Homeostasis, Exercise, and COVID-19 Isolation

(1) the immune system is strengthened through regular physical activity (Campbell and Turner, 2018; Simpson et al., 2020)

(2) psychological well-being is enhanced (Mandolesi et al., 2018).

However, exercise is no panacea.

Exercise must be applied with caution especially by people with chronic conditions. If a person has a heart condition, strenuous physical exercise may put them at risk (Keteyian et al., 2016).

In some chronic conditions such as ME/CFS, exercise tends to make many patients feel much worse (Geraghty et al., 2019).

However, if used safely and appropriately, the majority of people can quickly feel physical and mental benefits from regular exercise.

Physiological Mechanisms

Some significant effects of physical activity can be explained by physiological mechanisms (Lopresti et al., 2013). Exercise within the context of psychological health promotion has also been an active research area (Chekroud et al., 2018; Curioni and Lourenco, 2005; Mikkelsen et al., 2017; Tiggemann and Zaccardo, 2018). Some researchers have focused on neurophysiological mechanisms, which aim to identify the positive outcomes of the relationship between exercise and mental health (Eyre and Baune, 2012). Exercise is understood as a relationship between intensity and frequency, and positive outcomes are mostly based on which exercise protocol will determine a better neurophysiological response (Lopresti et al., 2013). Exercise is recognized as a mediator of primary monoamine neurotransmitters, namely, serotonin, noradrenaline and dopamine. These three neurotransmitters receive reciprocal regulation, while exercise intensity modulates the stimulation of monoamine system (Lin and Kuo, 2013). However, it is also important to recognize the affective responses of physical activities and psychological variables are likely to mediate the relationship between exercise and mental health (Rodrigues et al., 2019). There is a sound empirical basis for an integrated account of the emotional effects of exercise. A recent study with a representative US sample of 1.2 million individuals linked exercise to mental health and exercising was associated with reduced self-reported mental health burden. Furthermore, motivation and mindfulness-based techniques act as mediators for these relationships, which seem to account for the strongest effect of the exercise on fewer days of poor mental health (Chekroud et al., 2018).

Joy and Happiness

In the context of social isolation, exercise can be an inherently rewarding activity that contributes joy, happiness and satisfaction (Ryan and Deci, 2017; Standage and Ryan, 2012). The positive outcomes also appear as a function of affective consequences of exercise or anticipation of its affective response – the hedonic principle of the law of effect (Marks, 2018). In general, the expected pleasure versus displeasure is a determining principle of the motivation to repeat behaviour (Kwasnicka et al., 2016; Williams, 2008).

Isolation and quarantine are a disagreeable experience, which may lead to sadness and even impose dramatic mental illness for those who undergo it (Brooks et al., 2020). In this context, a daily exercise routine can be crucial to modulating pleasurable situations at some point during the day. People can feel more deeply satisfied through the experience of choice and volition, reinforce their sense of autonomy and competence, and renew a sense of joy (Lubans et al., 2017; Ryan and Deci, 2017; Standage and Ryan, 2012).

The benefits of exercise depend on the degree of internalization of the behaviour. In our daily lives, exercises are normally performed in order to achieve goals, such as social aesthetic standards (Sperandei et al., 2016). These goals are separable from the purpose of the exercise (a person may not enjoy exercising, but will do it to obtain a result); and therefore, people are generally not ‘authentic’. The lack of authenticity represents a person doing an activity for contingent reward or punishment, feeling tense and pressured, lacking intentionality and being oriented to avoid guilt, angst and social judgement or to protect contingent self-worth. Contrarily, people are authentic when exercise choice is aligned with personal goals, interest and is assimilated with the individual’s characteristics, ability and identity (Deci and Flaste, 1995). Identity is associated with ongoing positive experiences attendant on the behaviour (Kwasnicka et al., 2016), such as exercising at home.

Notably, the COVID-19 pandemic causes fear and the lockdown imposes limits on people’s movement (Brooks et al., 2020; Xiang et al., 2020).

The rationale for the positive side of exercising at home is that exercise can be experienced without any strong social pressure, having a totally internal source of inspiration. The behaviour might be accompanied by higher self-esteem and lower psychological ill-being, since we are free to choose the:

• types of exercise
• schedule
• frequency
• intensity

The fulfilment of basic psychological needs appear within this context.

Authenticity and Self-Compassion

Another helpful process is that of self-compassion – the ability to treat oneself with the same concern and support in distressing situations; it is related to self-kindness, common humanity and mindfulness. In fact, it is associated with self-regulation when performing health-promotion behaviours (Holden et al., 2020; Semenchuk et al., 2018). Exercising at home, in a crisis situation, can be performed without self-criticism, which could hinder the process by increasing pressure and self-judgement, which in turn may provide adaptive coping, problem-solving and psychological well-being.

Research has provided empirical evidence on the positive relationship between self-compassion and exercise in providing exercise maintenance and enhancing positive emotions (Holden et al., 2020; Semenchuk et al., 2018).

Mastery and Self-control

Exercising at home can increase the individual’s sense of control. Research suggests that self-mastery is a crucial criterion for promoting positive effects on psychological outcomes (Mikkelsen et al., 2017; Ryan and Deci, 2017). In the face of this pandemic, we have seen many examples across the world showing that exercise can create a social arena in which individuals learn social skills and build social networks by adhering to exercise challenges, exercising in condominiums and encouraging others. These virtual social connections enhance feelings of autonomy and being fully alive. When autonomous forms of regulation guide behaviour, positive affective responses are expected (Ryan and Deci, 2017; Standage and Ryan, 2012). One example is the QuaranTrain launched at HAN University of Applied Sciences in the Netherlands, an online fitness programme promoting evidence-based information on exercise and resources to stay active during COVID-19 pandemic through blogs and videos (HAN University of Applied Sciences, 2020). They provide daily online support, according to World Health Organization advice on physical activity. Users post their workouts routines in social media using the trending hashtags #quarantrain and #quarantraining, with more than 5000 posts worldwide.

Self-efficacy and Self-esteem

Being engaged in exercise may result in higher levels of self-efficacy (Bandura, 1997) which can have the knock-on effect of improving one’s ability to carry out other activities (Mikkelsen et al., 2017). The relationship between changes in the ability to perform activities successfully and increased self-efficacy is fundamental, considering the observed association between depression and low self-efficacy (White et al., 2009). In the context of social isolation, physical activity may be one key to enhancing people’s feeling of competence. In addition, achievement of internal goals and satisfaction has been related to greater psychological wellness (Ryan and Deci, 2017; Standage and Ryan, 2012). This hypothesis has been confirmed by an experimental protocol in which mindfulness self-efficacy appeared to mediate the indirect effects of exercise on mental health and perceived stress (Goldstein et al., 2018), reinforcing the positive account of emotion for a better quality of life (Joseph et al., 2014).

Mikkelsen et al. (2017) observed that exercise influences self-esteem through self-efficacy or mastery, and mood, distracting individuals from negative and worrying thoughts and rumination, improving the retrieval of positive thoughts and allowing time away from negative or stressful aspects of everyday life, and especially, the COVID-19 pandemic itself. These moderating factors might also explain the protection effect of exercise on mental health (Mikkelsen et al., 2017).

Physical activity programmes to improve self-esteem to people of all ages can be effectively delivered at home by DVD (e.g. see Awick et al., 2017) or by You Tube (e.g. PE with Joe).

Peer Support

Moreover, people in social isolation should try to create peer support through social networking services by involving friends and relatives in their exercise routines or challenges.

Resources

• COVID-19, Exercise, Children and their Developing Immune System | Blog
• A Call to Action: Physical Activity and COVID-19 | Op-Ed
  • Available in Spanish
• Staying Active During COVID-19 | A blog from Liz Joy, M.D., MPH, FACSM, FAMSSM and Exercise is Medicine
• Staying Active During the Coronavirus Pandemic | Handout
• Keeping Children Active during the Coronavirus Pandemic | Handout
• The Physician’s Perspective on COVID-19 | The Sports Medicine Checkup, a Podcast by ACSM
• Exercise, Immunity and the COVID-19 Pandemic | Blog
• Ten Sought-After Functions in Workout Apps | Infographic
• ACSM Summit Workouts | YouTube Playlist | Need a full at-home workout? Check out these workouts that were presented at previous ACSM Health & Fitness Summit events!
• Best Tips to Stay Active and Healthy While in Self-Isolation | Blog post from ACSM Sponsor Trainerize
• Exercise at Home: Options for People with Disability or Chronic Health Conditions | Video from ACSM partner NCHPAD