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Article history:
Received 14 January 2013
Received in revised form 20 March 2013
Accepted 29 March 2013
Objective: To examine how cardiorespiratory tness and self-perceived stress are associated with
burnout and depression. To determine if any relationship between stress and burnout/depression is
mitigated among participants with high tness levels.
Methods: 197 participants (51% men, mean age = 39.2 years) took part in the study. The Astrand bicycle
test was used to assess cardorespiratory tness. Burnout was measured with the ShiromMelamed
Burnout Questionnaire (SMBQ), depressive symptoms with the Hospital Anxiety and Depression Scale
(HAD-D). A gender-matched stratied sample was used to ensure that participants with varying stress
levels were equally represented.
Results: Participants with moderate and high tness reported fewer symptoms of burnout and
depression than participants with low tness. Individuals with high stress who also had moderate or
high tness levels reported lower scores on the SMBQ Tension subscale and the HAD-D than individuals
with high stress, but low tness levels.
Conclusion: Better cardiovascular tness seems to be associated with decreased symptoms of burnout
and a better capacity to cope with stress.
Practical implications: Promoting and measuring cardiorespiratory tness can motivate employees to
adopt a more physically active lifestyle and thus strengthen their ability to cope with stress exposure and
stress-related disorders.
2013 Elsevier Ireland Ltd. All rights reserved.
Keywords:
Astrand bicycle test
Burnout
Cardiorespiratory tness
Depression
Gender
Mental health
Stress
Submaximal tness test
1. Introduction
Having good cardiorespiratory tness is associated with
reduced cardiovascular risk markers, morbidity [1] and mortality
[25], as well as reduced risks of cancer [6,7].
At work, it has been shown that men with low and medium
cardiorespiratory tness may have an increased risk of cardiovascular and all-cause mortality if exposed to high physical work
demands [8]. Signicant cross-sectional and prospective relationships exist between cardiorespiratory tness and mental health
[9]. While a considerable amount of studies have shown that high
cardiorespiratory tness protects against the development of
depressive symptoms [1012], the question of whether cardiorespiratory tness is associated with stress-related symptoms of
occupational burnout is not thoroughly investigated [13,14].
Exposure to occupational stress is associated with both physical
impairments [15] and mental health problems [16], including
increased burnout [17]. These complications negatively impact
work productivity [18] and worker health [19,20]. Earlier studies
have revealed that symptoms of burnout can lead to a deeper
depression [21,22]. Epidemiological studies have demonstrated
that mild to severe burnout is highly prevalent in the general
working population [23,24], and that once developed, symptoms of
burnout remain persistent over time [25]. Given this knowledge,
public health authorities and businesses have recognized the
benets of occupational health promotion to reduce the number of
employees suffering from occupational burnout [26].
A physically active lifestyle can be viewed as an important
component of occupational health promotion [27], with prevalence rates of physical inactivity and low cardiorespiratory tness
147
Table 1
Social and demographic background of the total sample, and groups with differing cardiorespiratory tness and stress levels.
Total sample
Gender: n (%)
Women
Men
Marital status: n (%)
Married/living with someone
Single
Missing
Occupation: n (%)
Higher education
Lower education
Student/unemployed
Missing
Smoking status: n (%)
Smoker
Non-smoker
Missing
Cardiorespiratory tness: n (%)
Lowa
Moderatea
Higha
Perceived stress: n (%)
Lowb
Highb
a
Cardiorespiratory tness
Stress
Lowa
Moderatea
Higha
97 (49)
100 (51)
20 (21)
28 (28)
38 (39)
30 (30)
39 (40)
42 (42)
60 (62)
60 (60)
37 (48)
40 (40)
138 (70)
51 (26)
8 (4)
36 (75)
11 (3)
1 (2)
46 (68)
17 (25)
5 (7)
56 (69)
23 (28)
2 (3)
85 (71)
30 (25)
5 (4)
53 (69)
21 (27)
3 (4)
115
49
19
14
27
11
6
4
39
17
5
8
49
21
8
3
65
35
10
10
50
14
9
4
(58)
(25)
(10)
(7)
171 (87)
16 (8)
10 (5)
48 (24)
68 (35)
81 (41)
120 (61)
77 (39)
(56)
(23)
(13)
(8)
5 (10)
42 (88)
3 (2)
27 (23)
21 (27)
(57)
(25)
(7)
(10)
5 (8)
56 (82)
7 (10)
43 (36)
25 (33)
(61)
(26)
(10)
(4)
6 (7)
73 (90)
2 (3)
50 (42)
31 (40)
Lowb
(54)
(29)
(8)
(8)
Highb
(65)
(18)
(12)
(5)
107 (89)
8 (7)
5 (4)
64 (83)
8 (10)
5 (7)
27 (23)
43 (36)
50 (42)
21 (27)
25 (33)
31 (41)
Note. Information about how we dened low, moderate and high tness is provided at the end of Section 2.3.
Note. Information about how we dened low and high stress is provided in Section 2.4. No signicant differences (p > .05) were found with regard to sex, marital status,
occupation, smoking status, tness and perceived stress between participants with differing levels of cardiorespiratory tness and stress.
b
148
Table 2
Cut-offs for VO2max (ml/kg/min) dependent on participants age and gender used
to classify participants in groups with differing cardiorespiratory tness levels.
Age
Men
1519 years
2029 years
2039 years
4049 years
5059 years
6069 years
Women
1519 years
2029 years
2039 years
4049 years
5059 years
6069 years
Very low
Low
Average
High
Very high
32
33
28
24
22
18
3339
3441
2935
2532
2328
1923
4047
4250
3644
3340
2935
2429
4855
5159
4553
4148
3642
3036
56
60
54
49
43
37
29
31
27
23
20
17
3037
3239
2835
2430
2126
1822
3845
4047
3643
3137
2732
2328
4652
4855
4451
3844
3339
2934
53
56
52
45
40
35
Note. Categories used in the present study: low tness = very low to low, moderate
tness = average, high tness = high to very high.
Table 3
Descriptive statistics for the total index and the subscales of the ShiromMelamed
Burnout Questionnaire and the Depression Subscale of the Hospital Anxiety and
Depression Scale.
SMBQ
SMBQb
SMBQb
SMBQb
SMBQb
HAD-Dc
Total Score
Burnout
Tension
Listlessness
Cognitive Weariness
M SD
aa
Min
Max
Skew
3.1 1.3
2.9 1.4
3.1 1.5
3.3 1.4
3.0 1.5
3.1 2.8
0.97
0.93
0.89
0.88
0.94
0.80
1.0
1.0
1.0
1.0
1.0
0.0
6.4
6.9
6.5
6.8
7.0
15.0
0.5
0.7
0.4
0.4
0.6
1.4
Kurt
0.6
0.3
1.0
0.7
0.4
2.4
a = Cronbachs alpha.
149
Fig. 1. Differences between participants with low versus high stress (a) and
participants with low, moderate and high tness (b) in burnout and depressive
symptoms.
Table 4
Differences in burnout and symptoms of depression dependent on participants levels of cardiorespiratory tness and perceived stress.
Low stress
SMBQa
SMBQa
SMBQa
SMBQa
SMBQa
HAD-Db
a
Total Score
Burnout
Tension
Listlessness
Cognitive Weariness
High stress
Fitness
Low
tness
(n = 27)
Moderate
tness
(n = 43)
High
tness
(n = 50)
Low
tness
(n = 21)
Moderate
tness
(n = 25)
High
tness
(n = 31)
M SD
M SD
M SD
M SD
M SD
M SD
2.6 1.1
2.5 1.1
2.3 1.2
3.1 1.5
2.6 1.4
2.2 2.4
2.6 1.0
2.4 1.1
2.8 1.4
2.8 1.2
2.5 1.1
2.4 2.1
2.5 0.9
2.3 1.0
2.6 1.1
2.6 1.1
2.6 1.1
2.0 1.7
4.4 1.3
4.3 1.5
4.5 1.5
4.2 1.5
4.4 1.6
6.3 4.2
3.9 1.2
4.0 1.3
3.7 1.3
4.3 1.2
3.8 1.6
4.6 2.9
3.5 1.2
3.3 1.3
3.8 1.4
3.6 1.3
3.4 1.4
3.6 2.4
Stress
Fitness stress
h2
h2
h2
3.2*
3.7*
0.5
3.5*
2.3
4.7**
.03
.04
.00
.04
.02
.05
71.2***
70.4***
56.7***
41.6***
44.5***
49.3***
.27
.27
.23
.18
.19
.21
1.6
1.8
3.9*
1.2
2.0
3.8*
.02
.02
.04
.01
.02
.04
150
Fig. 2. Differences between participants with low, moderate and high tness on the
SMBQ Tension scale, if experiencing low versus high stress.
10
Low fitness
Moderate fitness
High fitness
Low stress
High stress
Fig. 3. Differences between participants with low, moderate and high tness levels
in depressive symptoms, if experiencing low versus high stress.
151
152
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