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The Covid-19 pandemic is affecting the entire world population. During the first spread, most governments have implemented quarantine and strict social distancing procedures. Similar measures during recent pandemics resulted in an increase in post-traumatic stress, anxiety and depression symptoms. The development of novel interventions to mitigate the mental health burden are of outmost importance. In this rapid review, we aimed to provide a systematic overview of the literature with regard to associations between physical activity (PA) and depression and anxiety during the COVID-19 pandemic. We searched major databases (PubMed, EMBASE, Sportdiscus, Web of Science) and preprint servers (MedRxivs, SportRxiv, ResearchGate and Google scholar), for relevant papers up to 25/07/2020. We identified a total of 21 observational studies (4 longitudinal, one cross-sectional with retrospective analysis and 16 cross-sectional), including information of 42,293 (age range = 6-70 years, median female = 68%) participants from 5 continents. The early evidence suggests that people who performed PA on a regular basis with higher volume and frequency and kept the PA routines stable, showed less symptoms of depression and anxiety. For instance, those reporting a higher total time spent in moderate to vigorous PA had 12% to 32% lower chances of presenting depressive symptoms and 15% to 34% of presenting anxiety. In order to maintain PA routines during Covid-19, specific volitional and motivational skills might be paramount to overcome Covid-19 specific barriers. Particularly, web-based technologies could be an accessible way to increase motivation and volition for PA and maintain daily PA routines.
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Can physical activity protect against depression and
anxiety during the COVID-19 pandemic? A rapid
systematic review
Sebastian Wolf ( sebastian.wolf@uni-tuebingen.de )
University of Tuebingen
Johanna Zeibig
University of Tuebingen
Britta Seiffer
University of Tuebingen
Jana Welkerling
University of Tuebingen
Luisa Brokmeier
University of Heidelberg
Beatrice Atrott
University of Tuebingen
Thomas Ehring
LMU Munich
Felipe Barreto Schuch
Federal University of Santa Maria
Systematic Review
Keywords: physical activity, covid-19, depression, anxiety, review
DOI: https://doi.org/10.21203/rs.3.rs-81150/v1
License: This work is licensed under a Creative Commons Attribution 4.0 International License.Read
Full License
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Abstract
The Covid-19 pandemic is affecting the entire world population. During the rst spread, most governments
have implemented quarantine and strict social distancing procedures. Similar measures during recent
pandemics resulted in an increase in post-traumatic stress, anxiety and depression symptoms. The
development of novel interventions to mitigate the mental health burden are of outmost importance. In this
rapid review, we aimed to provide a systematic overview of the literature with regard to associations between
physical activity (PA) and depression and anxiety during the COVID-19 pandemic. We searched major
databases (PubMed, EMBASE, Sportdiscus, Web of Science) and preprint servers (MedRxivs, SportRxiv,
ResearchGate and Google scholar), for relevant papers up to 25/07/2020. We identied a total of 21
observational studies (4 longitudinal, one cross-sectional with retrospective analysis and 16 cross-sectional),
including information of 42,293 (age range = 6-70 years, median female = 68%) participants from 5
continents. The early evidence suggests that people who performed PA on a regular basis with higher
volume and frequency and kept the PA routines stable, showed less symptoms of depression and anxiety.
For instance, those reporting a higher total time spent in moderate to vigorous PA had 12% to 32% lower
chances of presenting depressive symptoms and 15% to 34% of presenting anxiety. In order to maintain PA
routines during Covid-19, specic volitional and motivational skills might be paramount to overcome Covid-
19 specic barriers. Particularly, web-based technologies could be an accessible way to increase motivation
and volition for PA and maintain daily PA routines.
Key Points
The Covid-19 pandemic increased symptoms of anxiety and depression symptoms. Those reporting a
higher total time spent in moderate to vigorous physical activity, had 12% to 32% lower chances of
presenting depressive symptoms and 15% to 34% of presenting anxiety.
The promotion of physical activity habits and routines might be a cost-effective and comprehensive
worldwide applicable strategy to overcome the severe gap between people in need and people receiving
mental health care, especially in low-income countries with even non-existing mental health supplies.
Web-based technologies might be promising tools to increase motivation and volition for PA and
maintain daily physical activity routines even under pandemic-specic barriers. However, there is a clear
need for more systematic research for effectively and safely usable apps or web-based programs to
prevent psychiatric disorders through physical activity.
Introduction
With 23,057,288 conrmed cases all over the world (up to August 23th, 2020) [1], COVID-19 is a global public
health emergency. The World Health Organization (WHO) has issued recommendations to implement social
distancing measures for the general public as well as quarantining procedures, for people infected with the
COVID-19.
Quarantine and social distancing measures had already been enforced during earlier pandemics, such as the
2003 outbreak of SARS and the 2014 outbreak of Ebola [2]. Studies on the effects of these measures have
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reported increased symptoms of anxiety, post-traumatic-stress, and depressive disorders, as well as a 30%
increase in suicide rates in populations impacted by these measures [3, 4]. These ndings are being
replicated during the Covid-19 pandemic with multiple studies reporting an increased prevalence of
depression and anxiety [e.g. 5, 6-9].
Notably psychiatric disorders result in a considerable burden of disease, accounting for 6.7% of overall
disability-adjusted life years [10] and being attributable to 14.3% of death worldwide [11]. Despite the high
burden of psychiatric disorders, there is a severe gap between people in need and people receiving mental
health care [12]. This general treatment gap is especially severe in low- and middle-income countries, where
76% to 85% of people with mental disorders do not receive any treatment [13]. The latest WHO “mental
health Atlas” indicates that only 95,6 out of 100 000 depressed cases worldwide receive any professional
mental health care, whereas the treatment prevalence in high-income countries is 16-times higher compared
to low-income countries [14]. Although there is no current global data available, the treatment gap is
assumed to be much higher during or after the Covid-19 pandemic. Access to general mental health care
might be restricted for several reasons, including supply priorities that being focused on Covid-19 infections,
medication shortages, prohibition of face-to-face psychotherapeutic sessions of psychological treatment,
closing of inpatient facilities to mention only some reasons.
To mitigate the negative mental health consequences of pandemics, evidence suggests that policymakers
should ensure quarantine measures to be as short as possible, to provide adequate general supplies for
basic needs, give people as much information as possible and strengthen social support and
communication among people affected by the pandemic [2]. A recently published position paper on research
priorities for mental health science regarding COVID-19 [15] demands the interdisciplinary development of
novel interventions to protect mental wellbeing by mechanistically based approaches to strengthen altruism
and prosocial behavior. Among others, physical activity (PA) interventions are highlighted as a promising
approach. PA is dened as any bodily movement produced by skeletal muscles that results in energy
expenditure and exercise is dened as PA, that is planned, structured, and repetitive, with the primary aim to
improve or maintain physical tness [16]. International PA guidelines recommend 150 minutes of moderate
or 75 minutes of vigorous intensity PA per week for optimal physical and mental health benets [17]. Indeed,
in pre-pandemic times PA has been identied as a protective factor against incident depression [18] and
anxiety [19]. However decreased levels of PA were observed in the general population in multiple countries
during the pandemic [e.g. 20, 21, 9]. This rapid systematic review aims to outline current evidence regarding
the associations of PA and exercise with depression and anxiety during the Covid-19 pandemic.
Methods
In this rapid review, we sought for observational studies examining the associations of PA and depression
and anxiety during the COVID-19 pandemic. inclusion criteria were: 1) Observational studies in any
population, including cross-sectional and longitudinal designs. Longitudinal studies could be either
prospective or retrospective; 2) Studies have tested the association, of PA with depression or anxiety, using
linear or logistic regressions; 3) depression and anxiety were assessed using validated screening or
diagnostic tools. We excluded opinion pieces, systematic reviews, and studies addressing other viruses.
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We searched the electronic databases PubMed, EMBASE, Sportdiscus, and Web of Science using the
following strategy: (physical activity OR exercise OR sport) AND (coronavirus OR sars-cov-2 OR COVID* OR
severe acute respiratory syndrome OR pandemic) AND (depression OR anxiety OR mental health). Preprints
were searched in MedRxiv, SportRxiv, and Scielo preprints using the following strategy: "(physical activity OR
exercise) AND (coronavirus OR sars-cov-2 OR COVID* OR severe acute respiratory syndrome OR pandemic)".
Additional hand searches were performed on COVID-19 platform on ResearchGate and Google scholar.
Searches were made by an experienced reviewer (FS) on 29th July, 2020. Study selection was conducted in
three steps: 1) duplicates removal; 2) screening at the title and abstract level; and 3) assessment based on
full-text. The selection was made by one reviewer (FS). Data extraction of selected studies was then
performed by three researchers (FS, BS, SW). Data extracted were: Author and year, country of the included
sample, study design, sample size, age group of the sample included, when possible, mean or range of age
sample, % of women, instrument/question used to assess PA levels, instruments used to assess depression
and anxiety, publication type and statistical outcomes (regression standardized beta coecients and odd’s
ratios). If they were indicated in the report, fully adjusted coecients and odd’s ratios were extracted. As
studies included in this review used very heterogeneous statistical approaches, a meta-analysis could not be
conducted. Instead, we summarized the evidence and presented effect sizes (betas and odds ratios (OR))
with condence intervals and indicated signicant associations between PA and depression or anxiety,
separately (see table 2). In case the study just reported the unstandardized betas, we requested the
standardized betas by email. If standardized effects could not be obtained, unstandardized effects were
presented and indicated. The risk of bias of individual studies was assessed using the National Institutes of
Health (NIH) study quality assessment tool for observational cohort and cross-sectional studies [22]. The
NIH tool assessment is composed by 14 questions the risk of potential selection bias, information bias
measurement bias or confounding bias. There are 3 options (yes, no, other) for each question. Each “no” or
“other” is suggestive of the presence of some risk of bias. Questions #6 (exposure prior outcome), #7
(sucient time to see an effect), #10 (repeated exposure assessment), and #13 (follow-up rate) were
disregarded for cross-sectional studies. Due to the self-reported nature of the assessments, question #12
(blinding of outcome assessors) was also disregarded for all studies.
Results
Searches on PubMed, EMBASE, Sportdiscus, and Web of science resulted in 592 potentially relevant studies.
Preprint databases identied additional 572 potentially relevant studies. A ow-chart of the selection
process is provided in gure 1. Of the identied studies, 21 studies meet the criteria [9, 23-34, 5, 35-37, 6, 38-
40]. Four studies had a prospective longitudinal design [26, 29, 39, 36], one was a cross-sectional study with
a retrospective measure of the exposure factor (henceforth treated as retrospective) [5], and 16 were cross-
sectional studies [9, 23-25, 27, 29-35, 37, 6, 38, 40, 28, 41]. A total of 7 studies were conducted in Asia [24, 25,
27, 30, 33, 39, 40], 6 in Europe [9, 26, 31, 32, 35, 36], 3 in South America [28, 29, 6], 3 in North America [23, 34,
5], one in Oceania [38] and one study included a multinational sample [37].
Data form a total of 42,293 (median = 68% of women) participants were included. Only one study was
exclusively composed by older adults (over 50 years), 4 were in children, adolescents, or young adults, while
13 studies were in adults (over 18). Only 7 studies used validated measures to assess PA levels. A wide
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range of scales to measure depression or anxiety were used, the most used scales being the Beck
Depression and Anxiety inventory and the DASS-21. Most studies (n=14) were not per-reviewed (pre-prints).
A summary of studies is provided in Table 1.
Results are summarized and presented in table 2. Out of 9 studies reporting analyses on the association
between the overall volume of PA and depression, 6 studies showed that more PA is signicantly associated
with less depression symptoms [23, 25, 32, 33, 35, 37], and 3 out of 8 studies investigating the association
between the overall volume of PA and anxiety symptoms showed that more PA is signicantly associated
with less anxiety symptoms [25, 32, 35]. 3 out of 5 studies reported higher frequencies of PA to be
signicantly associated with less depression [27, 29, 36] and 2 out of 4 studies to be signicantly associated
with less anxiety [27, 29]. One study showed that vigorous but not moderate PA is signicantly associated
with less depression and anxiety symptoms [6] and another study indicated that light and vigorous PA is
signicantly correlated with less depression, but moderate intensity was not [23]. Out of 5 studies assessing
an association between regular and guideline-consistent PA less depression and anxiety symptoms, two
studies demonstrate that regular PA (compared to not regular) is signicantly associated with less
depression and anxiety symptoms [27, 30] and 1 study demonstrated that guideline conforming moderate to
vigorous PA is associated with lower odds of depression and anxiety [6]. 5 out of 6 studies showed that a
decreasing PA during the pandemic was signicantly associated with more depression symptoms [9, 27, 5,
38, 40] and 3 out of 6 studies showed that a decrease in PA was signicantly associated with more anxiety
symptoms [9, 27, 38]. 1 study reported that an increase in PA was associated with less depressive symptoms
[39].
The risk of bias of individual studies is presented in table 2. All studies clearly dened their research
questions and used valid tools to assess main outcomes. Among the cross-sectional studies, 11 (68.75%)
studies did not report the participation rate or included less than 50% of eligible participants, and 13
(81.25%) did not use valid tools to assess the exposure measure. A total of 3 out of 5 (60%) longitudinal
studies are in risk of bias in the evaluating the denition of the study population, the participation rate, the
validity of the exposure measure and in the retention of the sample.
Discussion
The present study is, to the best of our knowledge, the rst study to summarize the evidence on the
associations of PA with depression and anxiety during the COVID-19 pandemic. The majority of studies
included in the present review showed that those who performed PA on a regular basis with higher volume
and frequency and kept the PA routines stable, showed less symptoms of depression and anxiety. There was
consistent evidence that those who could not keep their PA routine stable during the pandemic showed more
depression and anxiety symptoms [9, 27, 5, 38-40]. However, the association was more consistent regarding
depressive compared to anxiety symptoms. Those reporting a higher total time spent in moderate to
vigorous PA had 12% to 32% lower chances of presenting depressive symptoms and 15% to 34% of
presenting anxiety. These ndings are in line with results of recent meta-analyses showing that those with
higher PA levels were 17% less likely of developing depression [18] and 26% less likely to develop anxiety
[19], independently of the the COVID-19 pandemic.
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Indeed, the found reduction of PA behavior during COVID-19 specic conditions is highly expected. For
example, due to social distancing, exercising in a group setting was limited or completely prohibited.
However high social support is associated with more engagement in PA [42]. Indeed, social support was one
of the strongest factors associated with adherence to PA in effective exercise interventions [43]. Furthermore,
the COVID-19 pandemic impaired opportunities to be physically active due to the closure of sports clubs,
gyms, or common indoor and outdoor places for PA. While some people were still allowed to do exercises
like jogging on the streets, others were not [44]. In general, a lack of sporting opportunities seems to be
associated with reduced PA [45]. Further negative consequences of the pandemic such as nancial
insecurities might have caused stress in individuals and stress, in turn, may differentially impact individuals’
level of PA. Whereas habitually active individuals might even increase their level of PA, those who had not
yet integrated exercise as a part of daily life, reduce their level of PA [46]. Thus, habitually active individuals
might have built PA-related health competence and learned to utilize PA as a strategy to cope with negative
feelings, such as stress, that may arise with sudden adaptions [47, 48]. Therefore, in order to prevent an
increase in psychiatric disorders during the current or further pandemics, factors that facilitate the
integration of PA into daily life routines, such as motivational and volitional skills, need to be identied and
encouraged [49, 50]. One of the best ways to promote motivation and volition is the application of behavior
change techniques (BCTs) [51]. During the COVID-19 pandemic, some BCTs appear to be particularly
important for the maintenance of regular PA. For instance, the knowledge about the benets of PA on
symptoms that accompany lock-down procedures, such as lowered mood or anxiety [2-4]. Furthermore,
individuals need the strong ability of coping planning to anticipate barriers that could discourage them to
engage in PA (e.g., closed facilities) and nd strategies to overcome them (e.g., engage in home training).
A web-based tool, e.g. a smartphone application could be a low-threshold and cost-effective option to train,
supervise, apply, and adopt such BCTs, especially in terms of COVID-19. First empirical evidence showed
preliminary ecacy of apps in promoting PA. Users of such apps are more likely to meet recommendations
on PA than non-users [52-54]. Furthermore, a meta-analysis showed that Internet-delivered interventions,
which are able to use different BCTs, were effective in increasing PA [55]. A major advantage of such web-
based tools is the possibility to overcome some of the COVID-19 specic barriers. For instance, it is possible
to become physically active online with friends or a virtual community, which might work against the lack of
social support. In addition, limited sporting opportunities may be expanded through tness technology and
the provision of structured programs, as they can be used both indoors (e.g. through tness videos) and
outdoors (e.g. through running apps) and therefore be adapted to the specic situation.
Limitations
Most of the studies included in this review used cross-sectional research designs. A causal nature of these
associations therefore remains unclear. There are notably differences in effect sizes which point at a high
heterogeneity of the effects. Several studies further showed methodological shortcomings, e.g. not reporting
the participation rate, including less than 50% of eligible participants, no validated tools to assess PA and
failure to report standardized coecients. Heterogeneity in research designs and statistical analyses
hindered meta-analytic approaches, which would have provided a more sophisticated overall effect
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estimate. Finally, several included studies were published as preprints and are currently in review processes
for nal publications. It is therefore planned to update this review in the future.
Conclusions, Future Research Directions And Implications
This rapid review shows promising evidence that higher volume and frequency of PA and the keeping of
regular PA habits during the Covid-19 pandemic is associated with less symptoms of depression and
anxiety. For instance, those reporting a higher total time spent in moderate to vigorous PA had 12% to 32%
lower chances of presenting depressive symptoms and 15% to 34% of presenting anxiety. Thus, the
promotion of PA habits and routines might be a cost-effective and comprehensive worldwide applicable
strategy to overcome the severe gap between people in need and people receiving mental health care,
especially in low-income countries with even non-existing mental health supplies. Particularly, web-based
technologies, could be an easily accessible way to increase motivation and volition for PA and maintain
daily PA routines even under pandemic-specic barriers. However only very few apps or websites have been
tested in RCTs with high methodological standards [56]. Thus, there is a clear need for more systematic
research for effectively and safely usable apps or web-based programs to prevent psychiatric disorders
through PA.
Declarations
Funding. No funding has been received for the conduct of this review and preparation of this manuscript.
Conict of Interest. All authors declare that they have no conict of interest.
Availability of data and material. Data sharing not applicable to this article as no datasets were generated or
analyzed during the current study.
Author Contributions. SW and FS devised the project and the main conceptual ideas. FS
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Tables
Table 1
. Characteristics of included studies
Page 12/17
Author Country Design TypeN age
group
(years)
%
females
PA
assessment
MH
assessment
Bauer et al.,
2020
Germany Cross-
sectional
pre-print 3,700 adults
(M = 33.13)
78.6 BSA-F PHQ-9; GAD-7
Callow et al.,
2020
US Cross-
sectional
peer-
reviewed
1,046 older adults
(< 50)
80 PASE GDS; GAS
Chen et al.,
2020a
China Cross-
sectional
peer-
reviewed
1,036 children/
adolescents
(R = 6-15)
48.7 NR DSRS-C;
SCARED
Chen et al.,
2020b
Iran Cross-
sectional
pre-print 474 adults
(R = 20-70)
51.3 Single item
(hours/day)
PHQ-2; GAD-2
Cheval et al.,
2020
France,
Switzerland
Longitudinal
(retrospective
and
prospective)
pre-print 110 adults
(M = 43)
68 IPAQ PROMIS
(adapted
questions for
depression and
anxiety)
Deng et al.,
2020
China Cross-
sectional
pre-print 1,607 adolescents/
young adults
(NR)
35.2 Multiple items
(duration,
frequency)
DASS-21
Filgueiras &
Stultz-
Kolehmainen,
2020a
Brazil Cross-
sectional
pre-print 1,460 adults
(M = 32.9)
72.87 Single item
(frequency)
FDI; SSTAI
Filgueiras &
Stultz-
Kolehmainen
2020b
Brazil Longitudinal
(prospective)
pre-print 360 adults
(M = 37.9)
68.8 Multiple items
(frequency,
type)
FDI; SSTAI
Fu et al.,
2020
China Cross-
sectional
peer-
reviewed
1,242 adults (NR) 69.7 NR PHQ-9; GAD-7
Fullana et al.,
2020
Spain Cross-
sectional
Peer-
reviewed
5,545 adults (M =
47)
73 NR PHQ-9; GAD-7
Jacob et al.,
2020
UK Cross-
sectional
peer-
reviewed
902 adults (NR) 63.8 Multiple items
(duration/day,
intensity)
BDI; BAI
Khan et al.,
2020
BangladeshCross-
sectional
pre-print 505 adolescents/
young adults
37.3 NR DASS-21
Lebel et al.,
2020
Canada Cross-
sectional
pre-print 1,987 adults
(M = 32.4)
100 Multiple items
(duration/week,
intensity)
EPDS; PROMIS
anxiety
Meyer et al.,
2020
US Longitudinal
(retrospective)
pre-print 3,052 adults (NR) 62 Multiple items
(duration/day,
intensity)
BDI; BAI
Moreira et al.,
2020
Portugal Cross-
sectional
pre-print 1,280 adults
(M = 37.1)
79.8 Single item
(duration/day,
intensity)
DASS-21
Planchuelo-
Gómez et al.,
2020
Spain Cross-
Sectional
pre-print 1,056 adults
(M = 32.1)
67.6 NR DASS-21
Plomecka et Multiple (12Cross- pre-print 12,817adults (NR) 72.3 NR BDI
Page 13/17
al., 2020 countries) sectional
Schuch et al.,
2020
Brazil Cross-
sectional
Peer-
reviewed
937 adults (NR) 72.3 Multiple items
(duration/day,
intensity)
BDI; BAI
Stanton et
al., 2020
Australia Cross-
sectional
peer-
reviewed
1,491 adults
(M = 50.5)
67 AAS DASS-21
Zhang et al.,
2020
China Longitudinal
(prospective)
peer-
reviewed
66 adolescents/
adults
(M = 20.7)
62.1 IPAQ DASS-21
Zheng et al.,
2020
China Cross-
sectional
pre-print 1,620 children/
adolescents
(M = 10.1)
47.8 Single item
(decrease since
Covid)
DSRSC; SASC
Abbreviations:
AAS = Active Australia Survey; BASF-F = The Physical Activity Exercise, and Sport
Questionnaire; DASS-21 = Depression and anxiety scale 21 items; DSRS-C = Depression Self-Rating Scale for
Children; EPDS = Edinburgh Depression Scale; FDI = Filgueira depression inventory; GAD-7 = Generalized
Anxiety Screener 7; GAS = geriatric anxiety scale; GDS = geriatric depression scale; IPAQ = International
physical activity questionnaire; M = Mean; MH = mental health; n = number of participants; NR = not
reported; PA = physical activity; PAVS = physical activity vital sign; PASE = Physical activity scale for the
eldery; PHQ-9 = patient health questionnaire 9; PROMIS = Patient-Reported Outcomes Measurement
Information System; R = Range; SASC = Social Anxiety Scale for Children; SCARED = Screen for Child
Anxiety Related Disorders; SSTAI = The Spielberg State and Trait Anxiety Inventory
   
Table 2.
Main results of multiple linear and logistic regressions analyzing the association of physical activity
or exercise with symptoms of depression or anxiety in the included studies
Page 14/17
Author Predictor Depressive Symptoms Anxiety Symptoms
Beta (95%
CI)
OR (95%
CI)
Beta (95%
CI)
OR (95%
CI)
Volume  
Bauer et al., 2020 EX (minutes/week) 0.00# (NR;
NR)
0.01# (NR;
NR)
Callow et al., 2020 PA (PASE score) -0.22***
(NR; NR)
-0.02 (NR;
NR)
Chen et al., 2020b EX (hours/day) 0.68*
(0.47;
0.97)
0.66*
(0.45;
0.96)
Cheval et al., 2020 PA (minutes/day) NR# (NR;
NR)
NR# (NR;
NR)
Jacob et al., 2020 EX (minutes/day) 0.88° (0.8;
0.97)
0.85°
(0.79;
0.97)
Khan et al., 2020 EX (any amount;
Ref.: No EX)
-2.1*
(-4.02;
-0.17)1
-0.55
(-1.92;
0.82)1
Moreira et al., 2020 EX (hours) -1.17° (NR;
NR)1
-0.81°(NR;
NR)1
Plomencka et al.,
2020
EX (> 15 min/day;
Ref.: 15 min/day, <60
min/day)
-0.13***
(NR; NR) NR# (NR;
NR)
 
EX (60 min/day;
Ref.: 15 min/day)
-0.15***
(-0.18;
-0.12)
NR# (NR;
NR)
 
Schuch et al., 2020 PA (minutes/day; per 10
minutes increase)
-0.03 (-0.1;
0.03)
 -0.05
(-0.13;
0.02)
  
Frequency  
Deng et al., 2020 EX (> 1 to 2 times/week; Ref: <
1x/week)
-0.11***
(NR; NR)
-0.09**
(NR; NR)
Filgueiras & Stultz-
Kolehmainen 2020a
EX (frequency/week) -2.68**
(NR; NR)1
-1.64***
(NR; NR)1
Fullana et al., 2020 EX (Unclear) 0.93 (NR;
NR)
0.95 (NR;
NR)
Planchuelo-Gómez et
al., 2020
EX (1-2 times/week; Ref.: No
EX)
-0.17 (NR;
NR)1
 
EX (3-5 times/week; Ref.: No
EX)
-0.85* (NR;
NR)1
 
EX (6-7 times/week; Ref.: No
EX)
-1.29***
(NR; NR)1
 
Filgueiras & Stultz-
Kolehmainen 2020b
EX (frequency/week) NR# (NR;
NR)
NR# (NR;
NR)
Intensity  
Callow et al., 2020 light PA (PASE score) 0.12** (NR;
NR)
 
Page 15/17
moderate PA (PASE score) -0.01 (NR;
NR)
 
vigorous PA (PASE score) 0.09* (NR;
NR)
 
Schuch et al., 2020 vigorous PA (minutes/day) -0.19*
(-0.34;
-0.04)
0.6**
(0.44;
0.83)
-0.22*
(-0.4;
-0.03)
0.71**
(0.52;
0.96)
moderate PA (minutes/day) 0.00 (-0.09;
0.09)
0.77
(0.57;
1.02)
-0.03
(-0.14;
0.08)
0.75
(0.58; 1)
Regular/Guideline
Conforming
 
Chen et al.,2020a EX (regular; 0.37 (NR;
NR)2
0.43 (NR;
NR)2
Ref.: not regular)  
Deng et al., 2020 EX (regular; -0.2***
(NR; NR)
-0.14***
(NR; NR)
Ref.: not regular)  
Fu et al., 2020 EX (not regular; 1.71***
(1.28;
2.29)
1.45*
(1.08;
1.93)
Ref.: regular)  
Lebel et al., 2020 EX (guideline conforming; Ref.:
not guideline conforming)
0.87
(0.67;
1.12)
0.81
(0.64;
1.03)
Schuch et al., 2020 PA ( 30 minutes/day; Ref.: <
30 minutes/day)
 0.72*
(0.54;
0.96)
 0.72*
(0.54;
0.96)
Change  
Bauer et al., 2020 EX (less; equal; more)3-0.08***
(NR; NR)
-0.05***
(NR; NR)
Deng et al., 2020 EX (no change; Ref.: large
change)
-0.27***
(NR; NR)
-0.21***
(NR; NR)
EX (little change; Ref.: large
change)
-0.22***
(NR; NR)
-0.17***
(NR; NR)
Filgueiras et al.,
2020b
EX (none, increase, decrease) NR# (NR;
NR)
NR# (NR;
NR)
Meyer et al., 2020 PA (increased; Ref.: maintained
high)
-0.01
(-0.05;
0.02)
0.00
(-0.03;
0.04)
PA (decreased; Ref.: maintained
high)
0.09***
(0.05;
0.13)
0.03
(-0.01;
0.07)
PA (maintained low; Ref.:
maintained high)
0.04 (0.00;
0.07)
0.02
(-0.02
; 0.05)
Stanton et al., 2020 PA (negative change; Ref.: no
change/positive change)
1.08***
(1.06;
1.11)
1.09***
(1.05;
1.13)
Zhang et al., 2020 PA (per 100 MET increase) -0.04*
(-0.08; 0)
-0.03
(-0.07; 0)
Page 16/17
Zheng et al., 2020 PA (decrease vs. no
change/increase)
2.07**
(NR; NR)
1.24 (NR;
NR)
Abbreviations:
AOR = adjusted odd's ratio; EX = Exercise; MET = metabolic equivalent of tasks; NR = not
reported; OR = Odd's ratio; PA = physical activity; PASE = Physical activity scale for the elderly; Ref. =
Reference category
*p < 0.05; **p < 0.01; ***p<0.001; °signicant association, p-value not reported; #no signicant association,
p-value not reported
1unstandardized regression coecient
2Odd's Ratio calculated from case counts
3Post-Hoc analysis revealed that a decrease in exercise was signicantly associated with less depression
compared to stable exercise and increase. No other comparison reached signicance
  
Table 3
. Risk of bias assessment (NIHM tool for observational studies)
Items 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Cross-sectional studies
Bauer et al., 2020 YYY YY- - Y Y -Y- - Y
Callow et al., 2020 YYY YY- - Y Y -Y- - Y
Chen et al., 2020a Y N NR N Y - - N N -Y- - N
Chen et al., 2020b Y Y N N Y - - Y N -Y- - Y
Deng et al., 2020 Y Y Y Y N - - Y N -Y- - N
Filgueiras & Stultz-Kolehmainen, 2020a Y N NR Y Y - - Y N -Y- - Y
Fu et al., 2020 Y Y NR Y Y - - N N -Y- - Y
Fullana et al., 2020 Y Y NR Y N - - N N -Y- - Y
Jacob et al., 2020 Y Y NR Y Y - - Y N -Y- - Y
Khan et al., 2020 Y N NR Y Y - - N N -Y- - Y
Lebel et al., 2020 Y Y NR Y Y - - N N -Y- - Y
Moreira et al,. 2020 Y Y NR Y Y - - N N -Y- - Y
Plomecka et al., 2020 YYY YY- - Y N Y  Y
Schuch et al., 2020 Y Y NR Y Y Y N -Y- - Y
Stanton et al., 2020 Y Y NR Y Y - - N Y -Y- - Y
Zheng et al., 2020 Y Y Y Y N - - N N -Y- - Y
Longitudinal studies         
Cheval et al., 2020 Y N Y Y Y Y Y Y Y Y Y -Y NR
Filgueiras & Stultz-Kolehmainen, 2020B Y N NR Y Y Y Y Y N Y Y -N Y
Meyer et al., 2020 Y Y Y Y Y N Y Y N N Y -NA Y
Planchuelo-Gómez et al., 2020 Y Y NR Y N Y Y Y NR Y Y -N Y
Zhang et al., 2020 Y N NR Y Y Y Y Y Y Y Y -Y NR
Figures
Page 17/17
Figure 1
PRISMA ow-chart of the screening and selection of studies.
... Our findings are consistent with those reported in a rapid review that has not yet undergone peer review. Wolf et al. (47) reviewed evidence examining the association between physical activity and depression and anxiety during the COVID-19 pandemic. They identified a total of 21 observational studies (four longitudinal, one cross-sectional with retrospective analysis, and 16 cross-sectional). ...
... A significant body of research conducted prior to COVID indicates a positive relationship between mental health and physical activity (6,7,13). The results of the current study and the greater literature (47,48) suggest that such associations hold true during a period of pandemic and significant socioeconomic disruption. Indeed, given both the extent and severity of disruptions, it is remarkable that a significant proportion of depressive symptomatology -7.7% of variance accounted forwas associated with MVPA. ...
... The purpose of the current study was to examine associations between physical activity, mental health, and mental illness during the COVID-19 pandemic. In line with emerging literature (47), individuals who maintained their levels of physical activity demonstrated less psychological disturbance. Results indicate a positive association between changes in MVPA and mental health, where those who experienced the greatest decline in MVPA reported relatively greater psychological distress and lower life satisfaction. ...
Article
Full-text available
Background: In addition to its physical health benefits, physical activity is increasingly recognized as a means to support mental health. Regular moderate-to-vigorous physical activity (MVPA) is associated with improved mental well-being, reduced likelihood of developing mental illness, and improved symptom management. Despite these benefits, most people fail to achieve minimum recommended levels of MVPA. Population levels of physical activity have further declined since the onset of the COVID-19 pandemic and implementation of public health measures (e.g., shelter-in-place protocols). The potential impact of this decline on mental heath outcomes warrants ongoing investigation. Purpose: To investigate associations between changes in MVPA and mental health (depressive symptoms, anxiety symptoms, and life satisfaction) in adults impacted by the COVID-19 pandemic. Method: Research followed a cross-sectional design. English-speaking adults were invited to complete an online questionnaire. MVPA was assessed retrospectively (before COVID-19) and currently (during COVID-19) with the International Physical Activity Questionnaire. Mental health was assessed with the Patient Health Questionnaire, 9-Item (PHQ-9), the Generalized Anxiety Disorder, 7-Item (GAD-7), and the Satisfaction with Life Scale (SWLS). Regression was used to assess relationships between MVPA and mental health. ANOVA with follow-up tests examined whether participants who differed in mental health status (e.g., no symptoms vs. severe symptoms) differed in their change in MVPA. T -tests were used to examine differences in mental health symptomatology between participants who were sufficiently (i.e., achieving MVPA guidelines of ≥ 150 min/week) vs. insufficiently active. Results: Prior to COVID-19, 68.2% of participants were classified as being sufficiently active, vs. 60.6% during COVID-19. The majority of participants reported experiencing some level of depressive symptoms (62.0%) or anxiety symptoms (53.7%). After controlling for covariates, changes in MVPA accounted for significant variability in the PHQ-9 (7.7%), GAD-7 (2.5%), and SWLS (1.5 %). Participants with clinically significant mental health symptomatology reported greater declines in MVPA than those who reported no symptoms. Conversely, participants who were sufficiently active during COVID-19 reported significantly lower depression and anxiety, and higher life satisfaction. Conclusion: Participants who experienced the greatest declines in MVPA reported relatively greater psychological distress and lower life satisfaction. While preliminary, these findings suggest the importance of maintaining and promoting physical activity during a period of pandemic.
... Finally, a behavioral factor that contributes to reduce the risk of suffering from these ailments is the practice of physical activity. Various studies have been carried out relating the frequency and intensity of physical activity with respect to its effectiveness in terms of mental health (23)(24)(25)(26). Here, we determined the distribution of the adult population that exercises with low or high weekly frequency and analyzed its relation with people's self-perception of GAD and depression. ...
... We divided this population into two groups of study: people between 18 and 30 years old and people between 31 and 50 years. This division was performed using as guidance the one established by the national institute for statistics and census (INDEC) to differentiate between young (15-29 years) and adults (17,26, within the economically active population (27)(28)(29)(30). In our case we excluded the population under 18 years old due to the impossibility of obtaining reliable on-line informed consents signed by the parents of the minors. ...
Article
Full-text available
Background Since the irruption of the coronavirus disease 2019 (COVID-19) the planet has submerged in a time of concern and uncertainty, with a direct impact on people's mental health. Moreover, the recurrent outbreaks that periodically harry different regions of the world constantly refocus people's concerns to the pandemic. Yet, each new wave heats the diverse countries in different situations, including the advances in their vaccination campaigns. In this research, we studied the levels of the general anxiety disorder (GAD) and depression in the Argentine population across the first and second waves of infections that occurred in our country.Methods We conducted an on-line survey, within each peak of the pandemic. People were asked to self-report GAD and depression symptoms using the GAD-7 and PHQ-9 questioners, inform their vaccination status, the frequency they performed physical activity as well as working condition and modality. Here, we identified the more vulnerable groups and evaluated factors that could mitigate the rise of these mental disorders, focusing on vaccination.ResultsOur data shows that reported GAD and depression levels were higher during the second wave than during the first one. More importantly, vaccinated people were less depressed than non-vaccinated people, while GAD levels remained equivalent in both groups. Other factors directly associated with lower GAD and depression levels were performing frequent physical activity and being employed, regardless of the employment modality. These observations were replicated in different age ranges and genders.Conclusion This work evidences GAD and depression in different pandemic waves in Argentina, as well the factors that may contribute to reducing the magnitude of these disorders, including vaccination.
... The majority of past research in this area has examined associations between movement behaviors and mental health over long time-periods with little-to-no data available for evaluating rapid alterations in behavior as occurred in response to the global pandemic. From our past research and that of others, cross-sectional or retrospective assessments of COVID-19-related decreased physical activity and increased sitting and screen time have been associated with higher anxiety symptoms, depressive symptoms, loneliness and stress, as well as lower positive mental health (PMH; a broad concept of mental well-being focused on positive constructs) (10)(11)(12)(13)(14). However, given the cross-sectional and/or retrospective recall designs of previous research, there is a need for prospective and longitudinal studies to determine the effects of pandemic-related changes in behavior on mental health over time. ...
... At baseline, predicted depressive symptoms were higher in those viewing screens for 13 Figure 1B), though the interaction between screen time and time was not significant. Predicted anxiety symptoms ( Figure 1E) and PMH (Figure 1H) did not differ by screen time at baseline or across time. ...
Article
Full-text available
The COVID-19 pandemic has elicited increased sedentary behaviors, decreased moderate-to-vigorous physical activity (MVPA), and worsened mental health, yet the longitudinal impact of these changes and their inter-relations remains unknown. Our purpose was to examine associations between changes in self-reported activity behaviors and mental health over an 8-week period following the COVID-19 outbreak. Participants from all 50 states and the District of Colombia were recruited through convenience and snowball sampling at baseline April 3–10, 2020. Prospective data from 2,327 US adults with ≥2 responses (63.8% female; 74.3% response rate) were collected weekly via online survey for eight consecutive weeks (April 3–June 3, 2020). Primary exposures were self-reported time spent sitting, viewing screens and in MVPA, with primary outcomes being depressive symptoms, anxiety symptoms, and positive mental health (PMH). A significant sitting-by-time interaction (p < 0.05) showed slightly higher marginal effects for depressive symptoms for the 90th-percentile of sitting time than the 10th-percentile at baseline (5.8 [95% confidence interval = 5.5–6.2] vs. 5.7 [5.4–6.1]), with the difference magnifying over time (week 8: 3.5 [3.2–3.9] vs. 2.7 [2.4–2.9]). No other interactions over time were significant. Screen time was negatively associated with PMH and positively associated with depressive and anxiety symptoms (p < 0.05). Sitting time was negatively associated with PMH (p < 0.05). Rapid changes in sitting patterns (e.g., due to a pandemic) may have lasting effects on depressive symptoms. Strategies targeting those most affected (i.e., young adults, females) and/or focused on reducing sitting time may be critical for preventing long-term mental health effects resulting from COVID-19 or other large-scale behavior changes in the general population.
... This is especially true when comparing physical activity to no physical activity, or activity performed with lower volume and frequency. According to a rapid systematic review, there is no consensus regarding the exact volume and frequency of physical activity, however, in the included studies vigorous physical activity done regularly as opposed to irregularly was significantly associated with fewer depression symptoms (Wolf et al., 2020). This is of particular relevance for this sample population, which shows low levels of self-reported physical activity and may be at risk of decreased immune response. ...
Article
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Introduction: Major depression is a psychiatric disease associated with physical inactivity, which in turn affects mental and physical health. A randomized controlled trial is being implemented to facilitate physical activity in people with major depression. In March 2020, Swiss state authorities temporarily legislated a lockdown to contain the Coronavirus disease-19 (COVID-19), which influenced health, behavior and research. The aim of this study was to find out whether data gathered before and during/after the lockdown among in-patients with major depression differ with regard to psychosocial health, physical activity and related attitudes and to establish whether baseline data have been affected by the lockdown. Methods: This is a cross-sectional analysis within a randomized controlled trial. Physically inactive, adult in-patients diagnosed with major depression were recruited from four Swiss psychiatric clinics between January 2019 and December 2020. Psychosocial health was measured with questionnaires pertaining to stress, sleep and health-related quality of life. Physical activity was measured with the Simple Physical Activity Questionnaire. Explicit attitudes were measured with seven questionnaires pertaining to physical activity-related motivation and volition. Implicit attitudes toward physical activity were captured with a single target implicit association test. Results: The sample consisted of 165 participants ( n = 119 before lockdown, n = 46 during/after lockdown). No statistically significant differences were found between in-patients with major depression assessed before and during/after the COVID-19 lockdown with regard to psychosocial health (stress, p = 0.51; sleep, p = 0.70; physical component of health-related quality of life, p = 0.55; mental component of health-related quality of life, p = 0.64), self-reported physical activity ( p = 0.16) and explicit as well as implicit attitudes toward physical activity ( p = 0.94). Hence, the COVID-19-induced lockdown seems not to have led to group differences. Conclusion: Baseline data gathered in in-patients suffering from major depression who are physically inactive upon admission to in-patient treatment in Switzerland seem to be unaffected by the COVID-19-induced lockdown. To assess changes in said population regarding psychosocial health and physical activity patterns over time, longitudinal data are needed.
... This is especially true when comparing physical activity to no physical activity, or activity performed with lower volume and frequency. According to a rapid systematic review, there is no consensus regarding the exact volume and frequency of physical activity, however, in the included studies vigorous physical activity done regularly as opposed to irregularly was significantly associated with fewer depression symptoms (Wolf et al., 2020). This is of particular relevance for this sample population, which shows low levels of self-reported physical activity and may be at risk of decreased immune response. ...
... In addition to those approaches, we also encourage the use of feasible individual homemade practices to address such issues. For instance, physical exercise is related to physical, psychological, and cognitive improvements in mood and general health (Schuch et al., 2016;Ashdown-Franks et al., 2019;Wolf et al., 2021). Mind-body integrative practices such as mindfulness meditation and yoga have also shown to be effective in reducing psychophysiological distress while improving positive psychological measures (Cahn et al., 2017;Pascoe et al., 2017;Goldberg et al., 2018;Solhaug et al., 2019;Sousa et al., 2021). ...
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Background: Mental health burden has been massively reported during the COVID-19 pandemic period. Aiming to summarise these data, we present a meta-review of meta-analyses that evaluated the impact of COVID-19 pandemic on anxiety, depressive and stress symptoms, psychological distress, post-traumatic stress disorder/symptoms (PTSD), and sleep disturbance, reporting its prevalence on general public (GP) and health care workers (HCW). Methods: A search was performed in the PubMed, EMBASE, and the Web of Science. Sleep disturbances, psychological distress, stress, and burnout were grouped as “Psychophysiological stress,” and anxiety, depression, and PTSD were grouped as “Psychopathology.” A random-effects model, calculating the pooled prevalence together with 95% confidence interval was performed for each domain. Subgroup analyses were performed for each population type (GP and HCW) and for each mental health outcome. For anxiety and depression, subgroup analysis for population type was performed. Heterogeneity is reported as I ² . Publication bias was assessed through visual inspection of the funnel plot, and further tested by Egger's test and trim and fill analyses. Results: A total of 18 meta-analyses were included. The prevalence of psychophysiological stress was 31.99% (CI: 26.88–37.58, I ² = 99.9%). HCW showed a higher prevalence (37.74%, CI: 33.26–42.45, I ² = 99.7%) than the GP (20.67%, 15.07–27.66, I ² = 99.9%). The overall prevalence of insomnia, psychological distress, and stress were, respectively, 32.34% (CI: 25.65–39.84), 28.25% (CI: 18.12–41.20), and 36% (CI: 29.31–43.54). Psychopathology was present at 26.45% (CI: 24.22–28.79, I ² = 99.9%) of the sample, with similar estimates for population (HCW 26.14%, CI: 23.37–29.12, I ² = 99.9%; GP: 26.99%, CI: 23.41–30.9, I ² = 99.9%). The prevalence of anxiety, depression, and PTSD was 27.77% (CI: 24.47–31.32), 26.93% (CI: 23.92–30.17), and 20% (CI: 15.54–24.37), respectively. Similar proportions between populations were found for anxiety (HCW = 27.5%, CI: 23.78–31.55; GP = 28.33%, CI: 22.1–35.5) and depression (HCW = 27.05%, CI: 23.14–31.36; GP = 26.7%, CI: 22.32–31.59). Asymmetry in the funnel plot was found, and a slight increase in the estimate of overall psychopathology (29.08%, CI: 26.42–31.89) was found after the trim and fill analysis. Conclusions: The prevalence of mental health problems ranged from 20 to 36%. HCW presented a higher prevalence of psychophysiological stress than the general population. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=252221 , identifier: CRD42021252221.
... Complementarily, it is possible that the decrease in physical activity during the pandemic in previously regular practitioners induces higher levels of anxiety as a result of withdrawal, i.e., abstinence effect, as indicated by some studies and reviews [84,85] and recent reviews on studies carried out during the COVID-19 pandemic [86]. This is also congruent with all the research that positively associates lower levels of exercise and a sedentary lifestyle with higher levels of anxiety [87,88]. ...
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The features of the COVID-19 pandemic and the social operations to contain the spread of the virus might have limited or altered coping, including healthy habits such as exercise, this contributing to a myriad of negative consequences for the mental health of the global population. We explored the contribution of coping and physical activity to the management of anxiety in Spanish adults during an active phase of the epidemic, as well as the relationship between these strategies. A total of 200 young and adult individuals (70% women) voluntarily completed an anxiety inventory, a coping skills self-report and a personal data section including exercise practice. The participants reported in average a mild yet existing level of anxiety symptoms; a third reported noticeable symptoms. At the time of the study, the participants used more adaptive than maladaptive coping styles. Participants’ anxiety was inversely correlated with an active coping style, and positively with an avoidant style; physical activity correlated positively with an active coping style, and regular exercisers used more frequently active coping. Controlling for confounders, active coping, avoidant coping and exercise during the pandemic predicted anxiety symptoms. Other findings indicated that exercise was used as a coping strategy for dealing with emotional distress. Our results highlight the positive impact of functional coping and exercise for the management of negative states such as anxiety during the pandemic, and underline the importance of developing interventions aimed at enhancing coping skills for promoting physical and mental well-being of the population during health and social crises.
... In addition to the risk factors, the protective factors were also identified and listed. Resilience, active coping skills, exercise, social support, self-efficacy, stable income are accounted as a protective shield against the effects of the COVID-19 [88][89][90][91]. ...
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Background/aim: The purpose of this review was to present the ultimate toll of the COVID-19 pandemic by focusing on the communication strategies and mental health. Materials and methods: We unsystematically reviewed the studies published between 2020 and 2021 from databases such as Google Scholar, Web of Science and ScienceDirect. Firstly, “new-normal” life challenges during the pandemic were discussed along with the public risk communication strategies. Later, mental health problems, posttraumatic growth, and protective factors were reviewed. Results: Literature highlighted that individuals mainly experience COVID-19 related fear, anxiety, stress, negative emotions and sleep problems. Furthermore, the rates of clinically significant depression, anxiety, obsessive compulsive disorder, and posttraumatic stress disorder suggest an increase. Specifically, COVID-19 stress syndrome, loneliness, and sleep problems were associated with mental health problems in the pandemic. However, some individuals seem to be resilient to the COVID-19 trauma and experience posttraumatic growth. Brief online intervention studies are promising for reducing the emotional toll of the COVID-19 as well as for making individuals more resilient. Conclusion: To conclude, the negative conditions of the pandemic seem to make some people, but not all, vulnerable to mental illness. In addition, framing the public warnings in an optimal emotional tone seems to be more effective to comply with the precautions.
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Background: Depression and anxiety are growing issues for college students, with both aerobic resistance training and mindfulness yoga exercises known to be effective in reducing symptoms and severity. However, no known research is available comparing these 2 depression and anxiety interventions simultaneously and in a web-based environment. Objective: This study aims to determine the effects of a web-based aerobic resistance exercise intervention (WeActive) and a web-based yoga mindfulness exercise intervention (WeMindful) on depression and anxiety symptoms in college students. Methods: The participants were 77 college students who anonymously completed a Qualtrics survey, including the Generalized Anxiety Disorder Scale and the Major Depression Inventory at baseline and after the intervention. Participants were randomly assigned to either the WeActive or WeMindful group and underwent two 30-minute web-based aerobic resistance exercise lessons or yoga mindfulness lessons per week for 8 weeks. Results: The results of analysis of covariance with repeated measures indicated that although not statistically significant, both groups showed a notable decrease in anxiety with a marginally significant main effect of time (F1=3.485; P=.07; η2=0.047) but no significant main effect of group and no significant interaction effect of time with group. The 2 intervention groups experienced a significant decrease in depression with the main effect of time (F=3.892; P=.05; η2=0.052). There was no significant main effect of group or interaction effect of time with group for depression. Conclusions: College students in both WeActive and WeMindful groups experienced a significant decrease in depression symptoms and a decrease, although not significant, in anxiety as well. The study suggests that web-based WeActive and WeMindful interventions are effective approaches to managing US college students' depression and anxiety during a pandemic.
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Regular physical activity is important for general health and reduces the risk for COVID-19 infections and for severe outcomes among infected people. However, measures to mitigate COVID-19 likely decrease population physical activity. This study aimed to examine 1) changes in exercise frequency in a representative sample of US adults during the pandemic (04/01/2020–07/21/2021), and 2) how sociodemographic characteristics, pre-COVID health-related behaviors and outcomes, and state-level stringency of COVID-19 containment measures predict exercise frequency. Self-reported exercise frequency and its individual-level predictors were determined based on 151,155 observations from 6,540 adult participants (aged ≥ 18 years) in all US states from the Understanding America Study. State-level stringency of COVID-19 control measures was examined from the Oxford COVID-19 Government Response Tracker. Exercise frequency varied significantly over 28 survey waves across 475 days of follow-up (F1,473 = 185.5, p
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Background: The self-distancing measures imposed major changes in daily life routine. This study aimed to (i) evaluate the changes (pre-versus during pandemic) in time spent in moderate to vigorous physical activity (MVPA) and sedentary behavior (SB) in selfisolating Brazilians during the COVID-19 pandemic, and (ii) to explore correlates of MVPA and SB. Methods: A cross-sectional self-report online survey, evaluating the time spent in MVPA and SB pre and during the COVID-19 pandemic. Sociodemographic, behavioral, clinical, variables, and time in self-isolation were also obtained. Changes in MVPA and SB and their correlates were explored using generalized estimating equations (GEE). Results: A total of 877 participants (72.7% women, 53.7% young adults [18-34 years]) were included. Overall, participants reported a 59.7% reduction (95%CI:35.6 to 82.2) in time spent on MVPA during the pandemic. Time spent in SB increased 42.0% (95%CI:31.7 to 52.5). Greater reductions in MVPA and/or increases in SB were seen in younger adults, those not married, those employed and those with a self-reported previous diagnosis of a mental disorder. Conclusions: People in self-isolation significantly reduced MVPA levels and increased SB. Public health strategies should be implemented during epidemic times to mitigate the impact of self-isolation on MVPA and SB, particularly in vulnerable groups.
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To understand Wuhan residents’ psychological reactions to the COVID-19 epidemic and offer a reference point for interventions, an online questionnaire survey was conducted. It included the Disorder 7-Item Scale (GAD-7), the Patient Health Questionnaire 9-Item Scale (PHQ-9), Athens Insomnia Scale, and Simplified Coping Style Questionnaire. Categorical data were reported as numbers and percentages. Multivariate logistic regression models were used to evaluate the association between demographic factors and anxiety, depression, sleep disorder, and passive coping style. A total of 1242 Wuhan residents investigated, 27.5% had anxiety, 29.3% had depression, 30.0% had a sleep disorder, and 29.8% had a passive response to COVID-19. Being female was the risk factor for anxiety (OR = 1.62) and sleep disorder (OR = 1.36); being married was associated with anxiety (OR = 1.75); having a monthly income between 1000 and 5000 CNY (OR = 1.44, OR = 1.83, OR = 2.61) or >5000 CNY (OR = 1.47, OR = 1.45, OR = 2.14) was a risk factor for anxiety, depression, and sleep disorder; not exercising (OR = 1.45, OR = 1.71, OR = 1. 85, OR = 1.71) was a common risk factor for anxiety, depression, sleep disorder, and passive coping style; and having a higher education level (bachelor’s degree and above) (OR = 1.40) was associated with having a sleep disorder. Wuhan residents’ psychological status and sleep quality were relatively poorer than they were before the COVID-19 epidemic; however, the rate of passive coping to stress was relatively higher.
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Introduction: Social distancing and quarantine measures applied during the COVID-19 pandemic might result in mental health problems. In this cross-sectional study we examined if perceived social support, exercise in minutes per week and change in exercise are protective factors regarding symptoms of depression, anxiety, and sleeping disorders. Method: In April 2020, n = 4271 German adults completed an online survey including mental health questionnaires regarding depression (PHQ-D), anxiety (PHQ-D) and sleep (PSQI), as well as questionnaires related to protective factors such as exercise (BSA-F), physical activity-related health competence (PAHCO) and social support (F-SozU). Results: Complete case analysis (n = 3700; mean age 33.13 ± 11.73 years, 78.6 % females) resulted in elevated prevalence of depressive disorder (31.4%), panic disorder (5.7%) and other anxiety disorders (7.4%). 58.3% reported symptoms of insomnia. Three separate models of multiple regression were conducted. Perceived social support was associated with lower values of anxiety (beta = -0.10; t(19) = -6.46; p >0.001), lower values of depressive symptoms (beta = -0.22; t(19) = -15.71; p < .001) and lower values of sleeping disorder symptoms (beta = -0.15; t(19) = -9.55; p < .001). Change towards less exercise compared to the time before Covid-19 was associated with and higher values of anxiety (beta = -0.05; t(19) = -2.85; p= .004), higher values of depressive symptoms (beta = -0.08; t(19) = -5.69; p < .001), and higher values of sleeping disorder symptoms (beta = -0.07; t(19) = -4.54; p < .000). Post-hoc analysis (ANOVAs) revealed that a change towards less exercise was significantly associated with more depressive, anxiety and sleeping disorder symptoms whereas a positive change was not. No significant association was found for exercise in minutes per week for all outcomes. Conclusion: The COVID-19 pandemic seems to have a negative impact on mental health in the German population. Social Support and a stable amount of exercise might attenuate these negative mental health consequences. Ongoing monitoring of the impact of the pandemic on mental health and possible protective factors is needed in order to create a basis for the development of appropriate prevention and intervention measures.
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The emerging body of research on the predictors of mental health in the COVID-19 pandemic has revealed contradictory findings, which prevent effective psychiatry screening for mental health assistance. This study aims to identify the predictors of nonsomatic pain, depression, anxiety, and distress, especially focusing on age as a nonlinear predictor. We conducted a survey of 474 adults in Iran during April 1-10, 2020, when Iran had just passed its first peak of the COVID-19 pandemic with new confirmed cases. We found that Age had a curvilinear relationship with nonsomatic pain, depression, and anxiety. Age was associated with pain, depression, and anxiety disorders negatively among adults younger than 45 years, but positively among seniors older than 70 years. Adults who were female, unsure about their chronic diseases, and exercised less per day were more likely to have mental health issues. This study advances the use of age as an effective predictor by uncovering a curvilinear relationship between individuals' age and mental health issues by using a sample of adults across a wide spectrum of ages. We hope future research on mental health during COVID-19 pays more attention to nonlinear predictors.
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This is a cross-sectional study evaluating the associations of self-reported moderate to vigorous physical activity, and sedentary behavior with depressive, anxiety, and co-occurring depressive and anxiety symptoms (D&A) in self-isolating Brazilians during the COVID-19 pandemic. Depressive and anxiety symptoms were collected using the Beck Depression and Anxiety Inventories (BDI and BAI). Among the 937 participants (females=72.3%), those performing ≥30 min/day of moderate to vigorous or ≥15 min/day of vigorous physical activity had lower odds of prevalent depressive, anxiety, and co-occurring D&A symptoms. Those spending ≥10 h/day sedentary were more likely to have depressive symptoms.
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Background The COVID-19 pandemic and lockdown might increase anxiety and depressive symptoms, but some behaviors may protect against them. Method To provide a preliminary evidence of the behaviors associated with decreased symptoms in the current COVID-19 pandemic and lockdown, we conducted a survey of 5545 adult individuals from the Spanish general population, two weeks after an official lockdown was established across the country. Results Sixty-five percent of the sample reported anxiety or depressive symptoms. Following a healthy/balanced diet and not reading news/updates about COVID-19 very often were the best predictors of lower levels of anxiety symptoms. Following a healthy/balanced diet, following a routine, not reading news/updates about COVID-19 very often, taking the opportunity to pursue hobbies, and staying outdoors or looking outside were the best predictors of lower levels of depressive symptoms. Limitations Cross-sectional nature and use of sample of convenience. Conclusions This study suggests that “simple” coping behaviors may protect against anxiety and depressive symptoms during the COVID-19 pandemic and lockdown.
Article
Objective To determine the relationship between the amount and intensity of physical activity performed by older adults in North America (U.S. and Canada) and their depression and anxiety symptoms while currently under social distancing guidelines (SDG) for the COVID-19 pandemic. Design Descriptive Cross-sectional Study. Setting Online survey conducted between April 9th and April 30th, 2020, during the COVD-19 pandemic. Participants 1046 older adults over the age of 50 who live in North America. Measurements Participants were asked about their basic demographic information, current health status, and the impact of the current SDG on their subjective state of mental health. Participants completed the Physical Activity Scale for the Elderly (PASE), to determine the amount and intensity of physical activity performed, as well as both the Geriatric Depression Scale (GDS) and Geriatric Anxiety Scale (GAS), to ascertain the extent of their depression and anxiety-like symptoms. Results 97% of participants indicated that they adhered to current SDG “Most of the time” or “Strictly.” Participants who performed greater levels of physical activity experienced lower levels of depression-like symptoms when age, sex, and education were accounted for; however, no relationship between physical activity and anxiety-like symptoms was found. A hierarchical regression analysis that incorporated the intensity of physical activity performed (light, moderate, and vigorous) in the model indicated that greater light and strenuous activity, but not moderate, predicted lower depression-like symptoms. Conclusions These results suggest that performing even light physical activity during the COVID-19 pandemic may help alleviate some of the negative mental health impacts that older adults may be experiencing while isolated and adhering to SDG during the COVID-19 pandemic.
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BACKGROUND Outbreak of COVID-19 has affected the global health. For college students, online physical education was a challenge as an outdoor course. OBJECTIVE The study used data from an online survey to evaluate the relationship of mental health status and exercise status, and the problems of online physical education has been stated as well. METHODS An online survey was conducted by snowball sampling from May 8th to May 11th. Demographic data, mental health status, exercise status of college students in Wuhan and the issues of online physical education were collected. Mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). RESULTS The study included 1607 respondents from 267 cities. The average scores of DASS-21 were significantly lower in our study (for depression, 2.46; for anxiety, 1.48; for stress, 2.59) than previous study (p<0.05). Lower scores of DASS-21 were significantly correlated with regular exercise, keeping exercise habits during the outbreak of COVID-19, exercising more than 1 to 2 times a week, exercise duration more than 1 hour, steps on pedometer more than 2000, and sleep duration more than 6 hours (p<0.05). None of the 3 forms of the online physical education was supported by more than 50% respondents. Frequent technical problems were confronted by 1087 (67.6%) students. Shape-up exercise (846, 52.6%), designed combination of exercise (710, 44.2%) and Chinese Kungfu (559, 34.8%) were suggested sports for online physical education. CONCLUSIONS The mental status was significantly correlated with regular exercise, sufficient exercise duration and sleep duration. Professional physical guidance was in urgent need for college students in selected sports. Unsatisfied forms, frequent technical problems, and distant interaction of online physical education were the main problems that should be solved in future.
Article
This study sought to identify factors associated with depression, anxiety, and PTSD symptomatology in U.S. young adults (18-30 years) during the COVID-19 pandemic. This cross-sectional online study assessed 898 participants from April 13, 2020 to May 19, 2020, approximately one month after the U.S. declared a state of emergency due to COVID-19 and prior to the initial lifting of restrictions across 50 U.S. states. Respondents reported high levels of depression (43.3%, PHQ-8 scores ≥ 10), high anxiety scores (45.4%, GAD-7 scores ≥ 10), and high levels of PTSD symptoms (31.8%, PCL-C scores ≥ 45). High levels of loneliness, high levels of COVID-19-specific worries, and low distress tolerance were significantly associated with clinical levels of depression, anxiety, and PTSD symptoms. Resilience was associated with low levels of depression and anxiety symptoms but not PTSD. Most respondents had high levels of social support; social support from family, but not from partner or peers, was associated with low levels of depression and PTSD. Compared to Whites, Asian Americans were less likely to report high levels across mental health symptoms, and Hispanic/Latinos were less likely to report high levels of anxiety. These factors provide initial guidance regarding clinical management for COVID-19-related mental health problems.
Article
Aims CoV-19/SARS-CoV-2 is a highly pathogenic virus that is causing a global pandemic with a high number of deaths and infected people. To contain the diffusion of infection, several Governments have enforced restrictions on outdoor activities or even collective quarantine on the population. The present commentary briefly analyzes the effects of quarantine on lifestyle, including nutrition and physical activity and the impact of new technologies in dealing with this situation. Data Synthesis Quarantine is associated with stress and depression leading to unhealthy diet and reduced physical activity. A diet poor in fruit and vegetables is frequent during isolation, with a consequent low intake of antioxidants and vitamins. However, vitamins have recently been identified as a principal weapon in the fight against the Cov-19 virus. Some reports suggest that Vitamin D could exert a protective effect on such infection. During quarantine, strategies to further increase home-based physical activity and to encourage adherence to a healthy diet should be implemented. The WHO has just released guidance for people in self-quarantine, those without any symptoms or diagnosis of acute respiratory illness, which provides practical advice on how to stay active and reduce sedentary behaviour while at home. Conclusions Quarantine carries some long-term effects on cardiovascular disease, mainly related to unhealthy lifestyle and anxiety. Following quarantine, a global action supporting healthy Diet and physical activity is mandatory to encourage people to return to a good lifestyle routine.