# Exercise as it relates to Disease/Physical activities role in mental health among twins
### What is the background to this research?

The paper being referenced in this analysis researches the role that the recent pandemic 'stay at home' protocols has had on exercise and its effect on mental health among twins. The study utilised surveys to conduct research on how stay at home orders have impacted participants levels of physical activity, stress and anxiety.
This paper is vital to research conducted in the field of the pandemic as it was conducted almost immediately after the initial 'stay at home' orders occurred across the world. Due to the fast role out of the survey the data collected is an insight into how individuals levels of physical activity were first impacted by the orders, and the impact this had on mental health.

### Where is the research from?

The research was conducted by researchers from both Washington State University and University of Washington with the use of the Washington State Twin Registry. The organisation is in Washington State although the participants were enlisted from multiple states in America. The location of the participants is meaningful as each State and in some cases, jurisdictions had differing 'stay at home' orders which decided the amount of exercise which was permitted and the extent of closure of gymnasiums and other places for exercise.
The primary author of the research Glen E Duncan and his team are all accredited in differing fields of health. Glen has been a part of many other research articles focusing on similar fields of exercise science in assessing exercise performance
There are no conflicting interests between the researching group or the topic of research. The Washington State Twin Registry is an organisation for which participants who are twins opt in conduct research for which there is significant link which would indicate any conflict of interest or biased issues.

### What kind of research was this?

The research article was designed to utilise observational study method. The study observed and recorded the effects that the ‘stay at home’ orders had on factors rather than interfere or any manipulation by the researchers. To stay in accordance with the non-experimental study design the researchers utilised a mixed method survey to accurately represent the changes levels of physical activity, stress and anxiety. Other studies which utilised the same method of data collection and interpretation found similar evidence supporting the research conducted in the study.

### What did the research involve?

The surveys asked the participants to scale the amount of change which had occurred in multiple areas since the beginning of ‘stay at home’ protocols. The level of stress was recorded with the use of the Perceived Stress Scale (PSS). The PSS included a 5-point Likert scale, the survey addressed multiple questions referring to the participants level of stress and a total was obtained from all concurring answers.
Brief Symptom Inventory (BSI) was implemented to record feedback on the participants level of anxiety. The study implemented the same method used for the PSS as participants once again completed a self-assessment and a score was obtained post testing.
The method used to identify the amount of physical activity being undertaken compared to pre ‘stay at home’ orders utilised the method of qualitative analysis, participants were asked to select an answer which best represented their amount of physical activity. The participants were given options are asked to select the answer which best reflected their changes in physical activity.
The use of surveys for data collection was ideal due to the conditions of the research and the purpose being to utilise the observational study type to not interfere with the research but record the effects of the lockdown measures on physical activity and mental wellbeing in twin.
The primary limitation of any survey research is the issue of selection bias. Self-selection bias may be present in the results due to the relatively low average stress and anxiety levels reported. These results indicate that the lower scores could be due to individuals with lower stress levels being willing to participate and less participation for those who were likely more stressed or anxious. Although without the results from the non-participants only speculations can be made on the limitations that selection bias had on the study.

### What were the basic results?

The study found high associations between a decrease in physical activity (PA) and a lower score in the anxiety levels when compared to those who recorded no change in PA. The research also an increase in perceived stress in twins who both recorded less or no change in physical activity. Although there was an association made between decreased PA and increased anxiety and stress levels there was no association found between an increase in PA and a decrease in both perceived stress and anxiety which counters the second hypothesis of the study.
The researchers made separate comparisons on the independent variables which concluded with a total of 4 comparisons made, the classical twin model was used to help with analysis of the independent components. Anxiety and perceived stress were separately regressed to assess the change in PA without reflecting shared environmental or genetic confounds.

### What conclusions can we take from this research?

The study shows that a decrease in perceived PA is associated with an increase in stress and anxiety due to the ‘stay at home’ pandemic mitigation methods. The elongation of measures and further restrictions being put in place which limit PA could see a further increase in mental health worries.
The results in a study assessing the link between mental health and physical activity during pandemic conditions found that participants who reported a decrease in their mental health had a greater reduction in PA compared to participants who reported a no change or an increase in mental health.

### Practical advice

This study is quite applicable as it shows a direct correlation between decreased PA and a decrease in mental health factors, although the research only shows the link with general PA and doesn’t give the consumers any further knowledge on duration and type of exercise and how it impacts mental health. Due to the study not having any recommendations on the exercise being conducted there is no considerations relevant for the consumers. The research also shows the importance accessibility to exercise and resources associated and the adverse effects of sedentary behaviour causes.

### Further information/resources

For the consumers that have an interest on furthering their knowledge on adverse health effects caused by pandemic related protocols and looking to improve mental wellbeing the following readings have been recommended.
The study by Mattioli and co investigates the effects that quarantine and sedentary behaviour has on increasing cardiovascular risk factors, a greater understanding how to increase cardiovascular well-being will help consumers be able to implement better habits during ‘stay at home’ protocols.
This research article examines the benefits and differences that both aerobic and resistance training has on an improved quality of life, his article will helpful for informing the consumer of the individual benefits of both training types.

### References

* G.Duncan, S.Anton, S Sydeman, (2005), Prescribing Exercise at Varied Levels of Intensity and Frequency. A Randomized Trial.
* M.Carlson, S.Morrison, (2009), Study Design, Precision, and Validity in Observational Studies
* B.Cheval, H.Sivaramakrishnan, S.Maltagliati, (2021), Relationships between changes in self-reported physical activity, sedentary behaviour and health during the coronavirus (COVID-19) pandemic in France and Switzerland.
* S.Cohen, (2018), Perceived Stress Scale
* L R Derogatis, N Melisaratos, (1983), The Brief Symptom Inventory: an introductory report
* Z.Greenacre, (2016), The Importance of Selection Bias in Internet Surveys
* G.Duncan, A.Avery, E.Seto, S.Tsang, (2020), Perceived change in physical activity levels and mental health during COVID-19: Findings among adult twin pairs
* M.Marashi, E.Nicholson, M.Orgodnik, B.Fenesi, J. Heisz, (2021), A mental health paradox: Mental health was both a motivator and barrier to physical activity during the COVID-19 pandemic
* A.Mattioli, M.Puviana, M.Nasi, A.Farinetti, (2020), COVID-19 pandemic: the effects of quarantine on cardiovascular risk.
* .Wanderley, N.Oliviera, E.Moreira, J.Carvalho, (2015), Aerobic Versus Resistance Training Effects on Health-Related Quality of Life, Body Composition, and Function of Older Adults
* ↑ G.Duncan, S.Anton, S Sydeman, (2005), Prescribing Exercise at Varied Levels of Intensity and Frequency. A Randomized Trial.
* ↑ M.Carlson, S.Morrison, (2009), Study Design, Precision, and Validity in Observational Studies
* ↑ B.Cheval, H.Sivaramakrishnan, S.Maltagliati, (2021), Relationships between changes in self-reported physical activity, sedentary behaviour and health during the coronavirus (COVID-19) pandemic in France and Switzerland.
* ↑ S.Cohen, (2018), Perceived Stress Scale
* ↑ L R Derogatis, N Melisaratos, (1983), The Brief Symptom Inventory: an introductory report
* ↑ Z.Greenacre, (2016), The Importance of Selection Bias in Internet Surveys
* ↑ G.Duncan, A.Avery, E.Seto, S.Tsang, (2020), Perceived change in physical activity levels and mental health during COVID-19: Findings among adult twin pairs
* ↑ M.Marashi, E.Nicholson, M.Orgodnik, B.Fenesi, J. Heisz, (2021), A mental health paradox: Mental health was both a motivator and barrier to physical activity during the COVID-19 pandemic
* ↑ A.Mattioli, M.Puviana, M.Nasi, A.Farinetti, (2020), COVID-19 pandemic: the effects of quarantine on cardiovascular risk
* ↑ F.Wanderley, N.Oliviera, E.Moreira, J.Carvalho, (2015), Aerobic Versus Resistance Training Effects on Health-Related Quality of Life, Body Composition, and Function of Older Adults