Effects of the lockdown period on the mental health of elite athletes during the COVID-19 pandemic: a narrative review

COVID-19 affected elite track-and-field athletes' Olympic preparation before Tokyo 2020 compared to Rio 2016

The COVID-19 pandemic has had a significant impact on elite sport by postponing the Olympic Games Tokyo 2020 four months before the original start. This impacted athletes' macro-cycle periodization, psychological stressors and resources. We analyse whether track-and-field athletes were able to maintain their performance levels successfully across the last two Olympic cycles, controlling for age, gender and doping prevalence. For this, worldwide competition results (excluding multi-events & relays) of at least national level since London 2012 and up to Tokyo 2020 were retrieved. Individual performance curves were analysed using hierarchical multilevel modelling. Individual baselines (random intercept) and developments (random slope) were analysed. 2,383 athletes (52% male) recorded 15,766 outcomes since London 2012. The final conditional growth model (ICC = 48%) shows that performances increased in the wake of Olympic games, dropped significantly in 2020 and recovered beyond previous form in 2021. There was no significant difference between men's and women's developments. Age was a significant predictor (b = 0.17, SE = 0.02), but doping violations was not (b = 0.01, SE = 0.03). These results showcase performance trends in international athletics and their variability, present an overall successful periodization to achieve peak performance at Tokyo 2020, and discuss predictions for track and field at Paris 2024.

Did social isolation affect anxiety and sleep quality of elite soccer players during the COVID-19 lockdown? Comparisons to training before distancing in the pandemic and outlook for mental health

Objective

To analyze the anxiety levels and sleep quality of elite soccer athletes in training pre-pandemic and during the lockdown caused by COVID-19.

Method

This is an exploratory study with a longitudinal design carried out with elite soccer athletes from two Brazilian soccer clubs. Data collection took place in person pre-pandemic (training) and online (during lockdown) between February and May 2020. The instruments used to assess sleep, daytime sleepiness, and anxiety were the Pittsburgh Sleep Quality Index (PSQI), Epworth Daytime Sleepiness Scale-(ESS-BR), and Competitive Anxiety Scale (SCAT). For data analysis, descriptive statistics (frequencies, percentages, maximum and minimum) and non-parametric inferential statistics were used, establishing a significance of p < 0.05.

Results

In total, 76 male soccer athletes participated in the study. A significant increase was observed in anxiety levels in confinement compared to pre-pandemic training (p = 0.017; g = 0.83), and sleepiness significantly reduced in training compared to baseline levels (p = 0.007; g = 0.48). The athletes demonstrated good sleep quality and the pandemic did not significantly alter daytime sleepiness compared to training and baseline.

Conclusion

From the results it can be concluded that elite soccer athletes presented alterations in anxiety levels compared to training during confinement, however, no effects of confinement were observed on sleep quality and sleepiness. New studies are needed to analyze the long-term consequences of the pandemic and the relationships between anxiety and sleep in training and competition in athletes.

Home Anxiety Assessment and Influencing Factors among Adolescent Athletes in Yantai City

OBJECTIVE

To understand the prevalence of home-related anxiety among adolescent athletes during the novel coronavirus pandemic and to ascertain the factors influencing this anxiety.

METHODS

We employed cluster sampling to select 1150 adolescent athletes (aged 8-18 years) from six sports training schools in Yantai City, Shandong Province. Mental health status was assessed and recorded. Chi-square tests and multivariable logistic regression were used to analyze the factors contributing to athletes' anxiety.

RESULTS

The survey revealed a COVID-19 infection rate of 38.23% (437 individuals) with an anxiety score of 40.98 ± 8.20 and an anxiety detection rate of 11.29% (129 individuals) during the COVID-19 epidemic. Female athletes exhibited a higher anxiety rate of 14.40% compared to 8.40% in male athletes. Multivariate analysis identified female gender as a risk factor for anxiety (OR = 1.64), while participation in aquatics emerged as a protective factor (OR = 0.24, 95% CI: 1.08-2.48). Professional training duration exceeding three years increased anxiety risk (OR = 3.05, 95% CI: 1.67-5.58), as did not seeking help during difficulties (OR = 2.59, 95% CI: 1.33-5.01). Interestingly, parental care was linked to increased anxiety risk (OR = 2.44, 95% CI 1.34-4.44), while care from friends was protective (OR = 0.60, 95% CI: 0.36-1.01), which was possibly due to the pressure associated with parental expectations.

CONCLUSIONS

Adolescent athletes, particularly females and those with extended training durations, exhibit a heightened susceptibility to anxiety. This study also highlights that athletes who proactively seek assistance during challenging situations tend to experience lower anxiety levels. Additionally, a lack of COVID-19 infection and the involvement of concerned parents contribute to reduced anxiety among these young athletes.

Mental Health in First- and Second-Division Soccer Players: A Cross-Sectional Study

BACKGROUND

The benefits of sport in mental health have been broadly studied. However, few studies have examined these outcomes in high-performance athletes. We aimed to analyze the state of the mental health of the Villarreal Soccer Club's first- (FD) and second-division (SD) players and the possible mediating effects of sex and professional category.

METHODS

This was a cross-sectional study with an initial sample of 108 soccer players (final sample n = 54). Data from MINI, HARS, HDRS, BARRAT-11 and SCSRQ questionnaires were analyzed.

RESULTS

The mean age was 23.41 years (SD = 4.56) and 61.1% (n = 33) were men. A proportion of 24.1% (n = 13) stated that they had undergone mental health treatment, 7.4% (n = 4) had taken psychotropic drugs, and 2.1% (n = 1) had made a suicide attempt. Differences were observed between the FD and SD players in terms of the sensitivity to punishment (t = -2.2; p = 0.033), overall impulsivity (t = -3.1; p = 0.003), unplanned impulsivity (t = 3.4; p = 0.001), and the HDRS (U = -110.5; p = 0.004), HARS-Total (U = -104.0; p = 0.006) and HARS-Psychological subscale scores (U = -104.0; p = 0.001). Differences were also observed between the female and male SD players for the HARS-Somatic subscale (U = 136.5; p = 0.028).

CONCLUSION

The low values obtained in the clinical scales, together with the reported psychopathological histories, suggested that the Villareal players showed better mental health than the general population.

The Impact of the SARS-COVID-19 Lockdowns on the Subjectively Perceived Performance Level of Amateur Athletes after Returning to the Gyms

Since December 2019, few issues have garnered as much global attention as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-19). The imposed lockdowns in 2020/21, which led to the closure of all gyms, barred people from participating in their favourite sports activities. This study explores athletes' self-evaluations of their performance levels upon return to training facilities post-reopening. Data were collected in May 2021, after the end of the second lockdown, using a national online questionnaire. The study recorded 20 demographic and training-specific parameters to discern the factors influencing self-perceived performance upon resuming gym activities after the 2020/2021 lockdown. A total of 1378 respondents participated in the study. Of the total number of participants, 27.5% (365) reported regaining 100% of their original performance level after reopening their studios, a proportion that comprised 212 males, 150 females, and 3 individuals of unspecified gender. Additionally, 35.7% (474) estimated their performance level to be up to 75%, followed by 30% (398) recording their performance level at 50%, and a minority of 6.8% (90) determining their performance level to be up to 25%. Exercise intensity prior to lockdown, training experience, sex, and concurrent practice of another sport significantly influenced the athletes' self-assessment of their current fitness levels (p > 0.001, p > 0.001, p > 0.001, and 0.006, respectively). We need to understand the factors that shape self-perception, especially in case of another lockdown, in order to provide preventive assistance concerning mental and physical well-being. Positive influences on self-perception include prior athletic experience, intensive training before the lockdown, and continued participation in sports throughout the lockdown. Younger age is also favourable, but this may not necessarily reflect the benefits of youth; rather, it could indicate the current lack of accessible online sports activities for older individuals. Women, however, might have a less favourable perception of their own athletic performance.

Comparative Study of the Long-Term Impact of the COVID-19 Pandemic on Mental Health and Nutritional Practices Among International Elite and Sub-Elite Athletes: A Sample of 1420 Participants from 14 Countries

BACKGROUND

Although several studies have shown that the Coronavirus Disease 2019 (COVID-19) lockdown has had negative impacts on mental health and eating behaviors among the general population and athletes, few studies have examined the long-term effects on elite and sub-elite athletes. The present study aimed to investigate the long-term impact of COVID-19 lockdown on mental health and eating behaviors in elite versus sub-elite athletes two years into the pandemic. A cross-sectional comparative study was conducted between March and April 2022, involving athletes from 14 countries, using a convenient non-probabilistic and snowball sampling method. A total of 1420 athletes (24.5 ± 7.9 years old, 569 elites, 35% women, and 851 sub-elites, 45% women) completed an online survey-based questionnaire. The questionnaire included a sociodemographic survey, information about the COVID-19 pandemic, the Depression, Anxiety and Stress Scale-21 Items (DASS-21) for mental health assessment, and the Rapid Eating Assessment for Participants (REAP-S) for assessing eating behavior.

RESULTS

The results showed that compared to sub-elite athletes, elite athletes had lower scores on the DASS-21 (p = .001) and its subscales of depression (p = .003), anxiety (p = .007), and stress (p < .001), as well as a lower REAP-S score indicating lower diet quality (p = .013).

CONCLUSION

In conclusion, two years into the pandemic, elite athletes were likelier to have better mental health profiles than sub-elite athletes but surprisingly had lower diet quality.

Physical fitness trend after COVID-19 restrictions in Italian school-aged children: a cross-sectional study

BACKGROUND

Physical fitness (PF) is a marker of health in children. Muscular strength and speed-agility PF components play a crucial role in musculoskeletal development and bone health. The outbreaks of COVID-19 pandemic changed the daily and sports activities in younger increasing sedentary habits with a detrimental effect on PF. We aimed to investigate the impact of COVID-19 restrictions on PF in Italian school-aged children.

METHODS

We recruited 286 elementary school children, and they were tested through an internationally validated battery test, which evaluate muscular strength and speed-agility (as a multifactorial performance) prior (2018) and after the outbreak of COVID-19 pandemic (2021).

RESULTS

Our results showed a reduction in the lower limb strength (SBJ in boys mean difference (MD) -0.42 m; SBJ in girls MD=-0.20 m; P<0.05) and in the speed-agility ability (10x5 m in boys MD=14.1 s; 10x5 m in girls MD=11.2 s; P<0.05), while the upper limb strength remained steady before and after the restrictions. Specifically, for boys of all ages there was a reduction in lower limb strength and in speed-agility but not in upper limb strength. For girls of all ages there was not a recurrent trend, while for 6-8 girls there was a reduction only speed-agility, for 9-11 girls there was a reduction in lower limb and speed-agility.

CONCLUSIONS

Our results could be useful to help teachers and sport specialists to evaluate and improve strength and speed-agility in children. We encourage trainers and sport specialists to implement programs to help children to become more active and healthier during their lifespan.

International fitness scale (IFIS): association with motor performance in children with obesity

Background

Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health; and compared with their normal-weight peers, these individuals tend to have a lower level of self-confidence, and consequently lower physical activity adherence. Due to these self-perceived barriers, the aim of our study was to evaluate the efficacy of an online training program on self-reported physical fitness (SRPF) in children with obesity (OB).

Methods

A total of 32 children with OB carried out physical fitness (PF) tests and were asked to complete the International Fitness Enjoyment Scale (IFIS) questionnaire. The physical fitness tests were the Standing Broad Jump (SBJ), the 6-Min Walking Test (6MWT) and the 4 × 10 m sprint test. Children participated in a 3-weekly 60-min training session through Zoom platform. Before the beginning of the training protocol, OB children were compared with normal weight (NW) ones for PF batteries and the IFIS questionnaire. Changes in performances after the training were assessed by paired Student t and Wilcoxon tests.

Results

After the online training program children increased their performance in 6MWT (mean difference (MD) = 54.93; p < 0.0001) in SBJ (MD = 10.00; p = 0.0001) and in 4 × 10 m sprint test (MD = -0.78; p < 0.0001). No differences were found in children's physical fitness perception.

Discussion

Our study highlighted how a structured online training program can lead to improvements in PF of children with OB. Instead, the lack of differences in SRPF after the training suggests interesting questions to be explored on the aspects linked to self-perception. Therefore, even if our training protocol could not directly improve SRPF in children with obesity, the enhancement of their PF could be a starting point for achieving this result with a longer training period and consequently improve PA participation for children with OB.

Evaluation of the Perceptions, Attitudes and Practices among Greek Non-Professional Athletes Visiting a Public Hospital during March 2022, towards COVID-19 Vaccination and Its Consequences on Sports Training and Sports Activity

Sports have been majorly impacted by the COVID-19 pandemic. After the lockdown period, vaccination and protocols were implemented to return to normality. We aimed to assess the attitudes and practices related to COVID-19 vaccination among athletes, and to record adverse effects of vaccination, if any. A questionnaire was distributed to 1012 male and female athletes, 15+ years old, within the region of Athens. Vaccination coverage with at least one dose was 93.5%, whereas 53.9% were fully vaccinated. More than half of the participants were infected with SARS-CoV-2 at the time of the study. More than 90% of the participants, considered the vaccines as safe, effective and important for public health. Concern about potential side-effects was raised especially by women athletes (59.1% of women compared to 42.2% of men, p < 0.001). The main reasons for avoiding vaccination were fear of vaccine safety, concern about the short time period for vaccine development and testing and doubt of risk of being exposed to SARS-CoV-2 infection. The main reported side-effects were pain at the injection site, fatigue, fever and headache. Approximately two thirds of the participants reported that vaccination did not affect their training, and none reported missing participation in scheduled athletic events. Participants reported high compliance to preventive measures by themselves and fellow athletes, but low satisfaction regarding the implementation of public protocols and the flow of information provided by the authorities. Athletes of older age and those less concerned about potential side-effects were more likely to get fully vaccinated. Nevertheless, the vast majority of the athletes in our study were vaccinated for COVID-19 despite any hesitation regarding effectiveness, safety, or potential side-effects from the vaccines.

Anxiety, insomnia, and depression during COVID-19 lockdown in elite individual and team sport athletes

PURPOSE

Pandemic-induced lockdowns disrupted sport training and competition. We aimed to identify the impact on the mental health of high-level athletes and clarify whether the effects differ for team-based and individual athletes.

METHODS

This cross-sectional survey, stratified by sex and sport type, collected demographic data and mental health measurements from 274 Brazilian high-performance athletes (142 from team sports and 132 from individual sports) involved with the Brazilian Olympic Committee program for the Tokyo Olympics 2021. Depression, disturbed sleep, and anxiety were assessed by the 9-Item Patient Health Questionnaire, 7-Item Insomnia Severity Index, and 7-Item Generalized Anxiety Disorder scale respectively. Responses were analyzed dichotomously according to published threshold values, characterizing the relative frequency distribution of prevalence (PCRS) or non-prevalence of clinically relevant symptoms (NPCRS).

RESULTS

Out of all participants, 47 [17.1%], Z(274) = 15.38, p = .001, 32 [11.7%], Z(274) = 17.94, p = .001, and 49 [17.9%], Z(274) = 15.04, p = .001 had PCRS of anxiety, insomnia, and depression, respectively. There were no significant differences in the PCRS among genders. Compared with individual sport athletes, team sport athletes were more likely to report PCRS of insomnia (12 [37.5%] vs 20 [62.5%], Z(274) = -2.00, p = .046), and depression (18 [36.7%] vs 31 [63.3%], Z(274) = -2.63, p = .009) but not for anxiety.

CONCLUSION

Athletes reported high levels of mental health problems during the lockdown. Team sport athletes reported worse symptoms of insomnia and depression than individual sport athletes, possibly due to the impact of unaccustomed social isolation and lack of social team activity. Therefore, it becomes relevant to consider psychological support to team sport athletes who for some reason, such as a pandemic, enduring crisis even injury rehabilitation needs to be isolated.

Self-Declared Physical Activity Levels and Self-Reported Physical Fitness in a Sample of Italian Adolescents during the COVID-19 Pandemic

Only 20% of children worldwide reach the suggested physical activity (PA) levels, and the COVID-19 restrictions seemed to have worsened this situation. In addition, physical fitness (PF) is a crucial marker of health and combined with PA could predict future health status. The aim of this study was to compare reported PA and PF levels in a sample of Italian adolescents. We administered the International PA Questionnaire and International Fitness Enjoyment Scale to 208 adolescents aged 16.0 ± 1.5 (N = 166 females, 16 ± 2.0 years) recruited from a high school in the province of Milan (Italy). The majority of the subjects were "Minimally active" but reported adequate PF levels. In particular, subjects who reported a "Very good" PF perception, had a lower PA level. The misperception of reported PA and PF from our sample could reduce the future PA level in adolescents and lead to a negative spiral of disengagement in PA. These findings should lead to more attention on and improvements to PA promotion in the adolescent population after the restrictions caused by the COVID-19 pandemic.