behavioral change towards reduced intensity physical activity is disproportionately CORD-Papers-2022-06-02 (Version 1)

Title: Behavioral Change Towards Reduced Intensity Physical Activity Is Disproportionately Prevalent Among Adults With Serious Health Issues or Self-Perception of High Risk During the UK COVID-19 Lockdown
Abstract: Objectives: We assessed whether lockdown had a disproportionate impact on physical activity behavior in groups who were or who perceived themselves to be at heightened risk from COVID-19. Methods: Physical activity intensity (none mild moderate or vigorous) before and during the UK COVID-19 lockdown was self-reported by 9190 adults between 2020-04-06 and 2020-04-22. Physician-diagnosed health conditions and topic composition of open-ended text on participants' coping strategies were tested for associations with changes in physical activity. Results: Most (63.9%) participants maintained their normal physical activity intensity during lockdown 25.0% changed toward less intensive activity and 11.1% were doing more. Doing less intensive physical activity was associated with obesity (OR 1.25 95% CI 1.081.42) hypertension (OR 1.25 1.101.40) lung disease (OR 1.23 1.081.38) depression (OR 2.05 1.892.21) and disability (OR 2.13 1.872.39). Being female (OR 1.25 1.121.38) living alone (OR 1.20 1.051.34) or without access to a garden (OR 1.74 1.561.91) were also associated with doing less intensive physical activity but being in the highest income group (OR 1.73 1.372.09) or having school-age children (OR 1.29 1.101.49) were associated with doing more. Younger adults were more likely to change their PA behavior compared to older adults. Structural topic modeling of narratives on coping strategies revealed associations between changes in physical activity and perceptions of personal or familial risks at work or at home. Conclusions: Policies on maintaining or improving physical activity intensity during lockdowns should consider (1) vulnerable groups of adults including those with chronic diseases or self-perceptions of being at risk and (2) the importance of access to green or open spaces in which to exercise.
Published: 2020-09-30
Journal: Front Public Health
DOI: 10.3389/fpubh.2020.575091
DOI_URL: http://doi.org/10.3389/fpubh.2020.575091
Author Name: Rogers Nina Trivedy
Author link: https://covid19-data.nist.gov/pid/rest/local/author/rogers_nina_trivedy
Author Name: Waterlow Naomi R
Author link: https://covid19-data.nist.gov/pid/rest/local/author/waterlow_naomi_r
Author Name: Brindle Hannah
Author link: https://covid19-data.nist.gov/pid/rest/local/author/brindle_hannah
Author Name: Enria Luisa
Author link: https://covid19-data.nist.gov/pid/rest/local/author/enria_luisa
Author Name: Eggo Rosalind M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/eggo_rosalind_m
Author Name: Lees Shelley
Author link: https://covid19-data.nist.gov/pid/rest/local/author/lees_shelley
Author Name: Roberts Chrissy h
Author link: https://covid19-data.nist.gov/pid/rest/local/author/roberts_chrissy_h
sha: 5d32750c91ba71838f1a5727167abeec3673c058
license: cc-by
license_url: https://creativecommons.org/licenses/by/4.0/
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 33102424
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/33102424
pmcid: PMC7554527
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554527
url: https://doi.org/10.3389/fpubh.2020.575091 https://www.ncbi.nlm.nih.gov/pubmed/33102424/
has_full_text: TRUE
Keywords Extracted from Text Content: PA insulin COVID-19 lockdown no-win children respondents muscle Lung lung lockdown mice https://www.who.int/news-room/detail/30-01-2020statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov NW parks ETP lockdowns XForm T8 Enketo toilet patients SARS-CoV2 Positivity/ Health/Exercise friends NR women pulmonary cardiovascular pre-COVID-19 lockdown T6 Facebook's 3-5 corpus Coronavirus disease 2019 Lockdown Coronavirus Act 2020 patient UK's lockdown https://getodk.github.io/xformsspec/ coronavirus people lines gardens Covid-19 T2 https://blogs.bmj.com/bmj/2020/03/16/covid-19home-based-exercise-activities-could-help-during-self-isolation/. COVID-19 HB left High-Dimensional Same heart UK Kit [EDK Figure 1 globe 5,502 human neural networks Figure 3 113,280 Facebook stop-words cancer ETPs pre-COVID-19 SARS-CoV-2 https://www.who.int/emergencies/diseases/ novel-coronavirus-2019/situation-reports line Supplementary Table 3 SL COVID-19 STM men UK lockdown participants Vaccine UK COVID-19 healthsurvey.hscic.gov.uk/media/63730/HSE16-Adult-phy-act.pdf Supplementary Table 4 South-East regions LE https://www.frontiersin.org/articles/10.3389/fpubh participants pre-print
Extracted Text Content in Record: First 5000 Characters:The pandemic spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (1) was declared a Public Health Emergency of International Concern by the World Health Organization on 30 January 2020 1 and by the end of April 2020 the virus had infected more than 3 million people worldwide, causing more than 200,000 deaths 2 . In order to limit the spread of Coronavirus disease 2019 (COVID- 19) , governments across the globe imposed varying degrees of social distancing advice and nationwide lockdowns. On 23 March 2020 the UK government enacted measures that were included in the Coronavirus Act 2020 and recommended that everyone must stay in their homes unless (i) shopping for essentials such as food and medicine, (ii) requiring medical assistance, (iii) caring for vulnerable people, (iv) traveling to and from work if absolutely necessary and (v) to carry out one form of exercise (e.g. walking, running, cycling) each day, either alone or with people who live together. Some adults aged 70 and over and those with specific underlying health conditions including asthma, heart disease, diabetes, and being seriously overweight were also advised to follow stricter social isolation recommendations. In this paper we refer to the combined package of measures as "lockdown". There have been growing concerns that the lockdown has placed limitations on opportunities for individuals to be physically active 3 (2) . It is well-established that physical activity (PA), a modifiable behavior, is protective against noncommunicable diseases (3) (4) (5) and that reduced levels of PA may have a negative impact on the control of chronic health problems including metabolic, cardiovascular, musculoskeletal, pulmonary, and psychiatric conditions; all of which are also often better controlled when PA is included as part of the management plan (6) . The tradeoff between protection from COVID-19 and increased risk of inactivity presents already vulnerable populations with a potential "no-win" situation; for instance, where the consequence of protection from acquiring SARS-CoV-2 infection is increased inactivity and associated downstream health impacts. Longer term, it is also possible that changes in PA behaviors could serve to increase the size of the population that is vulnerable to severe complications from COVID-19 in subsequent epidemic waves. Furthermore, a recent study showed that physical inactivity was one lifestyle-related risk factor for severe COVID-19 requiring hospital admission (7) . In this study we identify whether the UK's lockdown measures have had disproportionate impacts on PA intensity in groups who are, or who perceive themselves to be at risk of worse outcomes of 1 Available online at: https://www.who.int/news-room/detail/30-01-2020statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov). 2 World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report -101. Available online at: https://www.who.int/emergencies/diseases/ novel-coronavirus-2019/situation-reports. 3 Covid-19: Home based exercise activities could help during self-isolation. The BMJ. 2020. Available online at: https://blogs.bmj.com/bmj/2020/03/16/covid-19home-based-exercise-activities-could-help-during-self-isolation/. COVID-19 disease. This study takes the form of a UK-wide survey of adults aged 20 and over. Anonymous survey data were collected online between 2020-04-06 and 2020-04-22, roughly mapping to weeks 3-5 of the lockdown in the UK. The survey included 49 questions which covered a broad range of topics including (1) Demographics, (2) Health and Health Behaviors, (3) Adherence to COVID-19 Control measures, (4) Information sources used to learn about COVID-19, (5) Trust in various information sources, government and government decision-making, (6) Rumors and misinformation, (7) Contact & Communication during COVID-19 and (8) Fear and Isolation. The survey was publicized using a "daisy-chaining" approach in which respondents were asked to share and to encourage onward sharing of the survey's Uniform Resource Locator (URL) among friends & colleagues. The study team directly targeted a number of faith institutions, schools and special interest groups and also used Facebook's premium "Boost Post" feature. A "boosted" post functions as an advert which can be targeted at specific demographics. We boosted details of the survey and it's URL to a target audience of 113,280 Facebook users aged 13 and over and living in England, Wales, Scotland and Northern Ireland. Participants were also provided with URL links to a set of freely available summary reports and analyses which were periodically updated in near-real time. We used an ODK XForm (https://getodk.github.io/xformsspec/) deployed on Enketo smart paper (https://enketo.org/) via ODK Aggregate v.2.0.3 (https://github.com/getodk/aggregate). Form level encryption and end-to-end encryption
Keywords Extracted from PMC Text: PA insulin COVID-19 lockdown children 35–54 respondents Lung muscle lung lockdown mice NW parks ETP lockdowns XForm Weightlifting]" T8 Enketo toilet patients SARS-CoV2 Positivity/ Health/Exercise friends NR deaths2 women pulmonary cardiovascular https://getodk.github.io/xforms-spec/ pre-COVID-19 lockdown T6 Facebook's corpus Coronavirus disease 2019 Lockdown Coronavirus Act 2020 patient UK's lockdown coronavirus people gardens T2 England4 counts1 HB left High-Dimensional heart UK Kit [EDK Figure 1 no-win" ... globe 5,502 " human active3 neural networks Figure 3 113,280 Facebook stop-words cancer ETPs pre-COVID-19 SARS-CoV-2 line COVID-19" Supplementary Table 3 SL COVID-19 STM ..." men UK lockdown participants Vaccine 55–69 Supplementary Table 4 South-East regions LE lockdown"
Extracted PMC Text Content in Record: First 5000 Characters:The pandemic spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (1) was declared a Public Health Emergency of International Concern by the World Health Organization on 30 January 20201 and by the end of April 2020 the virus had infected more than 3 million people worldwide, causing more than 200,000 deaths2. In order to limit the spread of Coronavirus disease 2019 (COVID-19), governments across the globe imposed varying degrees of social distancing advice and nationwide lockdowns. On 23 March 2020 the UK government enacted measures that were included in the Coronavirus Act 2020 and recommended that everyone must stay in their homes unless (i) shopping for essentials such as food and medicine, (ii) requiring medical assistance, (iii) caring for vulnerable people, (iv) traveling to and from work if absolutely necessary and (v) to carry out one form of exercise (e.g. walking, running, cycling) each day, either alone or with people who live together. Some adults aged 70 and over and those with specific underlying health conditions including asthma, heart disease, diabetes, and being seriously overweight were also advised to follow stricter social isolation recommendations. In this paper we refer to the combined package of measures as "lockdown". There have been growing concerns that the lockdown has placed limitations on opportunities for individuals to be physically active3 (2). It is well-established that physical activity (PA), a modifiable behavior, is protective against non-communicable diseases (3–5) and that reduced levels of PA may have a negative impact on the control of chronic health problems including metabolic, cardiovascular, musculoskeletal, pulmonary, and psychiatric conditions; all of which are also often better controlled when PA is included as part of the management plan (6). The tradeoff between protection from COVID-19 and increased risk of inactivity presents already vulnerable populations with a potential "no-win" situation; for instance, where the consequence of protection from acquiring SARS-CoV-2 infection is increased inactivity and associated downstream health impacts. Longer term, it is also possible that changes in PA behaviors could serve to increase the size of the population that is vulnerable to severe complications from COVID-19 in subsequent epidemic waves. Furthermore, a recent study showed that physical inactivity was one lifestyle-related risk factor for severe COVID-19 requiring hospital admission (7). In this study we identify whether the UK's lockdown measures have had disproportionate impacts on PA intensity in groups who are, or who perceive themselves to be at risk of worse outcomes of COVID-19 disease. This study takes the form of a UK-wide survey of adults aged 20 and over. Anonymous survey data were collected online between 2020-04-06 and 2020-04-22, roughly mapping to weeks 3–5 of the lockdown in the UK. The survey included 49 questions which covered a broad range of topics including (1) Demographics, (2) Health and Health Behaviors, (3) Adherence to COVID-19 Control measures, (4) Information sources used to learn about COVID-19, (5) Trust in various information sources, government and government decision-making, (6) Rumors and misinformation, (7) Contact & Communication during COVID-19 and (8) Fear and Isolation. The survey was publicized using a "daisy-chaining" approach in which respondents were asked to share and to encourage onward sharing of the survey's Uniform Resource Locator (URL) among friends & colleagues. The study team directly targeted a number of faith institutions, schools and special interest groups and also used Facebook's premium "Boost Post" feature. A "boosted" post functions as an advert which can be targeted at specific demographics. We boosted details of the survey and it's URL to a target audience of 113,280 Facebook users aged 13 and over and living in England, Wales, Scotland and Northern Ireland. Participants were also provided with URL links to a set of freely available summary reports and analyses which were periodically updated in near-real time. We used an ODK XForm (https://getodk.github.io/xforms-spec/) deployed on Enketo smart paper (https://enketo.org/) via ODK Aggregate v.2.0.3 (https://github.com/getodk/aggregate). Form level encryption and end-to-end encryption of data transfer were implemented on all submissions. Participants were assessed for disability by asking about difficulties in six activities of daily living (ADLs) (8) including bathing, dressing, walking across a room, eating (such as cutting up food), getting in and out of bed, and using the toilet (including getting up and down). Disability was defined by the presence of at least one ADL. We also explored depressive symptomatology with the question "In the past 2 weeks, how often have you felt down, depressed, or hopeless?". Options were "not at all", "several days", "more than half the days", and "every day". Participants were classified as
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