Behavioral Change Towards Reduced Intensity Physical Activity Is Disproportionately Prevalent Among Adults With Serious Health Issues or Self-Perception of High Risk During the UK COVID-19 Lockdown

Abstract

Objectives: We assessed whether lockdown had a disproportionate impact on physical activity behavior in groups who were, or who perceived themselves to be, at heightened risk from COVID-19. Methods: Physical activity intensity (none, mild, moderate, or vigorous) before and during the UK COVID-19 lockdown was self-reported by 9,190 adults between 2020-04-06 and 2020-04-22. Physician-diagnosed health conditions and topic composition of open-ended text on participants' coping strategies were tested for associations with changes in physical activity. Results: Most (63.9%) participants maintained their normal physical activity intensity during lockdown, 25.0% changed toward less intensive activity and 11.1% were doing more. Doing less intensive physical activity was associated with obesity (OR 1.25, 95% CI 1.08-1.42), hypertension (OR 1.25, 1.10-1.40), lung disease (OR 1.23, 1.08-1.38), depression (OR 2.05, 1.89-2.21), and disability (OR 2.13, 1.87-2.39). Being female (OR 1.25, 1.12-1.38), living alone (OR 1.20, 1.05-1.34), or without access to a garden (OR 1.74, 1.56-1.91) were also associated with doing less intensive physical activity, but being in the highest income group (OR 1.73, 1.37-2.09) or having school-age children (OR 1.29, 1.10-1.49) were associated with doing more. Younger adults were more likely to change their PA behavior compared to older adults. Structural topic modeling of narratives on coping strategies revealed associations between changes in physical activity and perceptions of personal or familial risks at work or at home. Conclusions: Policies on maintaining or improving physical activity intensity during lockdowns should consider (1) vulnerable groups of adults including those with chronic diseases or self-perceptions of being at risk and (2) the importance of access to green or open spaces in which to exercise.

Keywords: COVID-19; SARS-CoV2; chronic condition; lockdown; mixed method approach; obesity; perceptions of risk; physical activity (exercise).

Figure 1

Odds ratios for having changed toward (a) less intense and (b) more intense physical activity since the UK COVID-19 lockdown began. The reference group is study participants who continued to do the same intensity of physical activity. All odds ratios are corrected for baseline physical activity intensity and all other variables.

Figure 2

Topic Correlations in the structural topic model for the corpus of text describing coping strategies. Nodes show topics and lines show positive correlations between the topics. There was a close correlation between topic T1 “Perceptions of risk, working or living in risk environments, already had COVID-19” and topics relating to mental health & anxiety (topic T7), strict adherence to social isolation practices (topic T5) and the balancing of ongoing work and family commitments (topic T8). Participants whose responses were focussed toward discussion of more intense PA (topic T9) or activities (including PA) around the house (topic T3) were less likely to also focus on T1, T7, T8, or T5. The topic correlation cut-off was 0.01.

Figure 3

Expected text proportions in open-ended narratives on participants' coping behaviors. Participants were asked to describe their coping behaviors during the UK COVID-19 related lockdown. Perceptions of risk, working or living in risk environments, and already having had COVID-19 (topic T1) were mentioned in 9.7% (9.3–10.1%) of responses from participants who had not changed, in 8.1% (7.1–9.0%, p = 0.001) of responses from people doing more PA and in 11.2% (10.4–11.9%, p < 0.001) among participants doing less PA. Topic T3 (p = 0.01) and T10 (p = 0.006) had lower ETPs in the PA group doing “less”. Topics T7 and T8 had, respectively, lower (p < 0.001) and higher (p = 0.006) in the PA group doing “more”. Topic T9 “Exercise” was notably much higher in the group which reported doing more intense PA under lockdown (p < 0.001). All analysis used the group which had not changed PA intensity as the reference.