Nurses' occupational physical activity levels: a systematic review

BACKGROUND: Nurses' physical performance at work has implications both for nurses' occupational health and patient care. Although nurses are the largest healthcare workforce, are present 24-hours a day, and engage in many physically demanding tasks, nurses' occupational physical activity levels are poorly understood. OBJECTIVES: The aim of this systematic review was to examine nurses' occupational physical activity levels, and explore how nurses accumulate their physical activity during a shift. DESIGN: This narrative systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Statement. DATA SOURCES: EBSCOHost (MEDLINE, CINAHL, Age Line, Academic Search Complete, Global Health, Health Business Centre, Health Policy Reference Centre, Health Source (Consumer and Nursing/Academic Edition) and SPORTDiscus), Embase, Informit, ProQuest Health and Medical, Science Direct, Scopus, and Web of Science databases. REVIEW METHODS: A systematic search of seven databases were completed to locate peer-reviewed journal articles documenting nurses' occupational physical activity levels from January 1990. Papers were included if they were original research papers; measured physical activity objectively and/or subjectively; reported nurses' occupational physical activity; and were published in English. Articles were excluded if nurses' data were not reported separately from other professional groups. Two researchers independently screened the articles, extracted data, and undertook the methodological quality assessments. RESULTS: Fifteen studies met the inclusion criteria. Nursing work predominantly comprised of light-intensity physical activity. In nine studies how nurses' accumulated occupational physical activity were documented and showed that the majority of a nurses' shift was spent standing or walking whilst completing direct patient care tasks. However, the definition of the nursing populations studied were often poorly reported, and few researchers reported the validity and the reliability of the measurement tools used. CONCLUSIONS: Nurses' occupational physical activity levels largely consist of light-intensity physical activity interspersed with moderate-intensity tasks. It is not known whether physical activity during one shift affects the activity levels in the following shift. This systematic review is the first step towards understanding the physical demands of nursing work, and how nurses' physical activity may impact workplace wellbeing and patient safety. LIMITATIONS: A meta-analysis was not possible due to the variability in how physical activity outcomes were presented. Several studies had heart rate outcomes that were converted, where possible, by the authors into physical activity outcomes. REGISTRATION: This systematic review is registered with PROSPERO; Registration number: CRD42016045427.