||Behavioural 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.
||Importance: There are growing concerns that the UK COVID-19 lockdown has reduced opportunities to maintain health through physical activity placing individuals at higher risk of chronic disease and leaving them more vulnerable to severe sequelae of COVID-19. Objective: To examine whether the UK's lockdown measures have had disproportionate impacts on intensity of physical activity in groups who are or who perceive themselves to be at heightened risk from COVID-19. Designs Setting Participants: UK-wide survey of adults aged over 20 data collected between 2020-04-06 and 2020-04-22. Exposures: Self-reported doctor-diagnosed obesity hypertension type I/II diabetes lung disease cancer stroke heart disease. Self-reported disabilities and depression. Sex gender educational qualifications household income caring for school-age children. Narrative data on coping strategies. Main Outcomes and Measures: Change in physical activity intensity after implementation of UK COVID-19 lockdown (self-reported). Results: Most (60%) participants achieved the same level of intensity of physical activity during the lockdown as before the epidemic. Doing less intensive physical activity during the lockdown was associated with obesity (OR 1.21 95% CI 1.02-1.41) hypertension (OR 1.52 1.33-1.71) lung disease (OR 1.311.13-1.49) depression (OR 2.02 1.82-2.22) and disability (OR 2.34 1.99-2.69). Participants who reduced their physical activity intensity also had higher odds of being female living alone or having no garden and more commonly expressed sentiments about personal or household risks in narratives on coping. Conclusions and relevance: Groups who reduced physical activity intensity included disproportionate numbers of people with either heightened objective clinical risks or greater tendency to express subjective perceptions of risk. Policy on exercise for health during lockdowns should include strategies to facilitate health promoting levels of physical activity in vulnerable groups including those with both objective and subjective risks.
||Rogers N T
||Brindle H E
||Eggo R M
||Roberts C h
|Keywords Extracted from Text Content:
||UK COVID-19 lockdown
PROLONGED LOCKDOWNS ARE BARBARIC
Supplementary Table S3
type II diabetes
medRxiv preprint T6
Coronavirus Act 2020
central fat [21, 22
|Extracted Text Content in Record:
First 5000 Characters:There are growing concerns that the UK COVID-19 lockdown has reduced opportunities to maintain health through physical activity, placing individuals at higher risk of chronic disease and leaving them more vulnerable to severe sequelae of COVID-19.
The pandemic spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)  was declared a Public Health Emergency of International Concern by the World Health Organisation on 30 January 2020  and by the end of April 2020 the virus had infected more than 3 million people worldwide, causing more than 200,000 deaths  . In order to limit the spread of 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) travelling 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 much stricter social isolation recommendations. In this paper we refer to the combined package of measures as 'lockdown'.
There have been growing concerns that the limitations lockdown has placed on opportunities for individuals to be physically active could have public health implications [4, 5] . 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, which could put these same individuals at disease because the topic of "Asthma" accounted for around 25% of the open text responses to this question (Determined by structural text modelling, see below) and because asthma was mentioned directly by 678 participants (Supplementary Figure S1 ) . The majority of people who reported having a doctor's diagnosis of lung disease also mentioned asthma (63.4%, n = 225, Supplementary Table S1) suggesting that they operationalised asthma as a lung disease and may have been referring to asthma when they reported their prior diagnosis of lung disease. 8.3% (n = 453) of people who did not report having 'lung disease' did however mention asthma in the free text.
We performed a complete case analysis of male and female gendered participants aged 20 years and over, opting to include only participants who had provided responses to all the relevant fields including baseline PA, PA during lockdown, highest educational qualifications, age (20-34; 35-54; 55-69; 70+), gender, whether living alone, household income, presence of ADLs, self-rated depression and pre-existing chronic diseases. Pearson's ꭓ 2 test was used to detect factor variables with statistically significant differences between the groups when the data were grouped according to baseline (pre-COVID-19) PA levels. Due to significant differences according to baseline PA, all further analyses were corrected for baseline PA. The main response variable for statistical association tests was any change in PA intensity from pre-COVID- 19 [e.g. Running/Jogging/Hiking, Cycling, Weightlifting] " ) to PA during COVID-19 lockdown ( "What type of exercise are you doing now?" , options as for baseline). Participants were classified as doing the "Same", "Less" or "More" than their usual PA intensity. Using the 'nnet' R package, we applied a multinomial log-linear model via neural networks  to the detection of factors which were associated with change in PA intensity during lockdown.
We used Structural Text Modelling (STM)  to identify key topics in the data on self-perceived medical risk factors (see above), and also to determine whether changes in PA intensity were associated with participants' other perceptions of risk from COVID-19. STM employs machine learning (ML) approaches to explore open ended survey questions in a highly structured and reproducible way  . The goal of STM is to identify topics and perspectives in free-text data, for instance by highlighting specific diseases, themes or perspectives being reported in the survey. This is functionally analogous and equivalent in results to the type of human coding of text data performed by anthropologists and ethnographers; but unlike more conventional topic modelling, STM makes it possible to link topic models to metadata and quantitative data in a way that is directly amenable to statistical modelling [16, 17] . All STM was performed using the 'stm' package  "me" , "that's" and "because" ) were stripped and data were trimmed to include only
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