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Effects of home confinement on physical activity, nutrition, and sleep quality during the COVID-19 outbreak in amateur and elite athletes.
Taheri, M, Irandoust, K, Reynoso-Sánchez, LF, Muñoz-Helú, H, Cruz-Morales, KN, Torres-Ramírez, R, Mirmoezzi, M, Youzbashi, L, Mirakhori, F, Dergaa, I, et al
Frontiers in nutrition. 2023;:1143340
Abstract
INTRODUCTION Despite the progress in the management of the pandemic caused by COVID-19, it is necessary to continue exploring and explaining how this situation affected the athlete population around the world to improve their circumstances and reduce the negative impact of changes in their lifestyle conditions that were necessitated due to the pandemic. The aim of this study was to analyze the moderating influence of physical activity (PA) and dietary habits on the impact of the COVID-19 pandemic experience on sleep quality in elite and amateur athletes. MATERIALS AND METHODS A total of 1,420 elite (40.1%) and amateur (59.9%) athletes (41% women; 59% men) from 14 different countries participated in a cross-sectional design study. Data were collected using a battery of questionnaires that identified sociodemographic data, sleep quality index, PA levels, dietary habits, and the athletes' perception of their experience during the COVID-19 pandemic. Means and standard deviations were calculated for each variable. The analysis of variances and the correlation between variables were carried out with non-parametric statistics. A simple moderation effect was calculated to analyze the interaction between PA or dietary habits on the perception of the COVID-19 experience effect on sleep quality in elite and amateur athletes. RESULTS The PA level of elite athletes was higher than amateur athletes during COVID-19 (p < 0.001). However, the PA level of both categories of athletes was lower during COVID-19 than pre-COVID-19 (p < 0.01). In addition, amateurs had a higher diet quality than elite athletes during the pandemic (p = 0.014). The perception of the COVID-19 experience as controllable was significantly higher (p = 0.020) among elite athletes. In addition, two moderating effects had significant interactions. For amateur athletes, the PA level moderated the effect of controllable COVID-19 experience on sleep quality [F (3,777) = 3.05; p = 0.028], while for elite athletes, the same effect was moderated by dietary habits [F (3,506) = 4.47, p = 0.004]. CONCLUSION Elite athletes had different lifestyle behaviors compared to amateurs during the COVID-19 lockdown. Furthermore, the relevance of maintaining high levels of PA for amateurs and good quality dietary habits by elite athletes was noted by the moderating effect that both variables had on the influence of the controllable experience during the COVID-19 pandemic on sleep quality.
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Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insights from the ECLB-COVID19 multicentre study.
Ammar, A, Trabelsi, K, Brach, M, Chtourou, H, Boukhris, O, Masmoudi, L, Bouaziz, B, Bentlage, E, How, D, Ahmed, M, et al
Biology of sport. 2021;38(1):9-21
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Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the respiratory syndrome coronavirus 2 (SARS-CoV-2). To curb the spread of the 2020 pandemic, social distancing, self-isolation and nationwide lockdown measures were put in place. These measures along with hygiene care are recognized as the most effective ways to curb the spread of disease. However; the weakening of social contacts can result in anxiety, frustration, panic attacks, loss or sudden increase of appetite, insomnia, depression, mood swings, delusions, fear, sleep disorders, and suicidal/domestic violence. The purpose of the study is to provide scientific data to help identify risk factors for the psychosocial strain during the COVID-19 outbreak. The study is an international cross-disciplinary online survey and was circulated in April 2020. 1047 replies were analysed from this preliminary phase. The results show a significant difference in all tested parameters and therefore reveal a large burden for mental wellbeing combined with a tendency towards an unhealthy lifestyle during, compared to before, the confinement enforced by the COVID-19 pandemic. These results highlight the importance for policy makers to consider strategies to promote wellbeing during future confinements.
Abstract
Although recognised as effective measures to curb the spread of the COVID-19 outbreak, social distancing and self-isolation have been suggested to generate a burden throughout the population. To provide scientific data to help identify risk factors for the psychosocial strain during the COVID-19 outbreak, an international cross-disciplinary online survey was circulated in April 2020. This report outlines the mental, emotional and behavioural consequences of COVID-19 home confinement. The ECLB-COVID19 electronic survey was designed by a steering group of multidisciplinary scientists, following a structured review of the literature. The survey was uploaded and shared on the Google online survey platform and was promoted by thirty-five research organizations from Europe, North Africa, Western Asia and the Americas. Questions were presented in a differential format with questions related to responses "before" and "during" the confinement period. 1047 replies (54% women) from Western Asia (36%), North Africa (40%), Europe (21%) and other continents (3%) were analysed. The COVID-19 home confinement evoked a negative effect on mental wellbeing and emotional status (P < 0.001; 0.43 ≤ d ≤ 0.65) with a greater proportion of individuals experiencing psychosocial and emotional disorders (+10% to +16.5%). These psychosocial tolls were associated with unhealthy lifestyle behaviours with a greater proportion of individuals experiencing (i) physical (+15.2%) and social (+71.2%) inactivity, (ii) poor sleep quality (+12.8%), (iii) unhealthy diet behaviours (+10%), and (iv) unemployment (6%). Conversely, participants demonstrated a greater use (+15%) of technology during the confinement period. These findings elucidate the risk of psychosocial strain during the COVID-19 home confinement period and provide a clear remit for the urgent implementation of technology-based intervention to foster an Active and Healthy Confinement Lifestyle AHCL).
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Perspective: Classifying Orthorexia Nervosa as a New Mental Illness-Much Discussion, Little Evidence.
Strahler, J, Stark, R
Advances in nutrition (Bethesda, Md.). 2020;(4):784-789
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Abstract
Significant prevalence rates of pathological healthful eating and its extreme form, orthorexia nervosa (ON), the pathological obsession with healthy eating, have led to increased efforts to understand this phenomenon's clinical relevance. This narrative review qualitatively summarizes existing evidence on the (psycho-)pathology and consequences of ON and offers an interpretation within the frame of existing theories and models of psychiatric disease. Adding to the controversy in the field of ON, this review offers important critiques and identifies gaps in our current understanding of ON as a (distinct) mental illness.
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Food cue-elicited brain potentials change throughout menstrual cycle: Modulation by eating styles, negative affect, and premenstrual complaints.
Strahler, J, Hermann, A, Schmidt, NM, Stark, R, Hennig, J, Munk, AJ
Hormones and behavior. 2020;:104811
Abstract
BACKGROUND While there is evidence for increased food intake and craving during the luteal phase, underlying mechanisms are incompletely understood. The present study investigated electrophysiological responses to food pictures as a function of menstrual cycle phase. In addition, the moderating effects of progesterone, eating behaviors (restraint, emotional, orthorexic), negative affect, and premenstrual complaints were explored. METHODS Using a within-subject design, 35 free-cycling women watched and rated pictures of food (high and low caloric) and control items during the follicular, the ovulatory, and the luteal phase (counterbalanced), while EEG was recorded to examine the late positive potentials (LPP). Salivary gonadal hormones and affect were examined at each occasion. Eating behaviors and premenstrual complaints were assessed once. RESULTS For parietal regions, average LPPs were comparable between cycle phases but slightly larger LPP amplitudes were elicited by high caloric food pictures as compared to the neutral category. Descriptively, both food categories elicited larger parietal LPPs than neutral pictures during the luteal phase. Analyses of LPPs for central-parietal regions showed no effect of picture category or cycle phase, except higher amplitudes in the right area during the luteal phase. During the luteal phase, progesterone and functional interference from premenstrual symptoms (but not age, BMI, picture ratings, affect, estradiol, or eating behaviors) significantly predicted larger parietal LPPs towards high caloric (but not low caloric) pictures. CONCLUSION Our findings suggest a heightened food cue reactivity during the luteal phase, which may relate to higher ovarian hormone secretion and more functional impact of premenstrual symptoms. This research contributes to a better understanding of menstrual health and the identification of preventive strategies for premenopausal women.
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Associations between Health Behaviors and Factors on Markers of Healthy Psychological and Physiological Functioning: a Daily Diary Study.
Strahler, J, Nater, UM, Skoluda, N
Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2020;(1):22-35
Abstract
BACKGROUND Cross-sectional and experimental knowledge highlight the contribution of various health-promoting behaviors, such as physical activity, regular sleep, and healthy nutrition to mental and physical health. Beyond these well-studied lifestyle behaviors, music listening and perceived respect in social interactions are just recently proposed everyday life experiences, which may act as health-promoting factors. PURPOSE This study tested the simultaneous contribution of several health-promoting behaviors and factors and examined listening to music and positive social interaction by means of perceived respect as new potentially preventive and health-promoting behaviors and factors using an ambulatory assessment design. METHODS Seventy-seven young healthy adults (38 women, 23.9 ± 4.5 years) completed surveys on their psychological state (i.e., mood, stress, and fatigue) five times a day for four consecutive days. A saliva sample was collected with each data entry to explore the physiological stress markers salivary cortisol, alpha-amylase, and flow rate as further outcome variables. As predictors, perceived respect, self-reported physical activity, the sleep's restfulness, daily coffee, alcohol, vegetable/fruit consumption, and music listening behavior were recorded. RESULTS Overall, restful sleep, mean daily perceived respect, and listening to music were most clearly associated with more positive psychological states, that is, better mood and lower fatigue and perceived stress. Associations with daily alcohol, coffee, and vegetable/fruit consumption appeared rather minor. While perceived respect scores were associated with lower daily cortisol output, coffee consumption was positively related to daily cortisol and alpha-amylase. Self-reported physical activity was unrelated to either outcome measure. CONCLUSIONS These findings provide important insights regarding potential resources of health (i.e., music and respect), their covariation, and which psycho-physiological mechanisms may underlie the links between health factors and well-being. Findings also have implications for the development of interventions aiming to increase resilience and foster health. Here, strategies for improving sleep quality, the use of music, and approaches that emphasize mutual respect and appreciation appear useful additions.
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Orthorexia nervosa: A behavioral complex or a psychological condition?
Strahler, J, Hermann, A, Walter, B, Stark, R
Journal of behavioral addictions. 2018;7(4):1143-1156
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Orthorexia nervosa (ON) is a condition characterised by an obsession for 'healthy eating' and avoidance of 'unhealthy food' with the violation of these rigid dietary rules being associated with shame, anxiety and distress. Whilst numerous studies have evidenced its existence, there is debate as to whether it is a behavioural phenomenon or a mental health condition like other eating disorders. Anecdotally, there are reports of physiological impacts (such as weight loss), psychological impacts (such as emotional instability) and social impacts (such as social isolation), which are similar to clinical eating disorders. This cross-sectional study aimed to explore whether ON is of clinical relevance, and if it can be distinguished from other mental health conditions. An online survey including orthorexic behaviours was completed by 713 subjects (80% female) aged 18-75 years. 4% showed significant orthorexic eating alongside lower levels of life satisfaction, wellbeing and higher levels of stress. Depression and obsessive compulsive tendencies were also found in 48% and 30% of those with ON respectively. The authors conclude that there are strong overlaps between ON, mental health conditions and disturbed eating behaviours, questioning whether it should be a mental health condition in its own right.
Expert Review
Conflicts of interest:
None
Take Home Message:
- Orthorexia nervosa has been associated with other mental health conditions, including depression and obsessive compulsive disorder.
- Given this association, and the desire for individuals with the condition to seek validation of their orthorexic eating, healthcare practitioners should make appropriate referral to ensure the safety and wellbeing of these individuals.
- Debate continues on whether orthorexia nervosa should be viewed as a mental health condition and eating disorder or a behavioural phenomenon.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Orthorexia nervosa (ON) is gaining increasing interest in research and clinical practice. Whilst research has evidenced its existence, there is still an active debate of whether it should be viewed as a mental health condition and eating disorder in its own right. Diagnoses may be useful for some individuals to make sense of the symptoms they are experiencing, reduce their feelings of isolation and to help them take steps to get the right support needed to improve their health. In a similar way to other eating disorders, orthorexia nervosa has been associated with other mental health conditions including depression and obsessive compulsive disorder.
Clinical practice applications:
Whether defined as an eating disorder in its own right or not, orthorexia nervosa nevertheless is likely to have an impact on wellbeing, life satisfaction and stress. It is an important condition or behavioural phenomenon for practitioners to be aware of, particularly in nutrition fields that may attract those individuals looking for more information or endorsement of their desired orthorexic eating. Given its association with other mental health conditions, safety and appropriate referral should be made to ensure the wellbeing of these individuals.
Considerations for future research:
Research on orthorexia nervosa is considerably smaller compared to other eating disorder conditions and behaviours. Further empirical evidence is needed to support the debate as to whether it is an eating disorder in its own right, or a behavioural phenomenon, and further insight needed to establish its full impact on physical and psychological health.
Abstract
BACKGROUND AND AIMS Numerous studies have provided evidence for orthorexia nervosa (ON), an eating pattern characterized by an almost manic obsession for and fixation on healthy eating, to be of epidemiological relevance. However, there is scientific debate on whether it is merely a behavioral or lifestyle phenomenon as compared to a mental disorder. Aim of this cross-sectional study was to explore whether ON is of epidemiological and clinical relevance, and whether ON can be distinguished from other mental health disorders and healthy lifestyle features. METHODS An online survey including a measure of orthorexic behaviors [Duesseldorf Orthorexia Scale (DOS)], well-being and distress, eating behaviors, pathological eating, anxiety and depression, addictive behaviors, obsessive-compulsive symptoms, personality, and health behaviors was completed by 713 subjects (79.8% women, 18-75 years, median age: 25 years). RESULTS Twenty-seven subjects (3.8%, 21 women) showed significant orthorexic eating (DOS ≥ 30). ON cases reported lower well-being, lower satisfaction with life, and higher current stress levels than non-ON cases. The highest percentage of variation in ON was explained by pathological eating (R2 = .380), followed by eating style, Mediterranean diet, compulsive symptoms, and subjective social status. Importantly, ON provided hardly any additional predictive value for well-being when also considering pathological eating. DISCUSSION AND CONCLUSIONS Our data confirmed the epidemiological and clinical relevance of orthorexic behaviors, but the strong conceptual overlap with other mental health problems and pathological eating raise initial doubts as to whether ON is a distinct mental health disorder category. This co-occurrence, unique symptoms, and underlying processes need further exploration by comparing ON cases with patients with other mental disorders.