Association between physical activity and the risk of burnout in healthcare workers: systematic review

Background: Burnout is a multidimensional psychological syndrome arising from chronic workplace stress. Healthcare workers, who operate in physically and emotionally exhausting work contexts, constitute a vulnerable group. This, coupled with the subsequent impact on patients and public economic resources, makes burnout a significant public health concern. Various self-care practices are suggested to have a positive effect against burnout of healthcare workers. Among these practices, physical activity stands out for its ability to combine psychological and physiological/biochemical mechanisms. In fact, it promotes psychological detachment from work and increases people's self-efficacy by inhibiting neurotransmitters and neuromodulators, increasing endorphin levels, enhancing mitochondrial function, and attenuating the hypothalamic pituitary-adrenal axis response to stress. Objective: Our objective is to conduct a systematic review of the evidence of association between physical activity and burnout among healthcare workers directly engaged in providing care services. Methods: We considered healthcare workers, physical activity, and burnout, framing them respectively as Population, Exposure, and Outcome. We searched APA PsychArticles, MEDLINE, and Scopus databases up until July 2022. We extracted relevant data on study design, methods to measure exposure and outcome, and statistical approaches. Results: Our analysis encompassed twenty-one independent studies. While two studies explicitly focused on physical activity, the remaining investigations were exploratory in nature and examined various predictors, including physical activity. The most commonly utilized questionnaire was the Maslach Burnout Inventory. Due to the heterogeneity in definitions and cutoffs employed, the reported prevalence of burnout varied widely, ranging from 7% to 83%. Heterogeneity was also observed in the measurement tools used to assess physical activity, with objective measures rarely employed. Three studies utilized structured questionnaires to assess different types of exercise, while the majority of studies only recorded the attainment of a benchmark or reported the frequency, intensity, and/or duration of exercise. The reported prevalence of physically active healthcare workers ranged from 44% to 87%. The analyses, though through a variety of inferential approaches, indicate that physical activity is often associated with a reduced risk of burnout, particularly in the domain of emotional exhaustion and depersonalization. Furthermore, we compiled and classified a list of factors associated with burnout. Conclusions: Our comprehensive overview of studies investigating the association between physical activity and burnout in healthcare workers reveals significant heterogeneity in definitions, measurements and analyses adopted in literature. To address this issue, it would be crucial to adopt a clear definition of physical activity and make thoughtful choices regarding measurement tools and methodologies for data analysis. Our considerations regarding the measurement of burnout and the comprehensive list of factors associated with it have the potential to improve future studies aimed also to inform decision makers, thus laying the foundations for more effective management measures to address burnout.