Physical Activity During Lockdowns Associated with the COVID-19 Pandemic: A Systematic Review and Multilevel Meta-analysis of 173 Studies with 320,636 Participants.

BACKGROUND: Many countries have restricted public life in order to contain the spread of the novel coronavirus (SARS-CoV2). As a side effect of related measures, physical activity (PA) levels may have decreased. OBJECTIVE: We aimed (1) to quantify changes in PA and (2) to identify variables potentially predicting PA reductions. METHODS: A systematic review with random-effects multilevel meta-analysis was performed, pooling the standardized mean differences in PA measures before and during public life restrictions. RESULTS: A total of 173 trials with moderate methodological quality (modified Downs and Black checklist) were identified. Compared to pre-pandemic, total PA (SMD - 0.65, 95% CI - 1.10 to - 0.21) and walking (SMD - 0.52, 95% CI - 0.29 to - 0.76) decreased while sedentary behavior increased (SMD 0.91, 95% CI: 0.17 to 1.65). Reductions in PA affected all intensities (light: SMD - 0.35, 95% CI - 0.09 to - 0.61, p = .013; moderate: SMD - 0.33, 95% CI - 0.02 to - 0.6; vigorous: SMD - 0.33, - 0.08 to - 0.58, 95% CI - 0.08 to - 0.58) to a similar degree. Moderator analyses revealed no influence of variables such as sex, age, body mass index, or health status. However, the only continent without a PA reduction was Australia and cross-sectional trials yielded higher effect sizes (p < .05). CONCLUSION: Public life restrictions associated with the COVID-19 pandemic resulted in moderate reductions in PA levels and large increases in sedentary behavior. Health professionals and policy makers should therefore join forces to develop strategies counteracting the adverse effects of inactivity.

Train at home, but not alone: a randomised controlled multicentre trial assessing the effects of live-streamed tele-exercise during COVID-19-related lockdowns.

OBJECTIVE: Public life restrictions associated with the COVID-19 pandemic caused reductions in physical activity (PA) and decreases in mental and somatic health. Considering the interplay between these factors, we investigated the effects of digital home exercise (DHE) during government-enforced lockdowns. METHODS: A multicentre randomised controlled trial was performed allocating healthy individuals from nine countries (N=763; 523 female) to a DHE or an inactive control group. During the 4-week main intervention, DHE members engaged in live-streamed multicomponent home exercise. Subsequently, both groups had access to prerecorded workouts for an additional 4 weeks. Outcomes, assessed weekly, included PA level (Nordic Physical Activity Questionnaire-Short), anxiety (Generalized Anxiety Disorder Scale-7), mental well-being (WHO-5 Questionnaire), sleep quality (Medical Outcome Study Sleep Scale), pain/disability (Chronic Pain Grade Scale) and exercise motivation (Self-Concordance Scale). Mixed models were used for analysis. RESULTS: Live-streamed DHE consistently increased moderate PA (eg, week 1: 1.65 times more minutes per week, 95% CI 1.40 to 1.94) and vigorous PA (eg, week 1: 1.31 times more minutes per week, 95% CI 1.08 to 1.61), although the effects decreased over time. In addition, exercise motivation, sleep quality and anxiety were slightly improved for DHE in the 4-week live streaming period. The same applied to mental well-being (mean difference at week 4: +0.99, 95% CI 0.13 to 1.86), but an inverted trend was observed after live streaming was substituted by prerecorded exercise. CONCLUSIONS: Live-streamed DHE represents an efficacious method to enhance PA and selected markers of health during pandemic-related public life restrictions. However, research on implementation is warranted to reduce dropout rates. TRIAL REGISTRATION NUMBER: DRKS00021273.

Health trends, inequalities and opportunities in South Africa's provinces, 1990-2019: findings from the Global Burden of Disease 2019 Study.

BACKGROUND: Over the last 30 years, South Africa has experienced four 'colliding epidemics' of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019. METHODS: We analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990-2007 and 2007-2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance. RESULTS: Across the nine provinces, inequalities in mortality and life expectancy increased over 1990-2007, largely due to differences in HIV/AIDS, then decreased over 2007-2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks; unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces. CONCLUSIONS: Reductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic.

Drastic Reductions in Mental Well-Being Observed Globally During the COVID-19 Pandemic: Results From the ASAP Survey.

Most countries affected by the COVID-19 pandemic have repeatedly restricted public life to control the contagion. However, the health impact of confinement measures is hitherto unclear. We performed a multinational survey investigating changes in mental and physical well-being (MWB/PWB) during the first wave of the pandemic. A total of 14,975 individuals from 14 countries provided valid responses. Compared to pre-restrictions, MWB, as measured by the WHO-5 questionnaire, decreased considerably during restrictions (68.1 ± 16.9 to 51.9 ± 21.0 points). Whereas 14.2% of the participants met the cutoff for depression screening pre-restrictions, this share tripled to 45.2% during restrictions. Factors associated with clinically relevant decreases in MWB were female sex (odds ratio/OR = 1.20, 95% CI: 1.11-1.29), high physical activity levels pre-restrictions (OR = 1.29, 95% CI 1.16-1.42), decreased vigorous physical activity during restrictions (OR = 1.14, 95% CI: 1.05-1.23), and working (partially) outside the home vs. working remotely (OR = 1.29, 95% CI: 1.16-1.44/OR = 1.35, 95% CI: 1.23-1.47). Reductions, although smaller, were also seen for PWB. Scores in the SF-36 bodily pain subscale decreased from 85.8 ± 18.7% pre-restrictions to 81.3 ± 21.9% during restrictions. Clinically relevant decrements of PWB were associated with female sex (OR = 1.62, 95% CI: 1.50-1.75), high levels of public life restrictions (OR = 1.26, 95% CI: 1.18-1.36), and young age (OR = 1.10, 95% CI: 1.03-1.19). Study findings suggest lockdowns instituted during the COVID-19 pandemic may have had substantial adverse public health effects. The development of interventions mitigating losses in MWB and PWB is, thus, paramount when preparing for forthcoming waves of COVID-19 or future public life restrictions.

A Pandemic within the Pandemic? Physical Activity Levels Substantially Decreased in Countries Affected by COVID-19.

Governments have restricted public life during the COVID-19 pandemic, inter alia closing sports facilities and gyms. As regular exercise is essential for health, this study examined the effect of pandemic-related confinements on physical activity (PA) levels. A multinational survey was performed in 14 countries. Times spent in moderate-to-vigorous physical activity (MVPA) as well as in vigorous physical activity only (VPA) were assessed using the Nordic Physical Activity Questionnaire (short form). Data were obtained for leisure and occupational PA pre- and during restrictions. Compliance with PA guidelines was calculated based on the recommendations of the World Health Organization (WHO). In total, n = 13,503 respondents (39 ± 15 years, 59% females) were surveyed. Compared to pre-restrictions, overall self-reported PA declined by 41% (MVPA) and 42.2% (VPA). Reductions were higher for occupational vs. leisure time, young and old vs. middle-aged persons, previously more active vs. less active individuals, but similar between men and women. Compared to pre-pandemic, compliance with WHO guidelines decreased from 80.9% (95% CI: 80.3-81.7) to 62.5% (95% CI: 61.6-63.3). Results suggest PA levels have substantially decreased globally during the COVID-19 pandemic. Key stakeholders should consider strategies to mitigate loss in PA in order to preserve health during the pandemic.

Restrictercise! Preferences Regarding Digital Home Training Programs during Confinements Associated with the COVID-19 Pandemic.

Confinement measures during the COVID-19 pandemic have caused substantial reductions in global physical activity (PA) levels. In view of the manifold health benefits of PA, the development of interventions counteracting this trend is paramount. Our survey with 15,261 participants (38 ± 15 years, 58.5% females) examined preferences towards digital home exercise programs in 14 countries affected by COVID-19. More than two-thirds of the sample (68.4%, n = 10,433) indicated being interested in home exercise, and most participants were willing to work out at least three times per week (89.3%, n = 9328). Binary logistic regression revealed that female sex, working part-time, younger age, and being registered in a gym were associated with willingness to exercise. Flexibility (71.1%, n = 7377), resistance (68.6%, n = 7116), and endurance training (62.4%, n = 6478) were the most preferred types of exercise. Our results may guide health providers in developing individually tailored PA interventions during the current and future pandemics.

Exploring opportunities for embedding graduate attributes in a first-year undergraduate anatomy course for allied health students.

BACKGROUND: There is a growing discontent within the health care industry regarding the state of preparedness of graduates to adequately function in a dynamic work environment. It is therefore required of higher education institutions to equip graduates with skills beyond disciplinary expertise, which would allow them to function optimally in work environments. This study presents a team dissection project that incorporates graduate attributes in an undergraduate first-year anatomy course for the medical orthotics and prosthetics program. METHOD: Focus group interviews with students (n = 23) were used to demonstrate the achievement of graduate attributes by aligning student perceptions of the dissection project with graduate attributes and indicators thereof. RESULTS: Students were positive about the effectiveness of the dissection project in enforcing anatomical knowledge; ensuring active engagement with human material; enhancing communication skills and teamwork; and increasing sensitivity towards cultural diversity. These views related largely to those graduate attributes which engage students towards becoming active and reflective learners; creative thinkers; independent and collaborative workers; effective communicators; and culturally and socially aware citizens. Areas of dissatisfaction included challenges with the use of technology for the video preparation; repetition of presentations and large dissection teams. CONCLUSION: There is an emerging view that graduate attributes be integrated as early as possible into program curricula so as to become intrinsic in a student's academic and professional development. Through the expansion of a dissection project forming part of a subject taught very early on in a program's curriculum, the integration of graduate attributes and discipline-specific competencies are highlighted.

Meta-Analyses of the Effects of Habitual Running on Indices of Health in Physically Inactive Adults.

BACKGROUND: In order to implement running to promote physical activity, it is essential to quantify the extent to which running improves health. OBJECTIVE: The aim was to summarise the literature on the effects of endurance running on biomedical indices of health in physically inactive adults. DATA SOURCES: Electronic searches were conducted in October 2014 on PubMed, Embase, CINAHL, SPORTDiscus, PEDro, the Cochrane Library and LILACS, with no limits of date and language of publication. STUDY SELECTION: Randomised controlled trials (with a minimum of 8 weeks of running training) that included physically inactive but healthy adults (18-65 years) were selected. The studies needed to compare intervention (i.e. endurance running) and control (i.e., no intervention) groups. STUDY APPRAISAL AND SYNTHESIS METHODS: Two authors evaluated study eligibility, extracted data, and assessed risk of bias; a third author resolved any uncertainties. Random-effects meta-analyses were performed to summarise the estimates for length of training and sex. A dose-response analysis was performed with random-effects meta-regression in order to investigate the relationship between running characteristics and effect sizes. RESULTS: After screening 22,380 records, 49 articles were included, of which 35 were used to combine data on ten biomedical indices of health. On average the running programs were composed of 3.7 ± 0.9 sessions/week, 2.3 ± 1.0 h/week, 14.4 ± 5.4 km/week, at 60-90% of the maximum heart rate, and lasted 21.5 ± 16.8 weeks. After 1 year of training, running was effective in reducing body mass by 3.3 kg [95% confidence interval (CI) 4.1-2.5], body fat by 2.7% (95% CI 5.1-0.2), resting heart rate by 6.7 min(-1) (95% CI 10.3-3.0) and triglycerides by 16.9 mg dl(-1) (95% CI 28.1-5.6). Also, running significantly increased maximal oxygen uptake (VO2max) by 7.1 ml min(-1) kg(-1) (95% CI 5.0-9.1) and high-density lipoprotein (HDL) cholesterol by 3.3 mg dl(-1) (95% CI 1.2-5.4). No significant effect was found for lean body mass, body mass index, total cholesterol and low-density lipoprotein cholesterol after 1 year of training. In the dose-response analysis, larger effect sizes were found for longer length of training. LIMITATIONS: It was only possible to combine the data of ten out the 161 outcome measures identified. Lack of information on training characteristics precluded a multivariate model in the dose-response analysis. CONCLUSIONS: Endurance running was effective in providing substantial beneficial effects on body mass, body fat, resting heart rate, VO2max, triglycerides and HDL cholesterol in physically inactive adults. The longer the length of training, the larger the achieved health benefits. Clinicians and health authorities can use this information to advise individuals to run, and to support policies towards investing in running programs.

Steps that count: the association between the number and intensity of steps accumulated and fitness and health measures.

BACKGROUND: Pedometer-based recommendations for accumulating steps/d largely focus on volume, with less emphasis on intensity and fitness/health outcomes. We aim to examine this relationship. METHODS: A convenience sample (N = 70, 35 men, 32 ± 8yrs) wore a pedometer (4 days). The pedometer classified steps as "aerobic" (≥ 60 steps/minute, minimum duration of 1 minute) or "non-aerobic" (< 60 steps/minute and/or < 1 minute). Estimated maximal oxygen uptake (VO2max), derived from a 12-minute submaximal step-test, and health outcomes: blood pressure (BP), body mass index (BMI), percentage body fat (%BF), and waist circumference (WC) were correlated with pedometer data. Participants were grouped according to number and intensity of steps: LOW (< 5000 steps/d), HIGH-LOW (≥ 5000 steps/d, no aerobic steps), HIGH-HIGH (≥ 5000 steps/d, including some aerobic steps). Analyses of covariance, adjusting for age, gender, and total steps/d were used to compare groups. RESULTS: Average steps/d was 6520 ± 2306. Total steps/d and total time spent accumulating "aerobic" steps (minutes/day) were inversely associated with %BF, BMI, WC, and systolic BP (P < .05). After adjusting for gender and total steps/d, %BF was different between all 3 groups, VO2max was different between the LOW and HIGH-HIGH groups, WC was lower in the HIGH-HIGH versus the other 2 groups (P < .03, respectively). CONCLUSION: Intensity seems an important factor to consider in steps/d cut-points.