Project Summary
This study explored how COVID-19 affected physical activity of individuals who participated in a survey in order to give recommendations to organisations, practitioners and services on how to manage changes in health care needs. Self-reported physical activity decreased throughout all five age groups included in this study. This decrease is associated with public life restrictions that were put in place to reduce harm from the COVID-19 pandemic. The consequence of the decrease in physical activity may include impaired mental and physical wellbeing. The expected surge in demand for health care must be addressed by health care decision-makers and relevant clinical pathways redesigned to withstand the increased demand.
Project Context
Due to the impact of COVID-19 on numerous health issues reported by various media for more than a year now, a study was designed to find how COVID-19 affected physical activity which has a strong relationship with health in general. This study used secondary data analysis of a survey. The survey was developed by the Healthy Aging Group (HAG), part of the Centre of Research for Health and Society based at the University of Cumbria. The group designed a survey called ‘Perceptions of Ageing in the North of England’ in 2020 in order to inform their strategic research objectives. Once ethical approval had been gained, the HAG group distributed the questionnaire through the university, community partners, personal contacts and personal social media.
Research Goal, Method, and Outcome
Introduction and Research Objective
Data from The Office for National Statistics (2020) shows that the mid-2019 UK population contained 12.4 million people aged 65 years and over which represents 18.5% of the population, with 2.5% of the population aged 85 and over. The most rapid demographic growth is expected for the “oldest” old (85+ years old) which is predicted to rise from 1.6 million in mid-2018 to 3.0 million in mid-2043. A growing older population draws attention to the needs of this group of people. Life expectancy steadily increased from 1950 to 2010 in most developed countries, although this increase slowed down between 2012 and 2018 where longevity was lower than projected (Minton et al., 2020). Overall, these predications show a larger number of people will enter older age, and that period of time has been extended by increases in longevity, creating resource challenges globally.
Ageing
Ageing is complex process characterised by reductions of cell count, tissue wasting, decreases of body fluid, metabolic abnormalities and many more items (Park and Yeo, 2013). This ageing process leads to decreases of physiological functions such as hearing loss, sarcopenia, inflammation, decrease of muscle strength, increase of number of fat cells and others (Jaul and Barron, 2017). Age related deteriorations of physiological systems can be detected after age of 40 (McPhee et al., 2016) indicating they have a relatively early onset. As a result of physiological changes physical functions may also decline, including walking speed, balance, incontinence, frailty and others (Jaul and Barron, 2017). Aging also has an effect on cognition and its domains including language, memory, attention and executive functions (Murman, 2015). For example, hearing can begin to decline for some individuals after 30 years of age and persons of 80 years old can have up to a 70% decline of hearing compared to 30 year olds (Murman, 2015). Age associated diseases have a high prevalence among individuals aged 65 and older (Alzheimer’s association, 2014). There are currently 850,000 people in the UK who have dementia, and it is expected that this number will rise to 1.6 million by year 2040 (Alzheimer’s Society, 2021). The most common cognitive disorders in the elderly population are: dementia, depression and anxiety (Perkovic et al., 2018). Depression and anxiety are associated with increases in level of disability (Kang et al., 2017). Ageing can therefore be associated with a decline in physical and mental wellbeing.
Ageing and Physical Activity
Whilst age is a good overall predictor of health status there is also significant variance among individuals. Some older people can present exceptional health status and others experience increased ageing and onset of age-related deterioration at early stages of their lives (McPhee et al., 2016). This inter-individual variability of health status at certain ages led to the development of a concept known as ‘healthy aging’ (Martin et al., 2014). Rowe and Kahn (1998) created a model defining healthy aging as avoidance of disease and disability, high mental and physical capacity and having active engagement with life (Urtamo, Jyväkorpi and Strandberg, 2019). Since the creation of Rowe and Kahn’s model a number of other theories have been put forward, some including modifiable lifestyle factors which are believed to promote healthy aging. Some of the modifiable lifestyle factors are weight, smoking, physical exercise, diet and alcohol intake (Atallah et al., 2018). These models account for the prevalence of Public Health initiatives promoting healthy lifestyles throughout the life course. For example, the UK’s National Health Service (NHS) physical activity guidelines include walking at a slow pace, housework, childcare, gardening, cycling or any physical exercise such as jogging. Adults over age 19 are recommended to be active daily and their physical activity should add up to 150 minutes of moderate intensity exercise spread across a week (NHS Digital, 2019). According to WHO, adults aged 18 and over should do at least 3-5 hours of moderate-intensity aerobic physical activity over a week (World Health Organization, 2020). In 2018 65% of adults met the UK physical activity guidelines, 12% of adults were fairly active and 22% were characterized as being inactive (NHS Digital, 2019).
Activity levels decrease with age, but the sharpest decline is recorded at ages 75-84 of which 48% are active, with only 26% of ages 85+ recorded as active (NHS Digital, 2019). Physical activity has always been an important part of human life and has shaped our bodies and minds throughout evolutionary processes (Di Liegro et al., 2019). For approximately 99.5% of our existence, humans lived as hunter gatherers, and foraging constituted a crucial part of a hunter gatherer lifestyle which most likely required periods of running, sprinting climbing or digging (Freese et al., 2018). Movement was crucial for our species and our bodies adapted to this need. However, in recent years lack of exercise and the prevalence of sedentary lifestyles have had devastating effects on our bodies in the form of metabolic diseases and stress related disorders (Freese et al., 2018). Thanks to our technical achievements in the past 150 years, which represent a blink of an eye in an evolutionary perspective, our need to exert physical activity on a daily basis has decreased drastically (Freese et al., 2018). Changes in society, therefore, account for variations in healthy ageing as physical activity is now a personal choice rather than a condition of survival.
Research Objective
In this study, effects of COVID-19 pandemic on physical activity were examined by comparing activity levels before and during COVID-19 pandemic periods. Comparisons between gender and among various age groups were made using descriptive statistics without statistical significance testing due to the significant discrepancies among group member frequencies (see Method).
Method
This study explored how COVID-19 effected physical activity of individuals who participated in a survey in order to provide recommendations to organisations, practitioners and services on how to manage changes in health care needs associated with the COVID-19 pandemic (Wickham, 2019). This study used secondary data analysis. Adopting a secondary data analysis approach meant that study results and their meaning were mostly drawn from the time participants had invested in completing the survey. Disadvantages of using secondary data analysis for this study are that the respondent demographics were skewed and the questionnaire didn’t include questions to determine the intensity of physical activity. Inclusion of the data from such questions would have increased the validity of this study.
Survey Questions and Data Analysis
The questions were a mixture of qualitative and quantitative items, with 43 questions in total. The survey was completed by 232 respondents. After primary analysis (Stuart et al., 2021), the data from the survey was anonymized and saved in a Microsoft Excel spreadsheet for secondary analysis. The secondary data set was reviewed and relevant data segments were identified. Of the 43 questionnaire items 12 items were used for this study, including gender and age group, and retrospective reports on physical activity before and after COVID-19. Activity was subdivided onto physical exercise such as jogging, swimming, gym, football and aerobics, cycling for leisure or to work, walking for leisure, to work, or shopping, housework/childcare and gardening. Participants in this study had an option to answer as none, up to one, one to three or over three hours of physical activity a week. Age groups were divided between 30-39, 40-49, 50-59, 60-69, 70-79 and 80-89 years old. See Table 2 and Table 3 for details of gender and age groups (Slide #2).
In order to turn qualitative data regarding physical activity (PA) spent every week into quantitative data, a coding frame was created. A summary of the coding frame is provided in Table 1 (Slide #2). Total PA was calculated for before and after the COVID pandemic. A group data frame was developed for total PA of zero, up to five, more than five, ten to fifteen and more than fifteen hours of PA. Participants were divided by their age group, gender and previously mentioned group data frame. This categorisation of the data enabled a descriptive statistical analysis.
Results
One respondent provided incomplete data and was excluded from current study, leaving a total of 231 participants. The data shows COVID-19 had a negative effect on amount of exercise of all age groups, as illustrated in Figure 1 (Slide #3). The greatest impact was in the 70-79 age group which registered a 36.19% decline. The 80-89 year-old age group shows the smallest decline of PA but this can be explained by a small number of participants.
Males decreased their physical activity (PA) by 11.97%, females by 8.06% and transgender by 42.33% as shown in Figure 2 (Slide #3). An almost four times greater decline of PA for transgender respondents was observed. However, this result is not as reliable as the males and females due to the very small sample size of transgender participants (3; 1.3%). Due to the differences in the number of participants between males (20%) and females (78%), the results should be interpreted with caution.
The average time people spent engaged in PA per week before and during the COVID pandemic was more than 5 hours for every age group (Figure 3, Slide #4), which is considered the minimal amount for individuals aged 18 and over (World Health Organization, 2020). The percentage of participants who exercised less or equal to the minimal recommended moderate aerobic physical activity guidelines throughout a week (World Health Organisation, 2020) increased in almost every age group , as shown in Figure 4 (Slide #4). The greatest increase in PA for people who exercised less than 5 hours a week was for the 70-79 age group, indicating the greatest pandemic impact on this age group. The 80-89 age group did not demonstrate any changes. Both age groups had small numbers of participants, requiring caution in the interpretation of the results.
Discussion
COVID-19 has affected almost all aspects of our lives in deep ways over the last year and into the current year, 2021, as I write this paper. Government control measures have been put in place to keep us safe, but these same measures have had a negative impact on physiological and psychological aspects of daily living for many individuals (Violant-Holz et al., 2020).
Physical Condition
The main finding of this study is that the amount of physical activity (PA) declined throughout all age groups, with the greatest decline of 36.19% of PA compared to pre-pandemic registered by the age group 70-79. One possible explanation of this marked decline of PA is that this age group is considered at high risk of severe illness from COVID-19 (Castañeda-Babarro et al., 2020). Individuals who are considered as high risk have been advised to shield and as a consequence of shielding, reduction of PA might have happened. Overall decline of PA is considered to be the result of closure of gyms, group exercise classes, public parks and social distancing measures which made exercise more difficult for the general population (Wilke et al., 2021).
The pre-pandemic average time of weekly PA for all age group was more than five hours which is considered the minimum amount of PA for persons older than 18 (World Health Organization: WHO, 2020). Although the COVID-19 pandemic negatively affected overall average time of PA for all age groups, the decrease did not fall below the minimum level. The percentage of people who exercised less than the recommended minimum amount of PA over a week increased in almost every age group except one. The 80-89 age group does not indicate any changes of percentage of participants who exercise less than five hours a week, but this can be explained by a small number of participants in this age group. The greatest decrease of PA registered age group 70-79 years old, which is also the most susceptible to its negative effects (Taylor, 2013). Low PA among older people is associated with sarcopenia, increase of body fat, higher chance of developing cardiovascular disease, diabetes, depression, anxiety and many more (Langhammer, Bergland and Rydwik, 2018).
The overall decrease of PA found in this study aligns with results of other studies considering the effects of the COVID-19 pandemic on activity of individuals (Castañeda-Babarro et al., 2020; Fearnbach et al., 2021; Wilke et al., 2021); these studies showed that self-reported amount of PA decreased throughout all age groups subsequent to COVID-19 restrictions. This drop of activity among the general population will bring various negative consequences in the years to come in the form of chronic conditions (Booth, Roberts and Laye, 2012). The findings of this study imply that organisations, practitioners and health-related services need to consider these impacts and to take necessary measures to decrease harmful impacts on the health and wellbeing of the general population.
The physical activity levels of older age groups such as reported above will likely result in negative consequences in various health areas. Three consequences discussed are: mental condition, falls, and rehabilitation.
Mental condition
Age UK (2021) conducted research on the impact of COVID-19 on older people. This study found that the majority of older people coped with the pandemic but a sizeable minority struggled. Individuals who had challenging times were more likely to have a long term health condition. Fear of the virus and months of being cooped up at home lead to increased prevalence of anxiety and physical deconditioning among this vulnerable group. The research also found cases of depression, lack of support, deteriorating physical health and pain due to unmanaged health problems. Age UK (2021) reported that 34% of participants were more anxious than pre-pandemic, 26% could not walk as far as they used to and 18% felt less steady on their feet. It is expected that a rise of mental health problems will surface among individuals who decreased their physical activity during the pandemic. The effects of physical activity on mental wellbeing during the COVID-19 pandemic was examined in a study by Faulkner et al. (2021). This study found a correlation between decreased physical activity and poorer mental health and wellbeing. The present study also found decreased physical activity among all age groups, with an increased prevalence of mental health issues also expected. From a services and practice perspective, mental condition may need to be considered holistically alongside issues of physical deterioration associated with lack of physical activity.
Falls
De La Cámara, Jiménez-Fuente and Pardos (2020) theorize that in the coming months to years an increase in the prevalence of falls among older adults will be recorded because of lowered physical activity during the COVID-19 pandemic. Jefferis et al. (2015) examined the relationship of physical activity and falls in older men and found that decreased physical activity leads to increased chance of falls. Our study found decreased amounts of physical activity throughout all age groups, including older adults, and therefore an increased incidence of falls in our area is expected.
Appeadu and Bordoni (2021) examined falls and fall prevention in the elderly. One of the main parts of effective fall prevention is accurate assessment of patient’s fall risk including gender, drugs, lifestyle, and immobility. Extrinsic factors also play a part in fall prevention, and lighting, walking surfaces and footwear needs to be assessed by trained health care professionals. Detailed physical examination and activities of daily living are also crucial parts of fall prevention. The Comprehensive Geriatric Assessment (CGA) is recommended in order to effectively evaluate an elderly individual’s risk of falls. The CGA results need to involve health care professionals such as orthopaedics, cardiologists, physical therapists, occupational therapists and more. The involvement of a multidisciplinary team in a treatment has shown higher effectiveness compared to conventional treatment. The decrease in PA associated with COVID-19 has arguably increased the likelihood of falls. Because of the complex nature of fall prevention and management, organisations should determine the most effective allocation of resources available for this aspect of healthcare and wellness.
COVID-19 Rehabilitation
The current study found a decrease of physical activity among all age groups. Decrease of physical activity has been shown to lead to increased onset of 40 chronic conditions (Ruegsegger and Booth, 2017). This increased onset of chronic conditions likely will result in a surge of rehabilitation needs.
De Biase et al. (2020) led research on rehabilitation and how it has changed during and likely will change beyond COVID-19. Their study found that the older population which lost physical conditioning as a result of self-isolating and inability of accessing healthcare will be in need of rehabilitation. New approaches to deliver rehabilitation services will need to be designed to sustain increased demand in the years to come.
Older patients who survived severe symptoms of COVID-19 and therefore were immobile and had poor food intake for longer periods of time are at risk of sarcopenia, which is loss of muscle mass. Survivors of severe COVID-19 illness may experience post-traumatic stress disorder and other cognitive and psychological deficits. Other neurological manifestations have been registered such as Guillain-Barre syndrome and encephalitis. As a result, rehabilitation strategies need to apply approaches that address deficits caused by COVID-19 but also address pre-existing conditions including age related degeneration. The expected surge in demand for rehabilitation brings an opportunity to redesign rehabilitation pathways with more emphasis on primary care, and community and agencies outside health care. This system of rehabilitation is more likely to be more responsive to patients in need of acute hospital admission and individuals who need rehabilitation without admission.
Study Limitations
The World Health Organisation (2021) advised a minimum of 150-300 minutes of moderate physical activity throughout a week. The original survey tool was not designed to include intensity of physical activity; therefore this should be considered when interpreting results. Sample size varied greatly between age groups with 87 participants at 50-59 and 3 participants at 80-89 age group; similarly, 78.4 % of participants were female but only 19.8% were males and 1.3% transgender. Differences in sample size of groups negatively affected validity of this study results (Faber and Fonseca, 2014). Selection bias could have had an effect of this study because of a convenience sampling approach where surveys were distributed through the university, community partners, personal contacts and personal social media. This study adopted a self-reporting questionnaire approach to collect data which can carry self-reporting bias and possible negative effects on the reliability of the study (Althubaiti, 2016).
Conclusion
Self-reported amount of physical activity during the pandemic decreased throughout all five age groups included in this study. This decrease is associated with public life restrictions that were put in place to reduce harm from the COVID-19 pandemic. The consequences of this decrease in physical activity may lead to impaired mental and physical wellbeing in the years to come. The expected surge in demand for health care associated with physical activity decreases must be addressed by health care decision-makers and relevant clinical pathways need to be redesigned to withstand this demand. Smaller scale research such as that found in the present study can be useful in helping local and regional practitioners and service provision organizations to plan for the coming impacts.
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To cite this work, please use the following reference:
Sotolar, J. (2021, May 25). The impact of COVID-19 on physical activity. Social Publishers Foundation. https://www.socialpublishersfoundation.org/knowledge_base/the-impact-of-covid-19-on-physical-activity/