Social Issues During the COVID-19 Quarantine Period: Interaction of Physical Activity and Mental State

A cross-sectional study was conducted by sending an Arabic-language questionnaire via social media platforms (Facebook, WhatsApp, and LinkedIn) to a sample of study participants. The questionnaire was supplied as a hyperlink to be completed during home confinement and takes the form of a google form. The questionnaire was issued to all Palestinian university employees, staff, and faculty members, as well as students, resulting in 360 responses from people aged 18 to 70 who were subjected to the Palestinian government's home confinement measures. The questionnaire includes questions on the participants' demographics as well as an assessment of their levels of physical activity. At the start of the questionnaire, the participants were informed of the study's aim and goals, and their consent to participate was sought; they were also given the freedom to answer the various portions of it, as well as the option to withdraw from the study or leave any parts unanswered. The questionnaire had a ten (10) minute completion period and was to be completed and returned by pushing a designated button (done). The participants were not requested to reveal any personal information (such as their names, e-mail addresses, or dates of birth) so order to retain their anonymity and respect for their privacy. Furthermore, the volunteers were not financially paid for their participation. The questionnaire was completed by 378 people, but those who provided insufficient or partial responses were not included or considered. As a result, only the data from 360 completed questionnaires was included for analysis in this study (184 females and 176 males). The demographic data of the participants is shown in Table 1.

After a week of testing the questionnaire with a pilot sample of 37 participants from both the study and non-study populations, the researchers calculated the stability factor by reapplying the questionnaire to the sample to ensure its internal and external consistency, as well as to ensure its clarity before applying it to the sample. A reasonable set of results (Cronbach a > 0.70) and an externally consistent set of results (an intraclass correlation coefficient > 0.70) have been obtained from the pilot sampling and the internal consistency test at the total and individual levels.

Table 1. Demographic information about the participants

2.1 A description of the study sample

Participant responses were received by electronic distribution of the questionnaire after its rigour had been confirmed and the content had been changed to be more appropriate for Palestinian society. The study's sub-measures comprised demographic and cultural data, the WHO-5 mental state index, and the IPAQ's brief module. Additionally, Gender, age, height, height, educational level, marital status, health status, use of various tobacco products, area, domicile, occupation, and presence of chronic diseases were all included in the study sample's demographics. These results were obtained using DCI, which are sample-specific personal estimation measures; BMI was calculated by dividing weight in kilogrammes (KG) by height in metres (m) squared [15].

The body mass index of the subjects was used to classify them into four categories: underweight, normal weight, overweight, and obese. The mental state was assessed using the WHO-5 scale, which is composed of five dimensions: How those aspects were measured was previously clarified; scored scores reflecting those dimensions were calculated up to a maximum of 25 points; and persons scoring greater than 13 points on the (WHO) scale were regarded to be in a good mental condition [15].

The IPAQ (International Physical Activity Questionnaire) [16] was used to evaluate the degree of physical activity of each participant based on their replies to the questionnaire. MET min/week is the metabolic equivalent of a week's worth of moderate-intensity physical activity and high-intensity physical activity, respectively. The seven paragraphs in this fast model contain information about these three categories of physical activity. Sitting time is also tracked by the application. According to the MET, which was previously reported [17], the sample was divided into three groups based on how active they were (low, medium, and highly active).

Table 1 summarises the demographic characteristics of the 360 questionnaire respondents (184 females and 1176 males). The majority of participants live in Palestinian cities, and female participation outnumbered male participation by a wide margin. Obesity and weight gain are common, much more prevalent in males than females (p0.0001), and males have a higher level of physical activity and mental health than females (p0.0001).

2.2 Statistical analysis

The following software was used to conduct the statistical analysis: (SPSS Statistics software, version 23, IBM Chicago, IL, USA.). All of the constant variable data's mean, average, and standard deviation were computed ANOVA and Tukey's post hoc test for inconsistent variables followed by an independent sample t-test revealed statistical differences and distinctions between the independent samples. Data from variables connected with categories were also provided as percentages. The Chi-square test was then applied to categorical variables. Pearson Statistical significance was considered as a value of p 0.05 or greater for the correlation coefficients used to examine the link between the mental state variable and the level of physical activity.

Analysis of variance (ANOVA) results showed substantial statistical differences in the levels of mental state and physical activity (F (2,357) = 46.231; P 0.0001). Individuals who engage in a high level of regular activity (17.3-3.6), as shown in the study results in Figure 2, have higher scores in the indicator of mind state compared to those who engage in a medium level of physical activity (13.7-4.2) and those who engage in a lower level of physical activity (12.5-4.9). Furthermore, the differences (P 0.0001) were statistically significant.

As evidenced by the study's findings, Figure 2 shows that there were significant statistical differences (P = 0.028) between people who engaged in medium and low levels of physical activity in terms of mental state. As shown in Table 2, the correlation between gender (male) and more active regular activity as well as a higher state of mental well-being can be explained by the fact that males reported lower levels of regular activity than females, which may be due to differences in gender characteristics in the "age" variable, which shows that females aged 23-31 were less active than males.

Additionally, Pearson's correlation coefficient analysis revealed a significant relationship between the mental state variable and the degree of physical activity; it is clear that the better one's mental condition is, the greater one's weekly physical activity level is (r=0.473; P=0.001). The current study examines the degree of link between physical activity and mental state, as physical activity can influence one's mental state during a period of COVID-19-related house confinement.

Numerous studies have shown that people who engage in consistent and regular physical activity have a better mental condition. Furthermore, a growing body of research suggests that physical activity, regardless of age or geographic location, can operate as a protective factor against depression [18]. According to McDowell et al. [19], physical activity protects against anxiety symptoms and disorders, and physical activity and mental state are favourably connected [20]. In young children, Bell et al. [21] discovered no link between mental health and physical activity. After three years of research, however, children aged 13 to 15 who engaged in rigorous physical activity experienced less mental anguish. Furthermore, our findings support those of Kilani et al. [22], who found that physical activity can help residents cope with the stresses of house confinement while also enhancing their mental health.

It's still thought that physical activity, based on prior studies, is capable of protecting study participants, particularly females, from mental decline brought on by home confinement, despite the fact that it has been shown to improve mental condition. There is a correlation between a high degree of physical activity and the reduction of anxiety and depression; in return, stretching and resistance exercises were negatively associated to each other as well as anxiety and depression, while domestic duties were negatively related to depressive symptoms.

Physical exercise, according to World Health Organization recommendations [23, 24], is a health-related topic that covers the benefits it gives in terms of psychological, physical, mental, and social well-being, as well as the drawbacks of not engaging in it. Absence and the positive impact it has on an individual's mental state are discussed. Furthermore, physical activity is regarded as a means of enhancing confidence and gaining social support [25], as it improves an individual's mood by increasing the level of a neurotransmitter (serotonin), which affects an individual's mood when exercising [26, 27]. Physical activity is also regarded as a means of gaining social support. It improves the individual's self-esteem and social acceptance [28], as well as relieves depressive symptoms, because cardio and strength activities are beneficial in improving the individual's condition [29, 30].

It also has a positive effect on the function of the heart, arteries, muscles, and bones. Furthermore, it has been shown to lower the chance of acquiring a multitude of illnesses, including high blood pressure, chronic heart disease, stroke, diabetes, breast cancer, colon cancer, and depression [24].

Regular exercise also has a beneficial effect on common psychological diseases and depression symptoms by generating the production of beta endorphins following exercise; this endorphin is associated with a happy mood and a sense of mental well-being [30]. Additionally, physical activity aids in relaxation [31], but it is necessary to emphasise that there are numerous barriers to exercise. Some are psychological (depression, lack of motivation, lack of confidence, insomnia), while others are social (lack of social support, poor environment, insufficient time, illness, fatigue) [32-34].

Regardless of the fact that home confinement is the best course of action and the World Health Organization's most important recommendation [5], it has unintended consequences for other aspects of an individual's health. This is especially true in light of the abrupt onset of home confinement, which fundamentally alters people's lifestyles by increasing immobility (sitting) time and jeopardising routinely practised physical activity. The majority of people are spending more time in front of screens, whether it's to check the news on their phone, participate in a Zoom call with family, watch an interesting Netflix series, or spend additional hours staring at a computer while working from home. This can result in a deterioration of social ties between family members [2].

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Figure 2. Evaluation the mental state variables in relation to the lifestyle-related and demographic variables that were chosen

Additionally, numerous studies have demonstrated a negative correlation between the duration of home confinement and the participants' mental state, as well as posttraumatic stress disorder and anger symptoms [35, 36]. Home confinement is associated with a variety of negative psychological effects, including posttraumatic stress disorder, confusion, anger, fear of infection, frustration, and boredom. As a result, according to the findings of Hawryluck et al. [35], individuals who were isolated for more than 10 days showed more evident signs of post-traumatic stress disorder than those who had been quarantined for less than ten days.

Further evidence suggests that household incarceration has a greater impact on female mental health than on male mental health, which researchers attribute to an increase in the burden women bear at home in the form of daily chores such as caring for children, performing house chores, and being burdened with the financial burdens associated with living decently, as well as feelings of loss of functional and social position as a result of being unable to participate in society's activities [37].

According to the findings of this study, men were found to have a positive mental state because of their capacity to get out of the house and go shopping, stroll through the yard or garden, or engage in physical activities. Adams-Prassl et al. [38] found that house confinement reduced the mental condition of American women and men, as well as those women experience greater negative repercussions than men because of increased domestic responsibilities, with the effect on males being close to zero.

Additionally, the researchers observed a correlation between the deterioration of mental status caused by home confinement and residence location, as research has shown that individuals who live in rural areas have a higher psychological status than those who live in urban areas or those who live in low psychological status. As a result of insomnia, exhaustion, and anxiety. Additionally, residents of larger homes with outside spaces report reduced anxiety, concern, and stress.

Moreover, a significant study conducted on children who lived in modern areas (cities) with their parents discovered that they were more likely to suffer from mental health problems as a result of being confined at home than children who lived in rural areas. According to the findings of the study, rural residents differ from city dwellers in terms of mobility while confined to their homes, owing to the strict restrictions placed on their ability to move around freely [39]. Another study discovered that children who grew up in rural areas surrounded by animals and bacteria have stronger immune systems, are more resilient to stress, and have a lower risk of developing mental health problems than city dwellers without pets. This study adds to the body of evidence demonstrating the "hygiene hypothesis," which asserts that highly sterile environments can be detrimental to health [40].

Additionally, prolonged confinement to the home as a result of closure and confinement increases lethargy, laziness, monotony, and physical activity levels, which can contribute to mental decline [41]. Regardless, being physically active at home may benefit people who are confined to their homes in terms of maintaining and protecting their mental health. Physical activity, according to Chen et al. [42], can aid children in recovering from mental health issues associated with quarantine during the COVID-19 crisis. The World Health Organization [5] has issued Adults should engage in at least one session of strenuous exercise of up to 75 minutes per week, or at least 150 minutes of moderate physical activity per week, or a combination of the two, according to special rules for those under quarantine.

Increased levels of brain-derived neurotrophic factor (BDNF) and body-induced opiates (endorphins) as a result of physical activity can help alleviate the symptoms of stress and depression. Other benefits of exercise include improved immune system function as well as an increase in one's own self-esteem [43]. Moderate to vigorous physical activity helps decrease the symptoms and effects of anxiety and depression linked with confinement at home thanks to the protective complexity and powerful neurological implications that it provides.