At-home exercise may help reduce depression symptoms, burnout, and absenteeism in healthcare workers, according to a new study.
The randomized clinical trial followed 288 healthcare workers over 12 weeks and found a reduction in depressive symptoms among participants who exercised for 80 minutes per week with an application-based program. Adherence to the program decreased to 23% of participants by the end of the study, however.
When combined with institutional support, “this is one solution that an individual can take to support themselves a little bit better,” study author Eli Puterman, PhD, Canada Research Chair in Physical Activity and Health and associate professor of kinesiology at the University of British Columbia in Vancouver, told Medscape Medical News.
The study was published August 9 in JAMA Psychiatry.
Improved Mental Health
During the COVID-19 pandemic, healthcare workers faced many new challenges and stressors. Concern about burnout and absenteeism among health workers also rose during this period and motivated the study. The pandemic likely exacerbated and revealed the extent of mental health concerns in the workforce, said Puterman.
“There was already a lot of burnout. There was a lot of stress, a lot of sick leave. I think the pandemic really brought these issues to light, and it just made them worse as well,” he added. The study participants had notably higher baseline depression scores than the prepandemic averages.
Between April and July 2022, the investigators recruited nearly 300 healthcare workers with low activity levels from an urban healthcare organization in British Columbia. They assigned participants to an intervention or control group for the 12-week study. The intervention group was asked to complete four 20-minute exercise sessions each week using apps that guided users in yoga, running, barre, and body weight interval training. The control group was placed on a wait list and received the apps at the end of the study.
The study population was racially and ethnically diverse, and there was a greater level of participation from nurses, who constitute a large part of the workforce. Roughly 85% of participants were women.
By the end of the 12 weeks, the investigators found a small to medium reduction in depressive symptoms (effect size [ES], −0.41), measured with the Center for Epidemiological Studies Depression Scale. Smaller, but still significant, effects were seen as early as 4 weeks into the study.
The investigators also found significant improvements among participants following the exercise program in symptoms of burnout, including cynicism (ES, −0.33) and emotional exhaustion (ES, −0.39), as well as absenteeism (r = 0.15).
Application-Based
The investigators designed the study with an at-home, application-based program through the Down Dog suite of exercise apps. This approach provided a low-cost option that was convenient during the height of the pandemic when gyms and other exercise facilities were closed.
“There’s an ease to at-home exercise that fulfills that need,” said Puterman. From an institutional perspective, app subscriptions are also more cost-effective than expensive gym memberships, for example. In the future, Puterman hopes to extend the study to more health workers across British Columbia and assess whether exercise interventions can help reduce healthcare expenditure.
Exercise apps may not be suitable for everyone, though. In the first week of the trial, about half of the participants completed the full 80 minutes of exercise with the apps. At week 12, that adherence dropped to less than a quarter of participants.
The low adherence at the end of the trial was “eye opening” for Puterman, who said that it demonstrated the importance of support mechanisms for maintaining good exercise habits. By contrast, one of his previous studies maintained greater adherence, which Puterman attributed to weekly phone calls to check in with participants.
“Timely, Relevant, Interesting”
Commenting on the study for Medscape, David Gratzer, MD, a physician and attending psychiatrist at the Centre for Addiction and Mental Health in Toronto, said that it is a well-designed investigation of a low-cost and highly scalable intervention for an increasingly relevant issue. Gratzer was not involved in the research.
“Research on burnout and a practical, real-world intervention is not only interesting from a literature perspective, it’s also highly relevant across North America,” said Gratzer. He summarized the study as “timely, relevant, interesting.”
Gratzer noted that the low adherence is a limitation of the study. “It’s not a cure-all or a panacea for all burnout,” he said. Rather, it may provide one possible low-cost option for some healthcare workers struggling with burnout and depressive symptoms.
Puterman hopes that institutions and governments will invest more in improving healthcare workers’ access to a range of mental health resources, adding that “there is a move in the right direction.”
The study was supported by the Kinesiology Equipment and Research Accelerator Fund at the University of British Columbia’s School of Kinesiology. Puterman and Gratzer reported no relevant financial relationships.
JAMA Psychiatry. Published August 9, 2023. Abstract
Gwendolyn Rak is a health reporter for Medscape and Univadis based in Brooklyn, New York.
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