Social cognitive theory (SCT) emphasizes the significance of self-efficacy, which refers to an individual’s confidence in their ability to perform behaviors required to achieve specific outcomes (Islam et al., 2023; Riley et al., 2016). Self-efficacy influences home-based physical activity (HBPA). For example, suppose that people believe that they can successfully engage in physical activity at home. They are more likely to participate in these activities, leading to improvements in mental and physical health, sleep quality, and psychological resilience (Schunk and DiBenedetto, 2016; Schunk and DiBenedetto, 2020). Furthermore, emotional characteristics such as psychological resilience (Gürsoy and Toksoy, 2023; McDaniel et al., 2022), physical fitness (Baretta et al., 2019; Islam et al., 2023), and mental health affect individuals’ ability to engage in home-based physical activity (Ertokus, 2022; Frutos et al., 2023; Furushima et al., 2018). Individuals with higher psychological resilience are more likely to engage in physical activity and reap its health benefits (Junge et al., 2013; Noseworthy et al., 2023). The environmental factors represented in the model (infectious diseases and their prevention) can influence behavior. According to SCT, environmental factors such as the availability of resources (e.g., online exercise programs) and social support (e.g., encouragement from family and friends) play a critical role in facilitating or hindering physical activity (Zhang and Zhao, 2023). During an infectious disease outbreak, the constraints of isolation measures can serve as both motivators and barriers to effective action. SCT explains that if the environment provides opportunities for home-based physical activity and individuals perceive support or have access to resources, they are more likely to engage in and maintain physical activity (McNamara et al., 2023). In contrast, physical fitness is positively associated with better health outcomes and a higher quality of life. As individuals engage in daily exercise, their physical fitness improves, which may further enhance their mental well-being (de Rondão et al., 2023; IJntema et al., 2023; Zhang and Zhao, 2023). Adequate sleep is crucial for overall health and well-being, and physical activity improves sleep quality. Therefore, engaging in physical activity may have a positive impact on sleep (Baretta et al., 2019; Compton and Shim, 2020), which may further improve health-related quality of life (WHO, 2023; Yuan et al., 2020). Mental health issues are also crucial aspects of health-related quality of life. Engaging in physical exercise has been shown to positively impact mental health and is associated with numerous other health benefits. In summary, this conceptual framework posits that HBPA may positively impact psychological resilience, physical fitness, sleep, and mental well-being, thereby improving the health-related quality of life of patients with infectious diseases.

The emergence of an infectious disease often triggers widespread fear, uncertainty, and stress (Bandura, 2004; Clair et al., 2021; Compton and Shim, 2020). People experience anxiety about contracting the disease, concerns about the well-being of their loved ones, and stress related to societal and economic disruptions caused by the pandemic, such as job losses, isolation, and uncertainty about the future (Clair et al., 2021; Kushwaha et al., 2017). Proposing that infectious diseases negatively impact mental health is crucial because mental well-being is fundamental to overall health. Understanding how a pandemic affects mental health can help inform interventions, such as well-being support services or public health campaigns, to address anxiety, depression, and stress during health crises. Sleep quality is closely linked to both psychological and physical health. Stress and anxiety caused by an infectious disease can lead to sleep disturbances, such as insomnia or restless sleep. People may have trouble sleeping due to worrying about their health, financial insecurity, or disruption to their daily routine. Sleep is essential for the proper functioning of the immune system, mental clarity, and overall health. Understanding how a pandemic affects sleep quality can highlight the need for interventions to promote good sleep hygiene, manage stress, and maintain healthy sleep patterns, even during stressful times. In addition, Azak et al. (2023) explained that the infectious disease problem has also resulted in a significant increase in substance use and abuse as individuals attempt to cope with the stress and uncertainty it caused. Substance abuse can lead to further mind-related problems, including addiction, and exacerbate existing mental health issues (Compton and Shim, 2020; Oftedal et al., 2019). In addition to their physical effects, diseases significantly affect individuals’ mental health, including sleep quality. Noseworthy et al. (2023) proved that the physical health of individuals can be negatively affected during a pandemic in several ways. Reduced physical activity due to lockdowns, sedentary behavior from staying indoors, changes in diet, and disruptions in regular healthcare services can contribute to a decline in health. Additionally, stress and anxiety can have physiological effects, such as increased blood pressure and weakened immune responses. Physical health is a critical component of overall well-being. Understanding the impact of the pandemic on physical health can help inform policies and recommendations for maintaining physical activity and healthy behavior during restrictions. Studies have shown that several infections, such as influenza (flu) and fungal nail infections, have considerably increased sleep problems and disturbances (de Araujo et al., 2022; Jroundi et al., 2015; Polisena et al., 2021; Selleck and Barnard, 2020).

Psychological resilience refers to the ability to cope with stress and adversities (Rishipathak et al., 2021). An infectious disease outbreak can test this resilience as people face long-term stressors such as fear of infection, economic hardship, and social isolation (Jroundi et al., 2015; McNamara et al., 2023). Some individuals struggle to adapt, which leads to decreased psychological resilience. Psychological resilience is essential for recovery from trauma and for maintaining mental health during crises. By investigating the negative impact of infectious diseases on resilience, this study highlights the importance of developing interventions that promote resilience, including community support programs, coping strategies and access to mental health resources. Preventive measures, such as staying indoors and limiting physical contact, can reduce opportunities for physical activity, leading to a more sedentary lifestyle (Bandura, 1998; Liu et al., 2020; Weston et al., 2018). This decrease in physical activity can negatively affect cardiovascular health, muscle strength, and overall physical fitness (Baretta et al., 2019; Daryabeygi-Khotbehsara et al., 2021). Disrupted routines may also contribute to unhealthy eating habits and weight gain. Infectious disease prevention measures, such as social distancing, quarantine, and lockdowns, can have significant psychological effects. Being isolated from loved ones, facing restrictions on social interactions, and experiencing disruptions to daily routines can increase feelings of loneliness, anxiety, and depression. Stress and lifestyle changes resulting from preventive measures disrupt the sleep quality. For instance, increased anxiety, lack of routine, and decreased physical activity can lead to sleep disturbances, such as insomnia or irregular sleep patterns (Clement-Carbonell et al., 2021; IJntema et al., 2023). Moreover, concerns regarding the pandemic and the impact of isolation can interfere with sleep. The current literature suggests that infectious diseases have a profound and negative impact on psychological resilience. The following hypotheses are proposed based on the research framework of this study (see Figure 1):

Physical activity has long been recognized as crucial for maintaining overall health and wellness (Anokye et al., 2012; Wu et al., 2022). The relationship between physical exercise and mental health is thought to be mediated by various biological and psychological mechanisms (Hamer et al., 2009; Turner et al., 2019). Infectious diseases and their preventive measures (such as isolation, quarantine, or social distancing) can lead to heightened stress, anxiety, and fear among the general population. Home-based physical activities can serve as an effective tool for reducing these negative psychological effects (Hamer et al., 2009; Weston et al., 2018). For instance, physical activity has been shown to increase endorphin levels (Geraedts et al., 2013), which are known to have mood-enhancing effects. The relationship between physical exercise and physical health is well established (Salerno et al., 2023), with numerous studies demonstrating the positive impact of physical exercise on various health outcomes, including cardiovascular health, weight management, and overall mortality (Kokkinos and Myers, 2010; Salerno et al., 2023; Thomas et al., 2003). Physical exercise is known to release endorphins, the “feel-good” hormones, which help alleviate stress, anxiety, and depressive symptoms, and promote better mental health (Anokye et al., 2012). Simultaneously enhancing physical fitness, boosting mood, and improving sleep promotes a comprehensive sense of well-being. Home-based physical activity is a key behavioral strategy that can improve psychological resilience, physical health, and sleep quality during infectious disease outbreaks. HBPA mediates physical health by improving the functioning of the cardiovascular and musculoskeletal systems (Di Francescomarino et al., 2009). Psychological resilience refers to a person’s ability to cope with stress and adversity and is positively associated with engaging in home-based physical activities (Campbell-Sills et al., 2006; Hamill, 2003). Physical exercise provides a practical and effective means of coping with stressors and physical limitations imposed by health crises, thereby enhancing the overall well-being. Based on the above discussion, the following hypotheses were proposed according to the framework (see Figure 1):

The two cities in which this study was conducted were Suzhou and Wuhan. Social media was used to recruit participants from a convenience sample of students. Participants had to be at least 20 years old, have completed an undergraduate-level education, and engage in physical activity at home while quarantined to be included in the study. The study adhered to ethical standards, including the Declaration of Helsinki of the World Medical Association, and was approved by the Ethics Committee of Hunan City University (HCU15012025). Informed consent was obtained from all the participants. The administration and design of our survey followed the CHERRIES standards (Eysenbach, 2004).

The research team developed an initial data collection tool in English based on validated instruments (Fabbri et al., 2021; Lee et al., 2011) and published studies on home-based physical activity and health during isolation (Kokkinos and Myers, 2013; Kokkinos and Myers, 2010). A rational approach was used as a standardized procedure to develop items and refine the multi-item questionnaires. Experts play a critical role in the questionnaire development process (Simms, 2008). This approach is suitable only when the construction of interest is studied briefly. The word “rational” applies to professionals’ ostensibly logical judgments. This technique can also be referred to as a pre-theoretical or an intuitive approach. The rational method for questionnaire development comprises eight steps: theoretical framework, concept analysis, item specification, item production, item judgment, scale construction, validation, and commenting (Simms, 2008). A team of six public health professionals examined the preliminary multi-item questionnaire using a rational method. Two independent translators translated the questionnaire (forward and backward) from the original language to the target language (Tsang et al., 2017). The final questionnaire consisted of 38 items across seven constructs (see Supplementary File): infectious disease (4 items), infectious disease prevention (6 items), home-based physical activities (7 items), mental health (5 items), sleep quality (5 items), physical health (5 items), and psychological resilience (6 items).

We used a multi-item self-administered questionnaire to evaluate the following study variables: study participants’ demographics, beliefs about infectious diseases, including their impacts and prevention measures, home-based physical activity, mental and physical health, sleep quality, and psychological resilience.

Several measures have been implemented to address the infectious diseases. Travel restrictions inside and between nations, the shutdown of business activities, social distancing and home isolation are some of the examples. Some people find it challenging to determine whether they have been quarantined, isolated, or locked in. Social distancing is detrimental to mental health because it discourages interaction with others (Moreira-Neto et al., 2021). Mental health was assessed in relation to the isolation period and its preventive measures by adapting the “Infectious Diseases, mental health, and wellness survey questionnaire” developed by El Tantawi et al. (2022). The pandemic has significantly affected sleep quality. Sleep quality was assessed using the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) (Mak et al., 2019). Physical health was assessed using self-rated health measures developed by Eriksson et al. (2001). Psychological resilience was evaluated using the Resilience Style Questionnaire (RSQ) developed by Barger (2006). In our study, we used a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = no opinion, 4 = agree, and 5 = strongly agree) to assess COVID-19 and its preventive measures.

Outdoor HBPA is said to be severely curtailed by preventive measures against infectious diseases, which further devastate rapid infections, making it especially important to maintain a safe distance from other people (Geraedts et al., 2013; Salerno et al., 2023). The survey participants were asked to respond on a Likert scale (1 = strongly disagree, 2 = disagree, 3 = no opinion, 4 = agree, and 5 = strongly agree) regarding the role of HBPA in health-related quality of life. As time spent outdoors and access to outdoor spaces have been severely reduced during the pandemic, many people have turned to home-based exercise as a coping mechanism to improve their quality of life. Self-isolation also has a detrimental effect on people’s physical activity levels, and increased screen time adversely affects physical health, happiness, sleep habits, and livability. Consequently, people can practice movements at home by engaging in exercises (Kröönström et al., 2020).

Anonymized web-based surveys provided most of the primary data. To ensure a reliable sample size, we conducted a pilot test using a questionnaire with 40 participants in the study. Some questions were revised based on the pilot study results to elicit the most relevant and precise responses. The researchers used WeChat to distribute the link to the final questionnaire in Wuhan and Suzhou, thereby extending its reach beyond the initial point of contact and attracting more participants. Participants were encouraged to share the survey with as many individuals as possible. The questionnaire was completed anonymously using a hyperlink accessible on mobile devices and computers. Only one submission was allowed per IP address, computer, or mobile phone to avoid duplications. In total, 2,300 people were sent a link to the online survey questionnaire along with information about the research and instructions on how to complete and submit it. After a quality check, the answers of 2,200 respondents were considered to compile the results of this study.

The collected data were analyzed using SmartPLS without imposing assumptions on the data distribution, including models with multiple constructs, structural pathways, and indicator variables. Smart PLS is a correlational approach that utilizes a structural equation model, emphasizing forecasting when estimating an empirical relationship with attributes that provide a potential explanation.

The demographics of the 2,200 respondents who completed the online survey, along with their responses, are shown in Table 1. The majority (52.2%) of the survey participants were male, and (47.8%) were female. The age distribution shows that the majority (35.6%) of the survey participants belonged to the 27–33, (21.3%) belonged to the 34–40, (13.6%) belonged to the 41–46, (13.4%) belonged to the 47–53, (9.7%) belonged to the 20–26 and (6.4%) belonged to the 59 + age group. The educational scenario showed that the majority (41.00%) were master’s degree holders, (28.2%) were bachelor’s degree holders, (18.2%) had a graduate level of education, (8.3%) were associate’s degree holders, (2.8%) were undergraduates, and (1.5%) were in other categories. Occupation statistics showed that (32.9%) were private employees, (29.7%) were self-employed, (22.3%) were government employees, (10.9%) were students, (0.9%) were retired, (0.8%) had no occupation, and (2.5%) were in other occupations. Most (80.5%) of the survey participants were married, (18.4%) were unmarried, and (1.1%) were otherwise.

The internal consistency of the measurements was evaluated using Cronbach’s alpha (α) and composite reliability (CR). It varied from (0.823 to 0.943) and (0.828 to 0.945), respectively, both above the 0.70 cut-off limit (Klein, 2016). Convergent validity testing was performed for each factor loading, and the average variance was determined. The average variance extracted (AVE) in statistics (classical test theory) measures the proportion of variation captured by a construct to the variation resulting from the estimation errors. All items had loadings of > 0.6. The AVE for all variables was above the 0.5 threshold, showing convergent validity (see Table 2).

Two approaches, heterotrait-monotrait (HTMT) and Fornell–Larcker, were used to assess discriminant validity (Campbell and Fiske, 1959). The correlation between the two constructs must be smaller than the square root of the average variance recovered by the measure. All the estimated average variance square roots were more significant than their associated inter-correlation values (Table 3).

During the SEM analysis, model fitness was assessed using the SRMR, d_ULS, d_G, Chi-square, and NFI values. The calculated model fitness values are presented in Table 4 and meet the requirements for SEM analysis.

Path coefficient, coefficient of determination for endogenous variables, effect size, multicollinearity, and predictive relevance were calculated to evaluate the models. Table 5 and Figure 2 present the results of the hypothesis testing. First, the relationship between infectious diseases and mental health was negative and significant (β = −0.241, t = 7.215). This suggests that infectious diseases have strong adverse effects on mental health, contributing to increased stress, anxiety, and other psychological challenges in patients. This hypothesis is supported by the findings of this study, which confirm that mental health deteriorates significantly during an infectious disease outbreak. The impact of infectious diseases on sleep quality was also negative and significant, although less pronounced (β = −0.092, t = 2.437). This indicates that the pandemic disrupted individuals’ sleep patterns, potentially due to anxiety, fear, and uncertainty. This hypothesis is supported by the adverse effects of infectious diseases on sleep quality. The relationship between infectious diseases and physical health was negative and significant (β = −0.232, t = 6.265). This shows that the pandemic led to a decline in physical health, possibly due to reduced mobility, restricted access to fitness facilities, or a more sedentary lifestyle. Thus, this hypothesis was supported. Infectious diseases negatively affected psychological resilience (β = −0.276, t = 9.354), indicating a significant reduction in individuals’ ability to cope with stress and adversity during the pandemic. This hypothesis was supported, emphasizing the harmful effects of infectious diseases on the psychological resilience. Finally, the relationship between infectious diseases and home-based physical activity (HBPA) was negative and significant (β = −0.372, t = 9.131). This suggests that the pandemic limited individuals’ ability or motivation to engage in physical activity at home, likely because of stress, a lack of routine, or limited space. Thus, this hypothesis is supported.

Infectious disease prevention measures (IDPs) had a significant negative effect on mental health (β = −0.217, t = 6.053). This suggests that strategies such as social distancing and quarantine may negatively impact mental well-being, possibly due to isolation or limited social interaction. Thus, this hypothesis is supported. The effect of IDPs on sleep quality was negative and significant (β = −0.179, t = 5.375). Preventive measures may lead to sleep disturbances, potentially caused by disrupted routines or anxiety regarding ongoing health crises. Thus, this hypothesis is supported. IDPs had a significant negative impact on their physical health (β = −0.166, t = 4.855), indicating that restrictions, such as staying indoors, contributed to physical inactivity or deterioration in health. Thus, H3c is supported.

Interestingly, IDPs had a positive effect on psychological resilience (β = 0.287, t = 10.321). This finding suggests that while preventive measures can create stress, they also promote adaptive coping mechanisms, possibly through the development of new routines or support systems. The relationship between IDPs and HBPA was negative but significant (β = −0.101, t = 2.478). This suggests that preventive measures slightly reduced the likelihood of engaging in physical activity at home, possibly due to a lack of motivation and/or stress. Thus, this hypothesis is supported.

The mediating role of home-based physical activity (HBPA) was evaluated using a bootstrapping procedure with 5,000 subsamples and bias-corrected 95% confidence intervals. Home-based physical activity positively affected mental health (β = 0.289, t = 11.065). Engaging in exercise can help alleviate stress and improve mood, ultimately leading to enhanced mental well-being. In H5b, HBPA significantly improved sleep quality (β = 0.390, t = 13.014), indicating that regular physical activity at home contributes to better sleep, possibly by reducing stress and improving fatigue. The impact of HBPA on physical health was highly positive (β = 0.389, t = 13.540). Home-based exercise helps maintain or enhance physical fitness and supports overall health (H5c). The relationship between HBPA and psychological resilience was negative but significant (β = −0.046, t = 2.006). This result was unexpected and suggests that, although small, some aspects of physical activity may not directly contribute to building psychological resilience. Thus, Hypothesis (H5d) is supported. Furthermore, the indirect effects of HBPA indicated that the indirect effect of infectious diseases on mental health through HBPA was negative and significant (β = −0.107, t = 6.834, 95% CI [−0.139, −0.077]). This suggests that the decline in physical activity due to the pandemic partially mediated its impact on mental health. The indirect effect on physical health was negative and significant (β = −0.145, t = 7.471, 95% CI [−0.183, −0.107]), indicating that lower HBPA levels during the pandemic contributed to the decline in physical health. The indirect effect of psychological resilience was not significant (β = 0.017, t = 1.888, 95% CI [0.001, 0.036]). This finding indicates that HBPA does not mediate the relationship between infectious diseases and resilience. The indirect effect of IDPs on mental health through HBPA was negative and significant (β = −0.029, t = 2.355). This finding implies that preventive measures can reduce HBPA levels and negatively impact mental health. The indirect effect on sleep quality was negative and significant (β = −0.039, t = 2.418), indicating that reduced HBPA due to preventive measures was associated with poor sleep quality. Thus, this hypothesis is supported. The indirect effect on physical health was negative and significant (β = −0.039, t = 2.388), indicating that lower HBPA resulting from preventive measures contributed to declining physical health. Finally, the indirect effect on psychological resilience was not significant (β = 0.005, t = 1.475), suggesting that HBPA did not mediate the relationship between preventive measures and resilience.