Research 668 Reprinted from AJGP Vol. 50, No. 9, September 2021 © The Royal Australian College of General Practitioners 2021 Tiago Mansur Kobbaz, Letícia Ayd Bittencourt, Bianca Vianna Pedrosa, Beatriz da Motta Fernandes, Leonardo Demier Marcelino, Bernardo Pires de Freitas, Natália Maciel, Ana Paula Rothfuchs, Elisa da Silva Magalhães, Nathália Salim Saud, Alexia Soares Vidigal, Bruna Yumi Gonçalves Miura, João Fernando Cunha Rodrigues, Ully Morize Müller, Luíza de Almeida Silva, Roberta Arnoldi Cobas, Fábio Akio Nishijuka, Kelly Biancardini Gomes Barbato Background and objective 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. Methods 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 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 pandemic’s impact on health behaviours, people will likely change how they deal with each pillar. The aim of this study was to assess how the COVID-19 pandemic changed medical students’ six lifestyle pillars and to investigate the effect that their previous lifestyles had on their emotional wellbeing during the social distancing period. Methods This cross-sectional study included medical students representing all six undergraduate years of a Brazilian private medical school. The data were collected through a digital questionnaire. Students who agreed to respond anonymously and signed the digital consent form were included. The local centre’s ethics committee approved the study protocol (CAAE: 34503620.6.0000.5239). Demographic data included sex (male/female), age (years), undergraduate year (from first to sixth year), marital relationship (yes or no) and living condition (alone or not). Information about the lifestyle medicine pillars, before and during the pandemic, included: quality of sleep, duration (minutes) and intensity of weekly physical exercise, quality of eating, spirituality, tobacco and alcohol use and interpersonal relationship quality. In addition to the lifestyle pillars, participants were also asked about their emotional wellbeing during the social distancing period. The lifestyle of Brazilian medical students What changed and how it protected their emotional wellbeing during the COVID-19 pandemic