Given the powerful transmissibility of SARS-CoV-2 from person to person, since the outbreak of COVID-19 in Italy, the Italian government’s response efforts have been directed at slowing the spread of the virus. On March 8, a lockdown was imposed in some northern regions, and within a few days, the quarantine was extended to the entire peninsula.
To ensure social distancing and limit population movement, schools, public places and businesses were closed. In addition, people can only move away from home for work (health care and social assistance, police and armed forces, firefighters, water and electricity supply) or essential activities (health visits, purchasing medicine or food).
Although this strategy has been reported to be effective in containing the COVID-19 outbreak, quarantine may be associated with several undesirable effects, due to the disruption of social habits. In particular, prolonged self-isolation has a negative impact on the psychological response, promoting symptoms of post-traumatic stress, confusion and anxiety.
Additionally, quarantine leads to physical inactivity, which contributes to adverse health changes such as premature aging, obesity, cardiovascular vulnerability, muscle atrophy, bone loss, and decreased aerobic capacity.
Exercise can counteract metabolic disorders, bone, muscle, and joint pathologies, and neurodegenerative diseases.
With respect to upper respiratory infection, caused by pathogens such as COVID-19, physical activity can improve pathological outcomes, promoting the release of stress hormones responsible for reducing excessive local inflammation within the respiratory tract and inducing the secretion of anti- inflammatory cytokines, such as IL-4 and IL-10, to prevent excessively prolonged T helper type 1 (Th1) cell population activity against the pathogen. There is also evidence that has shown that physical activity can be effective in improving mental well-being and has the potential to prevent mental health disorder symptoms such as depression and anxiety.
The purpose of this survey study was to examine (1) changes in physical activity levels during quarantine in Italy; (2) the correlation between physical activity and the well-being of individuals. For this purpose, an online questionnaire containing an adapted version of the International Physical Activity Questionnaire (IPAQ-SF) has been used to evaluate the level of physical activity and the equivalent energy expenditure in METs and the Psychological Wellbeing Index (PGWBI) to assess psychological and general well-being.
Methods
A total of 2974 Italian subjects completed an online survey, of which 2524 subjects were found eligible for this study. The questionnaire measured the total energy expenditure of weekly physical activity before and during quarantine (i.e., the sum of walking, moderate-intensity physical activities, and vigorous-intensity physical activities) in metabolic equivalents minute per week (MET). – min / week) using an adapted version of the International Physical Activity Questionnaire and its psychological well-being using the Psychological Well-being Index.
Results
1. General characteristics of the study populations
Overall, the study sample comprised 56.4% women and 43.6% men. Participants were divided into four age groups: young people <21 years (n=346); young adult from 21 to 40 years (n=1178); adults from 41 to 60 years old (n=704) and over 60 years old (n=296).
BMI was divided into three categories: underweight (BMI <18.5), normal weight (BMI 18.5–24.9), and overweight (BMI ≥25.0). 66.63% of the participants were classified as normal weight subjects.
2. Comparison of physical activity before and during the COVID-19 pandemic in Italy
Participants had to provide information (before and during the COVID-19 quarantine) related to vigorous and moderate-intensity physical activity, as well as walking activity and sedentary behaviors.
Examination of total physical activity in MET – minutes / week demonstrated a statistically significant difference between before and during the COVID-19 pandemic (mean: 2429 vs. 1577 MET – min / wk). Specifically, subjects’ vigorous physical activity, moderate activity, and walking scores during the COVID-19 emergency were significantly lower than those in the pre-quarantine period.
The results showed that before the emergence of COVID-19, 23.06% of the participants had low activity (<600 MET – minutes / week), 35.18% had moderate activity (≥600 MET – minutes / week) and 41.76 % had high activity (≥3000 MET – minutes/week).
During the COVID-19 quarantine, the percentage of individuals with low activity increased to 39.62%, while for medium and high activity levels the percentages were 29.75% and 30.63% respectively.
The physical activity levels of participants classified pre-COVID-19 as highly active and moderately active decreased dramatically during the COVID-19 pandemic.
These results suggest that the limitations imposed by the quarantine have induced that part of the population that generally performs moderate and high levels of physical activity to decrease their regular and habitual level during the isolation period.
In contrast, individuals classified pre-COVID-19 as low active significantly increased total energy expenditure from weekly physical activity during quarantine (mean: 408.1 vs. 755.3 MET-min/week).
This unexpected result could be due to the greater domestic activities carried out by these subjects forced to remain in their homes, compared to before the quarantine.
Regarding gender classifications, total physical activity between before and during quarantine decreased significantly in both groups. According to age classifications, total physical activity decreased significantly during quarantine in youth, young adults, adults and those over 60 years of age.
3. Correlation between physical activity and psychological well-being during the COVID-19 emergency in Italy
The total PGWBI score of the female and low-activity groups reflects moderate distress, while the other groups show positive psychological well-being. Interestingly, the correlation between physical activity and psychological well-being depending on gender showed a higher positive correlation in women compared to the male group, suggesting that variations in physical activity habits could influence psychological state more. of women than in men.
A significant positive correlation was detected between the variation in total activity and the PGWBI score in the young adult group , while no significant association was found between physical activity and psychological well-being in the other age groups.
Finally, the same correlation was evaluated for the three categories of participants, classified before COVID-19, as high, moderate and low activity. A significant correlation was found in the high and moderate activity groups.
No positive correlation was found between the variation of total activity and the PGWBI score in the low activity group.
Discussion
The global spread of the SARS-CoV-2 infection led the Italian government to apply unprecedented containment measures. The quarantine has altered the normality of daily life, forcing the population to social distance and self-isolate.
Precautionary measures have also involved sports-related activities, such as walking and running outdoors. Therefore, home training remained the only possibility to play sports and stay active during the Covid-19 pandemic.
In the present work, the psychological well-being of 2524 participants was analyzed, of which 41.76% were classified as a highly active group. Although the scientific community has highlighted the real benefits of staying active during the pandemic, the results of the present study showed a sharp reduction in physical activity levels, especially for vigorous activity and walking.
These data reflect the main difficulties in walking and performing intense exercise at home, compared to moderate activity.
Although running, fast swimming, playing basketball, soccer, represent vigorous intensity activities that burn more than 3000 MET-minutes/week, many other intense exercises can be performed at home, such as carrying/moving heavy loads (> 20 kg) or climbing walking stairs. Stairs can be found in most private homes, and climbing stairs (at least 10 minutes per day) is considered a vigorous-intensity activity.
An opposite trend was found for subjects classified as low activity before COVID-19, whose total physical activity energy expenditure during quarantine increased significantly. This phenomenon could be due to a radical change in daily schedules and habits.
People who stay at home spend much more time on low-intensity activities such as housework (cooking, washing dishes or gardening). Another reason could be the greater presence of women in the study, who are generally more likely to perform low-intensity activities.
This study also showed that physical activity levels decreased significantly in all age groups considered. Furthermore, the male group showed a highly significant variation between before and during the COVID-19 emergency compared to the female group.
Men practice physical activity mainly for social and competitive reasons. In addition, they prefer to practice sports outdoors and/or in public places. Women are more likely to do home exercise, aerobics, dance, yoga, Pilates or circuits with push-ups, squats, planks and jumping jacks.
The lower variation in physical activity levels in women is possibly explained by the fact that they perform a greater amount of physical activity at home than men.
Second, the authors investigated the impact of physical activity on psychological well-being during the pandemic. The results showed that reduced levels of physical activity are always related to a worse state of psychological well-being. The positive effects of regular physical activity on psychological health are indisputable in the field of modern medicine.
Regular exercise improves self-esteem and a sense of well-being, and people who exercise regularly exhibit fewer symptoms of depression and anxiety. Several studies have shown that the anxiolytic effects of regular exercise are related to the change in the hypothalamic-pituitary-adrenal (HPA) axis and the mediation of the endogenous opioid system, which are involved in stress reactivity, anxiety, mood. mood and emotional responses.
Furthermore, physical activity is involved in the modulation of different trophic factors, such as brain-derived neurotrophic factor (BDNF). BDNF, whose levels are upregulated after exercise, represents the most abundant neurotrophin in the brain, positively influencing both anxiety and depressive disorders.
The authors found that the correlation between reduced physical activity and psychological well-being is stronger in the female group. This evidence suggests that reducing physical activity levels may mainly influence the mental well-being of the female group.
The current study also showed a significant correlation between the change in total activity and the PGWBI score in subjects classified as high and moderate activity, as well as in the young adult group. The latter result is supported by previous studies that demonstrate the strong relationship between physical activity and psychological well-being in this age group.
Gyms, stadiums, swimming pools, dance and fitness studios, parks and playgrounds were closed, forcing people to find alternatives to exercise. Consequently, different lifestyle habits have been affected. Under such unusual conditions, the barriers to maintaining an active lifestyle are difficult to overcome. For these reasons, the impact of physical activity on psychological health during the Covid-19 pandemic was studied. The benefits of exercise have proven to be very useful, especially in times of anxiety, crisis and fear.
Therefore, there is concern that, in the context of the pandemic, lack of access to regular sports or exercise routines will lead to challenges to the immune system and physical health, including by initiating or exacerbating existing diseases that have its roots in a sedentary lifestyle.
Lack of access to exercise and physical activity also had impacts on mental health, experienced by many in the face of isolation from normal social life. The potential loss of family or friends to the virus and the impact of the virus on economic well-being and access to nutrition exacerbated these effects.
Limitations of this study included bias from overreporting of physical activity, as well as reporting at the same time point, information related to exercise levels before and during COVID-19. However, these questionnaires can provide a reliable approximation of physical activity at the population level, and their validity has been confirmed in different studies.
Conclusion
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