Psychological Impact of the Quarantine-Induced Stress during the Coronavirus (COVID-19) Outbreak among Italian Athletes

Supporting athletes during a challenging situation: recommendations from a global insight of COVID-19 home-based training experience

BACKGROUND

For athletes, overcoming obstacles in challenging situations like pandemic home training is crucial. Strategies and approaches in this context are not well-documented. Our study aims to investigate such a scenario from a performance standpoint, based on a major global crisis: the COVID-19 pandemic and lockdown.

METHODS

This cross-sectional study surveyed athletes without disabilities using online questionnaires (35 languages) from May to July 2020. Questions included aspects of alternative routines, training monitoring, recovery, sleep patterns, injury occurrence/prevention based on structured answers, and an open-ended question on lockdown training experiences.

RESULTS

Of the 11,762 athletes from 142 countries, 63% were male, including at World-Class, International, National, State and Recreational levels. During lockdown, 25% athletes used innovative or modern ways to maintain or improve fitness e.g., virtual reality and tracking devices (favoring World-Class level, 30%). Many athletes, regardless of gender (43%) watched video competitions to improve/maintain their mental skills and performance [World-Class (47%) and International (51%)]. Contact frequency between athletes and their coaches was mainly at least once a week (36%), more among higher-level (World-Class/International) than lower-level athletes (27 vs. 16%). Higher-level athletes (≥ 54%) monitored training load and were assisted by their coaches (21%). During lockdown, stretching (67%) was considered one of the primary means of recovery, especially for higher-level athletes (> 70%). Compared to pre-lockdown, about two-thirds of athletes reported "normal" or "improved" sleep quality and quantity, suggesting a low sleep quality pre-lockdown. On average, 40% utilized injury prevention exercises (at least) once a week [World-Class (51%) and International (39%)]. Most injury occurrences during lockdown involved the knee (18%), ankle (16%), and back (9%). Four key themes emerged regarding lockdown experiences: remote training adaptation (e.g., shifting training focus), training creativity (e.g., using household items), performance enhancement opportunities (e.g., refocusing neglected aspects), and mental and motivation challenges.

CONCLUSIONS

Both male and female athletes, particularly those of higher levels, displayed some adaptalibity during the COVID-19 lockdown, employing innovative approaches and technology for training. Many athletes implemented load monitoring, recovery, and attentive of injury prevention, while optimizing their sleep quality and quantity. Athletes demonstrated their abilities to navigate challenges, and utilized different coping strategies in response to the lockdown's constraints.

Balletic bodies under lockdown: The consequences of a pandemic for highly disciplined habitus

Like other elite athletes, ballet dancers are highly dedicated to the pursuit of their vocation. They work to perfect their bodies, their movements and their expression of the art form. The lockdowns that occurred during the COVID-19 pandemic represented a significant interruption to the extraordinary but everyday lives of ballet dancers, creating unique environments where exploration of the embodied habitus of ballet can be further investigated. The impacts of lockdown upon dancers were explored via a series of interviews with 12 professional dancers from Germany. Framed by previous research, theorising the balletic body from a Bourdieusian perspective, interview data were analysed using Interpretative Phenomenological Analysis. Our research highlights the way in which COVID-19 lockdowns and associated restrictions disrupt the habitus of dancers and results in a form of suffering that is comparable to injury or chronic illness. Our research suggests that individuals respond to the 'structural injuries' of lockdown measures in a manner comparable to the way they respond to physiological injury. Thus, dancers sought to repair or re-establish the social structures they ordinarily inhabit whilst the inevitable limitations of such efforts engendered occasions for reflexive thinking about their role, careers and identity as dancers.

Implications of the COVID-19 pandemic on athletes, sports events, and mass gathering events: Review and recommendations

Since the coronavirus disease 19 (COVID-19), which caused several respiratory diseases, was formally declared a global pandemic by the World Health Organization (WHO) on March 11, 2020, it affected the lifestyle and health of athletes, both directly through cardiorespiratory and other health related effects, and indirectly as the pandemic has forced the suspension, postponement, or cancellation of most professional sporting events around the world. In this review, we explore the journey of athletes throughout the pandemic and during their return to their competitive routine. We also highlight potential pitfalls during the process and summarize the recommendations for the optimal return to sport participation. We further discuss the impact of the pandemic on the psychology of athletes, the variance between the team and individual athletes, and their ability to cope with the changes. Moreover, we specifically reviewed the pandemic impact on younger professional athletes in terms of mental and fitness health. Finally, we shaded light on the various impacts of mass gathering events and recommendations for managing upcoming events.

Post-Traumatic Stress Disorder and Mental Health in Chinese College Athletes during and after the COVID-19 Pandemic: The Multiple Mediating Effects of Basic Psychological Needs and Generalized Anxiety Disorder

Psychological issues have a complex and multidimensional impact on a college athlete's training and performance. As the reserve talent of competitive sports, it is very important to investigate the psychological health of athletes. This study aims to explore the association between generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), basic psychological needs (BPN), and mental health (MH) among Chinese college athletes. Chinese college athletes who were willing to participate in the study, had participated in national competitions, and had a Chinese athlete rating certificate were included in this study. Participants completed the Kessler Psychological Distress Scale (K10), the Generalized Anxiety Disorder Scale (GAD-7), the Impact of Event Scale-Revised (IES-R), and the Basic Needs Satisfaction in General Scale (BNSG-S). The study involved 665 college athletes (415 males and 250 females), with an average age of 20.43 years (SD = 1.68). We performed descriptive statistics, correlation analyses, and moderated chain mediation analyses using SPSS 22.0 and Hayes' PROCESS macro. The results of the final model showed that basic psychological needs were positively correlated with mental health (r = 0.443, p < 0.001), while PTSD (r = -0.346, p < 0.001) and generalized anxiety disorder (r = -0.527, p < 0.001) were negatively correlated with mental health among college athletes. There were significant indirect impacts. According to the bootstrapping results, basic psychological needs and generalized anxiety disorder played a mediating role in 22.54% and 50.29% of the total effects of PTSD on mental health, respectively. Meanwhile, the chain mediating effect of basic psychological needs and generalized anxiety disorder (7.23%) was also significant. The study's findings advance our understanding of the connections between PTSD and mental health and highlight the significant roles played by basic psychological needs and generalized anxiety disorder in that link among Chinese college athletes.

T-cell-derived TNF-α and a cluster of immunological parameters from plasma allow a separation between SARS-CoV-2 convalescent versus vaccinated elite athletes

Guidelines for medical clearing after SARS-CoV-2 infection in elite athletes do not include T-cell immunity aspects despite its relevance in the course of COVID-19 disease. Therefore, we aimed to analyze T-cell-related cytokines before and after in-vitro activation of CD4⁺ T-cells. We sampled professional indoor sports athletes at medical clearing after SARS-CoV-2 infection obtaining clinical, fitness data, and serological data including CD4⁺ T-cell cytokines. All data were analyzed by principal component analysis and 2 × 2 repeated measures ANOVA. CD4⁺ T-cells were sampled for cell culture activation with anti-CD3/anti-CD28 tetramers. At medical clearing, CD4⁺ T-cells from convalescent athletes secreted increased levels of TNF-α 72 h after in-vitro activation compared to vaccinated athletes. IL-18 levels in plasma were elevated and a cluster of parameters differentiated convalescent from vaccinated athletes by 13 parameters at the timepoint of medical clearing. All clinical data indicate infection is resolved, while increased TNF-α may reflect altered proportions of peripheral T-cells as a hangover of infection.

Impact of Prolonged Cessation of Organized Team Training Due to the COVID-19 Pandemic on the Body Composition of Japanese Elite Female Wheelchair Basketball Athletes

Studies on the effects of training confinement on athletes with physical impairments are limited. Hence, in this retrospective cohort study, we aimed to investigate the impact of prolonged cessation of organized team training due to the coronavirus disease 2019 pandemic on the body composition of elite female Japanese basketball athletes. Fourteen female wheelchair basketball athletes (aged ≥20 years) were enrolled. The primary outcomes were lean and adipose indices measured using whole-body dual-energy X-ray absorptiometry. The impact of prolonged organized team training cessation on body composition was investigated by comparing the body composition at baseline and post-training confinement. A reduced whole-body lean mass (p = 0.038) and percent lean mass (p = 0.022), as well as an increased percent body fat (p = 0.035), were observed after the confinement period. The regional analysis revealed reduced percent lean and increased percent fat masses in the trunk (p = 0.015 and p = 0.026, respectively) and upper limbs (p = 0.036 and p = 0.048, respectively). In conclusion, prolonged organized team training cessation reduced lean mass and increased body fat percentage, primarily in the trunk and upper limbs. Individualized training programs targeting these body regions should be implemented to improve body composition and physical conditions in athletes during and after prolonged cessation of organized team training.

Athlete level, sport-type, and gender influences on training, mental health, and sleep during the early COVID-19 lockdown in Malaysia

Purpose: We evaluated the extent of changes in training practices, recovery, mental health, and sleep patterns of athletes during the early COVID-19 lockdown in a single country-cohort. Methods: A total of 686 athletes (59% male, 41% female; 9% World Class, 28% International, 29% National, 26% State, 8% Recreational) from 50 sports (45% individual, 55% team) in Malaysia completed an online, survey-based questionnaire study. The questions were related to training practices (including recovery and injury), mental health, and sleep patterns. Results: Relative to pre-lockdown, training intensity (-34%), frequency (-20%, except World-Class), and duration (-24%-59%, especially International/World-Class) were compromised, by the mandated lockdown. During the lockdown, more space/access (69%) and equipment (69%) were available for cardiorespiratory training, than technical and strength; and these resources favoured World-Class athletes. Most athletes trained for general strength/health (88%) and muscular endurance (71%); and some used innovative/digital training tools (World-Class 48% vs. lower classification-levels ≤34%). More World-Class, International, and National athletes performed strength training, plyometrics, and sport-specific technical skills with proper equipment, than State/Recreational athletes. More females (42%) sourced training materials from social media than males (29%). Some athletes (38%) performed injury prevention exercises; 18% had mild injuries (knees 29%, ankles 26%), and 18% received a medical diagnosis (International 31%). Lower-level athletes (e.g., State 44%) disclosed that they were mentally more vulnerable; and felt more anxious (36% vs. higher-levels 14%-21%). Sleep quality and quantity were "normal" (49% for both), "improved" (35% and 27%), and only 16% and 14% (respectively) stated "worsened" sleep. Conclusion: Lockdown compromised training-related practices, especially in lower-level athletes. Athletes are in need of assistance with training, and tools to cope with anxiety that should be tailored to individual country requirements during lockdown situations. In particular, goal-driven (even if it is at home) fitness training, psychological, financial, and lifestyle support can be provided to reduce the difficulties associated with lockdowns. Policies and guidelines that facilitate athletes (of all levels) to train regularly during the lockdown should be developed.

Psychometric Analysis of the Quarantine Coping Strategies Scale (Q-COPE) in the Spanish Language

The possibility of facing an epidemic or pandemic resulting in mandatory isolation or quarantine has become a relevant construct for comparing and evaluating coping strategies under such conditions. The objective of this research was to develop and analyze the psychometric properties of a scale to assess quarantine coping strategies (Q-COPE). This was an instrumental study and 1110 Peruvian adults (M = 26.9 years; SD = 9.77) participated in the context of social isolation. For the construction of the scale, qualitative and quantitative procedures were followed. The internal structure was evaluated by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The content analysis by expert judges supports the representativeness of the items related to the construct. EFA and CFA allowed the establishment of five factors: Emotional regulation, Information, Accommodation, Social support, and Altruism. The first-order model presents adequate goodness-of-fit indices: χ² = 489.048, df = 220, χ²/df = 2.223, SRMR = 0.025, CFI = 0.969, TLI = 0.965, RMSEA = 0.047. Likewise, the second order model presented similar values: χ² = 499.674, df = 225, χ²/df = 2.221, SRMR = 0.026, CFI = 0.969, TLI = 0.965, RMSEA = 0.047. The 23-item version was consistent with the proposed theory, obtained adequate fit indices and acceptable factor loadings (>0.70), and presented good internal consistency indexes evaluated by Cronbach's α, ordinal α, omega (ω), and H coefficient. It is concluded that the Q-COPE scale presents good psychometric properties that justify its use in an adult population and allows the assessment of the coping strategies that people use in the face of a quarantine situation.

Relationship between Psychological Distress, Basic Psychological Needs, Anxiety, Mental Pressure, and Athletic Burnout of Chinese College Football Athletes during the COVID-19 Pandemic

The rapid spread of the COVID-19 pandemic in early 2020 poses a significant threat to mental health, which may lead to psychological stress in a number of individuals. Athlete burnout is a common psychological phenomenon that has a negative influence on their sports career. The main purpose of this study was to evaluate the relationship between psychological distress and athletic burnout among Chinese college football athletes during the COVID-19 pandemic, and the mediating role of basic psychological needs, anxiety and mental pressure. In an online cross-sectional survey conducted in February 2022, the team coaches sent an electronic questionnaire to college football athletes. Participants completed questionnaires on relevant variables. Pearson correlation analysis and mediation effect analysis were carried out by using SPSS software and its plug-in process V3.3. The study included 672 participants and the results showed that: (1) psychological distress, basic psychological needs, anxiety, mental pressure and athletic burnout were significantly pairwise correlated, (2) mental pressure, anxiety and basic psychological needs play a mediating role between psychological distress and athletic burnout respectively, and (3) basic psychological needs and anxiety, basic psychological needs and mental pressure, anxiety and mental pressure, as well as mental pressure, anxiety and basic psychological needs respectively play a chain mediating role between psychological distress and athletic burnout. In conclusion, psychological distress during the COVID-19 pandemic is an important factor leading to athletic burnout among Chinese college football athletes and may further affect the level of athletic burnout through basic psychological needs, anxiety and mental pressure. The government and schools should strengthen the recognition of these factors in order to improve the situation of athletic burnout among Chinese college football athletes.

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.

The psychological impact of quarantine due to COVID-19: A systematic review of risk, protective factors and interventions using socio-ecological model framework

Background

Though quarantine is a pertinent control measure for the spread of COVID-19, it is equally important to consider its negative impacts, as it causes severe psychological, emotional, and financial problems not only for those who are quarantined but also for many others who are directly or indirectly connected to those who are quarantined. There appears to be a need to synthesise the available literature evidence on the psychological impact of quarantine experience, especially the multilevel risk factors that make individuals vulnerable to psychological impact and the protective factors to deal with the negative effects of quarantine.

Objective

This systematic review attempted to identify the various psychological impacts associated with the experience of quarantine, the risk and protective factors and list out various psycho-social interventions that can minimise the risks and facilitate the protective factors associated with the experience of quarantine.

Methods

A systematic search adhering to the PRISMA guidelines was performed in four databases PubMed, Scopus, PsycNet, Web of Science and 10518 articles related to COVID-19 and quarantine were obtained. After screening processes and quality assessment using standard checklist 74 articles that fulfilled the eligibility criteria were chosen for the final review.

Findings

Individuals subjected to quarantine had anxiety, depression, post-traumatic stress symptoms, sleep problems, and somatic difficulties. Some of the key risk factors during quarantine are young age, female gender, low money, fear of infection, poor sleep quality, reduced physical activity, increased sedentary behaviours, and a lack of social support. Financial difficulties and stigma remained risk factors even after the quarantine period had ended. Key protective factors were coping skills, home based exercise, leisure, recreational activities, maintaining relationships using social media and availability of mental health services. The findings also highlight the necessity for tele mental health interventions to address the psychological effects of quarantine.

Conclusion

Multilevel interventions are required to minimise the impact of risk factors and enhance protective factors.

Impact of COVID on Sports Injury Patterns, Changes in Mental Well-Being, and Strategies to Prepare for Future Pandemics in Sport

ABSTRACT

This review describes the available evidence of the acute respiratory syndrome coronavirus 2 (SARS-CoV-2, referred to COVID-19) pandemic on musculoskeletal injury patterns and prevalence in athletes. A brief overview of the epidemiology of COVID-19 and prevalence in active populations from youth through professional are provided. Responses to COVID-19 regarding sport participation at regional, national, and international organizations are summarized. Downstream effects of complete or partial training shutdown on injury risk and mental health are discussed. Strategies to maintain athletic potential and overall well-being include maintaining safe access to training facilities and resources, implementation of injury prevention programs, organization of athlete support networks, and incorporation of resilience and coping training.

Adapted physical activity in subjects and athletes recovering from covid-19: a position statement of the Società Italiana Scienze Motorie e Sportive

Coronavirus disease 2019 (COVID-19) is a worldwide pandemic illness that is impacting the cardiovascular, pulmonary, musculoskeletal, and cognitive function of a large spectrum of the worldwide population. The available pharmacological countermeasures of these long-term effects of COVID-19 are minimal, while myriads of non-specific non-pharmacological treatments are emerging in the literature. In this complicated scenario, particular emphasis should be dedicated to specific exercise interventions tailored for subjects and athletes recovering from COVID-19. Specific guidelines on adapted physical activity in this critical population are unavailable so far, therefore, in this position statement of the Società Italiana di Scienze Motorie e Sportive (SISMeS) the members of the steering committee of the research group Attività Motoria Adattata, Alimentazione, Salute e Fitness have indicated the adapted physical activity approaches to counteract the long-term effects of the COVID-19, both in good health people and athletes.

Athletes and Coaches through the COVID-19 Pandemic: A Qualitative View of Goal Management

Since the end of 2019 and throughout 2020, the world has been devastated by the COVID-19 pandemic. The sports world suddenly had to deal with a massive reorganization of events with important implications for the physical and psychological preparation of athletes and coaches. The purpose of this study was to explore how these changes impacted coaches’ and athletes’ goal-setting strategies and their experience of goal adjustment. As part of a wider mixed-method project involving 2162 coaches and 1354 athletes, an online qualitative survey was used, and data collected were analyzed using reflexive thematic analysis. Findings highlighted three overarching themes, in response to goal adjustment: “Moving on toward new goals”, “Letting go of goals”, and “Trying to hold on”, with several themes and sub-themes identifying different nuances of athletes’ and coaches’ experiences. The implications of such findings for the mental preparation of high-level athletes are discussed in two ways. Firstly, in light of existing literature on goal setting from an applied perspective; secondly, in the broader perspective of the sports culture and the application of our themes to other challenging moments that sports professionals might encounter.

The Effect of the COVID-19 Pandemic on the Mental and Emotional Health of Athletes: A Systematic Review

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has caused the cancellation or postponement of virtually every sporting event, resulting in training disruptions, income loss, and career uncertainties for athletes around the world. At present, the effect of the COVID-19 pandemic on the mental and emotional health of athletes is not well understood.

PURPOSE

To investigate the effect of the COVID-19 pandemic on the mental and emotional health of athletes and to identify risk factors associated with poor mental health outcomes.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

The PubMed, Embase, and Cochrane Library databases were searched to identify all articles reporting on athletes' mental and emotional health during the COVID-19 pandemic. Articles were selected based on relevant inclusion and exclusion criteria. Study characteristics, athlete demographics, and COVID-19 mental health data (sex-, type of sport-, and level of play-specific differences) were collected from each included article and analyzed.

RESULTS

A total of 35 studies were included in the final analysis, comprising athletes around the world and across numerous sports and levels of play. Most studies utilized at least 1 validated mental health questionnaire and assessed for outcomes such as depression, anxiety, stress, motivation, and athletic identity. Overall, athletes reported worse mental and emotional health during the COVID-19 pandemic, although these effects were attenuated by home training programs and quarantine training camps. Female sex and more elite levels of play were associated with an increased risk for poor mental health outcomes. Type of sport was associated with mixed results, with individual and team sports carrying different increased risks for poor mental and emotional health. Nearly all studies recommended the need for increased psychological support of athletes during the COVID-19 pandemic.

CONCLUSION

The effect of the COVID-19 pandemic on the mental and emotional health of athletes is complex and multifaceted. Increased social interactions with coaches and teammates, continued access to training facilities and mental health professionals, and active utilization of healthy coping mechanisms can improve mental health outcomes for athletes in the era of COVID-19.

Effect of Online Home-Based Training on Functional Capacity and Strength in Two CKD Patients: A Case Study

Chronic kidney disease (CKD) is a clinical condition characterized by the loss of kidney function over time, as well as several complications affecting gastrointestinal, cardiovascular, and musculoskeletal systems. Physical exercise seems to induce positive adaptations in CKD patients, without side effects. Usually, these patients show a reduced physical activity and physical performance. The aim of this case-report was to evaluate the effects of an online training protocol on functional capacity and on muscle mass, in CKD stage III patients. Methods: Two CKD (stage III according to KDIGO guidelines) participants (1 female, Patient A; 1 male, Patient B) were enrolled and they performed an online tailored-supervised combined training lasting 12 weeks, including multi-joint strength exercises using TheraBand and an aerobic session at 65–70% of the patients' heart rate reserve. Results: Both patients showed an improving trend on functional capacity (6 minutes walking test: Patient A = +3%; Patient B = +5.3%) and on strength of the upper arms (handgrip strength test-right: Patient A = +13.4%; Patient B = +19.1%; handgrip strength test-left: Patient A = +42.8%; Patient B= +12.9%), as well as a reduction in inflammation and oxidative stress biomarkers. The protocol was feasible, and no side effects were evidenced. These case studies suggest that the online combined training can produce beneficial effects in CKD patients under conservative therapy, by reducing the CKD-related complications and improving the adherence to exercise of this population of patients, overcoming logistic barriers such as transportation, availability of facilities, and working and personal-life schedule.

A Moderated Mediation Analysis of the Effects of the COVID-19 Pandemic on Well-Being and Sport Readiness of Italian Team Sports Players: The Role of Perceived Safety of the Training Environment

BACKGROUND

The protective restrictions (e.g., lockdowns, quarantines, social and physical distancing) consequent to the global pandemic caused by COVID-19 posited new challenges to athletes practicing competitive team sports. This study aimed to gain an understanding of the impact of the ongoing COVID-19 pandemic on the well-being and sports readiness to train and to compete of competitive female and male athletes practicing outdoor (i.e., rugby, soccer) and indoor (i.e., volleyball, basketball) team sports who were active during the Italian first and second waves of COVID-19.

METHODS

An online survey assessing demographic characteristics, perceived safety of the training environment, COVID-19 risk, fear of COVID-19, well-being, and sport (training and competition) readiness was administered to 619 team sports players. We examined differences by gender, previous COVID-19 experience, and team sport setting (i.e., outdoor vs. indoor). A moderated mediation analysis was conducted to assess the impact of perceived COVID-19 risk and fear of COVID-19 on athletes' well-being and sports readiness, using perceived safety of the training environment as a mediator and gender and sport setting as moderators.

RESULTS

Indoor team sports and female athletes showed higher perceived COVID-19 risk, while athletes with no-COVID-19 experience reported higher fear of COVID-19. Perceived COVID-19 risk (directly and via perceived safety of the training environment) and fear of COVID-19 were negatively associated with athletes' well-being and sports readiness.

CONCLUSIONS

This study highlighted an understanding of the psychological implications of the COVID-19 pandemic, emphasizing the role of the perceived safety of the training environment on athletes' well-being and sports readiness. Future studies may advance safety-based interventions to promote well-being and a safer return to sport.

Regression Analysis of Perceived Stress among Elite Athletes from Changes in Diet, Routine and Well-Being: Effects of the COVID-19 Lockdown and "Bubble" Training Camps

The COVID-19 pandemic has affected the lifestyles and training of elite athletes around the world. The detrimental effects of lockdown periods may vary among individuals, as well as among sports and sexes. This study investigated the changes in dietary habits, and the predictors of perceived stress during lockdown and a "bubble" training camp. This cross-sectional, online survey involved 76 elite and world-class athletes from six able-bodied sports and nine parasports, all of whom were involved in a 30-day "bubble" training camp. Questions were asked on socio-demographics, training routines and wellbeing, perceived stress, and dietary habits, pertaining to "normal" training (prelockdown), lockdown training, and "bubble" camp training periods. Changes in perceived stress were trivial to small during lockdown compared to "normal" training, and trivial to moderate during a "bubble" camp, compared to lockdown. Para-athletes, males, older athletes, less experienced athletes, married individuals, and specific ethnicities appeared to be more detrimentally affected (increased perceived stress) by lockdown. These negative experiences, however, were largely reversed during "bubble" camps. During lockdown, more athletes reported increased evening snack consumption (+8%), later meal-times (+6%), decreased fluid intake (-6%), and no breakfast (+7%). These changes were reversed during "bubble" camps (12-18% improvements). Sport classification accounted for 16% of the increased perceived stress (p = 0.001) during lockdown. Overall, socio-demographic factors, improvements in training routines, well-being, and dietary habits explained 28% of the decreased perceived stress during a "bubble" camp. In conclusion, better dietary habits, training routines and well-being have implications for reduced perceived stress. During lockdown, "bubble" camps may be beneficial, but this observation may be a case-by-case consideration, and short split "bubble" periods are recommended.

Impact of Active Breaks in the Classroom on Mathematical Performance and Attention in Elementary School Children

Background: The increasing need to face the problem of sedentarism, especially in the COVID-19 era, induced teachers and researchers to find new intervention methodologies in school context. Active breaks (ABs) include brief periods of physical activity as a part of the curriculum. This study aimed to investigate the AB acute responses on attentive skills and mathematical performance and attention in a primary school. Methods: A total of 141 children (aged 9.61 ± 0.82), divided into six classes, participated in this study. Each class was randomly assigned to three groups on the basis of the type of protocol performed during the three ABs scheduled in a school day: fitness (FIT), creativity (CREAT), and control group (CON). At baseline and at the end of interventions, all participants underwent the Stroop Color and Word test (SCWT) and the math test (MATH) to assess the level of attention and mathematical performance, respectively. The degree of enjoyment was evaluated through the modified Physical Activity Enjoyment Scale. Results: The factorial ANOVA showed significant differences between the FIT and CON in MATH test (p = 0.023) and SCWT (p = 0.034). CREAT and FIT groups showed higher degree of enjoyment than the CON (both ps < 0.001). Conclusions: This study showed a positive acute impact of AB interventions. FIT positively influenced attentive and math performances more than the CREAT, probably due to the correct work/rest ratio and executive rhythm that allowed children to reach a good level of exertion. This report showed that ABs can be a useful and productive activity to be performed between curricular lessons.

Self-reported measure of subjective distress in response to COVID-19 pandemic in patients referred to our skin cancer unit during the first wave

During the Italian first wave of the COVID-19 pandemic, social restrictions and bad news spread daily by mass media inevitably had a huge influence on the mental state of the population. To assess how much the COVID-19 outbreak impacted the psychologic state of patients referring to our Skin Cancer Unit from March 9 to May 31, 2020, we administered to them a self-report questionnaire, the Impact of Event Scale-Revised (IES-R). To evaluate the trend of the IES-R score over time, we set a temporal cutoff of March 27 (the day with the highest number of deaths for COVID-19 in Italy during the first wave). Three hundred fifty-five patients completed the questionnaire, reporting an average IES-R score of 25.5 (±16.4); 32.4% of participants reached a total IES-R score >32. Patients who visited after March 27, 2020 reported a higher psychologic impact, since the IES-R score significantly increased from 23.6 (±15.6) to 28.3 (±17.2). A group reported higher scores (of participants reaching an IES-R score >32, 57.4% were women and 33.9% were men). We gathered that, at an early stage of events of this magnitude, it could be useful to submit the IES-R questionnaire in high-risk and oncologic patients: we could potentially identify individuals at risk of developing post-traumatic stress disorders, who might be tempted to postpone necessary medical consultations. This could be also the basis for increasing targeted psychologic support in selected patients.

Stress Impact of COVID-19 Sports Restrictions on Disabled Athletes

The stress impact of COVID-19 restrictions has put the adapted sports community at an unprecedented level of emergency. The self-report Event Scale—Revised (IES-R) questionnaire was administered to assess the level of psychological distress and emotive reactions such as intrusion (INT), avoidance (AV) and hyperarousal (HYP) following training and competitions suspension within a sample of Italian disabled athletes. A total of 146 self-selected volunteers were included in this study: 73 disabled athletes (aged 42.11 ± 13.70) and 73 athletes (aged 40.23 ± 13.73) who served as the control group. Only 8.22% of the disabled participants vs. 30.14% of athletes were affected by subjective distress. MANOVA showed significant differences in IES-R subjective distress for age, where the emerging adults had a higher level of stress than adults (p = 0.031), and for the type of sport, where the individual sports group showed higher scores than the team sports group (p = 0.049). Regarding the IES-R subscales, significant differences were found in INT and AV for age, where the emerging adults showed higher scores than adults (p = 0.018 and p = 0.046, respectively). Significant differences were found in HYP for type of sport, where the individual sports group showed higher scores than the team sports group (p = 0.014). The results confirmed a lower distress level of disabled athletes to adverse events than that expressed by athletes. Both sports engagement and the experience of living with impairment, overcoming structural barriers, could act as a buffer effect against stress due to COVID-19 restrictions.

Training Conditions and Emotional Impact on Spanish Olympic Swimmers and Rowers in Social Isolation Due to COVID-19. Results of a Survey

This article analyzes the results of a survey conducted in 2020 with Spanish Olympic swimmers and rowers, who were confined to their homes due to the epidemiological crisis. The questionnaire was administered between 23 April and 25 May. Responses to the questionnaire on emotional and adaptive reactions during the COVID-19 confinement (REACOVID-19) were received from 88 subjects, who represented 100% of the total population of Spanish Olympic swimmers and rowers. Through this questionnaire, they were asked about their living conditions, their daily training habits and their psychological, cognitive and emotional adaptation during the confinement. The results show the commitment of these athletes to their sports goals and their responsibility in respecting the confinement rules. Sixty-seven per cent of them stated that they had not left their homes for 96 days. In these extreme circumstances, the majority trained an average of 11 to 13 h a week and coped with the confinement with a positive attitude, in spite of the inconveniences of social isolation, the lack of equipment and technical support for training and the limitations of their physical space. The article analyzes which emotional and social factors influenced both their motivation and their hours of training.

The Impact of Cheering on Sports Performance: Comparison of Serie A Statistics Before and During COVID-19

Background: The role of cheering in home advantage in sports performance is unclear. As anti-coronavirus disease 2019 (COVID-19) restrictive measures have prevented crowds from entering stadiums, analysis of the past two football seasons can reveal important details.

Objective: This paper aims to compare the last two football seasons in Italy with the previous six, highlighting changes due to the absence of cheering.

Methods: We compared the average percentages of points obtained in home matches from 2013 to 2019 with those in the timelapse 2019-2021. The same operation was performed with referee statistics, such as fouls, penalties, and cards awarded against home teams. To do this, we used Welch's t-test and percentage increases. Pearson and Spearman's correlations were searched between the percentages of points collected in home matches and total points earned from 2013 to 2021.

Results: The average percentage of points collected by teams in home matches dropped by 8% (Welch’s t = −4.3). The negative correlations between home collected points and total points in 2013-2019 timelapse have significantly diminished during the last two seasons (Welch’s t = 6.2), approaching zero. Penalties against home teams have increased by 30% (Welch’s t = 2.6), reaching 51.4%.

Conclusions: This research provides statistical evidence supporting the crowd’s impact on sports and refereeing performance in Serie A. However, our results also suggest that part of the home advantage is linked to factors independent of the audience. Future research can deepen the above phenomena from a theoretical-psychological point of view.

Successful Reboot of High-Performance Sporting Activities by Japanese National Women's Handball Team in Tokyo, 2020 during the COVID-19 Pandemic: An Initiative Using the Japan Sports-Cyber Physical System (JS-CPS) of the Sports Research Innovation Project (SRIP)

The COVID-19 pandemic has negatively impacted sporting activities across the world. However, practical training strategies for athletes to reduce the risk of infection during the pandemic have not been definitively studied. The purpose of this report was to provide an overview of the challenges we encountered during the reboot of high-performance sporting activities of the Japanese national handball team during the 3rd wave of the COVID-19 pandemic in Tokyo, Japan. Twenty-nine Japanese national women's handball players and 24 staff participated in the study. To initiate the reboot of their first training camp after COVID-19 stay-home social policy, we conducted: web-based health-monitoring, SARS-CoV-2 screening with polymerase chain reaction (PCR) tests, real-time automated quantitative monitoring of social distancing on court using a moving image-based artificial intelligence (AI) algorithm, physical intensity evaluation with wearable heart rate (HR) and acceleration sensors, and a self-reported online questionnaire. The training camp was conducted successfully with no COVID-19 infections. The web-based health monitoring and the frequent PCR testing with short turnaround times contributed remarkably to early detection of athletes' health problems and to risk screening. During handball, AI-based on-court social-distance monitoring revealed key time-dependent spatial metrics to define player-to-player proximity. This information facilitated appropriate on- and off-game distancing behavior for teammates. Athletes regularly achieved around 80% of maximum HR during training, indicating anticipated improvements in achieving their physical intensities. Self-reported questionnaires related to the COVID management in the training camp revealed a sense of security among the athletes that allowed them to focus singularly on their training. The challenges discussed herein provided us considerable knowledge about creating and managing a safe environment for high-performing athletes in the COVID-19 pandemic via the Japan Sports-Cyber Physical System (JS-CPS) of the Sports Research Innovation Project (SRIP, Japan Sports Agency, Tokyo, Japan). This report is envisioned to provide informed decisions to coaches, trainers, policymakers from the sports federations in creating targeted, infection-free, sporting and training environments.

Sports Training during COVID-19 First Lockdown—A Romanian Coaches’ Experience

COVID-19 restrictions impacted sports training and its human resources. The purpose of this study was to highlight the difficulties faced by Romanian coaches while carrying out online training during the first lockdown. It was assumed that the training coordinates were significantly influenced by distance coaching and that the coaches’ self-perceived efficacy was related to their digital skills. The study involved 407 coaches (62.16% men, 37.84% women), with a mean age of 41.7 ± 10.01 years, who completed an online questionnaire with 16 items. The statistics analysis was both quantitative and qualitative, with a significance level of 95%. T test was used for the training duration and for the differences between the coaches’ seniority. Chi-squared test was applied between sports branches and Anova for the non-parametric data. Correlations and regression model were performed to estimate the relationship between variables. It was revealed that 87.22% of the coaches adjusted their initial objectives and that the IT tools were provided through coaches’ own financial resources for 83.05% of them. Overall, 51.84% of the coaches failed to engage all athletes in online training; for the rest of them, an association with their professional experience and sports branches was demonstrated (χ2(8) = 34.688, p = 0.001). ANOVA confirmed that the ability to use IT tools influenced online training efficiency at p < 0.005. The results emphasized that Romanian coaches encountered difficulties related to training programming, IT use, with consequences on their professional self-efficacy.

Eating habits and mental health among rugby players of the Peruvian pre-selection during the second quarantine due to the COVID-19 pandemic

Objectives:

Social isolation during the COVID-19 pandemic impacts the mental health and diet of populations.

Aim:

The aim of the study was to evaluate whether the eating habits and mental health status of the rugby players of the Peruvian pre-selection were affected by the second quarantine of the COVID-19 pandemic.

Methods:

A cross-sectional study was carried out through a pre-structured online survey in 74 players, 42 men (56.8%) and 32 women (43.2%). The mean age was 20.5 ± 4.4 years. Participants completed a validated food frequency questionnaire and depression, anxiety, and stress scale-21 (DASS-21).

Results:

58.1% of the respondents reported that their dietary intake remained the same or increased. 58.3% of the players experienced anxiety, among which 26.4% reported moderate and severe symptoms. A greater proportion of participants <20 years old reported depression compared to those ⩾20 years (68.6% vs 31.4%, p = 0.010). Those who reported inadequate food intake were more likely to report depressive symptoms (p = 0.006).

Conclusion:

These findings reaffirm the need to implement programs of psychological support and nutritional counseling among athletes to reduce negative symptoms and better face mental health and dietary challenges in these times of crisis.

Impact of the SARS-CoV-2 Coronavirus Pandemic on Physical Activity, Mental Health and Quality of Life in Professional Athletes-A Systematic Review

Due to the rapid rate of spread of the SARS-CoV-2 coronavirus, a number of restrictions have been introduced into public spaces, including those related to the operation of sports facilities, compounding the difficulty for athletes to conduct appropriate forms of training. The aim of this study was to review current scientific reports assessing the impact of the pandemic on the physical activity, mental state, and quality of life of professional athletes. Popular scientific databases—PubMed, Scopus, and Embase—were systematically searched from the beginning of the pandemic until 12 July 2021. According to the adopted criteria, 14 articles were included in the review. Ten of the qualified studies determined the impact of the pandemic on the physical activity of athletes. The authors of 11 papers assessed the mental state and quality of life of athletes during the pandemic. The studies showed negative effects of the pandemic: a decrease in overall physical fitness and number of days and hours of training, as well as an increase in the occurrence of negative emotions (stress, fatigue, and depression) and a decrease in sleep quality. Changes in physical activity had an impact on overall well-being ratings, which depended on the sex of the subjects. Women were more likely to experience negative emotions compared to men. The mental state of the athletes affected the quality of sleep. This review summarises the negative effects of the SARS-CoV-2 coronavirus pandemic on the physical and mental health of professional athletes.

The Impact of the COVID-19 Pandemic and Societal Infection Control Measures on Children and Adolescents' Mental Health: A Scoping Review

Background: The COVID-19 pandemic is primarily a crisis that affects people's physical health. However, it is well-known from previous epidemics and pandemics that there are other indirect negative impacts on mental health, among others. The purpose of this scoping review was to explore and summarise primary empirical research evidence on how the COVID-19 pandemic and societal infection control measures have impacted children and adolescents' mental health. Methods: A literature search was conducted in five scientific databases: PubMed, APA PsycINFO, Web of Science, CINHAL, and Social Science Premium Collection. The search string was designed using the Population (0-18 years), Exposure (COVID-19), Outcomes (mental health) framework. Mental health was defined broadly, covering mental well-being to mental disorders and psychiatric conditions. Results: Fifty-nine studies were included in the scoping review. Of these, 44 were cross-sectional and 15 were longitudinal studies. Most studies reported negative impact of the COVID-19 pandemic on child and adolescent mental health outcomes, yet the evidence was mixed. This was also the case for studies investigating societal control measures. Strong resilience, positive emotion regulation, physical activity, parental self-efficacy, family functioning and emotional regulation, and social support were reported as protective factors. On the contrary, emotional reactivity and experiential avoidance, exposure to excessive information, COVID-19 school concerns, presence of COVID-19 cases in the community, parental mental health problems, and high internet, social media and video game use were all identified as potentially harmful factors. Conclusions: Due to the methodological heterogeneity of the studies and geographical variation, it is challenging to draw definitive conclusions about the real impact of the COVID-19 pandemic on the mental health of children and adolescents. However, the existing body of research gives some insight to how parents, clinicians and policy makers can take action to mitigate the effects of COVID-19 and control measures. Interventions to promote physical activity and reduce screen time among children and adolescents are recommended, as well as parenting support programs.

Exploring the Enjoyment of the Intergenerational Physical Activity

Intergenerational physical activity could be a pleasant method to prevent elderly sedentary behaviors. The aim of this study is to provide a basis to develop an intergenerational physical activity between preschool children and elderly people. An assessing enjoyment three questionnaire survey was administered to 140 participants (aged 67.8 ± 9.1): the global physical activity questionnaire (GPAQ) assessing the sedentariness degree; the physical activity enjoyment scale (PACES-Q) assessing enjoyment for the physical activity usually practiced; the physical activity enjoyment scale (PACES-INT) assessing the enjoyment for a hypothetical intergenerational program. Successively, the sample was divided into subgroups based on age, gender, marital status, education, employment, sports background, sedentariness level and residential location. Four multichoice questions, aiming to have guidelines in organizing an intergenerational program, were used. A total of 44.3% of the sample found the physical activity practiced pleasant, whereas 81.5% enjoyed the intergenerational program (only 7.1% expressed a negative judgment). A separated one-way ANOVA showed significant differences in PACES-INT for gender, (p = 0.009), residential location, (p < 0.001) and employment (p = 0.004). About 80% of the sample would adhere to the intergenerational programs, despite the fatigue fear and logistic or family relationship problems.

Effect of COVID-19 confinement on physical activity patterns in relation to sociodemographic parameters in Spanish population

BACKGROUND

The main purpose of the present study was to determine the socio demographic parameters associated to physical activity (PA) patterns changes during the COVID-19 lockdown in the Spanish population.

METHODS

Participants were recruited by sending a survey through various social network channels via the snowball method. A voluntary sample of 2430 individuals consisting of 1,203 men and 1,227 women (aged between 18 to 73 years old) from the Spanish national territory participated in this study. An online survey was performed to collect the information, which was tested through ad hoc analysis with different socio-demographic variables. Participants were a median of 34 years old (18-73 years old) with a mean BMI of 23.6 kg/m2.

RESULTS

The risk factors associated with the change in PA hours during confinement showed that to do sports (β; -56.88, 95%CI; -79.35 to -34.40, P <0.001), male sex (β - 34.78, 95%CI;-54.02 to -15.52, P<0.001) and the educational level (i.e., elementary school category) (β; -54.21, 95%CI;-89.10 to -19.32, P= 0.002) reported negative changes with hours of PA during confinement. By the contrary, the employment status (passive work) and to be student reported positive association (i.e., increase PA hours per week).

CONCLUSIONS

The COVID-19 lockdown led to a reduction PA patterns in Spanish population. Mostly men showed a drastic decrease in hours of PA compared to the women's group. Likewise, the groups of people with elementary and high education showed a decrease in hours of weekly PA, as well as unemployed people.

The Impact of Reduced Training Activity of Elite Kickboxers on Physical Fitness, Body Build, and Performance during Competitions

Background: Kickboxing is a combat sport where athletes require constant supervision of a coach. The outbreak of the pandemic caused by SARS-CoV-2 has led to a crisis in many sectors, including sport. Global efforts to limit the spread of the pathogen resulted in temporary lockdowns that limited sporting activity, thus deteriorating athletes' physical fitness. Methods: The participants included 20 kickboxers competing at the international level. Their physical fitness was evaluated based on the test developed by the International Committee on the Standardization of Physical Fitness Test (ICSPFT) and their body build was assessed using Tanita BC601 body composition monitor and a body height meter. Differences between physical fitness before the COVID-19 outbreak and during the pandemic after re-opening sports facilities were evaluated. Results: Temporary closing of sports clubs has led to the increase in body mass of the participants by 2.65 kg on average and significantly deteriorated physical fitness. Conclusions: Temporary closing of sports clubs and restrictions on physical activity aimed at containing the spread of COVID-19 caused a significant reduction in physical fitness and increased body mass of the participants. This is likely to cause worse performance in the nearest competitions and have a negative impact on the athletes' health status and immunity to diseases.

COVID-19 Pandemic and Quality of Life among Romanian Athletes

The aim of this study was to analyze athletes' quality of life during the COVID-19 pandemic. The study involved 249 athletes between 15 and 35 of age, M = 21.22, SD = 5.12. The sample was composed of eight Olympic Games medalists, three European medalists, 67 international medalists, and 63 national medalists. The instruments used were: (1) COVID-19 Anxiety Scale, (2) Athlete Quality of Life Scale, (3) Impact of Pandemic on Athletes Questionnaire, and (4) International Personality Item Pool (IPIP Anxiety, Depression, and Vulnerability Scales). The results indicate significant differences in COVID-19 anxiety depending on the sport practiced, F (9239) = 3.81, p < 0.01, showing that there were significant differences between sports. The negative impact of the COVID-19 pandemic mediates the relationship between trait anxiety and the athletes' quality of life. The percentage of mediation was 33.9%, and the indirect effect was -0.11, CI 95% (-0.18, -0.03), Z = -2.82, p < 0.01. Trait anxiety has an increasing effect on the intensity of the negative impact of the COVID-19 pandemic, 0.23, CI 95% (.10, 0.35), Z = 3.56, p < 0.01, and the negative impact of the COVID-19 pandemic has a decreasing effect on quality of life, -0.47, CI 95% (-0.67, -0.27), Z = -4.62, p < 0.01. Gender and age did not moderate the relationship between the negative impact of COVID-19 and athletes' quality of life. The results of the study highlighted the impact that social isolation and quarantine have on athletes' affective well-being.

A national COVID-19 quarantine survey and its impact on the Italian sports community: Implications and recommendations

The outbreak of the 2019 coronavirus disease (COVID-19) created an international public health emergency, challenging the psychological resilience of the general population. Regarding this matter, a web-based survey was performed. Data were collected from the following 1,668 self-selected volunteers: 800 athletes (28.30 ± 10.93 years old); 558 coaches (36.91 ± 11.93 years old); and 310 sports managers (42.07 ± 13.38 years old). To assess the level of psychological stress, an Impact of the Event Scale-Revised (IES-R) questionnaire was used. The results indicated that 34.4% of the participants who were interviewed were affected by subjective distress while 26.4% rated their psychological impact from the sports activity interruption as severe. Separated one-way analysis of variance (ANOVA) tests showed significant differences in the IES-R total score (TS), indicating that the level of stress in terms of gender revealed that women were more stressed than men (p = 0.000), for "sports roles" in which the manager and coaches were more stressed than the athletes (p < 0.05), and "type of sport" in which fitness and individual athletes were more stressed than team athletes (p < 0.01). The middle-level athletes showed significantly more hyperarousal levels than high-level athletes (p = 0.012). The results of this survey may raise awareness of this problem and help athletic associations to have appropriate guidelines in order to better sustain their memberships and organize an optimal resumption of their sports activities. Along these lines, social interactions, which are typical of team sports, are crucial to warrant resilience and psychological health. The athletes by managing independently the new rules and measures, thanks to a clear communication, could improve their adaptive stress reaction.

Psychometric Properties of the Impact of Events Scale-Revised (IES-R) Among General Iranian Population During the COVID-19 Pandemic

Objective: The aim of this study was to translate and evaluate the validity and reliability of the Impact of Events Scale-Revised (IES-R) among the Iranian general population during the coronavirus disease 2019 (COVID-19) pandemic. Method: This study was methodological cross-sectional. It was conducted on an Iranian public population from April to July 2020 which was during the COVID-19 pandemic. Construct validity was determined through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) with a total of 500 adults recruited via online data gathering. Reliability was checked through the average inter-item correlation (AIC), Cronbach's alpha, and McDonald's omega. Convergent and divergent validity was determined using Fornell and Larcker's approach. Results: The results showed that the Persian version of IES-R had three factors, including intrusion (six items), avoidance (seven items), and hyperarousal (five items), that explained 59.22% of the total variance of the IES-R. The CFA findings indicated that all goodness-of-fit indices confirmed the model fit. The Cronbach's alpha, McDonald's omega, composite reliability (CR), and maximal reliability were excellent, and the three factors have good convergent validity. Conclusion: The findings of this study indicated that the Persian version of the IES-R scale is efficient and useful to assess post-traumatic stress disorder among Iran general population in the COVID-19 outbreak.