key: cord-0859710-bjhz25ts
authors: Pišot, Saša; Milovanović, Ivana; Šimunič, Boštjan; Gentile, Ambra; Bosnar, Ksenija; Prot, Franjo; Bianco, Antonino; Lo Coco, Gianluca; Bartoluci, Sunčica; Katović, Darko; Bakalár, Peter; Slančová, Terézia Kovalik; Tlučáková, Lenka; Casals, Cristina; Feka, Kaltrina; Christogianni, Aikaterini; Drid, Patrik
title: Maintaining everyday life praxis in the time of COVID-19 pandemic measures (ELP-COVID-19 survey)
date: 2020-08-04
journal: Eur J Public Health
DOI: 10.1093/eurpub/ckaa157
sha: a86ab85d6e4d849dbc64fb163324a4940b270d9e
doc_id: 859710
cord_uid: bjhz25ts

BACKGROUND: The extreme social circumstances caused by declared COVID-19 pandemic deeply intervene people’s everyday life and should not be neglected but seen through the view of social reality pinpointing the “ordinary” people. In this paper, authors explored basic segments of everyday and their subjective perception to what extent sleeping habits, physical inactivity, physical activity, nutritional habits and smoking have changed. METHODS: The online survey was conducted in nine European countries (Bosnia and Herzegovina, Croatia, Greece, Kosovo, Italy, Serbia, Slovakia, Slovenia and Spain) in 4108 participants, aged 15-82 years. The survey took place 30 to 40 days after WHO declared COVID-19 pandemic state, from April 15th to May 3rd, 2020. RESULTS: The results have shown 30 minutes longer sleeping time, 50% longer physical inactivity time, 65% longer screen time, 43% shorter walking time, 24% shorter sport time and 37% longer physical work time. Additionally, body mass gains (0.3 kg) could be explained in 20.6% with meals sizes, unhealthy food consumption, screen time and sport time. Further, respondents reported more regular meals (44%) and healthier meals with less alcohol consumption and less smoking, which have been positive outcomes of home confinement. CONCLUSION: The findings draw attention to negative changes in everyday praxis (inactivity, body mass gain) after such a short period. Because of possible risk to population’s health (especially of countries such as Italy and Spain with serious threat and more stringent measures), findings enable development of recommendations for maintaining healthy lifestyle habits with minimal negative health consequences in similar pandemic circumstances.

The term "everyday life" in social sciences has long been considered trivial, platitude and therefore irrelevant for "serious" research (1, 2) , its main purpose being to "capture life as it is lived" (3) within few common denominators: the exposure of regular, repetitive phenomena and situations should be exposed.

That is why research concerning everyday life should not be neglected as the view of social reality that pinpoints the "ordinary" people and how they subjectively perceive their own and other's actions.

Therefore, in the research of everyday life, one should emphasize "the inevitability of an individual actor as an analytical focus" (4) . Lifestyles as "relatively coherent sets of material and symbolic practices in everyday life" are to some extent the creators of people's personal identity. This is reflected, among other things, in eating habits, sleeping habits, sports and recreational activities, body care, free time habits, forms of sociality, cultural consumption etc. (5, 6) . In this paper, we explored basic segments of everyday life in extraordinary/extreme social circumstances, during the COVID-19 pandemic, declared as global health outbreak by the representatives of the World Health Organization on March 11, 2020 . Each country has adopted its own precautionary measures either strict or mild, for their citizens during the pandemic they undoubtedly had on everyday life of citizens. These measures affected all segments of everyday life; the way the active population works (e.g. work from home wherever possible), the closure of kindergartens, schools, colleges and dormitories imposed (home schooling), the ban on visits to the elderly in homes as well as lockdown public life (public transport, cultural events and non-essential consumer services). The daily life was suddenly concentrated on home and screen media connections. The importance to investigate sleeping habits, PA, eating   habits and sedentary behaviour is to find out how people can be affected by restrictive measurements and what can we recommend to people how to adapt better to the new situation in terms of health-oriented lifestyle.

Recent evidence showed that COVID-19 pandemic home confinement together with restricted or prohibited physical participation (schools, sport events and sports clubs' activities lockdown) imposed increasing risk of sedentary behaviours or level of inactivity (7, 8) . Just a few days of sedentary lifestyle are sufficient to induce a lot of negative physiological adaptations of the human body (9, 10) . Along the negative effect on PA, Covid-19 pandemic state has impact on diet behaviour (11) . Feeling forced to stay indoors (public life lockdown, quarantine) could be considered as psychological risk factor for consuming more quantities of food of poorer quality compared to standard living conditions. This induced changes in nutrition habits and challenged the energy balance proportions resulting in gaining weight (12) .

In addition to PA and balanced food habits, the appropriate sleeping habits have changed. When individual habits and quality of one's own sleep change during life, it may significantly contribute to alterations in people's healthy lifestyle. Psychosocial stressors may affect sleep indirectly through unhealthy behaviours such as poor diet, lack of PA, increased sedentary behaviours, or other diseases such as diabetes, hypertension, or depressive symptoms (13) (14) (15) . On the other hand, getting enough sleep improves appetite and functioning of the immune system (16) .

Concerning the situation people faced in COVID-19 pandemic, we hypothesised that "Lefebvre" Survey participants were invited through different ways: personal e-mail addresses, official pages of the partners organizations, local on-line newspapers, etc. By clicking on the survey, the presentation of the main purpose with detailed instructions to fill the survey in was provided. Participants were also informed that all data will be processed and managed in accordance with the legislation on the protection of personal data and the General Data Protection Regulation (GDPR). Participant's responses were anonymous and confidential according to 1KA (on (https://www.1ka.si/d/en/help/manuals/gdpr-and-datacollection), and survey did not collect any personal data (names, birth date, contact information) to enable the respondent's identification. The participants were able to leave the questionnaire at any stage before the submission process. Only surveys with completed mandatory questions were taken into further analysis. Likert scale were analysed: 1-much less, 2-less, 3-the same, 4-little more, and 5-much more. While those that indicated 6-cannot estimate or 7-not applicable were excluded.

The sample consisted of respondents of 9 European countries (N= 4108, male =1527 (37.2%), age 32.0 (13.2), ranged from 15 to 82 years ( transportation with strict restriction of movement and recommended mantra "stay at home".

Consequences after a month of the newly introduced state showed that social reality from the position of "ordinary" people and subjective meaning of "new" everyday life has changed significantly.

The multivariate Hotelling's T 2 test confirmed differences in 12 main variables related to everyday praxis (p<0.001). Additionally, post hoc analysis in 12 variables indicated changes in sleeping habits, physical inactivity with screen time and PA habits.

There was a visible difference in all scores of nine countries in sleeping habits in "go to bed" time Figure 1D ). The time spent in sport activities decreased in majority of countries, except in Slovenia, Slovakia and Kosovo ( Figure 1E ); and the time spent in physical working (e.g. gardening) increased also in majority of countries, except in Italy, Spain and Greece ( Figure 1F ).

Firstly, we analysed body mass adaptation and found that participants that monitored their body mass (N=2208) had an increase for 0. (p<0.0008)), being between "stays the same" and "gain a little"; however, results again indicate gaining body mass (p<0.0008). To explain body mass gains in a subsample of 2208 participants that reported exact body mass changes we used multiple linear regression and found that the model explained 20.6% of body mass change variance (p<0.001) with increased meal sizes, unhealthy eating, increased screen time and decreased sport time during COVID-19 restriction measures ( Table 2) .

When comparing eating habits during COVID-19 restriction measures with those prior to restriction, we found more regular meals, larger meal sizes, less unhealthy food, lower alcohol, and tobacco consumption (Figure 2 ). Descriptive analysis is presented in Supplementary Figure 1 , where we found that 44% of the participants adopted eating habits with more regular meals, while 16% had fewer regular meals. Further, 29% of the participants enlarged meal size, while 20% of them decreased meal size. Unhealthy food consumption was increased in 33% of respondents, while 35% reported a decrease.

Unexpectedly, increase of the alcohol consumption and smoking behaviour were reported in less than 10% of the participants, while at the same time 36% drink and 14% smoke less or much less than before. Figure 1 ).

The results of this study focus on the changes in everyday life praxis after 30-40 days of COVID-19 restriction measures. We found marginal changes in all studied everyday life praxis.

Participants reported 0.5 hours longer sleeping time, 50% longer physical inactivity most likely due to 65% longer screen time, whereas walking time decreased for 43%, sport time decreased for 24% and physical work time decreased for 37%. Abovementioned changes were consistent in almost all countries, with some exceptions, which will be discussed below.

Going to bed half an hour after midnight and later waking up times were probably the effect of home confinement since people needed to compensate for having to organize working and schooling from home, which allowed a bit looser timetable. The results could be reported in two ways, the later bedtime could be related with increased screen time and physical inactivity or poor diet (13) (14) (15) , but on the other hand, people who used home confinement and got sufficient sleep could improve appetite and immune system functioning (16) . Regarding the body mass, we found the increase of 0.3 kg of those who monitored and was similar to those that reported their subjective estimates towards gaining a little weight. We found that body mass gains could be explained in 20.6% with meals sizes, unhealthy food consumption, screen time and sport time. Indeed, we found increased meal sizes, higher screen time and lower sport time during COVID -19 restriction measures, which was also reported by Butler & Barrientos (2020), but in opposite participants reported more regular meals and less unhealthy food consumption. The latter was found to be in contradiction with Butler and Barrientos (2020) and Ammar et al. (2020) ; however, the changes we reported were rather small but significant. Alcohol consumption and smoking decline could be explained by severe restrictions in order to control the pandemic outbreak reflected in social life and the accompanied social habits, drinking and smoking (especially in young people).

Despite all professional recommendations in mass media how to stay healthy and active in the time of quarantine, declines of PA levels with large increases in physical inactivity were reported.

Consequently, the most evident change in the study was in physical inactivity and screen time which increased for approx. three hours, where physical inactivity reached above the threshold area (6-8 hours daily). It is already known that sedentary lifestyle is one of the strongest factors for increasing risk of disease or mortality (24) (25) (26) (27) , going along with increased screen time. Additionally, the new ways (probably with information technology [IT] tools) to maintain a more optimal PA as regular low/medium intensity volume exercise, also in the time pandemic restriction, together with a 15-25% reduction in caloric intake have to be promoted in order to preserve neuromuscular, cardiovascular, metabolic and endocrine health (10) The findings definitely impose the need to draw attention to the negative changes in everyday practices and their risk to the health of population, which was evident in the more endangered countries (Italy and Spain) with stricter measures on everyday life (quarantine, movement restriction). Consequently the perspective of this "ELP COVID-19 study" is also to target the extent of effect of pandemic measure in each country following the demographic characteristics. Knowing the specific reaction in adopting the "new normality" by participated countries will enable us to prepare recommendations for positive outcomes in similar situations with minimal consequences to health of population. 

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