key: cord-0897080-08tuq38l authors: Amini, H.; Isanejad, A.; Chamani, N.; Movahedi-Fard, F.; Salimi, F.; Moezi, M.; Habibi, S. title: Physical activity during COVID-19 Pandemic in the Iranian population: A brief report date: 2020-11-02 journal: Heliyon DOI: 10.1016/j.heliyon.2020.e05411 sha: 0bcfcc0713927d3ea37f0b394feadd08652ec0b9 doc_id: 897080 cord_uid: 08tuq38l COVID-19 pandemic and restrictive public health measures due to it can have many effects on physical activity. Our study aimed to compare the levels of physical activity levels (expressed as MET–minute/week), among Qom city (Iran) adults in pre and during the COVID-19 pandemic (January 2020 and 20 to 29 May 2020, respectively). 670 adults were included in this study and grouped based on age and gender. The short-form International physical activity questionnaire (IPAQ, SF) was distributed to the participants through an online survey. The Wilcoxon signed-rank test was used for statistical analyses. The present study showed that the level of physical activity decreased significantly during COVID-19 compared to pre-COVID-19 in both sexes and age groups (p<0.001). Also, this study found that a total of 78% of the participants did not meet the physical activity guidelines during COVID-19 in Iran. Our results indicate the necessity to consider an integrated and comprehensive approach to reduce the inactivity caused by COVID-19. Coronaviruses are a large family of viruses that cause illness in mammals and birds. In 16 humans, these viruses can cause illness ranging from the common cold to more severe 17 diseases and respiratory tract infections 1 . In the last days of 2019, new pneumonia caused by 18 coronavirus appeared in Wuhan city of China 1 . The World Health Organization (WHO) gave 19 the name COVID-19" to the disease caused by this virus 2 . As of 31 May 2020, more than 20 6,000,000 cases have been diagnosed and at least 371,364 deaths caused by this virus have 21 been confirmed in the world, with major outbreaks in the USA, Brazil, Russia, and Spain 3 . The first official announcement of deaths from COVID-19 in Iran was on 19 February 2020, 23 in Qom city. In Iran and as of 4 June 2020, 164217 people have been diagnosed with 24 COVID-19, with 8071 fatalities 4 . 25 In Iran and many countries, governments have adopted restrictive measures such as 26 quarantine, isolation, and physical distancing, the suspension of any social event, and the 27 closure of schools and universities to reduce transmission of the virus, because no effective 28 medicines or vaccines have been created so far 5 . Also, access to gyms, sports centers, 29 swimming pools, public parks, and gardens was prohibited. All of these public health 30 restrictions likely reduce access to physical activity opportunities. A recent study from Giustino et al, (2020) indicated a significant decrease in the total weekly 32 energy expenditure during the COVID-19 in the Sicilian active population 6 . Also, in another 33 study from Fitbit Inc., a 12% reduction in step count across the US was observed during the 34 week of 22 March 7 . It is well known that regular and sustained physical activity affects almost every facet of 36 health across the lifespan and the prevention of mortality. Moreover, it improves defense 37 activity, metabolic health, and mental health 6 . 38 However, data are not yet available to indicate changes in physical activity due to pandemic-39 related public health restrictions in the Iranian population. Given the lack of data and the 40 rapidly evolving response to COVID-19, this study was designed to evaluate the impact of 41 COVID-19-public health restrictions on physical activity levels in the Iranian population. This study is a cross-sectional online survey conducted using the Google Drive web survey 3 platform. 4 Procedure and Participants 5 From a previous study (unpublished study), we had data of 1,200 adults (aged 18 years and 6 over) in Qom city. This data, which was collected in January 2020, included age, sex, and 7 physical activity level (measured by short-form International physical activity questionnaire). 8 From 20 to 29 May 2020, the online survey was shared with the personal contacts of these 9 adults via social media such as WhatsApp and Telegram. Adults were deemed eligible if they 10 were aged 18 to 64 and currently residing in the Qom city. This online survey form begins with a brief description of the study and its purpose. 12 Participants self-reported age, sex, stay-at-home days, and physical activity levels. In the 13 present study, the pre-COVID-19 and during COVID-19 periods were defined as January 14 2020 and 20 to 29 May 2020, respectively. During this study, social distancing was Physical activity measurement 21 We used a short-form International physical activity questionnaire (IPAQ, SF) for 22 measuring physical activity. This questionnaire is a 9-item scale that assessing the 23 number of minutes spent in vigorous and moderate-intensity activity and walking on 24 weekdays during the last 7 days. The questionnaire and its interpretation methods 25 have already been reported 9 . In healthy adults, IPAQ, SF had good test-retest 26 reliability (Spearman p=0.80) and moderate criterion validity (Spearman p=0.30) with 27 an accelerometer 10 . To analyze survey data, age was re-coded. Age classifications were grouped into 2 30 categories: adults aged 18-34 years and those aged 35-64 years 6 . The summary statistics 31 (percentiles, means, and standard deviations) were used to represent the physical activity 32 level (expressed in MET-min/wk) for the categorical variables, 33 The Wilcoxon signed-rank test was used to compare physical activity (MET-min/wk) pre and 34 during COVID-19. Also, we carried out a bivariate analysis to analyze the relationship A total of 1,200 adults that online survey was shared with them, 700 participants completed 40 the online survey. After excluding missing outcome data, a total of 670 with complete data 41 were analyzed (a completion rate of 58.3% with 55.8% after exclusions). The participants of the study comprised 518 females (77.4%) and 152 males (22.6%) with the age of 29.24 ± 9.5 1 years. Based on age classifications used, participants of this study were grouped into: 18-34 2 years: n = 473 (70.5%); 35-64 years: n =197 (29.5%). 3 4 The physical activity level of the participants in pre and during COVID-19 was reported in 5 To our knowledge, our study was among one of the first studies to investigate the impact of 10 the COVID-19 pandemic on physical activity in Iran. In agreement with previous studies 6,7 , 11 the present study showed that the level of physical activity decreased significantly during 12 COVID-19 compared to pre-COVID-19 in both sexes and age groups. Also, this study found 13 that a total of 78% of the participants did not meet the physical activity guidelines during 14 COVID-19 in Iran. Previous studies have identified that about 33% of the IRAN adult 15 population did not meet physical activity guidelines 11 , whereas the present study showed that 16 this level was at 78% during COVID-19. There are different causes of the lower physical activity levels during COVID-19. For 18 example, some people went to sports centers and clubs for physical and sports activities. With 19 the closure of these places and clubs in social distancing, people's access to coach / personal 20 trainer / instructor / training partner and equipment has decreased, and as a result, one of the 21 opportunities for physical activity has been lost. Also, some people went to parks and recreation centers for physical activity. These centers 23 were also closed during COVID-19 social distance. So another opportunity for physical 24 activity is missed. In some countries, people can walk and cycle in during COVID-19 social distance. However, due to the lack of safe walking and cycling routes in Qom and many cities improved host responses to influenza and pneumonia infection 13, 14 . There is also increasing 10 support for increase antibody responses to influenza immunization in active elderly adults 15 . Although there are many differences between COVID-19 and influenza, it can be said that 12 regular physical activity can strengthen the body's immune system through different 13 processes and leads to a better reaction of the body's immune system to the virus. 14 Also, about 70% of all deaths due to COVID-19 occurred in people with pre-existing health 15 conditions including cardiovascular diseases and diabetes 16 . Since inactivity is one of the risk 16 factors for these conditions 17 , then we can assume that deaths due to COVID-19 is higher in 17 sedentary people. 18 Also, since physical inactivity is one of the four major risk factors of Non-Communicable 19 Diseases (NDCs) 18 , so it can be expected that the prevalence of non-communicable diseases 20 will increase soon. Our results indicate the necessity to consider an integrated and 21 comprehensive approach to reduce the inactivity caused by COVID-19. In this approach, plans and programs must be made to correct the lifestyle created during the COVID-19 23 pandemic. One of these programs is media attention to physical activity. In the Iranian media, 24 more attention is paid to prevention methods as well as the dangers of QOVID-19, while less 25 attention is paid to effective issues such as physical activity and a healthy lifestyle. On the one hand, the media can increase people's awareness about the effects of physical 27 activity, and on the other hand, they can introduce various forms of physical activity specific 28 to this period (for example home-based exercise training). As far as possible, the government allocates parks and nature centers outside the city for 30 walking and cycling; so people can take advantage of these physical activity opportunities 31 (by following health protocols of COVID-19). Our study suffered from the limitations associated with the small number of the sample size 33 and self-report physical activity level of participants and thus potentially introducing self-34 reporting bias into the findings. Therefore, these funding must be interpreted in light of the 35 study limitations. This study showed that the COVID-19 pandemic leads to a decrease in physical 38 activity. Increased inactivity during the COVID-19 pandemic can have many negative 39 effects. For this reason, we believe that policymakers should pay attention to the 40 J o u r n a l P r e -p r o o f prevalence of this inactivity. Also, we strongly urge that health workers should 1 include physical activity promotion as part of their follow-up after the pandemic. Origin and evolution of pathogenic coronaviruses A novel coronavirus outbreak of global health 14 concern. The Lancet WHO International Health Regulations Emergency Committee for the COVID-19 16 outbreak COVID-19 battle during the toughest sanctions 18 against Iran Isolation, quarantine, social distancing and community 20 containment: pivotal role for old-style public health measures in the novel coronavirus (2019-21 nCoV) outbreak Levels and Related Energy Expenditure during COVID-19 Quarantine among the Sicilian 24 Active Population: A Cross-Sectional Online Survey Study Changes in physical activity and sedentary behavior 26 in response to COVID-19 and their associations with mental health in 3,052 US adults Emerging coronaviruses: genome structure, replication, and 29 pathogenesis Questionnaire-short form (IPAQ-SF) valid for assessing physical activity in Chronic Fatigue 32 Syndrome? Disability and rehabilitation International physical activity questionnaire: 12-34 country reliability and validity. Medicine & science in sports & exercise Worldwide trends in insufficient physical 37 activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1· 9 38 million participants. The Lancet Global Health The compelling link between physical activity and the body's 40 defense system Exercise improves host response to influenza 42 viral infection in obese and non-obese mice through different mechanisms Aerobic exercise protects from 1 pseudomonas aeruginosa-induced pneumonia in elderly mice Elderly men with moderate and intense 4 training lifestyle present sustained higher antibody responses to influenza vaccine Association of blood glucose control and outcomes in 7 patients with COVID-19 and pre-existing type 2 diabetes. Cell metabolism. 2020. 8 17. van der Ploeg HP, Hillsdon M. Is sedentary behaviour just physical inactivity by another 9 name? Physical inactivity: associated diseases and disorders Authors thank all the adults that participated in this study.