Physical activity levels across COVID-19 outbreak in youngsters of Northwestern Lombardy

Immediate and Intermediate-Term Effects of Disease Mitigation Measures on Activity Levels as Measured by Implantable Cardiac Devices

Routine activities of daily living are known to effect overall wellbeing, cardiovascular health, and quality of life. A decrease in daily activity level is recognized as a contributing factor to increasing rates of obesity and a decline in overall health. This study sought to evaluate the effect of disease mitigation strategies on activity level by evaluating changes in recorded cardiac parameters as measured by implantable cardiac devices for a period of time prior to and following implementation of COVID-19 mitigation efforts in Arizona. A retrospective cohort study of cardiac device data from January 1, 2019-December 31, 2020 was performed. Linear mixed-effects models with restricted maximum likelihood estimation were utilized to test for the fixed effects of Year, day, and the interaction between them. A significant decrease in daily activity minutes, daytime heart rates, and heart rate variability coincident with the initiation of disease mitigation strategies was observed. An increase in nighttime heart rates also coincided with initiation of disease mitigation strategies. These effects were noted to persist through the end of the study period. Implementation of statewide disease mitigation strategies resulted in both immediate and intermediate-term effects on activity levels, day and nighttime heart rates trends, and heart rate variability in patients with implanted cardiac devices. These data may serve useful in counseling patients regarding the importance of activity, movement, and exercise to routine health and encourage a return to pre-pandemic levels of activity.

Effects of the COVID-19 Pandemic on Pediatric and Adolescent ASCVD Risk Factors

PURPOSE OF REVIEW

In this review, we provide insight into and raise awareness of the impact of the COVID-19 pandemic on the prevalence of acquired atherosclerotic cardiovascular disease (ASCVD) risk factors in adolescents. We highlight data that could be used to guide the response to a future pandemic with the goal of reducing premature cardiovascular disease (CVD)-related morbidity and premature mortality.

RECENT FINDINGS

During the global COVID-19 pandemic, many individuals, including youth, voluntarily or were mandated to alter the usual lifestyle in order to limit exposure and reduce the spread of the virus. Some of these changes resulted in unintended consequences, particularly acquisition of risk factors such as excessive weight gain, insulin resistance/diabetes, and dyslipidemia, commonly associated with ASCVD. A study from China examined changes in the prevalence of obesity and found a 2.4% rise attributable to the pandemic. Adequate daily physical activity plays an important role in ASCVD risk reduction. A systematic review and meta-analysis showed a 20% (90% CI, -34 to -4%) reduction in physical activity from before vs. during the COVID-19 pandemic. Another study of patients with type 2 diabetes found the mean HbA1c was significantly elevated during the COVID-19 pandemic (7.53 ± 1.02% in 2020) compared with the previous 2 years. In addition, there has been an alarming rise of childhood mental health concerns and suicide during the pandemic. Early identification and optimum management of CVD risk factors play an important role helping prevent future cardiovascular disease. Following the rapid spread of the virus, the World Health Organization (WHO) officially declared COVID-19 a global pandemic on March 11th, 2020. In an attempt to avoid infection and reduce the spread of the virus, many alterations in lifestyle were adopted on an international scale. While necessary, these modifications resulted in many adverse unintended health consequences in children and adolescents. This paper reviews the impact of the pandemic and the associated lifestyle changes on the prevalence of acquired atherosclerotic cardiovascular disease (ASCVD) risk factors in youth. In addition to providing insight, we hope to raise awareness of the pandemic's impact, and highlight specific data that could be used to guide the response to a future pandemic.

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.

Physical, psychological, and behavioral problems among children and adolescents in countries with different economic statuses during the COVID-19 pandemic: a systematic review and meta-analysis

Introduction

The COVID-19 pandemic has impacted children and adolescents' physical activity (PA), sleeping patterns, and psychological and behavioral health. Yet, little is known about the differences between those in countries with various economic statuses.

Methods

Articles published from database inception through 16 March 2022 were retrieved using CINAHL Complete, Cochrane Library, EMBASE, Medline, PubMed, and PsycINFO. High-quality studies that reported the number of participants with parameters associated with PA, sleeping patterns, and psychological and behavioral problems in young people aged under 18 years during the pandemic were included. We referenced the Canadian 24-Hour Movement Guidelines for PA and sleep duration to provide the event rate for young people who were not compliant with the guidelines. The event rate of young people who had decreased sleep quality and experienced psychological and behavioral problems were also investigated. A subgroup analysis was conducted to identify the differences in those in countries with diverse economic statuses. Funnel plot analysis and Egger's test were also conducted to identify any risk of publication bias.

Result

A total of 66 studies with 1,371,168 participants aged between 0 and 18 years, involving 27 countries, were included. During the pandemic, we identified that 41% (95% CI: 39%, 43%; I²= 96.62) and 43% (95% CI: 34%, 52%; I²= 99.42) of young people did not meet the PA and sleep duration recommendation guidelines. In addition, 31% (95% CI: 28%, 35%; I²= 99.66) of young people had decreased their sleep quality. Yet, no significant difference was found across countries with different economic statuses. However, the event rates of participants with psychological and behavioral problems were 32% (95% CI: 28%, 36%; I²= 99.85) and 19% (95% CI: 14%, 25%; I²= 99.72), respectively. In addition, the rate of psychological problems was more severe in those who live in lower middle-income countries (p < 0.001), while the rate of behavioral problems was more severe in those who live in high-income countries (p = 0.001).

Discussion

During the pandemic, the discouragement of PA, poor sleep quality, and high risk of psychological and behavioral problems are concerning. A large number of young people did not comply with the recommendation guidelines. Timely implementation of recovery plans is critical to address the adverse effects on young people.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309209, identifier CRD42022309209.

The Factors and Relationships Influencing Forest Hiking Exercise Characteristics after COVID-19 Occurrence: At Seoul Metropolitan Area and in Hikers' 20s and 30s

The growing interest and usage of green space during the pandemic relates to why greenery increases enjoyment of daily life and alleviates troubles arising from infectious periods. However, it is necessary to understand what reactions to the degree of COVID-19's spread were expressed in hiking exercise characteristics (hiking frequency, actual movement distance, average speed, total exercise time). To understand the progress of forest usage behavior during the pandemic, we analyzed factors influencing hiking exercise characteristics and relationships between those factors and hiking exercise characteristics. Hiking record data were obtained (2019-2020) from the workout app "Tranggle" pertaining to hikers in their 20s and 30s who visited the 13 mountains in the Seoul Metropolitan Area most frequently. The differences in hiking exercise characteristics (2019 data subtracted from 2020) were linked with factor data that could be related to them, including the degree of COVID-19's spread (Rt). To explore relationships between hiking exercise characteristics and factors, we developed four models with a linear mixed model. We found that Rt, week, weekdays/weekends, and PM10 contributed to explaining the hiking exercise characteristics' differences. As a result of this analysis, the degree of COVID-19's spread (Rt) affected hiking frequency; the week affected hiking frequency and actual movement distance; weekdays or weekends affected hiking frequency, actual movement distance, average speed, and total exercise time; and PM10 affected hiking frequency. These findings indicate that hiking was an alternative way for those looking for a new strategy to replace lost opportunities for physical activity. Therefore, we conclude that it is necessary to induce the usage of green space so that many people can take advantage of the functions and benefits of greenery, which stood out during the pandemic era.

Changes in physical activity and energy intake according to abdominal obesity in Korean adult men before and after COVID-19: Data from 2019 and 2020 Korea National Health and Nutrition Examination Survey (KNHANES)

[Purpose] This study aimed to investigate changes in physical activity and energy intake according to abdominal obesity in Korean adult men before and after COVID-19.[Methods] Using data from the 2019 and 2020 KNHANES, the physical activity level measured by the Global Physical Activity Questionnaire (GPAQ) the physical activity level by GPAQ, number of days of walking and strength training, aerobic exercise, and total energy, protein, fat, carbohydrate, dietary fiber, and sugar intake for a total of 2,799 participants were analyzed.[Results] There were no changes in energy intake during the pandemic. The number of days of weekly walking was higher (2019, <i>p</i> = 0.006; 2020, <i>p</i> = 0.012) and strength training was significantly higher (2019, <i>p</i> < 0.0001; 2020 <i>p</i> < 0.0001) in the non-abdominal obesity group than in the abdominal obesity group before and after COVID-19. Strength training at least once a week suppressed abdominal obesity (0.628 times in 2019, <i>p</i> < 0.0001; 0.605 times in 2020, <i>p</i> < 0.0001). In addition, even when the total energy intake and age were adjusted for, strength training influenced the suppression of abdominal obesity (0.634 times in 2019, <i>p</i> < 0.0001; 0.614 times in 2020, <i>p</i> < 0.0001).[Conclusion] Even with the change in the physical activity level, such as walking and aerobic exercise, due to the influence of social distancing measures, strength training influenced the suppression of abdominal obesity, regardless of the COVID-19 pandemic.

The Role of Physical Activity in the Reduction of Generalised Anxiety Disorder in Young Adults in the Context of COVID-19 Pandemic

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 < 0.001), they spent more time engaging in sedentary behaviours (Me = 240 vs. Me = 300 min/day, p < 0.001), and they walked much less (from Me = 6930.0 (MET) min/week vs. 3861.0 (MET) min/week (44.29% decrease). Furthermore, after the outbreak of the pandemic the level of perceived generalised anxiety increased significantly (p < 0.001). Physical activity may play an important role in reducing anxiety disorder in young adults. During the COVID-19 pandemic young adults were significantly less involved in PA, which adversely affected their physical and mental condition. The importance of sufficient PA should be emphasised during this specific period, particularly among young adults.

Effects of an Online Supervised Exercise Training in Children with Obesity during the COVID-19 Pandemic

COVID-19 restrictions have dramatically reduced the active lifestyle and physical activity (PA) levels in the whole population, a situation that can contribute to weight gain and to develop obesity. To improve physical fitness (PF) in children with obesity during COVID-19 restrictions, sport specialists started to deliver physical training through tele-exercise. For these reasons, the aim of this study was to evaluate the effects of a 12-week online supervised training program in children with obesity on different PF components and PA levels. We enrolled a total of 40 Caucasian children (9 F/31 M; aged 11 ± 1.9 years) with obesity. The data collection consisted of a series of anthropometric measures, the PAQ-C questionnaire, and PF tests, valid and reliable tools to assess PF in children. We used a Wilcoxon’s t-test and a Student’s t-test, as appropriate, to assess the differences before and after the training protocol. A total of 37 patients completed the training protocol and were considered in the analysis. Our results show an improvement in all the PF tests, a reduction in the BMI z-score, the waist circumference, and in the waist-to-height ratio, and an increased PA level. In conclusion, the results of our study show that an online supervised training program is effective to promote PA, improving PF and reducing the BMI z-score in children with obesity.

Is It Important to Increase Physical Activity Among University Students During the Second-Wave COVID-19 Pandemic in Asian Countries? A Cross-Sectional Study of the Knowledge, Attitudes, and Practices in Asian Countries

Background

Difficulties in exercising have occurred for the entire world’s population during this COVID-19 pandemic, especially in the second wave at the end of 2021. Most worrying is the lack of physical activity in young adults, as lack of exercise will increase the risk of noncommunicable diseases in the future. The youth such as university student can be agents of change, to increase physical activity, from sedentary to sport life. This study aimed to determine the relationship between knowledge, attitudes, and actions of university students and the correlation between the related variables.

Methods

This study is a cross-sectional observational study involving 458 Asian university students based on Asian and African nationalities. This research was conducted from December 2021 to January 2022, during the second wave of the COVID-19 pandemic in Asia. The variables studied were the knowledge, attitudes, and actions of university students with regard to sports, and the statistical test used was the Chi-squared test.

Results

The results showed that the research subjects were mainly from Indonesia and India (95.8%), there were more women than men (69.9% vs 30.1%), the most common age range was 18–20 years (61.4%), and 45.4% had a normal body mass index. In total, 48.3% had high knowledge, 93.4% had a positive attitude, and 34.7% had good practice. There was a significant relationship between knowledge and attitude (p=0.002) but not with action.

Conclusion

This study found that good knowledge was associated with a good attitude, but due to the COVID-19 pandemic with activity restrictions on university students, there was no relationship with action.

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Physical Fitness of Chinese Primary School Students across the Coronavirus (COVID-19) Outbreak: A Retrospective Repeated Cross-Sectional Study

Social distancing measures against COVID-19 imposed restrictions on students that may have affected their physical health and fitness. The objective of this study was to investigate the change in physical fitness of primary school students across the coronavirus outbreaks from 2019 to 2021. This was a retrospective repeated cross-sectional study. We obtained the annual physical and fitness assessment data measured every November for all students at the same primary school in Guangzhou, China. There was a total of 6371 observations in the dataset for three years. The physical fitness of the students was evaluated with an overall physical fitness score, body mass index (BMI), lung vital capacity, physical flexibility (via a sit-and-reach test) and sports task performances (sprint, shuttle run, rope-jumping, and sit-up). Generalised estimating equations were used to determine any significant changes from 2019 to 2021, adjusted for confounders. After the COVID-19 outbreak in 2021, there was a significant elevation in BMI of 0.64 kg/m2 in 2020 and 0.39 kg/m2 in 2021 (p < 0.001). The overall physical fitness score was significantly increased by 2.1 and 4.1 points, respectively, in 2020 and 2021 (p < 0.001). Lung vital capacity and rope-jumping performance were significantly improved in both 2020 and 2021 compared with 2019, and sit-up performance was marginally significantly improved in 2020 and significantly improved in 2021. However, students demonstrated poorer flexibility and sprint and shuttle run performance in 2021 compared with 2019. A health promotion programme during and after COVID-19, including online physical education classes, television broadcasts, and a rope-jumping campaign, could account for these positive outcomes, along with the ease of administering rope-jumping and sit-ups at home.

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.

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

Purpose

This review aimed to assess the effects of COVID-19 pandemic lockdown on mental health to elite athletes. The emotional background influenced their sport career and was examined by questionnaires.

Methods

We included original studies that investigated psychological outcomes in elite athletes during COVID-19 lockdown. Sixteen original studies (n = 4475 participants) were analyzed.

Results

The findings showed that COVID-19 has an impact on elite athletes’ mental health and was linked with stress, anxiety and psychological distress. The magnitude of the impact was associated with athletes’ mood state profile, personality and resilience capacity.

Conclusion

The lockdown period impacted also elite athletes’ mental health and training routines with augmented anxiety but with fewer consequences than the general population thanks to adequate emotion regulation and coping strategies.

Use of Physical Activity and Exercise to Reduce Inflammation in Children and Adolescents with Obesity

Childhood obesity is a leading public health problem worldwide, as it is increasingly prevalent and therefore responsible for serious obesity-related comorbidities, not only in childhood but also in adulthood. In addition to cardio-metabolic obesity-related disorders, recent evidence suggests that excess adipose tissue in turn is associated with immune cell infiltration, increased adipokine release, and the development of low-grade systemic inflammation obesity. Exercise is considered a non-pharmacological intervention that can delay obesity-related comorbidities, improving cardiovascular fitness and modulating the inflammatory processes. It has been reported that the anti-inflammatory effect of regular exercise may be mediated by a reduction in visceral fat mass, with a subsequent decrease in the release of adipokines from adipose tissue (AT) and/or by the induction of an anti-inflammatory environment. In this narrative review, we discuss the role of AT as an endocrine organ associated with chronic inflammation and its role in obesity-related complications, focusing on the effect of exercise in reducing inflammation in children and adolescents with obesity. Regular physical exercise must be considered as a natural part of a healthy lifestyle, and promoting physical activity starting from childhood is useful to limit the negative effects of obesity on health. The crucial role of the immune system in the development of obesity-induced inflammatory processes and the efficacy of exercise as an anti-inflammatory, non-pharmacological intervention may provide possible targets for the development of new treatments and early preventive strategies.

Lockdown Due to COVID-19 and Its Consequences on Diet, Physical Activity, Lifestyle, and Other Aspects of Daily Life Worldwide: A Narrative Review

The novel coronavirus, termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for the disease called coronavirus disease 2019 (COVID-19). Besides the important rates of mortality and morbidity directly attributed to the infection itself, many studies detected an important shift towards mostly unhealthy lifestyle patterns in previously healthy non-infected populations all around the world. Although most of the changes in lifestyle had or will have a negative impact on general population health status, some findings are encouraging. Notwithstanding that there was an obvious necessity for governments to apply national lockdowns, it is also necessary to identify and comprehend the consequences they have caused. A narrative literature review was performed, based on scientific articles and previous reviews. An accurate description of changes in eating habits and alcohol consumption, physical activity, mental health, daily routines, economic impacts, and broader effects on society is provided for each continent and different age groups through this review. The volume of selected scientific surveys encompasses approximately 400,000 persons.

Players at home: Physical activity and quality of life in 12-17 years-old football (soccer) players during the Covid-19 lockdown

BACKGROUND

Aggressive preventive actions were required to face the Covid-19 outbreak. However, from March 2020 on, many healthy youth football players have seen their sporting activities disrupted by the restrictions on outdoor exercise.This study describes physical activity and quality of life during April 2020 lockdown of young people participating in organized football.

METHODS

1163 young football players aged 12-17 years (185 girls) completed a web-based questionnaire including the Youth Physical Activity and the Youth Quality of Life-Short Form Questionnaires; information on lifestyle and football-specific activity were also collected. Differences according to sex, urban/rural context and élite/non-élite club level were tested using a 2 × 2  ×  2 MANOVA (age considered as a covariate).

RESULTS

We found that: (i) on average, exposure to football accounted for 3.2 hours/week, was higher in élite clubs and changed in nature, being mainly performed individually; 19% of participants practiced football <1 hour/week; (ii) only 56% of the participants reported 7 or more hours/week of moderate-to-vigorous physical activity, which decreased with age and changed according to the geographical context; (iii) perceived quality of life was lower in youth playing for non-elite clubs and in older girls; (iv) coaches, rather that official initiatives, were the primary source of football exercises practiced at home.

CONCLUSION

A status of limited physical activity emerged; this might lead to deconditioning and susceptibility to injuries when football could restart. Governing bodies, football Associations and clubs could exploit these results to take informed decisions and support evidence-based interventions during and after the Covid-19 pandemic.

A Systematic Review of the Impact of the First Year of COVID-19 on Obesity Risk Factors: A Pandemic Fueling a Pandemic?

Obesity is increasingly prevalent worldwide. Associated risk factors, including depression, socioeconomic stress, poor diet, and lack of physical activity, have all been impacted by the coronavirus disease 2019 (COVID-19) pandemic. This systematic review aims to explore the indirect effects of the first year of COVID-19 on obesity and its risk factors. A literature search of PubMed and EMBASE was performed from 1 January 2020 to 31 December 2020 to identify relevant studies pertaining to the first year of the COVID-19 pandemic (PROSPERO; CRD42020219433). All English-language studies on weight change and key obesity risk factors (psychosocial and socioeconomic health) during the COVID-19 pandemic were considered for inclusion. Of 805 full-text articles that were reviewed, 87 were included for analysis. The included studies observed increased food and alcohol consumption, increased sedentary time, worsening depressive symptoms, and increased financial stress. Overall, these results suggest that COVID-19 has exacerbated the current risk factors for obesity and is likely to worsen obesity rates in the near future. Future studies, and policy makers, will need to carefully consider their interdependency to develop effective interventions able to mitigate the obesity pandemic.

Exploring the impact of daily food habit and modification of lifestyle for boosting immunity against COVID-19

The lockdown crisis due to novel coronavirus (COVID-19) mainly affected people who live under economic despair. Since boosting the immune system against the virus depends on a variety of food intake and lifestyle approaches; hence, it is crucial to know how daily food habits and lifestyle modification protect from pathogenic viral infections. This study focused on the benefit of plant-based foods, functional foods and the modified lifestyle which enhance the immunity of all aged groups against COVID-19 in Bangladesh. An online close-ended randomly selected structured multiple-choice questionnaire survey was conducted for people of different parts of Bangladesh (n = 161; male 51.55%, female 48.45%). The total percentage was counted for all variables. We found that plant-based foods, functional foods, and physical exercise played a vital role in enhancing people's immunity to control COVID-19. Plant-based micronutrients, nutraceuticals and antioxidants mainly took part to boost the immune system against the virus. Furthermore, physical activity had a vital role in improving people's immunity to manage COVID-19. Literature suggested that food habits, body immunity, awareness, stress and weight variation were affected by the COVID-19 pandemic. The vaccine or proper medication of COVID-19 still remains in an enigma. In this situation, boosting immunity to combat Coronavirus is the only way to survive.

The Influence of Physical Activity on COVID-19 Prevention Among Quarantined Individuals: A Case–Control Study

Background

Patients and Methods

Results

Conclusion

The effects of the home-based exercise during COVID-19 school closure on the physical fitness of preschool children in China

BACKGROUND

Social distancing and school closures during the COVID-19 pandemic reduced the physical activities of the preschool children living in China. However, the effects of home-based exercise on the physical fitness of Chinese preschool children during COVID-19 school closures are still unknown. This study aimed to investigate the effects of home-based exercise on the physical fitness of Chinese preschool children during COVID-19 school closure.

METHODS

In this retrospective analysis, data from 1,608 Chinese preschool children (aged 3-5.5 years) in a second-tier city of Guangdong Province of China (Zhongshan city) were extracted from three successive National Physical Fitness Measurement (NPFM) from 2019 to 2021. NPFM consists of weight, height, and six subtests of physical fitness including 10-m shuttle run test (SRT), standing long jump (SLJ), balance beam walking (BBW), sit-and-reach (SR), tennis throwing (TT), and double-leg timed hop (DTH) tests. The change differences or change ratios of all the items in NPFM between any two successive years from 2019 to 2021 were compared. The exercise profiles about home-based and outdoor exercise before, during, and after COVID-19 school closure were obtained from 185 preschool children via retrospective telephone survey.

RESULTS

Between 2019 and 2021, 1,608 preschool children were included in this study. We observed larger changes in SLJ, SR, TT, and DTH tests during school closure than after school closure. But the children showed lower reduction rates in the completion time of SRT and BBW. During school closure, higher change ratios in SLJ and TT were observed in the children primarily participating in home-based exercise than those primarily participating in outdoor exercise. However, no statistical differences were observed in the changes in SRT and BBW between home-based and outdoor training groups.

CONCLUSION

The home-based exercise program might be an alternative approach to improve the physical fitness of preschool children during COVID-19 school closure, but could not be beneficial to speed-agility and balance functions. A specific guideline geared toward a home-based exercise program during the COVID-19 outbreak is highly needed.

Effect of the COVID-19 pandemic on the psychotropic drug consumption

IMPORTANCE

Although the COVID-19 pandemic has had a negative impact on mental health, there is no comprehensive longitudinal study of the entire population of a country without selection bias.

OBJECTIVE

The objective of this study was to evaluate the prescription of psychotropic drugs during the COVID-19 pandemic, using data from the French national health data system (SNDS).

DESIGN SETTINGS AND PARTICIPANTS

Prescriptions for psychotropic drugs (antidepressants, anxiolytics, hypnotics, and antipsychotics) from 1 January 2015 to 30 September 2021 were collected from administrative data provided by the SNDS. This database includes more than 99% of the French population, i.e., 67 million people. The data were analyzed using an interrupted time series analysis (ITSA) model.

MAIN OUTCOMES AND MEASURES

Consumption of psychotropic drugs was aggregated in months and expressed in number of boxes per thousand inhabitants.

RESULTS

During the study period, more than 1.3 billion boxes of psychotropic medications were dispensed. Comparison of psychotropic drug dispensing before and after the pandemic showed a relative increase of 0.76 (95 CI 0.57 to 0.95, p<0.001) boxes per month per thousand inhabitants, all classes of psychotropic drugs combined. Three classes saw their consumption increase in an almost similar proportion, respectively, by 0.23 (0.15 to 0.32, p<0.001) boxes for antidepressants, 0.27 (0.20 to 0.34, p<0.001) boxes for anxiolytics and 0.23 (0.17 to 0.30, p<0.001) boxes for hypnotics. The change in antipsychotic consumption was very small, with an increase of 0.04 boxes (0.02 to 0.06, p = 0.001) per month per thousand population.

CONCLUSION AND RELEVANCE

The COVID-19 pandemic had led to an increase in the consumption of psychotropic drugs, confirming the significant impact of the pandemic on the mental health of the general population.

Impact of COVID-19 pandemic lockdown on movement behaviours of children and adolescents: a systematic review

INTRODUCTION

Several studies have examined how the lockdown restrictions enforced to halt the spread of COVID-19 have affected children and adolescents' movement behaviours, but there is a need to synthesise these findings. Therefore, we conducted this systematic review to examine the impact of COVID-19 lockdown on children and adolescents' movement behaviours.

METHODS

We searched eight databases and grey literature for relevant studies of all study designs; and conducted a narrative analysis of the results following synthesis without meta-analysis guidelines. We used appropriate tools to assess the risk of bias in quantitative and qualitative studies. We compared changes in physical activity, screen time and sleep duration and quality from before to during the COVID-19 lockdown.

RESULTS

This review included 71 studies reporting data from 35 countries and territories, mostly from high-income economies. A majority of the studies used a cross-sectional design and had fair to poor-quality ratings. Most studies reported reduced physical activity, increased screen time and longer sleep hours among children and adolescents. Children and adolescents facing strict lockdowns saw a larger decline in physical activity and a sharper increase in screen time than those under mild restrictions.

CONCLUSION

COVID-19-related lockdowns were detrimental to children and adolescents' movement behaviours, with stricter lockdowns tending to have a bigger impact. Children and adolescents under COVID-19 restrictions are likely to be less active, spend more time on screen, and sleep longer hours than before the lockdown. More studies from low-income and middle-income countries could provide a clearer picture of the impact.

PROSPERO REGISTRATION NUMBER

CRD42021245924.

Combatting Sedentary Behaviors by Delivering Remote Physical Exercise in Children and Adolescents with Obesity in the COVID-19 Era: A Narrative Review

The coexistence of childhood obesity (or its risk) and COVID-19 pandemic put children and adolescents in greater risk to develop respiratory and cardiovascular diseases. In fact, the restrictions introduced to limit the spread of the virus had detrimental effects on various lifestyle components, especially in young population. This resulted in augmented levels of physical inactivity and sedentary behaviors and a reduced time spent in play outdoors or sport practices. Contrariwise, the increased use of technology led clinicians, teachers, and trainers to maintain relations with obese children/adolescents so as to reduce sedentary behaviors and the associated health risks. This narrative review aims to describe the role of Telehealth and Tele-exercise as useful tools in the management of pediatric obesity during COVID-19 pandemic. Telehealth and Tele-exercise were effective in promoting self-monitoring and behavioral changes, including adherence to exercise training programs in children and adolescents. Moreover, tele-exercise platforms such as applications or exergames allowed flexible scheduling, limiting the infection risks.

COVID-19 Pandemic as Risk Factors for Excessive Weight Gain in Pediatrics: The Role of Changes in Nutrition Behavior. A Narrative Review

During the coronavirus disease 2019 (COVID-19) pandemic, social isolation, semi-lockdown, and "stay at home" orders were imposed upon the population in the interest of infection control. This dramatically changes the daily routine of children and adolescents, with a large impact on lifestyle and wellbeing. Children with obesity have been shown to be at a higher risk of negative lifestyle changes and weight gain during lockdown. Obesity and COVID-19 negatively affect children and adolescents' wellbeing, with adverse effects on psychophysical health, due in large part to food choices, snacking between meals, and comfort eating. Moreover, a markable decrease in physical activity levels and an increase in sedentary behavior is associated with weight gain, especially in children with excessive weight. In addition, obesity is the most common comorbidity in severe cases of COVID-19, suggesting that immune dysregulation, metabolic unbalance, inadequate nutritional status, and dysbiosis are key factors in the complex mechanistic and clinical interplay between obesity and COVID-19. This narrative review aims to describe the most up-to-date evidence on the clinical characteristics of COVID-19 in children and adolescents, focusing on the role of excessive weight and weight gain in pediatrics. The COVID-19 pandemic has taught us that nutrition education interventions, access to healthy food, as well as family nutrition counselling should be covered by pediatric services to prevent obesity, which worsens disease outcomes related to COVID-19 infection.

Adjustments in Food Choices and Physical Activity during Lockdown by Flemish Adults

Background: On Wednesday 18/03/2020 Belgium was placed in lockdown in order to curb the spread of COVID-19. Lockdown can lead to loneliness, boredom, anger, anxiety and depression, which in turn have an influence on food choices and physical activity (PA). This study aims to map the adjustments in food choices and PA by Flemish adults during lockdown. Methods: Chi square tests were performed to investigate the relationship between adjustments in food choices, PA and demographic variables. Results: A total of 1.129 respondents filled in the online questionnaire, aged between 18 and 81 years. The healthiest food choices were made by respondents living alone during lockdown, whilst people cohabiting with others increased their PA significantly. Moreover, the dietary adjustments of adults living with children evolved more favourably to healthier choices then those cohousing with other adults. However, respondents living with other adults showed a more favourable pattern regarding adjustments in PA. The strongest increase in sedentary behaviour was observed in students. Conclusions: This study shows the impact of lockdown on both PA and food choices, where healthier adjustments were observed in PA and respondents were prone to consume unhealthier food.

Telehealth: A Useful Tool for the Management of Nutrition and Exercise Programs in Pediatric Obesity in the COVID-19 Era

The COVID-19 pandemic has led to the implementation of policies that mandate various restrictions on daily life, including social distancing, the closure of public services and schools, and movement limitations. Even though these restrictive measures decreased the COVID-19 spread, they may have detrimental effects on various lifestyle components such as physical inactivity, sedentary behavior, and dietary habits, influencing the maintenance of weight and contributing to obesity among children and adolescents. The coexistence of childhood obesity and COVID-19 and changes in the bioecological environment have put children and adolescents at increased risk for developing obesity and exacerbating the severity of this disorder. The use of telehealth technology is a modern approach useful for the delivery of health care services by health care professionals, where distance is a critical factor. Telehealth is effective in promoting increased self-monitoring and behavioral change, and provides the opportunity to perform online nutritional support and exercise training programs to promote a healthy lifestyle and reduce sedentary behaviors in children and adolescents. Telehealth, including tele-exercise and tele-nutrition, has the potential to address many of the key challenges in providing health services, including in patients with obesity during the COVID-19 outbreak. This narrative review aims to describe the role of telehealth as an opportunity in the management of pediatric obesity in the COVID-19 era, and to deliver nutrition and exercise programs for the maintenance of health.

Suicidality in Bangladeshi Young Adults During the COVID-19 Pandemic: The Role of Behavioral Factors, COVID-19 Risk and Fear, and Mental Health Problems

BACKGROUND

It is said that psychological stressors have risen during the COVID-19 pandemic, which may contribute to suicidality. A few studies were conducted investigating suicidality amid the first wave of the pandemic in Bangladesh, but none of these studies explored the predictive role of the suicidality-related factors (eg, behavior and health-related variables, COVID-19 risk, fear of COVID-19). Thus, this study aimed to investigate the prevalence of suicidality and the predictive models explaining suicidality variance among Bangladeshi young adults during the second wave of the pandemic.

METHODS

An online-based cross-sectional survey was conducted during the second wave of the pandemic (between 1 and 13 April 2021; a year after the pandemic's inception in the country). The survey questionnaire collected information on socio-demographics, behavior and health-related variables, COVID-19 risk, fear of COVID-19, depression, anxiety, and suicidality. A total of 756 data were analyzed (male 59%; mean age 22.24 ±4.39 years), and hierarchical regression was performed considering suicidality as the dependent variable. A p-value <0.05 was set to be statistically significant with a 95% of confidence interval.

RESULTS

About 8.2% reported having at least suicidal thoughts within the pandemic inception to survey time (one-year suicidal ideation). More specifically, 7.40% had only suicidal ideation, whereas 0.10% planned for suicide, 0.70% attempted suicide. None of the socio-demographic variables was significantly associated with suicidality. Taking drugs, performing less physical activity, poor self-reporting health condition, being comorbid, being at higher COVID-19 risk, having fear of COVID-19 infection, and suffering from depression and anxiety were significantly associated with a higher risk of suicidality. However, the final model including all of the studied variables explained a 17.1% (F=8.245, p<0.001) variance in terms of suicidality.

CONCLUSION

Although this study reported a lower severity of suicidality than prior Bangladeshi studies conducted during the first wave of the pandemic, a portion of people are still at risk of suicide and they should be given attention.

A Rapid Review on the Influence of COVID-19 Lockdown and Quarantine Measures on Modifiable Cardiovascular Risk Factors in the General Population

Preceding coronavirus outbreaks resulted in social isolation, which in turn is associated with cardiovascular consequences. Whether the current COVID-19 pandemic negatively impacts cardiovascular health is unclear. The aim of the rapid review was to investigate, whether COVID-19 lockdown influences modifiable cardiovascular risk factors (i.e., physical inactivity, sedentary behaviour, smoking, alcohol use, unhealthy diet, obesity, bad blood lipids, and hypertension) in the general population. Medline and EMBASE were searched until March 2021. Title, abstracts, and full texts were screened by one reviewer and 20% by a second reviewer. Only studies using probability sampling were included in order to ensure the representativeness of the target population. Data extraction and critical appraisal were done by one reviewer and double-checked by another reviewer. We identified 32 studies that fulfilled our inclusion criteria. Findings show that physical activity decreased, and sedentary behaviour increased among all age groups during the COVID-19 lockdown. Among adults, alcohol consumption increased, dietary quality worsened, and the amount of food intake increased. Some adults reported weight gain. Studies on children and adolescents were sparse. This rapid review found a high number of epidemiological studies on the impact of COVID-19 lockdown measures on modifiable cardiovascular risk factors, but only a few used probability sampling methods.

Body Mass Index, Practice of Physical Activity and Lifestyle of Students During COVID-19 Lockdown

Purpose

Several factors influence the student’s physical activity and lifestyle. The coronavirus disease (COVID‐19) lockdown has restricted student’s activity and altered their routine lifestyle. This prospective cohort study aimed to determine the significant changes in body mass index (BMI), physical activity, and lifestyle of the students including diet, sleep, and mental health before and during COVID-19 lockdown.

Methods

The study participants were 628 students studying bachelor’s degree programs, between 18 and 30 years of age, both genders from the university of Al-Ahsa, Saudi Arabia. The lockdown began on 23 March and ended on 21 June 2020 in Saudi Arabia. The students were interviewed before (March 2020) and during (June 2020) lockdown. The structured tool included baseline information of the students, anthropometric data, global physical activity questionnaire (GPAQ), dietary recall, Pittsburgh sleep quality index (PSQI), and perceived stress scale (PSP). Chi-square tests were used to associate the baseline information with BMI changes during the lockdown.

Results

BMI of the students showed that 32% increased their weight, 22% lost their weight and 46% maintained the same weight during COVID-19 lockdown. The physical activity significantly decreased and sedentary time increased (p = 0.0001). Regarding the lifestyle components, fast and fried food consumption decreased, and calorie intake increased significantly (p = 0.001). Stress level (p = 0.001) significantly decreased, and sleep level (p = 0.001) increased during lockdown. The variables associated with weight changes were the level of students (p < 0.05) and time spent on social media per day (p < 0.0001).

Conclusion

Though half of the students maintained the same BMI during the lockdown, students who increased BMI were associated with physical activity and lifestyle. Hence, health awareness on weight maintenance, active physical activities, and a healthy lifestyle must be created among the students, which help in creating and implementing policies in the future.

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"CoVidentary": An online exercise training program to reduce sedentary behaviours in children with type 1 diabetes during the COVID-19 pandemic

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Covid-19 restrictions disrupted physical activities in children with type 1 diabetes.

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Diabetes management worsened in glycemia values and insulin delivery.

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Active breaks rather than structured training may interrupt sedentary in children with type 1 diabetes.

Aim

We explored the physical activity (PA) level and the variation in glycaemic control in children with type 1 diabetes (T1D) before and during the lockdown. Then, we proposed an online training program supported by sport-science specialists.

Methods

Parents of children with T1D (<18 years) filled out an online survey. Anthropometric characteristics, PA, play, sport and sedentary time and the medical related outcomes were recorded. An adapted online program “Covidentary” was proposed through full-training (FT) and active breaks (AB) modality.

Results

280 youth (11.8 ± 3.3 years) were included in the analysis. We reported a decline in sport (-2.1 ± 2.1 h/week) and outdoor-plays (-73.9 ± 93.6 min/day). Moreover, we found an increase in sedentary time (+144.7 ± 147.8 min/day), in mean glycaemic values (+25.4 ± 33.4 mg/dL) and insulin delivery (71.8% of patients). 37% of invited patients attended the training program, 46% took part in AB and 54% in FT. The AB was carried out for 90% of the total duration, while the FT for 31%. Both types of training were perceived as moderate intensity effort.

Conclusion

A decline of participation in sport activities and a subsequent increase of sedentary time influence the management of T1D of children, increasing the risk of acute/long-term complications. Online exercise program may contrast the pandemic's sedentary lifestyle.

Physical Activity during COVID-19 Lockdown in Italy: A Systematic Review

The recent COVID-19 pandemic has imposed a general lockdown in Italy, one of the most affected countries at the beginning of the outbreak, between 9 March and 3 May 2020. As a consequence, Italian citizens were confined at home for almost two months, an unprecedented situation, which could have negative effects on both psychological and physical health. The aim of this study was to review the published papers concerning the effects of the lockdown on physical activity and the consequences on general health. As expected, most studies highlighted a significant reduction in the amount of performed physical activity compared to before lockdown, in both the general population and in individuals with chronic conditions. This fact had negative consequences on both general health, in terms of increased body mass, and on specific chronic conditions, especially obesity and neurological diseases.

COVID-19 lockdown and lifestyles: A narrative review

Background: The primary objective worldwide during the coronavirus disease 2019 (COVID-19) pandemic has been controlling disease transmission. However, lockdown measures used to mitigate transmission have affected human behavior and altered lifestyles, with a likely impact on chronic non-communicable diseases. More than a year into the pandemic, substantial peer-reviewed literature has emerged on altered lifestyles following the varying lockdown measures imposed globally to control the virus spread. We explored the impact of lockdown measures on six lifestyle factors, namely diet, physical activity, sleep, stress, social connectedness, and the use of tobacco, alcohol, or other harmful substances. Methods: We comprehensively searched PubMed and the World Health Organization’s global literature database on COVID-19 and retrieved 649 relevant articles for the narrative review. A critical interpretative synthesis of the articles was performed. Results: Most of the articles included in the review identified the negative effect of lockdown measures on each of the lifestyle factors in many parts of the world. Encouraging lifestyle trends were also highlighted in a few articles. Such trends can positively influence the outcome of lifestyle-related chronic diseases, such as obesity and diabetes. Conclusions: The COVID-19 pandemic provides an opportunity to better understand the negative impact of strict lockdown measures on lifestyles. At the same time, it helps us identify and initiate positive behavioral changes, which, if consolidated, could improve chronic disease outcomes. It is up to governments, communities, and healthcare/academic entities to derive benefit from lessons learned from the pandemic, with the ultimate objective of better educating and promoting healthy lifestyles among communities.

The Physical Fitness Level of College Students Before and After Web-Based Physical Education During the COVID-19 Pandemic

Background: The COVID-19 pandemic has been an emergency worldwide. Web-based physical education is a choice for college students to keep on their study. The aim of this study was to compare the data of physical fitness of college students before and after web-based physical education. Methods: All the students of 2018 and 2019 in Wuhan University of Technology who had taken the web-based physical education class in 2020 were included in this study. The records of annual physical fitness tests of all the subjects in 2019 and 2020 which were carried out in September were reviewed, including weight, height, body mass index (BMI), vital capacity (VC), 50-m dash, sit-and-reach, standing long jump, male-specific pull-ups and 1,000-m race, and female-specific sit-ups and 800-m race. Results: There were 24,112 male and 9,690 female records of physical fitness tests included in our study. The results of 11,219 male and 4,651 female students who completed both physical fitness tests in 2019 and 2020 were employed for Wilcoxon signed-rank test. Declined performance was observed on male 50-m dash by 0.1 s, male 1,000-m race by 14 s, and female 800-m race by 11 s. Notably, the percentage of male obesity, based on BMI, rose from 10.6 to 15.2% and 17.1 to 21.8% for male overweight; correspondingly, the percentage of male normal weight declined from 55.9 to 51.9% and 16.4 to 11.1% for male thinness. The trend of increasing BMI in males should be paid attention to. Improved results on vital capacity, sit-and-reach, standing long jump for both males and females, female 50-m dash, female sit-ups, and male pull-ups were observed in 2020. All the results of physical fitness tests were significantly different between 2019 and 2020 (p < 0.01) by Wilcoxon signed-rank test. Conclusions: The changes of physical fitness tests before and after web-based physical education suggested that the focus should be placed on improvement for running tests through appropriate alternatives, such as fast running in place and shuttle run. In addition, the simple, convenient, and practical sport that require available equipment and little field should be considered for web-based physical education.