ArticlePDF AvailableLiterature Review

Abstract and Figures

Background 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 utmost importance. Objective 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. Data Source We searched major databases (PubMed, EMBASE, SPORTDiscus, and Web of Science) and preprint servers (MedRxiv, SportRxiv, ResearchGate, and Google Scholar), for relevant papers up to 25/07/2020. Study Eligibility Criteria We included observational studies with cross-sectional and longitudinal designs. To qualify for inclusion in the review, studies must have tested the association of PA with depression or anxiety, using linear or logistic regressions. Depression and anxiety must have been assessed using validated rating scales. Study Appraisal and Synthesis Methods Effect sizes were represented by fully adjusted standardized betas and odds ratios (OR) alongside 95% confidence intervals (CI). In case standardized effects could not be obtained, unstandardized effects were presented and indicated. Results We identified a total of 21 observational studies (4 longitudinal, 1 cross-sectional with retrospective analysis, and 16 cross-sectional), including information of 42,293 (age 6–70 years, median female = 68%) participants from five 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 12–32% lower chances of presenting depressive symptoms and 15–34% of presenting anxiety. Conclusion Performing PA during Covid-19 is associated with less depression and anxiety. 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.
Content may be subject to copyright.
Vol.:(0123456789)
Sports Medicine (2021) 51:1771–1783
https://doi.org/10.1007/s40279-021-01468-z
SYSTEMATIC REVIEW
Is Physical Activity Associated withLess Depression andAnxiety
During theCOVID‑19 Pandemic? ARapid Systematic Review
SebastianWolf1,2 · BrittaSeier1,2· Johanna‑MarieZeibig1,2· JanaWelkerling1,2· LuisaBrokmeier3·
BeatriceAtrott1,2· ThomasEhring4· FelipeBarretoSchuch5
Accepted: 1 April 2021 / Published online: 22 April 2021
© The Author(s) 2021
Abstract
Background 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 utmost importance.
Objective 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.
Data Source We searched major databases (PubMed, EMBASE, SPORTDiscus, and Web of Science) and preprint servers
(MedRxiv, SportRxiv, ResearchGate, and Google Scholar), for relevant papers up to 25/07/2020.
Study Eligibility Criteria We included observational studies with cross-sectional and longitudinal designs. To qualify for
inclusion in the review, studies must have tested the association of PA with depression or anxiety, using linear or logistic
regressions. Depression and anxiety must have been assessed using validated rating scales.
Study Appraisal and Synthesis Methods Effect sizes were represented by fully adjusted standardized betas and odds ratios
(OR) alongside 95% confidence intervals (CI). In case standardized effects could not be obtained, unstandardized effects
were presented and indicated.
Results We identified a total of 21 observational studies (4 longitudinal, 1 cross-sectional with retrospective analysis, and 16
cross-sectional), including information of 42,293 (age 6–70years, median female = 68%) participants from five 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 12–32% lower chances of presenting depressive symptoms and 15–34% of presenting anxiety.
Conclusion Performing PA during Covid-19 is associated with less depression and anxiety. 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.
* Sebastian Wolf
sebastian.wolf@uni-tuebingen.de
1 Department ofPsychology, Institute ofClinical Psychology
andPsychotherapy, University ofTuebingen, Tuebingen,
Germany
2 Institute ofSport Science, Department ofEducation &
Health Research, University ofTuebingen, Tuebingen,
Germany
3 Mannheim Institute ofPublic Health, Mannheim Medical
Faculty, University ofHeidelberg, Mannheim, Germany
4 Department ofPsychology, LMU Munich, Munich, Germany
5 Department ofSports Methods andTechniques, Federal
University ofSanta Maria, SantaMaria, Brazil
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1772 S.Wolf et al.
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
12–32% lower chances of presenting depressive symp-
toms and 15–34% 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-exist-
ing 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-
specific 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.
1 Introduction
With 106,125,682 confirmed cases all over the world (up to
February 10th, 2021), COVID-19 is a global public health
emergency. COVID-19 is characterized by a fast human-to-
human transmission through droplet or close contact. Given
the lack of appropriate treatments and vaccines during the
early stage of the pandemic, many countries implemented
procedures recommended by the World Health Organization
(WHO) [1], such as the isolation of symptomatic patients,
quarantining individuals with the history of contact with
COVID-19 infected persons, and further anti-contagion poli-
cies such as mandatory stay at home or business closures.
Those anti-contagion policies substantially reduced expo-
nential growth rates [2, 3].
Quarantine and social distancing measures had already
been successfully enforced during earlier pandemics, such
as the 2003 outbreak of SARS and the 2014 outbreak of
Ebola [4]. However, studies on the effects of these measures
have reported elevated symptoms of anxiety, post-traumatic
stress, and depressive disorders, as well as a 30% higher
suicide rates in populations impacted by these measures [5,
6]. These findings are being replicated during the Covid-19
pandemic with multiple studies reporting elevated preva-
lences of depression and anxiety [711].
Notably psychiatric disorders result in a considerable
burden of disease, accounting for 6.7% of overall disa-
bility-adjusted life years [12] and being attributable to
14.3% of death worldwide [13]. Despite the high burden
of psychiatric disorders, there is a severe gap between peo-
ple in need and people receiving mental health care [14].
This general treatment gap is especially severe in low- and
middle-income countries, where 76–85% of people with
mental disorders do not receive any treatment [15]. 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 [16]. 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. Indeed, current
international position papers point out a clear need to
adapt and improve mental health services worldwide due
to these specific challenges during and after the pandemic
[17, 18]. To mitigate the negative mental health conse-
quences of pandemics, evidence suggests that policymak-
ers 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 peo-
ple affected by the pandemic [4]. A recently published
position paper on research priorities for mental health
science regarding COVID-19 [18] demands the interdis-
ciplinary development of novel interventions to protect
mental wellbeing by mechanistically based approaches to
strengthen altruism and prosocial behavior. Among oth-
ers, physical activity (PA) interventions are highlighted
as a promising approach. PA is defined as any bodily
movement produced by skeletal muscles that results in
energy expenditure and exercise is defined as PA, which is
planned, structured, and repetitive, with the primary aim
to improve or maintain physical fitness [19]. International
PA guidelines recommend 150min of moderate or 75min
of vigorous intensity PA per week for optimal physical and
mental health benefits [20]. Indeed, in pre-pandemic times
PA has been identified as a protective factor against inci-
dent depression [21] and anxiety [22]. However, decreased
levels of PA were observed in the general population in
multiple countries [11, 23, 24] during the pandemic. This
rapid systematic review aims to outline current evidence
regarding the associations of PA and exercise with depres-
sion and anxiety during the Covid-19 pandemic.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1773
Association of Physical Activity with Depression and Anxiety During COVID-19
2 Methods
In this rapid review, we sought for observational stud-
ies examining the associations of PA and depression and
anxiety during the COVID-19 pandemic. Inclusion criteria
were: (1) observational studies in any population, includ-
ing 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) depres-
sion and anxiety were assessed using validated screening
or diagnostic tools. We excluded opinion pieces, system-
atic reviews, and studies addressing other viruses.
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 Pre-
prints 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
online repositories 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 research-
ers (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/ques-
tion used to assess PA levels, instruments used to assess
depression and anxiety, publication type and statistical out-
comes (regression standardized beta coefficients and odd’s
ratios). If they were indicated in the report, fully adjusted
coefficients and odd’s ratios were extracted. As studies
included in this review used very heterogeneous statisti-
cal approaches, a meta-analysis could not be conducted.
Instead, we summarized the evidence and presented effect
sizes [betas and odds ratios (OR)] with confidence inter-
vals and indicated significant 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 e-mail. If standardized effects
could not be obtained, unstandardized effects were pre-
sented 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 [25]. The NIH tool assessment is
composed by 14 questions the risk of potential selection
bias, information bias measurement bias or confounding
bias. There are three options (yes, no, other) for each ques-
tion. Each “no” or “other” is suggestive of the presence of
some risk of bias. Questions #6 (exposure prior outcome),
#7 (sufficient 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 asses-
sors) was also disregarded for all studies.
3 Results
Searches on PubMed, EMBASE, Sportdiscus, and Web of
Science resulted in 592 potentially relevant studies. Pre-
print databases identified additional 572 potentially relevant
studies. A flow-chart of the selection process is provided in
Fig.1. Of the identified studies, 21 studies meet the criteria
[7, 8, 11, 2643]. Four studies had a prospective longitudinal
design [29, 32, 39, 42], 1 was a cross-sectional study with
a retrospective measure of the exposure factor (henceforth
treated as retrospective) [7], and 16 were cross-sectional
studies [8, 11, 2628, 3038, 40, 41, 43, 44]. A total of 7
studies were conducted in Asia [27, 28, 30, 33, 36, 42, 43],
6 in Europe [11, 29, 34, 35, 38, 39], 3 in South America [8,
31, 32], 3 in North America [7, 26, 37], 1 in Oceania [41]
and 1 study included a multinational sample [40].
Data form a total of 42,293 (median = 68% of women)
participants were included. Only 1 study was exclusively
composed by older adults (over 50years), 4 were in chil-
dren, adolescents, or young adults, while 13 studies were in
adults (over 18). Only 7 studies used validated measures to
assess PA levels. A wide range of scales to measure depres-
sion or anxiety were used, the most used scales being the
Beck Depression and Anxiety inventory and the DASS-21.
Most studies (n = 14) were peer-reviewed, seven studies were
published as preprints. A summary of studies is provided
in Table1.
Results are summarized and presented in Table2. Out of
ten studies reporting analyses on the association between the
overall volume of PA and depression, seven studies showed
that more PA is significantly associated with less depres-
sion symptoms [26, 28, 30, 35, 36, 38, 40], and three out of
nine studies investigating the association between the overall
volume of PA and anxiety symptoms showed that more PA
is significantly associated with less anxiety symptoms [28,
35, 38]. Three out of six studies reported higher frequencies
of PA to be significantly associated with less depression [30,
32, 39] and two out of five studies to be significantly associ-
ated with less anxiety [30, 32]. One study showed that vig-
orous but not moderate PA is significantly associated with
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1774 S.Wolf et al.
less depression and anxiety symptoms [8] and another study
indicated that light and vigorous PA is significantly corre-
lated with less depression, but moderate intensity was not
[26]. Out of four studies assessing an association between
regular and guideline-consistent PA and depression and
anxiety symptoms, two studies demonstrate that regular PA
(compared to not regular) is significantly associated with
less depression and anxiety symptoms [30, 33]. One study
demonstrated that guideline conforming moderate to vig-
orous PA is associated with lower odds of depression and
anxiety [8]. Five out of six studies showed that a decrease
in PA during the pandemic was significantly associated with
more depression symptoms [7, 11, 30, 41, 43] and three out
of six studies showed that a decrease in PA was significantly
Fig. 1 PRISMA flow-chart of
the screening and selection of
studies
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1775
Association of Physical Activity with Depression and Anxiety During COVID-19
Table 1 Characteristics of included studies
Author Country Design Type NAge group (years) % females PA assessment MH assessment
Bauer etal. [11] Germany Cross-sectional Preprint 3,700 Adults (M = 33.13) 78.6 BSA-F PHQ-9; GAD-7
Callow etal. [26] US Cross-sectional Peer-reviewed 1,046 Older adults (< 50) 80 PASE GDS; GAS
Chen etal. [27] China Cross-sectional Peer-reviewed 1,036 Children/adolescents (R = 6–15) 48.7 NR DSRS-C;
SCARED
Chen etal. [28] Iran Cross-sectional Preprint 474 Adults (R = 20–70) 51.3 Single item
(hours/day)
PHQ-2; GAD-2
Cheval etal. [29] France, Switzer-
land
Longitudinal
(retrospective
and prospec-
tive)
peer-Reviewed 110 Adults (M = 43) 68 IPAQ PROMIS (adapted
questions for
depression and
anxiety)
Deng etal. [30] China Cross-sectional Peer-reviewed 1,607 Adolescents/young adults (NR) 35.2 Multiple items
(duration,
frequency)
DASS-21
Filgueiras and
Stultz-Kole-
hmainen [32]
Brazil Cross-sectional Preprint 1,460 Adults (M = 32.9) 72.87 Single item
(frequency)
FDI; SSTAI
Filgueiras and
Stultz-Kole-
hmainen [31]
Brazil Longitudinal
(prospective)
Preprint 360 Adults (M = 37.9) 68.8 Multiple items
(frequency,
type)
FDI; SSTAI
Fu etal. [33] China Cross-sectional Peer-reviewed 1,242 Adults (NR) 69.7 NR PHQ-9; GAD-7
Fullana etal.
[34]
Spain Cross-sectional Peer-reviewed 5,545 Adults (M = 47) 73 NR PHQ-9; GAD-7
Jacob etal. [35] UK Cross-sectional Peer-reviewed 902 Adults (NR) 63.8 Multiple items
(duration/day,
intensity)
BDI; BAI
Khan etal. [36] Bangladesh Cross-sectional Peer-reviewed 505 Adolescents/young adults 37.3 NR DASS-21
Lebel etal. [37] Canada Cross-sectional Peer-reviewed 1,987 Adults (M = 32.4) 100 Godin Shephard
Leisure-Time
Exercise Scale
EPDS; PROMIS
anxiety
Meyer etal. [7] US Longitudinal
(retrospective)
Peer-reviewed 3,052 Adults (NR) 62 Multiple items
(duration/day,
intensity)
BDI; BAI
Moreira etal.
[38]
Portugal Cross-sectional Preprint 1,280 Adults (M = 37.1) 79.8 Single item
(duration/day,
intensity)
DASS-21
Planchuelo-
Gómez etal.
[39]
Spain Cross-Sectional PEER-reviewed 1,056 Adults (M = 32.1) 67.6 NR DASS-21
Plomecka etal.
[40]
Multiple (12
countries)
Cross-sectional Preprint 12,817 Adults (NR) 72.3 NR BDI
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1776 S.Wolf et al.
associated with more anxiety symptoms [11, 30, 41]. One
study reported that an increase in PA was associated with
less depressive symptoms [42].
The risk of bias of individual studies is presented in
Table3. All studies clearly defined 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 eligi-
ble participants, and 13 (81.25%) did not use valid tools
to assess the exposure measure. A total of three out of five
(60%) longitudinal studies are at risk of bias in the evaluat-
ing the definition of the study population, the participation
rate, the validity of the exposure measure and in the reten-
tion of the sample.
4 Discussion
The present study is, to the best of our knowledge, the
first 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 [7, 11, 30, 4143].
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 symp-
toms and 15–34% of presenting anxiety. These findings are
in line with results of recent meta-analyses showing that
those with higher PA levels were 17% less likely of develop-
ing depression [21] and 26% less likely to develop anxiety
[22] independently of the COVID-19 pandemic.
Indeed, the observed reduction in PA behavior during
COVID-19 specific 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 [45]. Indeed, social support was one of the strongest
factors associated with adherence to PA in effective exer-
cise interventions [46]. Furthermore, the COVID-19 pan-
demic 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 [47]. In general, a lack of sporting opportuni-
ties seems to be associated with reduced PA [48]. Further
negative consequences of the pandemic such as financial
insecurities might have caused stress in individuals and
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 1 (continued)
Author Country Design Type NAge group (years) % females PA assessment MH assessment
Schuch etal. [8] Brazil Cross-sectional Peer-reviewed 937 Adults (NR) 72.3 Multiple items
(duration/day,
intensity)
BDI; BAI
Stanton etal.
[41]
Australia Cross-sectional Peer-reviewed 1,491 Adults (M = 50.5) 67 AAS DASS-21
Zhang etal. [42] China Longitudinal
(prospective)
Peer-reviewed 66 Adolescents/adults (M = 20.7) 62.1 IPAQ DASS-21
Zheng etal. [43] China Cross-sectional Preprint 1,620 Children/adolescents (M = 10.1) 47.8 Single item
(decrease since
Covid)
DSRS-C; SASC
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1777
Association of Physical Activity with Depression and Anxiety During COVID-19
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
Author Predictor Depressive symptoms Anxiety symptoms
Beta (95% CI) OR (95% CI) Beta (95% CI) OR (95% CI)
Volume
Bauer etal. [11] EX (minutes/
week)
0.00# (NR;
NR)
0.01# (NR;
NR)
Callow etal. [26] PA (PASE score) − 0.22***
(NR; NR)
− 0.02 (NR;
NR)
Chen etal. [28] EX (hours/day) 0.68* (0.47; 0.97) 0.66* (0.45;
0.96)
Deng etal. [30]EX (> 60min/
day;
Ref: < 60min/
day))
− 0.08***
(NR;NR)
− 0.05 (NR;
NR)
Cheval etal. [29] PA (minutes/day) NR# (NR; NR) NR# (NR; NR)
Jacob etal. [35] EX (minutes/
day)
0.88° (0.8; 0.97) 0.85° (0.79;
0.97)
Khan etal.[36] EX (any amount; − 2.1* (− 4.02;
− 0.17)a
− 0.55 (− 1.92;
0.82)a
Ref.: No EX)
Moreira etal. [38] EX (hours) − 1.17° (NR;
NR)a
− 0.81°(NR;
NR)
Plomecka etal. [40]EX (> 15min/
day;
− 0.13***
(NR; NR)
NR# (NR; NR)
Ref.: ≤ 15min/
day, < 60min/
day)
EX (≥ 60min/
day;
− 0.15***
(− 0.18;
− 0.12)
NR# (NR; NR)
Ref.: ≤ 15min/
day)
Schuch etal. [8] PA (minutes/
day; per 10min
increase)
− 0.03 (− 0.1;
0.03)
− 0.05 (− 0.13;
0.02)
Frequency
Deng etal. [30] EX (1 to 2
times/week;
Ref: < 1x/week)
− 0.11***
(NR; NR)
− 0.09** (NR;
NR)
EX (> 2
times/week;
Ref: < 1x/week)
− 0.15***
(NR; NR)
-0.12** (NR;
NR)
EX (every day;
Ref: < 1x/week)
− 0.11***
(NR; NR)
-0.09* (NR;
NR)
Filgueiras and Stultz-Kolehmainen [32] EX (frequency/
week)
− 2.68** (NR;
NR)a
− 1.64***
(NR; NR)a
Fullana etal. [34] EX (Unclear) 0.93 (NR; NR) 0.95 (NR; NR)
Lebel etal. [37] EX (Godin
Shephard
Leisure-Time
Exercise Score)
− 0.01* (NR;
NR)
0.99 (0.99; 0.99) − 0.01** (NR;
NR)
0.99 (0.99; 1.0)
Planchuelo-Gómez etal. [39] EX (1–2 times/
week; Ref.: No
EX)
− 0.17 (NR;
NR)a
EX (3–5 times/
week; Ref.: No
EX)
− 0.85* (NR;
NR)a
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1778 S.Wolf et al.
Table 2 (continued)
Author Predictor Depressive symptoms Anxiety symptoms
Beta (95% CI) OR (95% CI) Beta (95% CI) OR (95% CI)
EX (6–7 times/
week; Ref.: No
EX)
− 1.29***
(NR; NR)a
Filgueiras and Stultz-Kolehmainen
[31]
EX (frequency/
week)
NR# (NR; NR) NR# (NR; NR)
Intensity
Callow etal. [26] Light PA (PASE
score)
0.12** (NR;
NR)
Moderate PA
(PASE score)
− 0.01 (NR;
NR)
Vigorous PA
(PASE score)
0.09* (NR;
NR)
Schuch etal., 2020 [8] 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. [27] EX (regular; 0.37 (NR; NR)b0.43 (NR; NR)b
Ref.: not regular)
Deng etal. [30] EX (regular; − 0.2*** (NR;
NR)
− 0.14***
(NR; NR)
Ref.: not regular)
Fu etal. [33] EX (not regular; 1.71*** (1.28; 2.29) 1.45* (1.08;
1.93)
Schuch etal. [8]PA (≥ 30min/
day;
Ref.: < 30min/
day)
0.72* (0.54; 0.96) 0.72* (0.54;
0.96)
Change
Bauer etal. [11] EX (less; equal;
more)c
− 0.08***
(NR; NR)
− 0.05***
(NR; NR)
Deng etal. [30] 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. [31] EX (none,
increase,
decrease)
NR# (NR; NR) NR# (NR; NR)
Meyer etal.[7] PA (increased;
Ref.: main-
tained high)
− 0.01 (− 0.05;
0.02)
0.00 (− 0.03;
0.04)
PA (decreased;
Ref.: main-
tained 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)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1779
Association of Physical Activity with Depression and Anxiety During COVID-19
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
Table 2 (continued)
Author Predictor Depressive symptoms Anxiety symptoms
Beta (95% CI) OR (95% CI) Beta (95% CI) OR (95% CI)
Stanton etal. [41] PA (negative
change; Ref.:
no change/posi-
tive change)
1.08*** (1.06; 1.11) 1.09*** (1.05;
1.13)
Zhang etal. [42] PA (per 100
MET increase)
− 0.04*
(− 0.08; 0)
− 0.03 (− 0.07;
0)
Zheng etal. [43] PA (decrease
vs. no change/
increase)
2.07** (NR; NR) 1.24 (NR; NR)
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; °significant association, p value not reported; #no significant association, p value not reported
a Unstandardized regression coefficient
b Odd’s ratio calculated from case counts
c Post hoc analysis revealed that a decrease in exercise was significantly associated with less depression compared to stable exercise and increase.
No other comparison reached significance
Table 3 Risk of bias assessment
(NIHM tool for observational
studies)
Yyes, Nno, NRnot relevant
Items 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Cross-sectional studies
Bauer etal. [11] Y Y Y Y Y – Y Y Y Y
Callow etal. [26] Y Y Y Y Y – Y Y Y Y
Chen etal. [27] Y N NR N Y – N N Y N
Chen etal. [28] Y Y N N Y – Y N Y Y
Deng etal. [30] Y Y Y Y N – Y N Y N
Filgueiras and Stultz-Kolehmainen
[32]
Y N NR Y Y – Y N Y Y
Fu etal. [33] Y Y NR Y Y – N N Y Y
Fullana etal. [34] Y Y NR Y N – N N Y Y
Jacob etal. [35] Y Y NR Y Y – Y N Y Y
Khan etal. [36] Y N NR Y Y – N N Y Y
Lebel etal. [37] Y Y NR Y Y – N N Y Y
Moreira etal. [38] Y Y NR Y Y – N N Y Y
Plomecka etal. [40] Y Y Y Y Y – Y N Y Y
Schuch etal. [8] Y Y NR Y Y Y N Y Y
Stanton etal. [41] Y Y NR Y Y – N Y Y Y
Zheng etal. [43] Y Y Y Y N – N N Y Y
Longitudinal studies
Cheval etal. [29] Y N Y Y Y Y Y Y Y Y Yt – Y NR
Filgueiras and
Stultz-Kolehmainen [31]
Y N NR Y Y Y Y Y N Y Y N Y
Meyer etal. [7] Y Y Y Y Y N Y Y N N Y NA Y
Planchuelo-Gómez etal. [39] Y Y NR Y N Y Y Y NR Y Y N Y
Zhang etal. [42] Y N NR Y Y Y Y Y Y Y Y Y NR
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1780 S.Wolf et al.
[49]. 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 [50, 51]. Therefore,
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 moti-
vational and volitional skills, need to be identified and
encouraged. Motivation and volition are core components
of several theories of behavior change such as the Health
Action Process Approach (HAPA) [52]. HAPA is a social-
cognitive model specifying motivational and volitional
determinants of health behavior such as building inten-
tions for health behavior, planning the behavior, coping
with specific challenges, maintaining the behavior, and
perceiving self-efficacy for all processes. A recent meta-
analysis shows that action self-efficacy has large effects
on health behavior through intentions and maintenance
self-efficacy [53]. Especially, self-efficacy in building
intentions and action planning have larger effects on physi-
cal activity behavior compared with other health behav-
ior [53]. Indeed, Covid-19 specific interventions should
even more focus on self-efficacy experiences in building
intentions for PA and performing PA, since PA routines
are interrupted through anti-contagion policies. A widely
used way to promote these motivational and volitional
determinants is the application of behavior change tech-
niques (BCTs) [54, 55]. During the COVID-19 pandemic,
some BCTs appear to be particularly important for the
maintenance of regular PA. For instance, the knowledge
about the benefits of PA on symptoms that accompany
lock-down procedures, such as lowered mood or anxiety
might strengthen intentions for PA [46]. Furthermore,
individuals need the strong ability of coping planning to
anticipate barriers that could discourage them to engage
in PA (e.g., curfew, closed facilities) and find 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, super-
vise, apply, and adopt such BCTs, especially in terms of
COVID-19. First empirical evidence showed preliminary
efficacy of apps in promoting PA. Users of such apps are
more likely to meet recommendations on PA than non-users
[5659]. However, the evidence of long-term effects is cur-
rently inconclusive, since only few studies assess long-term
effects. A current meta-analysis claims for more research to
further elucidate the time course of intervention effects [59].
Furthermore, a meta-analysis showed that internet-delivered
interventions, which are able to use different BCTs, were
effective in increasing PA [60]. A major advantage of such
web-based tools is the possibility to overcome some of the
COVID-19 specific 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 fitness technology and the provision of
structured programs, as they can be used both indoors (e.g.,
through fitness videos) and outdoors (e.g., through running
apps) and, therefore, be adapted to the specific situation.
5 Limitations
Most of the studies included in this review used cross-sec-
tional research designs. A causal nature of these associa-
tions, therefore, remains unclear. There are notably differ-
ences 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 vali-
dated tools to assess PA and failure to report standardized
coefficients. Heterogeneity in research designs and statistical
analyses hindered meta-analytic approaches, which would
have provided a more sophisticated overall effect estimate.
Finally, several included studies were published as preprints
and are currently in review processes for final publications.
It is, therefore, planned to update this review in the future.
6 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 are associated with
less symptoms of depression and anxiety. For instance, those
reporting a higher total time spent in moderate to vigor-
ous PA had 12–32% lower chances of presenting depressive
symptoms and 15–34% of presenting anxiety. Thus, the pro-
motion of PA habits and routines might be a cost-effective
and comprehensive worldwide applicable strategy to over-
come the severe gap between people in need and people
receiving mental health care, especially in low-income coun-
tries with even non-existing mental health supplies. Particu-
larly, web-based technologies, could be an easily accessible
way to increase motivation and volition for PA and main-
tain daily PA routines even under pandemic-specific bar-
riers. However, only very few apps or websites have been
tested in RCTs with high methodological standards [59, 61].
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.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1781
Association of Physical Activity with Depression and Anxiety During COVID-19
Declarations
Funding Open Access funding enabled and organized by Projekt
DEAL.
Conflict of interest All authors declare that they have no conflict of
interest.
Availability of data and material Data sharing not applicable to this
article since all data extracted from studies are presented in the cur-
rent paper.
Author contributions SW and FS devised the project and the main con-
ceptual ideas. FS performed the literature research and selection. FS,
BS, and SW performed final data extraction. All authors significantly
contributed to drafting and carefully reviewing the final manuscript.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
included in the article’s Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in
the article’s Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/.
References
1. WHO. Overview of public health and social measures in the con-
text of COVID-19. Interim Guidance. 2020 [cited 15.07.2020].
Available from: https:// www. who. int/ publi catio ns/i/ item/
overv iew- of- public- health- and- social- measu res- in- the- conte
xt- of- covid- 19.
2. Hsiang S, Allen D, Annan-Phan S, Bell K, Bolliger I, Chong
T, etal. The effect of large-scale anti-contagion policies on the
COVID-19 pandemic. Nature. 2020;584(7820):262–7. https:// doi.
org/ 10. 1038/ s41586- 020- 2404-8.
3. Bendavid E, Oh C, Bhattacharya J, Ioannidis JPA. Assessing man-
datory stay-at-home and business closure effects on the spread of
COVID-19. Eur J Clin Invest. 2021. https:// doi. org/ 10. 1111/ eci.
13484.
4. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S,
Greenberg N, etal. The psychological impact of quarantine
and how to reduce it: rapid review of the evidence. Lancet.
2020;395(10227):912–20. https:// doi. org/ 10. 1016/ s0140-
6736(20) 30460-8.
5. Lee AM, Wong JG, McAlonan GM, Cheung V, Cheung C, Sham
PC, etal. Stress and psychological distress among SARS survivors
1 year after the outbreak. Can J Psychiatry. 2007;52(4):233–40.
https:// doi. org/ 10. 1177/ 07067 43707 05200 405.
6. Yip PS, Cheung YT, Chau PH, Law YW. The impact of epi-
demic outbreak: the case of severe acute respiratory syndrome
(SARS) and suicide among older adults in Hong Kong. Crisis.
2010;31(2):86–92. https:// doi. org/ 10. 1027/ 0227- 5910/ a0000 15.
7. Meyer J, McDowell C, Lansing J, Brower C, Smith L, Tully
M, etal. Changes in physical activity and sedentary behav-
ior in response to COVID-19 and their associations with
mental health in 3052 US adults. Int J Environ Res Public Health.
2020;17(18):6469. https:// doi. org/ 10. 3390/ ijerp h1718 6469.
8. Schuch FB, Bulzing RA, Meyer J, Vancampfort D, Firth J, Stubbs
B, etal. Associations of moderate to vigorous physical activity
and sedentary behavior with depressive and anxiety symptoms in
self-isolating people during the COVID-19 pandemic: a cross-
sectional survey in Brazil. Psychiatry Res. 2020;292:113339.
https:// doi. org/ 10. 1016/j. psych res. 2020. 113339.
9. Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, etal. The psycho-
logical impact of the COVID-19 epidemic on college students
in China. Psychiatry Res. 2020;287:112934. https:// doi. org/ 10.
1016/j. psych res. 2020. 112934.
10. Liu CH, Zhang E, Wong GTF, Hyun S, Hahm HC. Factors associ-
ated with depression, anxiety, and PTSD symptomatology during
the COVID-19 pandemic: clinical implications for US young adult
mental health. Psychiatry Res. 2020;290:113172. https:// doi. org/
10. 1016/j. psych res. 2020. 113172.
11. Bauer LL, Seiffer B, Deinhart C, Atrott B, Sudeck G, Hautzinger
M, etal. Associations of exercise and social support with mental
health during quarantine and social-distancing measures during
the COVID-19 pandemic: a cross-sectional survey in Germany.
medRxiv. 2020. https:// doi. org/ 10. 1101/ 2020. 07. 01. 20144 105.
12. Global Burden of Disease Collaborative Network. Global burden
of disease study 2017 (GBD 2017) results. Seattle: Institute for
Health Metrics and Evaluation (IHME); 2018.
13. Walker ER, McGee RE, Druss BG. Mortality in mental dis-
orders and global disease burden implications: a systematic
review and meta-analysis. JAMA Psychiat. 2015;72(4):334–41.
https:// doi. org/ 10. 1001/ jamap sychi atry. 2014. 2502.
14. Patel V. Global mental health: from science to action. Harv Rev
Psychiatry. 2012;20(1):6–12. https:// doi. or g/ 10. 3109/ 10673 229.
2012. 649108.
15. Thornicroft G, Chatterji S, Evans-Lacko S, Gruber M, Samp-
son N, Aguilar-Gaxiola S, etal. Undertreatment of people
with major depressive disorder in 21 countries. Br J Psychia-
try. 2017;210(2):119–24. https:// doi. org/ 10. 1192/ bjp. bp. 116.
188078.
16. WHO. Mental health ATLAS 2017. 2017 [cited 15.07.2020].
Available from: https:// www. who. int/ mental_ health/ evide nce/
atlas/ mental_ health_ atlas_ 2017/ en/.
17. Moreno C, Wykes T, Galderisi S, Nordentoft M, Crossley N, Jones
N, etal. How mental health care should change as a consequence
of the COVID-19 pandemic. Lancet Psychiatry. 2020;7(9):813–
24. https:// doi. org/ 10. 1016/ S2215- 0366(20) 30307-2.
18. Holmes EA, O’Connor RC, Perry VH, Tracey I, Wessely S,
Arseneault L, etal. Multidisciplinary research priorities for the
COVID-19 pandemic: a call for action for mental health science.
Lancet Psychiatry. 2020;7(6):547–60. https:// doi. org/ 10. 1016/
S2215- 0366(20) 30168-1.
19. Caspersen CJ, Powell KE, Christenson GM. Physical activity,
exercise, and physical fitness: definitions and distinctions for
health-related research. Public Health Rep. 1985;100(2):126–31.
20. WHO. Physical activity. 2018 [cited 15.07.2020]. Available from:
https:// www. who. int/ news- room/ fact- sheets/ detail/ physi cal- activ
ity.
21. Schuch FB, Vancampfort D, Firth J, Rosenbaum S, Ward PB,
Silva ES, etal. Physical activity and incident depression: a
meta-analysis of prospective cohort studies. Am J Psychiatry.
2018;175(7):631–48. https:// doi. org/ 10. 1176/ appi. ajp. 2018. 17111
194.
22. Schuch FB, Stubbs B, Meyer J, Heissel A, Zech P, Vancamp-
fort D, etal. Physical activity protects from incident anxiety: a
meta-analysis of prospective cohort studies. Depress Anxiety.
2019;36(9):846–58. https:// doi. org/ 10. 1002/ da. 22915.
23. Schuch FB, Bulzing RA, Meyer J, López-Sánchez GF, Grabo-
vac I, Willeit P, etal. Moderate to vigorous physical activity and
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1782 S.Wolf et al.
sedentary behavior change in self-isolating adults during the
COVID-19 pandemic in Brazil: A cross-sectional survey explor-
ing correlates. medRxiv. 2020. https:// doi. org/ 10. 1101/ 2020. 07.
15. 20154 559.
24. Mattioli AV, Sciomer S, Cocchi C, Maffei S, Gallina S. Quarantine
during COVID-19 outbreak: changes in diet and physical activity
increase the risk of cardiovascular disease. NutrMetabCardiovasc
Dis. 2020;30(9):1409–17. https:// doi. org/ 10. 1016/j. numecd. 2020.
05. 020.
25. National Institutes of Health (NIH). Quality assessment tool for
observational cohort and cross-sectional studies. 2014 [cited
15.07.2020]. Available from: https:// www. nhlbi. nih. gov/ health-
pro/ guide lines/ in- devel op/ cardi ovasc ular- risk- reduc tion/ tools/
cohort.
26. Callow DD, Arnold-Nedimala NA, Jordan LS, Pena GS, Won J,
Woodard JL, etal. The mental health benefits of physical activity
in older adults: survive the COVID-19 pandemic. Am J Geriatr
Psychiatry. 2020;28(10):1046–57. https:// doi. org/ 10. 1016/j. jagp.
2020. 06. 024.
27. Chen F, Zheng D, Liu J, Gong Y, Guan Z, Lou D. Depression and
anxiety among adolescents during COVID-19: a cross-sectional
study. Brain BehavImmun. 2020;88:36–8. https:// doi. org/ 10.
1016/j. bbi. 2020. 05. 061.
28. Chen J, Zhang SX, Wang Y, Jahanshahi AA, Dinani MM, Mada-
vani AN, etal. The curvilinear relationship between the age of
adults and their mental health in Iran after its peak of COVID-19
cases. medRxiv. 2020. https:// doi. org/ 10. 1101/ 2020. 06. 11. 20128
132.
29. Cheval B, Sivaramakrishnan H, Maltagliati S, Fessler L, Fores-
tier C, Sarrazin P, etal. Relationships between changes in self-
reported physical activity, sedentary behaviour and health during
the coronavirus (COVID-19) pandemic in France and Switzer-
land. J Sports Sci. 2020;39:1–6. https:// doi. org/ 10. 1080/ 02640
414. 2020. 18413 96.
30. Deng CH, Wang JQ, Zhu LM, Liu HW, Guo Y, Peng XH, etal.
Association of web-based physical education with mental health
of college students in Wuhan during the COVID-19 outbreak:
cross-sectional survey study. J Med Int Res. 2020;22(10):e21301.
https:// doi. org/ 10. 2196/ 21301.
31. Filgueiras A, Stults-Kolehmainen M. The relationship between
behavioural and psychosocial factors among Brazilians in quar-
antine due to COVID-19. SSRN Electron J. 2020. https:// doi. org/
10. 2139/ ssrn. 35662 45.
32. Filgueiras A, Stults-Kolehmainen M. Factors linked to changes
in mental health outcomes among Brazilians in quarantine due to
COVID-19. medRxiv. 2020. https:// doi. org/ 10. 1101/ 2020. 05. 12.
20099 374.
33. Fu W, Wang C, Zou L, Guo Y, Lu Z, Yan S, etal. Psychologi-
cal health, sleep quality, and coping styles to stress facing the
COVID-19 in Wuhan, China. Transl Psychiatry. 2020;10(1):225.
https:// doi. org/ 10. 1038/ s41398- 020- 00913-3.
34. Fullana MA, Hidalgo-Mazzei D, Vieta E, Radua J. Coping behav-
iors associated with decreased anxiety and depressive symptoms
during the COVID-19 pandemic and lockdown. J Affect Disord.
2020;275:80–1. https:// doi. org/ 10. 1016/j. jad. 2020. 06. 027.
35. Jacob L, Tully MA, Barnett Y, Lopez-Sanchez GF, Butler L,
Schuch F, etal. The relationship between physical activity and
mental health in a sample of the UK public: a cross-sectional
study during the implementation of COVID-19 social distancing
measures. Ment Health Phys Act. 2020;19:100345. https:// doi. org/
10. 1016/j. mhpa. 2020. 100345.
36. Khan AH, Sultana MS, Hossain S, Hasan MT, Ahmed HU, Sik-
der MT. The impact of COVID-19 pandemic on mental health
and wellbeing among home-quarantined Bangladeshi students:
a cross-sectional pilot study. J Affect Disord. 2020;277:121–8.
https:// doi. org/ 10. 1016/j. jad. 2020. 07. 135.
37. Lebel C, MacKinnon A, Bagshawe M, Tomfohr-Madsen L, Gies-
brecht G. Elevated depression and anxiety symptoms among preg-
nant individuals during the COVID-19 pandemic. J Affect Disord.
2020;277:5–13. https:// doi. org/ 10. 1016/j. jad. 2020. 07. 126.
38. Moreira PS, Ferreira S, Couto B, Machado-Sousa M, Fernández
M, Raposo-Lima C, etal. Protective elements of mental health
status during the COVID-19 outbreak in the Portuguese popula-
tion. medRxiv. 2020. https:// doi. org/ 10. 1101/ 2020. 04. 28. 20080
671.
39. Planchuelo-Gomez A, Odriozola-Gonzalez P, Irurtia MJ, de Luis-
Garcia R. Longitudinal evaluation of the psychological impact of
the COVID-19 crisis in Spain. J Affect Disord. 2020;277:842–9.
https:// doi. org/ 10. 1016/j. jad. 2020. 09. 018.
40. Plomecka MB, Gobbi S, Neckels R, Radziński P, Skórko B,
Lazerri S, etal. Mental health impact of COVID-19: a global
study of risk and resilience factors. medRxiv. 2020;12:983.
41. Stanton R, To QG, Khalesi S, Williams SL, Alley SJ, Thwaite TL,
etal. Depression, anxiety and stress during COVID-19: associa-
tions with changes in physical activity, sleep, tobacco and alco-
hol use in Australian adults. Int J Environ Res Public Health.
2020;17(11):4065. https:// doi. org/ 10. 3390/ ijerp h1711 4065.
42. Zhang Y, Zhang H, Ma X, Di Q. Mental health problems during
the COVID-19 pandemics and the mitigation effects of exercise: a
longitudinal study of college students in China. Int J Environ Res
Public Health. 2020;17(10):3722. https:// doi. org/ 10. 3390/ ijerp
h1710 3722.
43. Zheng Y, Li J, Zhang M, Jin B, Li X, Cao Z, etal. A survey of
the psychological status of primary school students who were
quarantined at home during the coronavirus disease 2019 epi-
demic in Hangzhou China. medRxiv. 2020. https:// doi. org/ 10.
1101/ 2020. 05. 28. 20115 311.
44. Lopez-Bueno R, Calatayud J, Ezzatvar Y, Casajus JA, Smith L,
Andersen LL, etal. Association between current physical activ-
ity and current perceived anxiety and mood in the initial phase
of COVID-19 confinement. Front Psychiatry. 2020;11:729.
https:// doi. org/ 10. 3389/ fpsyt. 2020. 00729.
45. Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJF, Martin
BW. Correlates of physical activity: why are some people physi-
cally active and others not? Lancet. 2012;380(9838):258–71.
https:// doi. org/ 10. 1016/ s0140- 6736(12) 60735-1.
46. Meade LB, Bearne LM, Sweeney LH, Alageel SH, Godfrey
EL. Behaviour change techniques associated with adherence to
prescribed exercise in patients with persistent musculoskeletal
pain: systematic review. Br J Health Psychol. 2019;24(1):10–30.
https:// doi. org/ 10. 1111/ bjhp. 12324.
47. Sallis JF, Adlakha D, Oyeyemi A, Salvo D. An interna-
tional physical activity and public health research agenda to
inform COVID-19 policies and practices. J Sport Health Sci.
2020;9(4):328–34. https:// doi. org/ 10. 1016/j. jshs. 2020. 05. 005.
48. Burke SM, Carron AV, Eys MA. Physical activity context and
university student’s propensity to meet the guidelines Centers
for Disease Control and Prevention/American College of Sports
Medicine. Med SciMonit. 2005;11(4):CR171–6.
49. Stults-Kolehmainen MA, Sinha R. The effects of stress on
physical activity and exercise. Sports Med. 2014;44(1):81–121.
https:// doi. org/ 10. 1007/ s40279- 013- 0090-5.
50. Buman MP, Tuccitto DE, Giacobbi PR. Predicting daily reports
of leisure-time exercise from stress appraisals and coping using
a multilevel modeling approach. J Sport Exercise Psychiatry.
2007;29:S150.
51. Sudeck G, Pfeifer K. Physical activity-related health compe-
tence as an integrative objective in exercise therapy and health
sports—conception and validation of a short questionnaire. Ger
J Exerc Sport Res. 2016;46(2):74–87. https:// doi. org/ 10. 1007/
s12662- 016- 0405-4.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1783
Association of Physical Activity with Depression and Anxiety During COVID-19
52. Schwarzer R. Modeling health behavior change: how to predict
and modify the adoption and maintenance of health behaviors.
ApplPsychol. 2008;57(1):1–29. https:// doi. org/ 10. 1111/j. 1464-
0597. 2007. 00325.x.
53. Zhang CQ, Zhang R, Schwarzer R, Hagger MS. A meta-anal-
ysis of the health action process approach. Health Psychol.
2019;38(7):623–37. https:// doi. org/ 10. 1037/ hea00 00728.
54. Abraham C, Kelly MP, West R, Michie S. The UK National
Institute for Health and Clinical Excellence public health guid-
ance on behaviour change: a brief introduction. Psychol Health
Med. 2009;14(1):1–8. https:// doi. org/ 10. 1080/ 13548 50080
25379 03.
55. Michie S, Ashford S, Sniehotta FF, Dombrowski SU, Bishop
A, French DP. A refined taxonomy of behaviour change tech-
niques to help people change their physical activity and healthy
eating behaviours: the CALO-RE taxonomy. Psychol Health.
2011;26(11):1479–98. https:// doi. org/ 10. 1080/ 08870 446. 2010.
540664.
56. Coughlin SS, Whitehead M, Sheats JQ, Mastromonico J, Smith
S. A review of smartphone applications for promoting physical
activity. Jacobs J Commun Med. 2016;2(1):021.
57. Carroll JK, Moorhead A, Bond R, LeBlanc WG, Petrella RJ,
Fiscella K. Who uses mobile phone health apps and does use
matter? A secondary data analytics approach. J Med Int Res.
2017;19(4):e125.
58. Gal R, May AM, van Overmeeren EJ, Simons M, Monninkhof
EM. The effect of physical activity interventions comprising wear-
ables and smartphone applications on physical activity: a system-
atic review and meta-analysis. Sports Med Open. 2018;4(1):42.
https:// doi. org/ 10. 1186/ s40798- 018- 0157-9.
59. Romeo A, Edney S, Plotnikoff R, Curtis R, Ryan J, Sanders I,
etal. Can smartphone apps increase physical activity? System-
atic review and meta-analysis. J Med Int Res. 2019;21(3):e12053.
https:// doi. org/ 10. 2196/ 12053.
60. Davies CA, Spence JC, Vandelanotte C, Caperchione CM, Mum-
mery WK. Meta-analysis of internet-delivered interventions
to increase physical activity levels. Int J BehavNutrPhys Act.
2012;9(1):52. https:// doi. org/ 10. 1186/ 1479- 5868-9- 52.
61. Direito A, Dale LP, Shields E, Dobson R, Whittaker R, Maddi-
son R. Do physical activity and dietary smartphone applications
incorporate evidence-based behaviour change techniques? BMC
Public Health. 2014;14(1):646.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1.
2.
3.
4.
5.
6.
Terms and Conditions
Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”).
Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers and authorised users (“Users”), for small-
scale personal, non-commercial use provided that all copyright, trade and service marks and other proprietary notices are maintained. By
accessing, sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of use (“Terms”). For these
purposes, Springer Nature considers academic use (by researchers and students) to be non-commercial.
These Terms are supplementary and will apply in addition to any applicable website terms and conditions, a relevant site licence or a personal
subscription. These Terms will prevail over any conflict or ambiguity with regards to the relevant terms, a site licence or a personal subscription
(to the extent of the conflict or ambiguity only). For Creative Commons-licensed articles, the terms of the Creative Commons license used will
apply.
We collect and use personal data to provide access to the Springer Nature journal content. We may also use these personal data internally within
ResearchGate and Springer Nature and as agreed share it, in an anonymised way, for purposes of tracking, analysis and reporting. We will not
otherwise disclose your personal data outside the ResearchGate or the Springer Nature group of companies unless we have your permission as
detailed in the Privacy Policy.
While Users may use the Springer Nature journal content for small scale, personal non-commercial use, it is important to note that Users may
not:
use such content for the purpose of providing other users with access on a regular or large scale basis or as a means to circumvent access
control;
use such content where to do so would be considered a criminal or statutory offence in any jurisdiction, or gives rise to civil liability, or is
otherwise unlawful;
falsely or misleadingly imply or suggest endorsement, approval , sponsorship, or association unless explicitly agreed to by Springer Nature in
writing;
use bots or other automated methods to access the content or redirect messages
override any security feature or exclusionary protocol; or
share the content in order to create substitute for Springer Nature products or services or a systematic database of Springer Nature journal
content.
In line with the restriction against commercial use, Springer Nature does not permit the creation of a product or service that creates revenue,
royalties, rent or income from our content or its inclusion as part of a paid for service or for other commercial gain. Springer Nature journal
content cannot be used for inter-library loans and librarians may not upload Springer Nature journal content on a large scale into their, or any
other, institutional repository.
These terms of use are reviewed regularly and may be amended at any time. Springer Nature is not obligated to publish any information or
content on this website and may remove it or features or functionality at our sole discretion, at any time with or without notice. Springer Nature
may revoke this licence to you at any time and remove access to any copies of the Springer Nature journal content which have been saved.
To the fullest extent permitted by law, Springer Nature makes no warranties, representations or guarantees to Users, either express or implied
with respect to the Springer nature journal content and all parties disclaim and waive any implied warranties or warranties imposed by law,
including merchantability or fitness for any particular purpose.
Please note that these rights do not automatically extend to content, data or other material published by Springer Nature that may be licensed
from third parties.
If you would like to use or distribute our Springer Nature journal content to a wider audience or on a regular basis or in any other manner not
expressly permitted by these Terms, please contact Springer Nature at
onlineservice@springernature.com
... Additional measures are needed to reduce the level of depression among students. In particular, physical activity can be beneficial, since it is shown that physical activity can reduce symptoms of depression [29,30]. ...
Article
Full-text available
COVID-19 is associated with a range of long-lasting symptoms related to cognitive and psycho-emotional spheres. Even mild cases of the disease can lead to persistent cognitive deficits and deterioration of the psycho-emotional state. The purpose of our study was to examine the presence and frequency of psycho-emotional disorders and cognitive deficits in students who recovered from mild form of COVID-19. A total of 40 COVID-19 survivors and 25 healthy controls participated in our study. We assessed three core cognitive functions (inhibition, working memory, task-switching), reaction time and motor speed. We also assessed depression, anxiety and fatigue with self-report questionnaires. The COVID-19 group manifested increased depression and decreased inhibition in comparison with the controls. Our results show that even in young adults who have recovered from mild COVID-19, there are persisting cognitive and psycho-emotional deficits.
... Physically inactive patients were 118% more likely to have high levels of acute depressive symptoms (OR: 2.181, 95%CI 1.730-2.748). A recent systematic review of the general population including 42,293 individuals from 21 studies has found that people performing physical activity on a regular basis and having a stable physical activity routine during the COVID-19 pandemic have shown a lower chance of presenting with depressive symptoms with around 12-32% [30] Our study was supportive of this finding highlighting the importance of keeping moderate physical activity. COVID-19-specific conditions are very likely. ...
Article
Full-text available
Background The large-scale changes in cardiac rehabilitation (CR) programme delivery in response to COVID-19 has led to diminished provision. The influence of these service changes on the depression symptoms of patients in CR programmes is unknown. Our study investigated the extent of depressive symptoms prior to and during the COVID-19 periods in patients with a previous history of depression at the start of CR. Methods Use of Registry routine practice data, National Audit of Cardiac Rehabilitation (NACR), from COVID-19 period Feb 2020 and Jan 2021, as well as pre COVID-19 period Feb 2019 and Jan 2020, was extracted. Depressive symptoms were defined according to Hospital Anxiety and Depression Score ≥ 8. Chi-square tests and independent samples t-tests were used to investigate baseline characteristics. Additionally, a binary logistic regression to examine the factors associated with high levels of depressive symptoms. Results In total 3661 patients with a history of depression were included in the analysis. Patients attending CR during COVID-19 were found to be 11% more likely to have high levels of acute depressive symptoms compared to patients attending CR prior to COVID-19. Physical inactivity, increased anxiety, a higher total number of comorbidities, increased weight, and living in the most deprived areas were statistically significant factors associated with high levels of acute depressive symptoms at the start of CR following multivariate adjustments. Conclusion Our research suggests that following a cardiac event patients with prior history of depression have high levels of acute depressive symptoms at CR baseline assessment. This finding exists in both the pre Covid-19 and Covid-19 periods in patients with a history of depression.
... [69]. This recent trend is alarming because the reduction in physical activity and exercise due to constraints from the COVID-19 pandemic not only substantially contributes to the widespread inactivity-related health problems, but is also associated with the development of psy-chological problems such as stress, anxiety and depression [70,71] and is linked with an increased risk of developing a severe COVID-19 disease course [72]. Paradoxically, it has been suggested that regular exercise, including HIIT, may have a preventive role across the COVID-19 pandemic and reduce infection rates and diseases severity [73]. ...
Article
Full-text available
Initially, we aimed to investigate the impact of a one-year worksite low-volume, high-intensity interval training (LOW-HIIT) on cardiometabolic health in 114 sedentary office workers. Due to the COVID-19 pandemic outbreak, LOW-HIIT was discontinued after 6 months and participants were followed up for 6 months to analyze physical activity/exercise behavior and outcome changes during lockdown. Health examinations, including cardiopulmonary exercise testing and the assessment of cardiometabolic markers were performed baseline (T-1), after 6 months (T-2, termination of worksite LOW-HIIT) and 12 months (T-3, follow-up). Cycle ergometer LOW-HIIT (5 × 1 min at 85–95% HRmax) was performed 2×/week. For follow-up analyses, participants were classified into three groups: HIIT-group (continued home-based LOW-HIIT), EX-group (continued other home-based exercises), and NO-EX-group (discontinued LOW-HIIT/exercise). At T-2, VO2max (+1.5 mL/kg/min, p = 0.002), mean arterial blood pressure (MAB, −4 mmHg, p < 0.001), HbA1c (−0.2%, p = 0.005) and self-reported quality of life (QoL, +5 points, p < 0.001) were improved. At T-3, HIIT-group maintained VO2max and QoL and further improved MAB. EX-group maintained MAB and QoL but experienced a VO2max decrease. In NON-EX, VO2max, MAB and QoL deteriorated. We conclude that LOW-HIIT can be considered a promising option to improve cardiometabolic health in real-life conditions and to mitigate physical inactivity-related negative health impacts during lockdowns.
... Simultaneously, highly educated individuals may have a high degree of understanding of the transmission vectors of COVID-19 and can better comply with personal protective measures (Bazaid et al., 2020). In addition, highly educated individuals can continue to maintain a high frequency of exercise during the closures caused by the pandemic (de Boer et al., 2021), and such a high frequency of exercise may make it easier for these individuals to release and relieve negative emotions, thereby allowing them to exhibit fewer symptoms such as depression and anxiety (Wolf et al., 2021). There are negative correlations among family income, hoarding behavior and negative emotions (depression, anxiety and stress). ...
Article
Full-text available
Hoarding behavior can effectively improve people's ability to resist risks, so as to reduce the negative effects of risks. However, excessive hoarding behavior will seriously reduce people's quality of life. The COVID-19 pandemic can cause excessive hoarding in a large number of people in a short period of time, and also cause a series of economic problems such as social material shortage. It is unclear how hoarding levels are linked to fear and negative emotions caused by COVID-19 among people of different educational backgrounds and social status. The purpose of this study was to explore the relationship between fear of COVID-19 and hoarding behavior in different populations in school and social contexts, as well as the mediating role of negative emotions and the moderating role of subjective/objective social status and education level in this process. An online cross-sectional survey was conducted in various provinces in China in January 2022. Demographic information, the MacArthur Scale of Subjective Social Status, the Fear of COVID-19 scale, the Depression Anxiety Stress-21, and the Saving Inventory-Revised were used to evaluate the severity of individual hoarding symptoms, the frequency of hoarding, the degree of fear, and the negative emotions (depression, anxiety, stress) caused by COVID-19. Research data showed that fear of COVID-19 was significantly correlated with hoarding behavior ( p < 0.05). Fear of COVID-19 was significantly lower in the student sample than in the nonstudent sample ( p < 0.05). Negative emotions played a mediating role in the relationship between fear of COVID-19 and hoarding behavior ( p < 0.05). Educational and economic levels moderated this process, but social status did not. Compared with the student sample, educational background and income had less of a moderating effect on the depression, anxiety, and stress caused by fear of COVID-19 in the nonstudent sample. However, these factors had a more regulative effect on the clutter and excessive acquisition behavior caused by depression, anxiety, and stress, although not on difficulty discarding. These findings suggest that reduce negative emotions in the population, improve cognitive levels, and provide financial support from governments may be effective ways to reduce hoarding symptoms.
... Evidências recentes, de uma revisão sistemática, descreve que a prática de atividade física durante esse período de pandemia da COVID-19 apresentando relação significativa com menores níveis de depressão e ansiedade. Assim, os indivíduos com níveis mais altos de AFMV apresentam de 12% a 32% menos chance de apresentar sintomas depressivos (24). Oportunizar formas de prática de atividades físicas durante o período de distanciamento social poderia reduzir o impacto da pandemia nos sintomas depressivos dos universitários. ...
Article
Full-text available
Evidence indicates a depreciation of mental health during the COVID-19 pandemic in several populations including university students. Physical inactivity and abusive smartphone use can negatively impact the mental health of this population. The present study aimed to verify the association between physical activity and problematic smartphone use with depression indicators in university students during the COVID-19 pandemic. A total of 128 students (18 years old) from a university in the state of Paraná participated in the study. Moderate to vigorous intensity physical activity (MVPA) was assessed using the IPAQ-short version questionnaire. Problematic smartphone use was assessed by the Smartphone Addiction Scale-Short Version (SAS-SV) and depressive episodes were assessed by the Patient Health Questionnaire-9 (PHQ-9). Linear regression verified the association of MVPA and problematic smartphone use with PHQ-9 scores with p<0.05. It was found that 41.4% of the participants had problematic smartphone use and 89.8% had some level of occurrence of depression symptoms (PHQ-9>9). Participants in the highest MVPA tertiles had lower PHQ-9 scores (B=-2.05, EP= 0.66, p<0.01). Participants with higher problematic smartphone use scores had higher PHQ-9 scores (B=0.21, EP=0.05, p<0.01). During the COVID-19 pandemic, most university students had some depressive symptoms, however for those who remained active, these symptoms were attenuated. On the other hand, problematic smartphone use seems to potentiate symptoms of depression among college students. * Autor correspondente: milenamorozini@gmail.com (Morozini M.)
... Perhaps more up-to-date research carried out after the outbreak pandemic will provide stronger evidence for the relationship between PA and mental health disorders. Wolf et al. performed a systematic review taking into account 21 observational studies related to this issue, and they estimated that a risk of depressive symptoms was 12-32% lower and a risk of anxiety disorder was 15-34% lower in the subjects reporting a higher total time spent in moderate to vigorous PA [51]. Marconcin et al. reviewed studies related to the first lockdown and showed that most findings suggest that sufficiently active participants reported significantly lower depression and anxiety and a higher life satisfaction. ...
Article
Full-text available
Physical activity is critically important not only for physical but also for mental health. Exercise may be a beneficial form of therapy for young adults with anxiety disorders. The global outbreak of the COVID-19 pandemic adversely affected the public, including young adults, in terms of their mental well-being and opportunities for physical activity. The study aimed to identify the influence of physical activity (PA) on generalised anxiety in young adults. It also assessed the changes which occurred in the level of PA and in generalised anxiety in young adults as a result of COVID-19 pandemic. A cross-sectional survey was carried out online with 506 young adults aged 18 to 34 years (=24.67 years ± 4.23 years). Respondents provided two answers to each question, i.e., information relating to the last 7 days during the pandemic (first hard lockdown), and to a period of 7 days before the pandemic (retrospective). The levels of physical activity were measured using 7-item International Physical Activity Questionnaire-Short Form (IPAQ–SF), whereas the level of generalised anxiety was assessed using the Generalised Anxiety Disorder 7 (GAD-7) questionnaire. During the pandemic there was a significant correlation between the level of generalised anxiety and the level of physical activity reported by the respondents (p = 0.048). A higher level of physical activity corresponded to lower level of generalized anxiety in young adults. During the pandemic, young adults spent significantly less time performing physical activity (8752.5 vs. 6174.6 metabolic equivalents (MET) min/week, p
Article
Objective. Although physical activity declined with social distancing measures and stay-at-home orders during the COVID-19 pandemic, youth who engaged in more physical activity experienced fewer mental health problems. If and how physical activity maintained its protective role throughout the ongoing pandemic remains unclear. This study models associations between three types of physical activity (indoor, outdoor, with parents), affect regulation, and anxious and depressive symptoms in two independent adolescent samples (T1: Summer 2020; T2: Winter 2020/21). Methods and Measures. Six hundred sixty-two Canadian adolescents (T1: Mage = 15.69, SD = 1.36; 52% girls; 5% trans+) and 675 Canadian adolescents (T2: Mage = 15.80, SD = 1.46; 50% girls; 6% trans+) participated in an online survey. Data included frequency of physical activity indoors, outdoors, and with parents, affect regulation difficulties, and measures of anxious and depressive symptoms. Results. Multiple-group path analysis showed indoor physical activity had an indirect effect on anxiety and depressive symptoms through affect dysregulation, but only at T1. Physical activity with parents was protective for adolescent anxiety and depressive symptoms at both T1 and T2 and had an indirect effect through affect dysregulation and suppression. Conclusion. Findings contribute to our understanding of how physical activity protects adolescent mental health, and point to strengthening family supports and recreation opportunities.
Article
Full-text available
Studies have shown that physical activity (PA) can provide a helpful, low-risk, and cost-effective intervention for children and adolescents suffering from mental health problems. This longitudinal study aimed to assess whether PA prevents the development of mental health problems, such as attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. Data were analyzed from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) collected from more than 15.000 children and adolescents at three different time points over a period of more than 10 years. Parents scored the PA of the study participants on three frequency levels according to WHO recommendations, and mental health problems were assessed by means of the Strengths and Difficulties Questionnaire (SDQ). The total problem score (SDQ-Total) and the hyperactivity/inattention symptoms sub-scale (SDQ-H/I) were used in an autoregressive cross-lagged model to examine their relationship with PA. The results showed that PA of boys and girls at preschool age was inversely associated with the occurrence of mental health problems and, in particular, ADHD symptoms about 6 years later. Higher levels of PA were associated with better general mental health and fewer ADHD symptoms at the next time point (Wave 1). These effects were not observed from preadolescence (Wave 1) to adolescence (Wave 2), neither for girls nor for boys. These findings indicate that medium-to-high PA may be a supportive factor for good mental health in children in preschool and elementary school. Future studies will have to show whether PA may be a helpful add-on for interventional programs for improving general mental health and alleviating ADHD symptoms among children and adolescents.
Article
Importance: Few risk factors for long-lasting (≥4 weeks) COVID-19 symptoms have been identified. Objective: To determine whether high levels of psychological distress before SARS-CoV-2 infection, characterized by depression, anxiety, worry, perceived stress, and loneliness, are prospectively associated with increased risk of developing post-COVID-19 conditions (sometimes called long COVID). Design, setting, and participants: This prospective cohort study used data from 3 large ongoing, predominantly female cohorts: Nurses' Health Study II, Nurses' Health Study 3, and the Growing Up Today Study. Between April 2020 and November 2021, participants were followed up with periodic surveys. Participants were included if they reported no current or prior SARS-CoV-2 infection at the April 2020 baseline survey when distress was assessed and returned 1 or more follow-up questionnaires. Exposures: Depression, anxiety, worry about COVID-19, perceived stress, and loneliness were measured at study baseline early in the pandemic, before SARS-CoV-2 infection, using validated questionnaires. Main outcomes and measures: SARS-CoV-2 infection was self-reported during each of 6 monthly and then quarterly follow-up questionnaires. COVID-19-related symptoms lasting 4 weeks or longer and daily life impairment due to these symptoms were self-reported on the final questionnaire, 1 year after baseline. Results: Of 54 960 participants, 38.0% (n = 20 902) were active health care workers, and 96.6% (n = 53 107) were female; the mean (SD) age was 57.5 (13.8) years. Six percent (3193 participants) reported a positive SARS-CoV-2 test result during follow-up (1-47 weeks after baseline). Among these, probable depression (risk ratio [RR], 1.32; 95% CI = 1.12-1.55), probable anxiety (RR = 1.42; 95% CI, 1.23-1.65), worry about COVID-19 (RR, 1.37; 95% CI, 1.17-1.61), perceived stress (highest vs lowest quartile: RR, 1.46; 95% CI, 1.18-1.81), and loneliness (RR, 1.32; 95% CI, 1.08-1.61) were each associated with post-COVID-19 conditions (1403 cases) in generalized estimating equation models adjusted for sociodemographic factors, health behaviors, and comorbidities. Participants with 2 or more types of distress prior to infection were at nearly 50% increased risk for post-COVID-19 conditions (RR, 1.49; 95% CI, 1.23-1.80). All types of distress were associated with increased risk of daily life impairment (783 cases) among individuals with post-COVID-19 conditions (RR range, 1.15-1.51). Conclusions and relevance: The findings of this study suggest that preinfection psychological distress may be a risk factor for post-COVID-19 conditions in individuals with SARS-CoV-2 infection. Future work should examine the biobehavioral mechanism linking psychological distress with persistent postinfection symptoms.
Article
Full-text available
Background The COVID-19 pandemic imposed major changes on daily-life routine worldwide. To the best of our knowledge, no study quantified the changes on moderate to vigorous physical activity (MVPA) and sedentary behaviors (SB) and its correlates in Brazilians. This study aimed to (i) evaluate the changes (pre versus during pandemic) in time spent in MVPA and SB in self-isolating Brazilians during the COVID-19 pandemic, and (ii) to explore correlates.MethodsA cross-sectional, retrospective, self-report online web survey, evaluating the time spent in MVPA and SB pre and during the COVID-19 pandemic in self-isolating people in Brazil. Sociodemographic, behavioral, and clinical measures, and time in self-isolation were also obtained. Changes in MVPA and SB and their correlates were explored using generalized estimating equations (GEE). Models were adjusted for covariates.ResultsA 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 35.6–82.2) in time spent on MVPA during the pandemic, equivalent to 64.28 (95% CI 36.06–83.33) minutes per day. Time spent in SB increased 42.0% (95% CI 31.7–52.5), corresponding to an increase of 152.3 (95% CI 111.9–192.7) minutes per day. Greater reductions in MVPA and 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 are needed to mitigate the impact of self-isolation on MVPA and SB.
Article
Full-text available
The outbreak of COVID-19 might produce dramatic psychological effects on the individuals’ life. In this study, we aimed to explore the elements that may reduce the negative effects on mental health of the quarantine period imposed by most governments during this worldwide crisis. We conducted an online survey to evaluate demographic, lifestyle and mental health variables in the Portuguese population. We observed that factors related with living conditions, maintaining the work either online or in the workplace, frequency of exercise and absence of a previous psychological or physic disorders are protective features of psychological well-being (anxiety, depression, stress and obsessive-compulsive symptoms). Finally, the individuals previously receiving psychotherapeutic support exhibited better psychological indicators if they did not interrupt the process as a consequence of the outbreak. Our results indicate that the practice of physical exercise, reduced consumption of COVID-19 information and the implementation of remote mental healthcare measures might prevent larger impacts on mental health during the COVID-19 outbreak.
Article
Full-text available
Background The COVID-19 outbreak has affected people’s health worldwide. For college students, web-based physical education is a challenge, as these course are normally offered outdoors. Objective The aim of this study was to use data from a web-based survey to evaluate the relationship between the mental health status of college students and their sports-related lifestyles. Problems related to web-based physical education were also examined. MethodsA web-based survey was conducted by snowball sampling from May 8 to 11, 2020. Demographic data, mental health status, and sports-related lifestyles of college students in Wuhan as well as issues related to web-based physical education were collected. Mental health status was assessed by the Depression, Anxiety, and Stress Scale (DASS-21). ResultsThe study included 1607 respondents from 267 cities. The average scores of the DASS-21 subscales (2.46 for depression, 1.48 for anxiety, and 2.59 for stress) were significantly lower in our study than in a previous study (P1 hour, and >2000 pedometer steps (all P
Article
Full-text available
Background and Aims The most restrictive non‐pharmaceutical interventions (NPIs) for controlling the spread of COVID‐19 are mandatory stay‐at‐home and business closures. Given the consequences of these policies, it is important to assess their effects. We evaluate the effects on epidemic case growth of more restrictive NPIs (mrNPIs), above and beyond those of less restrictive NPIs (lrNPIs). Methods We first estimate COVID‐19 case growth in relation to any NPI implementation in subnational regions of 10 countries: England, France, Germany, Iran, Italy, Netherlands, Spain, South Korea, Sweden, and the US. Using first‐difference models with fixed effects, we isolate the effects of mrNPIs by subtracting the combined effects of lrNPIs and epidemic dynamics from all NPIs. We use case growth in Sweden and South Korea, two countries that did not implement mandatory stay‐at‐home and business closures, as comparison countries for the other 8 countries (16 total comparisons). Results Implementing any NPIs was associated with significant reductions in case growth in 9 out of 10 study countries, including South Korea and Sweden that implemented only lrNPIs (Spain had a non‐significant effect). After subtracting the epidemic and lrNPI effects, we find no clear, significant beneficial effect of mrNPIs on case growth in any country. In France, e.g., the effect of mrNPIs was +7% (95CI ‐5%‐19%) when compared with Sweden, and +13% (‐12%‐38%) when compared with South Korea (positive means pro‐contagion). The 95% confidence intervals excluded 30% declines in all 16 comparisons and 15% declines in 11/16 comparisons. Conclusions While small benefits cannot be excluded, we do not find significant benefits on case growth of more restrictive NPIs. Similar reductions in case growth may be achievable with less restrictive interventions.
Article
Full-text available
Objective. To assess whether changes in physical activity and sedentary behaviour during the COVID-19 lockdown are associated with changes in mental and physical health. Design. Observational longitudinal study. Method. Participants living in France or Switzerland responded to online questionnaires measuring physical activity, physical and mental health, anxiety, and depressive symptoms. Paired sample t-tests were used to assess differences in physical activity and sedentary behaviour before and during lockdown. Multiple linear regressions were used to investigate the associations between changes in physical activity and changes in mental and physical health during lockdown. Results. A total of 267 (wave1) and 110 participants (wave2; two weeks later) were recruited. Lockdown resulted in higher time spent in walking and moderate physical activity (~10min/day) and in sedentary behaviour (~75min/day), compared to pre COVID-19. Increased physical activity during leisure time from week 2 to week 4 of lockdown was associated with improved physical health (β=.24, p=.002). Additionally, an increase in sedentary behaviour during leisure time was associated with poorer physical health (β=-.35, p=.002), mental health (β=-.25, p=.003), and subjective vitality (β=-.30, p=.004). Conclusions. Changes in physical activity and sedentary behaviour during lockdown are associated with changes in physical and mental health. Ensuring sufficient levels of physical activity and reducing sedentary time can play a vital role in helping people to cope with a major stressful event, such as the COVID-19 pandemic.
Article
Full-text available
The COVID-19 pandemic altered many facets of life. We aimed to evaluate the impact of COVID-19-related public health guidelines on physical activity (PA), sedentary behavior, mental health, and their interrelations. Cross-sectional data were collected from 3052 US adults 3-8 April 2020 (from all 50 states). Participants self-reported pre-and post-COVID-19 levels of moderate and vigorous PA, sitting, and screen time. Currently-followed public health guidelines, stress, loneliness, positive mental health (PMH), social connectedness, and depressive and anxiety symptoms were self-reported. Participants were grouped by meeting US PA guidelines, reporting ≥8 h/day of sitting, or ≥8 h/day of screen time, pre-and post-COVID-19. Overall, 62% of participants were female, with age ranging from 18-24 (16.6% of sample) to 75+ (9.3%). Self-reported PA was lower post-COVID among participants reporting being previously active (mean change: −32.3% [95% CI: −36.3%, −28.1%]) but largely unchanged among previously inactive participants (+2.3% [−3.5%, +8.1%]). No longer meeting PA guidelines and increased screen time were associated with worse depression, loneliness, stress, and PMH (p < 0.001). Self-isolation/quarantine was associated with higher depressive and anxiety symptoms compared to social distancing (p < 0.001). Maintaining and enhancing physical activity participation and limiting screen time increases during abrupt societal changes may mitigate the mental health consequences.
Article
Background Strict confinement and social distancing measures have been imposed due to the COVID-19 pandemic in many countries. The aim was to assess the temporal evolution of the psychological impact of the COVID-19 crisis and lockdown from two surveys, separated by one month, performed in Spain. Methods Symptoms of depression, anxiety and stress, and the psychological impact of the situation were longitudinally analyzed using the Depression Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale (IES) respectively. Results There was a total of 4,724 responses from both surveys. Symptomatic scores of anxiety, depression and stress were exhibited by 37.22%, 46.42% and 49.66% of the second survey respondents, showing a significant increase compared to the first survey (32.45%, 44.11% and 37.01%, respectively). There was no significant longitudinal change of the IES scores, with 48.30% of the second survey participants showing moderate to severe impact of the confinement. Constant news consumption about COVID-19 was found to be positively associated with symptomatic scores in the different scales, and daily physical activity to be negatively associated with DASS-21 scores. Conclusions Results indicated a temporal increase of anxiety, depression and stress scores during the COVID-19 lockdown. Factors such as age, consumption of information about COVID-19 and physical activity seem to have an important impact on the evolution of psychological symptoms.
Article
Background: COVID-19 is imposing threat both on physical and mental health since its outbreak. Bangladesh adopted lockdown strategy with potential consequences on day to day life, mental and physical health and this study aims to explore the impact of COVID-19 on mental health and wellbeing among Bangladeshi students. Methods: A cross-sectional study was conducted between 9th and 23rd April 2020 among 505 college and university students. Data was collected by using online questionnaire including DASS 21 and IES. Descriptive analysis and bivariate linear regression were performed to examine the association of variables. Results: 28.5 % of the respondents had stress, 33.3% anxiety, 46.92% depression from mild to extremely severe, according to DASS 21 and 69.31% had event-specific distress from mild to severe in terms of severity according to IES. Perceiving physical symptoms as COVID-19 was significantly associated with DASS stress subscale (B=3.71, 95% CI: 1.01 to 6.40), DASS anxiety subscale (B= 3.95, 95% CI: 1.95 to 5.96), DASS depression subscale (B=3.82, 95% CI: 0.97 to 6.67) and IES scale (B=7.52, 95% CI: 3.58 to 11.45). Additionally, fear of infection, financial uncertainty, inadequate food supply, absence of physical exercise and limited or no recreational activity had significant association with stress, anxiety, depression and post-traumatic symptoms. Conclusion: This COVID-19 outbreak imposes psychological consequences on people to a great extent which requires attention from the concerned authorities to cope with this situation mentally. The perception about the outbreak can also play a big role in psychological impact.
Article
Background Anxiety and depression symptoms in pregnancy typically affect between 10-25% of pregnant individuals. Elevated symptoms of depression and anxiety are associated with increased risk of preterm birth, postpartum depression, and behavioural difficulties in children. The current COVID-19 pandemic is a unique stressor with potentially wide-ranging consequences for pregnancy and beyond. Methods We assessed symptoms of anxiety and depression among pregnant individuals during the current COVID-19 pandemic and determined factors that were associated with psychological distress. 1987 pregnant participants in Canada were surveyed in April 2020. The assessment included questions about COVID-19-related stress and standardized measures of depression, anxiety, pregnancy-related anxiety, and social support. Results We found substantially elevated anxiety and depression symptoms compared to similar pre-pandemic pregnancy cohorts, with 37% reporting clinically relevant symptoms of depression and 57% reporting clinically relevant symptoms of anxiety. Higher symptoms of depression and anxiety were associated with more concern about threats of COVID-19 to the life of the mother and baby, as well as concerns about not getting the necessary prenatal care, relationship strain, and social isolation due to the COVID-19 pandemic. Higher levels of perceived social support and support effectiveness, as well as more physical activity, were associated with lower psychological symptoms. Conclusion This study shows concerningly elevated symptoms of anxiety and depression among pregnant individuals during the COVID-19 pandemic, that may have long-term impacts on their children. Potential protective factors include increased social support and exercise, as these were associated with lower symptoms and thus may help mitigate long-term negative outcomes.
Article
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.