Exercising in times of COVID-19: what do experts recommend doing within four walls?

The impact of the COVID-19 pandemic on the mood and family relationships of runners

Introduction

The aim of this study was to analyze the impact of the COVID-19 lockdown on the mood of amateur runners and on their relationships with their partners and families.

Methods

Adult runners 18 years or older (N = 260) completed an online survey that included demographic information, standardized psychological assessments of Exercise Dependence (EDS-R) and mood (POMS), and, to measure relationship functioning, either the Dyadic Adjustment Scale (DAS) if they did not have children, or the Basic Family Evaluation Questionnaire (CERFB), measuring conjugal and parental relationships. Participants also answered questions about their exercise habits and the coping strategies they adopted during lockdown.

Results

The results suggest that runners who saw the largest reductions in time spent exercising during lockdown tended to feel significantly less energetic (p < 0.05) and friendly (p < 0.01). In addition, they recorded significantly lower scores in marital satisfaction with their peers (p < 0.05). The runners with a higher degree of dependence on physical exercise registered significantly higher levels of depression, tension and anger than non-dependent runners (p < 0.001). Runners whose partners were physically active and did not have children had significantly higher scores marital satisfaction than runners whose partners were not physically active and had children (p < 0.05).

Discussion

These findings seem to indicate that the psychological approach to athletes in the context of crises such as the pandemic should consider not only individual aspects, but also include the family perspective.

Effects of a physical exercise program on HIF-1α in people with Chronic Obstructive Pulmonary Disease living at high altitude: study protocol for a clinical trial

BACKGROUND

Chronic Obstructive Pulmonary Disease (COPD) is a chronic, noncommunicable disease characterized by hypoxemia, with altered lung function, dyspnea on mild exertion, limited tolerance to physical exertion, and functional impairment. Physical exercise has been recommended worldwide as an efficient strategy to improve the autonomy and quality of life of patients affected by COPD. However, the adaptive molecular mechanisms occurring in these patients after the exposure to the hypoxic stimulus triggered by physical exercise have currently not been described in populations living at high altitude.

METHODS

The clinical trial we are presenting here consists of a quasi-experimental design with longitudinal analysis of repeated measures, with intra- and inter-group comparisons, measuring primary and secondary variables in 4 temporal points. Participants will be people with a diagnosis of COPD residing at high altitudes (> 2600 m), without oncological, renal, cardiac, or musculoskeletal comorbidities with a low level of physical activity. The intervention will be an 8-week program of physical exercise of resistance and muscular strength (8-WVP) which will be carried out at home. Primary outcome variables will be the expression of HIF-1α, VEGF, and EPO. As secondary outcome variables, we will consider lung function (measured by spirometry), physical performance (measured by ergospirometry and dynamometry), and hematological parameters.

DISCUSSION

The results obtained after the clinical trial proposed here will promote knowledge on the expression of signaling proteins as an adaptive response to hypoxia in people with COPD living at high altitude, which will be relevant because there are not data on this population group. The knowledge generated from the application of this protocol will increase the pathophysiological understanding of the disease and future medical and therapeutic decision-making based on physical exercise prescription. TRIAL REGISTRATION {2A}: NCT04955977 [ClinicalTrials.gov]-NCT04955977 [WHO ICRTP]. First Posted: July 9, 2021.

Comparative efficacy of remotely delivered mindfulness-based eating awareness training versus behavioral-weight loss counseling during COVID-19

Introduction

Dysregulated eating (emotional eating, cue-elicited eating, and dietary restraint and restriction) has been linked to being overweight or obese. The present investigation used a random controlled trial (RCT) to test the differential efficacy of remotely delivered Mindfulness-Based Eating Awareness Training (MB-EAT) and Behavioral Weight Loss (BWL) counseling.

Methods

The sample was recruited through advertisements that offered help to people "with problems controlling their eating" or "interested in improving their relationship with food" (n = 135).

Results

Retention was low in both groups (42%), but not dissimilar to retention rates reported in related clinical trials delivered "in person." Among the participants who completed treatment, we found no between-group differences in any of the treatment outcomes, but participants in both groups experienced significant increases in eating-related mindfulness [Mindful Eating Questionnaire (MEQ) and awareness [Multidimensional Assessment of Interoceptive Awareness (MAIA), and significant decreases in unhealthy eating patterns [Dutch Eating Behavior Questionnaire (DEBQ); Binge Eating Scale (BES), and weight over the course of treatment. Participants in both groups also experienced increases in self-reported depression and anxiety symptoms [Hospital Anxiety and Depression Scale (HADS)], although these increases likely reflected normative changes observed in the population at large during COVID-19.

Discussion

Overall, the results suggest that dysregulated eating and weight loss intervention delivered remotely via teleconference can be effective.

Associação entre Atividade Física e Aspectos Emocionais de Idosos durante a Pandemia da Covid-19

Para conhecer repercussões da pandemia da covid-19, investigamos a associação entre atividade física e aspectos emocionais de idosos. Para isso, 101 pessoas com 60 anos ou mais responderam a um questionário on-line, via Google Forms. Identificamos que 45,5% dos entrevistados pioraram o desempenho físico, enquanto 11% relataram melhora da aptidão física durante a pandemia. Os exercícios físicos mais praticados foram caminhada (54,5%) e musculação (21,8%). Sobre a mobilidade, as atividades mais frequentes foram ir ao mercado (76,2%), caminhar na vizinhança (64,4%) e sair para tomar sol (61,4%). O Modelo Linear Generalizado mostrou que a piora do desempenho físico foi associada aos níveis mais altos de sofrimento emocional (b=4,35; IC 95%: 1,31-7,11; p=0,003). Os nossos resultados indicam que a melhora do desempenho físico gera repercussões positivas sobre aspectos emocionais de idosos, reforçando a importância da prática regular de exercícios físicos, mesmo em um período de pandemia.

Eating behaviors, eating styles and body mass index during COVID-19 confinement in a college sample: a predictive model

BACKGROUND

COVID-19 confinement affected lifestyles. There is inconclusive evidence about changes in eating patterns, and there are few studies on the impact on body mass index (BMI), the occurrence of dysfunctional behaviors (binge eating, fat intake), and the predictive role of maladaptive eating styles (emotional, external, and restrained eating).

OBJECTIVES

(1) To analyze the differences in binge eating, fat intake, BMI, and maladaptive eating styles before and during COVID-19 confinement, and (2) to analyze whether maladaptive eating styles (before confinement) predicted binge eating, fat intake, and BMI during confinement.

METHODS

The sample consisted of 146 Spanish college students, divided into 104 females (71.2%; age: M = 22.20, SD = 2.97) and 42 males (28.8%; age: M = 24.74; SD = 3.53). All completed several dietary measures and BMI twice: before COVID-19 confinement (T1, November 2019) and during COVID-19 confinement (T2, April 2020).

RESULTS

BMI and maladaptive eating styles did not change in T2 (vs. T1). However, binge eating and fat intake decreased in T2. Emotional eating at T1 positively predicted BMI and binge eating at T2. External eating at T1 positively (and marginally) predicted fat intake at T2. Restrained eating at T1 positively predicted binge eating at T2, and negatively (and marginally) predicted BMI and fat intake at T2. The model explained 80.5% of the variance in BMI, 41.5% of the variance in binge eating, and 25.8% of the variance in fat intake during COVID-19 confinement.

CONCLUSIONS

The COVID-19 confinement had a positive impact on some eating behaviors. Future policies should focus part of their prevention on maladaptive eating styles to curb dysfunctional eating behaviors and BMI problems in times of stress.

Effects of nutrients on immunomodulation in patients with severe COVID-19: Current knowledge

Recent research has demonstrated that critically ill patients with coronavirus disease 2019 (COVID-19) show significant immune system dysregulation. Due to that, some nutrients that influence immunomodulation have been suggested as a form of treatment against the infection. This review collected the information on the impact of vitamins on the prognosis of COVID-19, with the intention of facilitating treatment and prevention of the disease risk status in patients. The collected information was obtained using the PubMed electronic database by searching for articles that relate COVID-19 and the mechanisms/effects of the nutrients: Proteins, glucose, lipids, vitamin B12, vitamin D, calcium, iron, copper, zinc, and magnesium, including prospective, retrospective, and support articles. The findings reveal an optimal response related mainly to omega-3, eicosapentaenoic acid, docosahexaenoic acid, calcium, and iron that might represent benefits in the treatment of critically ill patients. However, nutrient supplementation should be done with caution due to the limited availability of randomized controlled studies.

A Study on the Correlation Between Undergraduate Students' Exercise Motivation, Exercise Self-Efficacy, and Exercise Behaviour Under the COVID-19 Epidemic Environment

The outbreak of COVID-19 epidemic has influenced human beings from various aspects including physical exercise behaviours. This study aims to explore the influence of the COVID-19 epidemic on exercise self-efficacy and exercise behaviour, as well as the intermediary effects of exercise motivation. A sample of 1,115 undergraduate students was investigated using the physical exercise behaviour scale, exercise self-efficacy scale, and exercise motivation scale, combined with the COVID-19 epidemic environment as an influencing factor. SPSS was used for statistical analysis and AMOS for the prediction model building. Logical analysis was undertaken to sort out and analyse the data. The structural equation model reveals that exercise self-efficacy has a positive effect on exercise motivation and exercise behaviour. Meanwhile, the COVID-19 epidemic environment negatively influences exercise behaviour through the intermediary role of exercise self-efficacy and exercise motivation. Moreover, the intermediary effect of exercise self-efficacy is greater than that of exercise self-efficacy and exercise motivation. This study provides both theoretical implications and practical guidelines for society and undergraduate students to improve their exercise behaviour during epidemic.

Psychological Distress, Anxiety, and Academic Self-Efficacy as Predictors of Study Satisfaction Among Peruvian University Students During the COVID-19 Pandemic

The objective of this research study was to determine if psychological distress, anxiety, and academic self-efficacy predict satisfaction with studies in Peruvian university students during the COVID-19 pandemic. A cross-sectional and predictive design was used, in which 582 Peruvian university students participated, 243 men and 339 women, between the ages of 16 and 41. Student's t-statistics were used to analyze the differences in scores of psychological distress, anxiety, academic self-efficacy, and satisfaction with studies based on the sex of the participants, Pearson's R was used for the analysis of correlations between variables, and multiple linear regressions were used to evaluate the predictive model. In the analyses, the significance level was set at 0.05. The results show that men have higher levels of psychological distress, anxiety, and academic self-efficacy than women do (p < 0.01); high levels of psychological distress correlate with high levels of anxiety (r = 0.580, p < 0.01) and low levels of satisfaction with studies (r = -0.178, p < 0.01) and academic self-efficacy (r = -0.348, p < 0.01); high levels of anxiety correlate with low levels of satisfaction with studies (r = -0.122, p < 0.01) and academic self-efficacy (r = -0.192, p < 0.01); and high levels of academic self-efficacy correlate with high levels of satisfaction with studies (r = 0.429, p < 0.01). Academic self-efficacy was also found to predict satisfaction with studies (β = 0.429, p < 0.01). This concludes that, although there are significant correlations between psychological distress, anxiety, academic self-efficacy, and satisfaction with studies, academic self-efficacy is the variable that most predicts satisfaction with studies in Peruvian university students.

Have We Taken Advantage of the Quarantine to Develop Healthy Habits? A Cross-Sectional Analysis of the Spanish COVID-19 Situation by Gender

The confinement caused by the COVID-19 pandemic led to changes in people’s lifestyles, which in part provided an opportunity to develop habits at home. The aims were: (1) to verify if the psychological well-being (PWB) of people related to healthy habits, and if physical activity (PA) and diet mediated this relationship; (2) to test if there were differences in this model of relationships between women and men; (3) to analyze if there were differences in healthy habits, PA, diet, and PWB depending on gender; (4) to test if there were differences in healthy habits, PA, diet, and PWB depending on living area; (5) and to assess if there were interaction effects of gender and living area in healthy habits, PA, diet, and PWB. Using a cross-sectional design, we obtained a sample of 1509 participants (18–78 years, 1020 women). Diet and PA fully mediated the relationship between PWB and healthy habits, and women developed more healthy habits than men, whereas men had higher levels of PA and PWB. We also found that people who lived in rural areas during confinement practiced more PA and had lower PWB levels than those who lived in urban areas. These results can help in the planning of strategies to promote healthy habits.

Physical Activity among Adults Residing in 11 Countries during the COVID-19 Pandemic Lockdown

During the novel coronavirus (COVID-19) pandemic, physical activity (PA) behaviors were altered worldwide due to public health measures such as “lockdown.” This study described PA among adults residing in 11 countries during COVID-19 lockdown and examined factors associated with PA engagement. We conducted a cross-sectional anonymous survey among adults (≥18 years old) in 11 countries (Brazil, Bulgaria, China, India, Ireland, Malaysia, North Macedonia, Singapore, Spain, Turkey, United States). Of 11,775 participants, 63.7% were female and 52.8% were 18–34 years old. More than 40% of participants were insufficiently active (43.9%) and reported a decrease in their PA during lockdown (44.8%). Statistically significant differences were observed in (1) proportions of participants being insufficiently active, (2) level of PA, and (3) decrease in PA across the 11 countries. More stringent governmental policy responses were associated with greater likelihood of being insufficiently active during lockdown (adjusted odds ratio = 1.22, 95% confidence interval = 1.03, 1.45). Higher depression or anxiety scores were associated with greater likelihood of decreased level of PA during lockdown.We found substantial reductions in PA levels during COVID-19 lockdown across countries. Country-specific PA promotion interventions are needed during this and similar global emergencies.

COVID-19 lockdown consequences on body mass index and perceived fragility related to physical activity: A worldwide cohort study

Background

This paper is a follow‐up study continuing the COVISTRESS network previous research regarding health‐related determinants.

Objective

The aim was to identify the main consequences of COVID‐19 lockdown on Body MassIndex and Perceived Fragility, related to Physical Activity (PA), for different categories of populations, worldwide.

Design

The study design included an online survey, during the first wave of COVID‐19 lockdown, across different world regions.

Setting and participants

The research was carried out on 10 121 participants from 67 countries. The recruitment of participants was achieved using snowball sampling techniques via social networks, with no exclusion criteria other than social media access.

Main outcome measures

Body MassIndex, Physical Activity, Perceived Fragility and risk of getting infected items were analysed. SPSS software, v20, was used. Significance was set at P < .05.

Results

Body MassIndex significantly increased during lockdown. For youth and young adults (18‐35 years), PA decreased by 31.25%, for adults (36‐65 years) by 26.05% and for the elderly (over 65 years) by 30.27%. There was a high level of Perceived Fragility and risk of getting infected for female participants and the elderly. Correlations between BMI, Perceived Fragility and PA were identified.

Discussion and Conclusions

The research results extend and confirm evidence that the elderly are more likely to be at risk, by experiencing weight gain, physical inactivity and enhanced Perceived Fragility. As a consequence, populations need to counteract the constraints imposed by the lockdown by being physically active.

Eating Behavior Changes of People with Obesity During the COVID-19 Pandemic

OBJECTIVE

The precautions taken during the pandemic period may cause stress-related eating behavior disorders. It was aimed to test this hypothesis, and the study was carried out to examine pandemic measures the effect of on the nutritional, depression and stress conditions of people with obesity.

METHODS

The individuals who participated in the study were people with obesity who received follow-up dietary therapy in a private hospital. Three separate scales were applied to the individuals, which measured the desire to overeating request, depression status and stress-fighting status.

RESULTS

This study was conducted on 368 individuals. Women had lower values of BMI (28.57±3.89 kg/cm2) than men (30.64±2.87 kg/cm2). When the scores of the excessive eating request scale mean scores before and during the pandemic were examined, it was seen that the scores of the individuals increased during the pandemic. In the multivariate regression model, it was seen that the increase of stress and BMI increased the FCQ score (p<0.001). Multiple regression models were created by taking into account the criteria that caused the score increase. Each variable can predict the FCQ score separately. The predictor significance order of variants on FCQ score β values is as follows: the Patient Health Questionnaire-9 (PHQ-9) (β=0.774), before pandemic FCQ (β=0.601), the Perceived Stress Scale (PSS) (β=-0.268), before pandemic BMIa (β=-0.223), during pandemic BMIb (β=0.073), and age (β=-0.013).

CONCLUSION

COVID-19 pandemic, making applications such as quarantine in pandemic processes has successful results in being able to combat its. However, undesirable conditions such as stress can have serious negative consequences on other health measurements. It was observed in the results of this study that excessive eating food desire developed in people with obesity.

Strange Days: Adult Physical Activity and Mental Health in the First Two Months of the COVID-19 Pandemic

Background: In addition to its physical health benefits, physical activity is increasingly recognized as a means to support mental health. Regular moderate-to-vigorous physical activity (MVPA) is associated with improved mental well-being, reduced likelihood of developing mental illness, and improved symptom management. Despite these benefits, most people fail to achieve minimum recommended levels of MVPA. Population levels of physical activity have further declined since the onset of the COVID-19 pandemic and implementation of public health measures (e.g., shelter-in-place protocols). The potential impact of this decline on mental heath outcomes warrants ongoing investigation. Purpose: To investigate associations between changes in MVPA and mental health (depressive symptoms, anxiety symptoms, and life satisfaction) in adults impacted by the COVID-19 pandemic. Method: Research followed a cross-sectional design. English-speaking adults were invited to complete an online questionnaire. MVPA was assessed retrospectively (before COVID-19) and currently (during COVID-19) with the International Physical Activity Questionnaire. Mental health was assessed with the Patient Health Questionnaire, 9-Item (PHQ-9), the Generalized Anxiety Disorder, 7-Item (GAD-7), and the Satisfaction with Life Scale (SWLS). Regression was used to assess relationships between MVPA and mental health. ANOVA with follow-up tests examined whether participants who differed in mental health status (e.g., no symptoms vs. severe symptoms) differed in their change in MVPA. T-tests were used to examine differences in mental health symptomatology between participants who were sufficiently (i.e., achieving MVPA guidelines of ≥ 150 min/week) vs. insufficiently active. Results: Prior to COVID-19, 68.2% of participants were classified as being sufficiently active, vs. 60.6% during COVID-19. The majority of participants reported experiencing some level of depressive symptoms (62.0%) or anxiety symptoms (53.7%). After controlling for covariates, changes in MVPA accounted for significant variability in the PHQ-9 (7.7%), GAD-7 (2.5%), and SWLS (1.5 %). Participants with clinically significant mental health symptomatology reported greater declines in MVPA than those who reported no symptoms. Conversely, participants who were sufficiently active during COVID-19 reported significantly lower depression and anxiety, and higher life satisfaction. Conclusion: Participants who experienced the greatest declines in MVPA reported relatively greater psychological distress and lower life satisfaction. While preliminary, these findings suggest the importance of maintaining and promoting physical activity during a period of pandemic.

Exercise and COVID-19: reasons individuals sought coaching support to assist them to increase physical activity during COVID-19

OBJECTIVE

This paper explores the experiences of individuals who reported substantially decreasing physical activity (PA) as a result of COVID-19 and sought coaching support to increase PA.

METHODS

A qualitative study using phenomenological analysis. Eight individuals participated in semi-structured interviews that focused on their experiences of decreasing PA as a result of physical distancing measures, and why they sought PA coaching to overcome these issues. Responses were analysed thematically.

RESULTS

The participants reported markedly decreasing their PA following the enactment of physical distancing measures. The inability to subsequently engage in regular PA was a source of frustration for participants. Interview analysis revealed two themes that contributed to the understanding of why these individuals felt they needed PA coaching to increase PA; namely, a desire for both listening support and PA self-regulation support.

CONCLUSION

The individuals who decreased PA due to COVID-19 desired an autonomy-supportive counselling style, centred on listening support and self-regulatory support. Online PA interventions were not highlighted as strategies to overcome PA barriers. Implications for public health: The effect of physical distancing measures on the determinants of overall PA is important, particularly if prolonged physical distancing is required.

The Relationship between Cognitive Function, Lifestyle Behaviours and Perception of Stress during the COVID-19 Induced Confinement: Insights from Correlational and Mediation Analyses

Background: Home confinement during the COVID-19 outbreak may affect lifestyle behaviours, such as daily physical activity, social relationships, eating behaviours, and sleep, among others, which in turn may compromise mental health and psychological states. The aim of the present study was to determine the effects of COVID-19-induced home confinement on stress, attention, and lifestyle behaviours and the correlations between them. Methods: Participants included 144 students (aged 18-22 years, 62.5% female, 89.5% single). Stress, attention, and lifestyle behaviours were assessed using the Perceived Stress Scale (PSS), d2 test, and the Simple Lifestyle Indicator Questionnaire adapted and modified (SLIQ), respectively. Total PSS score, concentration performance (CP), errors (E), and lifestyle behaviours (e.g., diet, exercise/activity, alcohol, and smoking) before and during confinement were calculated. Results: The data showed a significant difference between before and during confinement in total PSS, CP, E, and all lifestyle behaviours (all, p < 0.05). Significant correlations existed between total PSS score, CP, E, and lifestyle behaviours (r= -87-98, all, p < 0.05). Conclusions: Home confinement has a negative effect on stress, attention, and lifestyle behaviours. This study suggests that the adoption of proper lifestyle behaviours, particularly diet, disciplined hygiene, and physical activity, boost health, psychological states, and cognitive function during COVID-19-induced confinement.

Impact of social isolation on the level of physical activity in young Brazilian athletes caused by COVID-19

Social detachment to prevent the spread of the COVID-19 pandemics in the year 2020 can significantly contribute to the physical inactivity of citizens worldwide. The study aimed to analyze the level of physical activity by identifying the training methods used during the social isolation resulting from the COVID-19 pandemic. Sixty-eight Brazilian athletes (both sex, 14.7 ± 1.68 years) answered and adapted the International Physical Activity Questionnaire (I-PAQ) through an online platform. Participants were asked to report their level of physical activity before and during the period of social distance. 67.7% of the interviewed athletes said they were able to adapt their sports training to the isolation environment under the guidance of a distance physical education professional. Only 4.38% of the sample was not training under such supervision and, therefore, inactive. Among the activities performed in the isolation environment, calisthenics was the primary practice (Effect Size: ƒ2 = 0.50, p <0.0001) and the sport practiced at home was the secondary practice (Effect Size: ƒ2 = 0.27, p = 0.004). During the pandemic, the training hours of athletes reduced significantly from ~ 3h to ~ 1h per day (Effect size: 1.74, p <0.0001), as well as, the perceived intensity decreased from "high" to "moderate" (Effect size: 1.38, p <0.0001). The weekly training frequency decreased from ~ 6 to 7 days to ~ 3 to 5 days (Effect size: 0.40, p = 0.03). Therefore, despite the social distance and the reduced pace of training, the young Brazilian athletes analyzed managed to remain physically active during the COVID-19 pandemic.

Obesity in COVID-19 era, implications for mechanisms, comorbidities, and prognosis: a review and meta-analysis

Background

Recent studies have shown that obesity is associated with the severity of coronavirus disease (COVID-19). We reviewed clinical studies to clarify the obesity relationship with COVID-19 severity, comorbidities, and discussing possible mechanisms.

Materials and methods

The electronic databases, including Web of Science, PubMed, Scopus, and Google Scholar, were searched and all studies conducted on COVID-19 and obesity were reviewed. All studies were independently screened by reviewers based on their titles and abstracts.

Results

Forty relevant articles were selected, and their full texts were reviewed. Obesity affects the respiratory and immune systems through various mechanisms. Cytokine and adipokine secretion from adipose tissue leads to a pro-inflammatory state in obese patients, predisposing them to thrombosis, incoordination of innate and adaptive immune responses, inadequate antibody response, and cytokine storm. Obese patients had a longer virus shedding. Obesity is associated with other comorbidities such as hypertension, cardiovascular diseases, diabetes mellitus, and vitamin D deficiency. Hospitalization, intensive care unit admission, mechanical ventilation, and even mortality in obese patients were higher than normal-weight patients. Obesity could alter the direction of severe COVID-19 symptoms to younger individuals. Reduced physical activity, unhealthy eating habits and, more stress and fear experienced during the COVID-19 pandemic may result in more weight gain and obesity.

Conclusions

Obesity should be considered as an independent risk factor for the severity of COVID-19. Paying more attention to preventing weight gain in obese patients with COVID-19 infection in early levels of disease is crucial during this pandemic.

Lifestyle factors in the prevention of COVID-19

Confinement to the home and psychological distress due to the coronavirus disease 2019 (COVID-19) pandemic may lead to harmful health behaviors, such as overeating, sedentary behavior with reduced physical activity, elevated alcohol and tobacco use and increased screen time causing impaired sleep. All of these behaviors are associated with non-communicable diseases and can interfere with immunity. While no foods, single nutrients or dietary supplements are capable of preventing infection with COVID-19, a balanced diet containing sufficient amounts of macronutrients and diverse micronutrients is a prerequisite of an optimally functioning immune system. High-energy "Western" diets and obesity are major risk factors for a more severe course of COVID-19. Alcohol use and tobacco also have detrimental effects on the immune system. Therefore, population-wide body weight control, reduction of smoking rates and limitation of alcohol consumption are important preventive measures. Furthermore, sufficient restorative sleep is needed for adequate immune functioning. Appropriate lifestyle changes in regard to nutrition, exercise, sleep, smoking and alcohol intake may help shift the population distribution of infection risk and aid in preventing severe COVID-19 disease. Large-scale surveys should explore the effects of lifestyle changes, and the provision of reliable lifestyle information and effective interventions to individuals and communities during the pandemic is a pressing need.

How children and young people can stay physically active during the novel coronavirus pandemic while take into account safety measures and precautions

The novel coronavirus (COVID-19) outbreak has caused major public concern and posed challenges to societies across the globe. The COVID-19 pandemic might have implications for health-related behaviors, such as physical activity, among people in different age groups. Lately, a number of papers have offered suggestions and recommendations on how to stay physically active during the novel coronavirus pandemic while take into account safety measures and precautions. Many of these suggestions and recommendations might be relevant for health professionals and health practitioners working to facilitate physical activity, health, and well-being among children and young people. In light of the COVID-19pandemic, this paper provides an overview of (a) suggestions and recommendations on physical activities; and (b) safety measures and precautions while being physically active.

Important Factors Affecting User Experience Design and Satisfaction of a Mobile Health App-A Case Study of Daily Yoga App

In recent years, mobile health (mHealth) has gained popularity. Yoga apps help users to exercise at home and improve their health. It is worth discussing how to give yogis a better experience and higher satisfaction to improve their willingness to keep using yoga apps. In this study, the Daily Yoga app was selected as the research object to explore important factors related to its user experience design and user satisfaction. Through a literature review and Delphi method composed of eight experts, this study put forward the important criteria framework of user experience design for the Daily Yoga app and then, used the DEMATEL (Decision Making and Trial Evaluation Laboratory)-based ANP (Analytic Network Process) method to determine the factors’ importance order and the causal relationships among them. Finally, combined with the results of an importance–performance analysis of 16 real users, we discuss the improvement measures. The research results show that the yoga class is the most critical factor in the user experience design of the Daily Yoga app, the target plan is a factor that is in great need of improvement, and having an attractive interface can improve user experience. The evaluation model of the study can act as a reference for improving user experience with the Daily Yoga app, and can also be widely used in the process of user experience design, questionnaire production, and evaluation optimization of mHealth app and related applications.

Uba C, Rivero-Perez N, Zaragoza-Bastida A, Shah MA, Behl T, Batiha GES. Factors Associated with Increased Morbidity and Mortality of Obese and Overweight COVID-19 Patients

Overweight and obesity are defined as an unnecessary accumulation of fat, which poses a risk to health. It is a well-identified risk factor for increased mortality due to heightened rates of heart disease, certain cancers, musculoskeletal disorders, and bacterial, protozoan and viral infections. The increasing prevalence of obesity is of concern, as conventional pathogenesis may indeed be increased in obese hosts rather than healthy hosts, especially during this COVID-19 pandemic. COVID-19 is a new disease and we do not have the luxury of cumulative data. Obesity activates the development of gene induced hypoxia and adipogenesis in obese animals. Several factors can influence obesity, for example, stress can increase the body weight by allowing people to consume high amounts of food with a higher propensity to consume palatable food. Obesity is a risk factor for the development of immune-mediated and some inflammatory-mediated diseases, including atherosclerosis and psoriasis, leading to a dampened immune response to infectious agents, leading to weaker post-infection impacts. Moreover, the obese host creates a special microenvironment for disease pathogenesis, marked by persistent low-grade inflammation. Therefore, it is advisable to sustain healthy eating habits by increasing the consumption of various plant-based and low-fat foods to protect our bodies and decrease the risk of infectious diseases, especially COVID-19.

Association between eating behavior and quarantine/confinement stressors during the coronavirus disease 2019 outbreak

BACKGROUND

Quarantine/confinement is an effective measure to face the Coronavirus disease 2019 (COVID-19). Consequently, in response to this stressful situation, people confined to their homes may change their everyday eating behavior. Therefore, the primary objective of this study is to evaluate the association between quarantine/confinement stressors and eating behavior during the COVID-19 outbreak. The secondary objective is to compare the association of quarantine/confinement stressors and diet behavior between two groups of participants, those attending diet clinics and those not (general population).

METHOD

A cross-sectional web-based online survey carried out between April 3 and 18, 2020, enrolled 407 participants from the Lebanese population. Eating Disorder Examination - Questionnaire (EDE-Q) were used to measure the behavioral features of eating disorders.

RESULTS

More than half of the sample (53.0%) abide by the home quarantine/confinement, 95.4% were living with someone in the quarantine/confinement, and 39.6% continued to work from home. Higher fear of COVID-19 was found in 182 (44.8%) participants, higher boredom in 200 (49.2%) participants, higher anger in 187 (46.3%), and higher anxiety in 197 (48.5%) participants. Higher fear of COVID-19 (Beta = 0.02), higher BMI (Beta = 0.05), and physical activity (Beta = 1.04) were significantly associated with a higher restraint score. Higher anxiety, higher fear of COVID-19, higher BMI, practicing physical exercise, and a higher number of adults living in the quarantine/confinement were significantly associated with higher shape and weight concerns.

CONCLUSION

Our results showed that the fear of COVID-19 was correlated with more eating restraint, weight, and shape concerns in the whole sample, but more specifically in the dietitian clients group. Public health control measures are needed to reduce the detrimental effects of psychological distress associated with quarantine/confinement on eating behaviors during the COVID-19 outbreak.

"Exercise with facemask; Are we handling a devil's sword?" - A physiological hypothesis

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The study demonstrates potential complications associated with facemasks during exercises.

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N95 respirators induces acidic environment which in turn affects the immune and metabolic systems.

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Facemasks during exercise may exacerbate the pathology of underlying chronic diseases.

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Further depression, anxiety induced by poor oxygenation and vasodilatory status when exercising with facemasks.

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The social exercisers should socially distance during exercise rather than wearing masks.

Straying away from a sedentary lifestyle is essential, especially in these troubled times of a global pandemic to reverse the ill effects associated with the health risks as mentioned earlier. In the view of anticipated effects on immune system and prevention against influenza and Covid-19, globally moderate to vigorous exercises are advocated wearing protective equipment such as facemasks. Though WHO supports facemasks only for Covid-19 patients, healthy “social exercisers” too exercise strenuously with customized facemasks or N95 which hypothesized to pose more significant health risks and tax various physiological systems especially pulmonary, circulatory and immune systems. Exercising with facemasks may reduce available Oxygen and increase air trapping preventing substantial carbon dioxide exchange. The hypercapnic hypoxia may potentially increase acidic environment, cardiac overload, anaerobic metabolism and renal overload, which may substantially aggravate the underlying pathology of established chronic diseases. Further contrary to the earlier thought, no evidence exists to claim the facemasks during exercise offer additional protection from the droplet transfer of the virus. Hence, we recommend social distancing is better than facemasks during exercise and optimal utilization rather than exploitation of facemasks during exercise.