The lifestyle of Brazilian medical students: What changed and how it protected their emotional wellbeing during the COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: Adopting healthy lifestyle pillars promotes longer lives free from major chronic diseases. The COVID-19 pandemic imposed behavioural changes and psychological burdens. The aim of this study was to assess changes in medical students' six lifestyle pillars that were imposed by the COVID-19 pandemic. METHOD: This cross-sectional study included 548 Brazilian medical students' digitally collected demographic data and lifestyle characteristics from before and during the pandemic. RESULTS: The pandemic had a neutral impact on sleep quality and a predominantly negative impact on interpersonal relationships, exercise and eating. Approximately 67.5% students decreased their tobacco and alcohol use. Spirituality was maintained at 66%. Those who reported having emotional wellbeing (27.9%) during the pandemic fulfilled a higher number of pre-pandemic lifestyle pillars (median [IQR]) when compared with those who reported an absence of wellbeing (4 [3-4] pillars, compared with 3 [2-4], P = 0.006). DISCUSSION: The results reinforce the importance of adhering to as many lifestyle pillars as possible to preserve emotional wellbeing during periods of stress such as those experienced during the pandemic.

The lifestyle of Brazilian medical students

Discussion The results reinforce the importance of adhering to as many lifestyle pillars as possible to preserve emotional wellbeing during periods of stress such as those experienced during the pandemic. the coviD-19 pandemic has grown exponentially worldwide since December 2019.1 Brazil implemented social distancing on 13 March 2020,2 which caused increasing distress and directly affected individuals mental health,3 work structures, lifestyles and interpersonal relationships.2 The lifestyle medicine pillars are based on healthy eating, routine exercise, stress management, avoidance of risky substances, positive relationships and better sleep.4 People who adopt healthy lifestyle pillars have a longer life expectancy, free from major chronic diseases such as diabetes, cardiovascular diseases and cancer, when compared with people who do not adopt healthy lifestyle pillars.5-8 Spirituality helps individuals to develop a sense of purpose in life and has been shown to equip individuals with highly effective strategies for coping with stress.9 Considering the pandemics impact on health behaviours, people will likely change how they deal with each pillar. Sleep is an essential biological function that mediates and reflects psychosocial functioning and quality of life.13 Its chronic restriction and poor quality influences wellbeing and mental health.14 In the present study, 60% of the students already had regular- or poor-quality sleep before the pandemic, similar to the Ribeiro et al study.15 This similarity can be explained by the heavy academic schedule of medical students.16 As expected, 34.5% of the students reported that their sleep quality worsened during the pandemic, similar to results seen in a Greek study.17 In contrast, approximately 36% of students in the present study reported improved sleep quality during the social distancing period, possibly because their time to rest increased as a result of reduced external activities. Physical activity reduces depression and anxiety,18 stabilises mood and improves cognition.19'20 In Brazil, 47% of the population is insufficiently active.21 However, almost 80% of the students in this study were previously physically active, but only 39.1% met the criteria for sufficient activity.22 Home isolation has previously been shown to profoundly decrease moderateto-intense physical activity levels and increase sedentary behaviour.23'24 In the present study, 33% of students worsened in the physical exercise pillar. Diverging from the present sample, men in the state of Rio de Janeiro, Brazil, had approximately 38% more opportunities to exercise during the quarantine period than women.25 However, a study of Italian university students concluded that females (approximately 22 years of age) who were previously active were more likely to reach the recommended levels of physical activity during the pandemic.26 Although 55% of students in this study self-reported a previously good or very good quality of eating, 43% of students' eating habits worsened.