Worldwide Effect of COVID-19 on Physical Activity: A Descriptive Study

The recent propagation of the COVID-19 virus led the World Health Organization (WHO) to officially declare an international global pandemic on March 11 2020, plunging most the world into an unseen period of general confinement. Progressively, governing bodies instituted a lockdown leading populations to remain at home, limiting their displacements and definitely changing their daily habits and routine. This unique situation definitely changed everyone’s overall physical activity and sedentary behaviors. Recently, Tison and colleagues proposed a great analysis of the population’s physical activity level during this period of confinement, based on the data collected through the smartphone app Argus (Azumio). According to their results and based on the record of about 19 144 639 daily step count measurements provided by 455 404 users of this app, representing 187 countries, there has been a clear and collective decrease in the daily step counts of individuals (reaching 27.3% after 30 days of confinement). The authors also point out an important variability between regions with Italy whose daily step count decrease reached 48.7% (ref). Although the authors point that these variations in step counts might be influenced by socioeconomic inequalities among regions and disparities in the ability to engage in or access to recreational physical activity within a region, their main results clearly suggest a global and worrying decline in the population’s daily physical activity (Tison et al., 2020).

Tison and colleagues provide us with a terrific international evaluation of the effect of the recent COVID-19-related confinement on our physical activity and must be commended for their work (Tison et al., 2020) that creates a great opportunity to better analysis, understand and discuss these human adaptations to such a situation that might not remain unique and isolated in the future. It seems however important to us that their results must be interpreted in light of their sample characteristics and specificities. First, we believe that the national sample used might not be representative of the overall situation.  As the French National Observatory for Physical Activity and Sedentary Behaviors (ONAPS), we focused our interest on their French sample that was composed of 4,114 individuals living in Paris. While their results clearly underline an overall decline in physical activity (using daily step counts as an indicator), our recent national survey gathering information from about 28,000 individuals indicates that about 40% of French adults increased their overall physical activity level, particularly those who did not reach the recommendations before the confinement (ref Genin et al., 2020). Importantly, our results regarding sedentary time also suggest different changes during this period depending on the pre-confinement behaviors with 74% of adults who spent less than 6 hours seated per day before confinement who increased this sedentary time while a decrease was observed in 16% of those who initially spent more than 6 hours seated per day (ref Genin et al., 2020). This clearly suggests the necessity to consider the initial physical activity and sedentary profile of individuals that might have oriented their active behaviors during the lockdown.

We also collectively believe that the sample used in the discussed paper (Tison et al., 2020), that entirely represents a urban population living in Paris for France or other main cities in the other studied countries, limit the interpretation of the results. Indeed, while physical activity and sedentary behaviors have been shown different between individuals living in rural and urban areas (Sygit et al., 2019; Cohen et al., 2018), our recent national survey also point out different modifications of these behaviors during the lockdown depending on this living area (Genin etv al., 2020). While we acknowledge that this difference remains slight regarding physical activity in our study (with 39% of people living in rural area declaring a reduction of their PA level against about 45% in urban and peri-urban zones), it is definitely more pronounced when it comes to sedentary time with 37% versus 27% of individuals respectively living in urban versus rural areas who declare an increase of their sitting time.

Altogether, we believe that the results presented by Tison and colleagues are of main importance and describe a global international trend for a decline in physical activity level during the COVID-19-related confinement period. Other markers than steps should be used/added as our study has shown that new home-based physical activities have been adopted during the lockdown (home-trainer, muscle strengthening) that are not identify by pedometers or equivalent. This should be taken into consideration for future recommendations.  Similarly, their analysis, according to us, should be deepen particularly considering the characteristics and profile of the individuals under study to better understand the effect of such a period on their active behaviors and then propose adapted post-confinement recommendation as well as potential recommendation in the likely case of a new lockdown in a more or less near future. 

References.

Tison GH, Avram R, Kuhar P, Abreau S, Marcus GM, Pletcher MJ, Olgin JE. Worldwide Effect of COVID-19 on Physical Activity: A Descriptive StudyFREE. Annals of Internal Medicine, 2020. In press.

Genin PM, Lambert C, Larras B, Pereira B, Thivel D,  Duclos M. How did the COVID-19 confinement period affect our on physical activity level and sedentary behaviors? Methodology and first results from the French National ONAPS Survey.  Journal of Physical Activity and Health. 2020. In press.

Sygit KM, Sygit M, Wojtyła-Buciora P, Lubiniec O, Stelmach W, Krakowiak J. Physical activity as an important element in organizing and managing the lifestyle of populations in urban and rural environments. Ann Agric Environ Med. 2019 Mar 22;26(1):8-12.

Cohen JA, Greaney ML, Sabik NJ. Assessment of Dietary Patterns, Physical Activity and Obesity From a National Survey: Rural-urban Health Disparities in Older Adults. PLoS One 2018 Dec 5;13(12):e0208268.

Disclosures:

The authors have no conflict of interest to declare