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Lockdown Lifestyle Advice Differs With Delta – Expert Reaction

The extension of Level 4 lockdown across the country, announced Monday, poses challenges in keeping well and active while largely staying at home.

And in this lockdown, a key difference is the Delta variant – and how that’s changed the expectations and rules. Much wider mask use, and many more people required to self-isolate within their homes, are just two of the changes this time around.

The SMC asked experts to comment on the following topics:

Being active

Associate Professor Susanna Every-Palmer, Psychiatrist and Head of Department of Psychological Medicine, University of Otago Wellington, comments:

“For those feeling stressed and anxious at the moment – don’t be hard on yourself. You’ve been designed to feel this way. Throughout human evolution, natural selection has favoured those who get anxious and take evasive action against perceived threats. However, while this is an excellent survival strategy when faced with a hungry predator it’s not helpful with a protracted threat that we have limited control over – like COVID-19.

“Data we collected last year suggest that one in three New Zealanders experienced anxiety and/or depressive symptoms during the first national lockdown. People with histories of mental illness or working on the frontline were at higher risk of poor mental health.

“Many of the current stressors are the same as previously but with the added burdens of pandemic fatigue and uncertainty around the new risks associated with the Delta variant. Uncertainty activates the autonomic nervous system’s fight-or-flight response. If we could test the wastewater for cortisol – a stress hormone – we would almost certainly be seeing high levels alongside the COVID-19 viral RNA.

“There are many good resources available on the internet for supporting lockdown wellbeing. My number one recommendation is to prioritise exercise. Exercise is a proven strategy to combat anxiety. It reduces levels of the body’s stress hormones, such as cortisol and adrenaline, and stimulates the production of endorphins – the brain’s ‘feel good’ neurotransmitters. Even short periods of exercise have been proven to improve mood and reduce anxiety.”

No conflict of interest.

Dr Wendy O’Brien, Assistant Lecturer, School of Sport, Exercise and Nutrition, Massey University, comments:

“During the initial New Zealand lockdown last year many of us noticed the large number of people out and about exercising in our neighbourhoods. These were families on bikes, scooters, with a ball or the dog as well as bubble groups walking, running and cycling. There were the home gym setups in garages and driveways where dedicated equipment or whatever was at hand was put to use for gym workouts and circuits. Whether out of boredom, having extra time, setting about achieving fitness goals or working to burn off extra calories from Lockdown home baking, many New Zealanders heeded the Government’s advice to get out and exercise daily.

“Physical activity in any form is known to have tremendous health benefits, both physically and mentally. Regular physical activity is strongly linked to improved mental health outcomes, especially related to anxiety and depression (Brunet et al., 2013; McMahon et al., 2017; Schuch et al., 2018; Teychenne et al., 2020), and has been identified as a coping strategy to facilitate lasting resilience to stress (Southwick et al., 2005). One study showed that even just 5 minutes each day of outdoor exercise improved mood and self-esteem (Barton & Pretty, 2010). The benefits of physical activity on mental health and wellbeing have been demonstrate with physical activity at almost any intensity and duration. While high-intensity workouts may suit some individuals, even just getting outside for a short walk around the block can have a positive impact on mental wellbeing.

“Numerous studies undertaken worldwide during COVID lockdowns have reported that individuals who are physically active are more likely to have better mental wellbeing than those who do little or no physical activity and who have increased sitting time (especially screen time). These effects have been demonstrated in a range off populations and countries and have been related to depression, stress, anxiety and subjective wellbeing. In fact, two New Zealand studies have shown that physical activity was positively associated with mental wellbeing during our initial COVID-19 lockdown (Jenkins et al., 2021, O’Brien et al., unpublished data). One of these studies showed that compared to the lowest levels of physical activity, better wellbeing scores were almost three times more likely among those who had the highest levels, and that even people reporting only moderate levels of physical activity were one and a half times more likely to reported better wellbeing. These results valid even after taking into account factors affecting physical activity and wellbeing such as age, socioeconomic status and exercise intentions. A study that gathered data from New Zealand, Australia, UK and Ireland also reported that individuals who did less exercise during lockdown (i.e., reduced their level of exercise from pre to during lockdown) had poorer mental health and wellbeing compared to those who did the same or more exercise (Faulkner et al. 2021).

“The evidence strongly suggests that almost any form of exercise, anywhere, for any amount of time has positive effects on mental wellbeing compared to no exercise. No only does this evidence support the importance of physical activity on mental wellbeing, it also highlights that the physical activity we perform does not necessarily need to be formal or structured. Simply getting moving, whether inside, outside or in front of an online exercise session will likely better equip us to endure the psychological challenges of the current and future lockdown periods.”

No conflict of interest declared.

Janey Goedhart, Clinical Exercise Physiologist and Clinic Manager, Exercise Well, comments:

“Covid-19 (Delta variant) has made its way to New Zealand, and we find ourselves in a nationwide Level 4 lockdown. High levels of stress and anxiety are a normal response to an unknown climate, so looking after yourself and others as best as possible is essential. Routine, exercise, sleep, and nutrition are easy to let slip during lockdown, so here are some simple tips to help:

“1) Be smart with your time. Exercise every day but keep it realistic. The more limitations you can take out of doing exercise, the more likely you are to consistently stick to it. Instead of planning to do an hour’s walk and not being able to fit it in, try to plan a 15–20-minute walk instead, as you will be able to fit it into your daily routine more easily. This type of short exercise will help with anxiety, mood, sleep, energy levels, and help increase your focus at work.

“2) Have a log-in, log-off time for work and stick to it. Working from home makes it tricky to differentiate work and home time. Plan your day with regular breaks, like you would usually do in the office.

“3) Drink plenty of water. Coffee and tea do not count! Any form of caffeine or alcohol stops the release of the hormone responsible for absorbing water into your bloodstream. Caffeinated drinks are dehydrating you. To break even, you’ll need to have two cups of water for each cup of coffee/tea – depending on the strength of the caffeine. Being hydrated helps with a range of things such as temperature control (if you get really hot or cold, you may be dehydrated!), skin elasticity, muscle cramps, tiredness/fatigue, increases the speed of your metabolism helping with weight loss, and much more.

“4) With the challenge of the highly-infectious Delta variant being passed through air particles, mask wearing is becoming essential in our communities. Wearing a mask helps prevent people who have the virus – but aren’t aware of it yet – from passing it on to other people.

“As we exercise, our respiration rate increases, meaning we breathe out around 100L of air per minute, compared to just 12L per minute at rest. This highlights the importance of mask wearing while exercising, especially if you can’t guarantee you will be able to stay at least 4m apart from others.

“5) Exercising with a mask on emphasises the need for deep breathing, as opposed to short, shallow breaths. Breathing in through the nose and out through the mouth should help slow breathing down, plus we are more used to warm air coming in through the nose compared to in through the mouth. Focus on air going all the way down into the lungs. Try to breathe out slightly longer than you are breathing in to get rid of the carbon dioxide from your body.

“Re-usable masks have been reported as the most comfortable to wear, plus they protect the environment. There are plenty available online, so shop around to find one you feel comfortable in.”

Conflict of interest statement: Janey Goedhart is Clinic Manager at Exercise Well, a small business that provides personalised exercise and wellness programmes to help treat or prevent long-term health conditions, chronic pain and injury.

Dr Caryn Zinn, Senior Lecturer and Dietician, Auckland University of Technology, comments:

“It’s never been a more important time to ensure optimal metabolic health. The last 18 months of evidence clearly shows that those with COVID do better if they are in good shape, metabolically. Strategies to strengthen the immune system, and your physical and mental health should be a focus, no matter how hard it might seems to achieve right now. Eating well (whole foods) and getting Vitamin D from outdoor exercise is a great start. While the temptation might be to reach for ultra-processed food for comfort, that’s the last thing the body needs right now.

“Mental health can be enhanced by daily activities that naturally release the body’s feel-good hormones that increase motivation (dopamine), closeness (oxytocin), calmness (serotonin) and delight (endorphins). Examples include being active outdoors, focusing on eating protein-rich foods, giving and receiving hugs (inside your bubble only of course), yoga / meditation, sleep-ins, new discoveries (eg. art, music) and laughter. While some things are hard to imagine doing while being locked down, they are surprisingly easy to achieve with minimal effort and a positive outlook.

“Daily case updates and vaccine encouragement is important, but so too is metabolic health; it’s disappointing that simple messaging along these lines don’t form part of daily media updates – when the entire country’s attention is tuned in.”

No conflict of interest

Associate Professor Melody Smith, Co-Associate Head (Research | Rangahau) of the School of Nursing, University of Auckland, comments:

“We know physical activity is fundamental to our physical wellbeing, importantly it also supports mental wellbeing and can help us connect with each other. Lockdowns can make it harder for us to be physically active, but now is arguably a more important time than ever to start a physical activity habit, or to maintain your activity.

“But the additional mental load of navigating these unprecedented times can make it hard to find time to even think about activity. Extra time pressures from reformulating work and life in general, including home schooling and checking in with/caring for others, alongside loss of usual supports, can all make being physically active harder than usual.

“The key thing to remember here is that any activity is better than none – starting small and building up might be a good strategy – 5 minutes a day is better than no minutes a day. It can be helpful to think of this time as giving your mind a break from any stress/anxiety/pressure you are feeling. Really focusing on the activity you are doing (like doing a body scan while exercising – how does it feel, what is my technique like, what muscles can I feel, how is my breathing going?) can help to calm your mind and reduce these feelings. Scheduling in time to be active can help keep you on track and it will be one small part of the day that you feel you have control over.

“On top of the physical restrictions we’ve become familiar with, Delta has complicated things even more. Getting fresh air and interacting with nature can help boost the benefits of physical activity and support mental wellbeing. Mask wearing and physical distancing can make outdoor activity more complicated, but are essential activities we can do to help keep everyone safe. If you find exercising outdoors with a mask uncomfortable (I’m thinking of you, runners), you might want to use some of Alert Level 4 time to focus on cross-training at home, or trying out some injury prevention activities.

“Some might be unable to get outside, or be feeling anxious about getting out of the house. Not everyone has a lot of space or equipment for being active at home, so a bit of Kiwi ingenuity is important. There’s lots of fun examples of people making up their own activity games – like exercise bingo for the ‘daily pressers’ (Covid updates), or even just using a deck of cards or a dice, and allocating an exercise for each card/number (try making your own cards or dice if you don’t have any). If you have internet access, there are lots of equipment-free home workouts worth a try. Activities like squats, lunges, press-ups, crunches, yoga, and stretching can be done with no equipment at all. A chair and some cans/bottles will help if you want to add some weight or complexity. You can even do workouts using just a towel or stretchy band. Boredom can set in here too, so change where you do your activities as much as you can – and see if you can get others to join in with you – either in your bubble or virtually online.

“If you have a garden or any green space at home, try being active in these spaces as much as possible. If not, even just opening the window and looking out while being active is worth a try. Finish off with sitting or lying down for a minute or two taking in the smells and sounds of the outdoors. Overall, the most important thing is that we’re looking after ourselves and others and getting through this together.”

Helpful links:

No conflict of interest

Professor Grant Schofield, Professor of Public Health, Human Potential Centre, AUT, comments:

“Levers for mental health and well being, especially when there’s a lockdown: My advice is to use as many of these levers as you can each day, choosing what you want to prioritise.

“1. Move! Physical movement, i.e. exercise, is a potent mood enhancer, anti-depressant, and longevity drug all in one. If in fact, it was a drug it would be the most effective medication with the least side effects ever invented! My lockdown dose – everyday – is a morning walk after waking up, then later in the day I take my bike for a short spin – with no traffic!

“2. Food is medicine. I concentrate on having as much whole unprocessed food as possible – food low in human interference, this is food that hopefully was growing, running, swimming or flying somewhere recently. That’s the opposite of ultra-processed food which is known to be associated with poor physical and mental health. I recommend eating as much whole quality food as you need to feel full.

“3. Sleep is medicine. Humans are designed to go to bed when it’s dark and wake up when it’s light. LED screens high in blue wavelength lights push the sleep hormone melatonin down and disrupt the quality and quantity of sleep. Can you think of any LED screens you and your kids spend time on? My lockdown advice: get outside when its light (see 1 above) and read a book in the hour or two before bed.

“4. You are more than just your thoughts. I’m a big fan of using Acceptance Commitment Therapy (ACT) in everyday life, especially lockdowns. ACT means that we accept that both positive and negative thoughts are part of being a fully functioning human, and living well means noticing these thoughts but not being consumed by and acting on them. Google ‘Acceptance Commitment Therapy’ and you will find some great tools which you can use right away.”

Conflict of interest statement: Grant Schofield receives funding to conduct research around physical activity and health. He is also the chief science officer for Prekure, a social enterprise which promotes education for health coaches. This includes physical activity and health.

Eating well

Emeritus Professor Elaine Rush, Professor of Nutrition, Auckland University of Technology, comments:

“The recipe for wellness includes four Fs : FOOD, FEET (walking, moving), FINGERS (not smoking) and FELLOWSHIP (good sleep, less stress and sharing with others). Maybe a fifth should be added FACE – wear a mask when leaving your bubble and use your feet to keep as distant as you can from others.

“To be the best we can be every day of our lives, we need to eat a variety of wholesome foods in sensible quantities, and for the health of the planet, mainly plants. This is very important for pregnant mothers and growing children.

“Food and shelter are human rights. What is often not quoted from the United Nations: Declaration of Human Rights is that responsible behaviour from others is also a human right. To quote: ‘We have a duty to other people and we should protect their rights and freedoms.’ (United Nations: Declaration of Human Rights).

“Our ability to function well as human beings and have a strong immune system depends on the five Fs. To focus on food, our wellness as a nation depends on feeding the team/whanau of 5 million well first, then feeding others. We are told that New Zealand is not short of food but in lockdown access to food generally and having enough money is a challenge to many and identifies complex problems with our food system – getting the food from farm to fork.

“Lockdown is an opportunity, where possible, to focus on food, to enjoy and share what you have with those in your bubble and if you can, to help the many volunteers and organisations. Foodbank.co.nz is one place to start- to find local food banks or where to donate.

“For the future we need to examine the ability of New Zealand to feed its own well and to work harder to protect the wellness of the land and water that we have. Our farmers produce good food, and special kudos to those who produce a variety of coloured vegetables and fruits. These foods should be half of the volume of all food eaten.

“Tips: Tinned and dried vegetables, fruit, and legumes are great for lockdown and also the emergency kit – or frozen foods if you have a freezer. Be kind to your body, feed it well.”

No conflict of interest.

Mask discrimination

Dr Amanda Kvalsvig, Epidemiologist, Department of Public Health, University of Otago, Wellington, comments:

“As an epidemiologist I’m very relieved that mask-wearing is becoming an integral part of our pandemic response. But as a deaf person it saddens me that the New Zealand public is being forced to negotiate this change without a national-level programme of communication guidance and support. Many people look at faces to know what’s being said. That includes people who identify as disabled, but it also includes virtually anyone with some degree of hearing impairment. The combination of loss of information from faces, speech muffled by masks, and background noise makes for a big communication challenge.

“I can confirm from my own experience as a deaf person that it’s extremely anxiety-producing to be in a situation where people are giving you important information but you can’t access what they’re saying. At best it’s frustrating for both sides. At worst, it’s simply terrifying: you know you’re being given bad news but you don’t know what’s happened.

“It is an absolute no-brainer that if the Government is requiring people to wear masks, communication support must be right there wherever people need it. There should be relevant communication training and resources available for all staff in public-facing roles. Resources could include clear masks for key roles, visual information that uses text or images, and access to NZSL interpreters. In particular these measures will apply to staff managing travel at the border and at all healthcare settings that are operating at Alert Level 4. There should also be guidance for the general public, who want to do the right thing but need some pointers.

“I welcome the announcement that New Zealanders are being asked to wear masks when they leave home. This is a key outbreak control measure because it significantly reduces the amount of virus that people are breathing into the air around them. So it’s especially relevant in the current situation when we don’t know the extent of community spread, and potentially a large number of people in the community may be infectious without knowing it.

“There are two main ways to maximise the effectiveness of wearing a mask. The first is to add multiple layers to increase the filtering effect – aiming for at least three layers, more if you can. The second is to make sure your mask fits closely around your face so that no air is escaping out of the sides. If you can, ask someone to check your mask before you go out so you’re confident that there are no gaps.

“A final reminder is that communication will be challenging when everyone is masked up. We’ll need to be patient and creative in our interactions with strangers. It might be helpful to point to things, write key messages down, or show somebody an image or text on your phone. Alert Level 4 is a great opportunity to brush up on your finger-spelling skills – that’s the alphabet of New Zealand Sign Language. It’s a great way to clear up confusion when someone is struggling to hear.”

No conflict of interest declared.

Associate Professor Elspeth Tilley, School of English and Media Studies, Massey University, comments:

“If people are wanting to do the ethical thing during this outbreak, the simplest bottom line of ethical reasoning is ‘do no harm’. It is therefore ethical (as well as legal) to wear a mask because evidence shows this reduces harm to ourselves and others. However, evidence also shows that some people may be harmed by enforcing mask use on them. For those people an exemption applies, such as for health reasons. For everyone else, the rule of ‘do no harm’ still applies. We need to ask ourselves; how will our reaction to someone not wearing a mask help or harm others?

“When our fear is heightened during a crisis, we can tend to rush to judgement more quickly than at other times, without thinking through the consequences. This is a natural stress response. But we need to slow down and ask ourselves, does our fear-based judgement risk doing harm?

“Given we do not have any information about the people we see wearing or not wearing masks, to ensure we do no harm, the most ethical response is to attend to our behaviours rather than the behaviour of others. This goes for social media, too. There is a complex list of situations in which mask-wearing might be exempt, and given we are not experts in the situation of others, to avoid harm through rushing to uninformed judgement, the ethical response here is also the simplest: to mind our own business.

“Even if someone were breaking the law in not wearing a mask, it’s very unlikely that such a person would shift their behaviour because of being ‘called out’ in person or on social media – in fact, the ‘boomerang effect’ as it is called in communication studies, shows that shaming a dogmatic person only reinforces their behaviour. So, commenting negatively on others’ mask use is unlikely to change anything, risks reinforcing wrongdoing, and risks doing harm to people with a legitimate exemption.”

No conflict of interest.

Behaviour change after 2020 lockdown

Associate Professor Leah Watkins, Department of Marketing, University of Otago, comments:

“The 2020 Consumer Lifestyles survey directly asked respondents about changes to their consumer behaviour after lockdown in 2020. Many long-standing consumer habits – more money spent on services, greater digital adoption and more time and money spend out of the home – have been interrupted, accelerated or reversed due to the pandemic. This data, collected 6 months out of lockdown for New Zealand, may indicate which of those changes will stick.

“57% of consumers report being more mindful about what they consume since lockdown last year, 43% say they have reduced their consumer spending, more of them shop locally (52%) and 42% have shopped online more. The reduction in consumer spending was significant across most product categories, in particular, restaurants, entertainment outside of the home and travel. Spending remained the same for personal care, household supplies and entertainment at home. The only category to increase was groceries, which aligns with 54% of people reporting that they have increased their home cooking. People also report changes to the nature of spending, with 41% buying less designer and luxury products and 38% switching to less expensive brands with 33% having tried new brands. The pandemic has accelerated some new behaviours, albeit from a low base, with 16% saying they will continue to use telemedicine, 16% will keep using meal kits and 23% will keep using fitness and wellness apps.

“Decreased consumer spending has led to changes in debt and savings behaviour, with 26% of consumers saying they have reduced debt, 35% increased saving and 24% increased investing. Changes also evident in the data, such as consumers making substantial investments in their home (‘home-nesting’) and shifts in loyalty, with consumers changing their shopping behaviours and their preferred brands, have also been noted in other countries around the world (e.g. McKinsey and colleagues, 2020). With regards to patterns of work, 32% of respondents said they have continued to work from home and 44% continue to use Zoom.”

No conflict of interest

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