive stress and post relaxation

therapies. This work was made possible to find out the changes on the

neuroendocrine (ANS and HPA axis) activity during intervention, or changes

induced in pre-competition stress.

Although short-term activations of the

HPA axis are adaptive and necessary for everyday functioning, extreme, frequent

or chronic activation of this system are

associated with negative health outcomes. Existing research has implicated the HPA

axis in the development of a variety of

sub-clinical and clinical conditions

including metabolic syndrome (Brunner et al., 2002), depression (Belmaker and

Agam, 2008), risk for cardiovascular

disease (Smith et al., 2005) and cognitive decline (Seeman et al., 1997).

References

Allen, K., Blascovich, J. 1994. Effects of music on cardiovascular reactivity among surgeons. JAMA 272: 882-884.

Antal, L., Shankar, R. 1994. Theory and Methodology of Training, Pistol Shooting. Psychonomic Bulletin & Review, 14(2): 243-248.

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