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May the Force be with you during the quarantine: A cross-sectional study on the perception of health locus of control, sports engagement and emotional eating of individuals who exercised regularly

Que a Força esteja com você durante a quarentena: um estudo transversal sobre a percepção do locus de controle da saúde, engajamento esportivo e alimentação emocional de indivíduos que se exercitam regularmente

ABSTRACT

Objective

This study evaluated the perception of health locus of control, sports engagement, and emotional eating during quarantine of individuals who regularly exercised before the quarantine.

Methods

Individuals who regularly attended the gym before the quarantine period were enrolled in the study. The questionnaire included the Multidimensional Health Locus of Control Scale-A, Sport Engagement Scale, and Emotional Eating Scale, which was applied online to 513 gym members.

Results

74.9% of participants adopted the perception of internal health locus of control. Emotional eating scores were higher in participants who did not exercise during the quarantine when compared to those who did and in those adopting the perception of chance health locus of control compared to participants adopting the perception of internal health locus of control. Participants who adopted the perception of internal health locus of control compared to the those who adopted the perception of chance or powerful others health locus of control had higher sports engagement (p<0.05). Individuals with a high BMI, who did not have a perception of internal health locus of control and who did not exercise during the quarantine were prone to emotional eating.

Conclusion

In conclusion, in those individuals who regularly went to gym before the quarantine, continuing to exercise during the quarantine may have provided an advantage in preventing emotional eating, and we also showed that sports engagement supported the continuation of exercise during the quarantine period. In addition, we determined that individuals with a high body mass index, who do not have a perception of internal health locus of control and who did not exercise during the quarantine were prone to emotional eating.

Keywords:
COVID-19; Fitness Centers; Locus of control; Nutrition; Quarantine; Sports

RESUMO

Objetivo

Este estudo avaliou a percepção do locus de controle da saúde, entre o envolvimento em esportes e comer emocional durante a quarentena de indivíduos que se exercitavam regularmente antes do período de isolamento.

Métodos

Indivíduos que frequentavam regularmente a academia antes do período de quarentena foram incluídos no estudo. O questionário incluiu: a Escala Multidimensional de Locus de Controle da Saúde, Escala de Envolvimento em Esportes e Escala de Comer Emocional. Esse estudo foi aplicado online a 513 membros da academia

Resultados

74,9% dos participantes que adotaram a percepção locus de controle da saúde interno. As pontuações do comer emocional foram mais altas em participantes que não se exercitaram durante a quarentena, em comparação com aqueles que fizeram, e aqueles que adotaram a percepção de locus de controle da saúde de chance, em comparação com participantes que adotaram a percepção de locus de controle da saúde interno. Participantes que adotaram a percepção de locus de controle da saúde interno tiveram um maior envolvimento em esportes em comparação com aqueles que adotaram a percepção de locus de controle da saúde de chance ou de poder de outros (p<0,05). Indivíduos com um alto IMC, que não tinham a percepção de locus de controle da saúde interna e que não se exercitaram durante a quarentena estavam mais propensos à comer emocional.

Conclusão

Em conclusão, naqueles indivíduos que frequentavam regularmente a academia antes da quarentena, continuar se exercitando durante a quarentena pode ter fornecido uma vantagem em termos de prevenção da Escala Comer Emocional, e também mostramos que o engajamento esportivo apoiou a continuação do exercício durante o período de quarentena. Além disso, determinamos que indivíduos com alto índice de massa corporal, que não têm percepção do locus de controle interno da saúde e que não se exercitam durante a quarentena eram propensos a Escala Comer Emocional.

Palavras-chave:
COVID-19; Academias esportivas; Local de controle; Nutrição; Quarentena; Esportes

INTRODUCTION

Quarantine is the isolation and restriction of movement of people who have been exposed to a potentially contagious disease to determine whether they are sick or not [11. Centers for Disease Control and Prevention. Quarantine and isolation [Internet]. Atlanta: CDC; 2017 [cited 2022 July 18]. Available from: https://www.cdc.gov/quarantine/index.html
https://www.cdc.gov/quarantine/index.htm...
]. With the emergence of Coronavirus Disease 2019 (COVID-19) worldwide, the quarantine implemented to control transmission caused radical changes in individuals' lifestyles. Moreover, the psychological impact of the quarantine has recently been reviewed, and certain adverse psychological effects have been reported, including symptoms of post-traumatic stress, anger, and confusion [22. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet. 2020;395(10227):912-20. ]. Furthermore, with these psychological impacts, decreased physical activity and poor dietary choices during the COVID-19 quarantine have been associated with negative mood [33. Ingram J, Maciejewski G, Hand CJ. Changes in diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown. Front Psychol. 2020;11:588604]. Although it has been reported that the harm caused by coronavirus is related to the age, gender, race, and medical conditions of the individual, lifestyle habits before and during the quarantine are also determining factors in the severity of the COVID-19 disease [44. Woods JA, Hutchinson NT, Powers SK, Roberts WO, Gomez-Cabrera MC, Radak Z, et al. The COVID-19 pandemic and physical activity. Sport Med Heal Sci. 2020;2(2):55-64. ]. Therefore, a healthy diet and regular exercise during the quarantine period may also protect against the physiological effects of COVID-19 and the negative psychological effects of quarantine [55. Jiménez-Pavón D, Carbonell-Baeza A, Lavie CJ. Physical exercise as therapy to fight against the mental and physical consequences of COVID-19 quarantine: Special focus in older people. Prog Cardiovasc Dis. 2020;63(3):386-8. ,66. Nieman DC. Exercise is medicine for immune function: implication for COVID-19. Curr Sports Med Rep. 2021;20(8):395-401.].

Locus of control is a concept in social psychology that refers to an individual's perception concerning the underlying main causes of events in their life and whether they attribute these results to their own control and power, or external forces such as chance and destiny [77. Graffeo LC, Silvestri L. Relationship between locus of control and health-related variables. Education. 2006;126(3):593-6. ]. The health locus of control measures a person's belief that they have control over a disease or its consequences [88. Theofilou P. Self-esteem in Greek dialysis patients: The contribution of health locus of control. Iran J Kidney Dis. 2012;6(2):136-40.]. Individuals with the perception of internal locus of control are more active people who believe that they can control the disease process and its outcome as a result of their own actions. On the contrary, individuals who believe that chance and destiny controls everything and that it is the external forces that affect their lives, mainly believe that nothing they do to improve their health will affect their diseases [99. Morowatisharifabad MA, Mahmoodabad SSM, Baghianimoghadam MH, Tonekaboni NR. Relationships between locus of control and adherence to diabetes regimen in a sample of Iranians. Int J Diabetes Dev Ctries. 2010;30(1):27-32. ]. While individuals with a perception of internal health locus of control are associated with positive health behaviours, individuals with a perception of external health locus of control are associated with negative health behaviours [1010. Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191-215. ]. It has been reported that those who exercise regularly have a perception of internal locus of control [1111. DeNeve KM, Cooper H. The happy personality: A meta-analysis of 137 personality traits and subjective well-being. Psychol Bull. 1998;124(2):197-229.-1313. Psouni S, Hassandra M, Theodorakis Y. Patterns of eating and physical activity attitudes and behaviors in relation to body mass index. Psychology. 2016;7(2):180-92. ], while those who do fewer sports activities have a higher perception of chance locus of control [1414. Grotz M, Hapke U, Lampert T, Baumeister H. Health locus of control and health behaviour: Results from a nationally representative survey. Psychol Heal Med. 2011;16(2):129-40. ]. Psychosocial factors like engaging in personal interactions, establishing connections with others, working environment, and accessibility have an important role in the lifestyles of individuals. Individuals that demonstrate an internal locus of control are likelier to adopt and adhere to healthy dietary practices and consistently engage in physical exercise [1515. Mercer DA, Ditto B, Lavoie KL, Campbell T, Arsenault A, Bacon SL. Health locus of control is associated with physical activity and other health behaviors in cardiac patients. J Cardiopulm Rehabil Prev. 2018;38(6):394-9.,1616. Krampe H, Danbolt LJ, Haver A, Stålsett G, Schnell T. Locus of control moderates the association of COVID-19 stress and general mental distress: Results of a Norwegian and a German-speaking cross-sectional survey. BMC Psychiatry. 2021;21(1):437.]. Exercise is recognized as a fundamental psychosocial necessity. It has been reported that physical activity significantly reduces depressive symptoms [1717. Konttinen H, Männistö S, Sarlio-Lähteenkorva S, Silventoinen K, Haukkala A. Emotional eating, depressive symptoms and self-reported food consumption. A population-based study. Appetite. 2010;54(3):473-9. ,1818. Paluska SA, Schwenk TL. Physical activity and mental health. Sport Med. 2000;29(3):167-80.], relieves anxiety [1919. Teychenne M, White RL, Richards J, Schuch FB, Rosenbaum S, Bennie JA. Do we need physical activity guidelines for mental health: What does the evidence tell us? Ment Health Phys Act. 2020;18:100315. ] and reduces binge eating [2020. Konttinen H, Silventoinen K, Sarlio-Lähteenkorva S, Männistö S, Haukkala A. Emotional eating and physical activity self-efficacy as pathways in the association between depressive symptoms and adiposity indicators. Am J Clin Nutr. 2010;92(5):1031-9. ] and emotional eating [2121. Annesi JJ, Mareno N. Indirect effects of exercise on emotional eating through psychological predictors of weight loss in women. Appetite. 2015;95:219-27. ].

Sports engagement is a continuous and consistent experience in a sports setting, including concepts such as belief, effort, energy and pleasure [2222. Hodge K, Lonsdale C, Jackson SA. Athlete engagement in elite sport: an exploratory investigation of antecedents and consequences. Sport Psychol. 2009;23(2):186-202. ]. Engagement is also called a positive state that emerges with vitality, internalization and dedication [2323. Schaufeli WB, Salanova M, González-romá V, Bakker AB. The measurement of engagement and burnout: A Two sample confirmatory factor analytic approach. J Happiness Stud. 2002;3(1):71-92. ]. While internal motivation factors have a very important effect on participating, engaging and continuing with sports, it is the external motivation factors that are generally regarded as the driving force in initiating participation in sports [2424. Cortés AS, Correa-Díaz AM, Benjumea-Arias ML, Valencia-Arias A, Bran-Piedrahita L. Motivational factors and effects associated with physical-sport practice in undergraduate students. Soc Behav Sci. 2017;237:811-5. ]. The stimuli that motivate and trigger people vary and for this reason, not every stimulant may be equally effective for every person. To motivate people, both internal and external motivational stimuli must overlap [2525. Aslan M, Doğan S. Dişsal Motivasyon, İçsel motivasyon ve performans etkileşimine kuramsal bir bakis. Sül D Uni Vis J, 2020;11(26):291-301. ]. Considering that external motivation factors have declined during the quarantine period, individuals with an internal locus of control may have engaged more in sports. In addition, Downward and Riordan [2626. Downward P, Riordan J. Social interactions and the demand for sport: An economic analysis. Contemp Econ Policy. 2007;25(4):518-37. ] emphasize that the main motivation determining active participation in sports is to create social environments.

Being physically active before and during the COVID-19 quarantine is linked to better mental health [2727. Pieh C, Budimir S, Probst T. The effect of age, gender, income, work, and physical activity on mental health during coronavirus disease (COVID-19) lockdown in Austria. J Psychosom Res. 2020;136:110186. ,2828. Fernandez-Rio J, Cecchini JA, Mendez-Gimenez A, Carriedo A. Mental well-being profiles and physical activity in times of social isolation by the COVID-19: A latent class analysis. Int J Sport Exerc Psychol. 2022;20(2):436-50. ]. It has been observed that during the COVID-19 quarantine there was a decrease in physical activity [2929. Chouchou F, Augustini M, Caderby T, Caron N, Turpin NA, Dalleau G. The importance of sleep and physical activity on well-being during COVID-19 lockdown: Reunion island as a case study. Sleep Med. 2021;77:297-301. ]; this was due to the fact that individuals were made to stay at home and also that gyms were closed [3030. Kiely K, Mase W, Melton B, Rochani H. Campus recreation and fitness center utilization during the COVID-19 pandemic. J Georg Public Heal Assoc. 2021;8(2):1-6.]. It has been reported that various social and demographic factors contribute significantly to decreased physical activity among pre-pandemic physically active individuals, including living alone, low household income, changes in income due to COVID-19, and losing one's job [3131. Kiely K, Mase WA, Hansen AR, Schwind J. Association between the health belief model, exercise, and nutrition behaviors during the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(23):15516. ,3232. Spinosa J, Christiansen P, Dickson JM, Lorenzetti V, Hardman CA. From Socioeconomic disadvantage to obesity: The mediating role of psychological distress and emotional eating. Obesity. 2019;27(4):559-64.]. However, it has also been reported that certain individuals who had an active life before continued to be active during quarantine [3333. Hammami A, Harrabi B, Mohr M, Krustrup P. Physical activity and coronavirus disease 2019 (COVID-19): Specific recommendations for home-based physical training. Manag Sport Leis. 2022;27(1-2):26-31. ]. It is emphasized that adopting an active life in every stage of life can have positive effects during the quarantine process [3434. Gallè F, Sabella EA, Ferracuti S, De Giglio O, Caggiano G, Protano C, et al. Sedentary behaviors and physical activity of italian undergraduate students. Int J Environ Res Public Heal Artic. 2020;17(6171):1-11. ].

This study aimed to evaluate the status of exercise, sports engagement, emotional eating and health locus of control during the quarantine among persons who had maintained a regular exercise routine before to the quarantine.

METHODS

The study was carried out in Ankara, Turkey. In March 2020, the Turkish government implemented quarantine measures and imposed a curfew in response to the outbreak of COVID-19. Additionally, all gyms are closed indefinitely. The research was conducted during the COVID-19 quarantine period between March and June 2020. Five hundred and thirteen recreational athletes who regularly attended different gyms before the lockdown and volunteered to participate in the research were included in the study. The researcher established contact with trainers/fitness coaches employed at gyms through personal connections. The inclusion criteria were using the gym for at least two days a week, for at least 2 hours recreationally or professionally before the quarantine, and being between the ages of 18-65. Not exercising during the lockdown was not an exclusion criterion. The questionnaire form was applied to the participants via online platforms (WhatsApp, Instagram, and Facebook) due to quarantine conditions. Participants completed the questionnaire in approximately 15 minutes using their computers or mobile phones.

The study protocol was approved by Ankara Medipol University-GOKAEK number 0020, dated 05/13/2020 and was conducted by the Declaration of Helsinki. All respondents read the written consent form and explicitly agreed to participate before starting the survey. Since the research was conducted during the COVID-19 period, the necessary permission was obtained from the Ministry of Health.

A form containing questions created by the researchers and a questionnaire form comprising three scales were used to evaluate health locus of control, emotional eating and sports engagement. The questionnaire form was divided into five sections: 1) Demographic (age, gender, income) and health information, nutritional habits, 2) Anthropometric measurements, 3) Emotional Eating Scale (30 items), 4) Sport Engagement Scale (15 items), and 5) Multidimensional Health Locus of Control Scale-A (18 items)

Demographic and health information, nutritional habits; Participants’ age, gender, education level, and the location of work during the lockdown (from home or the office) were questioned. Nutritional habits and the number of main meals and snacks were also questioned. Smoking, alcohol consumption, and exercise habits were recorded.

Anthropometric Measurements; The participants self-reported body weight and height values due to the quarantine conditions. Body mass index (BMI) was calculated by dividing the weight (kg) by height (m2). Participants were then classified into four categories, based on their BMI: underweight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (30.0 kg/m2) [3535. World Health Organization. A healthy lifestyle - WHO recommendations [Internet]. Geneve: Organization; 2010 [cited 2020 July 20]. Available from: https://www.who.int/europe/news-room/fact-sheets/item/a-healthy-lifestyle---who-recommendations
https://www.who.int/europe/news-room/fac...
].

The Emotional Eating Scale was developed by Bilgen [3636. Bilgen S. Türkçe Duygusal yeme ölçeğinin geliştirilmesi, geçerlilik ve güvenirliği çalışması [thesis]. İstanbul: Uskudar University; 2018. ] to determine the relationship between eating and emotion. The scale was specifically designed and validated for individuals of Turkish people, hence establishing its validity and reliability within this population. This five-point Likert-type scale consists of 30 items. Higher emotional eating scores are related to emotional eating. The scale is scored between 30-150. The Cronbach's Alpha coefficient of internal consistency of Emotional Eating Scale was found to be 0.96 [3636. Bilgen S. Türkçe Duygusal yeme ölçeğinin geliştirilmesi, geçerlilik ve güvenirliği çalışması [thesis]. İstanbul: Uskudar University; 2018. ]. The Cronbach's Alpha reliability coefficient of this study was 0.93.

Sport Engagement Scale; The original form of the scale, which is the “The Utrecht Work Engagement Scale”, was developed by Schaufeli et al. [2323. Schaufeli WB, Salanova M, González-romá V, Bakker AB. The measurement of engagement and burnout: A Two sample confirmatory factor analytic approach. J Happiness Stud. 2002;3(1):71-92. ]; while the Spanish version was adapted for athletes by Guillen and Martínez-Alvarado [3737. Guillen F, Martínez-Alvarado JR. The Sport Engagement Scale: An adaptation of the Utrecht Work Engagement Scale (UWES) for the sports environment. Univ Psychol. 2014(13):975-84. ]. The scale measures sports engagement consists of 15 items, and is structured in a 5-point Likert-type scale in three sub-dimensions. As the scores obtained from the scale increase, sports engagement increases respectively. As a result of the reliability analysis, Cronbach's Alpha reliability coefficient was calculated as 0.96 for the Sports Engagement Scale and the combined reliability index was calculated as 0.82 within the scope of this study. The Sport Engagement Scale was used to question the commitment of individuals to recreational sports during the lockdown The validity and reliability of the scale in Turkish was determined by Sırgancı et al. [3838. Sirganci G, Ilgar AE, ve Cihan B. Spora bağlılık ölçeği’nin geçerlik ve güvenirlik çalışması. J Youth Stud. 2019;7(17):171-82. ].

Wallston et al. [3939. Wallston KA, Wallston BS, DeVellis R. Development of the multidimensional health locus of control (MHLC) scales. Health Educ Monogr.1978;6:160-70. ] had originally developed two forms of the Multidimensional Health Locus of Control (MHLC) scale, namely Forms A and B. Form A was used for healthy individuals, while Form B was used for individuals with chronic conditions. The questions in the MHLC-A form were intended to determine whether individuals adopted more internal control, chance control or control of other powerful people (healthcare professionals, family and friends) regarding their health behaviour and included the three following factors: 1) Internal Health Locus of Control (IHLC): I can control my health, 2) Chance Health Locus of Control (CHLC): Chance plays a big role in determining when I will recover from the disease, and 3) The Powerful Others Health Locus of Control (PHLC): I should consult a healthcare professional when I feel unwell.

The MHLC-A form consisted of 18 items and is a six-point Likert-type scale. This form, which evaluated perceptions regarding internal control, external control (chance) and the control of other powerful people, was divided into three sub-dimensions consisting of six items. The degree of participation in the statements in the items is scored from 1 to 6. The average total participation in items was 36 while six was the lowest. Averages for the locus of control perception levels were evaluated among these scores. Each sub-dimension in the scale was scored independently from the other. As a result of scoring, the dimension with the highest score was considered the center that actually controlled health [3939. Wallston KA, Wallston BS, DeVellis R. Development of the multidimensional health locus of control (MHLC) scales. Health Educ Monogr.1978;6:160-70. ]. The validity and reliability of the scale in Turkish were determined by Güzel et al. [4040. Güzel A, Turan S, Üner S. Turkish validity and reliability of Multidimensional Health Locus of Control Scale Form A. Int J Nurs Pract. 2020;26(5):1-10. ].

The IBM®SPSS® software, version 23.0 statistical package program was used to evaluate the data. Continuous variables obtained by measurements were presented with mean and standard deviation values, and categorical variables were presented with frequency and percentage values. The suitability of quantitative variables to normal distribution was examined using the Kolmogorov-Smirnov or Shapiro-Wilk test. In the evaluation of quantitative variables. Independent samples t-test was used for the comparison of two independent groups for the variables for which parametric test conditions were met, and Tukey multiple comparison test was used together with one-way ANOVA for the comparison of three or more independent groups. In cases where the parametric test conditions were not met, Mann-Whitney U-test was used for the comparison of two independent groups, and Kruskal-Wallis H test and Mann-Whitney U were applied to compare three or more independent groups. Two-way variance test ANOVA was used to see the effect of age and gender on the scales.

RESULTS

Demographic characteristics and other descriptive information of the participants are presented in Table 1. Of the participants, 68.2% were female, 31.8% were male, and more than half (56.3%) had a normal BMI. While 68% of the individuals were employed, 72.5% worked only from home. The mean age of the participants was 29.5±8.91 years. While 76% of the participants exercised during quarantine, 24% did not. According to the health locus of control, 74.9% of the participants adopted the perception of internal locus of control, 21.2% the perception of powerful others, and 3.9% the perception of chance locus of control (Table 1).

Table 1 -
Demographic and health information and nutritional habits of the participants. Ankara, Turkey, 2020. (n=513).

Table 2 compares the emotional eating scores of individuals with various variables (exercise during quarantine, gender, perception of HLC, income status, BMI). Participants who did not exercise during the quarantine period compared to those who did, and female participants compared to males, had higher emotional eating scores (p<0.05). It was determined that those adopting the perception of chance locus of control exhibited more emotional eating behaviour than those adopting the perception of internal locus of control. It was observed that participants who were obese compared to those who were underweight, normal weight or overweight; and overweight participants compared to the normal weight participants exhibited more emotional eating behaviours (p<0.05), (Table 2).

Table 2 -
Comparison of emotional eating scale scores with some variables. Ankara, Turkey, 2020.

Table 3 compares the sport engagement scale scores of individuals with various variables. It was determined that participants with normal BMIs were more engaged in sports than those who were slightly overweight or overweight. It was determined that participants who exercised during the quarantine period compared to the ones who did not, and male participants compared to female participants, had higher levels of sports engagement (p<0.05).

It was observed that the participants who adopted the perception of the internal locus of control were more engaged in sports than those who adopted the perception of chance locus of control or the powerful others locus of control (p<0.05). It was found that participants who exercised for 2 hours or more per day had higher levels of sports engagement compared to the participants who exercised for ½-1 hour or 1-2 hours per day (Table 3).

Table 3 -
Comparison of sport engagement scale scores with some variables. Ankara, Turkey, 2020.
Table 4 -
Emotional eating and sports engagement scores by gender and age. Ankara, Turkey, 2020.

It was determined that the emotional eating (F=18.21, p<0.001) and sports commitment scores (F=15,69, p<0.001) of the participants showed a significant difference according to gender. Accordingly, women's emotional eating scores (78.1±24.1) are higher than men's emotional eating scores (65.3±17.7) (Table 2). Sports commitment scores of man (59.5±11.7) were higher than women's sports commitment scores (51.2±15.9).

Emotional eating scores of the participants did not show a significant difference according to age (F=0.67, p=0.413). In contrast, their sports commitment scores showed a significant difference according to age (F=4.86, p=0.028). Accordingly, it was determined that the sports commitment scores of participants aged 34 and under (54.73±15.05) were higher than the scores of participants aged 35 and over (50.98±15.32). When the results of the analysis regarding the joint effect of age and gender were examined, it was determined that the effects of age and gender variables on the participants' emotional eating (F=0.32, p=0.575) and sports commitment (F=1.22, p=0.270) scores were not significant (Table 4).

It was determined that there was a low correlation between sports engagement and emotional eating (r=-0.162). The eta coefficient showed a low correlation with emotional eating as the dependent variable and health locus as the independent variable (0.134). In addition, the eta coefficient showed a low correlation with sports engagement as the dependent variable and health locus as the independent variable (0.190).

DISCUSSION

The COVID-19 pandemic has placed unprecedented restrictions, affecting individuals' lifestyle behaviors. Brooks et al. [22. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet. 2020;395(10227):912-20. ] reported that the COVID-19 quarantine produced negative psychological effects, including symptoms of post-traumatic stress, confusion, and anger. It is widely recognized that such negative situations trigger emotional eating [4141. Sze KYP, Lee EKP, Chan RHW, Kim JH. Prevalence of negative emotional eating and its associated psychosocial factors among urban Chinese undergraduates in Hong Kong: a cross-sectional study. BMC Public Health. 2021;21(1):583.]. During the COVID-19 quarantine, daily physical activity decreased and sedentary time increased [4242. Castañeda-Babarro A, Coca A, Arbillaga-Etxarri A, Gutiérrez-Santamaría B. Physical activity change during COVID-19 confinement. Int J Environ Res Public Health . 2020;17(18):1-10. ] . For this reason, interventions aiming to increase physical activity and reduce sedentary time during the quarantine process have gained importance for the protection of health [4343. Schuch FB, Stubbs B. The role of exercise in preventing and treating depression. Curr Sports Med Rep . 2019;18(8):299-304.]. Since physical activity can improve mood and mental health [4444. Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, et al. Exercise for depression. Cochrane Database Syst Rev. 2013;(9):CD004366. ], it can be used as a coping strategy during a pandemic. In addition, physical activity is effective on depression symptoms [4545. Aylett E, Small N, Bower P. Exercise in the treatment of clinical anxiety in general practice - A systematic review and meta-analysis. BMC Health Serv Res. 2018;18(1):559. ]. In a meta-analysis, it was reported that aerobic exercise was effective in individuals with anxiety and patients diagnosed with anxiety [4646. Marques A, Santos T, Martins J, Matos MG, Valeiro MG. The association between physical activity and chronic diseases in European adults. Eur J Sport Sci. 2018;18(1):140-9. ].

Even a small amount of physical activity has been shown to reduce the risk of chronic disease [4747. Fearnbach SN, Flanagan EW, Höchsmann C, Beyl RA, Altazan AD, Martin CK, et al. Factors protecting against a decline in physical activity during the COVID-19 pandemic. Med Sci Sport Exerc. 2021;53(7):1931-99. ]. Individuals have been deprived of this therapeutic and protective effect of exercise during the quarantine. Especially individuals who used to exercise in gyms before the pandemic had difficulty maintaining these exercise habits. Unlike previous pandemics, the COVID-19 pandemic has coincided with the age of technology which has been an advantage. It has been shown that the use of digital platforms during this period has had a mediating role in supporting physical activity [4848. Parker K, Uddin R, Ridgers ND, Brown H, Veitch J, Salmon J, et al. The use of digital platforms for adults’ and adolescents’ physical activity during the COVID-19 pandemic (Our Life at Home): Survey Study. J Med Internet Res. 2021;23(2):e23389. ,4949. Martin AM, Champ F, Franklin Z. COVID-19: Assessing the impact of lockdown on recreational athletes. Psychol Sport Exerc. 2021;56:101978.]. Therefore, some individuals could maintain their physical activity habits with the help of various exercise videos on the internet [3333. Hammami A, Harrabi B, Mohr M, Krustrup P. Physical activity and coronavirus disease 2019 (COVID-19): Specific recommendations for home-based physical training. Manag Sport Leis. 2022;27(1-2):26-31. ]. In addition, exercising by using virtual fitness platforms and exercise equipment in one's home increased physical activity during this period [4848. Parker K, Uddin R, Ridgers ND, Brown H, Veitch J, Salmon J, et al. The use of digital platforms for adults’ and adolescents’ physical activity during the COVID-19 pandemic (Our Life at Home): Survey Study. J Med Internet Res. 2021;23(2):e23389. ]. It was recommended to encourage home-based exercise so that participants continued to exercise while in quarantine using online communication. Following the lockdown period, many individuals, both with or without exercise habits became members of online exercise platforms. However, many of them were not able to sustain this activity. The sample of this study consists of individuals who regularly attended the gym. Norman et al. [5050. Norman P, Bennett P, Smith C, Murphy S. Health locus of control and health behaviour. J Health Psychol. 1998;3(2):171-80.] reported that individuals who exercise regularly have a perception of an internal locus of control. Similarly, in this study, the majority of individuals (76.0%) who regularly attended the gym before the quarantine continued to exercise during the quarantine period. Additionally, it was determined that the majority of individuals (47.7%) exercised 3-4 days a week and more than half (70.0%) had an exercise duration of 1-2 hours. This shows that individuals had an exercise routine maintain these habits to a large extent even under psychological stress such as quarantine, which can be explained by the perception of locus of control of these individuals. The observed trend of a significant number of participants engaging in home-based exercise can potentially be attributed to the prevailing adoption of an internal locus of control among 74.9% of the participants.

The perspective of individuals' health locus of control is indicated by their belief in being protected from COVID-19 and/or their confidence in readily recovering from the condition. A perceived association exists between individuals' perception of health locus of control and their engagement in health improvement behaviours [5151. Bennett P, Moore L, Smith A, Murphy S, Smith C. Health locus of control and value for health as predictors of dietary behaviour. Psychol Health. 1994;10(1):41-54.,5252. Cecchetto C, Aiello M, Gentili C, Ionta S, Osimo SA. Increased emotional eating during COVID-19 associated with lockdown, psychological and social distress. Appetite. 2021;160:105122. ]. A recent study reported that individuals with the perception of internal locus of control exercise more in their spare time [1515. Mercer DA, Ditto B, Lavoie KL, Campbell T, Arsenault A, Bacon SL. Health locus of control is associated with physical activity and other health behaviors in cardiac patients. J Cardiopulm Rehabil Prev. 2018;38(6):394-9.]. Since 76% of individuals in this study who regularly exercised before the pandemic also did so during quarantine, it is not surprising that 74.9% of individuals also adopted an internal locus of control. It is possible to claimed that individuals who adopted the belief in internal locus of control persisted in their exercise routines throughout the quarantine duration.

In quarantine, increased emotional eating was predicted by higher anxiety, depression and quality of life, while the increase in binge eating was predicted by higher stress [5353. McAtamney K, Mantzios M, Egan H, Wallis DJ. Emotional eating during COVID-19 in the United Kingdom: Exploring the roles of alexithymia and emotion dysregulation. Appetite. 2021;161:105120. ]. It has also been shown that difficulties in identifying emotions indirectly cause emotional eating through affective dysregulation [5454. Coulthard H, Sharps M, Cunliffe L, van den Tol A. Eating in the lockdown during the Covid 19 pandemic; self-reported changes in eating behaviour, and associations with BMI, eating style, coping and health anxiety. Appetite. 2021;161:105082. ]. In particular, individuals who tended to overeat before the quarantine and those with a higher BMI, may increase overeating during a psychologically challenging period such as the quarantine period [5555. Barcın-Güzeldere HK, Devrim-Lanpir A. The Association between body mass index, emotional eating and perceived stress during COVID-19 Partial quarantine in healthy adults. Public Health Nutr. 2022;25(1):43-50. ]. A study showed that COVID-19 quarantine may be closely associated with emotional eating and weight gain, and participants with higher BMI exhibited more emotional eating behaviour [5656. Robinson E, Boyland E, Chisholm A, Harrold J, Maloney NG, Marty L, et al. Obesity, eating behavior and physical activity during COVID-19 lockdown: A study of UK adults. Appetite. 2021;156:104853. ]. In another study conducted during the quarantine period, it was found that individuals with higher BMI have lower physical activity levels, lower diet quality, and a higher frequency of overeating [5757. Dohle S, Hartmann C, Keller C. Physical activity as a moderator of the association between emotional eating and BMI: Evidence from the Swiss Food Panel. Psychol Heal. 2014;29(9):1062-80. ]. Similarly, the current study determined that obese (88.8±26.3) participants compared to underweight (64.5±19.4), normal weight (70.7±19.8) or overweight (76.7±22.7) participants, and overweight participants compared to normal weight participants exhibited more emotional eating behaviour. It can be suggested that a positive correlation exists between BMI and a tendency for engaging in emotional eating behaviour. The BMI offers as a physiological indicator of dietary patterns [5858. Platikanova M, Yordanova A, Hristova P. Dependence of body mass index on some dietary habits: An application of classification and regression tree. Iran J Public Health. 2022;51(6):1283-94. ]. The present study posits that emotional eating may serve as a contributing factor to the increased BMI observed. This conclusion aligns with findings from previous investigations. Individuals who engage in emotional eating might exhibit increased predisposition towards emotional eating behaviours during the stressful period such as quarantine. In a study, it was found that emotional eaters who are quite physically active may feel the urge to eat when under emotional stress; however, they have been shown to be able to choose healthier foods to cope with this distress. Increasing physical activity may be a promising intervention strategy in preventing weight gain in emotional eaters by changing their food choice [5959. Davidson AL, Boyle C, Lauchlan F. Scared to lose control? General and health locus of control in females with a phobia of vomiting. J Clin Psychol. 2008;64(1):30-9.]. Since the face-to-face survey technique could not be used in this study, food consumption records could not be obtained. It is widely acknowledged that individuals who experience stress tend to exhibit a propensity for consuming foods rich in fat, sugar, and high in energy content [6060. Cortes ML, Louzado JA, Oliveira MG, Bezerra VM, Mistro S, Medeiros DS, et al. Unhealthy food and psychological stress: The association between ultra-processed food consumption and perceived stress in working-class young adults. Int J Environ Res Public Health . 2021;18(8):1-10. ]. However, since food consumption could not be recorded in this study, we could not record the contents of the consumed foods. Due to the unavailability of data on food consumption in this study, it was not possible to document the specific constituents of the consumed foods. Nevertheless, based on the existing literature, it can be inferred that individuals who engage in regular physical activity and have an internal locus of control tend to consume foods low in energy, fat, and sugar [6161. Leow S, Jackson B, Alderson JA, Guelfi KJ, Dimmock JA. A role for exercise in attenuating unhealthy food consumption in response to stress. Nutrients. 2018;10(2):1-19. ]. Konttinen et al. [2020. Konttinen H, Silventoinen K, Sarlio-Lähteenkorva S, Männistö S, Haukkala A. Emotional eating and physical activity self-efficacy as pathways in the association between depressive symptoms and adiposity indicators. Am J Clin Nutr. 2010;92(5):1031-9. ] reported a negative correlation between emotional eating and physical activity self-sufficiency. Similarly, in this study, emotional eating scale scores of individuals who continued to exercise (71.2±19.7) during the quarantine period were found to be statistically lower than those who did not exercise (79.9±25.0).

The socioeconomic disadvantage in developing countries has been strongly associated with a higher propensity for obesity. This study was conducted in a developing country. According to Spinoza, low socioeconomic level seems to affect BMI by increasing psychological distress and emotional eating [3232. Spinosa J, Christiansen P, Dickson JM, Lorenzetti V, Hardman CA. From Socioeconomic disadvantage to obesity: The mediating role of psychological distress and emotional eating. Obesity. 2019;27(4):559-64.]. This study found a negative relationship was found between higher economic status and emotional eating scores. Increased unemployment and decreased income during the pandemic period may have caused increased stress and anxiety. This, in turn, can trigger emotional eating.

A recently published study conducted during the COVID-19 period, it was reported that the frequency of emotional eating was higher in women [6262. Hadar-shoval D, Alon-tirosh M, Asraf K, Tannous-haddad L. Lifestyle changes, emotional eating, gender, and stress during COVID-19 lockdown. Nutrients. 2022;14(18):3868. ]. A study conducted in Canada revealed that there was no significant alteration in individuals’ body weight during the COVID-19 period. However, adverse modifications in their dietary patterns were observed. According to latent class analysis, the group with a less healthy lifestyle reported that their body weight increased, their eating habits worsened, and their physical activity decreased [6363. Tessier A-J, Moyen A, Lawson C, Rappaport AI, Yousif H, Fleurent-Grégoire C, et al. Lifestyle behavior changes and associated risk factors during the covid-19 pandemic: Results from the canadian COVIDiet Online cohort study. JMIR Public Heal Surveill. 2023;9:e43786. ]. Unhealthy eating habits have been associated with depression, body image dissatisfaction, and increased stress levels. Another study found that women had higher levels of stress, depression, and anxiety, and therefore higher food consumption [6464. Thompson S. Gender and Racial Differences in Emotional eating, food addiction symptoms, and body weight satisfaction among undergraduates. J Diabetes Obes. 2015;2(4):1-6. ]. Similarly, another study found that women exhibited more emotional eating behaviour than men and scored higher on depression and anger subscales than men [6565. Guerrero-Hreins E, Stammers L, Wong L, Brown RM, Sumithran P. A Comparison of emotional triggers for eating in men and women with obesity. Nutrients. 2022;14(19):1-8. ]. In our research, although emotional eating scores were not generally very high; It was found that women's emotional eating scores were higher than men's. While the precise mechanisms remain unclear, emotional eating in reaction to negative affect may potentially function as a self-medication strategy for persons who are experiencing symptoms of depression. Understanding how disordered eating is triggered is key to this goal. For many people, food consumption is used to manage negative emotions. This argument carries particular significance in the context of women. Research has indicated that females exhibit a higher susceptibility, ranging from two to three times, to the development of anxiety and mood-related illnesses in comparison to males [6666. Bangasser DA, Valentino RJ. Sex differences in stress-related psychiatric disorders: neurobiological perspectives. Front Neuroendocrinol. 2014;35(3):303-19. ]. In addition, a number of other factors, such as gonadal hormones, environmental cues, rewarding properties of food, and cognitive control, may contribute to different risks for eating disorders between genders [6767. Anversa RG, Muthmainah M, Sketriene D, Gogos A, Sumithran P, Brown RM. A review of sex differences in the mechanisms and drivers of overeating. Front Neuroendocrinol . 2021;63:100941. ].

No difference was found between emotional eating scores according to age. It was found that participants under the age of 34 had a higher commitment to sports than participants aged 35 and over. Men's sports commitment was higher than women's when scores were compared. When the joint effect of age and gender on the scale scores was investigated, it was found that there was no effect. A study conducted in Turkey revealed no significant correlation between age and gender in individuals' commitment to sports [6868. Madak E, Kumartaşlı M, Gülen Ö, Sönmez HO. Taekwondo sporcularının spora bağlılık düzeylerinin milli sporculuk durumları ve çeşitli değişkenler açısından incelenmesi. Tojras. 2021;10(3):1-17. ]. In this study, the younger participants' better commitment to sports may be due to their better condition and health.

The belief in locus of control, which is the basis of the decisions people make, affects the health behaviours of participants such as regular exercise, healthy eating, moderate alcohol use and avoidance of smoking [1212. Shojaee M, French C. The relationship between mental health components and locus of control in youth. Psychology. 2014;05:966-78.,6969. Brincks AM, Feaster DJ, Burns MJ, Mitrani VB. The influence of health locus of control on the patient-provider relationship. Psychol Heal Med . 2010;15(6):720-8. ,7070. Ozcakir A, Dogan FO, Bayram N, Bilgel N. Health locus of control, health related behaviors and demographic factors: A study in a turkish population. Br J Med Med Res. 2014;4(21):3856-69. ]. It has been determined that the eating function is affected by the perception of locus of control of individuals, that individuals with the perception of internal locus of control consume healthier foods, tend to make more effort to reach the correct information, and are more determined to maintain their diets [1313. Psouni S, Hassandra M, Theodorakis Y. Patterns of eating and physical activity attitudes and behaviors in relation to body mass index. Psychology. 2016;7(2):180-92. ,1616. Krampe H, Danbolt LJ, Haver A, Stålsett G, Schnell T. Locus of control moderates the association of COVID-19 stress and general mental distress: Results of a Norwegian and a German-speaking cross-sectional survey. BMC Psychiatry. 2021;21(1):437.,5252. Cecchetto C, Aiello M, Gentili C, Ionta S, Osimo SA. Increased emotional eating during COVID-19 associated with lockdown, psychological and social distress. Appetite. 2021;160:105122. ]. Consistent with the literature, this study also determined that the participants adopting the perception of chance locus of control exhibited more emotional eating behaviour than those adopting the perception of internal locus of control. In addition, it was observed that the participants who adopted the perception of internal locus of control concerning their health behaviours had higher levels of sports engagement. The study revealed a positive correlation between internal locus of control and sports involvement, while a negative correlation was observed between internal locus of control and emotional eating, consistent with the expected results. Both the stress caused by the pandemic and having a perception of external locus of control can negatively affect activity and eating habits, which can lead to alarming levels of psychological distress. The perception of external locus of control in individuals exacerbates the relationship between pandemic-induced stress and general mental distress. In this respect, individuals who perceive of an external locus of control are particularly at risk [7171. Füzéki E, Groneberg DA, Banzer W. Physical activity during COVID-19 induced lockdown: Recommendations. J Occup Med Toxicol. 2020;15(1):25.]. In this study, it was seen that persons who had a perception of external locus of control exhibited greater levels of emotional eating compared to individuals who had internal locus of control perception. Additionally, it was shown that those with an external locus of control perception demonstrated lower levels of commitment to sports. Physical activity can potentially prevent the harmful cardiometabolic effects of physical inactivity and strengthen psychological aspects and coping skills. Therefore, it is emphasized that doctors and other healthcare professionals can turn the COVID-19 quarantine process into an opportunity to provide physical activity counselling for their patients.

CONCLUSION

The COVID-19 pandemic, which has penetrated the world, has brought many physiological and psychological negativities. Especially, the quarantine interventions applied during the pandemic period have affected the lifestyle and social lives of individuals in particular nutrition and physical activity. Individuals with a perception of internal locus of control tried to maintain their pre-quarantine habits even during quarantine since they eat and exercised regularly. It has been observed that sports engagement also supports exercising in quarantine. It has been determined that individuals with a high BMI, who do not have a perception of internal health locus of control and who did not exercise during quarantine are prone to emotional eating. In the presence of a stressor such as the COVID-19 quarantine, supporting physical activity, outdoor exercising, as well as in-home exercising via online methods should be planned as a public health policy so that individuals do not lose their positive habits or those without these habits are less affected by the psychological effects. This study is important in determining a specific group's habits and behaviours during the quarantine. Moreover, to the best of our knowledge, this was the first study to evaluate exercise habits, perception of locus of control and emotional eating of individuals with exercise habits during the quarantine period. For future studies, we suggest an evaluation in terms of perception of health locus of control, sports engagement, motivation to sports, as well as stress and anxiety with a greater sample size, different age groups and ethnic groups. In the presence of physical impossibilities and psychological distress, factors other than the perception of locus of control that ensures sports engagement in individuals should also be studied.

One of the limitations of this study was having to conduct it through online platforms due to the COVID-19 pandemic. Another limitation was that anthropometric measurements and exercise habits (previous and current) were self-reported. In addition, the stress and anxiety states of individuals were not determined in this study.

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Edited by

Editor:

Semíramis Martins Álvares Domene

Publication Dates

  • Publication in this collection
    27 May 2024
  • Date of issue
    2024

History

  • Received
    11 Nov 2022
  • Reviewed
    27 Oct 2023
  • Accepted
    24 Jan 2024
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