Introduction: The long-lasting threat of COVID-19 makes it necessary to explore strategies to improve coping skills which enable us to master a balanced life in the face of adversity. Objective: To unravel the most challenging aspects of COVID-19 in a nonclinical adult population and identify predictors of lost balance and consequent allostatic overload (AO). We examined the role of regular, moderate-intensity formula aerobic exercise (312 meridian exercise) in preventing allostatic overload through increasing well-being. Methods: An online survey was conducted to measure CO-VID-related allostatic overload according to clinimetric criteria. The Psychosocial Index (PSI), Kellner’s Symptom Questionnaire (KSQ), short Depression Anxiety Stress Scales (DASS-21), Public Health Surveillance Well-Being Scale -(PHS-WB), and Whiteley-7 were used to explore mental health characteristics. Univariate statistics logistic regression analysis and a general linear model were used. Results: According to 442 valid answers, 217 adults practiced physical exercise (PE) frequently (fPE, 3–5 times/every day) while 120 did it less regularly (1–2 times/week), and 105 did not exercise/practiced irregularly (controls). Restriction-related stressors were most challenging, resulting in AO in 29% (n = 128) of the sample. The main predictors were additional stressors (p = 0.005) and anxiety symptoms (p < 0.001). The prevalence of AO was lower (p = 0.018) in the fPE group when compared to controls. KSQ distress symptoms were also lower in fPE (p < 0.0001), while total well-being was increased (p < 0.001) after adjusting for sex, age, and number of chronic diseases. According to the PHS-WB, both physical and mental well-being were higher (p = 0.003 and p = 0.004, respectively) in fPE. Conclusions: Frequent moderate exercise is associated with better mental and physical well-being and a lower prevalence of AO.

1.
McEwen
BS
,
Stellar
E
.
Stress and the individual. Mechanisms leading to disease
.
Arch Intern Med
.
1993
Sep
;
153
(
18
):
2093
101
.
[PubMed]
0003-9926
2.
McEwen
BS
.
Stressed or stressed out: what is the difference?
J Psychiatry Neurosci
.
2005
Sep
;
30
(
5
):
315
8
.
[PubMed]
1180-4882
3.
Sterling
EJ
. Allostasis: A new paradigm to explain arousal pathology. In:
Fisher
S
,
Reason
J
, editors
.
Handbook of life stress, cognition and health
.
New York
:
John Wiley & Sons
;
1988
.
4.
McEwen
BS
,
Wingfield
JC
.
The concept of allostasis in biology and biomedicine
.
Horm Behav
.
2003
Jan
;
43
(
1
):
2
15
.
[PubMed]
0018-506X
5.
Picard
M
,
McEwen
BS
,
Epel
ES
,
Sandi
C
.
An energetic view of stress: focus on mitochondria
.
Front Neuroendocrinol
.
2018
Apr
;
49
:
72
85
.
[PubMed]
0091-3022
6.
McEwen
BS
.
Redefining neuroendocrinology: epigenetics of brain-body communication over the life course
.
Front Neuroendocrinol
.
2018
Apr
;
49
:
8
30
.
[PubMed]
0091-3022
7.
Miller
GW
,
Jones
DP
.
The nature of nurture: refining the definition of the exposome
.
Toxicol Sci
.
2014
Jan
;
137
(
1
):
1
2
.
[PubMed]
1096-6080
8.
Fava
GA
,
McEwen
BS
,
Guidi
J
,
Gostoli
S
,
Offidani
E
,
Sonino
N
.
Clinical characterization of allostatic overload
.
Psychoneuroendocrinology
.
2019
Oct
;
108
:
94
101
.
[PubMed]
0306-4530
9.
Fava
GA
,
Carrozzino
D
,
Lindberg
L
,
Tomba
E
.
The clinimetric approach to psychological assessment: A tribute to per Bech, MD (1942-2018)
.
Psychother Psychosom
.
2018
;
87
(
6
):
321
6
.
[PubMed]
0033-3190
10.
Fava
GA
,
Tomba
E
,
Sonino
N
.
Clinimetrics: the science of clinical measurements
.
Int J Clin Pract
.
2012
Jan
;
66
(
1
):
11
5
.
[PubMed]
1368-5031
11.
Fava
GA
,
Guidi
J
,
Semprini
F
,
Tomba
E
,
Sonino
N
.
Clinical assessment of allostatic load and clinimetric criteria
.
Psychother Psychosom
.
2010
;
79
(
5
):
280
4
.
[PubMed]
0033-3190
12.
Fava
GA
,
Cosci
F
,
Sonino
N
.
Current Psychosomatic Practice
.
Psychother Psychosom
.
2017
;
86
(
1
):
13
30
.
[PubMed]
0033-3190
13.
Zannas
AS
,
West
AE
.
Epigenetics and the regulation of stress vulnerability and resilience
.
Neuroscience
.
2014
Apr
;
264
:
157
70
.
[PubMed]
0306-4522
14.
Tabibnia
G
.
An affective neuroscience model of boosting resilience in adults
.
Neurosci Biobehav Rev
.
2020
Aug
;
115
:
321
50
.
[PubMed]
0149-7634
15.
Fava
GA
,
Bech
P
.
The Concept of Euthymia
.
Psychother Psychosom
.
2016
;
85
(
1
):
1
5
.
[PubMed]
0033-3190
16.
Fava
GA
,
Guidi
J
.
The pursuit of euthymia
.
World Psychiatry
.
2020
Feb
;
19
(
1
):
40
50
.
[PubMed]
1723-8617
17.
Yang
YC
,
Chou
CL
,
Kao
CL
.
Exercise, nutrition, and medication considerations in the light of the COVID pandemic, with specific focus on geriatric population: A literature review
.
J Chin Med Assoc
.
2020
Nov
;
83
(
11
):
977
80
.
[PubMed]
1726-4901
18.
Gao
Z
,
Lee
JE
,
McDonough
DJ
,
Albers
C
.
Virtual Reality Exercise as a Coping Strategy for Health and Wellness Promotion in Older Adults during the COVID-19 Pandemic
.
J Clin Med
.
2020
Jun
;
9
(
6
):
E1986
.
[PubMed]
2077-0383
19.
Penedo
FJ
,
Dahn
JR
.
Exercise and well-being: a review of mental and physical health benefits associated with physical activity
.
Curr Opin Psychiatry
.
2005
Mar
;
18
(
2
):
189
93
.
[PubMed]
0951-7367
20.
Chen
C
,
Nakagawa
S
,
An
Y
,
Ito
K
,
Kitaichi
Y
,
Kusumi
I
.
The exercise-glucocorticoid paradox: how exercise is beneficial to cognition, mood, and the brain while increasing glucocorticoid levels
.
Front Neuroendocrinol
.
2017
Jan
;
44
:
83
102
.
[PubMed]
0091-3022
21.
Rea
IM
.
Towards ageing well: Use it or lose it: Exercise, epigenetics and cognition
.
Biogerontology
.
2017
Aug
;
18
(
4
):
679
91
.
[PubMed]
1389-5729
22.
Zhang
Y
,
Zhang
H
,
Ma
X
,
Di
Q
.
Mental Health Problems during the COVID-19 Pandemics and the Mitigation Effects of Exercise: A Longitudinal Study of College Students in China
.
Int J Environ Res Public Health
.
2020
May
;
17
(
10
):
E3722
.
[PubMed]
1661-7827
23.
Ferioli
M
,
Zauli
G
,
Maiorano
P
,
Milani
D
,
Mirandola
P
,
Neri
LM
.
Role of physical exercise in the regulation of epigenetic mechanisms in inflammation, cancer, neurodegenerative diseases, and aging process
.
J Cell Physiol
.
2019
Feb
;
234
(
9
):
14852
64
.
[PubMed]
0021-9541
24.
Mikkelsen
K
,
Stojanovska
L
,
Polenakovic
M
,
Bosevski
M
,
Apostolopoulos
V
.
Exercise and mental health
.
Maturitas
.
2017
Dec
;
106
:
48
56
.
[PubMed]
0378-5122
25.
Caspersen
CJ
,
Powell
KE
,
Christenson
GM
.
Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research
.
Public Health Rep
.
1985
Mar-Apr
;
100
(
2
):
126
31
. Available from: https://www.who.int/ncds/prevention/physical-activity/intensity/en/
[PubMed]
0033-3549
27.
Burtscher
J
,
Burtscher
M
,
Millet
GP
.
(Indoor) isolation, stress, and physical inactivity: vicious circles accelerated by COVID-19?
Scand J Med Sci Sports
.
2020
Aug
;
30
(
8
):
1544
5
.
[PubMed]
0905-7188
28.
Ranasinghe
C
,
Ozemek
C
,
Arena
R
.
Exercise and well-being during COVID 19 - time to boost your immunity
.
Expert Rev Anti Infect Ther
.
2020
Dec
;
18
(
12
):
1195
200
.
[PubMed]
1478-7210
29.
Zhang
WR
,
Wang
K
,
Yin
L
,
Zhao
WF
,
Xue
Q
,
Peng
M
, et al.
Mental Health and Psychosocial Problems of Medical Health Workers during the COVID-19 Epidemic in China
.
Psychother Psychosom
.
2020
;
89
(
4
):
242
50
.
[PubMed]
0033-3190
30.
Shechter
A
,
Diaz
F
,
Moise
N
,
Anstey
DE
,
Ye
S
,
Agarwal
S
, et al.
Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic
.
Gen Hosp Psychiatry
.
2020
Sep - Oct
;
66
:
1
8
.
[PubMed]
0163-8343
31.
Cao
J
,
Wei
J
,
Zhu
H
,
Duan
Y
,
Geng
W
,
Hong
X
, et al.
A Study of Basic Needs and Psychological Wellbeing of Medical Workers in the Fever Clinic of a Tertiary General Hospital in Beijing during the COVID-19 Outbreak
.
Psychother Psychosom
.
2020
;
89
(
4
):
252
4
.
[PubMed]
0033-3190
32.
Schäfer
SK
,
Sopp
MR
,
Schanz
CG
,
Staginnus
M
,
Göritz
AS
,
Michael
T
.
Impact of COVID-19 on Public Mental Health and the Buffering Effect of a Sense of Coherence
.
Psychother Psychosom
.
2020
;
89
(
6
):
386
92
.
[PubMed]
1423-0348
33.
Zong-Xiang
Z
. The "3-1-2" Acupuncture Meridian Exercise Programme. A Chinese Way to Good Health and Longevity. Budapest: Health Security Foundation.
2011
. WHO Coronavirus disease (COVID-19) pandemic #HealthyAtHome - Physical Activity [cited 2020 Oct 4]. Available from: https://www.who.int/news-room/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome/healthyathome---physical-activity
34.
WHO Coronavirus disease (COVID-19) pandemic #HealthyAtHome – Physical Activity [cited October 4, 2020]. Available from: https://www.who.int/news-room/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome/healthyathome---physical-activity.
35.
Hsieh
HF
,
Shannon
SE
.
Three approaches to qualitative content analysis
.
Qual Health Res
.
2005
Nov
;
15
(
9
):
1277
88
.
[PubMed]
1049-7323
36.
Sonino
N
,
Fava
GA
.
A simple instrument for assessing stress in clinical practice
.
Postgrad Med J
.
1998
Jul
;
74
(
873
):
408
10
.
[PubMed]
0032-5473
37.
Piolanti
A
,
Offidani
E
,
Guidi
J
,
Gostoli
S
,
Fava
GA
,
Sonino
N
.
Use of the Psychosocial Index: A Sensitive Tool in Research and Practice
.
Psychother Psychosom
.
2016
;
85
(
6
):
337
45
.
[PubMed]
0033-3190
38.
Benasi
G
,
Fava
GA
,
Rafanelli
C
.
Kellner’s Symptom Questionnaire, a Highly Sensitive Patient-Reported Outcome Measure: Systematic Review of Clinimetric Properties
.
Psychother Psychosom
.
2020
;
89
(
2
):
74
89
.
[PubMed]
0033-3190
39.
Antony
MM
,
Bieling
PJ
,
Cox
BJ
,
Enns
MW
,
Swinson
RP
.
Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample
.
Psychol Assess
.
1998
;
10
(
2
):
176
81
. 1040-3590
40.
Lovibond
SH
,
Lovibond
PF
. Psychology Foundation of A. Manual for the depression anxiety stress scales. Sydney, N.S.W.: Psychology Foundation of Australia;
1995
.
41.
Henry
JD
,
Crawford
JR
.
The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample
.
Br J Clin Psychol
.
2005
Jun
;
44
(
Pt 2
):
227
39
.
[PubMed]
0144-6657
42.
Bann
CM
,
Kobau
R
,
Lewis
MA
,
Zack
MM
,
Luncheon
C
,
Thompson
WW
.
Development and psychometric evaluation of the public health surveillance well-being scale
.
Qual Life Res
.
2012
Aug
;
21
(
6
):
1031
43
.
[PubMed]
0962-9343
43.
Fink
P
,
Ewald
H
,
Jensen
J
,
Sørensen
L
,
Engberg
M
,
Holm
M
, et al.
Screening for somatization and hypochondriasis in primary care and neurological in-patients: a seven-item scale for hypochondriasis and somatization
.
J Psychosom Res
.
1999
Mar
;
46
(
3
):
261
73
.
[PubMed]
0022-3999
44.
Guidi
J
,
Offidani
E
,
Rafanelli
C
,
Roncuzzi
R
,
Sonino
N
,
Fava
GA
.
The Assessment of allostatic overload in patients with congestive heart failure by clinimetric criteria
.
Stress Health
.
2016
Feb
;
32
(
1
):
63
9
.
[PubMed]
1532-3005
45.
Guidi
J
,
Lucente
M
,
Sonino
N
,
Fava
GA
.
Allostatic load and its impact on health: a systematic review
.
Psychother Psychosom
.
2020
;(
Aug
):
1
17
.
[PubMed]
0033-3190
46.
Peng
M
,
Wang
L
,
Xue
Q
,
Yin
L
,
Zhu
BH
,
Wang
K
, et al.
Post-COVID-19 Epidemic: Allostatic Load among Medical and Nonmedical Workers in China
.
Psychother Psychosom
.
2020
Nov
;
1
10
.
[PubMed]
0033-3190
47.
Offidani
E
,
Ruini
C
.
Psychobiological correlates of allostatic overload in a healthy population
.
Brain Behav Immun
.
2012
Feb
;
26
(
2
):
284
91
.
[PubMed]
0889-1591
48.
Tomba
E
,
Offidani
E
.
A clinimetric evaluation of allostatic overload in the general population
.
Psychother Psychosom
.
2012
;
81
(
6
):
378
9
.
[PubMed]
0033-3190
49.
Liu
YZ
,
Wang
YX
,
Jiang
CL
.
Inflammation: The Common Pathway of Stress-Related Diseases
.
Front Hum Neurosci
.
2017
Jun
;
11
(
316
):
316
.
[PubMed]
1662-5161
50.
Horsburgh
S
,
Robson-Ansley
P
,
Adams
R
,
Smith
C
.
Exercise and inflammation-related epigenetic modifications: focus on DNA methylation
.
Exerc Immunol Rev
.
2015
;
21
:
26
41
.
[PubMed]
1077-5552
51.
Gardner
A
,
Boles
RG
.
Beyond the serotonin hypothesis: mitochondria, inflammation and neurodegeneration in major depression and affective spectrum disorders
.
Prog Neuropsychopharmacol Biol Psychiatry
.
2011
Apr
;
35
(
3
):
730
43
.
[PubMed]
0278-5846
52.
Carriedo
A
,
Cecchini
JA
,
Fernandez-Rio
J
,
Méndez-Giménez
A
.
COVID-19, Psychological Well-being and Physical Activity Levels in Older Adults During the Nationwide Lockdown in Spain
.
Am J Geriatr Psychiatry
.
2020
Nov
;
28
(
11
):
1146
55
.
[PubMed]
1064-7481
53.
Maugeri
G
,
Castrogiovanni
P
,
Battaglia
G
,
Pippi
R
,
D’Agata
V
,
Palma
A
, et al.
The impact of physical activity on psychological health during Covid-19 pandemic in Italy
.
Heliyon
.
2020
Jun
;
6
(
6
):
e04315
.
[PubMed]
2405-8440
54.
Jacob
L
,
Tully
MA
,
Barnett
Y
,
Lopez-Sanchez
GF
,
Butler
L
,
Schuch
F
, et al.
The relationship between physical activity and mental health in a sample of the UK public: A cross-sectional study during the implementation of COVID-19 social distancing measures
.
Ment Health Phys Act
.
2020
Oct
;
19
:
100345
.
[PubMed]
1755-2966
55.
Barsky
AJ
,
Orav
EJ
,
Bates
DW
.
Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity
.
Arch Gen Psychiatry
.
2005
Aug
;
62
(
8
):
903
10
.
[PubMed]
0003-990X
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