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Abstract

To reduce the spread of COVID-19, the World Health Organization and the majority of governments have recommended that the entire human population should ‘stay-at-home’. A significant proportion of the population live alone or are vulnerable to mental health problems yet, in the vast majority of cases, individuals in social isolation have no access to mental healthcare. The only resource is people themselves using self-help, self-medication and self-care. During prolonged COVID-19 isolation, an in-built system of homeostasis can help rebalance activity, thought and feeling. Increased physical activity enables a reset of physical and mental well-being. During periods of lockdown, it is recommended that exercise should be as vigorously promoted as social distancing itself.
https://doi.org/10.1177/1359105320925149
Journal of Health Psychology
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DOI: 10.1177/1359105320925149
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Introduction
These are extraordinary times. Throughout his-
tory, there have been plenty of pandemics but
the human response to coronavirus disease
(COVID-19) is unprecedented. The world will
never be the same again. It is estimated that
close to 4 billion people are living in social iso-
lation during this mother of all pandemics
(Sandford, 2020). Unless there is a revolt, poli-
cies of social isolation in one form or another are
expected to continue until a vaccine is available
6, 12 or 24 months from now. The cumulative
impacts of social distancing will be truly pro-
found. This article has the following two pur-
poses: (1) To review the science of human needs
as they can be expected to play out over a pro-
longed period of domestic confinement and (2)
to make preliminary recommendations concern-
ing necessary self-care focusing on exercise.
The COVID-19 pandemic involves a novel
coronavirus characterized by a respiratory illness
that results from a severe acute respiratory syn-
drome coronavirus 2 (SARS-CoV-2) infection
(Centers for Disease Control and Prevention,
2020). The disease was first reported in Wuhan,
China, on 31 December 2019 and symptomatic
patients frequently present with a dry cough,
fever and shortness of breath within 2 to 14 days
after exposure. The COVID-19 pandemic is
receiving intensive interest at all levels: political,
Human needs in COVID-19
isolation
Thiago Matias1, Fabio H Dominski2
and David F Marks3
Abstract
To reduce the spread of COVID-19, the World Health Organization and the majority of governments
have recommended that the entire human population should ‘stay-at-home’. A significant proportion of
the population live alone or are vulnerable to mental health problems yet, in the vast majority of cases,
individuals in social isolation have no access to mental healthcare. The only resource is people themselves
using self-help, self-medication and self-care. During prolonged COVID-19 isolation, an in-built system of
homeostasis can help rebalance activity, thought and feeling. Increased physical activity enables a reset of
physical and mental well-being. During periods of lockdown, it is recommended that exercise should be as
vigorously promoted as social distancing itself.
Keywords
communicable diseases, COVID-19 pandemic, exercise, mental health, needs, psychological homeostasis,
self-esteem
1UFSC, Brazil
2UDESC, Brazil
3Independent Researcher, France
Corresponding author:
Thiago Matias, UFSC, Campus Universitário Reitor João
David Ferreira Lima, Florianpolis 88040900, Brazil.
Email: thiago.matias@ufsc.br
925149HPQ0010.1177/1359105320925149Journal of Health PsychologyMatias et al.
research-article2020
Editorial
2 Journal of Health Psychology 00(0)
economic, social, scientific and in health care.
The epicentre of the COVID-19 outbreak moved
from China to Europe and a few weeks later to
the United States. As of 28 April 2020, there
were 3,050,308 confirmed cases including more
than 211,325 deaths have been reported world-
wide, affecting at least 201 countries, areas or
territories (Coronavirus COVID-19 Global
Cases by the Center for Systems Science and
Engineering (CSSE) at Johns Hopkins
University, 2020). Most cases are in the United
States (988,469 cases), followed by Spain
(229,422) and Italy (199,414) (Coronavirus
COVID-19 Global Cases by the Center for
Systems Science and Engineering (CSSE) at
Johns Hopkins University, 2020).
Owing to the absence of a prophylactic vac-
cine, official control measures have been imple-
mented to reduce the spread of COVID-19,
such as restrictions on people’s movements,
including social distancing, closing of gyms
and parks, travel restrictions, quarantines and
stay-at-home guidance. In China, some drastic
control measures substantially mitigated the
spread of the disease (Kraemer et al., 2020).
However, the popular policy of confinement
has significant health, economic, environmen-
tal and social consequences. In the psychologi-
cal sphere, recent evidence shows that similar
pandemics increased the prevalence of symp-
toms of post-traumatic stress disorder, as well
as confusion, feeling of loneliness, boredom
and anger during and after quarantine (Brooks
et al., 2020). Stressors during this critical period
include fear of infection, fear of death, uncer-
tainty, loss of social contacts, confinement,
inadequate information, conflicting advice, loss
of outdoor activities, disconnection from nature,
loneliness, depression, helplessness, anger, low
self-esteem, financial loss and obstacles to sup-
plies of food and water (Brooks et al., 2020;
Jiménez-Pavón et al., 2020; Xiang et al., 2020).
A survey in China during the initial outbreak of
COVID-19 found that 54% of respondents
rated the psychological impact of the outbreak
as moderate or severe, 17% reported moderate
to severe depressive symptoms, 29% reported
moderate to severe anxiety symptoms, and
8% reported moderate to severe stress levels
(Wang C et al., 2020). Given that a significant
proportion of the population live alone or are vul-
nerable to mental health problems, the impacts
of the COVID-19 pandemic on mental well-
being are only now just beginning to be felt.
In the light of the aforementioned issues,
systematic psychological self-care must be
given a high priority in coping with the detri-
mental impacts of COVID-19 and social dis-
tancing. Here, we discuss one of the most
fundamental tools of self-care for health
enhancement: increased physical activity.
Governmental recognition of the benefits of
exercise is evidenced by permitting exercise
outdoors during social isolation for indefinite
periods of weeks or months. Yet rarely is the
issue adequately addressed; an International
Task Force of experts to review and advise on
psychological and physical self-care would be
welcomed.
Consequently, during the COVID-19 pan-
demic special attention to systematic psycho-
logical health care is required by health care
staff and patients (Zaka et al., 2020; Zandifar
and Badrfam, 2020). Interventions to deal with
the pressing psychological needs of individuals
during the pandemic are being investigated but
in most parts of the world seriously lacking
(Wang Y et al., 2020; Xiang et al., 2020). One
example is physical exercise, which has been
observed to be one of the most important tools to
prevent mental illness and improve well-being
(Mandolesi et al., 2018). However, few public
health guidelines include daily physical exercise
routines for people living in varying degrees of
isolation during the pandemic (Chen et al., 2020;
Jiménez-Pavón et al., 2020).
Before discussing specific self-care meas-
ures to enhance ‘lockdown’ health, we briefly
introduce the psychological theory upon which
these measures are founded.
Psychological homeostasis
At every level of existence, from the cell to the
organism, from the individual to the population,
and from the local ecosystem to the entire
Matias et al. 3
planet, homeostasis is a drive towards stability,
security and adaptation to change. In a general
theory of behaviour claims that striving for bal-
ance and equilibrium is a primary guiding force
in all that we do, think and feel. A behavioural
type of homeostasis has been given the des-
criptive term: ‘Reset Equilibrium Function’ (or
‘REF’; Marks, 2018). The REF is thought to be
omnipresent, whatever we are doing and wher-
ever we are doing it, which includes the monot-
ony of COVID-19 isolation. When we are in
isolation, the REF stays with us, considers how
to restore equilibrium and reduce feelings of
unrest. The REF’s monitoring is not normally
attended to, but the REF’s products are feelings
of distress, boredom, loneliness and instability
can all be a focus for concern. Competing
drives, conflicts and inconsistencies all pull the
flow of thought and feeling ‘off balance’, trig-
gering an innate striving to restore equilibrium.
Individuals resort to a variety of methods to
restore a sense of balance and equilibrium.
Body and mind continuously regulate and
control many domains and levels simultane-
ously, with multiple adjustments to voluntary
and involuntary behaviour guided by two types
of homeostasis: Type I – inwardly striving or
physiological homeostasis, H[Φ], and Type II
– outwardly striving or psychological homeo-
stasis, H[Ψ]. Physiological regulation involves
drives such as hunger, thirst, sex, elimination
and sleep. The REF operates across all behav-
ioural systems that are investigated by psycho-
logical science.
The REF is a general control function that
automatically restores psychological processes
to equilibrium and stability. The REF is trig-
gered when any processes within a system
strays outside of its set range. The REF is innate
and exists in conscious organisms, which all
have Types I and II homeostasis. The two types
of homeostasis work in synergy. Psychological
and physiological processes operate in tandem
to maximize equilibrium for each particular set
of functions.
These include cognition, affect, chronic stress
and subjective well-being, and also out-of-
control conditions such as isolation, boredom,
addiction or insomnia that are in need of self-
care. When there is goal to make a behaviour
change, conscious awareness of the goal and
full engagement of one’s personal resources are
necessary preconditions for purposeful striving,
for example, the need to reduce boredom and
instability in COVID-19 isolation.
The needs hierarchy
Human experience is controlled by needs and
behaviours to satisfy needs. A general theory of
behaviour includes Maslow’s (1943) influen-
tial statement about human needs (with a few
minor modifications). It is assumed that needs
occupy a hierarchy of seven overlapping levels
(Figure 1). Like any hierarchical structure, the
stability of the system relies on the strength of
its foundation level. The first level – Immediate
Physiological Needs – incorporates physiolog-
ical homeostasis (Type I) and the sustenance of
all physiological needs. Higher level needs
from level 2 upwards are served by psychologi-
cal homeostasis (Type II). There is a progres-
sion in developmental priority as the individual
matures. The motivational hierarchy reflects
evolutionary function, developmental sequenc-
ing and current cognitive priority. Individuals
who are unable to meet their immediate physi-
ological needs at Level 1 are at a disadvantage
in meeting higher level needs. Think of a build-
ing with seven storeys. If Level 1 of the build-
ing is not strong, then the higher levels will be
vulnerable to collapse.
We consider next the likely impact of
COVID-19 social distancing in the light of the
hierarchy of human needs. We consider only
needs most directly impacted by social distanc-
ing at Levels 1–4, which we discuss in turn.
Immediate physiological needs (Level 1)
Physiological regulation involves the drives of
hunger, thirst, sex, elimination and sleep. Level 1
is a bedrock for all higher levels. We consider
first food, drink and other necessary products,
which have been an issue from the very start of
the pandemic with ‘panic buying’ and stockpiling
4 Journal of Health Psychology 00(0)
reported everywhere causing supermarkets and
stores to run out of supplies. In the United
Kingdom, in packaged food and beverages, the
highest growth has been evident in cereals (38%),
vegetables (37%), cocoa (25%), rice (22%) and
pasta (19%). There has also been an increase in
bottled water and indulgence foods, such as
chocolate (23%), olives (68%) and beer (20%)
(Kantar, 2020). Comfort eating and drinking is a
common strategy of individuals seeking ways to
ameliorate anxiety and distress associated with
lockdown. Comfort eating and drinking is associ-
ated with weight gain and the development of
obesity and eating disorders, especially in condi-
tions of isolation and boredom (Crockett et al.,
2015; Marks, 2015; Figure 2). Sadly, there is
likely to be an acceleration in the already high
prevalence of obesity over the lockdown period.
As the lockdown period is indefinitely extended,
with increasing joblessness and poverty, food
insecurity is likely to become a major concern for
many people.
A well-known and, to many, surprising
COVID-19 phenomenon has been the preva-
lence of toilet-tissue stockpiling (TTS). In the
United Kingdom, for the week ending 8 March
2020, the sales of toilet tissues rose by 60% year-
on-year (Kantar, 2020). Why should this be? In
fact, this behaviour is perfectly logical and in line
with the needs hierarchy where utmost priority is
given to needs at Level 1. TTS provides long-
term hygienic support to the necessary act of
elimination, which, during isolation, is more fre-
quent at home because people are unable to do it
at the workplace. Thus, TTS is consistent with
Level 1 of the hierarchy of needs.
Level 1 needs are automatically more com-
plex in cases of addiction to drugs, alcohol,
tobacco and other substances. If any of these
addictions are present, the entire needs structure
can be placed in jeopardy. In any case, disrup-
tion of sleep patterns is one prevalent conse-
quence of pandemic distress. A European task
force concluded,
Figure 1. The Hierarchy of Human Needs. Homeostasis operates at all seven levels. Physiological, or Type
I, homeostasis operates at Level 1. Psychological, Type II, homeostasis operates at Level 2 (self-protection)
and above. Reproductive goals are in the order they are likely to appear developmentally. Later developing
needs are overlapping with earlier developing needs. Once a need develops, its activation is triggered
whenever relevant environmental cues are salient. Reproduced from Kenrick etal. (2010) with permission.
Matias et al. 5
In the current global home confinement situation
due to the COVID-19 outbreak, most individuals
are exposed to an unprecedented stressful
situation of unknown duration. This may not only
increase daytime stress, anxiety and depression
levels but also disrupt sleep. Importantly, because
of the fundamental role that sleep plays in
emotion regulation, sleep disturbance can have
direct consequences upon next day emotional
functioning . . . Managing sleep problems as best
as possible during home confinement can limit
stress and possibly prevent disruptions of social
relationships. (Altena et al., 2020: 1)
It has been established that physical exercise
improves sleep for people of all ages (Flausino
et al., 2012; Reid et al., 2010; Yang et al., 2012).
We return to this later.
Need for self-protection (Level 2)
Self-protection needs during the COVID-19
pandemic are paramount. The World Health
Organization (WHO, 2020) and national gov-
ernments have required a lockdown of the
population with ‘social distancing’ and ‘stay-at-
home’ isolation. These policies have stoked fear
of death and infection while incentivizing indi-
viduals to carry out frequent handwashing,
wearing masks along with social isolation. The
advice to stay at home has been the main topic
of messaging from health authorities during the
pandemic.
An individual’s responses to COVID-19
lockdown are shown in Figure 3. In lockdown,
unmet self-protection needs become ‘normal’
and individuals experience systematic frustra-
tion of a deep-seated need to ensure protection
of self and their family. This high level of frus-
tration causes fear, anxiety and distress as
individuals feel incompetent to guarantee the
safety and protection of loved ones, family and
self. Fear, anxiety and distress are also associ-
ated with insomnia, irritability and aggression.
Especially, if an individual uses alcohol or
drugs to assuage their fears, aggression may
turn into physical violence to family members,
women, children and pets (Peterman et al., in
press). There are increases in the incidence of
homicides and suicides (e.g. Campbell, 2020).
Need for affiliation (Level 3)
The almost total cessation of full frontal face-to-
face affiliation outside of one’s domestic ‘bub-
ble’ is mandated by policies of home confinement
and ‘social distancing’. Connecting with others
normally helps individuals to regulate their
emotions, cope with stress, and remain resilient
(Williams et al., 2018). Loneliness and social
isolation, however, worsen the burden of stress,
and often produce deleterious effects on mental,
cardiovascular and immune health (Haslam
et al., 2018). Older adults, at the greatest risk of
severe symptoms from COVID-19, are also
Figure 2. Panel A shows the homeostasis system linking low self-esteem with negative affect, comfort eating
and overweight. Intervention to alter the dynamics of the system towards that shown in Panel B replaces
comfort eating with exercise designed to increase self-esteem and control weight gain (Marks, 2015).
6 Journal of Health Psychology 00(0)
most susceptible to isolation (Luo et al., 2012).
Intergenerational social support, self-esteem and
loneliness are all strongly associated with sub-
jective well-being (Tian, 2016). These effects
are not peculiar to older people. Even among
adolescents, loneliness is associated with physi-
cal inactivity (Pinto et al., 2019). Thus distanc-
ing threatens to aggravate feelings of loneliness
that likely will produce negative long-term
health consequences in many vulnerable people.
During the COVID-19 pandemic, the popula-
tion of people at risk is enormous. After the
lockdown period ceases, sadly mental health
services are expected to be overwhelmed.
People with unmet needs for affiliation at
Level 3 are also at risk of failing to meet needs
for status and self-esteem at Level 4.
Need for status/self-esteem (Level 4)
As noted, status and self-esteem needs are vul-
nerable if needs at Levels 1–3 are unmet. Failure
at Levels 1–3 accumulates with larger knock-on
effects as cumulative failure develops.
Furthermore, the pandemic is producing huge
increases in unemployment and poverty, vul-
nerability factors for lowered self-esteem and
social status (e.g. Goldsmith et al., 1997). Self-
esteem is associated with responses to success
and failure (Baumeister and Tice, 1985). Low
self-esteem also creates a vulnerability to
depression (Sowislo and Orth, 2013) and to
drinking alcohol (Hull and Young, 1983) – if
affordable. Self-esteem moderates the associa-
tions between body-related self-conscious emo-
tions and depressive symptoms (Brunet et al.,
2019). Self-esteem also appears to be an impor-
tant antecedent of the development of self-com-
passion (Donald et al., 2018).
From the above review, it can be seen that
COVID-19 lockdown has created a ‘perfect
storm’ of vulnerabilities that huge numbers of
people, and services, are ill-prepared to manage
with uncertain long-term consequences. What
solutions are available?
The role of physical activity
One underutilized tool that is freely available to
almost everyone can bring profound benefits if
applied systematically – regular physical exer-
cise. The impact of exercise is one of the most
powerful examples of regulation created by
homeostasis. Regular physical activity not only
has obvious physical benefits but significant
psychological benefits also. During COVID-19
isolation, exercise offers the capability to reset
body and mind to a state of equilibrium.
Figure 3. Behavioural systems at Level 2 of the needs hierarchy in COVID-19 lockdown. Panel A shows
a typical response early in lockdown for a person in self-quarantine. In panel A, fear and frustration are
accompanied by heightened surveillance of the external environment through TV news channels and social
media. Panel B shows a person who has adjusted to the self-quarantine. In panel B, fear and frustration are
replaced by self-compassion and empathy and surveillance is replaced by reaching out to others.
Matias et al. 7
There are the following two major aspects
of exercise: (1) the role of exercise in the
immune system through regular physical activity
(Campbell and Turner, 2018; Simpson et al.,
2020) and (2) the role of exercise in psychologi-
cal well-being (Mandolesi et al., 2018). However,
exercise is certainly no panacea. It must be
applied with caution by people with chronic con-
ditions. If a person has a heart condition, strenu-
ous physical exercise may put them at risk, or kill
them even (Keteyian et al., 2016). Also in some
chronic conditions such as ME/CFS, exercise
makes the majority of patients feel much worse
(Geraghty et al., 2019). However, if used safely
and appropriately, the majority of people can
quickly feel physical and mental benefits from
regular exercise.
Some significant effects of physical activity
can be explained by physiological mechanisms
(Lopresti et al., 2013). Exercise within the con-
text of psychological health promotion has also
been an active research area (Chekroud et al.,
2018; Curioni and Lourenco, 2005; Mikkelsen
et al., 2017; Tiggemann and Zaccardo, 2018).
Some researchers have focused on neurophysio-
logical mechanisms, which aim to identify the
positive outcomes of the relationship between
exercise and mental health (Eyre and Baune,
2012). Exercise is understood as a relationship
between intensity and frequency, and positive
outcomes are mostly based on which exercise
protocol will determine a better neurophysiologi-
cal response (Lopresti et al., 2013). Exercise is
recognized as a mediator of primary monoamine
neurotransmitters, namely, serotonin, noradrena-
line and dopamine. These three neurotransmitters
receive reciprocal regulation, while exercise
intensity modulates the stimulation of monoam-
ine system (Lin and Kuo, 2013). However, it is
also important to recognize the affective responses
of physical activities and psychological variables
are likely to mediate the relationship between
exercise and mental health (Rodrigues et al.,
2019). There is a sound empirical basis for an
integrated account of the emotional effects of
exercise. A recent study with a representative US
sample of 1.2 million individuals linked exercise
to mental health and exercising was associated
with reduced self-reported mental health burden.
Furthermore, motivation and mindfulness-based
techniques were discussed as mediators for these
relationships, which seemed to account for the
strongest effect of the exercise on fewer days of
poor mental health (Chekroud et al., 2018).
In the context of social isolation, exercise
can be an inherently rewarding activity that
contributes joy, happiness and satisfaction
(Ryan and Deci, 2017; Standage and Ryan,
2012). The positive outcomes also appear as a
function of affective consequences of exercise
or anticipation of its affective response – the
hedonic principle of the law of effect (Marks,
2018). In general, the expected pleasure versus
displeasure is a determining principle of the
motivation to repeat behaviour (Kwasnicka
et al., 2016; Williams, 2008).
Isolation and quarantine are a disagreeable
experience, which may lead to sadness and
even impose dramatic mental illness for those
who undergo it (Brooks et al., 2020). In this
context, a daily exercise routine can be crucial
to modulating pleasurable situations at some
point during the day. People can feel more
deeply satisfied through the experience of
choice and volition, reinforce their sense of
autonomy and competence, and renew a sense
of joy (Lubans et al., 2017; Ryan and Deci,
2017; Standage and Ryan, 2012).
The rationale for the positive side of exercis-
ing at home is that exercise can be experienced
without any strong social pressure, having a
totally internal source of inspiration. The behav-
iour might be accompanied by higher self-
esteem and lower psychological ill-being, since
people are free to choose the types of exercise,
schedule, frequency and intensity. The fulfill-
ment of basic psychological needs appear
within this context.
The benefits of exercise depend on the
degree of internalization of the behaviour. In
our daily lives, exercises are normally per-
formed in order to achieve goals, such as social
aesthetic standards (Sperandei et al., 2016).
These goals are separable from the purpose of
the exercise (a person may not enjoy exercising,
but will do it to obtain a result); and therefore,
8 Journal of Health Psychology 00(0)
people are generally not ‘authentic’. The lack of
authenticity represents a person doing an activ-
ity for contingent reward or punishment, feeling
tense and pressured, lacking intentionality and
being oriented to avoid guilt, angst and social
judgement or to protect contingent self-worth.
Contrarily, people are authentic when exercise
choice is aligned with personal goals, interest
and is assimilated with the individual’s charac-
teristics, ability and identity (Deci and Flaste,
1995). Identity is associated with ongoing posi-
tive experiences attendant on the behaviour
(Kwasnicka et al., 2016), such as exercising at
home.
Notably, the COVID-19 pandemic causes
fear and the lockdown imposes limits on peo-
ple’s movement (Brooks et al., 2020; Xiang
et al., 2020). Another helpful process is that of
self-compassion – the ability to treat oneself
with the same concern and support in distress-
ing situations; it is related to self-kindness,
common humanity and mindfulness. In fact, it
is associated with self-regulation when per-
forming health-promotion behaviours (Holden
et al., 2020; Semenchuk et al., 2018). Exercising
at home, in a crisis situation, can be performed
without self-criticism, which could hinder the pro-
cess by increasing pressure and self-judgement,
which in turn may provide adaptive coping,
problem-solving and psychological well-being.
Research has provided empirical evidence on the
positive relationship between self-compassion
and exercise (Holden et al., 2020; Semenchuk
et al., 2018), providing exercise maintenance
and enhancing positive emotions.
Thus, exercising at home can increase the
individual’s sense of control. Research suggests
that self-mastery is a crucial criterion for pro-
moting positive effects on psychological out-
comes (Mikkelsen et al., 2017; Ryan and Deci,
2017). In the face of this pandemic, we have
seen many examples across the world showing
that exercise can create a social arena in which
individuals learn social skills and build social
networks by adhering to exercise challenges,
exercising in condominiums and encouraging
others. These virtual social connections enhance
feelings of autonomy and being fully alive.
When autonomous forms of regulation guide
behaviour, positive affective responses are
expected (Ryan and Deci, 2017; Standage and
Ryan, 2012). One example is the QuaranTrain
launched at HAN University of Applied
Sciences in the Netherlands, an online fitness
programme promoting evidence-based infor-
mation on exercise and resources to stay active
during COVID-19 pandemic through blogs and
videos (HAN University of Applied Sciences,
2020). They provide daily online support,
according to World Health Organization advice
on physical activity. Users post their workouts
routines in social media using the trending
hashtags #quarantrain and #quarantraining,
with more than 5000 posts worldwide.
Being engaged in exercise may result in
higher levels of self-efficacy (Bandura, 1997)
which can have the knock-on effect of improv-
ing one’s ability to carry out other activities
(Mikkelsen et al., 2017). The relationship bet-
ween changes in the ability to perform activi-
ties successfully and increased self-efficacy is
fundamental, considering the observed associa-
tion between depression and low self-efficacy
(White et al., 2009). In the context of social
isolation, physical activity may be one key to
enhancing people’s feeling of competence. In
addition, achievement of internal goals and sat-
isfaction has been related to greater psychologi-
cal wellness (Ryan and Deci, 2017; Standage
and Ryan, 2012). This hypothesis has been con-
firmed by an experimental protocol in which
mindfulness self-efficacy appeared to mediate
the indirect effects of exercise on mental health
and perceived stress (Goldstein et al., 2018),
reinforcing the positive account of emotion for
a better quality of life (Joseph et al., 2014).
Moreover, we recommend that people in
social isolation should try to create peer support
through social networking services by involv-
ing friends and relatives in their exercise rou-
tines or challenges.
Mikkelsen et al. (2017) observed that exercise
influences self-esteem through self-efficacy or
mastery, and mood, distracting individuals from
negative and worrying thoughts and rumination,
improving the retrieval of positive thoughts and
Matias et al. 9
allowing time away from negative or stressful
aspects of everyday life, and especially, the
COVID-19 pandemic itself. These moderating
factors might also explain the protection effect of
exercise on mental health (Mikkelsen et al.,
2017). Physical activity programmes to improve
self-esteem to people of all ages can be effec-
tively delivered at home by DVD (e.g. see Awick
et al., 2017).
Conclusion
The negative impacts of COVID-19 lockdown
on mental health can be ameliorated by the use
of exercise, which should be as vigorously
promoted as social distancing itself. The suc-
cess of social isolation policies will depend on
minimizing long-term depreciation of mental
health. In this context, keeping moving seems
to be the key.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of inter-
est with respect to the research, authorship, and/or
publication of this article.
Funding
The author(s) received no financial support for the
research, authorship, and/or publication of this
article.
ORCID iDs
Fabio H Dominski https://orcid.org/0000-0003-
1767-6405
David F Marks https://orcid.org/0000-0002-4096
-2883
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... As of the onset of the COVID-19 pandemic worldwide, conventional methods of response have been invalid and inffeicient, as countries are generally encountered with uneven distribution of healthcare resources, operational inefficiencies, lack of flexibility, and shortages of hospital beds (4). To minize the transmission of COVID-19, the World Health Organization and the majority of governments have recommended "stay-at-home" (5). Due to the absence of a prophylactic vaccine, official control measures have been implemented to reduce the spread of COVID-19, such as staying at home (6). ...
... Nos. 1,4,5,8,9,13,14, and 15 candidate locations were selected after preliminary selection. Their comprehensive evaluation values were relatively high among all candidate locations. ...
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In the event of pandemic, it is essential for government authority to implement responses to control the pandemic and protect people's health with rapidity and efficicency. In this study, we first develop an evaluation framework consisting of the entropy weight method (EWM) and the technique for order preference by similarity to ideal solution (TOPSIS) to identify the preliminary selection of Fangcang shelter hospitals; next, we consider the timeliness of isolation and treatment of patients with different degrees of severity of the infectious disease, with the referral to and triage in Fangcang shelter hospitals characterized and two optimization models developed. The computational results of Model 1 and Model 2 are compared and analyzed. A case study in Xuzhou, Jiangsu Province, China, is used to demonstrate the real-life applicability of the proposed models. The two-stage localization method gives decision-makers more options in case of emergencies and can effectively designate the location. This article may give recommendations of and new insights into parameter settings in isolation hospital for governments and public health managers.
... The lockdown was lifted in France on May 11, 2020, after a dramatic decrease in the number of cases and deaths, but mobility restrictions had some major adverse consequences [6]. The ensuing reductions in social (collective training sessions or sport events) and physical (barred access to exercise facilities or parks) opportunities to exercise had a direct negative effect on health behaviors and well-being [7][8][9][10][11]. The lockdown also had a detrimental impact on various aspects of psychological health (eg, posttraumatic stress disorder, anxiety, and depression [12,13]), especially in high-density and socially deprived neighborhoods [14] and among people with pre-existing chronic conditions [15]. ...
... One possible explanation is that these measures were assessed in light of their restrictive nature [31], socioeconomic consequences (eg, unemployment, bankruptcy of businesses, mobility restrictions), and/or psychological burden (eg, anxiety, depression) [32]. For instance, the stay-at-home order for nonessential workers was linked to health anxiety, financial worry, decreased physical activity, isolation, and loneliness [9,33]. Similarly, closing all educational settings (schools and universities) jeopardized students' education and well-being [34][35][36], while closing bars and restaurants led to massive unemployment in the food and hospitality sector during the first lockdown. ...
... However, many vulnerable populations have limited digital literacy, including those of lower socio-economic status and limited health literacy (Beaunoyer et al., 2020), making alternative support measures a priority for these people. Self-help and self-care have also been espoused, with the suggestion that exercise and other health behaviours should be vigorously promoted (Matias et al., 2020). Such measures can be described as adaptive coping, adopted to build resilience in the context of significant adversity. ...
... Significant associations with resilience and negative emotions were evident for several adaptive coping strategies in the entire sample. In line with previous work, greater resilience was significantly associated with more exercise (Hu et al., 2020) and self-help (Matias et al., 2020). Self-help strategies included focusing on the things for which they could be grateful and challenging negative thoughts, rather than visiting a mental health professional or seeking virtual help of this nature from apps (Boyd et al., 2014). ...
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The mental health consequences of the COVID-19 pandemic have been significant in Australia. The aim of this study was to investigate coping strategies that individuals have adopted to assist them through this stressful period. Survey data collected in September and December 2020 as part of a larger study (the COLLATE project) were analysed. The number of adaptive coping strategies endorsed by respondents had a significant negative relationship with depression and a significant positive relationship with resilience. Females tended to use more of these strategies than men, as did people who said their mental health had improved rather than deteriorated because of the COVID-19 restrictions imposed by government. Specific adaptive coping strategies differed for those with and without a mental illness. People with a mental illness were more likely to seek professional and online help, while people without a mental illness were more likely to use self-help. Focusing on what one is grateful for and keeping oneself productively occupied (“using the time to do things around the house”) were the most beneficial coping strategies in terms of alleviating depression, anxiety and stress. Public health messaging promoting adaptive coping strategies may be useful in bolstering the mental health of individuals during lockdown periods. In particular, the promotion of coping flexibility should be recommended rather than the frequent use of the same coping strategies.
... 32 The telephone interview was completed during the coronavirus (COVID-19) pandemic, a time when individuals were overwhelmed with stressors such as increased screen time and lack of face-toface human contact. 33 Gender influences individual opportunities, choices, and health, 34 and unfortunately, our study included only 10% men. This high female response may have not addressed barriers and strategies specific to their male peers. ...
... The local, state, and national pandemic regulations could have increased level of participant anxiety and/or depression due to isolation and disruptions in normal routine. 33 In addition, the pandemic could have decreased the ability for participants to meet with their medical team due to COVID-19 restrictions. 35 A strength of the study was there were no restrictions to length of T1DM diagnosis. ...
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Purpose Individuals in the emerging adult age group (18-30 years) with type 1 diabetes (T1DM) have unique medical and social needs. The purpose of this study was to observe barriers and strategies for diabetes management among emerging adults with T1DM. Methods A qualitative grounded theory model was utilized. An open-ended approach with a telephone interview was designed to allow a deeper understanding of the T1DM experience. The participants were from a larger survey-volunteer participant group and were asked to complete 1 interview in spring 2020 (n = 21, diagnosed age: mean 15.00 ± 8.00, females, n = 19). The data were analyzed for cohesive themes using grounded theory. Results Participants indicated three main barrier themes (physiology, environment, and insurance) and 3 barrier subthemes (mental health, lack of social support, and weather). Three main strategy themes to diabetes management were recognized (medical technology, access to social support, and physical activity). There were 2 strategy subthemes (social media and social accountability). Conclusions Regular use of social media can be a key tool for social accountability while lack of social support and physiological shifts can be barriers to management of T1DM. Physical activity should be considered as part of an individualized plan for management of diabetes.
... The number of confirmed COVID-19 cases is still growing, and the outbreak continues to progress worldwide [2]. The WHO recommends quarantine to prevent and control the spread of the disease to new regions and reduce its transmission [5,6]. To reduce the transmission of this communicable pandemic disease by respiratory droplets, and to control its outbreaks, several restrictions and preventive strategies have been implemented to reduce interactions between people, such as social isolation, physical distancing, travel restrictions, and closing of public places such as parks and gyms [2,[7][8][9]. ...
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COVID-19 has caused a global pandemic that has spread rapidly to six continents, with over 2.5 million deaths from December 2019 to March 2021. The number of confirmed COVID-19 cases is still growing worldwide, and quarantines have been recommended to prevent the disease’s spread. However, quarantines affect people’s quality of life (QOL). The aim of this study is to assess the effect of social isolation—quarantine—on QOL during the first wave of the COVID-19 pandemic in Saudi Arabia. A cross-sectional, descriptive design was used in the present study. We obtained data from an online survey conducted in Saudi Arabia. We included a convenience sample of 775 participants in the study. Most of the participants were female (67%), with a mean age of 46 years ranging from 18 to 75 years. Many participants were government employees (n = 308, 39.7%) and had a bachelor’s degree or greater (n = 513, 66.2%). Most of the participants (n = 629, 81%) were free from any chronic disease. Nearly 88% of participants were partially isolated socially owing to COVID-19. Concerning QOL, the means of both the Physical Health Composite Scale and the Mental Health Composite Scale SF-12 scores were 44.7 and 34.6, respectively. Furthermore, the results demonstrate that partially socially isolated participants appeared to have significantly better physical health statuses (M = 44.96, SD = 5.90) than completely socially isolated participants (M = 42.87 ± 7.26). There was no significant social isolation effect on mental health status (t (773) = 2.5, p = 0.115). Social isolation during the COVID-19 pandemic considerably influenced various aspects of QOL including physical and mental health. Community-based interventions such as online counseling services and wellness programs are required to reduce the pandemic’s negative impact and enhance overall health status and QOL.
... Recent studies have shown that the lockdown confinement and the simultaneous closure of all leisure and socialization activities has important health, economic, environmental and social consequences [4]. ...
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Background The COVID-19 pandemic and the lockdown period lasted from March to May 2020, resulted in a highly stressful situation yielding different negative health consequences, including the worsening of smoking habit. Methods A web-based cross-sectional study on a convenient sample of 1013 Italian ever smokers aged 18 years or more was conducted. Data were derived from surveys compiled by three different groups of people: subjects belonging to Smoking Cessation Services, Healthcare Providers and Nursing Sciences’ students. All institutions were from Northern Italy. The primary outcome self-reported worsening (relapse or increase) or improvement (quit or reduce) of smoking habit during lockdown period. Multiple unconditional (for worsening) and multinomial (for improving) logistic regressions were carried out. Results Among 962 participants, 56.0% were ex-smokers. Overall, 13.2% of ex-smokers before lockdown reported relapsing and 32.7% of current smokers increasing cigarette intake. Among current smokers before lockdown, 10.1% quit smoking and 13.5% decreased cigarette intake. Out of 7 selected stressors related to COVID-19, four were significantly related to relapse (OR for the highest vs. the lowest tertile ranging between 2.24 and 3.62): fear of being infected and getting sick; fear of dying due to the virus; anxiety in listening to news of the epidemic; sense of powerlessness in protecting oneself from contagion. In addition to these stressors, even the other 3 stressors were related with increasing cigarette intensity (OR ranging between 1.90 and 4.18): sense of powerlessness in protecting loved ones from contagion; fear of losing loved ones due to virus; fear of infecting other. Conclusion The lockdown during the COVID-19 pandemic was associated with both self-reported relapse or increase smoking habit and also quitting or reduction of it.
... During the pandemic, parents and children stayed together for long periods, and the worries and fears that parents perceive in their children directly was reflected in themselves. In addition, individuals under confinement experience deep-seated frustration around the need to ensure the protection of themselves and their families, but this high degree of vigilance often leads to fear, anxiety, and pain (Matias et al., 2020). Parents may feel unable to protect their children, and the degree of phobic anxiety will increase with the deepening of their children's fear. ...
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To investigate the relations between young children's negative emotions and their mothers' mental health during the COVID‐19 pandemic. The COVID‐19 pandemic caused the public a certain degree of psychological symptoms, and family environments and relations have been changed dramatically as a result. The relations between young children's negative emotions and their mothers' mental health have not been sufficiently determined for the context of a pandemic or other large‐scale crises. A survey was administrated on 8119 Chinese mothers of 3‐ to 6‐year‐old children with the Symptom Checklist 90 and the Child Negative Emotion Questionnaire. The canonical correlation results indicated that there were covariation trends between young children's anger and their mother's obsessive–compulsive symptoms and hostility, children's fear and mothers' phobic anxiety, and children's tension and mothers' interpersonal sensitivity and depression. These correlations were all positively significant. During the COVID‐19 pandemic, the predictive power of young children's negative emotions to their mothers' mental health was greater than that of the reverse. This study provides a scientific guidance on the regulation of young children's negative emotions and the improvement of mothers' mental health during the pandemic as well as potential emergencies in the future.
... [16] Furthermore, Matias et al. insisted the government should pay attention to the psychological health of health-care staff and patients and self-care should be prioritized in coping with COVID-19's negative impacts and social isolation. [17] Mukherjee et al. identified fear, rage, guilt, and terror have all been exacerbated by quarantine, leading to a variety of mental illnesses among children and their families. The existence of a supportive family, as well as the lack of financial problems, are stabilizing influences for youngsters. ...
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Background: The human coronavirus was first identified in 1965, belongs to the same family of Viruses as SARS, MERS-Co. The current virus that affected worldwide came into existence in late 2019, recently found in Wuhan, China, and caused a global pandemic called coronavirus disease-2019 (COVID-19). This disease became a quick global pandemic due to the rapid transmission of the virus from one human to another. In the history of humankind, people were inside the four walls for more than a month. The COVID-19 pandemic has posed significant problems in a variety of fields. The current pandemic created many changes that are seen as challenges worldwide. However, it created opportunities and benefits for many, extend a helping hand towards the people in need, in the society, community, and the nation. This paper focuses on challenges, opportunities, and benefits during the (COVID-19) pandemic in India. Materials and methods: Online search engines like PubMed and Google Scholar were used to conduct the research. The review article's dates were not restricted in any way. A total of 48 articles were chosen. The data was tabulated based on the kind of study and the outcomes. There are just a few papers available that demonstrate the necessity for more study. Results: COVID-19 caused unforeseen changes in the health care industry, unequal distribution of health care, and consequences on mental health, according to the review studies. Teleconsultation, Internet use, and E-learning have all become more accessible. A period of transitory economic collapse and an increase in the number of migrants left many despondent. Improvement in family bonding, use of a face mask, and hygiene measures to adapt to the current scenario. There was also an impact on water sources, waste management systems, and environmental resource conservation. Conclusion: Difficult conditions can provide both problems and opportunities and advantages to the people during a pandemic outbreak.
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Disaster psychological assistance has become an important part of the disaster relief system, playing a crucial role in restoring and maintaining emotional stability and security of people and reducing trauma-related stress. As the first country to experience the outbreak of the coronavirus disease 2019 (COVID-19), China actively adopted psychological assistance measures in response to the panic caused by the epidemic. These measures are expected to help the Chinese government and governments in other parts of the world to better respond to the outbreaks of COVID-19.
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Though necessary to slow the spread of the novel Coronavirus (Covid-19), actions such as social-distancing, sheltering in-place, restricted travel, and closures of key community foundations are likely to dramatically increase the risk for family violence around the globe. In fact many countries are already indicating a dramatic increase in reported cases of domestic violence. While no clear precedent for the current crisis exists in academic literature, exploring the impact of natural disasters on family violence reports may provide important insight for family violence victim-serving professionals. Improving collaborations between human welfare and animal welfare agencies, expanding community partnerships, and informing the public of the great importance of reporting any concerns of abuse are all critical at this time.
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In the current global home confinement situation due to the COVID‐19 outbreak, most individuals are exposed to an unprecedented stressful situation of unknown duration. This may not only increase daytime stress, anxiety and depression levels but also disrupt sleep. Importantly, because of the fundamental role that sleep plays in emotion regulation, sleep disturbance can have direct consequences upon next day emotional functioning. In this paper we summarize what is known about the stress‐sleep link and confinement as well as effective insomnia treatment. We discuss those effects of the current home confinement situation that can disrupt sleep but also those that could benefit sleep quality. We suggest adaptions of cognitive behavioral therapy elements that are feasible to implement for those facing changed work schedules and requirements, those with health anxiety and those handling childcare and homeschooling, whilst also recognizing the general limitations imposed on physical exercise and social interaction. Managing sleep problems as best as possible during home confinement can limit stress and possibly prevent disruptions of social relationships.
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Multiple studies in humans and animals have demonstrated the profound impact that exercise can have on the immune system. There is a general consensus that regular bouts of short-lasting (i.e. up to 45 minutes) moderate intensity exercise is beneficial for host immune defense, particularly in older adults and people with chronic diseases. In contrast, infection burden is reported to be high among high performance athletes and second only to injury for the number of training days lost during preparation for major sporting events. This has shaped the common view that arduous exercise (i.e. those activities practiced by high performance athletes/ military personnel that greatly exceed recommended physical activity guidelines) can suppress immunity and increase infection risk. However, the idea that exercise per se can suppress immunity and increase infection risk independently of the many other factors (e.g. anxiety, sleep disruption, travel, exposure, nutritional deficits, environmental extremes, etc.) experienced by these populations has recently been challenged. The purpose of this debate article was to solicit opposing arguments centered around this fundamental question in the exercise immunology field: can exercise affect immune function to increase susceptibility to infection. Issues that were contested between the debating groups include: (i) whether or not athletes are more susceptible to infection (mainly of the upper respiratory tract) than the general population; (ii) whether exercise per se is capable of altering immunity to increase infection risk independently of the multiple factors that activate shared immune pathways and are unique to the study populations involved; (iii) the usefulness of certain biomarkers and the interpretation of in vitro and in vivo data to monitor immune health in those who perform arduous exercise; and (iv) the quality of scientific evidence that has been used to substantiate claims for and against the potential negative effects of arduous exercise on immunity and infection risk. A key point of agreement between the groups is that infection susceptibility has a multifactorial underpinning. An issue that remains to be resolved is whether exercise per se is a causative factor of increased infection risk in athletes. This article should provide impetus for more empirical research to unravel the complex questions that surround this contentious issue in the field of exercise immunology.
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