According to the recent report “Occupational Safety and Health in Europe: State and Trends 2023” by the European Agency for Safety and Health at Work, mental health disorders, along with musculoskeletal disorders (MSDs), are the leading causes of absence from work (1). Health conditions of adult workers impose a greater societal burden than work accidents; estimates from the Organization for Economic Co-operation and Development and the European Commission place annual mental disorder costs at over €600 billion in the EU (1). Depression-related illnesses, cardiovascular diseases, and MSDs are the most expensive conditions affecting employees, leading to increased presenteeism, absenteeism, and compromised work productivity (2, 3). MSDs contribute significantly to lost working days in EU Member States: upper extremity and low back MSDs account for about 39% of occupational diseases, with associated costs ranging from 0.5 to 2% of the EU’s gross national product, contributing to a loss of productivity across various economic sectors worldwide (4).

Physical health risks stem from multiple sources: manual workers (blue-collar) exhibit higher accident rates, shorter life expectancy, and reduced job expectancy, but in contrast, administrative workers (white-collar), though better off in these aspects, report a less favorable health situation. Indeed, sedentary jobs, through persistent sitting, contribute to MSDs and other health issues, such as cardiovascular diseases and weight gain. The European Survey of Enterprises on New and Emerging Risks (5) data ranks prolonged sitting as the EU27’s second most frequently reported risk factor. Moreover, sedentary behavior has been shown to be associated with worse cognitive performance, affecting several physiological mechanisms associated with cognition and mental health (6–8). Mental health is affected by various working conditions (work environment, workload pressure, social support, …); according to the EU labor force survey 2020, about 45% percent of employees report exposure to factors adversely impacting mental well-being (9). Furthermore, poor mental health is often associated with employees burnout: according to the World Health Organization, it represents an occupational phenomenon characterized by a chronic imbalance between job demands and resources (for example, job autonomy and supportive work relationships) (10). The definition of burnout includes three dimensions: emotional exhaustion (feeling of being depleted of one’s physical and emotional resources), depersonalisation (or cynism, representing the interpersonal context dimension of burnout), and reduced personal accomplishment (feeling of incompetence, lack of work productivity and achievement) (11, 12). However, burnout (and in particular emotional exhaustion) appear to be mitigated by engaging in physical activity (PA): in fact, several studies have reported a negative relationship between burnout and PA, highlighting that cases of burnout were lower in those who practiced more PA, both in sedentary (13) and non-sedentary workers (14–16).

So far, many studies investigated the effects of PA practice (both conducted in and out the workplace setting) on workers’ physical and mental health, showing that PA could be effective in reducing MSDs (4, 17) and mental health problems (17, 18), improving physical fitness (19, 20) and likely - indirectly - work performance (21). However, to the authors’ knowledge, the mutual interactions among PA, physical and mental health, and workplace well-being have been less studied. Recently, both mental and physical health have been reported to be positively associated with work engagement, defined as “a positive psychological construct characterized by vigor, dedication, and absorption” (22). A cross-sectional study conducted in Finland in 2014 among over 700 female employees found that both mental and physical health had a positive relationship with work engagement, with the latter relationship being driven by the association of a healthy diet and PA (22). However, it’s important to note that this study categorized PA as a binary variable, indicating whether participants met the American Heart Association’s PA guidelines or not. Consequently, the study could not determine whether participants just met these guidelines, exceeded them (and if so, by how much), or if higher levels of PA would have yielded greater benefits. Given the above, this observational study aimed to investigate the associations between PA levels (categorized as not reaching, reaching, or overcoming PA guidelines), MSDs, burnout, and work engagement, in a sample of Italian white-collar employees.

This cross-sectional study aimed to investigate the associations between PA levels and the occurrence of MSDs, burnout, and work engagement among Italian white-collar employees. The main findings suggest that leisure-time PA might play a pivotal role in reducing the severity of musculoskeletal problems, enhancing work engagement, and protecting from the development of burnout. Notably, our study reveals that merely reaching PA guidelines may not be sufficient to achieve significant positive effects on the measured parameters. Indeed, a few studies (15, 33) investigated the leisure-time PA dividing the participants into who met and who did not the guidelines, and found significantly lower levels of burnout in those who met the guidelines, but no significant effects on MSDs. However, these studies did not investigate whether higher levels of PA (i.e., overcoming the PA guidelines) would provide greater beneficial effects. On this line, Jonsdottir and colleagues (16) reported that light PA practice (defined as walking/cycling to work or gardening for 2 h/week) was sufficient to exert a positive effect on stress and burnout levels, but they also found that moderate-to-vigorous PA practice had a stronger effect, further lowering the relative risks ratios. Overall, these findings are coherent with the results of the present study, as in our sample, participants who met the PA guidelines did not show significantly lower MSDs or work-engagement levels, but only lower levels of emotional exhaustion; in contrast, workers who overcame the PA guidelines, showed significantly lower MSDs, lower emotional exhaustion, higher personal accomplishment, and better work engagement, suggesting that limiting oneself to reaching the guidelines does not seem to be enough to top up the benefits. Furthermore, we found that having MSDs increased the risk of developing burnout symptoms; this is in line with the results by Biddle et al. (33), who also reported that a large proportion of general practitioners experiencing burnout also had neck, shoulder, or back pain. Biddle and colleagues also reported that most of their participants did not meet the PA guidelines and spent most of their working time in prolonged sitting bouts; interestingly, those who had more regular breaks from prolonged sitting showed lower burnout and greater psychological well-being than those who had fewer breaks. Participants of our sample reported a “standard” level of breaks during the work time, with a median of two 8-min pauses, in line with the Italian National regulation, which guarantees a minimum of one 10-min break for every 6 hours of work. Notably, a recent German study reported that employees frequently skipped and/or interrupted their work breaks, and this was related to physical and mental health complaints (34).

In our study, and in accordance with other evidence (13, 15), the emotional exhaustion component of burnout was the one that seemed more influenced by the PA practice. A possible explanation, as reported by Aronsson et al. (11), is that burnout is a process in time, meaning that there is a time lag between the development of the three components. Indeed, emotional exhaustion, due to the high coping efforts with external demands, acts as a trigger for depersonalisation, which in turn causes a reduction in personal accomplishment, and this is a vicious cycle as low gratification contributes to further emotional exhaustion, and so on. This time effect is of pivotal importance, as persons who show high emotional exhaustion scores might not have still developed symptoms of depersonalisation or low personal accomplishment, and the fact that PA practice seems to have a greater influence on the first component of burnout could be a promising result, as it could means that - potentially - reducing the emotional exhaustion by PA practice would lead to a prevention of the other burnout dimensions.

Veromaa et al. (22) conducted a cross-sectional study in Finland aimed to investigate the factors influencing work engagement in a sample of female employees, and after dividing the sample into who met and did not meet the PA guidelines, found that the former showed higher levels of work engagement. This partially agrees with our results, as we found out that only the group who overcame the PA guidelines showed significantly higher levels of work engagement, although a smaller non-significant difference was also observed for whom reached the guidelines. This data suggests that merely reaching the guidelines could not be enough to improve work engagement, but higher PA levels, likely at moderate-to-vigorous intensity, are needed. Increasing the levels of work engagement should be of particular importance for both employers and employees, as it has been shown that it is strictly related to job performance. However, this relationship is not linear but inverted U-shaped, indicating that work performance is not only influenced by the presence of good working conditions, but also closely related to the state of each individual (35).

The findings of this study contribute to the existing literature by providing further support and highlighting the crucial role of engaging in PA in promoting the overall health of workers, both in physical and mental dimensions. What this study adds is the idea that the quantity and quality (frequency, duration, and intensity) of PA undertaken may play a pivotal role in the observed beneficial effects for employees. Given the substantial amount of time individuals spend at their workplaces, this context has been proposed as a suitable environment for implementing interventions aimed at fostering workers’ health through lifestyle modifications. Various types of physical activities (stretching, strength training, aerobic exercises, high-intensity interval training, or various combinations thereof) have been proposed, yielding promising but occasionally divergent outcomes (4, 19, 20, 36, 37). Well-designed, randomized, and controlled studies remain essential to explore the impact of PA on workers’ physical and mental well-being. Furthermore, future research should focus on quantifying the economic implications of these interventions for the companies themselves, to further encourage and raise employers’ awareness about the significance of their employees’ health.

Several limitations should be considered when interpreting the findings of this study. First, the cross-sectional design of the study restricts our ability to establish causality, as we can only examine biunivocal associations at a single point in time, cautioning against over-interpreting the causal relationship between PA and health outcomes. Additionally, the measurement of PA relied on self-assessment, which is susceptible to social desirability bias, potentially leading to overestimating PA levels. Moreover, the exact participation rate in the intervention group cannot be ascertained, as we lack information on how many employees received and read the email invitation, introducing a degree of uncertainty in the overall participation rate. Another limitation that should be acknowledged is the generalizability of our findings beyond the Italian white-collar workers. While our sample provides valuable insights into this population, it is essential to recognize that cultural and demographic factors may influence the relationship between PA and health outcomes differently in other populations or cultural contexts. Furthermore, our study lacks a formal economic analysis of the potential implications of PA interventions. While we recognize the importance of considering economic factors in public health interventions, our study did not include a comprehensive economic evaluation. This limitation highlights an important area for future research, as incorporating economic analyses could provide valuable insights into the cost-effectiveness and feasibility of PA interventions. In light of these limitations, future research should focus on employing more precise and objective measurements of PA, such as wearable devices or activity trackers, to enhance the accuracy of the collected data. Furthermore, investigating longitudinal study designs would enable a better understanding of the temporal relationships between PA, burnout, and other relevant variables, providing more robust evidence for potential causal relationships. Lastly, future studies should aim to include formal economic evaluations to better inform decision-making and policy development in this area.

Our cross-sectional study on white-collar employees highlights the pivotal role of leisure-time PA in reducing musculoskeletal problems, enhancing work engagement, and preventing burnout, echoing principles of sports medicine. Our findings challenge the adequacy of meeting PA guidelines, aligning with research emphasizing the need to surpass these standards (16, 33). Particularly, our focus on emotional exhaustion aligns with burnout research (13, 15), hinting at a time-sensitive cascade effect (11). Our work extends Veromaa et al.’s (22) findings on work engagement, emphasizing the value of PA beyond guidelines. Enhanced work engagement, with its nonlinear impact on job performance (35), underscores the importance of personalized well-being strategies. Integrating these insights into workplaces through tailored PA initiatives holds promise for employee health. Future research should explore economic implications and employ precise PA measurement methods for deeper understanding. In conclusion, our study bridges sports medicine and workplace wellness, accentuating the impact of PA on workers’ health. It emphasizes the necessity of exceeding PA guidelines for optimal benefits and offers actionable insights for healthier, more engaged, and less burnout-prone employees.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving humans were approved by Ethics Committee for Human Experimentation at the University of Urbino (approval number 20/2019). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

SA: Conceptualization, Investigation, Visualization, Writing – original draft, Writing – review & editing. EG: Conceptualization, Investigation, Writing – original draft, Writing – review & editing. DS: Data curation, Formal analysis, Methodology, Writing – original draft, Writing – review & editing. GP: Data curation, Writing – original draft, Writing – review & editing. GG: Project administration, Writing – original draft, Writing – review & editing. RR: Project administration, Writing – original draft, Writing – review & editing. GC: Project administration, Writing – original draft, Writing – review & editing. MR: Formal analysis, Methodology, Supervision, Writing – original draft, Writing – review & editing. FP: Supervision, Writing – original draft, Writing – review & editing.