School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Educational and Counselling Psychology and Special Education, University of British Columbia, Vancouver, British Columbia, Canada.
JAMA Psychiatry. 2023 Nov 1;80(11):1101-1109. doi: 10.1001/jamapsychiatry.2023.2706.
During the COVID-19 pandemic, health care workers (HCWs) reported a significant decline in their mental health. One potential health behavior intervention that has been shown to be effective for improving mental health is exercise, which may be facilitated by taking advantage of mobile application (app) technologies.
To determine the extent to which a 12-week app-based exercise intervention can reduce depressive symptoms, burnout, and absenteeism in HCWs, compared with a wait list control condition.
DESIGN, SETTING, AND PARTICIPANTS: A 2-group randomized clinical trial was conducted, with participants screened from April 6 to July 4, 2022. Participants were recruited from an urban health care organization in British Columbia, Canada. Participants completed measures before randomization and every 2 weeks thereafter.
Exercise condition participants were asked to complete four 20-minute sessions per week using a suite of body weight interval training, yoga, barre, and running apps. Wait-listed control participants received the apps at the end of the trial.
The primary outcome consisted of the between-group difference in depressive symptoms measured with the 10-item Center for Epidemiological Studies Depression Scale. The secondary outcomes corresponded to 3 subfacets of burnout (cynicism, emotional exhaustion, and professional efficacy) and absenteeism. Intention-to-treat analyses were completed with multilevel structural equation modeling, and Feingold effect sizes (ES) were estimated every 2 weeks.
A total of 288 participants (mean [SD] age, 41.0 [10.8] years; 246 [85.4%] women) were randomized to either exercise (n = 142) or wait list control (n = 146) conditions. Results revealed that ESs for depressive symptoms were in the small to medium range by trial's end (week 12, -0.41 [95% CI, -0.69 to -0.13]). Significant and consistent treatment effects were revealed for 2 facets of burnout, namely cynicism (week 12 ES, -0.33 [95% CI, -0.53 to -0.13]) and emotional exhaustion (week 12 ES, -0.39 [95% CI, -0.64 to -0.14]), as well as absenteeism (r = 0.15 [95% CI, 0.03-0.26]). Adherence to the 80 minutes per week of exercise decreased from 78 (54.9%) to 33 (23.2%) participants between weeks 2 and 12.
Although exercise was able to reduce depressive symptoms among HCWs, adherence was low toward the end of the trial. Optimizing adherence to exercise programming represents an important challenge to help maintain improvements in mental health among HCWs.
ClinicalTrials.gov Identifier: NCT05271006.
在 COVID-19 大流行期间，医护人员报告称他们的心理健康状况显著下降。已经证明，一种潜在的健康行为干预措施，即运动，通过利用移动应用程序（app）技术，可以有效改善心理健康，这可能是有益的。
确定为期 12 周的基于应用程序的运动干预措施与等待名单对照条件相比，在多大程度上可以减轻医护人员的抑郁症状、倦怠和缺勤率。
设计、设置和参与者：这是一项 2 组随机临床试验，参与者于 2022 年 4 月 6 日至 7 月 4 日进行筛查。参与者从加拿大不列颠哥伦比亚省的一个城市医疗保健组织招募。参与者在随机分组前和此后每 2 周完成一次测量。
运动条件组的参与者被要求每周使用一系列体重间歇训练、瑜伽、巴雷和跑步应用程序完成四组 20 分钟的课程。等待名单对照组在试验结束时获得了这些应用程序。
主要结果是使用 10 项流行病学研究中心抑郁量表评估的抑郁症状的组间差异。次要结果对应于倦怠的 3 个子方面（玩世不恭、情绪耗竭和职业效能）和缺勤率。采用多层次结构方程模型进行意向治疗分析，并每 2 周估计一次费因戈尔德效应量（ES）。
共有 288 名参与者（平均[标准差]年龄为 41.0[10.8]岁；246[85.4%]名女性）被随机分配至运动（n=142）或等待名单对照（n=146）条件。结果表明，到试验结束时，抑郁症状的 ES 处于小到中等范围（第 12 周，-0.41[95%置信区间，-0.69 至 -0.13]）。倦怠的 2 个方面表现出显著且一致的治疗效果，即玩世不恭（第 12 周 ES，-0.33[95%置信区间，-0.53 至 -0.13]）和情绪耗竭（第 12 周 ES，-0.39[95%置信区间，-0.64 至 -0.14]），以及缺勤率（r=0.15[95%置信区间，0.03-0.26]）。每周 80 分钟的运动锻炼的依从性从第 2 周到第 12 周从 78（54.9%）下降到 33（23.2%）名参与者。
尽管运动能够减轻医护人员的抑郁症状，但在试验结束时的依从性较低。优化运动方案的依从性是帮助维持医护人员心理健康改善的一个重要挑战。
ClinicalTrials.gov 标识符：NCT05271006。
