During the COVID-19 pandemic, China implemented city-lockdown management in many cities, such as Wuhan, Shanghai, and Chengdu until September 2022. At time of writing, the city lockdown policy is still being implemented in some areas, and some Chinese residents have to be quarantined at home for a long time. Many studies have found that long-term isolation or quarantine in a fixed area (such as at home) can significantly increase the risk of depression among residents (1–4). During the lockdowns, the lack of necessary and timely psychological intervention and treatment also increased the severity of depression cases (5, 6).

Many studies have found that moderate fitness and exercise can reduce the risk of depression (7–10). Lack of physical activity, including exercise, has been found to be associated with depression and increased anxiety levels during COVID-19 (11). In the Shanghai lockdown in the first half of 2022, a group of Chinese entertainers, represented by dancer and actor Liu Genghong, began to livestream HIIT dance at home on many Chinese social media platforms, such as Douyin, which led to many residents in lockdown areas following the exercises at home. After that, a large number of Chinese entertainment stars also began to teach HIIT dance on various Chinese social media platforms, instigating a popular trend. Many studies have also found the positive physiological and psychological effects of doing HIIT dance (12, 13). But does this kind of home HIIT exercise reduce the risk of depression, which was amplified during the COVID-19 lockdown? And if so, do other perceptual factors play a role? To explore these questions, 528 residents quarantined in the Shanghai lockdown during the first half of 2022 were surveyed, and responses combined with the health belief model to understand the data. The results show that doing home HIIT dance does have preventive effects on depression experienced during China's COVID-19 lockdown and that it was differently mediated by residents' personal perception factors, such as perceived benefits, severity, and self-efficacy. Perceived benefits and perceived severity can effectively magnify the preventive effect of doing home HIIT on depression, while low perceived self-efficacy can prevent this preventive effect.

On 23 January 2020, the Chinese government agreed on a lockdown policy in “The Silent City” of Wuhan, where China's first COVID-19 cases were discovered. This lockdown lasted 76 days, which included many strict requirements: all the city's public transport, including subway, ferry and long-distance passenger transport was suspended and citizens were not allowed to leave Wuhan without special reasons. All places of public entertainment, including cinemas, restaurants, amusement parks, and shopping malls, were closed. Residents were told not to leave their homes and all living materials were arranged by the government. The lockdown was believed to have effectively prevented the spread of COVID-19 in Wuhan and beyond. This experience was learned from when the virus spread to many other cities in China. On 28 March 2022, due to the sudden large-scale prevalence of COVID-19, Shanghai began to implement a lockdown policy. During the Shanghai lockdown, residents were also required to stay at home. All living materials were also purchased uniformly and transported by special personnel arranged by the government. This lockdown lasted for 75 days. China is currently implementing a “Dynamic Reset” policy (also called dynamic zero-COVID-19 policy) and lockdown policies for those cities with COVID-19 outbreaks.

The lockdowns during the pandemic were found to greatly increase the risk of depression and other psychological diseases among residents in the locked down cities (14–16). This conclusion has been reflected in multinational data. For instance, Khubchandani et al. (17) found an increased rate of depression and anxiety after the COVID-19 lockdowns in the USA; Schwinger et al. (18) also found increases in anxiety and depressive symptom and declines in autonomy, wellbeing and relatedness satisfaction in Germany because of the lockdowns. Wang et al. (16) and Du et al. (19) found a significant increase in the rate of depression in Chinese adolescents and adults, respectively. For Chinese students, COVID-19 on-campus quarantine increased diagnoses of depression from 9.1 to 36.1% (20). The rapid growth of psychological diseases such as depression caused by the COVID-19 lockdown or quarantine has become a common problem globally.

Many studies have already pointed out that sport or exercise can protect against symptoms of mental disorders, including depression, especially for adolescents and youths (21–24). Among many kinds of exercise, as a combination of physiological movement and dance music aesthetics (exercise and entertainment), high-intensity interval training (HIIT) dance has been demonstrated to have physiological and psychological benefits (12, 13), which may play a better role in the prevention of mental diseases. Some studies have demonstrated the preventive effects of HIIT dance on depression and other mental disorders, and further suggest that HIIT dance may be an easy and effective exercise mode for people with mental disorders (12, 25). But the literature evaluating the effects of HIIT on people with mental disorders is still in its infancy (26). As mentioned above, during lockdowns, when it was difficult to achieve regular outdoor fitness and other exercise, home HIIT dance became one of the most common forms of exercise for quarantined residents. But can this form of home fitness effectively cope with or prevent the increased risk of depression caused by the lockdowns? This question has not been answered effectively, especially in the Chinese context, where COVID-19 lockdowns are still in progress. This is also the main research question of this study.

According to the health belief model, people's health-related behaviors are highly affected by their perception factors, such as perceived susceptibility, severity, benefits and self-efficacy (27–29). Specifically, the preventive effect of exercise on depression and other mental disorders has also been found to be moderated by individual cognitive factors, such as personal risk perception and benefit perception (30–32). Other behavior research theories, such as the Theory of Planned Behavior (TPB), which is also widely used in health-related behaviors research, also indicate that the health behaviors and effects of individuals are affected by personal perception factors, including the health behaviors adopted to prevent and treat depression (33, 34). People with different perceptions on exercise and mental disorders will have different responses to the effects of exercise on depression. For instance, Warner et al. (35) found that Canadians with higher depression risk perception are more likely to benefit from self-help behaviors, including doing exercise. Bodin and Martinsen (36) also found that people with higher perceptions of self-efficacy tended to have better control in relation to exercise, which could further magnify the preventive effect of exercise on depression. For HIIT dance, it has also been found that personal perceptions such as perceived susceptivity, severity, benefits, and self-efficacy also significantly moderate its effects to prevent mental disorders (37, 38). Although the moderated effect of personal perceptions in the preventive effect of exercise on depression and other mental disorders has been widely found, its specific application during the COVID-19 lockdown has not been fully studied, especially in the Chinese context. Therefore, based on the above, we proposed the following two main research questions for this study (Figure 1):

RQ1. During the Chinese COVID-19 lockdown, was there a significant preventive relationship between doing home HIIT and depression among quarantined Chinese residents?

RQ2. If so, is the preventive relationship of doing home HIIT on the depression of quarantined Chinese residents moderated by their personal perception factors, including perceived susceptibility, severity, benefits, and self-efficacy?

A fixed-point survey was conducted via a Chinese professional survey company, Wenjuanxing, when Shanghai was locked down from 28 March to 12 June 2022. The study followed the ethical guidelines of the authors' universities. A total of 528 Shanghai residents who experienced this lockdown were surveyed and all participation was voluntary and paid. All participants were comprehensively informed about the purpose of the study and they all provided informed consent electronically. This study did not contain any personally identifying details.

The survey involves four variables: (1) social-demographic characteristics, including age, gender, educational level, income level; (2) frequency of home HIIT-dance participation during lockdown; (3) depression tendency assessment using the Zung Self-Rating Depression Scale (SDS) (39); and (4) individual cognition, including perceived susceptivity and severity of depression during lockdown, perceived benefits of the preventive relationship between HIIT-dance and depression, and perceived self-efficacy of doing HIIT-dance; this part and its measure were mainly based on the health belief model (27) (Table 1). The individual cognition factors were measured based on the potential relationship between doing HIIT-dance and depression tendency. For instance, “perceived susceptivity” measures the residents' perception of the possibility of suffering from depression during the lockdown period; “perceived severity” measures the residents' perception of the severity of suffering depression during lockdown; “perceived benefits” measures residents' perception of the effect of doing HIIT-dance on reducing the risk of depression during lockdown; and “perceived self-efficacy” measures the residents' perception of the feasibility of their psychological and objective conditions for doing HIIT-dance during lockdown.

Multiple linear regression (MLR) and a simple slope test (SST) were used to analyse the data using SPSS 26.0. MLR was used to identify the factors associated with depression tendency, while SST was used to identify the moderation effects of individual cognition factors on the possible preventive relationship between doing HIIT-dance and depression.

The present study sought to examine the psychological association between doing home HIIT dance and the depression of Chinese residents during COVID-19 lockdowns. Based on the statistical results and the theory of health belief model, we found that there is indeed a preventive association between doing home HIIT dance and depression among Chinese residents during COVID-19 lockdowns—the Chinese residents who more frequently practiced home HIIT dance were less likely to suffer from depression. The results overall are in line with our suppositions, indicating that the preventive association between doing home HIIT and depression among quarantined Chinese residents is indeed differently moderated by personal perception factors. However, although most of the correlations and verifications were statistically significant, there may be significant differences in the causes of the effects of those mediator variables.

For the two mediator variables of perceived severity and perceived benefits, it is easy to understand their moderation mechanisms. Many studies have pointed out that, in this risk society, risk-related perception significantly regulates people's psychological state and their behavior (44, 45). According to risk perception theory, perceived severity and perceived benefits are two important dimensions of people's risk perception (46–48). When we can clearly perceive that the negative consequences of a thing or behavior may be very serious, we are more inclined to have a response that can avoid it; and when we can clearly perceive the significant benefits of a thing or behavior, we are more inclined to adopt it (49). This is the basic mechanism of perceived severity and perceived benefits in people's health behavior tendency, according to the health belief model (50). Therefore, when Chinese residents can more clearly perceive the severity of the consequences of their depression during lockdown, they may be more inclined to seek relevant coping measures to avoid depression and be more active in the implementation of such measures to improve their effect, such as by doing home HIIT dance. Correspondingly, when they can more clearly perceive the effects of avoiding depression or other relevant benefits of certain measures, they may also be more active in doing them, thus further enlarging their positive effect. Consequently, to reduce depression through doing home HIIT dance during lockdowns and to further magnify its effect, we can add the relevant information about the severity of the consequences of depression in this special period and the effectiveness of doing home HIIT dance in avoiding depression, in publicizing this activity and its benefits.

A somewhat unexpected outcome is the negative mediation effect of perceived self-efficiency on the preventive association between doing home HIIT and depression of quarantined Chinese residents. Perceived self-efficacy refers to the psychological state in which individuals perceive that they can complete a task (51). When perceived self-efficiency is low, carrying out that task will bring a greater psychological burden, and further influence the completion and effect of that task (52). In this study, when Chinese residents have low perceived self-efficiency for home HIIT dance—believing that the environment and physical conditions are unfavorable for such exercise—forcing them to do home HIIT dance exercise may increase their psychological burden and further weaken its preventive association with depression. Many studies have found that during COVID-19, residents' perceived self-efficiency in many fields saw a significant decline, including online learning, food choice, and exercise (53–55). Therefore, to avoid the negative effect of low perceived self-efficiency on the preventive association between doing home HIIT and depression, more effective publicity and demonstrations are needed to improve the perceived self-efficiency of residents and to encourage them to engage in such exercise.

This study has deepened research on the psychological associations between doing home HIIT dance and preventing depression, especially in the COVID-19 lockdown period, emphasizing the possible moderation effects of different self-perception factors. The health belief model used in this study only provides one of many perspectives but this study has provided a new line of thought: it is already well-known that doing exercise, including home HIIT dance, can reduce the risk of depression, but it is less clear what perceptual factors have an effect on this outcome. Therefore, if we want to further understand such effects, we can start from a more detailed level of personal perception in future research and discussion.

This study observes that doing home HIIT dance has a preventative association with depression, especially during the COVID-19 lockdown period in China. But such an association is differently mediated by different personal perception factors, such as perceived severity, benefits and self-efficiency. Regarding the most important limitation of this study, we acknowledge that, due to the quasi-longitudinal questionnaire method, participants' estimations about their participation and impression of home HIIT dance during Shanghai's lockdown may be biased by memory and contrast effects as participants must recall their perceptions before or during home HIIT dance. Moreover, the samples are all from Shanghai, focusing on their psychological statuses and home exercise, which is not representative of the wider Chinese population, limiting the generalizability of the findings of this study. As a pilot study, our data still provides insights into the relations between personal perceptions and how to reduce the psychological consequences of the COVID-19 lockdown in China.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by Hanyang University; Soochow University. The patients/participants provided their written informed consent to participate in this study.

ZY and YH: conceptualization and data analysis. ZY and YM: methodology. ZY: writing. KS: review and editing. All authors contributed to the article and approved the submitted version.