StressNCT07705854
Box Breathing Versus Foot Reflexology on Physiological and Psychological Stress Indicators in Emergency Physicians
A study testing Box Breathing and Foot Reflexology in people with Stress, run by Cairo University at 1 site in Egypt.
Trial summary
This study aims to compare between the effect of box breathing and foot reflexology on physiological and psychological stress indicators in emergency physicians. Read more about this study
- Who is it for?
- Ages 30 to 40 years, men onlyHealthy volunteers can take part
- Conditions the study is for
- Stress
- What is being tested?
- Box Breathing and Foot Reflexology
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 54 participants
- Where
- 1 siteEgypt
- Study dates
- 20 Jul 2026to 30 Sep 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 30 to 40 years
- Men only
- Healthy volunteers accepted
- Adult
Who may be able to join
- 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.
Who cannot join
- 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.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Salma Ibrahim Al Ghitany, PhD contact
Egypt1 site
EL-Zeiton district Hospitals
Cairo
Sara Mohamed Ali Arafa, B.Sc, +20 11 13778146, sara3rafa96@gmail.com
About this study
This study aims to compare between the effect of box breathing and foot reflexology on physiological and psychological stress indicators in emergency physicians.
Read the 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.
- Conditions
- Stress
- Being tested
- Box Breathing, Foot Reflexology
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Box BreathingOther
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
Foot ReflexologyOther
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.
| Study group | Role | What they receive |
|---|---|---|
| Box Breathing Group | Experimental | 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. Receives: Other: Box Breathing |
| Foot Reflexology Group | Experimental | 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. Receives: Other: Foot Reflexology |
| Control Group | No intervention | 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 being measured
The primary outcome is the main question the study is designed to answer.
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.
Measured: 4 weeks
Secondary outcomes (4)
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.
Measured: 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.
Measured: 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.
Measured: 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.
Measured: 4 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted15 Jul 2026
- Study start20 Jul 2026 (estimated)
- Primary completion20 Sep 2026 (estimated)
- Study completion30 Sep 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for StressStudies of the same condition, open and under way.
- More trials run by Cairo UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 54 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Cairo University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Sara Mohamed Ali Arafa, Cairo University
- Investigators
- Hany Ezzat Obaya, PhD, Study chair, Professor, Cairo UniversityMohamed Ahmed Khatab, PhD, Study director, Professor, Ain Shams UniversitySalma Ibrahim Al Ghitany, PhD, Study director, Lecturer, Cairo University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07705854
- Sponsor's protocol ID
- P.T.REC/012/006075
- Status last verified
- Jul 2026
- First submitted
- 10 Jul 2026
- Last updated
- 15 Jul 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 15 Jul 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Box Breathing Versus Foot Reflexology on Physiological and Psychological Stress Indicators in Emergency Physicians
- ClinicalTrials.gov ID
- NCT07705854
- Acronym / sponsor ID
- P.T.REC/012/006075
- Conditions
- Stress
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 54 participants (estimated)
- Lead sponsor
- Cairo UniversityUniversity, hospital or other
- Study start
- 20 Jul 2026 (estimated)
- Primary completion
- 20 Sep 2026 (estimated)
- Study completion
- 30 Sep 2026 (estimated)
- First posted
- 15 Jul 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study aims to compare between the effect of box breathing and foot reflexology on physiological and psychological stress indicators in emergency physicians.
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 design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Box Breathing Group | Experimental | Other: Box BreathingParticipants 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. |
| Foot Reflexology Group | Experimental | Other: Foot ReflexologyParticipants 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. |
| Control Group | No intervention | –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. |
Who may qualify
- Ages
- 30 to 40 years
- Sex
- Male only
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (6 listed)
- 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.
Key exclusion criteria (5 listed)
- 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.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Box BreathingParticipants 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 | Other | Box Breathing Group |
| Foot ReflexologyParticipants 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 Group |
Primary outcome
Salivary Cortisol Level
Time frame: 4 weeks
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 secondary outcomes
Heart Rate Variability (HRV)
Time frame: 4 weeks
Perceived Stress Scale (PSS)
Time frame: 4 weeks
Maslach Burnout Inventory (MBI)
Time frame: 4 weeks
Pittsburgh Sleep Quality Index (PSQI)
Time frame: 4 weeks
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 15 Jul 2026.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Salma Ibrahim Al Ghitany, PhD contact
Hany Ezzat Obaya, PhD study chair
Professor, Cairo University
Mohamed Ahmed Khatab, PhD study director
Professor, Ain Shams University
Salma Ibrahim Al Ghitany, PhD study director
Lecturer, Cairo University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Box Breathing and Foot Reflexology in people with Stress, run by Cairo University at 1 site in Egypt.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 15 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Sara Mohamed Ali Arafa, B.Sc (+20 11 13778146, sara3rafa96@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Salivary Cortisol Level (time frame: 4 weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Jul 2026.