At-home, mobile app-based exercise reduced depressive symptoms and signs of burnout in healthcare workers, though adherence to the program proved challenging, the randomized COPE trial showed.
By the trial’s end at 12 weeks, a significant small to medium treatment effect was seen for depressive symptoms in the exercise group compared with a control group that was placed on a wait list for the apps (effect size [ES] -0.41, 95% CI -0.69 to -0.13), reported Eli Puterman, PhD, of the School of Kinesiology at the University of British Columbia in Vancouver, and co-authors in JAMA Psychiatry.
In the nearly 300-participant study, the health workers assigned to the intervention — which involved four 20-minute exercise sessions a week — also experienced significant reductions in two key signs of burnout: cynicism (ES -0.33, 95% CI -0.53 to -0.13) and emotional exhaustion (ES -0.39, 95% CI -0.64 to -0.14).
A significant treatment effect on rates of absenteeism was also observed (r=0.15, 95% CI 0.03-0.26).
The researchers sought to conduct this study after recognizing the mental health effects on healthcare workers driven by the COVID-19 pandemic.
“As a result of the wide and growing effects of the pandemic on HCWs [healthcare workers], managing this mental health crisis is now a global imperative,” Puterman and team wrote. “Attention to occupational influences (e.g., work hours, contractual demands) is necessary to protect the workforce from loss of experienced HCWs.”
“There is also a pressing need to deliver innovative and scalable interventions that can directly mitigate depleted mental health among HCWs, because without such interventions, HCWs’ mental health and intention to leave their professions will worsen to a devastating level, causing a potentially irretrievable strain on our healthcare systems,” they added.
Puterman told MedPage Today that “the main takeaway is this idea that physical activity and exercise at home using apps can improve mental health and sick leaves over a period of time, and especially [for] those who really stick with the program.”
However, participant adherence to the 80 minutes of exercise per week decreased from 54.9% to 23.2% of the 142 participants in the exercise group between weeks 2 and 12. By week 12, 26.1% of participants were engaged in less than 20 minutes of exercise per week. Still, those who maintained higher levels of exercise continued to see effects.
For example, for the participants who completed between 20 and 79 minutes of exercise each week, there were small and significant effects in cynicism (ES -0.34, 95% CI -0.58 to -0.09) and emotional exhaustion (ES -0.39, 95% CI -0.68 to -0.09) at week 12.
“Our work supports this conclusion that for people who can take up exercise with the simple free provision of a suite of apps, exercise can improve mental health,” Puterman said. “Yet, in our study, many did not find that our solution enabled them to maintain the minimum level of exercise to improve their mental health.”
“Almost all behavioral clinical interventions struggle with adherence,” he added. “In our study, there was a significant decline in those completing an average of 80 minutes per week over the 12 weeks. Yet, approximately 50% remained engaged with the apps to some extent, even if they did not meet the 80 minutes on average over the course of the trial.”
He noted that the results show the importance of finding interventions to support healthcare workers who want to remain engaged in physical activity whether it is app-based or not. The longer a healthcare worker can continue to exercise regularly, the better their outcomes for depression and burnout will be over time, he stressed.
Puterman also pointed out that many healthcare workers would likely benefit from psychological and behavioral support in addition to physical activity. More programs should be developed to provide healthcare workers with a range of options for managing depression and burnout, including better approaches to encourage exercise and the appropriate mental health support, he suggested.
“We have to figure out better approaches to improve adherence,” he added. “The evidence shows that for mild-to-moderate depression, exercise can sometimes be a stand-alone intervention program. Now, we just have to figure out how to get people to increase their motivation [and] their opportunities for it, so that’s on us as researchers and as an institution to develop the right types of programs that people would want to stick to.”
For the COPE trial, the researchers recruited 288 participants from an urban healthcare organization in British Columbia from April 6 to July 4, 2022. Mean age was 41 years, 85.4% were women, 37.2% were white, 19% were Chinese, 12% were Latin American, and 8% were Filipino. Most participants were either nurses (42%), allied health professionals (28%), or administrative staff (24%), but the trial also included some physicians/surgeons and pharmacists.
Researchers randomized 142 participants to the exercise group (consisting of the four 20-minute sessions per week using a suite of free body weight interval training, yoga, barre, and running apps) and 146 participants to the wait-listed control group (who received the apps at the end of the trial and were asked to maintain their current levels of physical activity).
They measured the between-group difference in depressive symptoms using the 10-item Center for Epidemiological Studies Depression Scale. They used the Feingold approach to calculate the effect sizes every 2 weeks. Burnout symptoms were measured using the 16-item Maslach Burnout Inventory, and absenteeism was measured by asking the participants the question, “In the past 2 weeks, how many days did you call in sick when you were scheduled to work?”
The researchers used the minutes recorded in the app to measure each participant’s adherence.
Puterman and team noted that the very small number of physicians who participated in the study was a limitation.
The trial was supported by the University of British Columbia’s School of Kinesiology Equipment and Research Accelerator Fund.
Puterman reported receiving personal fees as a member of the scientific advisory board for John W. Brick Mental Health Foundation.
Co-authors reported no financial conflicts of interest.
Source Reference: Gosselin Boucher V, et al “Effects of 12 weeks of at-home, application-based exercise on health care workers’ depressive symptoms, burnout, and absenteeism: a randomized clinical trial” JAMA Psychiatry 2023; DOI: 10.1001/jamapsychiatry.2023.2706.