Physical distance, lockdown and… physical activity? A brief summary of reviews investigating physical activity during the COVID-19 pandemic

Andreas Fröberg
Department of Food and Nutrition and Sport Science
University of Gothenburg


Introduction

Ever since it was identified in Wuhan, China, in December 2019, the coronavirus disease (COVID-19) has remained a public health concern worldwide. According to the World Health Organization (WHO) COVID-19 dashboard, approximately 190 million confirmed cases of COVID-19, and more than four million deaths, have been reported as of the end of July, 2021 (WHO, 2021a).

To mitigate the spread of the coronavirus, and protect oneself and others, WHO (2021b) has recommended people to undertake precautions, such as maintaining physical distancing, avoiding crowded places, cleaning hands, and to stay home when experiencing illness or symptoms thereof. In some countries and regions, health organisations and authorities have also introduced other restriction policies, such as closures of schools and workplaces, and lockdown (Islam et al., 2020). Although needed for preventing the spread of the coronavirus, these restriction policies may restrict people from engaging in their everyday routines, including daily physical activities.

Since the 1950s, a growing and compelling body of research has shown associations between physical activity and several physiological, psychological, and social health benefits across the lifespan (Piercy et al., 2018). Children and adolescents are currently recommended an average of 60 minutes or more per day of moderate-to-vigorous physical activity (MVPA) (Bull et al., 2020). Adults are recommend a minimum of 150-300 minutes per week of moderate-intensity physical activity, 75-150 minutes per week of vigorous-intensity physical activity, or an equivalent mix of moderate and vigorous physical activity (Bull et al., 2020). Even though many people did not reach these recommendations already before the COVID-19 outbreak (Guthold, Stevens, Riley, & Bull, 2018; 2020), there has been a concern that COVID-19-related restriction policies would decrease physical activity even more. Therefore, various health organisations and authorities, as well as researchers, have presented practical recommendations on how to be physically active safely during the COVID-19 pandemic (Bentlage et al., 2020; Polero et al., 2021).

Today, 17 months after the COVID-19 was declared as a pandemic on March 11, 2020, some countries and regions have begun to ease restrictions. Nonetheless, given the importance of physical activity for health, any information about the consequences of the COVID-19 pandemic on physical activity is essential for researchers, practitioners, and policy makers. This paper provides a summary of four reviews that have investigating physical activity during the COVID-19 pandemic. The selected reviews focused on physical activity during the COVID-19 pandemic among children and adolescents, and adults. Table 1 provide an overview of these reviews in terms of type of review and population, search method, and overall results (click to enlarge).

Summary of reviews

Children and adolescents

Three recent reviews have investigated physical activity during the COVID-19 pandemic among children and adolescents, of which two included studies with adults as well. In the first review, Caputo and Reichert (2020) searched six databases to find studies that investigated physical activity during the COVID-19 pandemic among children and adolescents, and adults. The search was limited to studies published from January to July 2020. The authors identified 13 studies that involved children and adolescents, and most of these reported decreases in physical activity.

In the second review, Stockwell et al. (2021) systematically searched nine electronic databases for papers published between November 2019 and October 2020. The authors found six studies among healthy children and adolescents, and one study among children with obesity. All studies reported that physical activity had decreased.

Several studies also reported that the proportion of children and adolescents reaching the physical activity recommendations decreased during the COVID-19 pandemic.

In a more recent scoping review, Paterson et al. (2021) summarised studies that investigated physical activity during the COVID-19 pandemic among children and adolescents. The authors searched six electronic databases for empirical studies, commentaries, reviews, and grey literature published between March 2020 and January 2021. In total, they identified 77 papers that investigated physical activity during the COVID-19 pandemic, in addition to a number of commentaries and reviews. The results showed that physical activity, including related concepts such as energy expenditure and exercise, had decreased among children and adolescents, including those with medical conditions. Several studies also reported that the proportion of children and adolescents reaching the physical activity recommendations decreased during the COVID-19 pandemic. Moreover, the changes in physical activity were generally greater among adolescents than children, and some of the reviewed studies indicated that girls had been more negatively affected by the COVID-19 pandemic as compared to boys.

Adults

Three reviews that investigated physical activity during the COVID-19 pandemic among adults, including older adults, have arrived at similar conclusions. In the review by Caputo and Reichert (2020), most of the 29 studies that involved adult population reported that physical activity decreased. The studies investigated physical activity in the form of walking, time and frequency of moderate- and vigorous-intensity physical activity, exercise time and intensity, and total physical activity, among others.

More recently, Stockwell et al. (2021) found 45 studies that had focused on changes in physical activity among healthy adults. All but one study that investigated change in the form of time spent on physical activity reported decreases. Studies showed that more than half of the study population either stayed the same or decreased their physical activity. Furthermore, the authors found 12 studies that involved adults with medical conditions, such as type 1 and types 2 diabetes, and these also showed that physical activity decreased.

In another systematic review, López-Valenciano, Suárez-Iglesias, Sanchez-Lastra, and Ayán (2021) investigated changes in physical activity pre- versus during-COVID-19 outbreak among adult university students. They searched four databases to identify studies published up to October 2020. Ten studies were found that together comprised about 3500 university students from eight different countries. Overall, the studies showed that physical activity had decreased; five studies showed that walking had decreased with 33 to 366 percent, four studies that MVPA decreased with four to 57 percent, and two studies that total physical activity decreased with 29 to 50 percent. The authors noted that those who met the physical activity recommendations pre-COVID-19 did so even during the lockdown, despite the fact that their overall physical activity decreased.

Comment

This summary of four reviews indicate that physical activity has decreased during the COVID-19 pandemic. This was expected given that health organisations and authorities introduced restriction policies that may restrict people from engaging in their daily physical activities. The results in the reviews are critical for researchers, practitioners, and policy makers given the importance of physical activity for health, even during the COVID-19 pandemic (Bentlage et al., 2020; Polero et al., 2021).

In parallel to the findings that physical activity has decreased, many studies have reported that sedentary behaviour has increased during the COVID-19 pandemic (Paterson et al., 2021; Stockwell et al., 2021). For example, Paterson et al. (2021) found that sedentary behaviour, including both academic-related and non-academic-related screen-time, increased among children and adolescents. The increase was also observed across a wide range of devices and media, such as computers, social media and Internet usage. Furthermore, Stockwell et al. (2021) found 26 studies that had investigated sedentary behavior among adults, and all of these showed that sedentary behavior had increased.

Due to some of these limitations, avaliable data may perhaps better reflect perceived rather than an actual change in physical activity.

Although the results appear to be consistent across the reviews, some interesting observations should be mentioned. For example, there were groups of children and adolescents in studies reviewed by Paterson et al. (2021) that increased their participation in unstructured physical activity during the COVID-19 pandemic. In addition, studies among adults indicated that some types of physical activity, such as housework and garden work, had increased during lockdown (Stockwell et al., 2021). Thus, some data suggest that changes in physical activity during the COVID-19 pandemic not necessarily have been uniform across different populations and domains.

Moreover, the reviewed studies have a number of limitations that should be addressed. The type and extent of restrictions may have varied between countries (sometimes even between regions within a country) and over time, making direct comparisons between individual studies challenging. Furthermore, while many studies involved relatively large sample sizes, most are not nationally representative, and this suggests that caution should be exercised when generalizing the results. In addition, virtually all studies have relied on non-validated, self-reported online questionnaires, and Stockwell et al. (2021) noted that many studies that collected information on physical activity, exercise, and sport did not report how these concepts were defined to the participants. There may also be a concern that the mental health of the participants, as a result of experiencing, for example, lockdown, may have affected the ability to accurately recall physical activity pre- and during-COVID-19 pandemic. Due to some of these limitations, avaliable data may perhaps better reflect perceived rather than an actual change in physical activity (Cross et al., 2021).

Despite these limitations, this summary indicate that physical activity has decreased during the COVID-19 pandemic among children and adolescents, and adults. The results are critical and calls for researchers, practitioners, and policy makers to design interventions to promote physical activity during the COVID-19 pandemic and beyond.

Copyright © Andreas Fröberg 2021

References

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