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The effect of exercise on resilience, its mediators and moderators, in a general population during the UK COVID-19 pandemic in 2020: a cross-sectional online study

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Abstract

Background: Resilience is central to positive mental health and well-being especially when faced with adverse events. Factors such as exercise, location, sleep, mental health, and personality are moderators and mediators of resilience. However, the impact of these factors on resilience during severe adverse events are unknown. The present study examined how the COVID-19 pandemic affected resilience and its moderators and mediators by investigating whether there was a difference in resilience and quality of life between people with varying levels of exercise, including those who changed their exercise levels pre and during a COVID-19-related lockdown, and whether location affected the relationship between levels of exercise and resilience and quality of life. Methods: Following ethical approval, a cross-sectional online survey capturing data on self-reported key moderators and mediators of resilience before and during the COVID-19 lockdown imposed on the 23rd March 2020 in the UK was distributed via social media and completed over a three week time period during July 2020 via a self-selecting sample of the general population (N = 85). The key moderators and mediators of resilience the survey assessed were exercise, location, life-orientation, mental health, and sleep quality. All data were self-reported. Results: Participants' exercise intensity level increased as resilience increased (F(2,82) = 4.22, p = .003: Wilks' lambda = .82, partial n2 = 0.09). The relationship between exercise, and resilience and quality of life was independent of sleep and mental health status pre-lockdown (p = .013, p = .027 respectively). In the face of the COVID-19 pandemic, this relationship was dependent on mental health but not sleep quality (p = <.001 for resilience p = .010 for quality of life). There were no statistically significant differences between participants living in urban or rural locations. Conclusion: Exercise is strongly correlated to resilience and during a pandemic such as COVID-19 it becomes a mechanism in which to moderate resilience. The relationship between exercise and resilience is supported by this study. The influence that a pandemic had on mental health is mediated by its effect on quality of life.
Lancasterand Callaghan BMC Public Health (2022) 22:827
https://doi.org/10.1186/s12889-022-13070-7
RESEARCH
The eect ofexercise onresilience, its
mediators andmoderators, inageneral
population duringtheUK COVID-19 pandemic
in2020: across-sectional online study
Molly Rose Lancaster1* and Patrick Callaghan2
Abstract
Background: Resilience is central to positive mental health and well-being especially when faced with adverse
events. Factors such as exercise, location, sleep, mental health, and personality are moderators and mediators of
resilience. However, the impact of these factors on resilience during severe adverse events are unknown. The present
study examined how the COVID-19 pandemic affected resilience and its moderators and mediators by investigating
whether there was a difference in resilience and quality of life between people with varying levels of exercise, includ-
ing those who changed their exercise levels pre and during a COVID-19-related lockdown, and whether location
affected the relationship between levels of exercise and resilience and quality of life.
Methods: Following ethical approval, a cross-sectional online survey capturing data on self-reported key moderators
and mediators of resilience before and during the COVID-19 lockdown imposed on the 23rd March 2020 in the UK
was distributed via social media and completed over a three week time period during July 2020 via a self-selecting
sample of the general population (N = 85). The key moderators and mediators of resilience the survey assessed were
exercise, location, life-orientation, mental health, and sleep quality. All data were self-reported.
Results: Participants’ exercise intensity level increased as resilience increased (F(2,82) = 4.22, p = .003: Wilks’
lambda = .82, partial n2 = 0.09). The relationship between exercise, and resilience and quality of life was independent
of sleep and mental health status pre-lockdown (p = .013, p = .027 respectively). In the face of the COVID-19 pan-
demic, this relationship was dependent on mental health but not sleep quality (p = <.001 for resilience p = .010 for
quality of life). There were no statistically significant differences between participants living in urban or rural locations.
Conclusion: Exercise is strongly correlated to resilience and during a pandemic such as COVID-19 it becomes a
mechanism in which to moderate resilience. The relationship between exercise and resilience is supported by this
study. The influence that a pandemic had on mental health is mediated by its effect on quality of life.
Keywords: Resilience, Exercise, Quality of life, Mental health, Sleep
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Background
e roots of resilience theory come from the study of
adversity, otherwise known as a pathogenic focus [1]
concerning how individuals achieve positive health
and wellbeing outcomes. e original concept of
resilience was developed as a response to large-scale
Open Access
*Correspondence: Mollyrose.x.lancaster@gmail.com
1 Conducted research at London Southbank University, 103 Borough
Road, London SE1 0AA, UK
Full list of author information is available at the end of the article
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Page 2 of 10
Lancasterand Callaghan BMC Public Health (2022) 22:827
external change [2], such as the United Kingdom lock-
down imposed on the 23rd March 2020 in response to
COVID-19. Resilience is complex in nature [3], and is
characterised as the process of effectively negotiat-
ing, adapting to, or managing significant sources of
stress or trauma [47]. Positive adaptation is the abil-
ity to maintain or regain mental health, despite expe-
riencing adversity [6]. Resilience provides people with
the strength to overcome adversity and decrease the
negative effects that adversity, such as a pandemic like
COVID-19 can cause [8].
Research into resilience and healthcare outcomes have
shown resilience and perceived quality of life (QOL) [9]
are correlated with optimism [10, 11] and lower psycho-
logical stress [12, 13]. Individuals demonstrating high
resilience are less likely to report adverse mental health
experiences [7, 14]. e positive impact of exercise on
resilience [1518], QOL [19] and mental health has been
demonstrated in clinical and general populations [12, 20,
21].
Exercise increases resilience at the core biological level;
promoting secretion of neurotransmitters and endor-
phins to induce a state of euphoria ([22, 23]; Highes etal.,
2013). Euphoria reduces dysfunctional ideation time, act-
ing as a distraction from stressful events ([22, 23]; Lines
etal., 2018; Peluso & de Andrade, 2005).
In a study of 775 adolescents, high self-esteem corre-
lated significantly with good mental health prognoses,
with a Pearson’s product-moment correlation demon-
strating a significant relationship, with resilience explain-
ing 60% of the variance [18]. However, as the positive
mental effects of exercise are enhanced by the social
interactions workout sessions provide ([15, 22]; Ka etal.,
2015; Peluso & de Andrade, 2005), most research to date
fails to control for the effect of these interactions on the
outcomes of interest.. erefore, it cannot be concluded
that exercising alone produces positive mental health
effects. However, as pandemic restrictions prohibited
socialising, this provided a unique research opportunity
to investigate the effects of exercise without any social
interactions during workout sessions.
Resilience is increased by euphoria as it increases
self-esteem by representing our self-rating of self-worth
(Peluso & de Andrade, 2005): the biological and psycho-
logical benefits of exercise working in unison to increase
resilience. Empirical evidence commonly reports exer-
cising at preferred intensity (one’s chosen exercise level)
has increased mental health benefits compared with
prescribed intensity (imposed exercise level) ([24, 25];
Carter, Bastounis, Guo, Morrell, & Carter, 2019 [26];;
Turner, Carter, Sach, Guo, & Callaghan, 2017). As mental
health mediates resilience, this suggests the simple act of
moving has an impact on one’s resilience.
Preferred intensity maybe indirectly related to improv-
ing self-esteem due to the self-controlled nature of exer-
cise, with observed body change results being dependent
on the individual choosing the intensity, thus a goal being
obtained and intrinsic motivation being stimulated ([27];
Pekrun, Hall, Goetz, & Perry, 2014). Research into pre-
ferred intensity is limited; being intervention-based six
to twelve-week studies. erefore, the effect of preferred
intensity upon mental health over a randomised self-
motivated population is not known. As many of the resil-
ient and continued protective effects from exercise are
correlated with the continuation of exercise throughout
the lifespan [19, 21], a short intervention study cannot
conclude confidently about the continued effect of pre-
ferred intensity exercise and resilience. e current study
targeted this limitation as all those who exercise had
done so autonomously, not knowing it would be inves-
tigated for research purposes. e comparison between
those who were already exercising before lockdown and
those who began once lockdown was imposed gave an
insight into the long-term effects of exercise on resilience
and how quickly exercise can promote resilience. is is
in-line with self-determination theory [27], with exercis-
ing during lockdown being intrinsically motivated and
causally related to preferred intensity, which as the cited
literature has suggested, maximises the effect on resil-
ience, thus providing clearer insights into how the exer-
cise of the population as a whole affects resilience.
To date, studies have researched resilience and its mod-
erators in either clinical or general populations, leaving
the general population under-researched, hence the cur-
rent study. Despite the reviewed literature suggesting a
study amongst a self-selecting sample of the population
into resilience should not be impacted by poor mental
health, it indicates a need to control for mental health as
a co-variant. Controlling for mental health as a co-variant
would strengthen the statement that exercise increases
resilience in the generic population.
e lockdown imposed on the UK on the 23rd March
2020 due to COVID-19 has provided a unique opportu-
nity for this study to investigate areas in which previous
research has been limited. e adversity and life-style
changes imposed [28] allows comparisons to be made
against the broad population within the UK who had
to adhere to rules that go against the natural biological
and psychological nature of Homo sapiens; pack animals
who require social interaction to form a social identity
which mediates resilience [15, 2931]. Adversity has
included isolation, separation, financial strain, grief, and
educational deficits (BBC, 2020 [32];), research shows
this negatively impacts resilience [33, 34]. ese studies
were not conducted in a pandemic, thus, whether these
constraints affect resilience similarly in a pandemic is
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Lancasterand Callaghan BMC Public Health (2022) 22:827
unknown and explored in the current study. Based on
data from past recessions; such as the 2008 economic cri-
sis, where suicide rates in Europe increased by 6.5% the
prognosis for mental health and wellbeing as a result of
lockdown is not predicted to be positive ([35, 36]; Radio4
(BBC), 2020 [37];). As research is scarce, we do not yet
know how the COVID-19 lockdown has impacted resil-
ience or its empirical moderators.
e aim of the current study was to examine how the
COVID-19 pandemic affected resilience and its modera-
tors by investigating if there was a difference in resilience
and quality of life between people with varying levels of
exercise, including those who changed their exercise lev-
els pre and during the COVID-19 pandemic, and whether
location played a role in this relationship. e authors
anticipated:
1) People reporting higher exercise levels would have
better resilience and QOL than those reporting low
and moderate exercise levels pre-COVID-19 lock-
down.
2) People who improve their exercise levels during
COVID-19 lockdown would have better resilience
and QOL than people whose exercise levels reduced
or remained the same.
3) Mental health and sleep quality would moderate the
relationship between exercise levels and resilience.
4) Exercise levels and resilience would differ between
people living in rural and urban environment during
COVID-19.
5) Life-orientation and resilience would differ between
people living in rural and urban environments.
6) e relationship between exercise levels, resilience
and QOL in people living in rural and urban environ-
ments would moderated by mental health and sleep
quality during COVID-19.
Methods
Design
e study used a cross-sectional online survey developed
on Qualtrics XM (version 26).
Participants
Following ethics approval from the University’s Research
Ethics Committee, data was collected from 126 Partici-
pants over a three-week period in June 2020. Forty-one
were removed due to an incomplete data set, leaving
85 participants. e participants consisted of 31 males
and 54 females with the mean age of 47.04 (SD = 18.98)
who accessed the survey advertised on social media.
Forty percent of participants (n= 34) and 60% (n= 51)
described their location as rural and urban respectively.
Before the initial lockdown period 52.9, 38.8 and 8.2% of
participants were very, moderately, or not active respec-
tively and during the initial lockdown 60, 31.8 and 8.2%
of participants were active, moderately active, or not
active respectively.
Questionnaires
e survey comprised measures of the following
variables:
Demographic information: age, gender, urban or
rural location.
e Connor-Davidson Resilience Scale (CD-RISC)
[5]: a 25-item self-report five-point Likert scale,
ranging from 0 (not true at all) to 4 (true nearly all
the time) to items such as “I am able to adapt when
changes occur”, designed to assess level of resilience
with higher scores indicating higher resilience. e
CD-RISC has a high level of internal consistency
(Cronbach’s alpha = .89) and a high test-retest reli-
ability (52.7–52.8).
Symptom Checklist 5 (SCL-5) [38]: a 5-item short-
ened version of the Hopkins Symptom Checklist,
measuring anxiety, depression and their resulting
adversity. e response options were measured on a
four-point Likert scale from 1 (not at all) to 4 (very
much) to statements such as, “In the last 14 days have
you been bothered by feeling fearful?”, with the cut-
off of 2 recommended as a valid predictor of mental
distress. e SCL-5 has been shown to correlate well
with the SCL-25 (r = 0.92). It is designed to screen
for global psychiatric morbidity, namely anxiety and
depression. e SCL-5 has good internal consistency
(Cronbach’s alpha = .80).
Mental Health Inventory (MHI) [39] consisting of 34
items designed to measure psychological well-being
and distress on a 5-point Likert scale that ranges
from 1 (all the time) to 5 (none of the time) to state-
ments such as, “Did you feel depressed?”, quanti-
fied people’s mental health state during adversity. A
higher score indicates better mental health. e MHI
has a high level of internal consistency (Cronbach’s
alpha = .93).
Revised Life-Orientation Test – Revised (LOT-R)
[40],is a 10 item life orientation test to assess people’s
outlook on life measured on a 5-point Likert scale
of 0 (strongly disagree) to 4 (strongly agree) to items
such as, “I enjoy my friends a lot., with higher scores
indicating a more pessimistic attitude. e correla-
tion between the original and revised scale is .95. e
LOT-R has an acceptable level of internal consistency
(Cronbach’s alpha = .72)
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Lancasterand Callaghan BMC Public Health (2022) 22:827
Physical activity was measured using the Interna-
tional Physical Activity Questionnaire short form
(IPAQ-SF) [4143], assessing frequency, intensity
and duration of physical activity in days and minutes;
a higher self-reported score indicates a higher level of
physical activity. e IPAQ has an acceptable level of
internal consistency (Cronbach’s alpha = .73) and has
been deemed suitable for national population-based
prevalence studies of participation in physical activ-
ity.
e Insomnia Severity Index (ISI) [44]. A 7-item
measure in which participants respond to statements
such as, ‘How satisfied/dissatisfied are you with your
current sleep pattern?’. ere are a variety of differ-
ent scales of response, each raw score for the seven
items is added to form a total score of sleep qual-
ity, the higher the total score, the higher the level of
insomnia or lower the sleep quality. e ISI has an
appropriate level of internal consistency (Cronbach’s
alpha = .84) and a high test-retest reliability (0.84–1)
and a strong positive correlation with the Pittsburgh
sleep quality index.
QOL was measured using the WHOQOL-BREF [45],
a 26- question short version of the original WHO-
QOL-100 designed to assess QOL. e response
options for each item are rated on a 5-point Likert
scale from 1 to 5 to statements such as, “How satis-
fied are you with yourself?”. e questionnaire splits
into four domains of QOL: physical health, psycho-
logical health, social relationships and environment,
with two questions to reflect overall QOL and gen-
eral health. Higher scores indicate higher QOL. e
WHOQOL-BREF has a high level of internal consist-
ency (Cronbach’s alpha = .89)
Procedure
e survey was distributed using the link generated by
Qualtrics via the social media channels ‘Facebook’ and
‘WhatsApp’, and email. Participants voluntarily opted
into the study. Data were coded and analysed using
the Statistic Package for the Social Sciences version 25
(SPSS).
Data analysis
e data was inputted into SPSS from Qualtrics and
cleansed, removing any participants who did not com-
plete the survey and checking the survey was transferred
appropriately without mistakes. e remaining data were
coded and scored and a total score for each participant
generated. e normality of distribution and variance
were checked via SPSS and we used Pearson’s correla-
tion coefficient, to check the data met the assumptions of
each test. Descriptive statistics were produced describ-
ing age, exercise categorial level, resilience, QOL, men-
tal health, sleep, and life-orientation. Based upon their
responses to the IPAQ during lockdown, participants
who increased, decreased, or kept their exercise level the
same were classified as progressors, regressors and main-
tainers respectfully.
A MANOVA was used to compare resilience and QOL
life scores, before lockdown and used to compare resil-
ience and QOL during lockdown at three different levels
of exercise: low, moderate, and high. Independent sam-
ple t-tests compared differences in QOL and resilience
scores between people changing exercise levels on each
dependant variable. e independent t-tests allowed the
authors to report the exercise level change that increased
QOL and resilience. ANCOVA was used to test whether
mental health and sleep quality moderated the level of
exercise on resilience. A t-test compared differences in
location on self-reported exercise levels and resilience.
Finally, MANCOVA compared the relationship between
exercise level and resilience and QOL whilst controlling
for sleep quality and mental health.
Results
Variable descriptive statistics
Descriptive statistics of participants’ responses are shown
Table1:
A Pearson’s correlation coefficient to measure the rela-
tionship strength between resilience and QOL was car-
ried out to check the data met the assumptions of each
test. A Pearson’s correlation coefficient between resil-
ience and QOL was statistically significant p < .001.
Based on a critical skewness value of 1.96 [46], data was
normally distributed on all measures except sleep quality
(see Table2).
MANOVA showed a statistically significant difference
between the groups on the combined dependant vari-
ables before lockdown, F (2,82) = 4.22, p= .003: Wilks’
lambda = .82, partial n2= 0.09. Analysis of each depend-
ant variable, using a Bonferroni adjusted alpha level of
0.17 showed a statistically significant contribution of
resilience F (2,82) = 6.65, p= .002, partial n2= 0.14 and
QOL F (2,82) = 6.62, p= .002, partial n2= 0.14. As exer-
cise level (low, moderate, vigorous) before lockdown
increased, so did QOL and resilience.
ere was a statistically significant difference between
the groups on the combined dependant variables before
lockdown, F (2,82) = 7.31, p< .001: Wilks’ lambda = .72,
partial n2= 0.15. Analysis of each dependant variable,
using a Bonferroni adjusted alpha level of 0.17 showed
a statistically significant contribution of resilience F
(2,82) = 11.46, p < .001, partial n2= 0.22 and QOL F
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Lancasterand Callaghan BMC Public Health (2022) 22:827
Table 1 Mean, standard deviation of participants’ scores on each variable
Age Exercise
before
lockdown
Exercise
during
lockdown
Exercise level change Resilience Quality of life Mental health Sleep Life-
orientation
Reducers Maintainers Progressors Before
lockdown During
lockdown Before
lockdown During
lockdown Dierence Before
lockdown During
lockdown
Mean
(SD) 47.04
(±
18.98)
2.45 (± .65) 2.52 (± .65) N/A N/A N/A 70.2 (±
17.29)
353.27 (±
46.83)
339.15 (±
59.4)
91.37 (±
18.08)
86.81 (±
20.95)
4.56 (± 16.1) 5.91 (± 4.81) 7.45 (± 6.72) 25.34 (±6.26)
Partici-
pant
Num-
ber
N/A N/A N/A 10 60 15 N/A N/A N/A N/A N/A N/A N/A N/A N/A
Partici-
pant
Per-
cent-
age
N/A N/A N/A 11.8 70.6 17.6 N/A N/A N/A N/A N/A N/A N/A N/A N/A
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Lancasterand Callaghan BMC Public Health (2022) 22:827
Table 2 Skewness and Kurtosis scores for participants’ responses to each measure
Resilience Quality of life Mental health Sleep Life-orientation Exercise
Before
lockdown During
lockdown Before
lockdown During
lockdown Before
lockdown During
lockdown Before
lockdown During lockdown
Standard error
of Kurtosis .517 .517 .517 .517 .517 .517 .517 .517 .517 .517
Kurtosis Sta-
tistic 1.833 .238 .244 .227 .068 .004 .995 .323 .445 .068
Standard error
of skewness .261 .261 .261 .261 .261 .261 .261 .261 .261 .261
Skewness
Statistic
1.028 .679 .674 .685 2.49 0.726 0.261 .890 .75 1.01
Skewness Score 3.94 2.6 2.58 2.62 2.49 2.78 4.36 3.41 2.87 4.68
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Lancasterand Callaghan BMC Public Health (2022) 22:827
(2,82) = 8.88, p< .001, partial n2= 0.18. As exercise level
during lockdown increased, so did QOL and resilience.
A higher QOL was reported by people who progressed
an exercise category from low to moderate or moderate
to vigorous (mean = 355.47, SD = 52.61) (mean = 335.66,
SD = 60.56). A higher resilience score was reported
by people who progressed an exercise category
(mean = 72.60, SD = 14.45) (me an = 69.69, SD = 17.89).
ere was no statistically significant difference in QOL
(t (83) = 1.17, p= .244) and resilience scores (t (83) = .59,
p= .56) between progressors and maintainers.
ANCOVA showed there was a statistically significant
effect of exercise level before lockdown on resilience, F
(1, 85) = 4.59, p = .013 even when controlling for sleep
quality and mental health scores. During lockdown,
ANCOVA showed there was a statistically significant
effect of exercise level on resilience, F (1, 85) = 6.53,
p = .002 even when controlling for sleep quality and
mental health scores.
ere were no statistically significant differences in
exercise levels (t (83) = 1.81, p= .07) and resilience scores
(t (83) = 1.28, p= .21) between those in an urban location
and those living in a rural location before lockdown.
ere was no statistically significant difference in
exercise levels and resilience and life orientation before
lockdown, F (2,82) = 0.86, p= .43: Wilks’ lambda = .98,
partial n2= 0.02. Analysis of each dependant variable,
using a Bonferroni adjusted alpha level of 0.17 showed
no statistically significant contribution of resilience F
(2,82) = 1.63, p =.206, partial n2= 0.09 and life-orienta-
tion F (2,82) = 1.01, p =.318, partial n2= 0.01. A one way
between-subjects MANCOVA showed there was a statis-
tically significant difference between the exercise levels
and resilience and QOL scores even when controlling for
sleep quality and mental health scores before lockdown,
F (2,82) = 2.89, p= .024: Wilks’ lambda = .87, parti al
n2= 0.07. Analysis of each dependant variable, using a
Bonferroni adjusted alpha level of 0.17 showed a statisti-
cally significant contribution of resilience to exercise lev-
els F (2,82) = 4.59, p= .013, partial n2= 0.10, and QOL F
(2,82) = 3.79, p= .027, partial n2= 0.09. As exercise level
before lockdown increased, so did QOL and resilience
independent of sleep quality and mental health.
During lockdown, a between-subjects one-way MAN-
COVA showed there was a statistically significant dif-
ference between exercise levels and resilience even
when controlling for sleep quality and mental health
scores, F (2,82) = 3.42, p= .010: Wilks’ lambda = .85,
partial n2= 0.08. Analysis of each dependant variable,
using a Bonferroni adjusted alpha level of 0.17 showed
a statistically significant contribution of resilience F
(2,82) = 6.53, p= .002, partial n2= 0.14, but not QOL F
(2,82) = 1.83, p= .168, partial n2= 0.04. As exercise level
before lockdown increased, so did resilience independ-
ent of sleep quality and mental health, whereas QOL
was affected by sleep quality and mental health. When
the MANCOVA was repeated using the results dur-
ing lockdown, with just the co-variate of sleep, analysis
of each dependant variable, using a Bonferroni adjusted
alpha level of 0.17 showed a statistically significant con-
tribution of resilience to exercise level F (2,82) = 10.11,
p < .001, partial n2= 0.20, and QOL F (2,82) = 4.92,
p= .010, partial n2= 0.12. As exercise level before lock-
down increased, resilience and QOL increased independ-
ent of sleep quality but not mental health.
Discussion
e study investigated how the COVID-19 pandemic
affected the mediators and moderators of resilience with
respect to exercising. e current study found that as
exercise level increases so does resilience. e relation-
ship between exercise and resilience is independent of
sleep and mental health under normal conditions. Dur-
ing a pandemic, this relationship is independent of sleep
quality, but not mental health. Location does not play a
statistically significant role in resilience.
Resilience andits mediators andmoderators
As no exercise intensity was imposed on participants,
all exercise was likely to be at the participants’ pre-
ferred intensity. is strengthens earlier findings that to
increase resilience and QOL the exercise preferred inten-
sity exercise is sufficient [2426, 47]. A previous study
by Carter etal., [26] reported an increase in some QOL
domains [26]. e limitation suggested by using a clini-
cal sample, exercise level being lower than the normal
distribution [48], was counterbalanced in this research
by hypothesis 3 and 6 which controlled for mental health.
We found that the relationship between resilience and
perceived QOL is independent of mental health under
normal conditions but not during a pandemic. e strong
p value in this study suggests exercising at a higher level
has a stronger effect [22, 4951], perhaps explaining the
difference in QOL findings between Carter et al. [26]
and this study. Higher intensity exercise being associ-
ated with higher self-efficacy [24, 50] could add further
insight into explaining this difference, as confidence in
body image leads to increased optimism [52, 53], which
is correlated with increased resilience. Carter and col-
leagues’ [26] short intervention time may limit the
effects seen [23]. Sustained exercise at a high level being
required to exert positive effects is further suggested
by our (non-significant findings), replicating the result
Dilornzo etal., found, although the non-significant sug-
gests caution in drawing this conclusion. However, this
result is more likely to do with a lower than expected and
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Lancasterand Callaghan BMC Public Health (2022) 22:827
an underpowered study. Our study takes the knowledge
of the relationship between exercise, resilience and QOL
a step further, suggesting that exercising continuously
at a higher preferred intensity increases perceived QOL
and resilience, but further research is needed to test this
hypothesis.
Contrary to previous literature [54], we found that
location does not influence resilience and QOL. e
research on how location effects exercise and resilience is
in its infancy, with studies having focused on the attach-
ment between the self and environment, drawing on
Bowlby and Ainsworth attachment theory [55]. ere-
fore, research has mostly focussed on infants, and it is
unknown whether this can be applied to adult’s attach-
ment with the environment. In-line with our hypothesis
on the relationship between location exercise, QoL and
resilience, and previous literature [54, 56, 57], this was
reversed during lockdown, where more people began
to exercise in rural locations and demonstrated higher
resilience levels. However, this was not statistically sig-
nificant. erefore, the effect of location on exercise and
resilience remains unproven. e current study’s non-
significant findings in conjunction with the unexpected
findings that exercise levels were higher in urban popula-
tions before lockdown, demonstrates the need for further
investigations into exercise and environment.
The eect ofapandemic onresilience
Descriptive statistics showed that 17.6% of participants
increased their exercise levels during lockdown. e
analysis of the findings reported in this study suggests
that exercise seemed to become a coping mechanism
to moderate resilience. is is demonstrated by resil-
ience increasing with exercise: the pandemic only affect-
ing QOL during lockdown as mental health became a
mediator. Exercise becoming a moderator of resilience
during a pandemic is further supported by the F value
almost doubling in hypothesis 1 during lockdown, show-
ing the results of the pandemic are more than one would
expect to see by chance. To the authors’ best knowledge,
this provides the first piece of evidence into the effects
of exercise on resilience in a pandemic. is is further
strengthened by the decreased p value demonstrating
that the relationship between exercise, resilience and
QOL is even more significant during a pandemic with
exercise contributing more strongly to the model. e
significant p value when just the co-variant of sleep was
controlled for, suggests that although the pandemic has
had a positive effect on resilience it is dependent on men-
tal health, further suggesting the use of exercise to mod-
erate resilience. is is in line with the current knowledge
that exercise is often used as a coping mechanism for
stress [5861], shown across student, aging and clinical
populations.
Strengths andlimitations
e study is the first of its kind to investigate how a pan-
demic affects resilience and its moderators and mediators
in an under-represented non-clinical population. Despite
an opportunistic sample, and a relatively small sample
size, data were acceptably normal. As to limitations, the
study required participants to remember past states and
conditions so a bias may have been introduced in which
positive and negative attitudes would be enhanced [62,
63] due to the episodic encoding and retrieval process
attaching emotion to each event stored [6466]. Exer-
cise levels could not be verified, therefore, we relied on
people to correctly self-report. e relatively low sample
size, not surprising considering the pandemic, does not
rule out a type two error for non-significant results. e
authors would like to clarify, the limitation of time hin-
dered the opportunity to leave data collection open for
longer.
Although exercise as a coping mechanism increases
resilience and reduces stress, it has been linked to per-
sonality type [61], with those who are extroverted and
less neurotic being more likely to exercise. In accordance
with social determination theory, extroverts demonstrate
more internal motivation [27, 67], being more likely to
exercise. e personality type of each participant in this
study was not measured, however, distribution of the sur-
vey on social media, coupled with extroverts’ increased
use of these platforms [68] suggests extroverts are more
likely to have completed it.
e authors recommend further studies capturing
larger samples, a measure of actual exercise levels, and
more longitudinal studies capturing the longer-term
impact of the pandemic on the relationships reported in
the current study. Future perspectives to support resil-
ience strategies can be carried out once rules on social
distancing are relaxed enough to take a measure of actual
exercise levels.
Conclusion
Exercise is strongly correlated to resilience and during a
pandemic such as COVID-19 it becomes a mechanism in
which to moderate resilience. e relationship between
exercise and resilience has been supported by this study.
However, the influence that a pandemic had on mental
health is mediated by its effect on quality of life.
Acknowledgements
The lead author would like to acknowledge Ms. Lisa Helen Wason BA for her
contribution to the writing of this article.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 9 of 10
Lancasterand Callaghan BMC Public Health (2022) 22:827
Authors’ contributions
ML and PC designed the study, analysed the data, and wrote the manuscript.
ML collected the data, wrote the main manuscript text, and prepared all
figures and tables. The author(s) read and approved the final manuscript.
Funding
N/A
Availability of data and materials
All date generated or analysed during this study are included in this published
article.
Declarations
Ethics approval and consent to participate
Ethical approval was obtained from ‘London South Bank University ’s Research
Ethics Committee’. Experiment protocol for involving humans was in accord-
ance with guidelines of the institution. Informed consent was obtained from
all subjects.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Author details
1 Conducted research at London Southbank University, 103 Borough Road,
London SE1 0AA, UK. 2 Professor of Mental Health Science and Associate Pro
Vice-Chancellor Research, London Southbank University, 103 Borough Road,
London SE1 0AA, UK.
Received: 27 October 2021 Accepted: 22 March 2022
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... Previous studies found that self-control regulates the correlation between PA and MPA. Factors such as negative emotions (eg, anxiety [69,70] and loneliness [71,72]) and mental toughness [73,74] have been shown to affect the relationship between PA and MPA. We speculate that these factors may modulate the relationship between PA and MPA. ...
Article
Full-text available
Background Previous studies have reported a potential negative correlation between physical activity (PA) and mobile phone addiction (MPA) among adolescents and young adults. To date, the strength of this correlation has not been well characterized. Objective This review and meta-analysis aimed to synthesize available empirical studies to examine the correlations between PA and MPA among adolescents and young adults. We also explored several potential moderators, including time of data collection, country or region, and type of population, associated with the relationship between PA and MPA. Methods Four electronic databases (PubMed, Scopus, PsycINFO, and Web of Science) were searched from database inception to March 2022 to identify relevant studies. The pooled Pearson correlation coefficients and their corresponding 95% CIs for the relationship between PA and MPA were calculated using the inverse variance method. The methodological quality of the included cross-sectional studies was determined based on the Joanna Briggs Institute appraisal checklist. The study conformed to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analyses) guidelines. Results In total, 892 relevant articles were identified, of which 22 were selected based on the inclusion and exclusion criteria. The final meta-analysis included 17 of the 22 studies. Results of random effects modeling revealed a moderate correlation between PA and MPA among adolescents and young adults (summary r=–0.243, P<.001). Sensitivity and publication bias analyses further demonstrated the robustness of our results. All the included studies were scored as high quality with a low risk of bias. Subgroup analysis further indicated that none of the hypothesized moderators (time of data collection, country or region, and type of population) significantly affected the relationship between PA and MPA, as confirmed by the mixed effects analysis. In addition, in the data collection subgroups, medium effect sizes were obtained for data collected before COVID-19 (r=–0.333, P<.001) and data collected during COVID-19 (r=–0.207, P<.001). In subgroup analyses for country or region, the correlation coefficient for China and other developing regions showed a similarly moderate effect size (r=–0.201, P<.001 and r= –0.217, P<.001, respectively). However, the effect sizes for developed regions were not significant (r=–0.446, P=.39). In a subgroup analysis based on the type of population, we found that the effect size for young adults was moderate (r=–0.250, P<.001). However, that of adolescents was not significant (r=–0.129, P=.24). Conclusions Our results demonstrate a moderately negative relationship between PA and MPA among young adults. The strength of this relationship was not influenced by the time of data collection, country or region, or type of population.
... Previous studies found that self-control regulates the correlation between PA and MPA. Factors such as negative emotions (eg, anxiety [69,70] and loneliness [71,72]) and mental toughness [73,74] have been shown to affect the relationship between PA and MPA. We speculate that these factors may modulate the relationship between PA and MPA. ...
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BACKGROUND Background: Exergames are a promising exercise tool for benefits related to health. To our knowledge, no systematic reviews examine the effect comparison of commercial exergames and conventional exercises on improving the EFs for children and adolescents. OBJECTIVE Objective: The purpose of this study was to investigate the effects of comparison of commercial exergames and conventional exercises on improving executive functions (EFs) in children and adolescents. METHODS Method: Following the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines, five databases (PubMed), Web of Science, Scopus, PsycINFO, SPORTDiscus) were searched from their inception to July 7, 2022, to identify the relevant randomized controlled trials (RCTs). The Physiotherapy Evidence Database was used to evaluate the risk of bias. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool was used to evaluate the overall quality of evidence. RESULTS Results: Eight RCTs including 435 children and adolescents were included in the analysis. Commercial exergames had no-significant better benefit on overall executive functions (EFs) compared with conventional exercises (g=1.464; 95% confidence interval [CI] -0.352 to 3.280; p>0.05). For core EFs, no evidence suggests) that commercial exergames have more benefits of improving cognitive flexibility (g=0.906; 95%CI -0.274 to 2.086; p>0.05), inhibitory control (g=1.323; 95%CI -0.398 to 3.044; p>0.05) and working memory (g =2.420; 95%CI -1.199 to 6.038; p>0.05), compared with conventional exercises. CONCLUSIONS Conclusion: Commercial exergames appear to have no better beneficial effects on overall and core EFs in children and adolescents compared with conventional exercises. It is still noteworthy that this study only included commercial exergames rather than custom exergames. CLINICALTRIAL CRD42022324111
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Objective: Physical activity (PA) in an outdoor environment has been shown to exert positive effects on mental well-being beyond those found for PA indoors. The specific effect of an alpine environment has not been investigated so far. Here we evaluate the association of PA in an alpine environment with resilience and quality of life (QOL) in patients with psychosomatic disorders and controls. Methods: 194 patients with psychosomatic disorders (mostly somatoform disorder and major depressive syndrome) and 326 healthy controls were included in this web-based cross-sectional study. PA was scored using an adapted version of the Global Physical Activity Questionnaire including the environmental aspect (indoor, outdoor, alpine environment). Resilience was assessed using the Resilience Scale-13, QOL using the WHOQOL-BREF. Group comparisons, correlation and mediation analyses were performed. Results: Patients showed significantly lower levels of resilience (p < 0.001) and QOL (p < 0.001) compared to controls. PA in an alpine environment was associated with resilience (patients: r = 0.35, p < 0.001; controls r = 0.18, p < 0.001). There were no significant associations between PA in other environments (outdoor or indoor) and resilience. PA in all three environments correlated with subcategories of QOL. The effect of PA in an alpine environment on QOL was partly mediated by resilience in patients (68% of total effect mediated, p < 0.001) and controls (49% mediated, p = 0.006). Conclusion: There is a positive effect of PA in an alpine environment on mental health beyond that of physical activity itself. Preventive and therapeutic programs should thus include physical activity, but also take additional benefits of natural environments into account.
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Objectives To assess the cost-effectiveness of preferred intensity exercise programme for young people with depression compared with a treatment as usual control group. Design A ‘within trial’ cost-effectiveness and cost-utility analysis conducted alongside a randomised controlled trial. The perspective of the analysis was the UK National Health Service and social services. Setting The intervention was provided in a community leisure centre setting. Participants 86 young people aged 14–17 years attending Tier 2 and Tier 3 CAMHS (Child and Adolescent Mental Health Services) outpatient services presenting with depression. Interventions The intervention comprised 12 separate sessions of circuit training over a 6-week period. Sessions were supervised by a qualified exercise therapist. Participants also received treatment as usual. The comparator group received treatment as usual. Results We found improvements in the Children’s Depression Inventory-2 (CDI-2) and estimated cost-effectiveness at £61 per point improvement in CDI-2 for the exercise group compared with control. We found no evidence that the exercise intervention led to differences in quality-adjusted life years (QALY). QALYs were estimated using the EQ-5D-5L (5-level version of EuroQol-5 dimension). Conclusions There is evidence that exercise can be an effective intervention for adolescents with depression and the current study shows that preferred intensity exercise could also represent a cost-effective intervention in terms of the CDI-2. Trial registration number NCT01474837.
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Background: We sought to understand what distinguishes people who confront health challenges but still manage to thrive. This study investigated whether resilience helps to explain the impact of health challenges on quality of life (QOL) outcomes, and how resilience relates to appraisal. Methods: A web-based survey of rare-disease panel participants included the Centers for Disease Control Healthy Days Core Module, the PROMIS-10, and comorbidities. The QOL Appraisal Profile-v2 assessed cognitive processes underlying QOL. Resilience was operationalized statistically using residual modeling, and hierarchical regressions tested the mediation hypothesis that resilience accounts for a significant amount of the relationship of appraisal to QOL. Results: The study sample (n = 3,324; mean age 50; 86% female; 90% White) represented a range of diagnostic codes, with cancer and diseases of the nervous system being the most prevalent health conditions. After adjusting for comorbidities (catalysts), resilience was associated with better physical and emotional functioning, and different appraisal processes were associated with better or worse physical or emotional functioning. After controlling for catalysts, 62% of the association of Physical Functioning and 23% of the association between Emotional Functioning and appraisal were mediated by resilience. Physical and emotional resilience comprised some of the same appraisal processes, but physically resilient people were characterized by more appraisal processes than their emotionally resilient counterparts. Conclusions: Resilient people employ different appraisal processes than non-resilient people, and these processes differ for physical and emotional outcomes. Resilience was a stronger mediator of the relationship between physical rather than emotional functioning and appraisal.
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In three experiments, we examined whether group-affirmation reduces prejudice against outgroups. In Experiments 1 and 2, White participants completed a test of abilities then were assigned to one of three affirmation conditions. Participants either received positive feedback about their ingroup’s performance, positive feedback about their personal performance, or no feedback. Participants then provided judgments toward Blacks. Across both experiments, participants who received the ingroup performance feedback expressed the lowest levels of anti-Black prejudice, but Experiment 2 indicated this effect was limited to strongly White-identified participants. In Experiment 3, we used a different group-affirmation procedure (writing about American values) and outgroup target (Middle Easterners). Among strongly American-identified participants, those who explained why a value was important for Americans expressed lower levels of prejudice against Middle Easterners compared to those in a control condition. We suggest that affirming one’s group—or social identity—can serve as a beneficial resource in the domain of prejudice.
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This study examined the influence of exercise environment and gender on post-exercise mood and exertion. College student participants (55 females, 49 males) were instructed to pedal a stationary bike at a moderate pace for 20 minutes. Participants were randomly assigned to one of three laboratory conditions: (1) exercising in front of a mirror and posters showing ideal fit body types (i.e., celebrity male and female personal trainers), (2) exercising in front of a mirror only, or (3) a control condition in which participants exercised without a mirror or posters. The Activation-Deactivation Adjective Check List (AD-ACL), measuring exercise-induced mood states, was administered both before and after exercise. Average bike speed throughout the exercise session measured exertion. Mirrors and posters of ideally fit celebrities did interact with gender on post-exercise tension in that women felt most tense after exercising in front of the mirror and posters while men were most tense after exercising in front of the mirror only. Exercise exertion was also impacted by experimental condition such that participants rode significantly faster in the mirror and posters condition. There was no significant interaction of gender and condition on exercise exertion, but women pedaled fastest in the mirror and poster condition relative to the other conditions. Results suggest that exercise exertion and tension reduction are partially a by-product of gender and exercise environment.