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

This study aims to compare between the effect of box breathing and foot reflexology on physiological and psychological stress indicators in emergency physicians.

Study Overview

• Status: Not yet recruiting
• Conditions: Stress
• Intervention / Treatment: Other: Box Breathing; Other: Foot Reflexology

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Estimated): 54
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Salma Ibrahim Al Ghitany, PhD
• Study Contact Backup: Name: Sara Mohamed Ali Arafa, B.Sc; Phone Number: +20 11 13778146; Email: sara3rafa96@gmail.com

Study Locations

• Egypt
  • Cairo, Egypt
    • EL-Zeiton district Hospitals
    • Contact: Sara Mohamed Ali Arafa, B.Sc; Phone Number: +20 11 13778146; Email: sara3rafa96@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

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.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Box Breathing Group; Participants will perform box breathing exercises daily for 4 weeks. Each session will last 5 minutes and will be performed three times per day. Participants will receive supervised sessions three days per week and will perform the remaining sessions as a home program. The box breathing technique consists of inhaling for 4 seconds, holding the breath for 4 seconds, exhaling for 4 seconds, and holding the breath again for 4 seconds, repeated in cycles with scheduled rest periods.	Other: Box Breathing; Participants will perform box breathing exercises daily for 4 weeks. Each session will last 5 minutes and will be performed three times per day. Participants will receive supervised sessions three days per week and will perform the remaining sessions as a
Experimental: Foot Reflexology Group; Participants will receive foot reflexology sessions three times per week for 4 weeks. Reflexology will be performed with the participant in a comfortable supine position and will include general stimulation of plantar reflex points followed by targeted pressure applied to the solar plexus and adrenal gland reflex areas of both feet.	Other: Foot Reflexology; Participants will receive foot reflexology sessions three times per week for 4 weeks. Reflexology will be performed with the participant in a comfortable supine position and will include general stimulation of plantar reflex points followed by targeted pressure applied to the solar plexus and adrenal gland reflex areas of both feet.
No Intervention: Control Group; Participants will not receive box breathing exercises or foot reflexology during the 4-week study period. They will undergo the same baseline and post-intervention outcome assessments as the intervention groups.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Salivary Cortisol Level	Change in salivary cortisol concentration (µg/dL) from baseline to the end of the 4-week intervention period. Saliva samples will be collected before and after the intervention period and analyzed to determine changes in physiological stress.	4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Heart Rate Variability (HRV)	Change in heart rate variability from baseline to the end of the 4-week intervention period. HRV will be assessed using the Welltory smartphone application as a physiological indicator of autonomic nervous system activity and stress.	4 weeks
Perceived Stress Scale (PSS)	Change in perceived stress level from baseline to the end of the 4-week intervention period, assessed using the Perceived Stress Scale. Total scores range from 0 to 40, with higher scores indicating greater perceived stress.	4 weeks
Maslach Burnout Inventory (MBI)	Change in occupational burnout from baseline to the end of the 4-week intervention period, assessed using the Maslach Burnout Inventory, including the domains of Emotional Exhaustion, Depersonalization, and Personal Accomplishment.	4 weeks
Pittsburgh Sleep Quality Index (PSQI)	Change in sleep quality from baseline to the end of the 4-week intervention period, assessed using the Pittsburgh Sleep Quality Index. Higher scores indicate poorer sleep quality.	4 weeks

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Study Director: Salma Ibrahim Al Ghitany, PhD, Lecturer, Cairo University; Study Chair: Hany Ezzat Obaya, PhD, Professor, Cairo University; Study Director: Mohamed Ahmed Khatab, PhD, Professor, Ain Shams University

Study record dates

Study Major Dates

• Study Start (Estimated): July 20, 2026
• Primary Completion (Estimated): September 20, 2026
• Study Completion (Estimated): September 30, 2026

Study Registration Dates

• First Submitted: July 10, 2026
• First Submitted That Met QC Criteria: July 10, 2026
• First Posted (Actual): July 15, 2026

Study Record Updates

• Last Update Posted (Actual): July 15, 2026
• Last Update Submitted That Met QC Criteria: July 10, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: P.T.REC/012/006075

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No