importance of exercise in pandemic essay

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Physical Fitness and Exercise During the COVID-19 Pandemic: A Qualitative Enquiry

Harleen kaur.

1 Freelance Researcher and Activist, Jaipur, India

2 Department of Psychology, Banaras Hindu University, Varanasi, India

Tushar Singh

Yogesh kumar arya, shalini mittal.

3 Amity Institute of Behavioural and Allied Sciences (AIBAS), Amity University Uttar Pradesh, Lucknow, India

Associated Data

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation, to any qualified researcher.

The COVID-19 pandemic has brought this fast-moving world to a standstill. The impact of this pandemic is massive, and the only strategy to curb the rapid spread of the disease is to follow social distancing. The imposed lockdown, resulting in the closure of business activities, public places, fitness and activity centers, and overall social life, has hampered many aspects of the lives of people including routine fitness activities of fitness freaks, which has resulted in various psychological issues and serious fitness and health concerns. In the present paper, the authors aimed at understanding the unique experiences of fitness freaks during the period of lockdown due to COVID-19. The paper also intended to explore the ways in which alternate exercises and fitness activities at home helped them deal with psychological issues and physical health consequences. Semi-structured telephone interviews were conducted with 22 adults who were regularly working out in the gym before the COVID-19 pandemic but stayed at home during the nationwide lockdown. The analysis revealed that during the initial phase of lockdown, the participants had a negative situational perception and a lack of motivation for fitness exercise. They also showed psychological health concerns and overdependence on social media in spending their free time. However, there was a gradual increase in positive self-perception and motivation to overcome their dependence on gym and fitness equipment and to continue fitness exercises at home. Participants also tended to play music as a tool while working out. The regular fitness workout at home during the lockdown greatly helped them to overcome psychological issues and fitness concerns.

Introduction

The COVID-19 pandemic is a massive global health crisis ( Bavel et al., 2020 ) and rapidly spreading pandemic ( Bentlage et al., 2020 ) of recent times. As compared to the earlier pandemics the world has witnessed, the current COVID-19 pandemic is now on the top of the list in terms of worldwide coverage. This is the first time the whole world is affected simultaneously and struck strongly in a very short span of time. Initially, the death rate due to COVID-19 was around 2%, which has now increased to around 4–6% ( World Health Organization [WHO], 2020 ). The statistics does not look so severe, but the total number of cases and the rate at which these cases are increasing day by day make the situation alarming. Exponential growth in COVID-19 cases has led to the isolation of billions of people and worldwide lockdown. COVID-19 has affected the life of nearly each person around the world. The difference between personal or professional lives has narrowed due to work-from-home instructions, and people’s lives are revolving around these two due to the lockdown. People have also been pondering over a vital concern at home, i.e., the importance of their health and fitness.

Although imposing lockdown or quarantine for the population has been one of the widely used measures across the world to stop the rapid spread of COVID-19, it has severe consequences too. Recent multinational investigations have shown the negative effect of COVID-19 restrictions on social participation, life satisfaction ( Ammar et al., 2020b ), mental well-being, psychosocial and emotional disorders as well as on sleep quality ( Xiao et al., 2020 ), and employment status ( Ammar et al., 2020d ). Announcement of a sudden lockdown of all services and activities, except few essential services, by the authorities has resulted in a radical change in the lifestyle of affected people ( Jiménez-Pavón et al., 2020 ) and has severely impaired their mental health, which has been manifested in the form of increased anxiety, stress, and depression ( Chtourou et al., 2020 ). The sudden changes in people’s lifestyle include, but are not limited to, physical activities and exercise. Ammar et al. (2020a) have reported that COVID-19 home confinement has resulted in a decrease in all levels of physical activities and about 28% increase in daily sitting time as well as increase in unhealthy pattern of food consumption. Similar results are also reported by other researchers ( Ammar et al., 2020c ; de Oliveira Neto et al., 2020 ) as well. Although these abrupt changes have influenced every individual, many people who were regularly following their fitness activities in gyms, or in the ground, or other places before the lockdown have been affected intensely. Closure of fitness centers and public parks has forced people to stay at home, which has disturbed their daily routines and hampered their fitness activities. While compulsion to stay at home for a long period of time poses a challenge to the continuity of physical fitness, the experience of hampered physical activities, restricted social communication, uncertainty, and helplessness leads to the emergence of psychological and physical health issues ( Ammar et al., 2020a , c ). Varshney et al. (2020) have found that psychological problems are occurring in adults while adjusting to the current lifestyle in accordance to the fear of contracting the COVID-19 disease. However, effective coping strategies, psychological resources, and regular physical exercise can be helpful in dealing with such health-related problems during the COVID-19 pandemic ( Chtourou et al., 2020 ).

It is important to note that physical activities (PA) and exercise not only maintain physical and psychological health but also help our body to respond to the negative consequences of several diseases such as diabetes, hypertension, cardiovascular diseases, and respiratory diseases ( Owen et al., 2010 ; Lavie et al., 2019 ; Jiménez-Pavón et al., 2020 ). In a recent review of 31 published studies, Bentlage et al. (2020) concluded that physical inactivity due to current pandemic restrictions is a major public health issue that is a prominent risk factor for decreased life expectancy and many physical health problems ( Jurak et al., 2020 ). Exercise is shown to keep other physical functions (respiratory, circulatory, muscular, nervous, and skeletal systems) intact and supports other systems (endocrine, digestive, immune, or renal systems) that are important in fighting any known or unknown threat to our body ( Lavie et al., 2019 ; Jiménez-Pavón et al., 2020 ).

Regular physical activity, while taking other precautions, is also considered effective in dealing with the health outcomes of the COVID-19 pandemic ( Chen et al., 2020 ). Researchers from the University of Virginia Health System ( Yan and Spaulding, 2020 ) suggests that regular exercise might significantly reduce the risk of acute respiratory distress syndrome, which is one of the main causes of death in COVID-19 patients. Exercise and physical activities have important functions for individuals’ psychological well-being as well ( Stathi et al., 2002 ; Lehnert et al., 2012 ). There is sufficient literature to show that exercise can play a vital role in the promotion of positive mental health and well-being (e.g., Mazyarkin et al., 2019 ). However, when health promotion activities such as sports and regular gym exercises are not available in this pandemic situation, it is very difficult for individuals to meet the general WHO guidelines (150 min moderate to mild PA or 75 min intensive PA per week or combination of both) (cf. Bentlage et al., 2020 ). Amidst this pandemic-related restriction (home confinements and closed gyms, parks, and fitness centers), how people cope up and find ways to continue their physical fitness remains an important question.

Rationale for the Present Research

Since the onset of this disease, people have been confined to their homes, which has not only resulted in various psychological health issues but also challenged their physical fitness and health ( Ammar et al., 2020a , b , c , d ; Chtourou et al., 2020 ; Xiao et al., 2020 ). Although this pandemic situation has led to the unexpected cessation of almost all the outside routine activities of all the individuals, it has profoundly hampered the physical activities of fitness freaks (those who regularly go to the gym for their physical fitness), as gyms and other such places have been shut down due to the lockdown. However, studies addressing the issues of fitness freaks, who used to spend a significant amount of time for regular workout in order to maintain their physical fitness, health, and appearance, seem to have found no place so far in the literature in relation to the current pandemic situation. Supposedly, the unique experiences of such people, their health issues, and the ways in which they have dealt with these issues during the COVID-19 pandemic have remained underexplored.

Also, it is well-known that the COVID-19 pandemic has made it difficult for people to adequately maintain their normal physical activity patterns at home ( Ammar et al., 2020a ). There are plenty of studies that have addressed the impact of COVID-19 on physical activities of the general public ( Ammar et al., 2020a , b , c , d ; Chtourou et al., 2020 ; Xiao et al., 2020 ), demonstrated the significant decrease in physical activities and exercise patterns, and illustrated its ill effects on physical and mental health status. There is also a growing body of literature that suggests strategies to encourage people to be involved in home-based exercises and fitness activities ( Ammar et al., 2020a , b , c , d ; Chtourou et al., 2020 ; de Oliveira Neto et al., 2020 ). However, all these studies were conducted in the earlier phase of the pandemic. There is a lack of studies investigating the way in which people have dealt with the problems arising from the COVID-19 pandemic and subsequent lockdown/home confinement. In fact, it would be interesting to explore how and to what extent people were able to follow and benefited from the workout at home advices. Therefore, the present research aims at understanding people’s unique experiences during the period of lockdown due to COVID-19 and exploring the ways in which regular exercise engagements helped them deal with the psychological and physical consequences of home confinement.

In order to gain a rich and extensive understanding of experiences into people’s lives during this pandemic and their efforts to maintain a healthy lifestyle, a qualitative approach was adopted for the study. We used Interpretive Phenomenological Analysis (IPA) to delve into the participants’ perceptions and to provide a close picture of the participants’ unique experiences during the lockdown period.

Participants

A homogeneous sample of 22 participants was selected for this study. The criterion-based purposive sampling technique was used to identify and select the participants. We first contacted the gym owners/trainers and sought their consent to help us in the conduction of this study. Upon consent, we requested them to provide us with the details of their regular gym members who continuously go to the gym and do fitness exercises for at least 6 months prior to the imposed lockdown. Once the list was generated, the prospective participants were then connected by phone, were explained the purpose of the study, and were requested for their consent to participate. Those who consented for their inclusion in the study were then asked some questions based on the pre-decided inclusion and exclusion criteria for the study. On the basis of this information, those participants who met the inclusion criteria (i.e., those who were continuing fitness workout in their home or hostels and were following strict home confinement measures during the COVID-19 pandemic and subsequent lockdown) were further contacted and requested to provide an appointment for a telephone interview.

Inclusion and Exclusion Criteria for the Participants

The participants meeting the following criteria were included in the study:

• • Individuals aged 18 years or older.
• • Individuals with no known history of physical and/or psychological illness.
• • Individuals who were doing regular gym workout for the last 6 months or more for at least 45 min daily before COVID-19.
• • Individuals who were completely dependent on gym exercise for their physical fitness.

However, individuals meeting the following criteria were not included in the study:

• • Individuals who were irregular or occasional gym visitors.
• • Individuals who were practicing other physical exercises besides gym workout.
• • Individuals with any physical and/or psychological conditions or individuals on any kind of medication.

Table 1 presents the demographic and exercise characteristics of the participants included in this study.

Demographic characteristics of the participants.

The purpose, importance, and relevance of the study were explained to the participants, and informed consent was obtained for their participation. All the participants were assured of the confidentiality of their responses and identity. Upon consent, the participants were requested to share their convenient time for a telephone interview. Semi-structured telephone interviews were conducted to explore the exclusive experiences of the participants with regard to their physical fitness during the lockdown. An interview schedule composed of non-directive, open-ended questions was prepared. There was no fixed order of questions; they were modified and re-modified as per the flow of the conversation with each participant. Some of the main questions prepared for the semi-structured interviews included “What is your perception of this situation we are currently living in?,” “What is your lockdown experience?,” “How frequently you used to go to gym for exercise before the lockdown was imposed?,” “How do you manage exercise at home?,” “What is your exercise schedule now?,” “What changes did you perceive in yourself during this lockdown?,” “How are you coping with this lockdown?,” “Did you experience any psychological issue during this period of time?,” “How do physical exercises help in combating the crisis you are facing?,” “What background aid do you use while exercising at home?,” “What is the need to use such aids while exercising?,” “How does fatigue impact you when you exercise during the lockdown?,” “What is the importance of proper sleep in following a regular schedule of exercise during this lockdown?,” “Do you miss your gym mates?,” “Do you feel you share an identity with your fellow gym mates?,” etc. Additional probing questions were also added as the need occurred during the individual interviews. In addition questions were also asked t o understand the differences between their pre and during COVID-19 lockdown fitness exercise patterns (see Table 2 ). All the interviews were conducted in the native language of the participants in Hindi and English. With due permission from the participants, the interviews were recorded. The interview time duration range was between 20 and 30 min. All the interviews conducted in Hindi were transcribed and then translated in English by the researchers. The translated interviews were then proofread by a native English speaker for correctness and consistency.

Pre- and during COVID fitness exercise information of the participants.

Analysis and Results

All the recorded interviews were transcribed. These transcripts were then analyzed using the Interpretative Phenomenological Analysis (IPA) framework to identify the participants’ experiences of lockdown, their alternative choice to continue their fitness routine, and its impact on their health. A stepwise progression method was used to analyze the data. At first, the researchers read the transcripts many times to get a deeper understanding of the experiences as described by the participants. In order to gain as close an understanding of the data as possible, the researchers listened to the audio recordings of the participants while reading the transcribed data.

In the following step, the attempts were made to transform the transcripts into a conceptual framework that was deeply connected to the participant’s original verbatim in order to identify emergent themes (see Table 3 ).

Major themes and subthemes that emerged from the interviews indicating participants’ experiences during the COVID-19 pandemic.

After identifying the emerging themes, the transcripts were read again so as to cluster these emergent themes together according to their similarities at the basic level. In this process, some themes emerged as the broad themes under which subthemes were incorporated. The major themes and subthemes that emerged in the analysis are presented in Table 3 .

Table 3 presents six major themes describing the experiences of participants with regard to the COVID-19 pandemic and their efforts to maintain a healthy lifestyle. The following section discusses each of these themes and its subthemes along with the relevant excerpts from participants’ experiences.

Psychological Health Issues

Almost every participant reported facing psychological health issues linked to the COVID-19 pandemic and subsequent lockdown. Participants experienced frustration, anxiety, fear, and stress. For example, participant 11 reported,

• “I am experiencing frustration daily for spending my 24 by 7 time at home, looking at same faces and am not allowed to go anywhere. Anxiety of work and its upcoming scenarios tickle my mind a lot. What if I have to do my job virtually for a lifetime? ………….Like that. And especially experiencing a fear of losing my ever charming personality, the economic status of family, no wages or less wages, fewer opportunities in future, job shift, health care of my family.”

The closure due to the pandemic has created a state of uncertainty about an individual’s own future as well as about the future of the family and community, which in turn is being reflected in terms of psychological states of frustration, anxiety, fear, and stress.

Individuals stuck at their homes without a clearly defined routine and work are not able to prioritize their work schedules, resulting in the experience of unexplained laziness and fatigue. Participant 7, for example, reports that

• “Physical fatigue has reduced as there is no physical load or fixed working hours, but the mental fatigue and mental pressure has increased manifolds. Worries have increased. Spare time is more than what was required and due to this lethargy has increased. Frustration level is going up.”

The monotonous and closed life cycle of one confined to one’s own home has also resulted in extreme disturbances of one’s sleep cycle. For example, Participant 5 reports,

• “Sleep a lot, a lot!! Just imagine I have been sleeping 10 to 12 hours after the lockdown. My sleep pattern was set earlier due to office, but it is disturbed now in the absence of a routine. I have virtual meetings now also, but if the meeting is to start at 10, I would get up at 9.40, wash my face and attend the meeting. After that I feel like taking a nap again. I sleep for 8 hours wake up and exercise in the morning, but I have the liberty to be flexible with my time. seriously I am craving for gyms to open, my trainer to keep a check on me, scold me, I really want complete sleep and a routine.”

It is therefore evident from these examples that the onset of the COVID-19 pandemic has resulted in the experience of psychological problems characterized by frustration, anxiety, fear, and stress. The sleep–wake cycle is interrupted, leading to a state of laziness and mental fatigue.

Lack of Motivation for Fitness

The closure of gyms and other fitness activity centers, including sports stadiums, morning walk parks, etc., and the heightened psychological health issues have resulted in the lack of fitness motivation. For example, participant 1 reports,

• “See, ultimately due to the shutdown of gym during this pandemic, my rhythm has been disturbed, you are getting it? I have had a tight schedule always due to my profession but each evening I used to hit the gym daily…………. I mean, that zeal is gone, ……….now also I am getting time in the evening but then also I am unable to ask myself to work out because that gym environment is gone, the gym people as you would see other fellows at gym, that would motivate you, their body gives you an inspiration that how he or she is that fit, they motivate you, here I share an identity with them, I find those people as source of my motivation to physical exercise, those people give you so much morale and now that is lost totally, I literally crave for that.”

The motivation for fitness is not only internal but also external. People are motivated when they observe others doing fitness activities. Gym mates and their physique work as motivating factors for individuals to engage in a regular and routine gym activity. Participant 10 said in frustration that,

• “Almost all gone, ………….the motivation is the most ruined thing today, ……….talking about my workout, I have been hitting the gym since I was 22………, Imagine how much that space motivated me, I miss that, my pals there……., not because we are friends or something, see gym doesn’t provide you an environment to make pals or something as people change their gyms and many a thing but, they give you a lot of competition, you become jealous of their appearance and later that workout that space becomes your habit, I miss that, say like anything, but still I am trying.”

It is evident from the above statement that a lack of motivation for fitness was due to the home confinement and lack of presence of others. The presence of others engaged in a similar activity not only creates a sense of shared identity but also is a source of healthy competition and thus motivation.

Change of Perception

As the days progressed, individuals learned to respond to the pandemic in a more constructive and positive manner. Their perception for the situation remained the same (negative), but their perception toward themselves started to change. They started believing that even though they could not change the situation, they could do the same for their own self to deal with the situation. Participant 2, for example, commented on the situation and said,

• “Ah! Talking about the situation we are living in, it is so unprecedented, anything can happen anytime, though I am less stressed as compared to the date the lockdown was announced, I perceive this whole situation is so terrible, worst… what is this happening, you just tell me, wake up in fear and sleep in fear. I wonder when this is going to end.”

However, upon asking about her/his own self, s/he added

• “You know this COVID has done only one thing right, that is, you know giving me immense time to work on myself, which otherwise I always overlooked. Though I went to gym for my physique only but never gave time to my thoughts, skills, etc. So when talking about changes in myself or perception of self, I would say changes come under three categories in me- first physical, that is appearance, personal, like I will quote enjoying every bit of time. Who knows I am next. I now celebrate life, and finally social changes in myself, as I have got time to work on my communication skills, talking on virtual platforms and sense of oneness or say unity, as I am locked down in hostel and we guys do every deed and task on our own without family, standing together.”

Similarly participant 22 summarized the situation as

• “(Laughing), Seriously! The Virus is making a joke on us, truly this is the worst of situations I can ever imagine, I am so negative about the situation we are in, I am in… everyone in….you know how stressful it is for me to know that I am unable to practise. You know as a clinician how hard it is to be like this. Though I am still a student but think likewise, harsh situation madam, extra precautions for everything, negative, too much negative. This time would be a memorable time for generations; sorry my tone has become louder I am kind of in agony, all credits to this so called CORONA.”

S/he, however, further commented that

• “my experience throughout the past few months in this Corona Era is so negative but myself-perception or I would say how I am taking myself now from earlier has meaningfully changed now. You know, I am someone who is giving time to myself, exploring my hobbies, giving time to leisure, learning kitchen skills, learning new dishes, becoming a chef besides being a dentist you know. So, for me, myself, I am so positive with regards to myself.”

It is therefore evident that increased experiences with an initial unfamiliar situation initiate the coping mechanisms within an individual, which is reflected in the changed perception of their own self, and reappraisal of the situation in a more positive manner.

Shifting Focus on Substitutes of Gym Workout and Equipment

With the positive change in perception, individuals started to think about their normal routine and tried to find ways to substitute their normal activities. They started trying to shift their exercises from gym to other available places and using alternatives to gym equipment for their fitness activities. The statement of participant 20 indicated how shifting from gym-based exercises to yoga practices was an effective alternative for coping with the habitual compulsion for gym exercises.

• “Since I get a pace back again for my physical fitness in this lockdown, I have made a shift to yoga, especially the power yoga in the morning time. I prefer doing meditation as well. Earlier I never used to practise the same but now I have seen videos of some asanas good for health, I am following them and practising them. It’s a shift for peace I guess. I tried something new and found my gym addiction could be controlled or moderated by taking out time for yoga and meditation even after COVID.”

Similarly, participant 17 reported her/his shift to high-intensity workouts at home.

• “See, as you might know not everyone has exercise equipment at home which we used to have in gym. So, I prefer those exercises which require less or zero weights say jumping jacks, skipping.”

After resuming motivation, in order to stay physically active and fit, participants actively engaged in the process of finding alternatives to their routine physical exercise equipment. Participant 14 reported shifting to alternatives to heavy weights

• “I personally was too much dependent on equipment to exercise in the gym. Now there is no option left because even online, the 5 and 10 kg weights are out of stock, And, nearby stores are either closed or you can’t go out. So, for me it was tough but I searched the internet, the social media, talked to fitness experts and used some ‘JUGAAD’ at home. So, they are using buckets, big water bottles and skipping ropes. I had 10 kg iron rods of water pipeline spare at my home, I am using that and these are helpful and I guess need of the hour.”

Social Media Dependence

One of the major shifts in the individuals’ lives during this pandemic was the increased social media dependence. As a result of social distancing, people were spending more time online to virtually connect with others and stream entertainment. In the backdrop, the COVID-19 pandemic led to an increase in the time spent on social media that helped people kill time. Participant 12 reported the benefits as well as the drawbacks of this social media dependence.

• “Social-media is a mixed feeling platform. I mean at one hand it keeps me updated with the happening around; the facilities promised by the government; and… it keeps me connected with the world. But on the other, it irritates me a lot, a lot of misinformation creates a worry in you. So yes, there is a dual objective of this social media.”

However, participant 4 viewed this increased dependence on social media as an effective strategy to break the silence and to overcome the monotonous days.

• “Our life has given us so much time ……., I mean I have so much spare time but besides that, I have a monotonous schedule every day, so social media keeps me busy, for example, web series suggestion and reviews, movies suggestion and reviews, video games, etc. Also, on the one hand, I do not get bored as one day I am learning some planting technique at home through media, the other day something to cook, some family or friend sharing his/her recipe, hobby ideas, craft ideas, writing, etc. Physical workout schedule helps me a lot. I am doing one thing useful at a time, and that keeps me busy.”

Similarly, participant 3 reported that

• “Definitely social media has impacted my sitting schedule as I am just sitting for a long span of time, say while eating or talking to family. I am sitting scrolling YouTube, Facebook, WhatsApp, Instagram, one post after the other. It has become my habit now. I feel like I will only watch a single video or only this news but I end up spending 1 to 2 hours scrolling and watching. Seriously, it’s a habit now, but I am glad that workout is something I do in my schedule, which is so productive, and I really feel good about myself because of the physical fitness.”

However, participant 21 pointed out the experience of lack of emotional attachment, sympathy, and support resulting from the content consistently served by social media.

• “Social media is full of content which reveal crime stories, life matters, relationships, suicides, etc. at a large scale. So many movie clips, videos, web series show a lot of crime, aggression or say anything on that. So, I feel now-a-days emotionally detached to any relationship, friendship or even to my family. If I receive their call, I would say yes okay fine, no further interest in how they are dealing or what they are experiencing. And if they ask I would say, so what, I am not a kid anymore. I lead my life you lead yours, definitely social media is making me someone I never used to be. In fact, my sister has become the same, though she is living with the family under the same roof. Earlier I was so sensitive to any suicide or crime. If I heard of that I would cry or be sad. I used to feel the pain of the victim. Now, I hear a story for real and I am like, yeah part of life, or you pay for deeds like that. No sympathy left I guess, so detached.”

However, what was more important was that social media was seen to be helping individuals in maintaining their daily fitness routines by providing them alternative fitness tools and techniques, the virtual company of other fitness freaks, and by helping them back, influencing others and getting influenced by others. Participant 6 reported that

• “Social media has lots of side effects, but a good effect of it now-a-days for a gym freak like me is that social media provides videos of trainers, and other freaks working out at home or hostels. I can know now virtually how to maintain a schedule. They are sharing their experience, they are influencing me a lot, I am trying my best, and workout is helping me a lot.”

Favorable Attitude Toward Music as a Tool

Many participants also reported the use of music as an aid while exercising. Participant 7 reported that

• “I have two schedules of exercise. If working out in the morning, I prefer soothing music, like that of birds chirping, or instrumental jazz. And if I am exercising in evening, I want to listen to EDM, that is electronic dance music, I have made a playlist of computerised music and listen to that in evening. I prefer music because it takes you to another world, which is needed the most now (exclaimed!) It creates an environment like that of a gym in my head, or say, I imagine I am in the gym, as I cut off all the surrounding voices.”

Similarly, participant 9 reported that

• “I just love to have old-country music while I am exercising. It is a kind of genre of songs, the old country one, and sometimes I love random numbers of songs. It is needed because you can say it lets me focus, helps me to calm down. Also, when I am locked at home, it actually provides me a world free of distractions, just my own world, where there is no corona. Music is ultimate fun. If there is no music available I will not workout, because workout makes me happy and I really want to exercise effectively and enjoy it too.”

It is, therefore, evident that music is an important supporting tool that helps individuals relax and enjoy their original routine even when they are working out at home. Music is a powerful tool that recreates the same environment that participants used to have during their gym exercise times.

The COVID-19 pandemic has brought major upheaval in the life of every individual across the globe. It has hampered the day-to-day activities of almost all individuals including those who depend on gyms for their physical fitness routine. The present study was conducted with individuals for whom going to the gym was a routine activity so as to explore their experiences in terms of their perceptions of the pandemic situation and their ways of coping with COVID-19-induced uncertainties and health issues.

The findings of this study not only are consistent with a range of studies that have reported psychological health issues due to the COVID-19 pandemic and subsequent lockdown ( Hawryluck et al., 2004 ; Ammar et al., 2020a , b , c , d ; Chtourou et al., 2020 ; de Oliveira Neto et al., 2020 ; Shigemura et al., 2020 ; Varshney et al., 2020 ) but also go beyond those to suggest that, with time, individuals learn to adopt to situations in healthy and positive ways. Participants reported experiencing a significant change in their sleeping pattern, unexplained laziness, and mental fatigue, and having a general feeling of fear, anxiety, stress, and frustration due to home confinement, which impacted their motivation to find alternate ways to continue fitness exercises.

Other factors found responsible for the lack of fitness motivation were the absence of gym partners and the lack of gym environment, which were also considered as potential sources of gym motivation in earlier studies ( Sonstroem and Morgan, 1989 ; Sonstroem and Harlow, 1994 ; McAuley et al., 2000 ; Fox, 2003 ; Tamur, 2014 ). It is important to note that, being a social entity, people like the company of others and feel connected to each other. This feeling of connectedness is found to be associated with various psychological constructs such as persistence, motivation, self-esteem, self-efficacy, and physical as well as psychological health ( Scully et al., 1998 ; Proctor et al., 2011 ; Haslam et al., 2015 ; Begun et al., 2018 ). The absence of this feeling of connectedness that people were used to experiencing in a gym environment probably was one of the reasons for the lack of motivation for home exercise.

The findings of the study also indicated that although the participants’ perception of the pandemic situation was negative initially, their self-perception gradually improved toward a positive one, as they realized that they had enough time to look after themselves. Rauthmann et al. (2015) reported that environment and behavior, if different from the usual, lead to a negative situational perception. However, with an increase in time available to devote to oneself, perceptions change in a positive direction ( Karagiannidis et al., 2015 ). Such a change in perception is likely to promote the process of self-approval and find effective ways to deal with the current situation.

In the present study, a shift from the gym workout and fitness equipment toward substitutes is clearly visible during the latter part of the lockdown. After the initial confusion and passive wait for things to normalize, participants accepted the reality and started thinking about alternatives to exercises related to heavy gym equipment. Some of the alternatives listed by them included switching to yoga and meditation ( National Center for Complementary and Integrative Health, 2020 ), high-intensity workout at home, and lifting heavy buckets, big water bottles, and skipping. All these alternative arrangements not only helped individuals maintain their daily exercise routine but also contributed to their physical and mental health ( Jiménez-Pavón et al., 2020 ; Nicol et al., 2020 ). In fact, the American College of Sports Medicine had recommended 150–300 min of aerobic exercise per week and two sessions per week of moderate-intensity muscle strength exercises for people to be physically active during the COVID-19 pandemic ( Joy, 2020 ).

The mixed impact of social media usage and listening to music during exercise was also observed in this study. Results clearly indicate that participants found social media to be an effective medium to keep themselves up to date about the pandemic situation and to overcome the monotony of home confinement. Apart from this, participants also experienced a lack of emotional attachment, as face-to-face interaction during the said period was missing. This encouraged participants to use social media to get connected to people as well as to witness their regular activities, which they were missing otherwise. Several studies in the past have argued that social support boosts motivation for training and can increase up to 35% more adherence to a physical exercise program ( Rhodes et al., 2001 ) and that it can be an additional strategy to make exercise events more interactive and less dissociated from afferent body responses (heart rate, breathing), which in turn results in more positive training experience ( Kravitz and Furst, 1991 ; Pridgeon and Grogan, 2012 ).

Social media was also used as a platform to know about virtual fitness techniques and opportunities for online training for physical exercise. Ammar et al. (2020d) demonstrated 15% higher use of Information and Communications Technology (ICT) during the COVID-19 confinement duration, which indicates higher use of social media and app use for home-based fitness activities ( Tate et al., 2015 ; Ammar et al., 2020a ).

Furthermore, participants also found that listening to music was an effective aid to keep themselves engaged as they exercised. This also supports the finding that music helps people to continue their fitness workout for a significantly longer period of time ( Thakare et al., 2017 ). A series of studies have shown that music creates an ergogenic effect during physical and cognitive performance and is linked to heightened motivation and engagement and lower levels of stress, anxiety, and depression ( Chtourou et al., 2015 ). In their recent meta-analytic review Terry et al. (2020) have concluded that listening to music during physical activity boosts positive affective valence and results in improved physical engagement and enhanced physiological responses. It is therefore clearly evident that listening to music while doing physical exercise during the current pandemic has enabled people to focus on the exercise without any distraction from the home setting and has enabled them to create their own world, where there is no COVID-19.

To conclude, the findings of the study indicate that the perceptions and social media habits of fitness freaks, who were hitting gyms for a regular workout before the lockdown, were greatly impacted by the COVID-19 pandemic. They also experienced psychological health issues during the initial phase of the pandemic. However, they gradually changed their dependence on gym-based workout and switched to alternative exercises that helped them greatly to restore their mental and physical health.

Implications and Future Suggestions

The present study shows that despite the initial experience of anxiety and fear and the lack of motivation to engage in physical exercise at home, fitness freaks were able to shift to home exercises and were greatly supported by social media uses and listening to music. One could argue that this study only included fitness freaks who find it difficult to detach themselves from physical activities for a long time, and this was probably the reason for their shift to home-based exercises. However, there is no doubt that the findings of this study have demonstrated that if performed regularly, physical exercise has the potential to mitigate the ill physical as well as psychological effects of the COVID-19 pandemic. The findings of this study, therefore, could be extended to the common public to also persuade them to engage in physical fitness exercises, which would result not only in a better physical health but also in an enhanced psychological health and well-being. The findings of this study strengthen the recommendations made by researchers and organizations (for details see Chtourou et al., 2020 ; World Health Organization [WHO], 2020 ) to engage in home-based exercises (including, but not limited to, aerobic activities, balance and flexibility exercises, and muscular strength and endurance training) for about 150–180 min per week; to use social media, music, and/or similar techniques to increase adherence to physical exercises; and to practice dancing and yoga to reduce stress, anxiety, and depression, and even improve the quality of sleep ( Chennaoui et al., 2015 ; Chtourou et al., 2015 ). It is also noted that one should start physical exercise and its alternatives in a progressive manner and must adhere to his/her fitness levels for choosing the amount and intensity of these exercises.

Data Availability Statement

Ethics statement.

All procedures followed in this study were in accordance with the APA’s ethical standards and with the Helsinki Declaration of 1964 and its later amendments. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

HK, TS, and YA conceptualized the study. HK and TS prepared study protocols. HK collected data, conducted initial data analysis, and wrote the first draft. TS, SM, and YA finalized data analysis, reviewed, and commented on the draft manuscript. HK, TS, SM, and YA contributed to the preparation of the final draft. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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How the Pandemic Is Changing Our Exercise Habits

Many of us have been moving less since the pandemic began. But some, including many older men and women, seem to be moving more.

By Gretchen Reynolds

Are you exercising more or less since the coronavirus pandemic began?

According to a new study that focused on physical activity in the United Kingdom , most of us — not surprisingly — have been less physically active since the pandemic and its waves of lockdowns and quarantines began. Some people, however, seem to be exercising as much or more than before, and surprisingly, a hefty percentage of those extra-active people are older than 65. The findings have not yet been peer reviewed, but they add to a mounting body of evidence from around the globe that the coronavirus is remaking how we move, although not necessarily in the ways we may have anticipated.

The pandemic lockdowns and other containment measures during the past six months and counting have altered almost every aspect of our lives, affecting our work, family, education, moods, expectations, social interactions and health.

None of us should be surprised, then, to learn that the pandemic seems also to be transforming whether, when and how we exercise. The nature of those changes, though, remains rather muddled and mutable, according to a number of recent studies. In one, researchers report that during the first few weeks after pandemic-related lockdowns began in the United States and other nations, Google searches related to the word “exercise” spiked and remained elevated for months.

And many people seem to have been using the information they gleaned from those searches by actually exercising more. An online survey conducted in 139 countries by RunRepeat, a company that reviews running shoes, found that a majority of people who had been exercising before the health crisis began reported exercising more often in the early weeks after. A separate survey of almost 1,500 older Japanese adults found that most said they had been quite inactive in the early weeks of lockdowns, but by June, they were walking and exercising as much as ever.

A gloomier June study, however, using anonymized data from more than 450,000 users of a smartphone step-counting app, concluded that, around the world, steps declined substantially after lockdowns began. Average daily steps declined by about 5.5 percent during the first 10 days of a nation’s pandemic lockdowns and by about 27 percent by the end of the first month.

But most of these studies and surveys relied on people recalling their exercise habits, which can be unreliable, or looked at aggregate results, without digging into differences by age, socioeconomic group, gender and other factors, which might turn up telling variations in how people’s exercise habits might have changed during the pandemic.

So, for the new study, which has been posted at a biology preprint site awaiting peer-review, researchers at University College London turned to data from a free, activity-tracking smartphone app available in the United Kingdom and some other nations. The app uses GPS and similar technologies to track how many minutes people had spent walking, running or cycling, and allows users to accumulate exercise points that can be used for monetary or other rewards. (One of the study’s authors works for the app maker but the company did not provide input into the results or analysis of the research, according to the study’s other authors.)

The researchers gathered anonymized data from 5,395 app users living in the United Kingdom who ranged in age from adolescent to older adults. All of them had been using the app since at least January 2020, before the pandemic had spread to that country.

The researchers used data from the app on users’ birth dates and ZIP codes to divide people by age and locale to learn how much they exercised in January. Then they began comparing, first to the early days of social-distancing restrictions in various parts of the United Kingdom, then to the stricter lockdowns that followed and finally, to the dates in midsummer when most lockdowns in that country eased.

They found, unsurprisingly, that almost everyone’s exercise habits changed when the pandemic started. An overwhelming majority worked out less, especially once full lockdowns began — regardless of their gender or socioeconomic status. The drop was most marked among those people who had been the most active before the pandemic and among people under the age of about 40 (who were not always the same people).

After lockdowns lifted or eased, most people began exercising a bit more often, but, in general, only those older than 65 returned to or exceeded their previous minutes of exercise.

The results are surprising, says Abi Fisher, an associate professor of physical activity and health at University College London, who oversaw the new study, “especially because 50 percent of the older group were 70 or older.”

Of course, these older people, like the other men and women in the study, downloaded and used an exercise app, which distinguishes them from a vast majority of people around the world who do not use such apps. The study also looked only at “formal” exercises like walking, running or cycling and not lighter activities like strolling or gardening, which can likewise benefit health and most likely also changed during the pandemic.

And the study tells us nothing about why exercise habits differed for people during the pandemic, although some mixture of circumstance and psychology may very likely be a factor. Older people probably had more free time for exercise than younger adults who are juggling child care, work and other responsibilities during the pandemic, Dr. Fisher says. They also might have developed greater concerns about their immune systems and general health, motivating them to get up and move.

Far more large-scale and long-term research about exercise during the pandemic is needed, she said. But for now, the message of the available research seems to be that we may all want to monitor how much we are moving to help assure that we are exercising enough.

“While it is no surprise that the lockdowns disrupted people’s exercise patterns,” Dr. Fisher said, “we cannot just assume everyone will bounce back once restrictions are lifted. We need to help people to get back to doing regular exercise, within the limits of ongoing pandemic restrictions, of course.”

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Open Access

Peer-reviewed

Research Article

The health benefit of physical exercise on COVID-19 pandemic: Evidence from mainland China

Roles Conceptualization, Formal analysis, Writing – original draft

Affiliation School of Economics and Management, Tongji University, Shanghai, China

Roles Data curation, Supervision, Writing – review & editing

Affiliation International College of Football, Tongji University, Shanghai, China

Roles Software, Validation, Visualization

Roles Methodology, Writing – original draft

* E-mail: [email protected]

• Ruofei Lin, 
• Xiaoli Hu, 
• Lige Guo, 
• Junpei Huang

• Published: October 12, 2022
• https://doi.org/10.1371/journal.pone.0275425
• Reader Comments

Our study aims to investigate the health benefit of regular physical exercise participation on a series of COVID-19 outcomes including COVID-19 morbidity, mortality, and cure rate.

Prefecture-level panel data related to physical exercise and the COVID-19 pandemic in China were collected from January 1 to March 17, 2020, (N = 21379). Multiple linear regression was conducted, and the ordinary least squares technique was used to estimate the coefficient.

It was shown that regular sports participation significantly negatively affected COVID-19 morbidity (estimate = -1.1061, p<0.01) and mortality (estimate = -0.3836, p<0.01), and positively affected cure rate (estimate = 0.0448, p<0.01), implying that engaging in physical exercise regularly does have a significant positive effect on COVID-19 outcomes. Then, we explored the heterogeneity of the effect of physical exercise on areas with different risk levels and it was revealed that the effect of physical exercise was more pronounced in high-risk areas in terms of morbidity (estimate = -1.8776, p<0.01 in high-risk areas; estimate = -0.0037, p<0.01 in low-risk areas), mortality (estimate = -0.3982, p<0.01 in high-risk areas; estimate = -0.3492, p<0.01 in low-risk areas), and cure rate (estimate = 0.0807, p<0.01 in high-risk areas; 0.0193 = -0.0037, p<0.05 in low-risk areas).

Conclusions

Our results suggest that regularly engaging in physical exercise before the pandemic has positive health effects, especially in the case of a more severe epidemic. Therefore, we urge readers to actively engage in physical exercise so that we can reduce the risks in the event of a pandemic.

Citation: Lin R, Hu X, Guo L, Huang J (2022) The health benefit of physical exercise on COVID-19 pandemic: Evidence from mainland China. PLoS ONE 17(10): e0275425. https://doi.org/10.1371/journal.pone.0275425

Editor: Zulkarnain Jaafar, Universiti Malaya, MALAYSIA

Received: May 2, 2022; Accepted: September 18, 2022; Published: October 12, 2022

Copyright: © 2022 Lin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting information files.

Competing interests: The authors have declared that no competing interests exist.

1 Introduction

As an ongoing pandemic, the COVID-19 pandemic has so far infected 500 million people and killed more than 6 million people worldwide. On January 30, 2020, it was declared global health emergency by the World Health Organization (WHO), and then a global pandemic on March 11, 2020 [ 1 ]. The COVID-19 pandemic has posed huge challenges to economic and social development and people’s daily life around the world. A large number of medical resources are currently occupied, and the lack of such resources has led to excess mortality [ 2 , 3 ]. In addition, public health measures such as quarantine and isolation, work at home, and school closure, have seriously affected normal social order and economic production, brought huge economic losses [ 4 ], and also have caused a negative impact on the quality of life and physical and mental health of populations worldwide [ 5 ]. Therefore, intervention measures should be taken to curb the outbreak as much as possible and minimize the adverse consequences of the epidemic.

Despite a range of outbreak mitigation strategies aimed at social distancing in most countries, practices that have been effective in preventing most citizens from becoming infected during the pandemic, such strategies have paradoxically left people with no immunity to the virus and therefore vulnerable to additional waves of infection [ 6 ]. In addition, these public health policies have led to the closure of public places such as parks and gyms, resulting in an increase in sedentary behavior and a decrease in physical exercise (PEx) among individuals, which has also adversely impacted people’s immunity. It is believed that the world will not be able to return to pre-pandemic normalcy until safe and effective vaccines are available and global vaccination programs are successfully implemented [ 7 ]. Therefore, countries around the world have been actively developing and promoting COVID-19 vaccines since the outbreak of the COVID-19 pandemic. As of April 26, 2022, a cumulative total of 11.55 billion doses of the COVID-19 vaccine has been reported worldwide, with a vaccination rate of 65.16% [ 8 ]. In China, as of April 29, 2022, there have been a cumulative total of 334,308,000 doses administered, with a vaccination rate of 88.64%.

However, despite the proven effectiveness of the vaccine in preventing infection and avoiding critical conditions [ 9 , 10 ], it has become evident that the SARS-CoV-2 virus can mutate very rapidly [ 11 , 12 ] with strong antibody evasion [ 13 – 16 ]. Besides, there are still potential negative effects of vaccination [ 17 ], especially the prevalence of relatively low vaccination rates but high mortality rates in the elderly [ 18 ]. Therefore, at this stage, in addition to timely and effective pharmacological interventions, non-pharmacological interventions aimed at improving autoimmunity are also crucial. As an important part of a healthy lifestyle, it is of great theoretical and practical significance to explore the health benefits of physical exercise in the COVID-19 pandemic.

Physical exercise (PEx) is regarded as an important way to promote health, as well as prevent and protect the body from a variety of diseases [ 19 , 20 ], and it has been shown to have significant health benefits [ 21 ]. Likewise, it is an effective treatment for most chronic diseases and has direct, positive effects on both physical and mental health [ 22 ]. It is well documented that exercising regularly significantly improves the nervous system [ 23 ], bones and muscles [ 24 , 25 ], cardiovascular [ 26 ] and cardiopulmonary functions [ 27 ], and cognitive ability [ 28 ], and it has inhibitory effects on adverse health outcomes, including premature death [ 29 , 30 ], cardiovascular disease [ 30 , 31 ], hypertension [ 32 ], stroke [ 33 ], osteoporosis [ 34 ], type 2 diabetes [ 35 ], obesity [ 36 – 38 ], cancer [ 39 ], depression [ 40 – 42 ], anxiety [ 43 ] and other health outcomes. More importantly, physical exercise can strengthen the immune system [ 21 , 44 – 46 ], improve immune function, and reduce the risk, duration, or severity of viral infections [ 47 ]. Therefore, in theory, regular physical exercise can play an important role in strengthening the body’s immune system against COVID-19 [ 48 ], and individuals can maintain the requisite immunity to fight the novel infection COVID-19 through adhering to a healthy lifestyle [ 21 , 49 ].

This study aims to investigate the health benefit of physical exercise on COVID-19 morbidity, mortality, and cure rate. It contributes to the extensive literature on assessing the health benefits of physical exercise. A large body of literature has concluded that PEx has a positive influence on physical and mental health, with studies showing that moderate and regular physical exercise is important for preventing premature death [ 29 , 30 ], reducing obesity [ 36 – 38 ], avoiding chronic disease, such as cardiovascular and cerebrovascular diseases [ 32 ], as well as strengthening bones, muscles [ 25 ], and the immune system [ 44 – 46 ]. In addition, it can clear one’s mind and make one energetic [ 50 ], help relieve mental stress and reduce the incidence of psychological disorders, such as depression and anxiety [ 40 – 43 , 51 ]. In contrast to these articles, this paper focuses on the influence of physical exercise on the public health during the COVID-19 pandemic, and we selected COVID-19 morbidity, mortality, and cure rates as health outcomes of interest.

In addition, our research contributes to ongoing emerging literature related to factors that influence the COVID-19 pandemic. Since the COVID-19 outbreak, the factors influencing the COVID-19 pandemic have been well-discussed in a large number of articles, mainly focusing on pharmacological interventions [ 52 , 53 ], public health interventions [ 54 – 57 ], environmental variables [ 58 – 60 ], demographic characteristics [ 61 , 62 ], and healthcare resources [ 63 ]. In addition, the benefit of physical exercise (or physical activity) on physical and mental health during the pandemic has also been documented [ 22 , 64 – 71 ]. In contrast to those investigations, this paper focuses on the effect of engaging in physical exercise before the outbreak on a series of COVID-19 outcomes during the pandemic.

2.1 Study area

In this research, the study area was 279 prefecture-level Chinese cities. All of the provinces in mainland China were included in our analysis, which also included the great majority of prefectural cities. Cities in ethnic minority autonomous zones including Tibet, Xinjiang, Inner Mongolia, and Southwest China were removed because of the significant amount of missing data, which was unreliable and unrepresentative. It is documented that more than 98% of China’s total population and more than 99% of its GDP were represented by the 279 metropolitan cities [ 72 ].

2.2 Data and variables

In this article, in order to empirically investigate the influence of physical exercise on COVID-19 morbidity, mortality and cure rates, prefectural data were collected daily from January 1, 2020 to March 17, 2020 in mainland China, N = 21379. Regarding epidemic-related data, the daily data of confirmed cases, death, and cure rates used to calculate morbidity, mortality, and cure rates were collected from official releases on the official websites of the national and provincial Health Committee. Regarding PEx-related data, the proportion of regular physical exercise participants was gathered by collecting data from provincially issued National Fitness Report, the National Fitness Development Survey Bulletin, and the National Fitness Action Program. GDP per capita, population density, and total number of publicly operated buses and taxis were obtained from the China Urban Statistical Yearbook. Applying big data mining technology, population migration data utilized to calculate effective distance were gathered from website of Baidu Migration ( http://qianxi.baidu.com/ ), and the search popularity of the term used to characterize residents’ awareness of prevention was obtained from the website of Baidu Index ( http://qianxi.baidu.com/ ). The original data for public health interventions were compiled from provincial and municipal emergency response headquarters for the prevention and control of COVID-19.

2.2.1 Dependent variable: COVID-19 outcomes.

2.2.2 Independent variable: Physical exercise participation.

Data on the proportion of regular physical exercise participants were collected from official bulletins in the National Fitness Report, the National Fitness Development Survey Bulletin, and the National Fitness Action Program released by each province, which refers to the proportion of residents aged 7 years and above who participate in physical exercise, moderate intensity or above, for at least 30-minute 3 times or more per week. According to the General Administration of Sport of China, moderate-intensity physical exercise refers to activities that require some exertion but still allow you to speak easily during the activity, such as fast walking, dancing, leisure swimming, playing tennis, and playing golf. Moderate exercise intensity is often represented by brisk walking, and the lower limit of moderate intensity is a medium speed (4km/h).

To comprehend the general situation of the physical fitness participation of urban and rural residents in China and to evaluate the implementation effect of the national fitness strategy, the General Administration of Sport of China regularly organizes the investigation of the national fitness and issues the National Fitness Investigation Bulletin. According to the guiding opinions stemming from the investigation, each provincial General Administration of Sport collects information including the number of people who participate in physical exercise once or more a week, the number of people who regularly participate in physical exercise, the venues and facilities, and the content and the duration of physical exercise of the permanent population of cities, counties, and districts using multistage stratified random sampling.

2.2.3 Control variables.

With respect to control variables, social and economic factors affected the development of the epidemic, among which population density [ 73 ], economic development [ 55 ], and traffic flow [ 74 ] were important influential factors. Therefore, in this paper, we selected urban population density, per capita GDP, and the total number of public-operated buses and taxis as control variables and introduced them into the model.

The epidemic risk perception of the public helped them to take personal precautions in time and reduce unnecessary contacts, thus reducing the possibility of being infected [ 75 , 76 ]. In this paper, we made use of the Baidu search index term "COVID-19" as the proxy variable of residents’ protection awareness. We converted the Baidu search index, a continuous variable, into a 0–1 dummy variable according to the mean value. If it was higher than the mean value, the value was 1, indicating high self-protection awareness of residents; otherwise, the value was 0.

In China, timely and strict public health interventions have played a crucial role in the mitigation of the COVID-19 outbreak. Referring to Huang et al. [ 77 ], we scored the public health measures implementation intensity of each city based on the epidemic prevention policy announcement issued by the health commission and converted it into a dummy variable according to the mean value. If the value was higher than the mean value, then the value was 1, indicating relatively strict prevention and control intensity; otherwise, the value was 0.

Studies have shown that population mobility does not mainly depend on the geographical distance between regions, but on the convenience of mobility, that is, the effective distance between regions [ 77 ]. Referring to Lin et al. [ 59 ], we calculated the effective distance to Wuhan, the city with the most severe epidemic in China. We retrieved the data from the Baidu migration website using big data technology.

2.3 Study design

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https://doi.org/10.1371/journal.pone.0275425.t001

3.1 Statistical description

A statistical description of the variables is shown in Table 1 .

3.2 Influence of PEx on COVID-19 outcomes

Table 2 demonstrates the effects of physical exercise on COVID-19 outcomes, broken down as follows: columns (1)—(2) of Table 2 report the influence of PEx on COVID-19 morbidity, columns (3)—(4) report the influence of PE on COVID-19 mortality, and columns (5)—(6) report the PEx effect on COVID-19 cure. Columns (1), (3), and (5) report the results of regressions of dependent variables on independent variables alone. To avoid biased estimation results due to significant omitted variables, columns (2), (4), and (6) introduce a series of factors that also influence the variable of interest, i.e., control variables, based on columns (1), (3) and (5), the treatment of which helped to identify causal relationships. It can be seen that the coefficients of PEx in columns (1) and (2) are negative and significant at the 1% level, indicating that physical exercise participation shows a negative causal relationship with the COVID-19 incidence, i.e., participating in physical exercise significantly reduces the morbidity of COVID-19 epidemic. Similarly, PEx coefficients in columns (3) and (4) are also significantly negative, indicating that engaging in physical exercise can significantly reduce the COVID-19 mortality rate. As for the right-hand third of the Table 2 , PEx coefficients in columns (5) and (6) were significantly positive, indicating that physical exercise positively affects COVID-19 cure rate.

https://doi.org/10.1371/journal.pone.0275425.t002

3.3 Robustness test

First, considering that Hubei was the province with the most severe outbreak in 2020, in the robustness test, we excluded Hubei Province from the full sample to re-estimate the coefficients, and the results are reported in columns (1) to (3) of Table 3 . Second, since the large-scale COVID-19 outbreak in China did not begin until late January 2020, there were no cases in most cities in January. To prevent the interference of too many zero values on the estimation results, we excluded the sample of January to re-estimate the coefficients, and the results are reported in columns (4) to (6) of Table 3 . The results of the robustness test show that the regression coefficients of PEx on morbidity and mortality remained significantly negative, and those on cure rate remained significantly positive, which is consistent with the result of baseline regression, which proves the robustness of the results.

https://doi.org/10.1371/journal.pone.0275425.t003

3.4 Heterogeneity of health benefits of PEx in high-risk and low-risk areas

Further, we defined samples with cumulative case growth rates greater than the mean value as the high-risk group and those less than the mean value as the low-risk group, and performed sub-sample regressions to explore the heterogeneous PEx benefit in high- and low-risk areas. Columns (1) and (2) in Table 4 report the subsample results for the PEx effect on morbidity; columns (3) and (4) report the results for mortality; and columns (5) and (6) report that of cure rates. The results show that the coefficient of PEx is greater in high-risk areas than in low-risk areas for both morbidity, mortality, and cure rates, especially for the effect on the morbidity of the epidemic, suggesting that the health benefits of physical exercise are relatively greater and more significant when the pandemic is more severe.

https://doi.org/10.1371/journal.pone.0275425.t004

4 Discussion

There are many factors that influence COVID-19 outcomes, including public health interventions, vaccination availability and rates, demographic characteristics, environmental variables, health care resources, etc. [ 52 – 54 , 58 – 61 , 63 ]. In our research, we constructed a two-way fixed effect model of multiple linear regression to empirically investigate the effects of physical exercise on a series of COVID-19 outcomes using prefecture-daily data related to PEx and COVID-19 from January 1 to March 17, 2020 in mainland China. The results show that there is relatively lower COVID-19 morbidity, mortality, and a higher cure rate during the pandemic in areas with a higher proportion of engaging in regular physical exercise before it, implying that PEx does have a significant effect on COVID-19 outcomes.

Our study expands the body of research on the health benefits of physical exercise, which has been demonstrated in existing studies to be effective not only in reducing the risk of chronic diseases [ 79 , 80 ] but also in improving autoimmunity [ 81 ] and also has a positive effect on the suppression of emerging infectious diseases [ 46 ]. Furthermore, our study is consistent with the results of the existing literature exploring physical exercise effect on pandemics, demonstrating the positive role of PEx in the pandemic [ 82 – 84 ], with the difference being that we focus on the effects of physical exercise before the outbreak on the health outcomes during it, i.e., we pay more attention to the long-term effects of physical exercise. Moreover, in contrast to the existing literature, in addition to infection and mortality rates, we also discuss the influence of PEx on COVID-19 cure rates.

Further, we also explore the heterogeneity of the physical exercise effect in areas with different risk levels, and the results show that the influence of PEx is more significant in high-risk areas, in terms of morbidity, mortality, and cure rates. In particular, the difference in PEx benefits on morbidity is greatest between high- and low-risk areas, suggesting that the effect of PEx on morbidity is most pronounced in high-risk areas. This result suggests that participating in physical exercise regularly before such an outbreak makes significant health effects, especially in the case of a more severe epidemic; therefore, we should actively engage in physical exercise to reduce risks to our health when a pandemic comes.

However, there are still some limitations that need to be explored in the future. First, restricted by the available data and the period of the selected sample in this study, we do not consider the effect of vaccination. In the following studies, we will attempt to obtain data sets for longer periods, as well as vaccination-related data. In addition, the current results fail to control individual factors that would influence COVID-19 outcomes, so we attempt to match region-level data with micro-individual data to control for the potential impact of individual information on epidemic outcomes and to explore more heterogeneous results for individual-level characteristics such as gender and age. Third, limited by the availability of physical exercise-related data, we are unable to capture information on exercise intensity, which is also a very important influential factor. In the following studies, we will try to apply data mining techniques to access exercise big data to better identify information on exercise duration, intensity, and frequency to obtain more accurate conclusions.

5 Conclusion

In this article, we constructed a two-way fixed effects model of multiple linear regression, collected daily prefectural data related to physical exercise and the COVID-19 pandemic in mainland China from January 1 to March 17, 2020, and estimated the health benefit of engaging in regular physical exercise before the pandemic on a series of COVID-19 outcomes during the pandemic. We found that there is relatively lower COVID-19 morbidity, mortality, and a higher cure rate in areas with a higher proportion of individuals engaging in regular physical exercise before the pandemic, implying that PEx has a significant positive effect on COVID-19 outcomes. Finally, we also examined the heterogeneity of the health benefit of physical exercise in areas with different risk levels, and the results showed that the effect of PEx was more pronounced in high-risk areas in terms of morbidity, mortality, and cure rates.

Supporting information

https://doi.org/10.1371/journal.pone.0275425.s001

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Lack of physical activity is a global problem

Linked research.

Effectiveness of physical activity interventions delivered or prompted by health professionals in primary care settings

• Related content
• Peer review
• Tobias Haseler , GP lead for anticipatory care 1 ,
• Christine Haseler , general practitioner 2
• 1 Camden Central PCN, London, UK
• 2 Royal Crescent Surgery, Cheltenham, UK
• Correspondence to: T Haseler toby.haseler{at}nhs.net

Primary care is an essential partner in the response

Physical activity has been more important than ever during the covid-19 pandemic. Insufficient physical activity is a global health problem and has itself been called a pandemic. 1 Lockdowns have reduced time spent on physical activity and increased sedentary time, 2 3 both of which are associated with risks to health.

World Health Organization guidance (updated in 2020) recommends a minimum of 150-300 minutes of moderate intensity physical activity or 75-150 minutes of vigorous intensity physical activity weekly, and encourages people to exceed these targets. 4 5 Healthcare professionals have an important role in helping people to make any necessary changes to their behaviour. 6

The linked systematic review and meta-analysis of randomised trials by Kettle and colleagues (doi: 10.1136/bmj-2021-068465 ) provides evidence of the effectiveness of physical activity interventions delivered or prompted by health professionals in primary care. 7

The authors reviewed 51 trials evaluating ‘predominantly aerobic based physical activity’ interventions delivered to adults. Participants in trial intervention groups increased moderate to vigorous intensity physical activity (MVPA) by a modest 14 min/week on average relative to controls. But this weighted mean could obscure substantial variation between individuals. These participants were also more likely than controls to meet guideline targets for MVPA. Interventions involving five or more contacts with health professionals, longer follow-up, or those delivered by primary care and other professionals were associated with greater improvements. 7

Many gaps remain in the literature, however, and Kettle and colleagues’ findings reflect this uncertainty. 8 Trials measuring physical activity with objective devices, such as accelerometers or wearable activity trackers, found no significant difference in MVPA between groups, while trials relying on self-reported activity showed an increase of 24 min/week in intervention groups. 7 In a previous meta-analysis, Larsen and colleagues found that interventions using physical activity monitors increased MVPA by 48.5 min/week. 9 But they judged this evidence to be ‘low certainty’ due to publication and small study biases.

The 14 minute improvement reported by Kettle and colleagues might be an underestimate because some control group participants received brief advice on physical activity, itself a recognised intervention. 8 This advice could have increased physical activity levels among controls, reducing the difference between control and intervention groups.

Broad range of benefits

The benefits of physical activity are broad and include better mental health, a lower risk of cardiovascular disease, improved sleep, and a lower risk of some cancers. 10 Benefits are dose dependent and nonlinear, with no lower threshold. The biggest benefits occur when moving from no activity to some activity; even small changes are clinically significant. 4 5 11 12 Increasing duration of physical activity of any intensity, and less time spent sitting, is associated with a reduced risk of premature mortality. 13

Evidence from the H1N1 influenza epidemic suggests that regular physical activity is associated in a dose dependent manner with reduced incidence, duration, and severity of acute upper respiratory infections. 14 Evidence is emerging that physical activity could even improve immune response to covid-19 vaccines. 15 16

Time spent sitting (sedentary time) is an independent risk factor for all cause mortality, cardiovascular disease, cancer, and type 2 diabetes. 4 Kettle and colleagues reported no significant effect of primary care interventions on sedentary time, while Larsen and colleagues found that physical activity monitor based interventions were associated with a mean decrease of 9.9 min/day. 7 9

The benefits of physical activity were already clear, 4 and this new meta-analysis shows that interventions delivered by health professionals can increase physical activity levels among primary care patients. 7 According to a third recent meta-analysis, 17 the number needed to treat for primary care promotion to increase one inactive adult’s physical activity to internationally recommended levels is 12. This figure compares favourably with a number needed to treat of 20 for nicotine replacement therapy for smoking cessation. 18

The interventions most powerfully associated with improvements are not yet clear, but guidelines such as those from the National Institute for Health and Care Excellence or other simple frameworks 8 19 take a pragmatic approach and can be a useful tool in conversations with patients. But there is room for digital innovation: people using streaming and subscription services, apps, online platforms, and recorded or live activity classes are more likely to meet guideline targets for physical activity. 20 Tailored solutions are also likely to be more effective; home based exercise can improve physical activity levels in older adults, for example. 21

Primary care is an essential partner in global efforts to increase physical activity to levels recommended by WHO, and we now have evidence to support primary care interventions. Future research should focus on identifying the most effective interventions, optimising outcomes for all population groups, and evaluating how best to decrease sedentary time as well as increasing physical activity.

Acknowledgments

We would like to thank patient Michael Mortell for his helpful comments on a draft of this editorial.

• Research, doi: 10.1136/bmj-2021-068465

Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare no other interests.

Provenance and peer review: Commissioned; not externally peer reviewed.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

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May 14, 2024

Understanding how exercise affects the body

At a glance.

• A study of endurance training in rats found molecular changes throughout the body that could help explain the beneficial effects of exercise on health.
• Large differences were seen between male and female rats, highlighting the need to include both women and men in exercise studies.

Exercise is one of the most beneficial activities that people can engage in. Regular exercise reduces the risk of heart disease, diabetes, cancer, and other health problems. It can even help people with many mental health conditions feel better.

But exactly how exercise exerts its positive effects hasn’t been well understood. And different people’s bodies can respond very differently to certain types of exercise, such as aerobic exercise or strength training.

Understanding how exercise impacts different organs at the molecular level could help health care providers better personalize exercise recommendations. It might also lead to drug therapies that could stimulate some of the beneficial effects of a workout for people who are physically unable to exercise.

To this end, researchers in the large, NIH-funded Molecular Transducers of Physical Activity Consortium (MoTrPAC) have been studying how endurance exercise and strength training affect both people and animals. The team is examining gene activity, protein alterations, immune cell function, metabolite levels, and numerous other measures of cell and tissue function. The first results, from rat studies of endurance exercise, were published on May 2, 2024, in Nature and several related journals.

Both male and female rats underwent progressive exercise training on a treadmill over an 8-week period. By the end of training, male rats had increased their aerobic capacity by 18%, and females by 16%. Tissue samples were collected from 18 different organs, plus the blood, during the training period and two days after the final bout of exercise. This let the researchers study the longer-term adaptations of the body to exercise.

Changes in gene activity, immune cell function, metabolism, and other cellular processes were seen in all the tissues studied, including those not previously known to be affected by exercise. The types of changes differed from tissue to tissue.

Many of the observed changes hinted at how exercise might protect certain organs against disease. For example, in the small intestines, exercise decreased the activity of certain genes associated with inflammatory bowel disease and reduced signs of inflammation in the gut. In the liver, exercise boosted molecular changes associated with improved tissue health and regeneration.

Some of the effects differed substantially between male and female rats. For example, in male rats, the eight weeks of endurance training reduced the amount of a type of body fat called subcutaneous white adipose tissue (scWAT). The same amount of exercise didn’t reduce the amount of scWAT in female rats. Instead, endurance exercise caused scWAT in female rats to alter its energy usage in ways that are beneficial to health. These and other results highlight the importance of including both women and men in exercise studies.

The researchers also compared gene activity changes in the rat studies with those from human samples taken from previous studies and found substantial overlap. They identified thousands of genes tied to human disease that were affected by endurance exercise. These analyses show how the MoTrPAC results from rats can be used to help guide future research in people.

“This is the first whole-organism map looking at the effects of training in multiple different organs,” says Dr. Steve Carr, a MoTrPAC investigator from the Broad Institute. “The resource produced will be enormously valuable, and has already produced many potentially novel biological insights for further exploration.”

Human trials are expected in the next few years. Information on participating can be found here .

—by Sharon Reynolds

Related Links

• Gut Microbes May Affect Motivation to Exercise
• Exercise-Induced Molecule Reduces Obesity in Mice
• Testing Ways to Encourage Exercise
• Hormone Links Exercise with Cognitive Benefits
• Exercise-Induced Protein May Reverse Age-Related Cognitive Decline
• Getting Active Later in Life Brings Benefits
• Get Active Together: Social Support Can Help Keep You Moving
• Personalized Exercise? How Biology Influences Fitness
• Maintain Your Muscle: Strength Training at Any Age
• Molecular Transducers of Physical Activity Consortium (MoTrPAC)
• Participating in MoTrPAC

References:  Temporal dynamics of the multi-omic response to endurance exercise training. MoTrPAC Study Group; Lead Analysts; MoTrPAC Study Group. Nature . 2024 May;629(8010):174-183. doi: 10.1038/s41586-023-06877-w. Epub 2024 May 1. PMID: 38693412. Sexual dimorphism and the multi-omic response to exercise training in rat subcutaneous white adipose tissue. Many GM, Sanford JA, Sagendorf TJ, Hou Z, Nigro P, Whytock KL, Amar D, Caputo T, Gay NR, Gaul DA, Hirshman MF, Jimenez-Morales D, Lindholm ME, Muehlbauer MJ, Vamvini M, Bergman BC, Fernández FM, Goodyear LJ, Hevener AL, Ortlund EA, Sparks LM, Xia A, Adkins JN, Bodine SC, Newgard CB, Schenk S; MoTrPAC Study Group. Nat Metab . 2024 May 1. doi: 10.1038/s42255-023-00959-9. Online ahead of print. PMID: 38693320. The impact of exercise on gene regulation in association with complex trait genetics. Vetr NG, Gay NR; MoTrPAC Study Group; Montgomery SB. Nat Commun . 2024 May 1;15(1):3346. doi: 10.1038/s41467-024-45966-w. PMID: 38693125.

Funding:  NIH’s Office of the Director (OD), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institute on Aging (NIA), National Human Genome Research Institute (NHGRI), National Heart, Lung, and Blood Institute (NHLBI), and National Library of Medicine (NLM); Knut and Alice Wallenberg Foundation; National Science Foundation (NSF).

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Importance of Exercise Essay

500+ words essay on the importance of exercise.

We all know that exercise is extremely important in our daily lives, but we may not know why or what exercise can do. It’s important to remember that we have evolved from nomadic ancestors who spent all their time moving around in search of food and shelter, travelling large distances on a daily basis. Our bodies are designed and have evolved to be regularly active. Over time, people may come across problems if they sit down all day at a desk or in front of the TV and minimise the amount of exercise they do. Exercise is a bodily movement performed in order to develop or maintain physical fitness and good health overall. Exercise leads to the physical exertion of sufficient intensity, duration and frequency to achieve or maintain vigour and health. This essay on the importance of exercise will help students become familiar with the several benefits of doing exercise regularly. They must go through this essay so as to get an idea of how to write essays on similar topics.

Need of Exercise

The human body is like a complex and delicate machine which comprises several small parts. A slight malfunction of one part leads to the breakdown of the machine. In a similar way, if such a situation arises in the human body, it also leads to malfunctioning of the body. Exercise is one of the healthy lifestyles which contributes to optimum health and quality of life. People who exercise regularly can reduce their risk of death. By doing exercise, active people increase their life expectancy by two years compared to inactive people. Regular exercise and good physical fitness enhance the quality of life in many ways. Physical fitness and exercise can help us to look good, feel good, and enjoy life. Moreover, exercise provides an enjoyable way to spend leisure time.

Exercise helps a person develop emotional balance and maintain a strong self-image. As people get older, exercise becomes more important. This is because, after the age of 30, the heart’s blood pumping capacity declines at a rate of about 8 per cent each decade. Exercise is also vital for a child’s overall development. Exercising helps to maintain a healthy weight by stoking our metabolism, utilizing and burning the extra calories.

Types of Exercise

There are three broad intensities of exercise:

1) Light exercise – Going for a walk is an example of light exercise. In this, the exerciser is able to talk while exercising.

2) Moderate exercise – Here, the exerciser feels slightly out of breath during the session. Examples could be walking briskly, cycling moderately or walking up a hill.

3) Vigorous exercise – While performing this exercise, the exerciser is panting during the activity. The exerciser feels his/her body being pushed much nearer its limit compared to the other two intensities. This could include running, cycling fast, and heavy-weight training.

Importance of Exercise

Regular exercise increases our fitness level and physical stamina. It plays a crucial role in the prevention of cardiovascular diseases. It can help with blood lipid abnormalities, diabetes and obesity. Moreover, it can help to reduce blood pressure. Regular exercise substantially reduces the risk of dying of coronary heart disease and eases the risk of stroke and colon cancer. People of all age groups benefit from exercising.

Exercise can be effective in improving the mental well-being of human beings. It relieves human stress and anxiety. When we come back from work or school, we feel exhausted after a whole day of work. If we can go out to have a walk or jog for at least 30 minutes, it makes us feel happy and relaxed. A number of studies have found that a lifestyle that includes exercise helps alleviate depression. Those who can maintain regular exercise will also reduce their chances of seeing a doctor. Without physical activity, the body’s muscles lose their strength, endurance and ability to function properly. Regular exercise keeps all parts of the body in continuous activity. It improves overall health and fitness, as well as decreases the risk of many chronic diseases. Therefore, physical exercise is very important in our life.

Exercise can play a significant role in keeping the individual, society, community and nation wealthy. If the citizens of a country are healthy, the country is sure to touch heights in every facet of life. The country’s healthy generation can achieve the highest marks in various fields and thereby enable their country to win laurels and glory at the international level. The first step is always the hardest. However, if we can overcome it, and exercise for 21 days continuously, it will be a new beginning for a healthy life.

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Frequently Asked Questions on the Importance of Exercises Essay

What are the benefits of exercising regularly.

Regular exercise helps in the relaxation of the mind and body and keeps the body fit. It improves flexibility and blood circulation.

Which are some of the easy exercises that can be done at home?

Sit-ups, bicycle crunches, squats, lunges and planks are examples of easy exercises which can be done at home without the help of costly equipment.

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Cycling is a low-impact exercise and acts as a good muscle workout.

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An empirical analysis of factors determining changes in physical exercise during the COVID-19 pandemic

• Original Article
• Open access
• Published: 08 May 2024

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• Susana Pulgar   ORCID: orcid.org/0000-0002-6845-248X 1 ,
• Cristina Mazas   ORCID: orcid.org/0000-0001-7009-1567 1 ,
• Sepideh Kaviani   ORCID: orcid.org/0000-0002-4004-6551 2 ,
• Carolyn Butts-Wilmsmeyer   ORCID: orcid.org/0000-0002-2890-8796 3 &
• Maria Fernandez-del-Valle   ORCID: orcid.org/0000-0003-1421-5099 4 , 5  

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The main objective of the study was to report the changes that have taken place in the practice of physical exercise during confinement and to examine the factors that favor or detract from it.

Material and methods

To determine the objective, a survey was carried out in the United States during the pandemic and a sample of 511 participants was obtained. A binary logit model was used to process the data, as well as several independence tests.

The main result of this study is the increase in the practice of physical activity of the individuals surveyed during the pandemic. Some of the elements that most influenced this increase were annual family income, education level, and eating habits, but these results are subject to change depending on the respondent’s body mass index. On the other hand, the results also show changes in physical exercise habits during the pandemic, especially in the time of the week when it is performed, and these changes are highly correlated with the use of electronic devices, hours of sleep, and physical condition of the respondents before the pandemic.

Determining the different factors that affect the practice of physical exercise during pandemic periods seems to be important to determine in which populations it is more important to act or what resources are necessary when implementing physical exercise programs in specific situations such as pandemics.

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Introduction

In December of 2019, a series of unexplained cases of pneumonia and mild respiratory infections were reported in Wuhan City, the largest metropolitan area in China’s Hubei province (Tang et al. 2020 ). On January 30, 2020, the World Health Organization (WHO) classified this epidemic as a public health emergency of international concern (Zhu et al. 2020 ). On February 11, 2020, it was reported that the disease had been caused by a new type of coronavirus (CoV), called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was responsible for the coronavirus disease in 2019 (COVID-19) (Zhu et al. 2020 ). In the following weeks, infections spread in China and other countries, and the COVID-19 epidemic became a global health threat (Maugeri et al. 2020 ). The contamination of COVID-19 occurs from person-to-person mainly through respiratory droplets generated by coughing, sneezing and talking, and other sources of contagion that include biological fluids and already contaminated surfaces (Van Doremalen et al. 2020 ; Guo et al. 2020 ).

The clinical manifestations of COVID-19 are nonspecific and range from asymptomatic infection to severe respiratory failure. In most cases, it appears as an acute respiratory illness that includes fever, cough, myalgia, fatigue, dyspnea, and sore throat (Guo et al. 2020 ; Li et al. 2020 ). In moderate to severe cases, the disease progresses to respiratory difficulties, respiratory distress, and extra-respiratory symptoms that include heart and kidney damage and, in some cases, even death (Tsai et al. 2021 ). Furthermore, as indicated by Mesquita (da Rosa Mesquita et al. 2021 ), the death rate increased dramatically in patients already affected by one or more pathologies, those with preexisting health conditions, for example, diabetes, obesity, and cardiovascular disease.

Faced with the COVID-19 pandemic, public health recommendations led the governments worldwide to impose strict confinement rules on their citizens (Zajenkowski et al. 2020 ). Despite intense public health and research efforts to identify effective therapeutic and vaccination strategies to contain the spread of the virus and avoid the collapse of the health system, implementation of physical isolation measures were inevitable to stop the spread of the disease (Hossain et al. 2020 ). Among these measures are social isolation, teleworking, wearing masks while in public and maintaining social distancing or closure of educational centers, shops or non-essential services (Ferran et al. 2020 ). Therefore, people could only leave their home to perform essential jobs (health and social care sectors, police and armed forces, firefighting, water and electricity supply) or carry out essential activities (health visits, purchase of medications or food) (Hossain et al. 2020 ). While these restrictions were necessary and helped reduce the rate of infection among the population (Perry et al. 2021 ), they were not without limitations or adverse effects. Limited participation in normal physical and daily activities, cancelation of unnecessary travel, and the alteration of social and recreational habits added sources of stress and anxiety (Brooks et al. 2020 ; Droit-Volet et al. 2020 ; Hossain et al. 2020 ; Vicario-Merino and Muñoz-Agustín  2020 ), which negatively impacted physical activity levels (Hoffman et al. 2022 ; Narici et al. 2020 ) and ultimately compromised both physical and mental health (Williams et al. 2020 ). Such restraints and limitations during confinement reduced physical activity to levels well below the daily recommendation of 7500–10,000 steps per day (Blair 2009 ; Booth et al. 2017 ). In addition, a study conducted in Spain by Castañeda-Babarro et al. ( 2020 ) showed that healthy adults had reduced their self-reported daily physical activity while increasing their sedentary time during COVID-19 confinement. Such low levels of physical activity are shown to be associated with increased screen time and poor dietary habits across all ages (Booth et al. 2017 ; Husain and Ashkanani 2020 ). A sedentary lifestyle (i.e., office work, watching television, or prolonged sitting) has been consistently associated with increased all-cause mortality and increased mortality from metabolic syndrome and cardiovascular disease (Van der Ploeg et al. 2012 ). Several studies to date have shown that decreased physical activity can negatively influence glycemic control and lipid profile and is associated with increased fat mass and decreased lean mass with greater impact in individuals with overweight and obesity (Breen et al. 2013 ; Marzetti et al. 2017 ). During the course of the COVID-19 pandemic, work from home (WFH) increased abruptly and persisted after the outbreak for some workers (Bick et al. 2020 ; Tønnessen et al. 2021 ). Although social distancing was found to be an effective measure to reduce the spread of the disease, the resulting work pattern also affected people’s mental and emotional well-being that could also be a culprit for a more sedentary lifestyle (Tsamakis et al. 2021 ). In a study conducted with 869 participants who worked from home, an increase in the prevalence of health problems was identified, including weight gain and psychosocial problems (Ekpanyaskul and Padungtod 2021 ). These effects on health were shown to be associated with an increased number of working hours per day during this period, causing an interference with the biological and social rhythms for sleep, recovery, and social interactions (Arlinghaus and Nachreiner 2014 ).

Social isolation alone is also a potent risk factor for compromised overall health at all stages of life (Hawkley and Capitanio 2015 ), with the worst consequences being represented in the elderly, the poor and minorities, some of them the fastest growing segments of the US population (Cacioppo and Hawkley 2003 ). Previous research has identified a wide range of indicators of social isolation that pose health risks, such as living alone, having a small social network, infrequent participation in social activities, and feelings of loneliness (Cornwell and Waite 2009 ). Evidence indicates that loneliness increases sensitivity to social threats and motivates renewal of social connections, but it can also affect executive functioning, sleep, and physical and mental well-being (Park et al. 2020 ). Together, these effects contribute to higher rates of morbidity and mortality in lonely older adults (Cacioppo and Cacioppo 2014 ). Not all individuals respond equally to confinement, with some developing more adaptive strategies to remain physically active (Alomari et al. 2020 ); therefore, reducing stress and anxiety and improving physical health (Joyner and Green 2009 ). Developing strategies for an active lifestyle under confinement is of utmost importance as it not only protects against physical complications (Narici et al. 2020 ) but also helps maintain good mental health (Paluska and Schwenk 2000 ).

Therefore, the objective of this study was to report the changes that have taken place in the practice of physical exercise during COVID-19 confinement and to examine the factors that favor or detract from it.

An online survey on Qualtrics, hosted at Southern Illinois University Edwardsville, was utilized to assess how adults were dealing with the COVID-19 confinement period. To participate in this study the inclusion criteria were as follows: being 18–89 years old and residing within the US. The survey was approved by the Institutional Review Board at Southern Illinois University (ID: 775) and launched online on April 7, 2020 and remained open until June 30, 2020. A snowball sampling method was used to recruit participants through social media and by email. All the participants read the information about the study and provided consent by clicking on the first page of the survey. Participants could withdraw at any given time by not proceeding or submitting the survey. The survey was set, so it was not possible to be taken twice utilizing the same device.

The initial data of this survey included all responses. The database was then cleaned for provided consent ( n  = 2), incomplete surveys ( n  = 55), and respondents outside the US ( n  = 8). Additionally, those respondents reporting a body mass index corresponding with underweight ( n  = 6) were removed to avoid skewed analysis. A total of 511 responses were analyzed in this study (see flow diagram, Fig.  1 ).

Flow diagram

The survey had a total of 60 questions and took approximately 10 min to complete. The survey comprised four different sections: (1) demographics, (2) health history, (3) daily habits (i.e., dietary and sleep habits, and screen time), and (4) exercise (i.e., habits, facilities, technology, equipment, barriers/facilitators) (see Supplementary Table S1 ).

Statistical analysis

Descriptive and frequency analysis were used for the initial characterization of the sample divided by demographics (age, gender, race, civil status, annual family income, education level, regular dwelling, working conditions, employment status), healthy history (medical conditions, BMI group, smoking), daily habits (dietary, screen habits, and sleep) and exercise (physical fitness and exercise before and during COVID-19 confinement, company, and workout location). A quantitative analysis was carried out using a logistic regression model with two dichotomous dependent variables: “participants who increased their level of exercise during the confinement” (FIT) and “participants who decreased their level of exercise during the confinement” (NEGFIT). This statistical analysis was performed to answer the following questions: “Which factors are associated with an increased level of fitness during the COVID-19 pandemic?” and “Which factors are associated with a decreased level of fitness during the COVID-19 pandemic?”. Regression analyses were carried out with dichotomous dependent variables (FIT and NEGFIT), and several variables were used as regressors (gender, race, education level, annual family income, dietary habits, weekday, pre outdoors, working conditions, BMI group, exercise before and pre work). The p-value determined whether these variables were determinant in explaining the changes in the practice of physical exercise. The models estimated for each of the variables (FIT and NEGFIT) are not homogeneous since both the variables and their significance are different in each case. Based on the dependence of the change in exercise behavior and the BMI, the 511 participants were filtered into four groups (extremely healthy, normal, optimal, and unhealthy) and analyzed. When a variable was considered significant, the relative influence of the categories of that same qualitative variable was analyzed in more detail. Finally, in a complementary manner and considering the results of the previous regressions, independence contrasts were carried out between the most relevant variables when it comes to a person doing physical exercise. All the logistic regression calculations were carried out in PROC GLIMMIX (SAS, version 9.4) and Chi-Square Tests of Independence (PROC FREQ, SAS version 9.4). To determine the relevance of the variables in the estimated models, significance levels of 10%, 5%, and 1% were used.

Descriptive statistics

First, we will describe the main characteristics of the complete sample (511 participants), as well as the results only for those who reported having performed physical exercise during the confinement (450 participants).

Complete sample

Demographics.

The survey respondents of this study resided in 32 states of the US, with the majority located in Illinois, Missouri, and Texas (see Fig. 2 in Appendix). Table 1  shows demographic characteristics of the participants. Approximately, 70% of the respondents were between 30–59 years of age while the remaining ~30% were almost equally distributed between the age groups of 18–29 and 60–89 years. In terms of gender, the majority of respondents (76.9%) were female and 86.3% reported to be white. The marital status of respondents was reported as 66.5% married and 22.5% never married. Regarding annual household income, the most frequent family income ranges are above $60,000 per year (76.1%) and those who reported incomes between $51,000 and $60,000 (6,9%). Respondents’ education level showed 61.6% holding a graduate degree, followed by bachelor’s degree (28.8%) and some college but no degree (4.7%). About working conditions, 71.8% did not work remotely, 56% worked more than 40 h per week before the pandemic, 35.6% worked between 1 and 39 h per week, and 3.5% were unemployed. This contrasts with working conditions during the pandemic, in which the percentage of employees working more than 40 h per week decreased by 12 points to 43.8% while there was an increase in the number of participants working between 1 and 39 h (43.4%) as well as the unemployed, which more than double compared to before the pandemic (8%) (see Supplementary Table  2 ).

Health history

More than half of the respondents reported eating the same amount of food during the pandemic (50.5%) and 35.8% increased their daily intake during that period. The same is true for sleep habits: 47.7% reported that they slept the same hours and 35.2% that their sleep hours had increased. In addition, screen hours increased during the confinement (59.7%).

Exercise habits and workout location

There was a great variety in the physical fitness of the respondents prior to the pandemic, with a predominance of those who declared having a normal physical fitness (52.6%) and improved physical fitness during the confinement (31.7%) that showed to be higher by more than 6 points compared to those who had worsened (25.6%). Interestingly, data reflected an 8 percentage point increase in the practice of physical exercise during the pandemic (88.1%). On the other hand, the respondents’ favorite place for physical exercise before the pandemic was the gym (40.9%), followed by home (34.1%) and outdoors (22.7%).

Individuals performing physical exercise

Results exercise during the pandemic.

The results of the 450 participants who reported having exercised during the pandemic are shown in Table  1 . Sociodemographic characteristics and healthy and daily habits of this subsample showed similar proportions among the different categories of the study variables (gender, race, age, income, marital status, etc.) to the full sample, which includes the respondents who did not exercise.

Change in exercise habits during confinement

In those respondents who did exercise, changes in physical exercise habits were observed during the pandemic. Of the 450 participants who exercised during the confinement, 14.4% reported that they did not exercise before the pandemic.

Fitness during the pandemic improved for 35.1% of the respondents and worsened for 21.8%. With respect to the frequency of physical exercise, participants who exercised more than four days a week increased from 45.8% to 58.2%, as did the number of hours per week of physical exercise, which increased by almost 9 percentage points. There were also changes in the days of the week on which physical exercise is practiced; 27.6% of respondents reported an increase in exercise during weekends versus 14.7% who indicated a decrease during those days of the week. On weekdays, there were also changes, with 48.4% of respondents stating an increase in physical exercise on these days and 21.3% reporting a decrease.

Taking into account the intensity of exercise, light exercise increased almost threefold, from 6.4% to 15.6%. Other relevant changes can be seen in moderate-intensity exercise, which went from 48.4% before the pandemic to 58% during the pandemic. Vigorous-intensity exercise decreased from 29.6% to 6.7%, and very-vigorous exercise increased from 1.1% to 19.8%. Finally, 43.8% reported having practiced new activities, and the location for the practice of physical exercise was similar to that reported in the full sample.

Logit model

To determine the factors influencing the practice of physical exercise (FIT variable), several logit models were estimated, in which the most relevant/influencing variables were education level, annual family income, dietary habits, outdoor practice before the pandemic, and physical exercise practice during the week. The results are shown in Table  2 .

With respect to education level, only being a student ( p  < 0.05) or having a university degree ( p  < 0.01) has a significant impact on physical exercise behaviors. In relation to annual family income, the most influential levels in the practice of physical exercise are incomes below $20,000 ( p  < 0.05) or above $60,000 ( p  < 0.05) and the relation with physical exercise practice is inverse. In addition, those with family income between 41,000 and 50,000 dollars are also significant. Finally, among eating habits, those who reported eating more ( p  < 0.01) or the same ( p  < 0.01) during the pandemic are relevant, and its relation with physical exercise practice is also inverse. The above results are shown in Table  3 .

In contrast, the most important factors for not practicing physical exercise (NEGFIT) are family income, working conditions, BMI group, and the practice of exercise during the week. The results are also shown in Table  3 . All income levels are significant in the lack of practice of physical exercise with the exception of those who reported annual incomes between 41,000 and 50,000 dollars. Working conditions are also relevant, both for those who performed face-to-face ( p  < 0.01) and remote ( p  < 0.01) work. With respect to the BMI group, the three categories (healthy, overweight, and obese) are significant in explaining the non-practice of physical exercise ( p  > 0.01). Changes in physical exercise during the week are relevant, with a significance level of 1%, in not practicing physical exercise. Finally, performing or not performing physical exercise at work is a determinant for not performing physical exercise ( p  < 0.01) (see Table  4 ).

Estimations of the logit model performed on four subsamples (extremely healthy, normal, optimal, and unhealthy) for each of the BMI group categories, with the dependent variable FIT and the regressors (education level, annual family income, working conditions, and diet) (Table  5 ). The only significant results were reported in the normal BMI group, in which working conditions were relevant in determining the practice of physical exercise ( p  < 0.1) and in the optimal group, in which diet was the key factor ( p  < 0.05). In the rest of the estimations, no significant differences were found.

Contrasts of independence

Finally, considering the results of the previous section, several independence tests were carried out between the most relevant variables of the Logit analysis (p-value), which are the BMI group and changes in physical exercise practice during the week. The first independence tests (for the whole sample) associate the BMI group with the place of physical exercise prior to the pandemic. The results show that there is a dependence relationship between BMI and having performed physical exercise at work ( p  < 0.05), at home ( p  < 0.01), and in community places ( p  < 0.05). However, the same dependence relationship is not shown for the variables BMI and outdoor exercise (see Table  6 ).

Independence contrasts between changes in physical exercise practice during the week and demographic variables, on medical history, daily habits, and exercise practice was performed for those participants who exercised during the pandemic. As can be seen in Table  7 , there is a relationship between changes in physical exercise practice during the week and age ( p  < 0.1), gender ( p  < 0.05), race ( p  < 0.05), and annual family income ( p  < 0.05). There is also a dependency relationship with daily habits, hours of sleep ( p  < 0.05), and screen time ( p  < 0.05). Finally, there is a strong relationship between the weekday variable and physical exercise habits; specifically, having done physical exercise before the pandemic ( p  < 0.01) and choosing community locations ( p  < 0.01).

The scope of this study is to report the changes that have taken place in the practice of physical exercise during the confinement and to examine the factors that favor or detract from it. One of the relevant results is the increase of 8 percentage points in the practice of physical exercise during the pandemic, which raises to 88% the percentage of participants who report performing physical exercise. These results coincide with those observed in a study by Constand et al. ( 2020 ) who stated that the increase in the practice of physical exercise during the pandemic was almost one third in very active people and almost two thirds in inactive people.

To address which factors are relevant in the decision to practice or not to practice physical exercise, we can first introduce those that affect the sociodemographic characteristics of the respondent. First, from the information collected, it seems that those participants with a higher level of education are more likely to practice physical exercise; specifically, those who either have an academic degree or are in the process of obtaining one. This positive relationship between the practice of physical exercise during the pandemic and education level is consistent with the results obtained in different studies over the years. A study by Wildbur ( 2003b ) reported that Latina women living in the United States who had less than a high school education performed less physical exercise compared to those with a higher level of education. In another, conducted by the same author, but with a sample of African-American women, those who completed high school were four times more likely to be active than those that did not. Moreover, women with a university degree were still two to three times more likely to be active than those with a lower level of education (Wilbur et al. 2003a ). Along the same lines, MacDougall et al. ( 1997 ) also showed that people with no education or primary education were more likely to have a low level of activity than those with higher education. Regarding the relationship between income and physical exercise, in our study, there is a contrast between those earning less than $20,000 per year and those earning between $41,000–50,000 and more than $60,000 per year. As with data obtained in other studies, earnings above $41,000 are associated with higher physical exercise (Bauman et al. 2012 ; Chatton and Kayser 2013 ). Income level is a key contributing factor to the education level and practice of physical exercise in addition to other factors. In this sense, it is not surprising the negative relationship between the low-income group (< $20,000) and with a reduced participation in sports and exercise at younger ages as they tend to have lower income (Wolla and Sullivan n.d.). Finally, working conditions are among the factors that have an impact on the decrease in physical exercise, being significant both for those who work remotely and those who do not. During the COVID-19 pandemic, in jobs where telecommuting was possible, a considerable number of employees worldwide were allowed to work from home (Mitchell 2021 ); however, in places where this was not a feasible solution, they were forced to suspend operations with consequent pay suppression (Harangi-Rákos et al. 2022 ). It seems that both factors may have a negative impact on the practice of physical exercise, either from the economic problems due to salary suppression (Roberts 2017 ) or the increase in the proportion of sedentary time derived from teleworking (Ráthonyi et al. 2021 ). In this regard, in a study by Hernandez et al. ( 2021 ), one of their objectives was to analyze the degree of physical activity during the COVID-19 pandemic in remote workers, and it was shown that more than 70% of the workers surveyed reported increased sedentary behaviors.

In terms of factors relevant to the practice or not of physical exercise during the COVID-19 pandemic (daily habits, specifically, diet) our data revealed that the practice of physical exercise is related to eating habits. As is well known, periods of confinement, related to negative psychological effects (Brooks et al. 2020 ), imply changes in the daily routine of the population (Sánchez-Sánchez et al. 2020 ), and may lead to inappropriate behaviors such as physical inactivity or the consumption of unhealthy food and beverages (López-Bueno et al. 2020 ) and the consequent increase in the development of certain diseases such as obesity or diabetes (Vergara Castañeda et al. 2020 ). In this sense, following a balanced and healthy diet, while maintaining minimum levels of physical exercise takes on special importance in relation to its health benefits during confinement (Reyes-Olavarría et al. 2020 ). These results are in line with those obtained in the review by Bennet et al. ( 2021 ) where six of the included studies showed an increase of both quantity and frequency of their meals during quarantine. Consequently, when considering the increase in physical activity in our sample and taking into account that food consumption (whether equal or higher) also positively influences physical activity, it is evident that the confinement period due to COVID-19 generated both beneficial and detrimental effects. However, it should also be noted that our study did not consider the type of food that increased in consumption, as other studies have also reported an increase in the consumption of fresh produce (Di Renzo et al. 2020 ) and home cooking (Pietrobelli et al. 2020 ) during the confinement period.

Related to physical exercise habits, the most significant factor affecting exercise during confinement was not exercising outdoors before the pandemic. This result may suggest that people who exercised in other places, such as their own home or workplace, may be more likely to continue exercising in their own home during the pandemic. The results obtained in our study are in agreement with those obtained by Dunton et al. ( 2020 ) who showed that physical activity at home was associated with fewer declines in physical activity during the pandemic, which may imply that the barriers of confinement affect outdoor and low-cost exercise. Another study, by Yang and Koenigstorfer ( 2020 ) suggests that users of digital exercise aids were less likely to experience a reduction in their physical activity levels, which could be related to the fact that such tools are more likely to be used by people who do not exercise outdoors. Another factor, also associated with the practice of physical exercise (both positively and negatively) during the pandemic for all its variables (no physical exercise during the week, more or fewer days, or more days per week), is that referring to changes in the days of the week for the practice of exercise (more, less, or the same). It could be affirmed that these patterns are to be expected, since, as is well known, the state of confinement changed the daily life of the workers, altering their lifestyle behaviors, including those related to the practice of physical exercise (Loef et al. 2022 ).

The factors with the greatest influence on changes in physical exercise habits during the week in the confinement period were, on the one hand, sleep habits and the use of electronic devices and, on the other hand, physical fitness prior to the pandemic and the practice of physical activity in groups. In relation to sleep habits and the practice of exercise, there is great evidence that physical exercise practiced regularly has a positive impact on total sleep time (Kredlow et al. 2015 ), being of great importance since the quality of sleep has a fundamental role in health promotion and risk of suffering chronic diseases and depression (Irwin 2015 ). Also, it appears that factors influencing exercise changes during the week, such as pre-pandemic fitness and group physical activity, could be connected. During confinement, there was a significant increase in screen time (Jia et al. 2020 ), being also higher for young adults (Qin et al. 2020 ). In this sense, studies show both a positive and negative association in the use of digital media and physical activity. For example, the use of smartphones and video games is associated with a lower likelihood of exercising (Grimaldi-Puyana et al. 2020 ) and the use of social networks (especially those with sports content) may favor this practice (Shimoga et al. 2019 ). Therefore, although some people increased their dependence on social networks as a form of entertainment, others used social networks as a means to perform physical activity and break the daily routine derived from confinement (Areiza-Padilla et al. 2021 ).

Finally, our study showed that body mass index related variables (healthy, overweight, or obese) were determinants of not performing physical exercise. Interestingly, these variables were strongly related to the location where the participants performed physical exercise (outdoors, at the workplace, at home or in a group) before the pandemic: body mass index (all groups) and exercising at home or in a group and, very strongly, with the practice of physical exercise at home. This relationship shows that lifestyle components, such as physical inactivity, are one of the main factors that influence the maintenance of the body mass index, contributing to the incidence of obesity and overweight (Missiriya Jalal et al. 2021 ).

Strengths and limitations

It is necessary to extend the study in those variants that are relevant to our results, specifying in more detail some key variables. To achieve this, it is essential to use a more diverse and heterogeneous sample, given that the setting in which the data were collected was mostly composed of college graduates. In addition, it would be beneficial to extend the study to other geographic areas and to carry out comparisons between different states.

Future research

For future research, it is crucial to consider several areas of study and proposals based on our results. For example, we could explore the implementation of specific programs targeting groups with different body mass indexes (BMI) or programs that encourage physical activity both at home and outdoors, examine the possibility of providing resources to users based on their income, and/or develop a public health protocol that takes into account the income levels of the population in situations such as pandemics. This protocol could include programs designed to serve specific groups of people, whether special populations or those with chronic pathologies. We could also consider creating specific resources for people who are accustomed to exercising outside the home, as they appear to have experienced more difficulties during confinement.

Given the observed increase in the practice of physical exercise during confinement, it would be interesting to conduct a long-term follow-up of these individuals to determine if they have maintained their improved habits or if they have returned to their pre-confinement routines. This would allow us to better understand trends and factors influencing exercise adherence.

This would provide us with valuable information on the impact of exercise on people’s overall health and well-being.

Conclusions

- During confinement, there was an increase in the practice of physical exercise.

- Among all the variables analyzed, the elements that most favor/distort the practice of physical exercise are dietary habits, annual family income, and education level. These factors also affect physical exercise differently according to body mass index.

- Other significant results are the changes in the days of the week used for physical exercise due to the circumstances derived from confinement, which are also closely related to the use of electronic devices and screens, the hours of sleep, and the physical state prior to the pandemic.

Availability of data and material

Data are available upon request from the corresponding author.

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(using CRediT taxonomy) Dr. Susana Pulgar: Methodology, research, formal analysis, visualization, writing (preparation of the original draft), writing (review and editing). Dr. Cristina Mazas: data curation, methodology, resources, visualization writing (review and editing). Dr Sepideh Kaviani: Conceptualization, methodology, data curation, writing (review and editing). Dr Carolyn Butts-Wilmsmeyer: Methodology, resources, data curation, writing (review and editing). Dr María Fernández del Valle: Conceptualization, methodology, data collection, resources, visualization, writing (review and editing), project management, supervision.

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Pulgar, S., Mazas, C., Kaviani, S. et al. An empirical analysis of factors determining changes in physical exercise during the COVID-19 pandemic. J Public Health (Berl.) (2024). https://doi.org/10.1007/s10389-024-02238-7

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