Physical activity and its relationship with burnout and fatigue among medical residents and fellows in Lebanon: a multicenter cross-sectional study

Abstract

Burnout and fatigue are major concerns among medical residents, affecting well-being, performance, and patient safety. Physical activity is known to improve mental health and reduce stress and fatigue, yet residents often have limited opportunities to remain active due to demanding schedules. In Lebanon, these challenges are intensified by economic collapse, political instability, and recurring crises that strain the healthcare system and increase stress on trainees. Given the potential protective role of physical activity and the lack of data in this context, this study aimed to evaluate the relationship between physical activity, burnout, and fatigue among medical residents and fellows in Lebanon. A multicenter cross-sectional survey was done using convenience sampling between November 2024 and February 2025 including residents and fellows across all 8 medical schools in Lebanon. Participants completed an anonymous questionnaire assessing sociodemographic characteristics, physical activity using the International Physical Activity Questionnaire (IPAQ short form), fatigue using the 3D Work Fatigue Inventory, and burnout using the Maslach Burnout Inventory. Bivariate and multivariable analyses identified factors associated with burnout and fatigue. A total of 265 residents and fellows participated. Overall, 40% met criteria for burnout (high emotional exhaustion or high depersonalization), while 51.7% exhibited at least one elevated burnout dimension. Physical activity was inversely associated with fatigue and burnout. In multivariable analyses, moderate physical activity independently predicted lower physical (β= −2.388, 95% CI: −3.897, − 0.88), mental (β = −2.425, 95% CI: −3.974, − 0.875), emotional (β = −2.255, 95% CI: −4.04, − 0.47), and total fatigue scores (β = −7.068, 95% CI: −11.419, − 2.717) (all p < 0.05). Physically active residents had significantly lower odds of burnout (OR = 0.20, 95% CI: 0.06, 0.64), though minimally active residents did not show a statistically significant reduction in odds (OR = 0.52, 95% CI: 0.24, 1.13). Conversely, each additional hour of daily sitting time was associated with higher physical (β = 0.544, 95% CI: 0.267, 0.82), mental fatigue (β = 0.354, 95% CI: 0.07, 0.638) and total fatigue (β = 0.972, 95% CI: 0.175, 1.770) (all p < 0.05), but was not significantly associated with emotional fatigue or with burnout odds in the adjusted models. Total fatigue was strongly correlated with emotional exhaustion ( r = 0.70, p < 0.001) and moderately correlated with depersonalization ( r = 0.542, p < 0.001). This multicenter study highlights the high burden of burnout among medical residents and fellows in Lebanon, likely reflecting the challenging training environment amid the country’s ongoing socioeconomic crises. Despite these circumstances, burnout patterns were comparable to those reported internationally. Higher levels of physical activity were associated with lower burnout and fatigue. Promoting physical activity alongside institutional wellness initiatives, structured reforms, and supportive work environments should be prioritized to sustain physicians’ physical and mental well-being and preserve the quality of healthcare delivery.