COVID-19 Related Employment Changes and Physical Activity and Sedentary Behavior [COVID-19 and Physical Activity Series]

Working From Home and Job Loss Due to the COVID-19 Pandemic Are Associated With Greater Time in Sedentary Behaviors by Dr. McDowell and co-authors examined associations of changing COVID-19-related employment conditions with physical activity and sedentary behavior. Data was collected from 2,303 previously employed U.S. adults between April 3, 2020 and April 7, 2020. Linear regression quantified associations of COVID-19-related employment changes with physical activity, sitting time, and screen time, controlling for age, sex, race, BMI, smoking status, marital status, chronic conditions, household location, public health restrictions, and recalled physical activity, sitting time, and screen time prior to the COVID-19 pandemic. Dr. McDowell and co-authors found that, compared to those whose employment remained unchanged, individuals whose employment changed (either working from home or job loss) due to COVID-19 reported higher sitting time (WFH: g = 0.153, 95% CI = 0.095–0.210; lost job: g = 0.212, 0.113–0.311) and screen time (WFH: g = 0.158, 0.104–0.212; lost job: g = 0.193, 0.102–0.285). This equated to 31 and 33 minutes more sitting and screen time per day, respectively, among those working from home, and 44 and 40 minutes more sitting and screen time per day, respectively, among those who lost their jobs. There were no significant group differences for physical activity (WFH: g = −0.030, −0.101 to 0.042; lost job: g=-0.070, −0.178 to 0.037). COVID-19 related employment changes were associated with greater sitting and screen time. As sedentary time is consistently negatively associated with current and future health and wellbeing, increased sedentary time due to employment changes is a public health concern.

McDowell, C. P., Herring, M. P., Lansing, J., Brower, C., & Meyer, J. D. (2020). Working From Home and Job Loss Due to the COVID-19 Pandemic Are Associated With Greater Time in Sedentary Behaviors. Frontiers in public health, 8.

BMI and Walking Pace and Severe COVID-19 Risk [COVID-19 and Physical Activity Series]

Obesity, walking pace, and risk of severe COVID-19 by Dr. Yates and co-authors assessed self-reported walking pace as a risk factor for severe COVID-19 independent of obesity.  Analysis was conducted using 414,201 UK Biobank participants—a large prospective cohort of middle-aged adults—with complete covariate and linked COVID-19 data for the period March 16, 2020 to June 20, 2020.  Previous research shows that self-reported walking pace, a measure of functional fitness, is a strong predictor of mortality—individuals with a self-reported slow walking pace have 2 to 4 times the risk of cardiovascular mortality compared to individuals with a brisk walking pace.  Dr. Yates and co-authors found that slow walkers had the highest risk of severe COVID- 19 regardless of obesity status.  Specifically, compared to normal weight brisk walkers, the odds of severe COVID-19 in slow walkers was over 2 times greater across all categories of obesity status. [1.39 (0.99, 1.98) versus 2.48 (1.56, 3.93)].  This study highlights BMI and walking pace as potential risk factors for severe COVID-19, slow walkers in particular having the greatest risk. Ongoing public health and research surveillance studies should consider incorporating simple measures of physical fitness in addition to BMI as potential risk factors that have important public health implications. 

Yates, T., Razieh, C., Zaccardi, F., Seidu, S., Davies, M. J., & Khunti, K. (2020). Obesity, walking pace and risk of severe COVID-19: Analysis of UK Biobank. medRxiv (preprint).

COVID-19 Stay-At-Home Orders, Health Behaviors and Mental Health [COVID-19 and Physical Activity Series]

The impact of COVID-19 stay-at-home orders on health behaviors in adults by Dr. Flanagan and co-authors assessed lifestyle changes across different BMI classifications in response to the pandemic. Data was collected from 7,753 participants between April 3, 2020 and May 3, 2020.  The online survey captured information across five domains: demographics and household information, sedentary behaviors, physical activity, diet, sleep, and mental health.  Dr. Flanagan and co-authors found that sedentary leisure behaviors, such as watching television, using the phone for entertainment, and playing video games, increased by 16.83±0.84 (p<0.001) and 21.25±0.90 minutes (p<0.001) on weekend days and week days, respectively.  They also found that physical activity declined 18.32±4.63 minutes per week and, after accounting for exercise intensity, declined by 111.88±22.07 weekly MET minutes (both p<0.001), and respondents who reported weight gain demonstrated the largest declines in physical activity.  Dr. Flanagan and co-authors also found that 27.3% of the respondents reported weight gain and weight gain was more prevalent with obesity compared to overweight and normal weight (33.4% vs 20.5% and 24.7%, respectively p<0.001).  Similarly, reported anxiety scores nearly doubled during the pandemic and the magnitude of increase was significantly greater in people with obesity (p≤0.01).  Government mandates together with fear of contracting the virus have significantly impacted lifestyle behaviors alongside declines in mental health. These deleterious impacts have disproportionately affected individuals with obesity. 

Flanagan, E. W., Beyl, R. A., Fearnbach, S. N., Altazan, A. D., Martin, C. K., & Redman, L. M. (2020). The impact of COVID‐19 stay‐at‐home orders on health behaviors in adults. Obesity.

Physical Activity and Positive Mental Health Before and During COVID-19 Stay-At-Home Orders [COVID-19 and Physical Activity Series]

Physical activity is positively associated with college students’ positive affect regardless of stressful life events during the COVID-19 pandemic by Dr. Maher and co-authors examined the associations between physical activity and affect among college students before and during COVID-19 stay-at-home orders and how change in physical activity predicts change in affect.  Data was collected from 107 college students before COVID-19 stay-at-home orders (January 21-March 11, 2020)  and again between April 17 and May 5, 2020.  Data about physical activity was collected using the International Physical Activity Questionnaire–Short Form; data about positive and negative affect was collected using the Positive and Negative Affect Schedule; data about sleep quality was assessed using the Pittsburgh Sleep Quality Index; data about food security was collected using the U.S. Household Food Security Survey Module; and data about stressful life events was collected using the Social Readjustment Rating Scale.  Dr. Maher and co-authors found significant decreases in minutes of moderate-to-vigorous physical activity (t (106) = -2.4, p = 0.02), positive affect (t (105) = -6.93, p < 0.001), and sleep quality (t (106) = 5.14, p < 0.001).  They also found that negative affect significantly increased (t (105) = 6.29, p < 0.001).  Dr. Maher and co-authors found that physical activity was associated with positive affect before (B = 0.01, p < 0.01) and during (B = 0.01, p = 0.01) COVID-19 stay-at-home orders.  They also found that physical activity only predicted negative affect before COVID-19 stay-at-home orders (B = −0.003, p = 0.04) and was unable to protect against or attenuate increases in negative affect during COVID-19 stay-at-home orders.  Results from the current study suggest that physical activity promotion efforts during the COVID-19 pandemic are needed to enhance positive mental health and well-being, particularly as phased re-openings continue, COVID-19 hotspots emerge, and new quarantines and closures potentially loom.

Maher, J. P., Hevel, D. J., Reifsteck, E. J., & Drollette, E. S. (2020). Physical activity is positively associated with college students' positive affect regardless of stressful life events during the COVID-19 pandemic. Psychology of sport and exercise, 52, 101826.

Step #10 Toward Being Trusted Facilities Where Physicians Refer Their Patients [Connecting Health Clubs to Healthcare Series]

Research conducted at the Harvard School of Public Health between May 2019 and February 2020 compiled data from physicians about characteristics of health & fitness centers/exercise professionals that they trust to refer their patients. Step #10 of a 10-step roadmap for health & fitness centers toward being trusted facilities where physicians refer their patients is:

Facilitate peer-to-peer physician trainings with repeat referrers

Physicians who have personal familiarity with a facility have the potential to become champions for the facility. They are also more likely to become repeat referrers. Create opportunities where physicians can share their experiences referring patients to your facility with other physicians.

They started getting a couple physician champions on board that they noticed would come to the facility, and then those physicians would trust in us and get the word out to other physicians. Exercise Professional

Bantham, A. (2020). Perspectives on Exercise Prescriptions/Referrals and Patient Exercise Behavior Change: A Mixed Methods Study of Physicians and Exercise Professionals (Doctoral dissertation).

Step #9 Toward Being Trusted Facilities Where Physicians Refer Their Patients [Connecting Health Clubs to Healthcare Series]

Research conducted at the Harvard School of Public Health between May 2019 and February 2020 compiled data from physicians about characteristics of health & fitness centers/exercise professionals that they trust to refer their patients. Step #9 of a 10-step roadmap for health & fitness centers toward being trusted facilities where physicians refer their patients is:

Raise physicians’ awareness of your facility’s infrastructure.

Physicians note the importance of a health & fitness center’s infrastructure, such as equipment that is safe, inclusive and meets the needs of their patients. They also cite its accessibility (e.g., convenience, hours, price). Increase physicians’ knowledge of your facility’s location, hours of operation, equipment, affordability, programming and services as a good fit for their patients.

And so then they have the opportunity to use different equipment, and the classes, and they have a swimming pool there, so it is a great way to get people into a program and then they can decide what equipment they like. Physician

Bantham, A. (2020). Perspectives on Exercise Prescriptions/Referrals and Patient Exercise Behavior Change: A Mixed Methods Study of Physicians and Exercise Professionals (Doctoral dissertation).

Physical Activity and Decreased Risk of Severe COVID-19 Illness[COVID-19 and Physical Activity Series]

Modifiable lifestyle factors and severe COVID-19 risk: Evidence from Mendelian randomization analysis by Dr. Li explored the causal relationship between severe COVID-19 illness and four lifestyle factors—physical activity, obesity, smoking, and alcohol consumption.  Mendelian randomization is a method using exposure-associated genetic variants as instrumental variables to assess the causal relationship between exposures and outcomes.  Dr. Li found that genetically predicted BMI was associated with about 2-fold (1.91, 95% confidence interval [CI], 1.55, 2.35, P=7.4 x 10-10) increased risk of severe COVID-19 illness.  He also found that lifetime smoking was associated with about 2-fold (1.84, 95% CI, 1.08 to 3.13, P=0.02) increased risk of severe COVID-19 illness.  Dr. Li noted this is the first study providing evidence that physical activity causally decreases the risk of severe COVID-19 illness. Genetically predicted physical activity was associated with about 5-fold (95% confidence interval [CI], 1.4, 20.3; P=0.02) decreased risk of severe COVID-19 illness. This study highlights the importance of maintaining a healthy lifestyle in protecting from COVID-19 severe illness and its public health value in fighting against the COVID-19 pandemic. 

Li, S. (2020). Modifiable lifestyle factors and severe COVID-19 risk: Evidence from Mendelian randomization analysis. medRxiv (preprint).

Physical Activity Behavior and COVID-19 Lockdowns [COVID-19 and Physical Activity Series]

Physical Activity Behavior Before, During and After COVID-19 Restrictions: A Longitudinal Smartphone Tracking Study of 5,395 UK Adults by Ms. McCarthy and co-authors explored patterns of tracked physical activity from walking, running and cycling in the UK before, during and after COVID-19 restrictions.  Tracked longitudinal weekly minutes of physical activity were captured using BetterPoints—a free, publicly available smartphone app—between January and June 2020.  Ms. McCarthy and co-authors found that, at baseline (the week of January 22, 2020), 51% of users were active (>150 minutes of physical activity per week), 23% were fairly active (30-149 minutes), and 26% were inactive (0-29 minutes).  During the week lockdown was announced (March 23, 2020), the median change in physical activity was 30 minutes less than baseline. By the first full week of lockdown (week of March 25, 2020), the median change in physical activity was 57 minutes less than baseline, representing a 37% reduction in weekly minutes of physical activity.  According to UK lockdown guidance, people were allowed to spend time outside for physical activity except for those in quarantine or isolation.  Ms. McCarthy and co-authors confirmed that 63% of people decreased their physical activity levels between baseline and the first week of COVID-19 restrictions, 16% did not change, and 21% increased. Younger people showed more physical activity before lockdown but the least physical activity after lockdown, while older people (65+) remained more active throughout lockdown, and increased their physical activity levels as soon as lockdown was lifted.  Ms. McCarthy and co-authors concluded that physical activity levels among those who were active at baseline showed a significant decrease compared with those who were fairly active or inactive, and inactive people remained consistently inactive throughout lockdown.  Significant differences by age group and prior physical activity levels suggests that the government’s response to COVID-19 needs to...consider the impact on younger age groups, encourage everyone to increase their physical activity and not assume that people will recover prior levels of physical activity on their own. 

McCarthy H., Potts, H., Fisher, A. (2020). Physical Activity Behavior Before, During and After COVID-19 Restrictions: A Longitudinal Smartphone Tracking Study of 5395 UK Adults.  Journal of Medical Internet Research. 

Step #8 Toward Being Trusted Facilities Where Physicians Refer Their Patients [Connecting Health Clubs to Healthcare Series]

Research conducted at the Harvard School of Public Health between May 2019 and February 2020 compiled data from physicians about characteristics of health & fitness centers/exercise professionals that they trust to refer their patients. Step #8 of a 10-step roadmap for health & fitness centers toward being trusted facilities where physicians refer their patients is:

Raise physicians’ awareness of your exercise professionals’ capabilities.

Exercise professionals equate education and certifications with experience and knowledge. But physicians prioritize other metrics as a proxy for experience and knowledge because they do not understand exercise professional credentialing. Increase physicians’ knowledge of your exercise professionals’ capabilities in working with different types of patient populations to change their exercise behavior.

I don’t think I have enough understanding of what it takes to be a credentialed trainer, so I don’t know that that would sway me as much as just somebody who was a good motivator for exercise. Physician

Bantham, A. (2020). Perspectives on Exercise Prescriptions/Referrals and Patient Exercise Behavior Change: A Mixed Methods Study of Physicians and Exercise Professionals (Doctoral dissertation).

COVID-19 Closures and Physical Activity and Sedentary Behavior in Children [COVID-19 and Physical Activity Series]

Early Effects of the COVID-19 Pandemic on Physical Activity and Sedentary Behavior in US Children by Dr. Dunton and co-authors investigated the effects of COVID-19 related closures, cancellations, and restrictions on physical activity and sedentary behavior in U.S. children ages 5–13 years.  Data was collected between April 26 and May 16, 2020 through a baseline online survey of parents recruited through convenience sampling.  Parents reported on their child’s previous day physical activity and sedentary behavior, their child’s levels of physical activity and sedentary behavior in April-May as compared to February, and locations of their child’s physical activity including use of remote/streaming services.  Dr. Dunton and co-authors found that, on average, children expended a total of 892.0 (SD = 902.07) MET-min on previous day physical activity and 489.4 (SD = 211.5) min on previous day total sitting.  About 36% of parents reported their child had done much less physical activity in the past 7 days as compared to February, and 41% of parents reported their child had done much more sitting in the past 7 days as compared to February.  Dr. Dunton and co-authors also found that more children performed physical activity at home or in the garage, and on sidewalks and roads in their neighborhood in April-May as compared to February, and that the most frequently reported physical activities were free play/unstructured physical activity (e.g., running around, tag, other active games) and going for a walk.  Children ages 9–13 were more than five times as likely as children ages 5-8 to participate in team sports training sessions or practices through remote/streaming services.  Dr. Dunton and co-authors concluded that although school and park closures and cancellations of team sports and organized activity classes were necessary steps to mitigate COVID-19 spread, they appear to have had a profound impact on children’s physical activity and sedentary behavior levels, especially among children ages 9–13.  In fact, twice as many parents of children ages 9-13 versus children ages 5-8 reported their child had done much less physical activity in the past 7 days as compared to February.  The data suggest that children overwhelmingly spent their unstructured free time in April-May on sedentary behavior (e.g., watching television/videos/movies, playing computer or video games) instead of physical activity.  In order to avoid permanent changes in behavior extending beyond the duration of the COVID-19 closures, measures must be taken over the summer and fall of 2020 to promote home- and neighborhood-based physical activity during children’s leisure time. 

Dunton, G., Do, B. & Wang, S. (2020). Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S. BMC Public Health 20, 1351. 

Obesity and Risk for Intubation or Death from COVID-19 [COVID-19 and Physical Activity Series]

Body Mass Index and Risk for Intubation or Death in SARS-CoV-2 Infection by Dr. Anderson and co-authors is a retrospective cohort study.  Data from 2,466 adults hospitalized with SARS-CoV-2 infection between March 10th and April 24th at New York-Presbyterian/Columbia University Irving Medical Center and Allen Hospital were analyzed.  Patients’ median age was 67 years, median BMI was 27.9 kg/m2, and median number of comorbid conditions was two.  Dr. Anderson and co-authors concluded that obesity is associated with increased risk for intubation or death from COVID-19 in adults younger than 65 years, but not in adults aged 65 years or older.  Specifically, compared with overweight patients, patients with BMI of 40 kg/m2 or higher had the highest risk for intubation or death (hazard ratio, 1.6 [95% CI, 1.1 to 2.1]). Moreover, the link between obesity and worse outcomes was strongest among patients aged younger than 65 years (p for interaction by age = .042).  Dr. Anderson and co-authors also found that obesity is associated with intubation or death independent of several comorbid conditions (e.g., diabetes and hypertension).  They posited that the absence of an association between obesity and intubation or death in older adults may reflect a high mortality due to comorbidity, frailty, or worse immune function with older age.  These findings might inform discussions between health care providers and patients regarding advanced care planning and benefits of prolonged social distancing, particularly for younger adults with class 2 or 3 obesity.  

Anderson, M. R., Geleris, J., Anderson, D. R., Zucker, J., Nobel, Y. R., Freedberg, D., ... & Natarajan, K. (2020). Body mass index and risk for intubation or death in SARS-CoV-2 infection: a retrospective cohort study. Annals of internal medicine.

Step #7 Toward Being Trusted Facilities Where Physicians Refer Their Patients [Connecting Health Clubs to Healthcare Series]

Research conducted at the Harvard School of Public Health between May 2019 and February 2020 compiled data from physicians about characteristics of health & fitness centers/exercise professionals that they trust to refer their patients. Step #7 of a 10-step roadmap for health & fitness centers toward being trusted facilities where physicians refer their patients is:

Invite physicians to work with your exercise professionals to showcase their experience with different injuries, diagnoses, and conditions. 

Physicians observe how their own personal familiarity with exercise professionals influences their likelihood of referral. They want to know that exercise professionals have experience working with special populations, such as people with different injuries, disabilities, and diagnoses. Increase physicians’ personal familiarity with your exercise professionals.

Ideally, I have personal interaction with them. I know what they do...and I know that they are going to have some knowledge of the conditions that patients have that I am sending to them. Physician

Bantham, A. (2020). Perspectives on Exercise Prescriptions/Referrals and Patient Exercise Behavior Change: A Mixed Methods Study of Physicians and Exercise Professionals (Doctoral dissertation).

Obesity and Risk of Death from COVID-19 [COVID-19 and Physical Activity Series]

Obesity and mortality among patients diagnosed with COVID-19 by Dr. Tartof and co-authors is a retrospective cohort study.  Electronic health records of 6,916 Kaiser Permanente Southern California patients diagnosed with COVID-19 from February 13 to May 2, 2020 were examined.  Dr. Tartof and co-authors found a J-shaped association between BMI and patients’ risk for death, even after adjusting for obesity-related comorbidities. Compared with patients with a BMI of 18.5 to 24 kg/m2, those with BMIs of 40 to 44 kg/m2 and greater than 45 kg/m2 had relative risks of 2.68 (95% CI, 1.43 to 5.04) and 4.18 (CI, 2.12 to 8.26), respectively.  High BMI was more strongly associated with COVID-19 mortality in younger adults and male patients.  Dr. Tartof and co-authors did not find an increased risk for death associated with asthma, neighborhood population density, neighborhood income, or African American race or Hispanic ethnicity.  Our findings also reveal the distressing collision of 2 pandemics: COVID-19 and obesity…and underscore the need for future collective efforts to combat the equally devastating, and potentially synergistic, force of the obesity epidemic. 

Tartof, S. Y., Qian, L., Hong, V., Wei, R., Nadjafi, R. F., Fischer, H., ... & Saxena, T. (2020). Obesity and mortality among patients diagnosed with COVID-19: results from an integrated health care organization. Annals of internal medicine.

Changes in Physical Activity and Mental Health during COVID-19 [COVID-19 and Physical Activity Series]

Perceived change in physical activity levels and mental health during COVID-19 By Dr. Duncan and co-authors is a cross-sectional study of 909 adult twin pairs.  Data was collected between March 26 and April 5, 2020 using a survey examining the impact of COVID-19 mitigation strategies on health behaviors and health outcomes.  Specifically, the exposure was perceived change in physical activity levels and the outcome was perceived anxiety and stress levels.  Previous studies have shown impacts of COVID-19 mitigation strategies on psychological symptoms (e.g., depression, anxiety, stress) and physical activity levels.  Dr. Duncan and co-authors found that more twin pairs reported a decrease in physical activity levels (42%) than those reporting no change (31%) or increased physical activity levels (27%).  They attributed a decrease in physical activity levels to a lack of time (e.g., balancing work at home with child care) or a lack of resources (e.g., equipment at home, living in neighborhoods that do not support being physically active).  Dr. Duncan and co-authors also found that a perceived decrease in physical activity levels was associated with higher stress and anxiety levels.  Interestingly, respondents who reported an increase in their physical activity levels also reported higher levels of stress and anxiety.  The physical activity-stress relationship was confounded by genetic and shared environmental factors, while the physical activity-anxiety relationship was confounded by age and sex.  Physical distancing...may have an impact on individuals’ daily activities and mental health, specifically with slightly higher levels of stress and anxiety among those who experienced a decreased amount of physical activity.  Dr. Duncan and co-authors call for longitudinal studies to better understand the long-term impact of COVID-19 mitigation strategies on health behaviors and outcomes and to examine whether physical activity and mental health levels return to pre-COVID-19 levels.

Duncan, G. E., Avery, A. R., Seto, E., & Tsang, S. (2020). Perceived change in physical activity levels and mental health during COVID-19: Findings among adult twin pairs. PloS one, 15(8), e0237695.

Obesity and COVID-19 from Risk to Mortality [COVID-19 and Physical Activity Series]

Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships by Dr. Popkin and co-authors examined the relationship of individuals with obesity and COVID-19 over the full spectrum from risk to mortality.  A systematic review and meta-analysis was conducted of data from 399,461 diagnosed patients in 75 studies from January-June 2020, including five case–control studies, 33 retrospective or prospective cohort studies, and 37 observational cross-sectional studies.  Dr. Popkin and co-authors show with pooled analysis that individuals with obesity are at 46% higher (OR = 1.46; 95% CI, 1.30–1.65,  p < 0.0001) risk for COVID-19 positive, 113% higher (OR = 2.13; 95% CI, 1.74–2.60, p < 0.0001) risk for hospitalization, 74% higher (OR = 1.74; 95% CI, 1.46–2.08, p < 0.0001) risk for ICU admission, and 48% higher risk for mortality (OR = 1.48; 95% CI, 1.22–1.80, p < 0.001).  Dr. Popkin and co-authors concluded that individuals with overweight and obesity face a greater risk of severe consequences from COVID-19, including hospitalization, intensive clinical care requirements and death. They also found that individuals with obesity are likely to face reductions in the effectiveness of vaccines developed to address COVID-19 due to a weakened immune response.  This is particularly relevant In a world where almost all countries have a prevalence of individuals with overweight and obesity greater than 20%, and no country has experienced a reduction in the prevalence of individuals with overweight and obesity.  The high prevalence of individuals with obesity exacerbates the threat to everyone's health, and the economic, social distancing and stay-at-home components compound the impacts [through their effects on dietary and physical activity patterns].    

Popkin, B. M., Du, S., Green, W. D., Beck, M. A., Algaith, T., Herbst, C. H., ... & Shekar, M. (2020). Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships. Obesity Reviews.

Step #6 Toward Being Trusted Facilities Where Physicians Refer Their Patients [Connecting Health Clubs to Healthcare Series]

Physically active physicians serve as role models for their patients.  In a study conducted at the Harvard School of Public Health between May 2019 and February 2020, physicians mention how their own personal familiarity with a health & fitness center makes them more credible with their patients, and influences their likelihood of referral. Increase physicians’ personal familiarity with your facility. 

Step #6 of a 10-step roadmap for health & fitness centers toward being trusted facilities where physicians refer their patients is:

Invite physicians to spend time in the club to increase their personal familiarity with programs and equipment.  

It is helpful if you have actually been into the club and you know where the machines are.  I can talk to them about, yeah go upstairs and go into that group of machines and it is the third machine.  So patients like that, that you are familiar with it.  Physician

Bantham, A. (2020). Perspectives on Exercise Prescriptions/Referrals and Patient Exercise Behavior Change: A Mixed Methods Study of Physicians and Exercise Professionals (Doctoral dissertation).

Metabolic Syndrome and COVID-19 Mortality [COVID-19 and Physical Activity Series]

Metabolic Syndrome and COVID-19 Mortality Among Adult Black Patients in New Orleans by Dr. Xie and co-authors is a retrospective, observational study of hospitalized patients.  Data was collected between March 30 and April 5, 2020 at two tertiary, academic hospitals in New Orleans, an early epicenter with the highest death rate per capita in the U.S. (37.93 per 100,000 people) at that time.  Metabolic syndrome is a chronic low-grade inflammatory state and is diagnosed if three or more of the following five metabolic comorbidities exist: obesity, hypertension, prediabetes/diabetes, high triglycerides, and reduced HDL levels.  Dr. Xie and co-authors examined the association between obesity, hypertension and diabetes—individually and clustered as metabolic syndrome—and COVID-19 outcomes.  They found that metabolic syndrome was associated with 3.42 increased odds of hospital mortality (CI 1.52–7.69), 4.59 increased odds of intensive care unit requirement (CI 2.53–8.32), 4.71 increased odds of invasive mechanical ventilation (CI 2.50–8.87), and 4.70 increased odds of acute respiratory distress syndrome (CI 2.25–9.82) when compared with non-metabolic syndrome.  In contrast to comorbidities clustered as metabolic syndrome, in separate subgroup multivariable analyses, obesity, hypertension and diabetes individually showed no association with hospital mortality.  However, obesity was associated with increased odds of intensive care unit requirement (adjusted odds ratio [aOR] 2.18 [95% CI 1.25–3.81]), acute respiratory distress syndrome (aOR 2.44 [95% CI 1.28–4.65]), and invasive mechanical ventilation (aOR 2.36 [95% CI 1.33–4.21]).  Dr. Xie and co-authors concluded that patients with metabolic syndrome exhibited almost four times greater odds of fatal COVID-19 outcomes compared with those without metabolic syndrome.  These findings suggest that metabolic syndrome (obesity, hypertension, diabetes) is a composite predictor of COVID-19 lethal outcome, increasing the odds of mortality by the combined effects of its individual components. 

Xie, J., Zu, Y., Alkhatib, A., Pham, T. T., Gill, F., Jang, A., ... & Bojanowski, C. M. Metabolic Syndrome and COVID-19 Mortality Among Adult Black Patients in New Orleans. Diabetes care, dc201714.

Outdoor Physical Activity During COVID-19 [COVID-19 and Physical Activity Series]

Social Distancing and Outdoor Physical Activity During the COVID-19 Outbreak in South Korea by Dr. Park and co-authors is a cross-sectional analysis of a public bicycle sharing system.  A difference-in-differences approach was used to analyze a public dataset of two groups (COVID-19 non exposure and exposure) at two different points in time (January-March 2019 and January-March 2020).  During the COVID-19 outbreak, strict social distancing was imposed in Seoul beginning March 22nd, including staying at least 6 feet away from others, avoiding crowds, not using public transportation, and following work and quarantine restrictions.  This led to a significant shift in transport behavior.  Dr. Park and co-authors found that the average daily usage of a public bike sharing system in 2020 doubled over that of 2019 (30,697 vs 77,996, P < .001).  They also found that commuter, weekend users, and new subscribers increased significantly.  Social distancing during the COVID-19 outbreak increased outdoor physical activity, specifically public bike sharing system usage.  Meaningful outdoor physical activity during the COVID-19 pandemic can be safe from infection and psychologically stabilized as long as keeping meticulous physical distancing, such as hand hygiene, wearing facial masks, and surface cleaning of public resources. 

Park, S., Kim, B., & Lee, J. (2020). Social Distancing and Outdoor Physical Activity During the COVID-19 Outbreak in South Korea: Implications for Physical Distancing Strategies. Asia-Pacific journal of public health.

Depression, Anxiety and Stress During COVID-19 [COVID-19 and Physical Activity Series]

Depression, Anxiety and Stress During COVID-19 by Dr. Stanton and co-authors is an online survey of 1,491 Australian adults.  Data was collected in April 2020, after the March 2020 enactment of physical distancing restrictions, including the closure of usual places to be physically active such as health & fitness centers and outdoor recreation facilities. Previous studies have demonstrated strong positive associations between physical activity and lower psychological distress, indicating that beginning or continuing physical activity during the pandemic could aid in reducing psychological distress.  Psychological distress was assessed using the Depression, Anxiety and Stress Scale (DASS 21) and physical activity was assessed using the Active Australia Survey (AAS).  Dr. Stanton and co-authors found negative changes reported for physical activity (48.9%), sleep (40.7%), alcohol (26.6%) and smoking (6.9%) since the onset of the COVID-19 pandemic.  They also found that negative changes in physical activity, sleep, smoking and alcohol intake were associated with higher depression, anxiety and stress symptoms.  Specifically, participants who reported a negative change in physical activity were more likely to have higher depression (adjusted OR = 1.08, 95% CI = 1.06, 1.11), anxiety (adjusted OR = 1.09, 95% CI = 1.05, 1.13), and stress (adjusted OR = 1.08, 95% CI=1.05, 1.11) symptoms.  Health-promotion strategies directed at adopting or maintaining positive health-related behaviors should be utilized to address increases in psychological distress during the pandemic. 

Stanton, R., To, Q. G., Khalesi, S., Williams, S. L., Alley, S. J., Thwaite, T. L., ... & Vandelanotte, C. (2020). Depression, Anxiety and Stress during COVID-19: Associations with Changes in Physical Activity, Sleep, Tobacco and Alcohol Use in Australian Adults. International Journal of Environmental Research and Public Health, 17(11), 4065.

Step #5 Toward Being Trusted Facilities Where Physicians Refer Their Patients [Connecting Health Clubs to Healthcare Series]

Based on the results of a research study conducted at the Harvard School of Public Health between May 2019 and February 2020, 28% of physicians surveyed responded “I don’t know” when asked to what extent their patients adhere to the written exercise prescriptions/referrals that they make. 

Patients play a very important role in building trust between their physicians and health & fitness centers. Recognize and leverage that role, encouraging members to report back on their progress. Members acting as ambassadors to their physicians encourages referrals of other patients, so that your facility and exercise professionals become their “go to.” 

Step #5 of a 10-step roadmap for health & fitness centers toward being trusted facilities where physicians refer their patients is:

Encourage members to be patient ambassadors, reporting back to their physicians on their progress, outcomes and experience.

So if they had a good experience, they go back and talk to the physicians, and say, this is a great program, I felt so comforted, I knew exactly what I was doing, I made progress. Then their physicians are more likely to send to us.  Exercise Professional

Bantham, A. (2020). Perspectives on Exercise Prescriptions/Referrals and Patient Exercise Behavior Change: A Mixed Methods Study of Physicians and Exercise Professionals (Doctoral dissertation).