The Covid Conundrum: Keeping safe, but becoming inactive

A rapid systematic review determined that across 25 studies reporting on change in PA behaviour, 14-73% of participants reported a decrease in PA. Similar decreases were seen across all types of PA (n=17) (walking, moderate, vigorous, moderate-to-vigorous, and daily step counts). Exercise levels (n=12) also decreased, with 7 studies reporting a decrease in exercise behaviour, ranging from 19-65%. While activity decreased, there was a sharp increase in sedentary behaviour. Eight studies reported a significant increase in sedentary behaviour time from pre- to during- COVID-19.

The results of the rapid review confirm the previous assumptions we held about loss of PA, given the very nature of lockdowns. PA behaviour is encouraged by a combination of capability, opportunity, and motivation [1]. Capability, reflecting having the knowledge and ability to be physically active, has been undermined by imposed restrictions, resulting in the loss of usual PA prompts in daily life, such as leaving home for work as a cue for active commuting. Opportunities for PA also changed with quarantines and lockdowns. The closure of facilities left fewer places to be active, reducing opportunities to be active and to socially interact with others. Motivation for being physically active involves both reflective (e.g. attitudes, confidence, intentions) and automatic (e.g. emotion and habit) processes [2]. Restrictions were effective in dramatically disrupting routines; reducing the automatic behavioural response (e.g. the habit of going to the gym after work). Additionally, during the ever-changing contexts during the pandemic, motivation for PA is easily lost with the competing stresses of lockdown.

This loss of PA has several negative health impacts, including:

• Deconditioning – is the decline in physical body function due to physical inactivity and leads to decline in muscle strength and bulk. Even short-term inactivity (1-4 weeks) [3] is associated with negative health impacts. Social deconditioning can also occur due to isolating and loneliness and can result in the loss of cognitive and emotional wellbeing [4].
• Worsening mental health – PA can protect against poor mental health, however the decline in PA during the pandemic has been associated with increased levels of stress, anxiety and depression [5].
• Increase in chronic non-communicable disease – physical inactivity has been associated with increased risk of coronary heart disease, type 2 diabetes, and some types of cancers. With the rise in inactivity, it could increase the burden on the healthcare system [6].
• Increased risk of negative COVID outcomes – research indicates that people who were physically inactive before the pandemic were more likely to be hospitalised, require intensive care, and to die from COVID-19 [7].

Looking at other disaster research, we can expect that COVID-19 will continue to impact lives for many years to come. Previous evidence suggests that there is no return to pre-disaster levels of physical activity for up to 3 years following a disaster. This highlights that physical inactivity could persist in the long-term and action must be taken.

With restrictions easing over the next several months within the UK, now is the time for action to ensure PA is at the centre of our planning moving forward. With every key date where restrictions are lessening, we have the opportunity to take advantage of a ‘fresh start’ effect – they signify a maker as a time to do something new. Key recommendations to facilitate physical activity are:

1. Reactivate feelings of capability and motivation, and provide opportunities to re-engage in activity – it is now more important than ever to ensure people feel able and encouraged to be active, while providing safe opportunities to do so.
2. Physical activity may not be a priority for most people; consider how to approach and encourage this behaviour - basic needs such as income or housing will be more important, and we need to consider how to approach and encourage physical activity in a compassionate way, while acknowledging and sharing struggles with others.
3. Address new barriers or competing interests/concerns – COVID-19 has brought in new barriers to being physically active. It is likely many individuals will still be cautious and worried about engaging in activity in a post-COVID environment. These barriers will need to be considered and strategies will need to be implemented to reduce them.
4. Accent supportive social and environmental factors - With restrictions easing, there are now opportunities to see friends and family again, need to take advantage of this and provide the chance to make small changes to their daily lives. It will be important to activate the idea of ‘N5’ by offering programmes that are near, now, no-cost or low cost, new, and next-wise.

This is a once in a century opportunity that can’t be missed. The goal should not simply be to return PA levels back to ‘normal’ but to establish sustainable mechanisms to promote healthy behaviour and create a new normal.

For more information on our rapid reviews, check out the following recorded presentations:

carnegieXchange Presentation:https://drive.google.com/file/d/1Nhv7D-TnfMHugv4p2hD1hWBsfi8nqu9P/view?usp=sharing

Workplace: https://drive.google.com/file/d/1IpgMfJ2Tgv9r4mSdu3dxAa_J6-NyTPLl/view?usp=sharing

Access to healthcare; Children and Young People; LGBT: https://drive.google.com/file/d/1kBI_PODS1lPtYfynYs4ghKH7bGUaEaOn/view?usp=sharing

Deprivation, Social Determinants of Health, and Deconditioning: https://drive.google.com/file/d/1hHnYGV7MYm2ZCp5M9uHzBzcpa5ypD3KE/view?usp=sharing

Resilience and Long Covid: https://drive.google.com/file/d/1Pq6WrQiwdGCcAxGqZBo2fbhDVBcW2IJA/view?usp=sharing

References

1.            Michie S, Van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science. 2011;6(1):1-12.

2.            Spence JC, Rhodes RE, McCurdy A, Mangan A, Hopkins D, Mummery WK. Determinants of physical activity among adults in the United Kingdom during the COVID-19 pandemic: The DUK-COVID study. British journal of health psychology. 2020. Epub 2020/12/19. doi: 10.1111/bjhp.12497. PubMed PMID: 33336562.

3.            Malta DC, Szwarcwald CL, Barros MBdA, Gomes CS, Machado ÍE, Souza Júnior PRBd, et al. The COVID-19 Pandemic and changes in adult Brazilian lifestyles: a cross-sectional study, 2020. Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil. 2020;29(4):e2020407. doi: 10.1590/S1679-49742020000400026. PubMed PMID: 32997069.

4.            Douglas M, Katikireddi SV, Taulbut M, McKee M, McCartney G. Mitigating the wider health effects of covid-19 pandemic response. BMJ (Clinical research ed). 2020;369.

5.            Roshanaei-Moghaddam B, Katon WJ, Russo J. The longitudinal effects of depression on physical activity. General hospital psychiatry. 2009;31(4):306-15.

6.            Mera-Mamián AY, Tabares-Gonzalez E, Montoya-Gonzalez S, Muñoz-Rodriguez DI, Monsalve-Vélez F. Practical recommendations to avoid physical deconditioning during confinement due to pandemic associated with COVID-19. Universidad y Salud. 2020;22(2):166-77.

7.            Sallis R, Young DR, Tartof SY, Sallis JF, Sall J, Li Q, et al. Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients. British journal of sports medicine. 2021.