Box Breathing Versus Foot Reflexology on Physiological and Psychological Stress Indicators in Emergency Physicians

Healthcare workers are an especially vulnerable group, with stressful environments and work pressure often leading to burnout. Long hours, overwork, shift work, inadequate staffing, emotional demands, are all believed to be contributors, and it has been suggested that stress and burnout have been associated with decreased job satisfaction, poor job performance, and negative patient outcomes. Emergency physicians showed a high risk for developing burnout and work stress-related problems. Emergency physicians report higher scores of emotional exhaustion and depersonalization when compared to other healthcare professionals. The high flow of patients exceeding the teamwork capacity lead to excessive stressful working environment among the Egyptian emergency physicians rather than other emergency physicians in many Western countries. Work-related stress have a negative impact on workers' health and safety. This includes cardiovascular disease, gastrointestinal complaints, sleep troubles, mental health problems, fatigue, job dissatisfaction, accidents and injuries at work, reduced vigilance and job performance. Box breathing exercise is a technique of slow breathing rhythm also known as square breathing used universally. It increases the performance and concentration level; it also acts as a powerful stress relief. Foot reflexology stimulates reflex zones in the foot that correspond to specific parts of the body, Reflex effects are known to release symptoms of stress by accelerating blood flow, diminishing tension, relaxing the mental state, increasing immunity, and improving the sense of well-being. Therefore, the primary aim of this study will impact future researcher about the significance of the difference between box breathing and foot reflexology on physiological and psychological stress indicators in emergency physicians.

Inclusion criteria

• Male emergency physicians aged 30-40 years.
• Body mass index (BMI) between 18.5 and 29.9 kg/m².
• Working 8-hour day shifts.
• Non-smokers.
• At least 1 year of professional experience.
• Able and willing to provide informed consent and comply with the study interventions and assessments.

Exclusion criteria

• Medical conditions that contraindicate participation in the interventions, including severe cardiovascular conditions or foot injuries that preclude foot reflexology.
• Use of medications that may affect hormonal or stress-related outcomes, including antidiabetic medications, thyroid medications, and antidepressants.
• Regular participation in stress-reduction techniques or relaxation programs.
• Working night shifts.
• BMI ≥30 kg/m² or <18.5 kg/m².