In the past few centuries, the health status of people was affected by the presence of chronic and infectious diseases. Major epidemics occurred and reports indicate that infectious diseases such as cholera, plague, yellow fever are back,[1]. Recently, new ones have emerged such as Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), Zika, and now the new coronavirus known as Coronavirus Disease 2019 (Covid-19). [2, 3]
In December, 2019, Wuhan city, the capital of Hubei province in China, became the center of an outbreak of pneumonia of unknown cause.[4] Since then, the disease has spread quickly over the globe and World Health Organization (WHO) announced it as a global pandemic.[5] By the end of May 2020, globally about 6 Million people were reported to be infected and with death reaching about 370,000. Data changes rapidly and might not reflect some cases still being reported (Covid-19 Alert, 2020).
It seems that the persistence of bad news received every day about the COVID-19, which causes an increasing number of deaths, economic collapses, an increase in the unemployed, losses of major international companies, travel bans, daily home confinement, etc. has become a concern for people all over the world and might impact their mental wellbeing. Although governments have highlighted the spread of the disease and the ability of health ministries to restraint its spread and treat patients, they have neglected the negative impact on the mental wellbeing across the globe. For example, suicides increased in some countries which might indicate mental wellbeing disorders associated with the COVID-19 pandemic. Moreover, there is an urgent need for timely attention to mental health care, social support / work programs, as well as an optimal treatment for mental disorders. It is also imperative to pay attention to other factors of lifestyle that can enhance mental wellbeing. [6, 7]
The recommended procedures to prevent the spread of the disease so far focused on social distancing (minimum of 1.5-meter) and home confinement. These were imposed by several governments and were reported to be “very effective” for people who stand still indoors or outdoors. [8] However, home confinement, up to curfew in some incidents is of concern since it may affect physical activity and eating behaviors as well as mental wellbeing.
The impact of COVID-19 transformed social life as we know it. Most Arab countries have taken extreme measures to prevent the spread of the disease and to protect its people following the Chinese approach of aggressive isolation measures, which led to a progressive reduction of cases [9, 10]. Thus, academic institutions were closed as early as March 13th and shifted to online activities. Curfew was enforced, few cities were isolated and access to workplaces, Gyms, etc. was prohibited. Grocery stores (convenience stores), Bakery shops and medical facilities were the only available services people can walk-visit during limited hours of the day and only for limited age-groups. These measures favor sedentary lifestyle due to low mobility and consequently may impact cardiovascular and mental health integrities.
The American Heart Association, [11] indicated that “Prevention is the key to limiting the spread of coronavirus and as more people work remotely or reduce their public exposure, it is important to maintain healthy habits at home”. Physical activity includes all forms of skeletal muscles-driven movement that encompasses activities of different levels of intensity. Physical activities include leisure time activities such as walking, hiking, gardening, cycling and dancing. Although, competitive sports have been prevented from continuing to play, playing and cleaning the house and carrying heavy shopping continued as a compensatory physical activity. Many are very restricted in movement through the pandemic of COVID-19, it is extremely important for people of all ages and abilities to be as active as possible. Short break from long sitting by doing physical movements for 3-5 minutes every one hour has significant impact on health.[12] Walking or stretching exercises would help relieving muscle fatigue, mental tension and improve blood circulation and overall physical wellness. [12]
Prior to this pandemic and associated confinement, mankind health was already jeopardized due to the sedentary lifestyle the hypokinetic-triggered diseases. The lifestyle modifications may become a serious threat affecting many daily activities and lifestyle alterations for people of all ages. Benefits of physical activities in this emerging condition is expected to exceed the known benefits to improve mental status and help people to cope with the new stay-home status quo and social-life withdrawal. It has been reported that moderate regular physical activity can enhance the immune response [13], also reports provide evidence that moderate regular physical activity is inversely related to the occurrence of upper respiratory tract infections(URTI), which are usually caused by viral agents. [14]
Home confinement and curfew forced most people to work or study at home, a practice that is thought to compromises the routine physical activity by increasing the sitting time. Most people are thought to spend a long periods of stay in front of the screen, whether it is to check the news on the phone, or join Zoom with the family, or watch the interesting Netflix, or spend additional hours staring at a computer while working from home, and this can mean increasing social spacing in the family because of the long stay in front of the screen. Such behaviors would be expected to decrease.
Non-Exercise Activity Thermogenesis (NEAT) and thus total energy expenditure, which may have long term implication on body weight, and life expectancy [15] . Moreover, home confinement may alter eating behaviors resulting from broadness and access to food. Thus, a proper nutrition become of vital importance to support immune system and improve energy balance, in order to reduce the risk of developing chronic and infectious diseases. [16]
Staying stuck at home, especially if it has low levels of natural light, may reduce light-based signals for wakefulness and sleep, which are necessary for our daily rhythm (circadian). Especially since many do not work or have their weekly working hours reduced due to COVID-19, the majority of them may be tempted to sleep every morning. It can make sleeping more than seven to eight hours a night and waking up on time more difficult, This in turn leads to drowsiness, irritation, insomnia and lack of focus throughout the day. [17, 18] . Sleep is important for physical health and the effective functioning of the immune system. It promotes emotional wellness and mental health and helps to overcome stress, depression and anxiety. Millions of people have suffered from insomnia before the coronavirus, but with the epidemic a host of new challenges are producing even for people who have never had trouble sleeping before. Excessive stay in front of the screen, especially in the late evening, can have a detrimental effect on sleep. This is probably because of the blue light from the screens that affects the natural production of melatonin, a hormone the body makes to help us sleep.[19, 20, 21]
Finally, Mental wellbeing is an important issue in our daily life and may change from day to day. Each person has a different potential to cope with stress and can be affected by several factors. Among these factors can be regular physical activity, good sleep and good food. As the WHO indicates in defining health that it is not only free of disease, but rather a state of physical, mental, spiritual and social integration .Therefore, the purpose of this study was to determine to what extend that the lifestyles’ behavior includes Physical activity, sleep, and diet contributed to mental wellbeing during the COVID 19 pandemic confinement. Consequently, we hypothesized that good physical activity, good diet quality, and good sleep would be linked with better mental wellbeing.