Homeostasis, Exercise, and COVID-19 Isolation

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The Value of Exercise

A recent post explored human needs during COVID-19 isolation. The success of social isolation policies will depend on minimizing long-term depreciation of mental health. In this post, I explain the benefits of developing a system of daily exercise to bolster well-being.

Exercise is an under-utilised resource that is freely available to almost everyone, which can bring profound benefits if applied systematically. The impact of exercise is one of the most powerful examples of regulation created by homeostasis. Regular physical activity not only has obvious physical benefits but significant psychological benefits also. During COVID-19 isolation, exercise offers the capability to reset body and mind to a more optimum state of equilibrium.

Hawley et al. (2014) state: “Exercise represents a major challenge to whole-body homeostasis, and in an attempt to meet this challenge, myriad acute and adaptive responses take place at the cellular and systemic levels that function to minimize these widespread disruptions.”

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The Physiological Responses to Voluntary, Dynamic Exercise. Multiple organ systems are affected by exercise, initiating diverse homeostatic responses. Reproduced from ‘Integrative Biology of Exercise’ by Hawley et al. (2014).

Note of caution

Apart from its general ability to challenge homeostasis to reset the body’s biological equilibrium, exercise has a role in two domains of well-being:

(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

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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

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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).

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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

 

The negative impacts of COVID-19 lockdown on mental health can be ameliorated by the use of exercise, which should be as vigorously promoted as social distancing itself.

In this context, keeping moving seems to be the key.

Reference:

Thiago Matia, Fabio H Dominski and David F Marks (2020)

Human Needs in COVID-19 Isolation

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A Perfect Storm

These are extraordinary times. Throughout history there have been plenty of pandemics but the human response to COVID-19 is unprecedented. The world will never be the same again. It is estimated that close to four billion people are living in social isolation during this mother of all pandemics (Sandford, 2020). Unless there is a revolt, policies of social isolation in one form or another are expected to continue until a vaccine is available 6, 12 or 24 months from now.  The cumulative impacts of social distancing will be truly profound.

COVID-19 lockdown has created a perfect storm’ of vulnerabilities that huge numbers of people, and services, are ill-prepared to manage. This post reviews the science of human needs as they are expected to play out over a prolonged period of domestic confinement.

The COVID-19 pandemic involves a novel coronavirus characterized by a respiratory illness that results from a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (Centers of Disease Control and Prevention, 2020). The disease was first reported in Wuhan, China, in December 2019 and symptomatic patients frequently present with a dry cough, fever and shortness of breath within 2 to 14 days after exposure. The coronavirus disease (COVID-19) pandemic is receiving intensive interest at all levels: political, economic, social, scientific and in health care.  The epicenter of the COVID-19 outbreak moved from China to Europe and a few weeks later to the US. As of 22 April 2020, there were 2,564,038 confirmed cases and 177,424 deaths reported worldwide, affecting at least 201 countries, areas or territories (Johns Hopkins University, 2020). Most cases are in the USA (823,786 cases), followed by Spain (204,178) and Italy (183,957) (Johns Hopkins University, 2020).

Isolation

Owing to the absence of a vaccine, official control measures have been implemented to reduce the spread of COVID-19, such as restrictions on people’s movements, including social distancing, closing of gyms and parks, travel restrictions, quarantines and stayathome guidance. The policy of confinement has significant health, economic, environmental and social consequences. In the psychological sphere, recent evidence shows that similar pandemics increased the prevalence of symptoms of post-traumatic stress disorder, as well as confusion, feeling of loneliness, boredom and anger during and after quarantine (Brooks, Webster, Smith, Woodland, Wessely, Greenberg, et al. 2020). 

Stressors during this critical period include fear of infection, fear of death, uncertainty, loss of social contacts, confinement, inadequate information, conflicting advice, loss of outdoor activities, disconnection from nature, loneliness, depression, helplessness, anger, low self-esteem, financial loss and obstacles to supplies of food and water (Brooks et al., 2020; Jiménez-Pavón, Carbonell-Baeza & Lavie, et al., 2020; Xiang, Yang, Li, Zhang, Zhang, Cheung, et al., 2020). A survey in China during the initial outbreak of COVID-19 found that 54% of respondents rated the psychological impact of the outbreak as moderate or severe; 17% reported moderate to severe depressive symptoms; 29% reported moderate to severe anxiety symptoms, and 8% reported moderate to severe stress levels (Wang, Pan, Wan, Tan, Xu, Ho et al., 2020). Given that a significant proportion of the population live alone or are vulnerable to mental health problems, the impacts of the COVID-19 pandemic on mental wellbeing are only now just beginning to be felt.  

 

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In light of these issues, systematic psychological self-care must be given a high priority in coping with the detrimental impacts of COVID-19 and social distancing. Here we discuss one of the most fundamental tools of self-care for health enhancement: increased physical activity. Governmental recognition of the benefits of exercise is evidenced by permitting exercise outdoors during social isolation for indefinite periods of weeks or months. Yet rarely is the issue adequately addressed; an International Task Force of experts to review and advise on psychological and physical self-care would be a welcome initiative.

During the COVID-19 pandemic special attention to systematic psychological health care is required (Zaka, Shamloo, Fiorente & Tafuri, 2020; Zandifar and Badrfam, 2020). Interventions to deal with the pressing psychological needs of individuals during the pandemic are being investigated but in most parts of the world seriously lacking (Xiang et al., 2020; Wang, Zhao, Fen, Liu, Yao, & Shi, et al., 2020). 

One example is physical exercise, which is one of the most important tools to prevent mental illness and improve well-being (Mandolesi, Polverino, Montuori, Foti, Ferraioli, Sorrentino et al., 2018). However, few public health guidelines include daily physical exercise routines for people living in varying degrees of isolation during the pandemic (Chen et al., 2020; Jiménez-Pavón et al., 2020).  The role of physical exercise in psychological wellbeing during the pandemic is discussed in a later post.

Here I introduce concepts that help to enable effective self-care measures for COVID-19 isolation. These concepts are part of A General Theory of Behaviour.

 Psychological Homeostasis

At every level of existence, from the cell to the organism, from the individual to the population, and from the local ecosystem to the entire planet, homeostasis is a drive towards stability, security and adaptation to change.  In a general theory of behaviour claims that striving for balance and equilibrium is a primary guiding force in all that we do, think and feel.  A behavioural type of homeostasis has been given the descriptive term: “Reset Equilibrium Function” (or ‘REF; Marks, 2018). The REF is thought to be omnipresent, whatever we are doing and wherever we are doing it, which includes the monotony of COVID-19 isolation. When we are in isolation, the REF stays with us, considers how to restore equilibrium and reduce feelings of unrest. The REF’s monitoring is not normally attended to, but the REF’s products are: feelings of distress, boredom, loneliness and instability can all be a focus for concern. Competing drives, conflicts, and inconsistencies all pull the flow of thought and feeling ‘off balance’, triggering an innate striving to restore equilibrium. Individuals resort to a variety of methods to restore a sense of balance and equilibrium.

Body and mind continuously regulate and control many domains and levels simultaneously, with multiple adjustments to voluntary and involuntary behaviour guided by two types of homeostasis: Type I – inwardly striving or physiological homeostasis, H[Φ], and Type II – outwardly striving or psychological homeostasis, H[Ψ]. Physiological regulation involves drives such as hunger, thirst, sex, elimination and sleep. The ‘Reset Equilibrium Function’ (REF) operates across all behavioural systems that are investigated by psychological science. 

The Reset Equilibrium Function is a general control function that automatically restores psychological processes to equilibrium and stability. The REF is triggered when any processes within a system strays outside of its set range. The REF is innate and exists in conscious organisms, which all have Type I and II homeostasis. The two types of homeostasis work in synergy. Psychological and physiological processes operate in tandem to maximize equilibrium for each particular set of functions. 

These include cognition, affect, chronic stress, and subjective well-being, and also out-of-control conditions such as isolation, boredom, addiction or insomnia that are in need of self-care. When there is goal to make a behavior change, conscious awareness of the goal and full engagement of one’s personal resources are necessary preconditions for purposeful striving, e.g. the need to reduce boredom and instability in COVID-19 isolation.

The Needs Hierarchy

Human experience is controlled by needs and behaviours to satisfy needs. A general theory of behaviour includes Maslow’s (1943) influential statement about human needs(with a few minor modifications). It is assumed that needs occupy a hierarchy of seven overlapping levels (Figure 1). Like any hierarchical structure, the stability of the system relies on the strength of its foundation level.  The first level  Immediate Physiological Needs  incorporates physiological homeostasis (Type I) and the sustenance of all physiological needs.  Higher level needs from level 2 upwards are served by psychological homeostasis (Type II). There is a progression in developmental priority as the individual matures.  The motivational hierarchy reflects evolutionary function, developmental sequencing, and current cognitive priority. Individuals who are unable to meet their immediate physiological needs at level 1 are at a disadvantage in meeting higher-level needs. Think of a building with seven storeys. If level 1 of the building is not strong, then the higher levels will be vulnerable to collapse.

NEW Needs Pyramid 

Figure 1. The Hierarchy of Human Needs. Homeostasis operates at all seven levels. Physiological, or Type I homeostasis operates at level 1. Psychological, Type II, homeostasis operates at level 2 (Self-protection) and above. Reproductive goals are in the order they are likely to appear developmentally. Later developing needs are overlapping with earlier developing needs. Once a need develops, its activation is triggered whenever relevant environmental cues are salient. Adapted from Kenrick, Griskevicius, Neuberg and Schaller (2010) with permission.

 

I consider next the likely impact of COVID-19 social distancing in light of the needs hierarchy. Four needs most directly impacted by social distancing at levels 1 to 4 are discussed in turn.

Immediate Physiological Needs (Level 1)

Physiological regulation involves the drives of hunger, thirst, sex, elimination and sleep. Level 1 is a bedrock for all higher levels. We consider first food, drink and other necessary products, which have been an issue from the very start of the pandemic with panic buying and stockpiling reported everywhere causing supermarkets and stores to run out of supplies. In the UK, in packaged food and beverages, the highest growth has been evident in cereals (38%), vegetables (37%), cocoa (25%), rice (22%) and pasta (19%). There has also been an increase in bottled water and indulgence foods, such as chocolate (23%), olives (68%) and beer (20%) (Kantar, 2020).Comfort eating and drinking is a common strategy of individuals seeking ways to ameliorate anxiety and distress associated with lockdown. Comfort eating and drinking is associated with weight gain and the development of obesity and eating disorders, especially in conditions of isolation and boredom (Crockett, Myhre & Rokke, 2015; Marks, 2015; Figure 2). Sadly, there is likely to be an acceleration in the already high prevalence of obesity over the lockdown period. As the lockdown period is indefinitely extended, with increasing joblessness and poverty, food insecurity is likely to become a major concern for many people. 

 

FIG 2

 

Figure 2.  Panel A shows the homeostasis system linking low self-esteem with negative affect, comfort eating and overweight. Intervention to alter the dynamics of the system towards that shown in Panel B replaces comfort eating with exercise designed to increase self-esteem and control weight gain (Marks, 2015).

 

A well-known and, to many, surprising COVID-19 phenomenon has been the prevalence of toilet-tissue stockpiling (TTS). In the UK, for the week ending 8 March 2020 the sales of toilet tissues rose by 60% year-on-year (Kantar, 2020). Why should this be?  In fact, this behaviour is perfectly logical and in line with the needs hierarchy where utmost priority is given to needs at level 1. TTS provides long-term hygienic support to the necessary act of elimination, which, during isolation, is more frequent at home because people are unable to do itat the workplace. Thus, TTS is consistent with level 1 of the hierarchy of needs.

 

Level 1 needs are automatically more complex in cases of addiction to drugs, alcohol, tobacco and other substances. If any of these addictions are present, the entire needs structure can be placed in jeopardy. In any case, disruption of sleep patterns is one prevalent consequence of pandemic distress. A European task force concluded: “In the current global home confinement situation due to the COVID-19 outbreak, most individuals are exposed to an unprecedented stressful situation of unknown duration. This may not only increase daytime stress, anxiety and depression levels but also disrupt sleep. Importantly, because of the fundamental role that sleep plays in emotion regulation, sleep disturbance can have direct consequences upon next day emotional functioning Managing sleep problems as best as possible during home confinement can limit stress and possibly prevent disruptions of social relationships” (Altena, Baglioni, Espie, Ellis, Gavriloff, Holzinger, et al., 2020, p. 1). It has been established that physical exercise improves sleep for people of all ages (Flausino, Da Silva Prado, de Queiroz, Tufik, & de Mello, 2012; Reid, Baron, Lu, Naylor, Wolfe & Zee, 2010;  Yang, Ho, Chen, & Chien, 2012). We return to this later.  

Need for Self-Protection (Level 2)

Self-protection needs during the COVID-19 pandemic are paramount. The World Health Organisation (WHO, 2020) and national governments have required a lockdown of the population with social distancing and ‘stay-at-home’ isolation. These policies have stoked fear of death and infection while incentivizing individuals to carry out frequent handwashing, wearing masks along with social isolation. The advice to stay at home has been the main topic of messaging from health authorities during the pandemic.  

An individual’s responses to COVID-19 lockdown is shown in Figure 3. In lockdown, unmet self-protection needs become ‘normal’ and individuals experience systematic frustration of a deep-seated need to ensure protection of self and their family. This high level of frustration causes fear, anxiety and distress as individuals feel incompetent to guarantee the safety and protection of loved ones, family and self. Fear, anxiety and distress are also associated with insomnia, irritability and aggression. Especially if an  individual uses alcohol or drugs to assuage their fears, aggression may turn into physical violence to family members, women, children and pets(Peterman, Potts, O’Donnell, Thompson, Shah, Oertelt-Prigione, et al., 2020). There are increases in the incidence of  homicides and suicides (e.g. Campbell, 2020).

 

FIG 3

 

Figure 3. Behavioural systems at level 2 of the needs hierarchy in COVID-19 lockdown. In panel A, fear and frustration are accompanied by heightened surveillance of the external environment via TV news channels and social media. In panel B, fear and frustration are replaced by self-compassion and empathy and surveillance is replaced by reaching out to others.

Need for Affiliation (Level 3)

The almost total cessation of full frontal face-to-face affiliation outside of one’s domestic bubble is mandated by policies of home confinement and “social distancing”. Connecting with others normally helps individuals to regulate their emotions, cope with stress, and remain resilient (Williams, Morelli, Ong & Zaki, 2018).  Loneliness and social isolation, on the other hand, worsen the burden of stress, and often produce deleterious effects on mental, cardiovascular, and immune health (Haslam, Jetten, Cruwys, Dingle, & Haslam, 2018). Older adults, at the greatest risk of severe symptoms from COVID-19, are also most susceptible to isolation (Luo, Hawkley, Waite, & Cacioppo, 2012). Intergenerational social support, self-esteem, and loneliness are all strongly associated with subjective well-being (Tian, 2016). 

 

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These effects are not peculiar to older people. Even among adolescents, loneliness  is associated with physical inactivity (Pinto, Oppong Asante, Puga Barbosa, Nahas, Dias and Pelegrini, 2019). Thus distancing threatens to aggravate feelings of loneliness that likely will produce negative long-term health consequences in many vulnerable people. During the COVID-19 pandemic, the population of people at risk is enormous. After the lockdown period ceases, sadly mental health services are expected to be overwhelmed.

People with unmet needs for affiliation at level 3 are also at risk of failing to meet needs for status and self-esteem at level 4.

Need for Status/Self-esteem (Level 4)

As noted, status and self-esteem needs are vulnerable if needs at levels 1 – 3 are unmet. Failure at levels 1-3 accumulates with larger knock-on effects as cumulative failure develops. Furthermore, the pandemic is producing huge increases in  unemployment and poverty, vulnerability factors for lowered self-esteem and social status (e.g. Goldsmith, Veum & Darity, 1997). Self‐esteem is associated with responses to success and failure (Baumeister & Tice, 1985). Low self-esteem also creates a vulnerability to depression (Sowislo & Orth, 2013) and to drinking alcohol (Hull & Young, 1983)  if affordable. Self-esteem moderates the associations between body-related self-esteem, conscious emotions and depressive symptoms (Brunet, Pila, Solomon-Krakus, Sabiston & O’Loughlin, 2019).  Self-esteem also appears to be an important antecedent of the development of self-compassion (Dona, Parker, Sahdra, Marshall, & Guo, 2018).  

 

Conclusion

COVID-19 lockdown has created a perfect storm’ of vulnerabilities that huge numbers of people, and services, are ill-prepared to manage. The success of social isolation policies will depend on minimizing long term depreciation of mental health. 

 

References

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