Exercise apps a good prescription to boost healthcare workers' mental health

The study, published today in JAMA Psychiatry, divided participants into either a waitlisted control group or an exercise group who were given free access to a suite of home exercise apps called DownDog, that included yoga, cardio and strength training. They were asked to aim for at least 80 minutes of moderate-intensity exercise per week over 12 weeks.

"The exercise group reported significantly lower levels of depressive symptoms compared to the control group as the study progressed," said first author Dr. Vincent Gosselin-Boucher, a postdoctoral fellow at UBC's school of kinesiology. "The majority of the participants in the study started very high on the scale for depressive symptoms compared to the general population so the changes were actually quite amazing to see."

The positive effects were most pronounced among participants who completed an average of at least 80 minutes of exercise per week.

In addition to depressive symptoms, the researchers measured burnout symptoms and sick days over the two-week period prior to the beginning of their participation in the study, and every two weeks during the trial, while the exercise apps tracked participants' workouts.

Exercise improved two measured facets of burnout, namely cynicism and emotional exhaustion. The exercise group also reported fewer sick days than the control group.

Using physical activity to boost mental health

While previous research has shown that exercise can improve depressive symptoms, researchers said behavioural approaches such as exercise were missing in the mental health initiatives offered by healthcare institutions around the world to address covid-19's toll on their staff's mental health.

"Our study provides the first evidence that working out at home using exercise apps, even with limited equipment, can significantly enhance the mental health of healthcare workers," said lead author Dr. Eli Puterman, an associate professor at UBC's school of kinesiology and Canada Research Chair in Physical Activity and Health.

"The past three years have been incredibly difficult for healthcare workers. Offering accessible, easy ways to exercise could be a great tool for employers to support their staff's mental well-being, in addition to the institutional, provincial, and federal measures currently being undertaken to reduce healthcare workers' burnout, sick leave and resignations."

The study was conducted in collaboration with Providence Health Care and recruited participants across acute and long-term care hospitals in Vancouver, B.C. Most participants were women who worked as nurses.

For study co-investigator Agnes Black, director of Health Services and Clinical Research and Knowledge Translation at Providence Health Care, the study offers a welcome, preventative approach to mental health care.

"We recognize the incredible stress healthcare workers have endured during the pandemic and amid ongoing staff shortages. This is a really innovative and low-cost way to have a positive impact by putting our money upstream, before people are in crisis, are burnt out and have to call in sick. It's a way to say, 'We want to make it super easy for you to fit exercise into your day so you can stay physically and mentally healthy as you continue your vital work.'"

Making working out a habit

The study found that a major challenge was getting participants to stick to the program: between week two and week 12, adherence to the recommended 80 minutes of exercise per week dropped to 23 per cent of participants, from 54 per cent.

In the future, the researchers plan to explore whether providing motivational support such as fitness coaches can nurture the exercise habit.

"We also hope to do longer-term trials to focus on the broader mental, physical and economic impacts of this type of intervention," said Dr. Puterman.

He encourages healthcare institutions to think about other ways they can support healthcare workers to be more physically active, such as offering free gym memberships, walk breaks at work, or staff exercise rooms within hospitals.

"While our findings underscore the potential of low-barrier interventions like offering exercise apps, we also have to figure out and address factors that prevent healthcare workers from exercising. Whether these are work-related stressors or other factors, we need to support healthcare workers on multiple fronts."