A mental health paradox: Mental health was both a motivator and barrier to physical activity during the COVID-19 pandemic

The COVID-19 pandemic has impacted the mental health, physical activity, and sedentary behavior of people worldwide. According to the Health Belief Model (HBM), health-related behavior is determined by perceived barriers and motivators. Using an online survey with 1669 respondents, we sought to understand why and how physical activity and sedentary behavior has changed by querying about perceived barriers and motivators to physical activity that changed because of the pandemic, and how those changes impacted mental health. The following results were statistically significant at p < .05. Consistent with prior reports, our respondents were less physically active (aerobic activity, -11%; strength-based activity, -30%) and more sedentary (+11%) during the pandemic as compared to 6-months before. The pandemic also increased psychological stress (+22%) and brought on moderate symptoms of anxiety and depression. Respondents’ whose mental health deteriorated the most were also the ones who were least active (depression r = -.21, anxiety r = -.12). The majority of respondents were unmotivated to exercise because they were too anxious (+8%,), lacked social support (+6%), or had limited access to equipment (+23%) or space (+41%). The respondents who were able to stay active reported feeling less motivated by physical health outcomes such as weight loss (-7%) or strength (-14%) and instead more motivated by mental health outcomes such as anxiety relief (+14%). Coupled with previous work demonstrating a direct relationship between mental health and physical activity, these results highlight the potential protective effect of physical activity on mental health and point to the need for psychological support to overcome perceived barriers so that people can continue to be physically active during stressful times like the pandemic.

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A Mental Health Paradox: Mental health was both a motivator and barrier to physical activity during the COVID-19 pandemic

10.1101/2020.09.03.280719 ◽

2020 ◽

Author(s):

Maryam Marashi ◽

Emma Nicholson ◽

Michelle Ogrodnik ◽

Barbara Fenesi ◽

Jennifer Heisz

Keyword(s):

Mental Health ◽

Physical Activity ◽

Health Outcomes ◽

Online Survey ◽

Perceived Barriers ◽

Physically Active ◽

Aerobic Activity ◽

Physical Health Outcomes ◽

Strength Based ◽

Barriers And Motivators

AbstractThe COVID-19 pandemic has impacted the mental health, physical activity, and sedentary behavior of citizens worldwide. Using an online survey with 1669 respondents, we sought to understand why and how by querying about perceived barriers and motivators to physical activity that changed because of the pandemic, and how those changes impacted mental health. Consistent with prior reports, our respondents were less physically active (aerobic activity, −11%, p <0.05; strength-based activity, −30%, p<0.01) and more sedentary (+11%, p<0.01) during the pandemic as compared to 6-months before. The pandemic also increased psychological stress (+22%, p <0.01) and brought on moderate symptoms of anxiety and depression. Respondents’ whose mental health deteriorated the most were also the ones who were least active (depression r = −.21, p<0.01; anxiety r = −.12, p<0.01). The majority of respondents were unmotivated to exercise because they were too anxious (+8%, p <0.01), lacked social support (+6%, p =<0.01), or had limited access to equipment (+23%, p <0.01) or space (+41%, p <0.01). The respondents who were able to stay active reported feeling less motivated by physical health outcomes such as weight loss (−7%, p<0.01) or strength (−14%, p<0.01) and instead more motivated by mental health outcomes such as anxiety relief (+14%, p <0.01). Coupled with previous work demonstrating a direct relationship between mental health and physical activity, these results highlight the potential protective effect of physical activity on mental health and point to the need for psychological support to overcome perceived barriers so that people can continue to be physically active during stressful times like the pandemic.

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Income-related health inequality among Chinese adults during the COVID-19 pandemic: evidence based on an online survey

International Journal for Equity in Health ◽

10.1186/s12939-021-01448-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Peng Nie ◽

Lanlin Ding ◽

Zhuo Chen ◽

Shiyong Liu ◽

Qi Zhang ◽

...

Keyword(s):

Mental Health ◽

Physical Activity ◽

Health Outcomes ◽

Family Member ◽

Health Inequalities ◽

Online Survey ◽

Mainland China ◽

Decomposition Analysis ◽

National Sample ◽

Vulnerable Groups

AbstractBackgroundPartial- or full-lockdowns, among other interventions during the COVID-19 pandemic, may disproportionally affect people (their behaviors and health outcomes) with lower socioeconomic status (SES). This study examines income-related health inequalities and their main contributors in China during the pandemic.MethodsThe 2020 China COVID-19 Survey is an anonymous 74-item survey administered via social media in China. A national sample of 10,545 adults in all 31 provinces, municipalities, and autonomous regions in mainland China provided comprehensive data on sociodemographic characteristics, awareness and attitudes towards COVID-19, lifestyle factors, and health outcomes during the lockdown. Of them, 8448 subjects provided data for this analysis. Concentration Index (CI) and Corrected CI (CCI) were used to measure income-related inequalities in mental health and self-reported health (SRH), respectively. Wagstaff-type decomposition analysis was used to identify contributors to health inequalities.ResultsMost participants reported their health status as “very good” (39.0%) or “excellent” (42.3%). CCI of SRH and mental health were − 0.09 (p < 0.01) and 0.04 (p < 0.01), respectively, indicating pro-poor inequality in ill SRH and pro-rich inequality in ill mental health. Income was the leading contributor to inequalities in SRH and mental health, accounting for 62.7% (p < 0.01) and 39.0% (p < 0.05) of income-related inequalities, respectively. The COVID-19 related variables, including self-reported family-member COVID-19 infection, job loss, experiences of food and medication shortage, engagement in physical activity, and five different-level pandemic regions of residence, explained substantial inequalities in ill SRH and ill mental health, accounting for 29.7% (p < 0.01) and 20.6% (p < 0.01), respectively. Self-reported family member COVID-19 infection, experiencing food and medication shortage, and engagement in physical activity explain 9.4% (p < 0.01), 2.6% (the summed contributions of experiencing food shortage (0.9%) and medication shortage (1.7%),p < 0.01), and 17.6% (p < 0.01) inequality in SRH, respectively (8.9% (p < 0.01), 24.1% (p < 0.01), and 15.1% (p < 0.01) for mental health).ConclusionsPer capita household income last year, experiences of food and medication shortage, self-reported family member COVID-19 infection, and physical activity are important contributors to health inequalities, especially mental health in China during the COVID-19 pandemic. Intervention programs should be implemented to support vulnerable groups.

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The impact of sitting time and physical activity on mental health during COVID-19 lockdown

Sport Sciences for Health ◽

10.1007/s11332-021-00791-2 ◽

2021 ◽

Author(s):

Matthew Pears ◽

Susanna Kola-Palmer ◽

Liane Beretta De Azevedo

Keyword(s):

Mental Health ◽

Physical Activity ◽

Health Outcomes ◽

Online Survey ◽

Depression Score ◽

Sitting Time ◽

Multiple Stepwise Regression Analysis ◽

Previous Diagnosis ◽

The Uk ◽

The Impact

Abstract Objective The primary aim of this study was to investigate the association between physical activity (PA) and sitting time on adults’ mental health (i.e., depression, anxiety and wellbeing) and the influence of mediators and confounders. Methods An online survey was disseminated in the UK between May and June 2020. A total of 284 participants (33.5 ± 12.4 years) self-reported their PA, sitting time and mental health through validated questionnaires. Results Multiple stepwise regression analysis revealed that being of younger age, female, on a lower income, with one or more comorbid health conditions, with a previous diagnosis of mood disorder and increased sitting time independently correlated with higher depression scores (F (13,219) = 12.31, p < 0.001), and explained 42% of the variance. Similar results were found for wellbeing where socio-demographic, health outcomes and sitting time influenced the subjective wellbeing (F (14,218) = 5.77, p < 0.001, 27% variance), although only socio-demographic and health outcomes contributed to the variation in anxiety score (F (13,219) = 7.84, p < 0.001, 32% variance). PA did not explain variation when sitting time was taken into account in any of the models. Combined analysis revealed that participants with lower sedentary time (< 8 h) and with both low or moderate and high PA presented a significantly lower depression score [low PA: (B = −2.7, 95% CI −4.88, −0.52); moderate and high PA (B = −2.7, −4.88, −0.52)]. Conclusion Sitting time was strongly associated with adverse mental health during COVID-19 lockdown and should be considered in future public health recommendations.

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

BMC Public Health ◽

10.1186/s12889-021-10931-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Costas I. Karageorghis ◽

Jonathan M. Bird ◽

Jasmin C. Hutchinson ◽

Mark Hamer ◽

Yvonne N. Delevoye-Turrell ◽

...

Keyword(s):

Mental Health ◽

Physical Activity ◽

Young Adults ◽

Sedentary Behavior ◽

Online Survey ◽

Electronic Device ◽

Well Being ◽

Middle Aged ◽

Steps Per Day ◽

Western Nations

Abstract 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.

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The Effect of the COVID-19 Pandemic Movement Restrictions on Self-Reported Physical Activity and Health in New Zealand: A Cross-Sectional Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041719 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1719

Author(s):

Rebecca M. Meiring ◽

Silmara Gusso ◽

Eloise McCullough ◽

Lynley Bradnam

Keyword(s):

Mental Health ◽

Physical Activity ◽

New Zealand ◽

Online Survey ◽

Short Form ◽

Physical And Mental Health ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Physically Active ◽

Positive Effect

This study describes self-reported physical activity (PA), motivation to exercise, physical and mental health and feelings towards PA during the March-May 2020 COVID-19 lockdown in New Zealand. Adults over the age of 18 years (n = 238; 80.2% female) completed the International Physical Activity Questionnaire (IPAQ), the Behavioural Regulation in Exercise Questionnaire 3, the Short Form-36 and open-ended questions about PA through an anonymous online survey. Regular exercise was undertaken by 85% of respondents prior to lockdown, but only 49.8% were able to maintain their usual level of PA. Although respondents were considered sufficiently physically active from the IPAQ, 51.5% reported not being able to maintain their usual level of PA primarily due to the closure of their gym facilities. Sixty percent of respondents reported that PA had a positive effect on their overall wellbeing. When asked to specify which aspects of wellbeing were affected, the effect on mental health was reported the most while the effect on body image or fitness was reported the least. Strategies to increase or maintain engagement in physical activity during lockdowns should be encouraged to promote positive mental health during the COVID-19 pandemic.

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Does Physical Activity Matter for the Mental Health of University Students during the COVID-19 Pandemic?

Journal of Clinical Medicine ◽

10.3390/jcm9113494 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3494

Author(s):

Aleksandra M. Rogowska ◽

Iuliia Pavlova ◽

Cezary Kuśnierz ◽

Dominika Ochnik ◽

Ivanna Bodnar ◽

...

Keyword(s):

Mental Health ◽

Physical Activity ◽

University Students ◽

Online Survey ◽

Mental Health Problems ◽

Virus Disease ◽

Anxiety And Depression ◽

Cross Sectional ◽

Physically Active ◽

The Relationship

Research indicates that university and college students are at higher risk of experiencing mental health problems than other populations. This study aims to examine the relationship between Physical Activity (PA) and the mental health of Ukrainian university students during the Corona Virus Disease 2019 (COVID-19) pandemic lockdown. The conventional sample consisted of 1512 students from 11 Ukrainian universities, with a mean age of 20 years (M = 20.06, SD = 3.05) and 69% of whom were female. The cross-sectional online survey was disseminated through the most popular social media channels in Ukraine (i.e., Facebook, Viber, Telegram) and included the Generalized Anxiety Disorder (GAD-7) scale to measure anxiety and the Patient Health Questionnaire (PHQ-9) to assess depression. Data were collected from 14 May to 4 June 2020 during the COVID-19 pandemic outbreak in Ukraine. Among university students, 43% were engaged in PA ≥ 150 min weekly, 24% met the criteria of GAD, and 32% met the criteria of depression. More students were involved in PA before the COVID-19 outbreak than during the national lockdown. Students with anxiety and depression were almost two times less likely to engage in PA than their counterparts without mental health disorders. The inactive group had higher scores of anxiety and depression than the physically active group. The relationship of PA with anxiety and depression was statistically significant but weak during the COVID-19 pandemic.

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Sedentary Behavior among 6–14-Year-Old Children during the COVID-19 Lockdown and Its Relation to Physical and Mental Health

Healthcare ◽

10.3390/healthcare9060756 ◽

2021 ◽

Vol 9 (6) ◽

pp. 756

Author(s):

Rima Breidokienė ◽

Roma Jusienė ◽

Vaidotas Urbonas ◽

Rūta Praninskienė ◽

Sigita Girdzijauskienė

Keyword(s):

Mental Health ◽

Physical Activity ◽

Sedentary Behavior ◽

Screen Time ◽

Online Survey ◽

Somatic Symptoms ◽

Well Being ◽

Parental Distress ◽

Physical And Mental Health ◽

And Behavior

As a result of the outbreak of SARS-CoV-2 and consequent restrictions in spring 2020, children in many countries might be engaged in more sedentary behavior and have limited possibilities to access the necessary level of physical activity to maintain their physical and mental health. The aim of this study was to explore the relationships between child sedentary behavior, physical activity, mental and physical health, and parental distress in a sample of Lithuanian children aged 6–14 years during the COVID-19 pandemic lockdown in March–June 2020. Parents of 306 children (52.9% female) completed an online survey in May–June 2020 and reported on their children’s screen time for educational and recreational (leisure) purposes, the level of physical activity and time outdoors, somatic symptoms, and emotional well-being and behavior. Parents also reported on stressful life events in the family and personal distress. The results revealed that 57.5% of children exceeded the recommended maximum of 2 h of recreational screen time per day, and 33.6% of the children did not meet the recommended guidelines of 60 min of physical activity per day. Longer screen time for educational purposes and parental distress significantly predicted a higher prevalence of somatic symptoms in children and parental distress also served as a significant predictor of children’s decreased emotional well-being and behavior. These results highlight the importance of psychosocial support interventions for parents who experience distress when raising children at a stressful time, such as during a pandemic.

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How is the COVID-19 lockdown impacting the mental health of parents of school-age children in the UK? A cross-sectional online survey

BMJ Open ◽

10.1136/bmjopen-2020-043397 ◽

2021 ◽

Vol 11 (5) ◽

pp. e043397

Author(s):

Austen El-Osta ◽

Aos Alaa ◽

Iman Webber ◽

Eva Riboli Sasco ◽

Emmanouil Bagkeris ◽

...

Keyword(s):

Mental Health ◽

Physical Activity ◽

Social Isolation ◽

Online Survey ◽

Female Gender ◽

School Age Children ◽

School Age ◽

Cross Sectional ◽

The Uk ◽

The Impact

ObjectiveInvestigate the impact of the COVID-19 lockdown on feelings of loneliness and social isolation in parents of school-age children.DesignCross-sectional online survey of parents of primary and secondary school-age children.SettingCommunity setting.Participants1214 parents of school-age children in the UK.MethodsAn online survey explored the impact of lockdown on the mental health of parents with school-age children, and in particular about feelings of social isolation and loneliness. Associations between the UCLA Three-Item Loneliness Scale (UCLATILS), the Direct Measure of Loneliness (DMOL) and the characteristics of the study participants were assessed using ordinal logistic regression models.Main outcome measuresSelf-reported measures of social isolation and loneliness using UCLATILS and DMOL.ResultsHalf of respondents felt they lacked companionship, 45% had feelings of being left out, 58% felt isolated and 46% felt lonely during the first 100 days of lockdown. The factors that were associated with higher levels of loneliness on UCLATILS were female gender, parenting a child with special needs, lack of a dedicated space for distance learning, disruption of sleep patterns and low levels of physical activity during the lockdown. Factors associated with a higher DMOL were female gender, single parenting, parenting a child with special needs, unemployment, low physical activity, lack of a dedicated study space and disruption of sleep patterns during the lockdown.ConclusionsThe COVID-19 lockdown has increased feelings of social isolation and loneliness among parents of school-age children. The sustained adoption of two modifiable health-seeking lifestyle behaviours (increased levels of physical activity and the maintenance of good sleep hygiene practices) wmay help reduce feelings of social isolation and loneliness during lockdown.

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The Comparison of Physical Activity, Sedentary Behavior, and Mental Health between Early Menopausal Women and Age-Matched General Middle-Aged Women

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147256 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7256

Author(s):

Ji-Su Kim ◽

Ju-Pil Choe ◽

Jeong-Hui Park ◽

Eunhye Yoo ◽

Jung-Min Lee

Keyword(s):

Mental Health ◽

Physical Activity ◽

Sedentary Behavior ◽

Healthy Lifestyle ◽

Multinomial Logistic Regression ◽

Middle Aged ◽

General Group ◽

Menopausal Women ◽

Global Physical Activity Questionnaire ◽

Causes Of Mortality

The current study is to examine the differences in physical activity (PA), sedentary behavior (SB), and mental health (i.e., stress, depression, and suicidal behaviors) between early menopausal women and age-matched general middle-aged women. Among 1348 participants in South Korea, 674 participants who experienced menopause before the age of 45 were defined as the early menopausal group, and 674 women who experienced menopause from 45 years to 55 years were classified as the general group by matching age based on early menopausal women. PA, SB, and mental health were evaluated by using the Global Physical Activity Questionnaire (GPAQ). An independent t-test was used to compare the associations of PA, SB, and mental health between the two groups. To demonstrate the predictors of early menopause, variables in the study were analyzed by multinomial logistic regression. The main findings were that moderate-to-vigorous PA (MVPA) and light PA (LPA) had significant differences between the two groups, but SB had no significant differences. In mental health, only perceived stress had significant differences in this study. The moderate level of stress in the early menopausal group was twice as high as that of the general group, and the severe level of stress was even 2.6 times higher than the general group. PA plays an essential role in mitigating the causes of mortality and the risk of various chronic diseases and improving quality of life; thus, the main findings of this study could be important to provide insights on the corresponding impact between early menopausal women and PA to encourage their healthy lifestyle. Further longitudinal studies are needed to examine the mechanisms underlying the effects of PA, SB, and mental health on early menopausal women.

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Physical Activity, Sedentary Behavior, and Cardiorespiratory Fitness in Hazardous and Non-Hazardous Alcohol Consumers

American Journal of Health Promotion ◽

10.1177/0890117120985830 ◽

2021 ◽

pp. 089011712098583

Author(s):

Mats Hallgren ◽

Davy Vancampfort ◽

Thi-Thuy-Dung Nguyen ◽

Elin Ekblom-Bak ◽

Peter Wallin ◽

...

Keyword(s):

Physical Activity ◽

Sedentary Behavior ◽

Cardiorespiratory Fitness ◽

Leisure Time ◽

Health Assessment ◽

Cross Sectional Study ◽

Cycle Ergometer ◽

Cross Sectional ◽

Physically Active ◽

Alcohol Abstainers

Purpose: To describe physical activity habits, sedentary behavior, and cardiorespiratory fitness levels among alcohol abstainers, hazardous and non-hazardous drinkers. Design: Cross-sectional study with data collected between 2017-19. Setting: Sweden. Subjects: Adults aged 18-65 years (n = 47,559; 59.4% male). Measures: During a routine health assessment, participants answered validated single-item questions regarding: habitual physical activity, structured exercise, and the percentage of time spent sedentary during leisure-time (past 30 days), and completed a 6-minute cycle ergometer test (V02max) to determine cardiorespiratory fitness (CRF). Participants were categorized as alcohol abstainers, non-hazardous drinkers or hazardous drinkers (low/high) based on the Alcohol Use Disorders Identification Test (AUDIT-C) cut-points for men and women. Analysis: Logistic regression models stratified by sex and age. Results: Compared to non-hazardous drinkers, the heaviest drinkers were less physically active (males: OR = 1.38, CI = 1.13-1.67, p = .001; females: OR = 1.41, CI = 1.01-1.97, p = .040) and more sedentary during leisure time (males: OR = 1.94, CI = 1.62-2.32, p = .000; females: OR = 1.62, CI = 1.21-2.16, p = .001). Apart from young females, the heaviest drinkers also did less structured exercise than non-hazardous drinkers (males: OR = 1.22, CI = 1.15-1.51, p = .000; females: OR = 1.43, CI = 1.15-1.78, p = .001). The strongest associations were seen among adults aged 40-65 years (shown here). High-hazardous drinking was associated with low CRF among older males only (OR = 1.19, CI = 1.00-1.41). Conclusion: Middle-aged adults with AUDIT-C scores of ≥6 (women) and ≥7 (men) were less physically active and more sedentary during leisure time and may be appropriate targets for physical activity interventions.

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