**3. Results**

#### *3.1. Intergroup Comparisons*

In the first step of the conducted analysis, levels of weekly physical activity of the subjects were compared. Results are shown in Table 2.


**Table 2.** Comparison of physical activity levels of women and men.

Markings: *n*—count, *%*—percent, *x*2—c2 test value, *p*—significance level, *V*—effect size expressed by Crammer's *V* coefficient, \*—levels of weekly physical activity were distinguished based on results expressed in MET units.

Nearly three-quarters of the women surveyed showed a sufficient level of weekly physical activity. A high level of activity characterized 15.0% of female respondents, and a low level of activity characterized more than one-tenth of female respondents.

In the group of men, more than three-quarters of the study participants were characterized by a high level of weekly physical activity. The activity of nearly one-fifth of the respondents was sufficient, while the lowest percentage of men showed insufficient weekly physical activity.

The analysis resulted in a strong statistically significant gender effect for weekly physical activity.

Women, compared to men, less often revealed a high level of physical activity, while more often, their weekly activity was classified as sufficient and insufficient.

In the second step of the analysis, the level of physical activity, mental health, cognitive processes and the quality of social functioning of the surveyed women and men were assessed. The results of the comparative analysis are presented in Table 3.

**Table 3.** Comparison of physical activity, mental health, cognitive processes and social functioning of women and men.


Markings: *M*—mean, *SD*—standard deviation, *t*—value of Student's *t*-test for independent data, *p*—significance level, *d*—measure of Cohen's *d* effect size, \*—results expressed in MET units, \*\*—raw results, \*\*\*—results expressed in sten.

The weekly physical activity of the surveyed women was classified as sufficient. However, in the male population it reached a high level. Regardless of gender, the respondents spent the most time on walks, then on intense physical activity, and the least on training with a moderate level of vigorous activity and passive rest (sitting, lying down).

The general mental health of the study participants was within the upper limit of the average results, which also suggests that in the analyzed population of women, in the event of the occurrence of adverse factors generating severe and chronic stress, there may be a risk of developing symptoms characteristic of mental health disorders. In women, somatic symptoms were most severely intensified, followed by anxiety and insomnia, symptoms of depression and symptoms typical of disorders in everyday functioning. In the group of men, the overall mental health condition was moderate. The respondents were dominated by a sense of anxiety and insomnia, while functional disorders, somatic symptoms and symptoms of depression were less severe.

The functioning of the cognitive processes of the studied populations was classified as moderate. In the female population, the most pronounced difficulties related to perceptual work, followed by perception deficits and attention deficits. The highest intensity of perception deficits was observed in men, while the problems with perceptual work and attention deficits were at a slightly lower level.

Social functioning of the analyzed groups was in the area of moderate results. Women did best in family relationships and among acquaintances and friends, and the worst

in professional interactions. Men showed the highest level of coping skills in interpersonal relationships, then in family relationships, and the poorest quality of interactions in professional relationships.

As a result of the comparative analysis, a strong gender effect was noted for moderate activity; moderate gender effects for weekly activity, somatic symptoms, cognitive functioning, perceptual work, attention deficits and professional relationships; and weak gender effects for walking, vigorous activity, mental disorders, functional disorders, depressive symptoms and family relationships.

Compared to men, women showed a lower level of weekly physical activity, walking, moderate physical activity and vigorous physical activity, as well as a lower quality of family relationships. Moreover, more severe mental disorders, somatic symptoms, functional disorders, depressive symptoms, cognitive disorders, perceptual work disorders, attention deficits and a higher quality of relationships in the area of professional life were more often noted in the female population than in men. On the other hand, sitting and lying down, anxiety and insomnia, perception deficits, social relationship and interpersonal relationships were at a comparable level in the analyzed groups.

#### *3.2. Estimation of Measurement Models*

Prior to estimation of the complete interactive structural model presenting the relationships between physical activity, mental health, cognitive disorders and social functioning, its four measurement parts were estimated. Model specifications were carried out in the group of women and men.

In the first measurement model, physical activity is a latent variable, while its partial indicators are walking, moderate activity and vigorous activity. Figure 1 shows the results of verification of the constructed model of physical activity measurement in the group of women, and Figure 2 illustrates the measurement model of physical activity in the group of men.

As a result of the estimation, the following measures were obtained: CMIN/DF = 1.75; GFI = 0.99; AGFI = 0.99; NFI = 0.99; RFI = 0.95; IFI = 0.99; TLI = 0.99; CFI = 0.99; RM-SEA = 0.001(0.001; 0.05); PCLOSE = 0.92; *N* HOELTER(1269; 1561), which confirm that the model reflects the nature of the relationships between the analyzed variablesvery well. The standardized values of factor loadings and the percentages of variances explained in each of the analyzed groups show that the constructed model of physical activity measurement is acceptable.

**Figure 1.** Standardized effects of the model of physical activity measurement in the group of women.

**Figure 2.** Standardized effects of the model of physical activity measurement in the group of men.

In the second measurement model, the presence of mental health disorders is an unobservable variable, and its partial indicators are somatic symptoms, anxiety and insomnia, functional disorders and the symptoms of depression. The results of the verification of the constructed model for measuring mental health disorders in the group of women are shown in Figures 3 and 4 illustrates the measurement model of mental health disorders in the group of men.

**Figure 3.** Standardized effects of the mental health disorder measurement model in the group of women.

**Figure 4.** Standardized effects of the mental health disorder measurement model in the group of men.

The following measures were obtained during the verification of the model: CMIN/DF = 1.75; GFI = 0.99; AGFI = 0.99; NFI = 0.99; RFI = 0.95; IFI = 0.99; TLI = 0.99; CFI = 0.99; RMSEA = 0.001(0.001; 0.05); PCLOSE = 0.92; *N* HOELTER(1116; 1442), which confirm that it is correctly fitted to the data, and the standardized values of factor loadings and the percentages of variances explained in the group of women and men allow for recognizing the constructed model of mental health disorders measurement as acceptable.

In the third measurement model, the presence of cognitive disorders is an unobservable variable, and its partial indicators are perceptual work, perception deficits and attention deficits. The results of the verification of the constructed model for measuring cognitive disorders in the group of women are shown in Figures 5 and 6 illustrates the measurement model of cognitive disorders in the group of men.

**Figure 5.** Standardized effects of the measurement model of cognitive disorders in the group of women.

**Figure 6.** Standardized effects of the measurement model of cognitive disorders in the group of men.

As a result of the estimation, the following measures were obtained: CMIN/DF = 1.75; GFI = 0.99; AGFI = 0.99; NFI = 0.99; RFI = 0.95; IFI = 0.99; TLI = 0.99; CFI = 0.99; RMSEA = 0.001(0.001; 0.05); PCLOSE = 0.92; *N* HOELTER(1317; 1596), which confirm that the model reflects the nature of the relationships between the analyzed variablesvery well. The standardized values of factor loadings and the percentages of variances explained in each of the analyzed groups show that the constructed model of cognitive disorders measurement is acceptable.

In the fourth measurement model, social functioning is an unobservable variable, and its partial indicators are support received from family members, friends, colleagues and medical professionals. The results of the estimation of the social support functioning model in the group of women are presented in Figures 7 and 8 illustrates the measurement model of social functioning in the group of men.

**Figure 7.** Standardized effects of the measurement model of social functioning in the group of women.

**Figure 8.** Standardized effects of the measurement model of social functioning in the group of men.

The following measures were obtained: CMIN/DF = 1.75; GFI = 0.99; AGFI = 0.99; NFI = 0.99; RFI = 0.95; IFI = 0.99; TLI = 0.99; CFI = 0.99; RMSEA = 0.001(0.001; 0.05); PCLOSE = 0.92; *N* HOELTER(1335; 1428), which confirm its compliance with the data. The standardized values of factor loadings and the percentages of variances explained in the groups analyzed indicate that the constructed model of social functioning measurement is acceptable.

#### *3.3. Structural Model Estimation*

The estimation and acceptance of the constructed measurement models allows for the estimation of the full interactive structural model, which was developed on the basis of the theoretical frameworks. As in the case of measurement models, its specification was carried out in the group of women and men. Figure 9 shows the construction and detailed standardized parameters of the interactive model of the relationship between physical activity, mental health, cognitive disorders and social functioning in the group of women, and Figure 10 depicts the results obtained in the group of men.

The accuracy of the interactive structural model was positively verified based on the following measures of goodness of fit: CMIN/DF = 1.38; GFI = 0.99; AGFI = 0.97; NFI = 0.98; RFI = 0.96; IFI = 0.99; TLI = 0.99; CFI = 0.99; RMSEA = 0.019 (0.008; 0.28); PCLOSE = 1.00; *N* HOELTER(1008; 1120).

In the group of women, the constructed model explained 51.0% of social functioning, which reflects the quality of tolerable family, interpersonal and professional relationships, and in the population of men, 41.0% of the variance of the analyzed variable was explained. In the group of women, there was a strong, directly proportional correlation between mental health disorders and cognitive disorders (*p* = 0.001), as well as a weak negative relationship of physical activity with mental health disorders (*p* = 0.001) and with cognitive disorders (*p* = 0.001). There was also a moderate, inversely proportional relationship between mental health disorders (*p* = 0.001) and social functioning, as well as a weak relationship between cognitive impairment and social functioning (*p* = 0.002).

In the group of men, there was a strong, directly proportional correlation between mental health disorders and cognitive disorders (*p* = 0.001), as well as a moderate negative relationship of physical activity with mental health disorders (*p* = 0.001) and with cognitive disorders (*p* = 0.001). There was also a moderate, inversely proportional relationship between mental health disorders (*p* = 0.001), cognitive disorders (*p* = 0.001) and social functioning.

**Figure 9.** Standardized effects of the structural model of the relationship between physical activity and psychosocial functioning in a group of women.

**Figure 10.** Standardized effects of the structural model of the relationship between physical activity and psychosocial functioning in a group of men.

The model shows that the consequences of the COVID-19 epidemic in Eastern Poland expressed in the form of mental health disorders and symptoms typical of cognitive disorders were moderated by physical activity from various sources. The more often the respondents engaged in physical activity by going for walks and training moderately and vigorously, the lower the risk was of developing mental disorders, manifested in the form of somatic symptoms, anxiety and insomnia, functional disorders and the symptoms of depression, as well as the occurrence of cognitive disorders, such as perceptual work disorders, perception deficits and attention deficits. Moreover, physical activity weakened the relationship between mental health disorders and disorders of cognitive processes and social functioning in family, interpersonal and professional relationships of the studied groups.

It should also be added that the comparisons of the values of parameters within and between groups showed that the relationship between mental health disorders and cognitive disorders was comparable in each group and stronger than the correlations between physical activity and mental health disorders and cognitive disorders. Moreover, in the case of women, the leading factor associated with the quality of social interactions was the state of mental health, which was less dependent on the level of physical activity than on the functioning of cognitive processes moderated by physical effort, while the quality of male social interactions depended on the relationship between the state of mental health and the cognitive functioning that is impaired by physical activity. In the population of women, compared to men, physical activity was less important for mental health and the functioning of cognitive processes, and the occurrence of symptoms typical of mental health disorders was more strongly associated with the quality of social interactions of women than men. It has also been shown that disorders of cognitive processes correlate more weakly with the social functioning of women than men.

## **4. Discussion**

The outbreak of the COVID-19 pandemic caused severe and long-lasting stress in many people from different countries of the world, the relatively common consequences of which were mental health problems associated with deterioration of cognitive and social functioning [6,53,54]. Despite many published empirical studies devoted to the discussed issue, the role of physical activity in the prevention of psychosocial functioning of the inhabitants of Eastern Poland has not been analyzed so far [53,55,56].

Therefore, research was carried out to assess the level of physical activity, mental health, cognitive processes and social functioning, as well as the interactions and relationships between them, in the population of Eastern Poland, depending on gender.

With regard to the above goals, two hypotheses were formulated. The first of them assumed that during the COVID-19 pandemic, in the inhabitants of Eastern Poland, the level of physical activity and the severity of symptoms characteristic of mental health disorders, cognitive disorders and the quality of social functioning differed depending on gender.

The conducted analysis allowed us to positively verify the adopted assumption in terms of statistically significant gender differences regarding levels and severity of weekly activity, as well as the severity of vigorous activity, moderate activity, walking, mental disorders, somatic symptoms, functional disorders, depressive symptoms, cognitive disorders, perceptual work, attention deficits, family relationships and professional relationships. It has been shown that women were less likely than men to show a high level of physical activity, but more often their weekly activity ranked at sufficient and insufficient levels. It was also noted that surveyed men showed higher than average physical activity, walking, moderate physical activity and vigorous physical activity than women, and they functioned more efficiently in family relationships, but had more difficulty finding their way in professional interactions. Moreover, men showed a lower severity of mental disorders, somatic symptoms, functional disorders, depressive symptoms, cognitive disorders, perceptual work disorders and attention deficits as compared to women.

The men had a moderate state of mental health and cognitive processes, while women's scores in mental disorders and perceptual work disorders were approaching the edge of the elevated area. The average weekly physical activity of men was high, and that of women was at a sufficient level, with the activity of more than three-quarters of the men surveyed being high, at nearly one-fifth sufficient, and 5.8% insufficient. In contrast, the women's group reported markedly different results. Almost three-fourths of the female respondents showed a sufficient level of activity, while high and low activity levels were reported by 15.0% and 13.7% of the respondents, respectively.

Comparing the data obtained with the results of surveys conducted in other regions of Poland and the world, one can see significant discrepancies. The research already mentioned in the theoretical introduction proves that both men and women from the northeastern part of Poland manifest an insufficient and significantly understated level of physical activity in comparison to residents of other regions of this country and European

countries. At the same time, men engaged in moderate physical activity and rode a bicycle more frequently than women [33].

Another empirical study also observed that women reported lower moderate physical activity than men, but were more likely to engage in light physical activity. It is worth noting, however, that because the study was conducted in a population of patients with a diagnosis of peripheral artery disease, vigorous activity was not analyzed in the study [57].

In contrast, a Canadian study, similar to our own, reported that women were less physically active than men during the COVID-19 pandemic, a result that was statistically significant [58]. Analogous observations have also come from the general population of Beirut [59]. In addition, women reported more barriers to engaging in systematic physical activity and reported significantly weaker mental fitness than the opposite sex [58,59]. A key observation appears to be that, among women, the most severe adverse mental health symptoms occurred in subjects whose physical activity was very low [58].

Thus, both the results of our own study and the conclusions of the work of other researchers sugges<sup>t</sup> that, especially in the group of women, in the event of the occurrence or intensification of the impact of existing stressors, there may be a risk of developing undesirable symptoms in the state of mental health and cognitive processes [60]. This observation seems to be particularly important in the situation of a prolonged health crisis, because the effectiveness of coping, under the influence of chronic distress, may show a downward trend, and this directly implies an increased risk of undesirable symptoms in the field of mental health [61].

This effect was observed by Di Maio's team. On the basis of the conducted moderation analysis, he noted that the belief in the possessed remedial abilities was directly related to physical activity in a situation where the encountered challenges were relatively low. On the other hand, when these challenges were high, the relationship between physical effort and faith in one's abilities did not reach the level of statistical significance. The observed dependencies confirm the need to monitor not only direct but also long-term consequences in terms of the mental health of people affected by the COVID-19 pandemic [62].

The need to conduct this type of longitudinal research is also indicated by other researchers who, while forecasting the upcoming increase in the number of patients with depressive and anxiety disorders resulting from the current health crisis, as well as from the current problems of the mental health care system, point to the important role of physical activity in preventive interventions [7,63]. Systematic endurance training, by activating the HPA axis, stimulates the release of dopamine, which is responsible for self-regulation and mood [64,65]. The results of the meta-analysis, which included the data of 40,550 adults, show that the respondents who undertook systematic physical activity, compared to women and men with moderate and low activity, were less likely to develop mental disorders. The highest risk group was those who led a sedentary lifestyle [66], while the level of physical activity, physical fitness, mental health, cognitive processes and the quality of functioning in social interactions were higher in men than in women [67–70].

In this context, it should be noted, however, that the relationships between the aforementioned variables in the interactive and multidimensional approach have not been analyzed so far [71,72]. Taking into account the above premises, the second hypothesis assumed that during the COVID-19 pandemic in the inhabitants of Eastern Poland, depending on gender, the following are different: the importance of interactions between physical activity, mental health and cognitive disorders for social functioning.

The constructed structural model of the relationship between physical activity and selected aspects of psychosocial functioning allowed for a positive verification of the assumption. As a result of its estimation, in the group of women and men, the existence of interactions between physical activity, disorders of mental health and cognitive processes was confirmed, and their association with the social functioning of the analyzed groups was verified. Systematic physical activity, including intense and moderate endurance training and walking, was negatively associated with symptoms characteristic of mental health disorders, which include symptoms of depression, functional disorders, anxiety and insomnia and somatization, as well as cognitive disorders manifesting as weakened speed of perception and deficits in perceptiveness and attention to social functioning of the respondents.

In the case of women, the leading factor related to the quality of social interactions was the state of mental health, which was less dependent on the level of physical activity than on the functioning of cognitive processes, while the quality of men's social interactions was most dependent on the relationship between the state of mental health and the functioning of cognitive processes. Moreover, in the group of women, compared to men, physical activity was more weakly linked to the state of mental health and the functioning of cognitive processes, and the occurrence of symptoms typical of mental health disorders had correlated more strongly with the quality of women's social interactions than men's. In turn, cognitive disorders were more weakly linked to the social functioning of women than men.

Relating the observed regularities to the conclusions of the empirical works of other researchers, it can be seen that they are to some extent similar [67,73]. In a sample of 5856 adults aged 26–70 years, it was noted that in the male population, physical activity was more negatively associated with problems in the sphere of mental functioning than in the group of women [67].

Another empirical study positively verified and moderated the role of gender in relation to physical activity, health-related quality of life and perceived social support. It was shown that people with the lowest assessments of mental health status had a 1.8 times lower probability of obtaining social support than respondents who showed high and average assessments of mental condition, while the participants with the lowest results in terms of physical health were twice as likely to be deprived of the help of their relatives than women and men who perceived their somatic health as very good or average. Moreover, men with low physical activity compared to women more often reported poor mental and somatic health and a lower overall quality of life than women. It should be added, however, that the discussed model did not take into account the symptoms characteristic of cognitive disorders [73].

Summing up the discussion, it is worth emphasizing that the results of our own research seem promising in the context of preventing the psychosocial functioning of adult inhabitants of Eastern Poland who have been affected by the COVID-19 epidemic. Nevertheless, due to the existing limitations, the observed effects require further empirical verification.

The aforementioned limitations include the fact that, in order to minimize the risk of SARS-CoV-2 infection and taking into account the epidemic restrictions in the country, the study was conducted online, which might not have been fully comfortable for the participants. In addition, the study sample consisted of volunteers, who had access and the ability to use a computer, which, despite a relatively large number of observations and controlling for a number of side variables, could have affected the results. Consequently, the data may not fully reflect the psychosocial situation in the Eastern region of Poland. In addition, the study population was made up exclusively of people who were employed and those in marriages and partnerships. This suggests, therefore, that the research results obtained should be generalized, with some caution, only to the population of healthy, economically active residents of Eastern Poland with life partners.

It should also be added that there were no people infected with the SARS-CoV-2 coronavirus and COVID-19 patients among the participants, so in the subsequent studies, it would be worth verifying whether this factor differentiates mental health disorders, cognitive disorders and social functioning. Another area requiring exploration is the determination of the level of physical activity and these parameters and the relationships between them in the population of medical staff, especially those who specialize in COVID-19 treatment. Due to the specificity of their work, the indicators of physical activity, mental health and cognitive problems as well as social functioning may be higher in this group than in the general population. It is also important to mention that the region of Eastern

Poland is characterized by a relatively low transmission of the SARS-CoV-2 coronavirus; therefore, the psychosocial consequences of the epidemic may be lower in the inhabitants of this part of the country than in those affected by a higher epidemic risk.

Another aspect that should be mentioned in the context of discussing the limitations of the presented results is that due to the cross-sectional nature of the research and the lack of data from before the outbreak of the pandemic, the conducted analysis showed only the current intensity of individual parameters and the strength of the relationships between them; however, the dynamics of changes under the influence of SARS-CoV-2 transmission were not estimated. For this reason, it is not possible to precisely determine to what extent the current pandemic situation has influenced the change in the intensity of the analyzed variables and the strength of their relationships.

It is also worth mentioning that the measurement of physical activity was carried out using the short form of the questionnaire (*IPAQ-SF*), which may have made it slightly less reliable than the full version (*IPAQ*) [25,50]. However, the decision to choose the *IPAQ-SF* was based on the suggestions of the authors of the Polish adaptation of the test, who, based on the conclusions of a number of empirical studies, recommend the use of the abbreviated Polish version of the tool for research conducted both within one country and conducted internationally. They point out that the full version of the *IPAQ*—due to its detail—requires much greater involvement of the subjects, and this in turn directly implies impatience, a tendency to give random answers, skip questions or drop out of the survey [50]. Researchers from other regions of the world have also encountered similar problems with the full version of the test [25]. Given that in our study, in addition to the test used to measure physical activity, four other questionnaires were used, the aforementioned risks were reduced by using the *IPAQ-SF* [25–50].

Nevertheless, the presented study is the first and largest project focused on the analysis of the psychosocial functioning of the inhabitants of Eastern Poland during the COVID-19 epidemic, in which diagnostic tools with high psychometric properties and advanced statistical methods were used. This allowed for the visualization of the structure of mutual and multifaceted relationships between particular variables in the group of women and men.

Moreover, the discoveries are of grea<sup>t</sup> cognitive and practical importance. Determining the current level of psychosocial functioning of the inhabitants of Eastern Poland during the pandemic, in terms of the level of physical activity, mental health, cognitive processes and the quality of social functioning, as well as verifying the occurrence and significance of interactions and relationships depending on gender, not only enriches knowledge about the mechanisms shaping the responses of adults to the current health crisis, but it is above all the basic element that allows for taking effective preventive actions. Confirmation that various forms of physical activity are a factor protecting against negative effects on mental health, cognitive processes and social functioning may constitute the basis for developing gender-individualized, interdisciplinary psychopreventive interventions aimed at strengthening the intrapsychic and interpersonal spheres of women and men at risk of the negative consequences of SARS-CoV-2 transmission.
