Skip to main content
Download PDF

Health-related factors of the Iraqi adult population during the 2020 COVID-19 pandemic: physical activity, eating behavior, quality of life, general health, and mood states cross-talk

BMC Public Health volume 23, Article number: 1046 (2023) Cite this article

Abstract

Background

The lockdown and social distancing caused by Coronavirus disease 2019 (COVID-19) may have changed Physical Activity Level (PAL), eating behavior, and health habits due to long-term confinement worldwide.

Objective

This study aimed to evaluate the PAL, eating behavior, Quality of Life (QoL), General Health (GH), and mood states during COVID-19 confinement in a large sample of Iraqi adults.

Methods

3738 healthy adults (age 18–70 years) residing in Halabjeh, Iraq answered the online questionnaires including the short form of international physical activity, GH, three-factor eating (TFEQ-R18), and a short form of the profile of mood states (POMS-SF) questionnaires. Data analysis was done by Chi-square, and Spearman’s correlation using SPSS statistical software at a significant level of (P < 0.05).

Results

The results showed unfavorable PAL, eating behavior, QoL, GH, and mood states in the total population. Low PAL was observed in 69.96% of the men and 75.99% of the women; only 3.60% of the men and 0.77% of the women had a high PAL. There was a significantly positive relationship between low PAL and the incidence of COVID-19 both in men and women (P = 0.801; r = 0.001; and P = 0.682; r = 0.011), respectively; While a significant negative relationship was observed between the moderate and high PAL and the incidence of COVID-19 in men (P = 0.011; r=-0.682 and P = 0.027, r=-0.589), and women (P = 0.001; r=-0.796 and P = 0.018, r=-0.623). No significant relationships were observed between PAL and eating behavior (men: P = 0.086; r = 0.256 and women: P = 0.365, r=-0.121); While, the results show significant positive relationships between PAL with QoL in men (P = 0.012; r = 0.623) and women (P = = 0.001; r = 0.837). based on the results, significant negative relationships between PAL with GH and mood state scores were observed in both men (P = 0.001; r=-0.837 and P = 0.001, r=-0.786) and women (P = 0.010; r=-0.652 and P = 0.001, r=-0.745), respectively.

Conclusions

The Iraqi adult population showed low PAL, GH, QoL, and mood state during COVID-19 which might be due to the confinement. Also, the significant relationships between low PAL with GH, and mood state recommends physical activity as a valuable health optimizing factor during the COVID-19 pandemic.

Peer Review reports

Introduction

Coronavirus disease 2019 (COVID-19) is an infectious disease induced by newly found Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), reported first in Wuhan [1]. To this end, health authorities imposed confinement regulations to reduce the spreading of COVID-19, including social distancing, wearing face masks, locking down cultural and sports events, staying in quarantine if the infection is doubted, and isolation if the infection is approved [1]. Home confinement harmed eating behavior, and caused strict restrictions on regular exercise training or physical activities, especially in the population with underlying diseases [2, 3]. Thus, remained long-term consequences on General Health (GH), and Quality of Life (QoL) are not unexpected [2, 4, 5]. Recent literature investigated Physical Activity Level (PAL) during confinement; However, there were inconsistent results on the association between physical activity patterns and confinement conditions [6, 7]. Lesser et al. (2020) showed that PAL decreased among 40.5% while increased among 33% of modestly active adults, also that 22.4% of active adults got less active whereas 40.3% of active people got more active during the lockdown [8]. Also, Phillipou et al. (2020) investigated eating and exercise behaviors during the COVID-19 pandemic in Australia reporting both increased restricting and binge eating behaviors and less exercise relative to before the pandemic in the general population [9]. A similar study in Italy compared the data collected three weeks to the social lockdown with the confinement period in 41 obese children and adolescents reporting relatively less exercise and increased consumption of ‘unhealthy’ junk foods [10]. While, Constandt et al. observed that adults with low PAL before the confinement reported exercising more while those with high PAL reported exercising less with increased sitting time during the confinement [11]. Given this package of data, it appeared plausible that the effect of the COVID-19 crisis on eating behavior and physical activity is indefinite but substantial [12, 13]. Additionally, physical activity is an essential key factor affecting mood state, GH, and QoL in both healthy and clinical samples [14,15,16]. While some study observed neither increased nor decreased PAL and showed no alteration in GH and mood state among Iranian adults attending team sports activities during the COVID-19 pandemic [17]. Other studies approved that COVID-19 outbreak deteriorated the mood state and reduced GH and QoL [13, 18]. Also, previous studies investigating the psychological distress among adults reported poor mood state, particularly in women [19, 20]. To date, no research has explored the alteration of PAL, eating behavior, QoL, GH, and mood states during the COVID-19 pandemic in the Iraqi population. To counterbalance the lack of such research, we aimed to investigate the PAL, eating behavior, QoL, GH, and mood states during COVID-19 confinement in a large sample of Iraqi adults.

Materials and methods

Study design and population

This applied research studied the men and women of Halabja, Iraq using the available sampling method from August to December 2021; a period in which Iraq faced a high infection rate with an average of 83098 new cases per week and 2465545 total cases up to now [21]. For this purpose, the statistical population of this cross-sectional-descriptive study consisted of all Iraqi adults in Halabja city aged 18–70 years. According to Chirico’ study [22], and Khani et al [23] the sample size was estimated 4000 Iraqi citizens using a convenience sampling approach. The questionnaire was sent to available samples online using Telegram, WhatsApp, and other social media applications, of which 3927 individuals filled the questionnaire. After the final investigations and excluding the incomplete answers, 3738 individuals (1914 men and 1824 women) were considered for further analyses.

Participants were informed about the aims of the study, the confidential data handling, and the ethical approval of the study at the beginning of the questionnaires. Next, to provide the informed consent online, participants clicked the box of the agreement to participate as volunteers. The study was performed following the seventh and current revision (World Medical Association, 2013) of the Declaration of Helsinki. Also, all educated participants and the legal guardian of illiterate participants were asked to complete the written informed consent at the beginning of the study.

Measures

Sociodemographic Information

Participants reported their age (years), sex (women, men), bodyweight (BW), height, marital status (single, married), educational level (illiterate, undergraduate, and college), occupational tatus (employed, unemployed, and student), smoking, and Hospitalization in the last.

Physical activity levels

To determine the PAL Short Form of International Physical Activity Questionnaire (SF-IPAQ) was utilized in this study. IPAQ contains 7 questions classifying all types of physical activity lasting longer than 10 min within the last 7 days including leisure time, domestic and gardening (yard) activities, work-related and transport-related activities [24, 25] into three categories: walking, moderate and vigorous [26]. The Walking category included all types of walking; Moderate category included carrying light loads, cycling, swimming, volleyball, and all other activities that cause small increases in breathing and/or heart rate; Vigorous category covers all physical activities that cause large increases in breathing and/or heart rates such as carrying or lifting heavy loads, digging, running, football or construction work. Frequency (days per week) and duration (time per day) were recorded. The Metabolic Equivalent (MET) was calculated in kcal/kg/hour for each activity. Eight METs were considered for vigorous activities, 4 METs for moderate, and 3.3 METs for walking. Then, the score for each activity was calculated by multiplying its METs *frequency (days per week) * duration (time per day in minutes). The total PAL was calculated by adding the Walking, Moderate, and Vigorous activities MET scores. High PAL was defined as scores > 1500 MET, moderate PAL as scores between 600 and 1500 MET, and low PAL as any scores < 600 MET [24, 25].

Eating behavior

In this study, the 18-item Three-Factor Eating Questionnaire (TFEQ-R18) was used that measures 3 different aspects of eating behavior: uncontrolled eating (UE; intended to eat more than usual due to a loss of control over intake combined with subjective feelings of hunger, 9 questions), conscious restriction (CR; restriction of food intake to control body weight or to promote weight loss, 6 questions), and emotional eating (EE; inability to resist emotional cues, 3 questions). It has been validated that the instrument is valid in both obese and non-obese individuals [27]. The responses were coded on a 4-point scale (1 = definitely true, 2 = mostly true, 3 = mostly false, 4 = definitely false) with higher values indicating more of the behavior. The raw scale scores are standardized to a 0–100 scale using the following formula:

Standardized score = [(raw score-lowest possible raw score)/possible raw score range] × 100.

General health

To assess and identify health problems within the past two weeks we used a 28-item GH questionnaire (GHQ-28; including somatic symptoms, anxiety and insomnia, social dysfunction, and depression subscales, each with seven questions) which was developed and psychometrically evaluated by Goldberg and Homan, respectively [28]. The responses were scored with 4 points of 0, 1, 2, and 3 thus the scores for each subscale could be between 0 and 21 and the total GHQ-28 score between 0 and 84 in which higher scores represent lower GH and any scores above 23 were considered as impaired GH [28]. The validity of the Persian version of GHQ-28 for assessing the GH in the Iranian population was reported by Taghavi previously[29].

Mood state

The Short Form of the Profile of Mood States (POMS-SF) is a reliable and valid measure of subjective mood states that has been used extensively in a wide variety of studies [30]. This questionnaire has 37 questions in six subscales including tension or anxiety, anger or hostility, vigor or activity, fatigue or inertia, depression or dejection, and confusion or bewilderment. Participants respond on a five-point, Likert-type scale ranging from 0 (not at all) to 4 (extremely). The total mood states score was computed by adding the five negative subscale scores (tension-anxiety, depression, anger-hostility, vigor, fatigue, and confusion) and subtracting the vigor score. Higher scores for the total mood state score indicate a greater degree of mood disturbance. The reliability of the Persian of POMS-SF using Cronbach’s alpha coefficient was acceptable in the range of 0.74 to 0.88.

Quality of life

The QoL was assessed using the SF-12 was developed as a shorter alternative to the SF-36, applicable to large-scale health surveys where the application of the more extended instrument would be too time-consuming or costly. The SF-12 has 12 questions which are grouped into eight domains or two summary components of the physical component and mental component scales of physical functioning, role limitations due to physical health, bodily pain, GH perception, social functioning, role limitations due to emotional problems, vitality, and mental health. The final score of the SF-12 ranged from 0–to 100, with a higher score indicating a better QoL. Cronbach’s alpha coefficient was 0.88, indicating a high internal consistency. The SF 12 was adapted and validated to Persian conditions by Rohani et al. [31]. Concerning criterion validity, correlations between the subscales of the SF-12 were 0.63–0.78.

Statistical analysis

All statistical analyses were performed using the SPSS statistical software (version 21; SPSS Inc., Chicago, IL, USA) at a significant level of P < 0.05. The Kolmogorov–Smirnov test was used to evaluate the normality of distribution. The descriptive (mean, standard deviation, and percent) and deductive (Chi-square and Spearman’s correlation) statistic methods were used for analyzing the data.

Results

Table 1 shows the Mean ± SD of anthropometric characteristics and physiologic variables among the participants. Based on these results, the subjects were overweight (men: 28.50 ± 7.82; women: 29.51 ± 8.29) and had an insufficient PAL (men: 571.75 ± 608.56; women: 539.94 ± 451.38).

Table 1 Anthropometric characteristics of participants
Full size table

The results showed that 36.90% of the participants in the present study were in the older adults age (36–55) category and also 72.45% of the participants in the present study were married (Table 2), significant differences were observed between men and women in marital status. In concern with educational level, only 31.30% of the participants had a college education. According to the results, significant differences were observed between men and women in the educational level. In addition, 44.23% of the participants in the present study were unemployed and there were significant differences in the rate of unemployment between men and women (men: 35.60%; women: 53.2%). Also, only 73.92% of the participants in the study were cigarette smokers; The highest frequency of smoking was observed in men (35%). According to the results of Table 2, 41.20% of men and 48% of women experienced hospitalization in the last year which showed a significant difference (Table 2).

Table 2 Demographic status of participants in the total population and different sex categories
Full size table

Table 3 presents the frequency and percentage of COVID-19 symptoms in 3 categories (less common, more common, and serious symptoms). Based on the results, almost all subjects reported having all of the symptoms of the first (less-common symptoms; 39.98% of men and 36.57% of women) and second categories (common symptoms; 39.65% of men and 42.49% of women). while difficulty breathing was the most reported symptom in the third category (33.03% of men and 29.17% of women). There was significant difference between men and women in the COVID-19 symptoms.

Table 3 The frequency and percentage of COVID-19 symptoms among men and women
Full size table

Also, a significantly positive relationship between low PAL and the incidence of COVID-19 both in men and women (P = 0.801; r = 0.001; and P = 0.682; r = 0.011), respectively; While a significant negative relationship was observed between the moderate and high PAL with the incidence of COVID-19 in men (P = 0.011; r=-0.682 and P = 0.027, r=-0.589), and women (P = 0.001; r=-0.796 and P = 0.018, r=-0.623) (Table 4).

Table 4 The relationship between the PAL and the incidence of COVID-19
Full size table

The results showed unfavorable, PAL, eating behavior, QoL, GH, and mood states in the total population. Low PAL was observed in 69.96% of the men and 75.99% of the women; only 3.60% of the men and 0.77% of the women had a high PAL. The results showed significant differences between different genders in the low (P = 0.032), moderate (P = 0.041), and high (P = 0.045) PAL. Also, uncontrolled eating behavior was observed in 50.57% of the men and 47.37% of the women while 38.09% of the men and 41.45% of the women were emotional eaters; and 11.34% of the men and 11.18% of the women had conscious restraints. There were no significant differences in the eating behavior variables between men and women. The results indicate poor GH, QoL, and mood state in all participants. However, there were no significant differences in the GH, QoL, and mood state between men and women; but both genders showed low GH, QoL, and mood state (Table 5).

Table 5 PAL, Eating behavior, QoL, GH, and mood states
Full size table

The results of show significant negative relationships between PAL with BMI in both men and women (P = 0.003; r=-0.690; and P = 0.093; r=-0.649), respectively (Table 6). While no significant relationships were observed between PAL and eating behavior (men: P = 0.086; r = 0.256 and women: P = 0.365, r = 0.121). Also, the result shows significant positive relationships between PAL with QoL in men (P = 0.012; r = 0.623) and women (P = = 0.001; r = 0.837). While significant negative relationships between PAL with GH and mood state scores were observed in both men (P = 0.001; r=-0.837 and P = 0.001, r=-0.786) and women (P = 0.010; r=-0.652 and P = 0.001, r=-0.745), respectively (Table 6). It should be mentioned that higher scores in GH and mood state indicate lower GH and higher mood disturbance.

Table 6 Relationship between PAL with BMI, Eating behavior, QoL, GH, and mood state among men and women
Full size table

The results show significant negative relationships between COVID-19 incidence with PAL (P = 0.001; r=-0.832; and P = 0.021; r=-0.520), QoL (P = 0.023; r=-0.541; and P = 0.001; r=-0.802) in both men and women, respectively (Table 7). While no significant relationships were observed between COVID-19 incidence with eating behavior (men: P = 0.263; r = 0.142 and women: P = 0.295, r = 0.216). Also, significant positive relationships between COVID-19 incidence with GH and mood state scores were observed in both men (P = 0.001; r = 0.769 and P = 0.018, r = 0.591) and women (P = 0.001; r = 0.794 and P = 0.001, r = 0.841), respectively (Table 7); considering the higher scores indicating lower GH and mood state.

Table 7 Relationship between COVID-19 incidence with PAL, Eating behavior, QoL, GH, and mood state among men and women
Full size table

Discussion

This research aimed to analyze the effect of COVID-19 confinement on PAL, eating behavior, GH, QoL, and mood states in a large sample of Iraqi adults. The study showed that Iraqi adults significantly decreased PAL, QoL, GH, and mood states while increased eating disorders during the confinement period. Also, subjects with lower PALs, both men, and women, showed poorer eating behavior, QoL, GH, and mood state.

Regarding the health impact of COVID-19 confinement, poorer mood state and lower PAL, resulting from the extended period of confinement perception, fear of getting infected, boredom, and frustration were described [32]. In line with our results Azmodeh et al. (2021) showed inadequate PAL, low QoL, and GH in men and women recovering from COVID-19; also showing sex differences between men and women that were not observed in the present study [6]. These findings are in line with Amini et al. (2020) investigating Iranian adults that showed low physical activity in the majority of the participants during COVID-19 [33]. In contrast, Aghababa et al. (2020) observed decreased physical activity intensity but increased physical activity frequency among Iranian adults during the confinement compared with before stating no evidence of systematic change in physical activity patterns and related mood states [17].

Based on the results of the studies, COVID-19 confinement has induced extensive lifestyle changes in different populations that are predicted to continue for a long time. Among these dramatic changes was the disruption of eating habits and eating patterns. Although the results indicated poor eating behavior between men and women, the results of the present study indicate no significant relationship between PAL and eating behavior. Another study that investigated the impact of COVID-19 on eating behavior among the Italian population reported higher adherence to a healthy diet in the age group of 18–30 years compared to the younger and the elderly population [34]. Also, a recent study in Saudi Arabia observed that the lockdown significantly impacted the physical activity and dietary behaviors of several citizens and residents in an unhealthy way [35]. Also, a previous study that assessed the effect of the lockdown on eating habits in the United Arab Emirates (UAE) reported a 31% weight gain while an increased rate of unhealthy eating behavior [36]. The eating behavior alterations might be due to boredom, anxiety, low motivation to have a healthy diet, reduced goods availability, and limited food access considering store opening restrictions [37]. These changes in eating behavior together with low PAL might lead to negative effects on GH, QoL, and mood state.

Interestingly, our results show significant negative relationships between PAL with GH, and mood state; considering the higher scores showing poorer results in the mentioned variables. In line with our results, studies indicate adequate PAL improves the GH [38, 39] and mood state [38, 40]. Overall, maintaining adequate PAL in men and women might benefit GH and mood states. Although the main mechanism of exercise improving GH is not fully elucidated, increased PAL and exercise help improve anxiety, confusion, anger, depression, insomnia, and social dysfunction [41], thus optimizing GH and mood state in both men and women probably via increasing serotonin, stress hormones, and endorphins in the brain [42]. In addition, positive correlations were found between the PAL and QoL among both men and women. In other words, increased QoL was observed with increased PAL. Similar results were obtained in a previous study regarding a positive and significant relationship among patients with COVID-19 [43]. Based on the results of other studies physical activity can promote QoL through its consequent physical and psychological benefits including reduced risk of illness, improved immune response, higher mental stimulation, increased social interactions, and improved self-esteem [44, 45]. Focusing on gender-based differences, in this study men tend to show better results in the measured variables however these differences were not significant between men and women.

Limitation

The acceptance rate to contribute in this study varied among different families and some refused to participate in this study. Also, there were areas with no internet network, so using Telegram, WhatsApp, and other social media applications were not possible in the people of that areas. Although we had a quiet large sample size in this study, it is more considerate not to generalize this information to the whole society considering the limitations that were stated above.

Conclusion

In this study, we have provided for the first time data on the Iraqi population. In general, the findings of the present study showed that the Iraqi adult population showed low PAL, GH, QoL, and mood state during COVID-19 confinement that might be due to the increased stress, and anxiety caused by the COVID-19 pandemic. Also, the significant relationships between low PAL with GH, and mood state recommends physical activity as a valuable health optimizing factor in the COVID-19 pandemic.

Data availability

The datasets generated and analyzed during the current study are not publicly available due to ongoing data analysis but are available from the corresponding author on reasonable request.

References

  1. Spinelli A, Pellino G. COVID-19 pandemic: perspectives on an unfolding crisis. J Br Surg. 2020;107(7):785–7.

    Article  CAS  Google Scholar 

  2. Ammar A, Brach M, Trabelsi K, Chtourou H, Boukhris O, Masmoudi L, Bouaziz B, Bentlage E, How D, Ahmed M. Effects of COVID-19 home confinement on eating behavior and physical activity: results of the ECLB-COVID19 international online survey. Nutrients. 2020;12(6):1583.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Gallé F, Quaranta A, Napoli C, Diella G, De Giglio O, Caggiano G, Di Muzio M, Stefanizzi P, Orsi GB, Liguori G. How do Vaccinators experience the pandemic? Lifestyle behaviors in a sample of italian Public Health Workers during the COVID-19 era. Vaccines. 2022;10(2):247.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Caputo EL, Reichert FF. Studies of physical activity and COVID-19 during the pandemic: a scoping review. J Phys Activity Health. 2020;17(12):1275–84.

    Article  Google Scholar 

  5. Mehrsafar AH, Gazerani P, Zadeh AM, Sánchez JCJ. Addressing potential impact of COVID-19 pandemic on physical and mental health of elite athletes. Brain Behav Immun. 2020;87:147.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Azmodeh M, Hoseini R, Amiri E. Physical activity levels and self-perception of fitness in COVID-19-Recovered individuals. Iran J Psychiatry Behav Sci 2022, 16(1).

  7. Gallè F, Sabella EA, Di Muzio M, Barchielli B, Da Molin G, Ferracuti S, Liguori G, Orsi GB, Napoli C. Capturing the features of physical activity in old adults during the COVID-19 pandemic: results of an italian survey. Int J Environ Res Public Health. 2022;19(11):6868.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lesser IA, Nienhuis CP. The impact of COVID-19 on physical activity behavior and well-being of Canadians. Int J Environ Res Public Health. 2020;17(11):3899.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Phillipou A, Meyer D, Neill E, Tan EJ, Toh WL, Van Rheenen TE, Rossell SL. Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia: initial results from the COLLATE project. Int J Eat Disord. 2020;53(7):1158–65.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pietrobelli A, Pecoraro L, Ferruzzi A, Heo M, Faith M, Zoller T, Antoniazzi F, Piacentini G, Fearnbach SN, Heymsfield SB. Effects of COVID-19 lockdown on lifestyle behaviors in children with obesity living in Verona, Italy: a longitudinal study. Obesity. 2020;28(8):1382–5.

    Article  CAS  PubMed  Google Scholar 

  11. Constandt B, Thibaut E, De Bosscher V, Scheerder J, Ricour M, Willem A. Exercising in times of lockdown: an analysis of the impact of COVID-19 on levels and patterns of exercise among adults in Belgium. Int J Environ Res Public Health. 2020;17(11):4144.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Gallè F, Sabella EA, Roma P, Ferracuti S, Da Molin G, Diella G, Montagna MT, Orsi GB, Liguori G, Napoli C. Knowledge and lifestyle behaviors related to COVID-19 pandemic in people over 65 years old from southern Italy. Int J Environ Res Public Health. 2021;18(20):10872.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Gallè F, Sabella E, Ferracuti S, De Giglio O, Caggiano G, Protano C, Napoli C. Sedentary behaviors and physical activity of italian undergraduate students during lockdown at the time of CoViD – 19 pandemic. Int J Environ Res Public Health. 2020;17(17):6171.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Maugeri G, Castrogiovanni P, Battaglia G, Pippi R, D’Agata V, Palma A, Di Rosa M, Musumeci G. The impact of physical activity on psychological health during Covid-19 pandemic in Italy. Heliyon. 2020;6(6):e04315.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Suryavanshi N, Kadam A, Dhumal G, Nimkar S, Mave V, Gupta A, Cox SR, Gupte N. Mental health and quality of life among healthcare professionals during the COVID-19 pandemic in India. Brain and behavior. 2020;10(11):e01837.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Wei L, Hu Y, Tao Y, Hu R, Zhang L. The Effects of Physical Exercise on the quality of life of healthy older adults in China: a systematic review. Front Psychol. 2022;13:895373.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Aghababa A, Zamani Sani SH, Rohani H, Nabilpour M, Badicu G, Fathirezaie Z, Brand S. No evidence of systematic change of physical activity patterns before and during the Covid-19 pandemic and related mood states among iranian adults attending team sports activities. Front Psychol. 2021;12:641895.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gallè F, Sabella E, Da Molin G, De Giglio O, Caggiano G, Di Onofrio V, Ferracuti S, Montagna M, Liguori G, Orsi G. Knowledge, attitudes, practices, fear and stress before Covid-19 in nursing students and recent graduates in Colombia. Int J Environ Res Public Health. 2020;17:3481.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gao W, Ping S, Liu X. Gender differences in depression, anxiety, and stress among college students: a longitudinal study from China. J Affect Disord. 2020;263:292–300.

    Article  PubMed  Google Scholar 

  21. Int Cw. : WHO coronavirus (covid-19) dashboard [internet]. 2022.

  22. Chirico A, Lucidi F, Galli F, Giancamilli F, Vitale J, Borghi S, La Torre A, Codella R. COVID-19 outbreak and physical activity in the italian population: a cross-sectional analysis of the underlying psychosocial mechanisms. Front Psychol. 2020;11:2100.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Khani Jeihooni A, Jafari F, Shiraly R, Rakhshani T, Asadollahi A, Karami H. Physical activity behavior during Covid 19 pandemic among iranian dwellers in Southern Iran based on planned behavior theory: a SEM analysis. BMC Public Health. 2022;22(1):1–7.

    Article  Google Scholar 

  24. Cleland C, Ferguson S, Ellis G, Hunter RF. Validity of the International Physical Activity Questionnaire (IPAQ) for assessing moderate-to-vigorous physical activity and sedentary behaviour of older adults in the United Kingdom. BMC Med Res Methodol. 2018;18(1):1–12.

    Article  Google Scholar 

  25. Ács P, Betlehem J, Oláh A, Bergier J, Melczer C, Prémusz V, Makai A. Measurement of public health benefits of physical activity: validity and reliability study of the International Physical Activity Questionnaire in Hungary. BMC Public Health. 2020;20(1):1–10.

    Google Scholar 

  26. Graff-Iversen S, Anderssen SA, Holme IM, Jenum AK, Raastad T. An adapted version of the long International Physical Activity Questionnaire (IPAQ-L): construct validity in a low-income, multiethnic population study from Oslo, Norway. Int J Behav Nutr Phys Activity. 2007;4(1):1–7.

    Article  Google Scholar 

  27. Karlsson J, Persson L-O, Sjöström L, Sullivan M. Psychometric properties and factor structure of the three-factor eating questionnaire (TFEQ) in obese men and women. Results from the swedish obese subjects (SOS) study. Int J Obes. 2000;24(12):1715–25.

    Article  CAS  Google Scholar 

  28. Goldberg DP. The detection of psychiatric illness by questionnaire. Maudsley Monogr 1972, 21.

  29. Taghavi M. Assessment of the validity and reliability of the general health questionnaire. J Psychol. 2001;5(3):381–98.

    Google Scholar 

  30. Chen K-M, Snyder M, Krichbaum K. Translation and equivalence: the profile of mood states short form in English and Chinese. Int J Nurs Stud. 2002;39(6):619–24.

    Article  PubMed  Google Scholar 

  31. Rohani C, Abedi HA, Langius A. The iranian SF-12 Health Survey version 2 (SF-12v2): Factorial and convergent validity, internal consistency and test-retest in a healthy sample. Iran Rehabilitation J. 2010;8(2):4–14.

    Google Scholar 

  32. Doraiswamy S, Cheema S, Al Mulla A, Mamtani R. COVID-19 lockdown and lifestyles: a narrative review. F1000Research. 2021;10:363.

    Article  Google Scholar 

  33. Amini H, Isanejad A, Chamani N, Movahedi-Fard F, Salimi F, Moezi M, Habibi S. Physical activity during COVID-19 pandemic in the iranian population: a brief report. Heliyon. 2020;6(11):e05411.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Di Renzo L, Gualtieri P, Pivari F, Soldati L, Attinà A, Cinelli G, Leggeri C, Caparello G, Barrea L, Scerbo F. Eating habits and lifestyle changes during COVID-19 lockdown: an italian survey. J translational Med. 2020;18(1):1–15.

    Article  Google Scholar 

  35. Alfawaz H, Amer OE, Aljumah AA, Aldisi DA, Enani MA, Aljohani NJ, Alotaibi NH, Alshingetti N, Alomar SY, Khattak MNK. Effects of home quarantine during COVID-19 lockdown on physical activity and dietary habits of adults in Saudi Arabia. Sci Rep. 2021;11(1):1–7.

    Article  Google Scholar 

  36. Cheikh Ismail L, Osaili TM, Mohamad MN, Al Marzouqi A, Jarrar AH, Abu Jamous DO, Magriplis E, Ali HI, Al Sabbah H, Hasan H. Eating habits and lifestyle during COVID-19 lockdown in the United Arab Emirates: a cross-sectional study. Nutrients. 2020;12(11):3314.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Bennett G, Young E, Butler I, Coe S. The impact of lockdown during the COVID-19 outbreak on dietary habits in various population groups: a scoping review. Front Nutr. 2021;8:626432.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Zhang X, Zhu W, Kang S, Qiu L, Lu Z, Sun Y. Association between physical activity and mood states of children and adolescents in social isolation during the COVID-19 epidemic. Int J Environ Res Public Health. 2020;17(20):7666.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Candelaria D, Randall S, Ladak L, Gallagher R. Health-related quality of life and exercise-based cardiac rehabilitation in contemporary acute coronary syndrome patients: a systematic review and meta-analysis. Qual Life Res. 2020;29(3):579–92.

    Article  PubMed  Google Scholar 

  40. Chan JS, Liu G, Liang D, Deng K, Wu J, Yan JH. Special issue–therapeutic benefits of physical activity for mood: a systematic review on the effects of exercise intensity, duration, and modality. J Psychol. 2019;153(1):102–25.

    Article  PubMed  Google Scholar 

  41. Bourbeau K, Moriarty T, Ayanniyi A, Zuhl M. The combined effect of exercise and behavioral therapy for depression and anxiety: systematic review and meta-analysis. Behav Sci. 2020;10(7):116.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Sharifi M, Hamedinia M, Hosseini-Kakhak S. The effect of an exhaustive aerobic, anaerobic and resistance exercise on serotonin, beta-endorphin and BDnf in students. Phys Educ students 2018(5):272–7.

  43. Qi M, Li P, Moyle W, Weeks B, Jones C. Physical activity, health-related quality of life, and stress among the chinese adult population during the COVID-19 pandemic. Int J Environ Res Public Health. 2020;17(18):6494.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Slimani M, Paravlic A, Mbarek F, Bragazzi NL, Tod D. The relationship between physical activity and quality of life during the confinement induced by COVID-19 outbreak: a pilot study in Tunisia. Front Psychol. 2020;11:1882.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Azmodeh M, Hoseini R, Amiri E. Relationship of physical activity level with quality of life and General Health among COVID-19 recovered individuals. Mod Care J 2021, 18(3).

Download references

Acknowledgements

The authors would like to thank the participants for their cooperation.

Funding

The authors declared that the research did not receive any financial grants.

Author information

Authors and Affiliations

  1. Physical Education and Sport Sciences Department, University of Halabja, Kurdistan Region, Halabja, 46018, Iraq

    Hiwa Ahmed Rahim & Dashni Anwer Kareem

  2. Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, P.O.Box. 6714414971, Kermanshah, Iran

    Rastegar Hoseini & Zahra Hoseini

  3. Physical Education and Sport Sciences Department, University of Sulaimani, Kurdistan, Iraq

    Eman Najemaldeen Abbas

Authors
  1. Hiwa Ahmed Rahim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rastegar Hoseini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zahra Hoseini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eman Najemaldeen Abbas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dashni Anwer Kareem
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

This study was designed by RH, and ZH. HAR, DAK and ENA supervised the fieldwork and data collection. The analysis was performed by DAK and HAR with input and guidance from RH. The draft of the paper was written by RH, and ZH, and all authors reviewed various versions. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Rastegar Hoseini.

Ethics declarations

Ethical approval

This study has been ethically approved by the Institutional Review Board of the Faculty of Physical Education and Sport Sciences, University of Halabja, with a registration number of 100/6/7; on 21/10/2021. The authors confirm that all methods were performed in accordance with relevant guidelines and regulations. Online informed consent was obtained from all participants.

Consent for publication

Not applicable. No identifiable participant data has been included.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rahim, H.A., Hoseini, R., Hoseini, Z. et al. Health-related factors of the Iraqi adult population during the 2020 COVID-19 pandemic: physical activity, eating behavior, quality of life, general health, and mood states cross-talk. BMC Public Health 23, 1046 (2023). https://doi.org/10.1186/s12889-023-15898-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12889-023-15898-z

Keywords

BMC Public Health

ISSN: 1471-2458

Contact us