Journal of Preventive Medicine

Introduction
The negative psychological effects of social distancing and quarantine during the COVID-19 pandemic have been reported in various studies. Quarantine and social distancing caused a great decrease in communications and social gatherings. This also affected the sports and caused the cancellation of important events and championship competitions in the world including the 2020 Olympic Games, as well as the closure of large and small sports clubs. Emotional eating is a response to negative feelings such as anger, depression, anxiety, anger, and loneliness. Evidence shows that the type of foods, diets, and feelings are related to one another in many ways such that negative feelings can lead to an increase in high-energy food intake. This study aims to assess whether there is a relationship between the emotional eating caused by quarantine during the COVID-19 pandemic and the physical and mental health of elite athletes.

Methods
This is a descriptive-correlational survey. The study population includes elite athletes from different provinces of Iran in 2020-2021. Due to the fact that the volume of the study population is unknown, the maximum number (n=384) was determined as the sample size based on the Cochran formula. The sampling was done using cluster random sampling method. Those with a history of participation in the national team camp or Asian and world competitions were selected. The demographic questionnaire was used to survey information about gender, age, height, weight, history of sports activity, the level of activity, history of infection with COVID-19, place of residence and monthly income. To measure physical activity of participants, the international physical activity questionnaire (IPAQ) developed in 1998 by the World Health Organization (WHO) was used. The impact of event scale-revised (IES-R) and the depression, anxiety, and stress scale-21 (DASS-21) were used to measure the psychological health of participants. To measure their emotional eating, the emotional eater questionnaire (EEQ) was used. Data analysis was done in SPSS software, version 26 using Pearson correlation test, linear regression analysis, and multivariate analysis of variance.

Results
The results showed a positive and significant relationship between IPAQ and EEQ scores (R=0.594, P=0.027), a negative and significant relationship between the body mass index (BMI) and EEQ score (R=-0.710, P=0.019), and a positive and significant relationship between the scores of IES-R (R=0.131, P=0.010) and DASS-21 (R=0.113, P=0.026) with EEQ score. The results of bivariate simple linear regression showed that IPAQ score (t=0.567, P=0.004) and BMI (t=0.420, P=0.004) had the ability to predict emotional eating habits. In the regression model, the value of the correlation coefficient between psychological health and emotional eating habits was 0.7 (P=0.001). Also, the value of the adjusted coefficient of determination was 0.49, indicating that 49% of the total variance in psychological health can be explained by the emotional eating and the rest (51%) contribute to factors outside the model. 

Conclusion
The results of this study showed that the physical activity and psychological health of elite athletes in Iran have a significant relationship with emotional eating habits caused by quarantine the COVID-19 pandemic. In this regard, Zare et al. also showed that physical activity had a significant effect on the level of perceived mental stress during the quarantine and it was able to significantly reduce it. Nabilpour et al. showed a correlation between the psychological well-being of bodybuilders and physical activity during the quarantine. Our results also showed that during the quarantine, the amount of food consumption at homes increased in elite athletes, and more than one-third of them stated that during this period, they stored more quantities of packaged foods at home that can be remained for a long time. Psychological interventions can be useful in the early stages of a pandemic, when anxiety and worry are expected to be high, and also in later stages, when people are exposed to traumatic events such as witnessing the death of friends and loved ones and unresolved grief. During the pandemic, physical and mental health professionals should actively participate in psychological intervention of athletes to improve their mental and physical health and skills such as resilience.

Ethical Considerations
Compliance with ethical guidelines
Ethical approval was obtained from the Ethics Committee of Baqiyatallah University of Medical Sciences (Code: IR.BMSU.REC.1399.139).

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions
Study design and statistical analysis: Atefeh Esmaili; Data collection: Morteza Taheri and Atefeh Esmaili; Resources and preparation of initial draft: Khadija Irandoost and Maghsoud Nabilpour; Review and editing: All authors.

Conflicts of interest
The authors declared no conflict of interest. 

Acknowledgements
The authors express their gratitude to all athletes participated in this study.

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