A tale of two pandemics: How will COVID-19 and global trends in physical inactivity and sedentary behavior affect one another?

Effects of the COVID-19 lockdown on glycaemic control in subjects with type 2 diabetes: the glycalock study

AIM

To assess the effect of the coronavirus disease 2019 (COVID-19) lockdown on glycaemic control in subjects with type 2 diabetes (T2D).

MATERIALS AND METHODS

In this observational, multicentre, retrospective study conducted in the Lazio region, Italy, we compared the differences in the HbA1c levels of 141 subjects with T2D exposed to lockdown with 123 matched controls with T2D who attended the study centres 1 year before. Basal data were collected from 9 December to 9 March and follow-up data from 3 June to 10 July in 2020 for the lockdown group, and during the same timeframes in 2019 for the control groups. Changes in HbA1c (ΔHbA1c) and body mass index (ΔBMI) during lockdown were compared among patients with different psychological well-being, as evaluated by tertiles of the Psychological General Well-Being Index (PGWBS).

RESULTS

No difference in ΔHbA1c was found between the lockdown and control groups (lockdown group -0.1% [-0.5%-0.3%] vs. control group -0.1% [-0.4%-0.2%]; p = .482). Also, no difference was found in ΔBMI (p = .316) or ΔGlucose (p = .538). In the lockdown group, subjects with worse PGWBS showed a worsening of HbA1c (p = .041 for the trend among PGWBS tertiles) and BMI (p = .022).

CONCLUSIONS

The COVID-19 lockdown did not significantly impact glycaemic control in people with T2D. People with poor psychological well-being may experience a worsening a glycaemic control because of restrictions resulting from lockdown. These findings may aid healthcare providers in diabetes management once the second wave of COVID-19 has ended.

Influence of social distancing during the COVID-19 pandemic on physical activity in children: A scoping review of the literature

BACKGROUND/OBJECTIVES

There is an urgent concern about physical inactivity among children caused by recent restrictions for containing the spread of the novel coronavirus disease (COVID-19). This scoping review aims to identify the impact of the pandemic and related factors on children's physical activity (PA).

METHODS

Twenty-one studies published in 2020 that evaluated PA among children under the age of 18 were extracted from electronic databases. The survey contexts, samples, PA measurement methods, and main findings of each study were categorized and summarized.

RESULTS

The review yielded the following results: 1) the PA of children and adolescents mostly decreased; 2) the decrease in PA was more prevalent in boys and older children and adolescents; 3) the decrease in PA was less prevalent in children who live in detached houses, houses with more space, rural areas, and with more family members; and 4) parental support and consideration of location and activity types may help children maintain or increase their PA during the pandemic.

CONCLUSION

This review shows a decline in PA among children and raises concerns about the pandemic's impact on physical and mental health. Declines in PA appear greater among children who participate in organized team sports and those with limited space and opportunity for habitual PA at home or in their neighborhood. Public support for children and families should consider these findings to prevent the negative effects of physical inactivity.

Relationships among behavioural regulations, physical activity, and mental health pre- and during COVID-19 UK lockdown

A nationwide survey was conducted during the first UK lockdown to further understanding of the degree to which motives for exercise were associated with physical activity (PA) behaviours and, in turn, how PA behaviours were associated with mental health. A cross-sectional design was employed and data were collected by use of a one-off online survey (N = 392; 18-85 years; M _BMI = 25.48; SD _BMI = 5.05; 314 women). Exercise motives, PA, and mental health were measured by use of the Behavioural Regulations in Exercise Questionnaire-3, Brunel Lifestyle Physical Activity Questionnaire, and General Health Questionnaire-12, respectively. Participants were also asked to specify their average step count per day, if they used a mobile device for this purpose (n = 190). Analyses comprised hierarchical regressions and partial correlations. Results indicated that behavioural regulations were more strongly associated with planned PA pre-lockdown, compared to during lockdown. There were no differences observed in explained variance between pre- and during lockdown for unplanned PA and steps per day. Planned and unplanned PA were significant explanatory variables for mental health both pre- and during lockdown, but sedentary behaviour was not. Partial correlations, with BMI and age partialled out, showed that steps per day were not correlated with mental health either pre- or during lockdown. The range of variables used to explain planned and unplanned PA and mental health suggest that people's motives to exercise were tempered by lockdown. For those who routinely measured their steps per day, the step count was unrelated to their mental health scores both pre- and during lockdown. It appears that engagement in regular PA confers some minor benefits for mental health.

Effect of COVID-19 response policies on walking behavior in US cities

The COVID-19 pandemic is causing mass disruption to our daily lives. We integrate mobility data from mobile devices and area-level data to study the walking patterns of 1.62 million anonymous users in 10 metropolitan areas in the United States. The data covers the period from mid-February 2020 (pre-lockdown) to late June 2020 (easing of lockdown restrictions). We detect when users were walking, distance walked and time of the walk, and classify each walk as recreational or utilitarian. Our results reveal dramatic declines in walking, particularly utilitarian walking, while recreational walking has recovered and even surpassed pre-pandemic levels. Our findings also demonstrate important social patterns, widening existing inequalities in walking behavior. COVID-19 response measures have a larger impact on walking behavior for those from low-income areas and high use of public transportation. Provision of equal opportunities to support walking is key to opening up our society and economy.

The effectiveness of two levels of active office interventions to reduce sedentary behavior in office workers: a mixed-method approach

Sedentary behavior (SB) rates are rising globally, especially during working hours. This research focused on the effectiveness of two levels of active office interventions to reduce SB in office workers. Participants were 78 nonacademic university employees divided into a control (CON) group and an intervention (INT) group. At the organizational level, it was found that the organizational health culture, the physical and social environment, and the organizational health behavior were dramatically changed. At the individual level, compared with the CON group, the INT group was significantly higher in the METs rate; light-intensity physical activity (LPA); and moderate-to-vigorous-intensity physical activity, and was lower in SB (CON, 397.30 ± 39.33 minutes vs. INT, 389.09 ± 37.59 minutes), all p < .05. The intervention was effective in changing health behavior related to SB of office workers in both organization and individual levels.

Outdoor Physical Activity During the First Wave of the COVID-19 Pandemic. A Comparative Analysis of Government Restrictions in Italy, France, and Germany

Introduction: Mandated restrictions on outdoor physical activity (PA) during the coronavirus pandemic disrupted the lifeworld of millions of people and led to a contradictory situation. On the one hand, PA was perceived as risky behaviour, as it might facilitate transmission of the virus. On the other hand, while taking precautions, regular PA was an important tool to promote the population's health during the lockdown. Methods: This paper examines the differences in government restrictions on PA in France, Germany, and Italy during the first wave of the COVID-19 pandemic. We draw on techniques of qualitative content analysis and apply a critical theoretical framework to assess the countries' restrictions on PA. Results: Our analysis shows that the restrictions on PA varied in the three countries, in all three countries. This variance is attributed both to differences in the timing and severity of the pandemic in the countries analysed, as well as to the divergence in the relationships between the countries' sport and health systems. Conclusion: At the national level, the variance in restrictions on PA reflect the differences in the spread of the coronavirus and in the health systems' understanding of and approach to PA. The global scientific discourse on the pandemic represents a further key influencing factor. The management of the coronavirus pandemic has demonstrated that the extreme complexity of societies in terms of public health, politics, and the economy pose challenges and unsolvable contradictions.

Weight Bias During the COVID-19 Pandemic

PURPOSE OF REVIEW

This review explores potential sources of weight bias and stigma during the COVID-19 pandemic, including "quarantine-15" messages and discussion of obesity in media and public health campaigns. We examine evidence of the effects of weight bias on well-being during the pandemic and highlight unanswered questions to be addressed in future research.

RECENT FINDINGS

Studies that have investigated weight change during stay-at-home orders have yielded mixed findings and relied predominantly on self-reported retrospective recall, thus providing weak evidence of a widespread "quarantine-15" effect. No studies to date have evaluated the effects on weight stigma and health of obesity-focused COVID-19 media and public health messages. Individuals with a history of experiencing weight bias may be more vulnerable to binge eating and psychological distress during the pandemic. Weight bias and stigma during the COVID-19 pandemic, and their effects on health and well-being, warrant greater investigation and consideration in public health efforts.

COVID-19 and the golden years

ABSTRACT

The impact of COVID-19 on older adults may not be readily apparent. Personal protective and social distancing measures can reduce activity levels, increase feelings of isolation and loss, and result in lapsed medical care. NPs must recognize detrimental impacts on overall health and wellness and assist older adults in overcoming them.

Examining the Impact of a Mobile Health App on Functional Movement and Physical Fitness: Pilot Pragmatic Randomized Controlled Trial

Background

Numerous mobile apps available for download are geared toward health and fitness; however, limited research has evaluated the real-world effectiveness of such apps. The movr app is a mobile health app designed to enhance physical functioning by prescribing functional movement training based on individualized movement assessments. The influence of the movr app on functional movement and physical fitness (flexibility, strength, and cardiovascular fitness) has not yet been established empirically.

Objective

This study aims to examine the real-world impact of the movr app on functional movement, flexibility, strength, and cardiovascular fitness.

Methods

A total of 48 healthy adults (24 women and 24 men; mean age 24, SD 5 years) completed an 8-week pilot pragmatic randomized controlled trial in which they were randomly assigned to either 8-week use of the movr app (n=24) or 8-week waitlist control (n=24). Measures of functional movement (Functional Movement Screen [FMS]), strength (push-ups, handgrip strength, and countermovement jump), flexibility (shoulder flexibility, sit and reach, active straight leg raise [ASLR], and half-kneeling dorsiflexion), and cardiovascular fitness (maximal oxygen uptake []) were collected at baseline and the 8-week follow-up.

Results

Repeated measures analyses of variance revealed significant group-by-time interactions for the 100-point FMS (P<.001), shoulder flexibility (P=.01), ASLR (P=.001), half-kneeling dorsiflexion (P<.001), and push-up tests (P=.03). Pairwise comparisons showed that FMS scores increased from pre- to postintervention for those in the movr group (P<.001) and significantly decreased for those in the control group (P=.04). For shoulder flexibility, ASLR, half-kneeling dorsiflexion, and push-up tests, improvements from pre- to postintervention were found in the movr group (all values of P<.05) but not in the control group (all values of P>.05). There were no changes in the sit and reach or handgrip strength test scores for either group (all values of P>.05). A significant main effect of time was found for the countermovement jump (P=.02), such that scores decreased from pre- to postintervention in the control group (P=.02) but not in the movr group (P=.38). Finally, a significant group-by-time interaction was found for (P=.001), revealing that scores decreased pre- to postintervention in the control group (P<.001), but not in the movr group (P=.54).

Conclusions

The findings revealed that movr improved indices of functional movement (FMS), flexibility (shoulder, ASLR, and dorsiflexion), and muscular endurance (push-ups) over an 8-week period compared with the control group while maintaining handgrip strength, lower body power (countermovement jump), and cardiovascular fitness (). Thus, this study provides initial evidence of the effectiveness of the movr app for enhancing functional movement and physical fitness among healthy adults.

Trial Registration

ClinicalTrials.gov NCT04865666; https://clinicaltrials.gov/ct2/show/NCT04865666

Physical activity and mental well-being under COVID-19 lockdown: a cross-sectional multination study

BACKGROUND

COVID-19 lockdowns have reduced opportunities for physical activity (PA) and encouraged more sedentary lifestyles. A concomitant of sedentariness is compromised mental health. We investigated the effects of COVID-19 lockdown on PA, sedentary behavior, and mental health across four Western nations (USA, UK, France, and Australia).

METHODS

An online survey was administered in the second quarter of 2020 (N = 2541). We measured planned and unplanned dimensions of PA using the Brunel Lifestyle Physical Activity Questionnaire and mental health using the 12-item General Health Questionnaire. Steps per day were recorded only from participants who used an electronic device for this purpose, and sedentary behavior was reported in hours per day (sitting and screen time).

RESULTS

In the USA and Australia samples, there was a significant decline in planned PA from pre- to during lockdown. Among young adults, Australians exhibited the lowest planned PA scores, while in middle-aged groups, the UK recorded the highest. Young adults exhibited the largest reduction in unplanned PA. Across nations, there was a reduction of ~ 2000 steps per day. Large increases in sedentary behavior emerged during lockdown, which were most acute in young adults. Lockdown was associated with a decline in mental health that was more pronounced in women.

CONCLUSIONS

The findings illustrate the deleterious effects of lockdown on PA, sedentary behavior, and mental health across four Western nations. Australian young and lower middle-aged adults appeared to fare particularly badly in terms of planned PA. The reduction in steps per day is equivalent to the non-expenditure of ~ 100 kcal. Declines in mental health show how harmful lockdowns can be for women in particular.

Physical Activity during the First Lockdown of the COVID-19 Pandemic: Investigating the Reliance on Digital Technologies, Perceived Benefits, Barriers and the Impact of Affect

The measures to fight the spread of the COVID-19 pandemic have been concentrated on inviting people to stay at home. This has reduced opportunities to exercise while also shedding some light on the importance of physical health. Based on an online survey, this paper investigated physical activity behaviours of a Belgians sample (n = 427) during the lockdown period between the end of May 2020 and the beginning of June 2020 and found that, during this period, the gap between sufficiently and insufficiently active individuals widened even more. This paper analysed important moderators of physical activity behaviours, such as barriers and benefits to exercise, digital support used to exercise, and individuals’ emotional well-being. Descriptive analysis and analyses of variance indicated that, generally, individuals significantly increased their engagement in exercise, especially light- and moderate-intensity activities, mostly accepted the listed benefits but refused the listed barriers, increased their engagement in digital support and did not score high on any affective measures. A comparison between sufficiently active and insufficiently active individuals during the lockdown showed that the former engaged even more in physical activity, whereas the latter exercised equally (i.e., not enough) or even less compared to before the lockdown. By means of a logistic regression, five key factors of belonging to the sufficiently active group were revealed and discussed. Practical implications for government and policies are reviewed.

Impacts of lockdown on dietary patterns among youths in China: the COVID-19 Impact on Lifestyle Change Survey

Objective:

To assess changes in dietary patterns among youths in China after COVID-19 lockdown.

Design:

This study was based on the COVID-19 Impact on Lifestyle Change Survey (COINLICS), a national retrospective survey established in early May 2020. The questionnaire was distributed through social media platforms. The sociodemographic information and routine dietary patterns before and after lockdown of participants were investigated. t tests and χ² tests were used to compare the differences in consumption patterns of twelve major food groups and beverages between sex and across educational levels before and after lockdown. Factor analysis was employed to obtain the main dietary patterns.

Settings:

China.

Participants:

A total of 10 082 youths.

Results:

A significant decrease was observed in the average weekly frequency of rice intake, while significant increases were observed in the frequency of intake of wheat products, other staple foods, fish, eggs, fresh vegetables, preserved vegetables, fresh fruit and dairy products (all P values < 0·01). Heterogeneities of average weekly frequency existed between sex and across educational levels to different extents. The three main dietary patterns derived were loaded most heavily on dairy products, rice and wheat products, separately; the rice pattern became more dominant than the wheat products pattern after lockdown. The frequency of sugar-sweetened beverage consumption had decreased, while the frequency of other beverages had increased.

Conclusions:

Our timely survey would inform policymakers and health professionals of these significant changes in youths’ dietary patterns after lockdown, with heterogeneities observed to different extents between sex and across educational levels, for better policy-making and public health practice.

Changes in Sitting Time, Screen Exposure and Physical Activity during COVID-19 Lockdown in South American Adults: A Cross-Sectional Study

The worldwide prevalence of insufficient physical activity (PA) and prolonged sedentary behavior (SB) were high before the coronavirus (COVID-19) pandemic. Measures that were taken by governments (such as home confinement) to control the spread of COVID-19 may have affected levels of PA and SB. This cross-sectional study among South American adults during the first months of COVID-19 aims to (i) compare sitting time (ST), screen exposure, moderate PA (MPA), vigorous PA (VPA), and moderate-to-vigorous PA (MVPA) before and during lockdown to sociodemographic correlates and (ii) to assess the impact of lockdown on combinations of groups reporting meeting/not-meeting PA recommendations and engaging/not-engaging excessive ST (≥7 h/day). Bivariate associations, effect sizes, and multivariable linear regressions were used. Adults from Argentina (n = 575) and Chile (n = 730) completed an online survey with questions regarding demographics, lifestyle factors, and chronic diseases. Mean reductions of 42.7 and 22.0 min./day were shown in MPA and VPA, respectively; while increases of 212.4 and 164.3 min./day were observed in screen and ST, respectively. Those who met PA recommendations and spent <7 h/day of ST experienced greatest changes, reporting greater than 3 h/day higher ST and more than 1.5 h/day lower MVPA. Findings from the present study suggest that efforts to promote PA to South American adults during and after COVID-19 restrictions are needed.

Comparison of Physical Activity Levels in Youths before and during a Pandemic Lockdown

This study aimed to compare physical activity (PA) levels before and during a pandemic lockdown among adolescent Polish youths in relation to meeting the World Health Organization’s (WHO) recommendations of moderate-to-vigorous physical activity (MVPA) and identify potential environmental factors that may affect these levels. An online survey tool that included validated measures of adolescents’ MVPA and socio-environmental, potential confounders was administered to youths (e.g., lack of classmates, motivation, possibility of choosing any physical exercise time, possibility of choosing your own exercises, home environment). The analytic sample comprised 127 adolescents aged 15.4 ± 0.5 years on average (52% girls and 48% boys). The results highlight that among adolescents who did not meet the WHO MVPA recommendations before the lockdown, 13.4% had an increased frequency of PA (from 2.9 to 5.4 day/week) (p = 0.01) during the lockdown. In the group who did meet these recommendations before the lockdown, 50% significantly decreased their level of MVPA below the WHO’s recommendations (p = 0.01). Self-rated health for PA showed a significantly strong correlation with MVPA in the group of students who met the WHO recommendations before the pandemic (r = 0.76; p < 0.05) but failed to maintain that recommendation during the COVID-19 restriction. The results suggest a negative impact of the pandemic on PA undertaken by youths. Based on these results we see the need for increased action by both Physical Education (PE) teachers and parents to motivate and support youngsters in taking up systematic PA consciously.

The Effect of Social Isolation on Physical Activity during the COVID-19 Pandemic in France

The objective of this cross-sectional study is to analyze the changes in physical activity (PA) practice of a sample of 2099 French adults, mostly females, who answered an online questionnaire during the first COVID-19 lockdown (March-May 2020). A descriptive analysis of participants was performed using relative frequencies. Chi-squared tests were performed to compare the responses of selected variables. Multinomial logistic regressions were performed to compare the variations of PA with all the variables identified. The age of participants ranged from 18 to 88. Among people who practiced PAs before the first lockdown, the probability to keep practicing PAs is higher among those with a lower level of education, among housewives and retirees and among those who lived in cities of 10,000-19,999 inhabitants. For those who did not practice PAs before the social distancing, the probability of starting to practice is greater in those with a lower level of education and for those who suffered from a chronic disease. Our results place the emphasis on the complexity and multifactoriality of the changes that emerged during the first lockdown. The "education" factor emerges, as a significant determinant of PA that should certainly be explored further.

Cardiopulmonary exercise testing during the COVID-19 pandemic

The outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has presented a global public health emergency. Although predominantly a pandemic of acute respiratory disease, corona virus infectious disease-19 (COVID-19) results in multi-organ damage that impairs cardiopulmonary (CP) function and reduces cardiorespiratory fitness. Superimposed on the CP consequences of COVID-19 is a marked reduction in physical activity that exacerbates CP disease (CPD) risk. CP exercise testing (CPET) is routinely used in clinical practice to diagnose CPD and assess prognosis; assess cardiovascular safety for rehabilitation; and delineate the physiological contributors to exercise intolerance and exertional fatigue. As such, CPET plays an important role in clinical assessments of convalescent COVID-19 patients as well as research aimed at understanding the long-term health effects of SARS-CoV-2 infection. However, due to the ventilatory expired gas analysis involved with CPET, the procedure is considered an aerosol generating procedure. Therefore, extra precautions should be taken by health care providers and exercise physiologists performing these tests. This paper provides recommendations for CPET testing during the COVID-19 pandemic. These recommendations include indications for CPET; pre-screening assessments; precautions required for testing; and suggested decontamination protocols. These safety recommendations are aimed at preventing SARS-CoV-2 transmission during CPET.

The association of estimated cardiorespiratory fitness with COVID-19 incidence and mortality: A cohort study

Background

It has been suggested that cardiorespiratory fitness (CRF) may be used to identify those at greatest risk for severe COVID-19 illness. However, no study to date has examined the association between CRF and COVID-19. The objectives of this study were to determine whether CRF is independently associated with testing positive with or dying from COVID-19.

Methods

This is a prospective cohort study of 2,690 adults from the UK Biobank Study that were followed from March 16^th, 2020 to July 26^th, 2020. Participants who were tested for COVID-19 and had undergone CRF assessment were examined. CRF was estimated (eCRF) and categorized as low (<20^th percentile), moderate (20^th to 80^th percentile) and high (≥80^th percentile) within sex and ten-year age groups (e.g. 50–60 years). Participants were classified as having COVID-19 if they tested positive (primarily PCR tests) at an in-patient or out-patient setting as of July 26, 2020. Participants were classified as having died from COVID-19 if the primary or underlying cause of death was listed ICD-10 codes U071 or U072 by June 30^th, 2020. Adjusted risk ratios (aRR) and 95% confidence intervals (CI) were estimated and a forward model building approach used to identify covariates.

Findings

There was no significant association between eCRF and testing positive for COVID-19. Conversely, individuals with moderate (aRR = 0.43, 95% CI: 0.25, 0.75) and high fitness (aRR = 0.37, 95% CI: 0.16, 0.85) had a significantly lower risk of dying from COVID-19 than those with low fitness.

Conclusions

While eCRF was not significantly associated with testing positive for COVID-19, we observed a significant dose-response between having higher eCRF and a decreased risk of dying from COVID-19. This suggests that prior gains in CRF could be protective against dying from COVID-19 should someone develop the virus.

Self-reported physical activity before a COVID-19 'lockdown': is it just a matter of opinion?

There are growing concerns that the COVID-19 pandemic has facilitated a sedentary shift in our physical activity habits. A reduction in physical activity during the pandemic may be secondary to restrictive policies implemented at the government-level, typically those policies which limit interpersonal contact; for example, physical/social distancing. It is without question that social distancing is a necessary measure to mitigate community transmission of the novel virus; however, these policies often limit the public's opportunities to engage in physical activity. The strictest enforcement of social distancing occurs during an authority-mandated 'lockdown' (also known as a 'shelter-in-place' or 'stay-at-home' order). This Viewpoint focuses on the current evidence demonstrating that physical activity declines during a COVID-19 'lockdown'. We highlight the point that most of the available evidence stems from investigations using non-validated, self-reported measures of physical activity and discuss the caveats therewith. This Viewpoint explores whether current evidence reflects an 'actual' or rather a 'perceived' reduction in physical activity, and raises the question of whether this distinction matters in the end.

Physical exercise and COVID-19 pandemic in PubMed: Two months of dynamics and one year of original scientific production

Our aim was to conduct a narrative review about physical exercise and Corona Virus Disease 2019 (COVID-19). A literature search was completed crossing the keywords “COVID-19” and “physical exercise”, for a narrative review, and physical activity (PA), physical exercise, physical training, sport, physical fitness, for a systematic review; search strategy (Randomized Controlled Trial, in the last 1 year, English). The first search date was closed on 04/26/2020 and 06/26/2020. This strategy was chosen to assess the dynamics of scientific information production for the pandemic. In two months, an increase of 76%, from 12 (19.4%) to 50 (80.64%) COVID-19 articles (n = 62, 100%) was found. The main types of articles published were editorial articles (16.13%, n = 10 of 62 articles) and commentary (9.68%, n = 6 of 62 articles). The most frequent country of origin of the scientific production was the United States (12.90%, n = 8 of 62 articles), the United Kingdom (12.90%, n = 8 of 62 articles), and Brazil (11.29%, n = 7 of 62 articles). However, in 2020, there were only 2 relevant randomized controlled trials on the COVID-19 topic in the context of physical exercise. Scientific information production shows the concern of the PA science community to bring a solution to the increase in physical inactivity generated by the COVID-19 pandemic. Our findings show the dynamics of scientific production on the COVID-19, in a situation so unique such as a pandemic, denotes that the practice of PA is essential to improve and/or maintain physical and mental health.

Physical Activity during COVID-19 Lockdown: Data from An Italian Survey

The COVID-19 pandemic has forced governments to impose quarantines and lockdowns as containment strategy, raising concerns about mental health and low level of physical activity performed by quarantined populations. In this study, we assess the level of physical activity and psychological wellbeing in a sample of the Italian population during lockdown through an online format of International Physical Activity Questionnaire (IPAQ) and Psychological General Well-Being index-Short version (PGWB-S) . Of 317 adult responders considered, most were female (61.2%), young adults (52.4%), living in little-to-medium size cities (80.1%) and with high-level education (62.8%). Most of our sample performed physical activity mostly during leisure time and domestic activities, and 60.9% were highly active. No interactions were found between physical activity and the demographic characteristics considered. Subjects performing high level of physical activity felt more energetic and vital than those with moderate (p < 0.0001) and low levels (p < 0.0001) of physical activity. Our participants performed enough activity to satisfy the WHO Guidelines, mainly due to domestic activity and activity performed during leisure time, with an overall moderately positive psychological reaction to lockdown.

Distortions to the passage of time during England's second national lockdown: A role for depression

In attempts to control the spread of the Covid-19 virus, many governments have resorted to imposing national lockdowns on their citizens. Previous research has demonstrated the passage of time becomes distorted for many people during these lockdowns. To date, research has only examined how time was experienced early in initial lockdowns. The current study examined whether distortions to the passage of time were also present later into the global pandemic. An online questionnaire was used to collect passage of time judgments for the day, week and 8 month period since the first UK lockdown. In addition, measures of affect, social satisfaction, task-load, compliance and health status were also recorded. The results show that over 80% of people reported experiencing distortion to the passage of time during the second English lockdown in comparison with normal. Depression, satisfaction with social interaction and shielding status were found to be significant predictors of temporal distortion. A slower passage of time was associated with greater depression, shielding and greater dissatisfaction with social interactions. Feeling like it was longer than 8 months since the UK's first lockdown was associated with greater depression, increased dissatisfaction with social interaction and greater change of life as a result of lockdown. The results suggest that distortions to the passage of time are an enduring feature of lockdown life and that different factors predict temporal experience during different points in lockdown.

Associations among physical activity tracking, physical activity motivation and level of physical activity in young adults

Whether physical activity (PA) tracking devices are associated with PA motivation in young adults is largely unknown. We compared total PA minutes per week, total minutes walking/week, meeting moderate-to vigorous PA guidelines, and past-year activity tracking across motivation cluster profiles among 799 young adults. Participants with "self-determined" profiles reported the highest total PA minutes/week followed by participants with "low intrinsic," "controlled self-determined," and "high external" profiles. A behavior regulation profile X activity tracking frequency interaction was not significant. Behavior regulation profiles may need to be considered in PA interventions using activity trackers.

Exploring Two Pandemics in Academic Arena: Physical Activity and Sedentary Behaviors Profile of University Students in Bangladesh

The overlay of the COVID-19 pandemic on the pandemic of physical inactivity has become a great concern. Both types of pandemics can decrease the health protection capacity and consequently increase complexity in human lives. This cross-sectional study intended to examine changes in physical activity and sedentary behaviors during the COVID-19 pandemic among university students in a second-tier city of Bangladesh. Two hundred and nine students responded to an online questionnaire administered via Google Survey. In addition to descriptive statistics, parametric and non-parametric tests for comparing means, medians and distributions were used to assess differences in activity traits before and during the COVID-19 pandemic. Results show that the occurrence of COVID-19 has significantly reduced the practice of walking and physical activities among the students. They are commonly motivated by introjected regulation. Father's occupation and the type of family of a student have significant influences on the total physical activity in either situation. Bangladeshi university students have, particularly, been perceived as not generally used to vigorous physical activities. They are inactive compared to students from other countries. Thus, the public health policymakers and the corresponding authority should inspire the students to be more physically active by implementing different strategies such as increasing bicycling and walking facilities on the campus.

A COVID-19 Rehabilitation Prospective Surveillance Model for Use by Physiotherapists

The long-term sequelae of coronavirus disease 2019 (COVID-19) are only now beginning to be defined, but it is already known that the disease can have direct and indirect impacts mainly on the cardiorespiratory and neuromuscular systems and may affect mental health. A role for rehabilitation professionals from all disciplines in addressing COVID-19 sequelae is recognised, but it is essential that patient assessment be systematic if health complications are to be identified and treated and, if possible, prevented. The aim is to present a COVID-19 prospective surveillance model based on sensitive and easily used assessment tools, which is urgently required. Following the Oxford Centre for Evidence-Based Medicine Level of Evidence Tool, an expert team in cardiorespiratory, neuromuscular and mental health worked via telemeetings to establish a model that provides guidelines to rehabilitation professionals working with patients who require rehabilitation after suffering from COVID-19. A COVID-19 prospective surveillance model is proposed for use by rehabilitation professionals and includes both face-to-face and telematic monitoring components. This model should facilitate the early identification and management of long-term COVID-19 sequelae, thus responding to an arising need.

The Effect of Meditation and Physical Activity on the Mental Health Impact of COVID-19-Related Stress and Attention to News Among Mobile App Users in the United States: Cross-sectional Survey

BACKGROUND

The COVID-19 pandemic has been declared an international public health emergency, and it may have long-lasting effects on people's mental health. There is a need to identify effective health behaviors to mitigate the negative mental health impact of COVID-19.

OBJECTIVE

The objectives of this study were to (1) examine the regional differences in mental health and COVID-19-related worry, attention to news, and stress, in light of the state-level prevalence of COVID-19 cases; (2) estimate the associations between mental health and COVID-19-related worry, attention to news, and stress and health behavior engagement (ie, physical activity, mindfulness meditation); and (3) explore the mediating effect of health behavior engagement on the associations between mental health and COVID-19-related worry, attention to news, and stress.

METHODS

A cross-sectional survey was distributed to a sample of US adult paying subscribers to the Calm app (data were collected from April 22 to June 3, 2020). The survey assessed COVID-19-related worry, attention to news, and stress; health behavior engagement; and mental health (ie, perceived stress, posttraumatic stress disorder, and anxiety and depression). Statistical analyses were performed using R software. Differences in COVID-19-related worry, attention to news, and stress and mental health by location were assessed using t tests and chi-square tests. Logistic and ordinary least squares models were used to regress mental health and health behavior on COVID-19-related worry, attention to news, and stress; moreover, causal mediation analysis was used to estimate the significance of the mediation effects.

RESULTS

The median age of the respondents (N=8392) was 47 years (SD 13.8). Participants in the Mid-Atlantic region (New Jersey, New York, and Pennsylvania) reported higher levels of stress, more severe depression symptoms, greater worry about COVID-19, paying more attention to COVID-19-related news, and more stress related to social distancing recommendations than participants living in other regions. The association between worry about COVID-19 and perceived stress was significantly mediated by changes in physical activity (P<.001), strength of meditation habit (P<.001), and stopping meditation (P=.046). The association between worry about COVID-19 and posttraumatic stress disorder symptoms was significantly mediated by changes in physical activity (P<.001) and strength of meditation habit (P<.001).

CONCLUSIONS

Our findings describe the mental health impact of COVID-19 and outline how continued participation in health behaviors such as physical activity and mindfulness meditation reduce worsening of mental health due to the COVID-19 pandemic. These data have important implications for public health agencies and health organizations to promote the maintenance of health habits to reduce the residual mental health burden of the COVID-19 pandemic.

Impact of COVID-19 Pandemic on Life-Space Mobility of Older Adults Living in Brazil: REMOBILIZE Study

Background: The COVID-19 pandemic hit Brazil in a scenario of substantial socioeconomic and health inequalities. It is unknown the immediate impact of social restriction recommendations (i.e., lockdown, stay-at-home) on the life-space mobility of older people. Objective: To investigate the immediate impact of COVID-19 pandemic on life-space mobility of community-dwelling Brazilian older adults and examine the social determinants of health associated with change in life-space mobility. Design: Baseline data from a prospective cohort study (REMOBILIZE Study). Setting: Community. Subject: A convenience snowball sample of participants aged 60 and older (n = 1,482) living in 22 states in Brazil. Methods: We conducted an online and phone survey using an adapted version of the Life-Space Assessment (LSA). Linear regression models were used to investigate social determinants of health on the change in LSA score. Results: Regardless of their gender and social determinants of health, participants showed a significant reduction in life-space mobility since COVID-19 pandemic outbreak. Life-space mobility reduction was higher among black individuals, those living alone and aged between 70 and 79. Other variables associated with change in life-space mobility, to a lesser extent, were sex, education and income. Conclusion: Social restriction measures due to pandemic caused substantial reduction in older adults' life-space mobility in Brazil. Social inequalities strongly affected vulnerable groups. Concerted actions should be put in place to overcome the deterioration in life-pace mobility amongst these groups. Failure in minimizing health inequalities amplified by the pandemic may jeopardize the desired achievements of the Decade of Healthy Aging.

Educational and Social Exergaming: A Perspective on Physical, Social, and Educational Benefits and Pitfalls of Exergaming at Home During the COVID-19 Pandemic and Afterwards

Physical inactivity and coronavirus disease 2019 (COVID-19) signify two pandemics with negative physical, mental, and economic consequences. Younger and older people have not reached the recommended physical activity level for years. Societal restrictions due to COVID-19 additionally reduce opportunities for physical activity, and they increase social isolation. Here, we outline how playing exergames with others (social exergaming) at home could foster physical and mental health and promote communication and discussions on exergaming. Accordingly, we highlight the educational and social benefits of exergaming at home and delineate the concept of Educational and Social Exergaming (EASE). We outline specific benefits and pitfalls of exergaming regarding its physical and nonphysical effects, including educational values of discussing exergaming experiences and related topics. Moreover, we discuss the relevance of practical guidelines for educational and social exergaming at home as well as prospects for future research. Overall, educational and social exergaming could alleviate several detrimental effects of both pandemics on the health and well-being of people of all ages.

Health, Psychosocial, and Social Issues Emanating From the COVID-19 Pandemic Based on Social Media Comments: Text Mining and Thematic Analysis Approach

Background

The COVID-19 pandemic has caused a global health crisis that affects many aspects of human lives. In the absence of vaccines and antivirals, several behavioral change and policy initiatives such as physical distancing have been implemented to control the spread of COVID-19. Social media data can reveal public perceptions toward how governments and health agencies worldwide are handling the pandemic, and the impact of the disease on people regardless of their geographic locations in line with various factors that hinder or facilitate the efforts to control the spread of the pandemic globally.

Objective

This paper aims to investigate the impact of the COVID-19 pandemic on people worldwide using social media data.

Methods

We applied natural language processing (NLP) and thematic analysis to understand public opinions, experiences, and issues with respect to the COVID-19 pandemic using social media data. First, we collected over 47 million COVID-19–related comments from Twitter, Facebook, YouTube, and three online discussion forums. Second, we performed data preprocessing, which involved applying NLP techniques to clean and prepare the data for automated key phrase extraction. Third, we applied the NLP approach to extract meaningful key phrases from over 1 million randomly selected comments and computed sentiment score for each key phrase and assigned sentiment polarity (ie, positive, negative, or neutral) based on the score using a lexicon-based technique. Fourth, we grouped related negative and positive key phrases into categories or broad themes.

Results

A total of 34 negative themes emerged, out of which 15 were health-related issues, psychosocial issues, and social issues related to the COVID-19 pandemic from the public perspective. Some of the health-related issues were increased mortality, health concerns, struggling health systems, and fitness issues; while some of the psychosocial issues were frustrations due to life disruptions, panic shopping, and expression of fear. Social issues were harassment, domestic violence, and wrong societal attitude. In addition, 20 positive themes emerged from our results. Some of the positive themes were public awareness, encouragement, gratitude, cleaner environment, online learning, charity, spiritual support, and innovative research.

Conclusions

We uncovered various negative and positive themes representing public perceptions toward the COVID-19 pandemic and recommended interventions that can help address the health, psychosocial, and social issues based on the positive themes and other research evidence. These interventions will help governments, health professionals and agencies, institutions, and individuals in their efforts to curb the spread of COVID-19 and minimize its impact, and in reacting to any future pandemics.

Physical exercise effects on the brain during COVID-19 pandemic: links between mental and cardiovascular health

The current pandemic was caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The quarantine period during corona virus disease 19 (COVID-19) outbreak might affect the quality of life leading thousands of individuals to diminish the daily caloric expenditure and mobility, leading to a sedentary behavior and increase the number of health disorders. Exercising is used as a non-pharmacological treatment in many chronic diseases. Here, we review the molecular mechanisms of physical exercise in COVID-19 pandemic on mental health. We also point links between exercise, mental, and cardiovascular health. The infection caused by SARS-CoV-2 affects host cells binding to angiotensin-converting enzyme-2 (ACE2), which is the receptor for SARS-CoV-2. If there is not enough oxygen supply the lungs and other tissues, such as the heart or brain, are affected. SARS-CoV-2 enhances ACE2 leading to inflammation and neuronal death with possible development of mood disorders, such as depression and anxiety. Physical exercise also enhances the ACE2 expression. Conversely, the activation of ACE2/Ang 1-7/Mas axis by physical exercise induces an antiinflammatory and antifibrotic effect. Physical exercise has beneficial effects on mental health enhancing IGF-1, PI3K, BDNF, ERK, and reducing GSK3β levels. In addition, physical exercise enhances the activity of PGC-1α/ FNDC5/Irisin pathway leading to neuronal survival and the maintenance of a good mental health. Thus, SARS-CoV-2 infection leads to elevation of ACE2 levels through pathological mechanisms that lead to neurological and cardiovascular complications, while the physiological response of ACE2 to physical exercise improves cardiovascular and mental health.

Exercise and COVID-19: reasons individuals sought coaching support to assist them to increase physical activity during COVID-19

OBJECTIVE

This paper explores the experiences of individuals who reported substantially decreasing physical activity (PA) as a result of COVID-19 and sought coaching support to increase PA.

METHODS

A qualitative study using phenomenological analysis. Eight individuals participated in semi-structured interviews that focused on their experiences of decreasing PA as a result of physical distancing measures, and why they sought PA coaching to overcome these issues. Responses were analysed thematically.

RESULTS

The participants reported markedly decreasing their PA following the enactment of physical distancing measures. The inability to subsequently engage in regular PA was a source of frustration for participants. Interview analysis revealed two themes that contributed to the understanding of why these individuals felt they needed PA coaching to increase PA; namely, a desire for both listening support and PA self-regulation support.

CONCLUSION

The individuals who decreased PA due to COVID-19 desired an autonomy-supportive counselling style, centred on listening support and self-regulatory support. Online PA interventions were not highlighted as strategies to overcome PA barriers. Implications for public health: The effect of physical distancing measures on the determinants of overall PA is important, particularly if prolonged physical distancing is required.

Barriers to physical activity during the COVID-19 pandemic in adults: a cross-sectional study

Social isolation due to the coronavirus disease 2019 (COVID-19) pandemic has reduced physical activity levels in both men and women. The identification of barriers to physical activity may assist in developing strategies to increase levels of physical activity during this pandemic. The study aim was identify the barriers to regular participation in physical during the COVID-19 pandemic in Brazilian adults. This cross-sectional study included 1570 [56.6% women; aged: 39.1 (37.7–40.7) years old] in social isolation due COVID-19. Barriers to physical activity were obtained using the validated questionnaires. “Laziness and fatigue” (50.2%), “lack of motivation” (31.2%), “lack of appropriate facilities/equipment/space” (17.4%), and “lack of time” (13.0%) were the barriers most prevalent in the study. Lack of motivation (OR = 1.49; 95% CI = 1.19–1.86) and lack of appropriate facilities/equipment/space (OR = 2.11; 95% CI = 1.57–2.83) were most associated with impacting physical activity levels due to the COVID-19, independent of sex, age, education level, days of social isolation and status weight. In conclusion, personal barriers to physical activity are common between both sexes, with lack of motivation and lack of appropriate facilities/equipment/space most associated with a decreased level of physical activity due to the COVID-19 pandemic.

Health promotion preparedness for health crises - a 'must' or 'nice to have'? Case studies and global lessons learned from the COVID-19 pandemic

The current COVID-19 pandemic has exposed missing links between health promotion and national/global health emergency policies. In response, health promotion initiatives were urgently developed and applied around the world. A selection of case studies from five countries, based on the Socio-Ecological Model of Health Promotion, exemplify ‘real-world’ action and challenges for health promotion intervention, research, and policy during the COVID-19 pandemic. Interventions range from a focus on individuals/families, organizations, communities and in healthcare, public health, education and media systems, health-promoting settings, and policy. Lessons learned highlight the need for emphasizing equity, trust, systems approach, and sustained action in future health promotion preparedness strategies. Challenges and opportunities are highlighted regarding the need for rapid response, clear communication based on health literacy, and collaboration across countries, disciplines, and health and education systems for meaningful solutions to global health crises.

Physical activity recommendations during the COVID-19 pandemic: a practical approach for different target groups

Introduction

Ensuring health and well-being during this pandemic is essential according to the United Nations Sustainable Development Goals. Physical exercise has an important role in the preservation of the immune system, which is vital to prevent infections. To promote physical exercise and maintain a healthy status, recent studies have suggested general exercise routines to be implemented during the quarantine period. However, to improve the health-related physical fitness components, any specific prescription should include intensity, volume, duration, and mode. Controversy persists about which is the best intensity of physical activity, while performing exercise at a moderate intensity could bring important benefits to asymptomatic people. High intensity or unaccustomed exercise should be restricted for older people, and for people of all ages with chronic diseases or compromised immune system, obesity, or upper respiratory tract infection with limited symptoms. Besides, physical activity guidelines should be particular to each population group, giving special consideration to those vulnerable to COVID-19 who are much more likely to suffer more self-isolation. Therefore, the present study is to provide specific physical activity recommendations for different populations during this pandemic.

Physical Sports Activities and Exercise Addiction during Lockdown in the Spanish Population

The coronavirus disease 2019 (COVID-19) pandemic has led to the paralysis of the worldwide economy caused by the population's lockdown to stop the virus spreading, making it difficult to do exercise. The aim of this study is to analyse the commitment to and feeling of insecurity related to practising sport, sports habits and the profile of the Spanish population during lockdown according to the level of addiction to exercise. The sample consisted of 1019 subjects with a mean age of 35 years old. The variables analysed were exercise addiction, commitment to and feeling of insecurity related to sport, and sport habits. Three groups were identified according to their addiction level to exercise: asymptomatic (n = 202), symptomatic (n = 756), and at risk of addiction (n = 61). The main results indicated that a higher addiction level was associated with a higher number of days and time spent on exercise per week. Six percent of the subjects were at addiction risk, and they had a lower feeling of insecurity towards sport. These findings provide information to governments on the need to promote physical activity programmes at home to promote adequate fitness and mental wellbeing in the population.

Effect of COVID-19-Related Home Confinement on Sleep Quality, Screen Time and Physical Activity in Tunisian Boys and Girls: A Survey

COVID-19 home confinement has led to a stressful situation for children around the world and affected their lifestyle. The present study aimed to investigate the effect of these restrictions on sleep quality, screen time (ST) and physical activity (PA) in Tunisian children with a special focus on gender differences. An online survey was launched in April 2020. Questions were presented in a differential format, with expected responses related to "before" and "during" confinement. Participants (52 boys and 48 girls, age: 8.66 ± 3.3 years) responded to the Pittsburgh Sleep Quality Index (PSQI), the digital media use, and the Ricci and Gagnon sedentary behavior questionnaires. Findings revealed that COVID19 home confinement had a negative effect on all the considered parameters (p < 0.05). Significant effects of gender were found on sleep disturbances (p = 0.016, np2 = 0.05), subjective sleep quality (p < 0.01, np2 = 0.07), global score of PSQI (p = 0.01, np2 = 0.01) and nocturnal and global screen time (p < 0.001, np2 = 0.09) with poorer sleep and higher screen time in girls compared to boys during home confinement. A significant correlation was shown between Global ST and PSQI score (r = 0.39, p < 0.001). Programs of PA for children and sensitization campaigns against the use of screens have been deemed urgent with special focus oriented to girls.

Effects of a 48-Day Home Quarantine during the Covid-19 Pandemic on the First Outdoor Running Session among Recreational Runners in Spain

COVID-19-induced quarantine may lead to deleterious effects on health status as well as to impaired performance and increased injury risk when re-starting training after lockdown. We investigated the physical activity (PA) habits of recreational runners in Spain during a 48-day home quarantine during the COVID-19 pandemic and the characteristics of the first outdoor running session after confinement. A cross-sectional study, including a self-reported running questionnaire completed after the first outdoor running session after quarantine, was performed. Three hundred recreational runners (74% males; 60% 18-40 years old; most typical running experience >3 years, 10-30 km weekly running distance distributed in 3-4 sessions) were considered for analysis. Advanced runners ran, at least, 4 days/week and participated in running events. They performed significantly longer and more non-supervised weekly training sessions during confinement (p < 0.01 for both) than novice and amateur runners. Most runners performed their first outdoor running session on asphalt (65.3%) and ran 5 to 10 km (61%) at a pace above 5 min/km (60%), reporting no pain before (77%), during (64%), and 24 h after (76%) the session. Advanced runners performed a significantly longer running session, at a higher pace, and covered a greater distance (p < 0.01 for all) than novice and amateur runners, while enjoyment and motivation tended to be significantly higher when runners' level increased (p < 0.05). Higher training levels prior to and during confinement may lower the collateral effects (e.g., detraining, injury risk) of home quarantine when runners return to previous PA levels.

Relationship between Sedentary Time, Physical Activity, and Health-Related Quality of Life in Spanish Children

Higher sedentary time and lower physical activity (PA) are associated with a poor health-related quality of life (HRQoL) in children. The aims of this study were: (1) to analyze the sedentary time, objectively measured PA levels (light, moderate, vigorous, and moderate-to-vigorous physical activity (MVPA)), and HRQoL dimensions (physical well-being, emotional well-being, self-esteem, family, friends, school, and total score) in children; and (2) to examine the association between sedentary time, PA levels, and HRQoL in children separately by sex. A total of 459 children (8.4 ± 0.4 years old, 50.54% males) from 15 schools in Granada (Spain) participated in the study. A tri-axial accelerometer was used to measure PA levels in the children for 7 consecutive days. The Revidierter KINDer Lebensqualitätsfragebogen (KINDL-R) questionnaire was used to determine the children’s HRQoL dimensions. The results showed that males presented more minutes engaged in MVPA than females. Both sedentary time and PA levels were associated with self-esteem and total score (all p < 0.05). In males, moderate and vigorous PA levels were associated with higher HRQoL, whereas light PA was associated with higher HRQoL in females. Future studies should take into account the use of activities with difference intensities in order to increase HRQoL in males and females.

Impact of social isolation on the level of physical activity in young Brazilian athletes caused by COVID-19

Social detachment to prevent the spread of the COVID-19 pandemics in the year 2020 can significantly contribute to the physical inactivity of citizens worldwide. The study aimed to analyze the level of physical activity by identifying the training methods used during the social isolation resulting from the COVID-19 pandemic. Sixty-eight Brazilian athletes (both sex, 14.7 ± 1.68 years) answered and adapted the International Physical Activity Questionnaire (I-PAQ) through an online platform. Participants were asked to report their level of physical activity before and during the period of social distance. 67.7% of the interviewed athletes said they were able to adapt their sports training to the isolation environment under the guidance of a distance physical education professional. Only 4.38% of the sample was not training under such supervision and, therefore, inactive. Among the activities performed in the isolation environment, calisthenics was the primary practice (Effect Size: ƒ2 = 0.50, p <0.0001) and the sport practiced at home was the secondary practice (Effect Size: ƒ2 = 0.27, p = 0.004). During the pandemic, the training hours of athletes reduced significantly from ~ 3h to ~ 1h per day (Effect size: 1.74, p <0.0001), as well as, the perceived intensity decreased from "high" to "moderate" (Effect size: 1.38, p <0.0001). The weekly training frequency decreased from ~ 6 to 7 days to ~ 3 to 5 days (Effect size: 0.40, p = 0.03). Therefore, despite the social distance and the reduced pace of training, the young Brazilian athletes analyzed managed to remain physically active during the COVID-19 pandemic.

Influence of the characteristics of the house and place of residence in the daily educational activities of children during the period of COVID-19' confinement

The period of confinement motivated by the COVID-19 pandemic and established by the governments of different countries has influenced the lifestyle of millions of children, not being able to continue carrying out multiple educational activities as they did until confinement. The objective of this research was to determine and analyze whether the living conditions of children during the period of confinement caused by COVID-19 influenced their daily educational activities. A descriptive, comparative and cross-sectional quantitative study with a non-experimental design was carried out, with a single measurement in a single group. Factors associate with living conditions were analyzed, such as the place of residence and the type of house in which Spanish children have been confined, as well as the number and use of technological devices. The parents' perception of the children's state of fatigue, happiness, energy and tiredness was also analyzed. We have worked with a sample of 837 Spanish children. As a data collection instrument, the validated questionnaire on Equipment and Use of Information and Communication Technologies in Households (TIC-H2019) of the National Statistics Institute (INE) was used, following the recommendations of the Statistical Office of the European Union (EUROSTAT). The results confirm some statistically significant influence of the conditions of the house and place of residence on the daily time dedicated to different educational activities such as reading, physical activity, free play or use of technological devices between children residing in small flats and those residing in large flats or houses with garden and those residing in urban and rural settings.

Current Activities Centered on Healthy Living and Recommendations for the Future: A Position Statement from the HL-PIVOT Network

We continue to increase our cognizance and recognition of the importance of healthy living (HL) behaviors and HL medicine (HLM) to prevent and treat chronic disease. The continually unfolding events precipitated by the coronavirus disease 2019 (COVID-19) pandemic have further highlighted the importance of HL behaviors, as indicated by the characteristics of those who have been hospitalized and died from this viral infection. There has already been recognition that leading a healthy lifestyle, prior to the COVID-19 pandemic, may have a substantial protective effect in those who become infected with the virus. Now more than ever, HL behaviors and HLM are essential and must be promoted with a renewed vigor across the globe. In response to the rapidly evolving world since the beginning of the COVID-19 pandemic, and the clear need to change lifestyle behaviors to promote human resilience and quality of life, the HL for Pandemic Event Protection (HL-PIVOT) network was established. The 4 major areas of focus for the network are: (1) knowledge discovery and dissemination; (2) education; (3) policy; (4) implementation. This HL-PIVOT network position statement provides a current synopsis of the major focus areas of the network, including leading research in the field of HL behaviors and HLM, examples of best practices in education, policy, and implementation, and recommendations for the future.

Impact of the recreational use of virtual reality on physical and mental wellbeing during the Covid-19 lockdown

The Covid-19 pandemic has brought about significant changes to most aspects of our lives. As a result of the quarantine enforced by governments and authorities worldwide, people had to suddenly adapt their daily routines, including work, study, diet, leisure and fitness activities to the new circumstances. A growing body of research indicates that the engagement with virtual reality (VR) activities can have a positive impact on users’ mental and physical wellbeing. This study aims to evaluate the impact of VR activities on users under lockdown due to the Covid-19 pandemic. An online survey was carried out to investigate the recreational use of VR during the lockdown period and to gather users’ opinions on its impact on their physical and mental health. Non-parametric tests were used to evaluate the statistical significance of the responses provided by the 646 participants. The results of the survey show that VR use has significantly increased during the lockdown period for most participants, who expressed overwhelmingly positive opinions on the impact of VR activities on their mental and physical wellbeing. Strikingly, self-reported intensity of physical activity was considerably more strenuous in VR users than in console users. Given the current uncertainty as to the duration and course of the pandemic, as well as the possibility of intermittent lockdown in the upcoming years, the outcomes of this study could have a significant impact towards the development and deployment of VR-based strategies aimed at helping the population cope with prolonged social distancing, with particular regards to vulnerable individuals.

COVID-19 psychological factors associated with pain status, pain intensity, and pain-related interference

The 2019 novel SARS-CoV2 disease causing COVID-19 has had a devastating impact on the world, and those with pain conditions may be at heightened risk for these negative consequences. Given COVID-19 limitations, including social distancing and stay-at-home orders, pain is likely largely going untreated, leading to greater pain and associated consequences. Mental health symptoms, which have been found to be elevated due to COVID-19, may contribute to elevated pain experience, but little work has examined how COVID-19-specific mental health factors may be associated with pain. Therefore, the current study examined (1) how COVID-19-specific psychological factors and general mental health symptoms differ between those with pain and without, and (2) among those with pain, which psychological factors were most strongly associated with pain experience. Results from a national (U.S. based) online sample of 174 adults (42.5% female, M_age = 37.80 years, SD = 11.30, 88 with pain) collected between April and May 2020 indicated that, compared to those individuals reporting no pain, those with pain reported significantly higher values on all variables. Additionally, COVID-19 fear and sleep problems were associated with pain intensity, and for pain-related interference, fear, sleep problems, and depression were significantly associated. These results highlight the potential importance of COVID-19-specific psychological factors in pain experience.

The relationship between positivity for COVID-19 RT-PCR and symptoms, clinical findings, and mortality in Turkey

Introduction: This study aimed to assess the correlation between nucleic acid amplification test (real-time reverse transcription-polymerase chain reaction, RT-PCR) positivity of patients presenting with suspected COVID-19 and pneumonic infiltration consistent with COVID-19-specific pneumonia diagnosis on thoracic computed tomography (CT), with symptoms, laboratory findings, and clinical progression.

Methods: The study included 286 patients (female:male 131:155; mean age, 53.3 ± 17.9 years) who were divided into two groups according to their RT-PCR test results. The symptoms, laboratory examinations, clinical findings, and thoracic CT imaging of the patients were evaluated.

Results: While the physical examination, comorbidities, and total CT scores were similar between the groups, taste/smell abnormalities were observed more frequently in the PCR-positive group. The use of moxifloxacin, lopinavir/ritonavir, and tocilizumab was higher in the PCR-positive group (p = 0.016, p < 0.001, and p = 0.002, respectively). The duration of hospitalization, intensive care requirement, and mortality rate of the studied groups did not differ between the groups.

Conclusions: Among patients presenting with suspected COVID-19 and pneumonic infiltration consistent with COVID-19 on thoracic CT, the symptoms, physical examination, total CT scores, duration of hospitalization, intensive care requirement, and mortality rate were similar between RT-PCR-positive and RT-PCR-negative patients. However, PCR-positive patients appeared to require more specific treatments.

The Relevance of a Physical Active Lifestyle and Physical Fitness on Immune Defense: Mitigating Disease Burden, With Focus on COVID-19 Consequences

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a fast spreading virus leading to the development of Coronavirus Disease-2019 (COVID-19). Severe and critical cases are characterized by damage to the respiratory system, endothelial inflammation, and multiple organ failure triggered by an excessive production of proinflammatory cytokines, culminating in the high number of deaths all over the world. Sedentarism induces worse, continuous, and progressive consequences to health. On the other hand, physical activity provides benefits to health and improves low-grade systemic inflammation. The aim of this review is to elucidate the effects of physical activity in physical fitness, immune defense, and its contribution to mitigate the severe inflammatory response mediated by SARS-CoV-2. Physical exercise is an effective therapeutic strategy to mitigate the consequences of SARS-CoV-2 infection. In this sense, studies have shown that acute physical exercise induces the production of myokines that are secreted in tissues and into the bloodstream, supporting its systemic modulatory effect. Therefore, maintaining physical activity influence balance the immune system and increases immune vigilance, and also might promote potent effects against the consequences of infectious diseases and chronic diseases associated with the development of severe forms of COVID-19. Protocols to maintain exercise practice are suggested and have been strongly established, such as home-based exercise (HBE) and outdoor-based exercise (OBE). In this regard, HBE might help to reduce levels of physical inactivity, bed rest, and sitting time, impacting on adherence to physical activity, promoting all the benefits related to exercise, and attracting patients in different stages of treatment for COVID-19. In parallel, OBE must improve health, but also prevent and mitigate COVID-19 severe outcomes in all populations. In conclusion, HBE or OBE models can be a potent strategy to mitigate the progress of infection, and a coadjutant therapy for COVID-19 at all ages and different chronic conditions.

Impact of COVID-19 Lockdown on Physical Activity Among the Chinese Youths: The COVID-19 Impact on Lifestyle Change Survey (COINLICS)

Background: The study sought to assess the changes in physical activity (PA) and sedentary time among Chinese youths at different stages after the COVID-19 outbreak. Methods: It was based on a retrospective online survey conducted in May 2020. More than 10,000 youths voluntarily recalled their PA-related information at three stages: before COVID-19 (January), during lockdown (February), and after lockdown (May). χ2 tests were conducted to evaluate the significance of the differences in participants' characteristics between sexes, and Wilcoxon Rank Sum tests were performed to examine the significance of differences in changes in PA and sedentary behavior levels between sexes. Results: A total of 8,115 participants were included, with a mean age of 20. The percentage of no PA per week increased significantly and then slightly fell, and that of ≥150 min/week substantially decreased and then rebounded partially (all p < 0.001) (for instance, the percentage of ≥150 min/week of PA total decreased from 38.6 to 19.4%, then rebounded back to 25.3%). Means hours per day spent in sedentary behaviors had significantly increased during lockdown comparing to pre-COVID-19 (all p < 0.001). There were more participants reported reduced PA level than those indicated increased, and more participating youths had their sedentary behavior level increased than those who had it decreased. Conclusions: The study found COVID-19 had both immediate and longer-term impacts on self-reported physical activities and sedentary behaviors among Chinese youths. Relevant efforts should be strengthened to get youths physically moving again.