Staying Active in a Pandemic: The Relationships Between Physical Activity and Mitigation Policies and Behaviors, and COVID-19 Severity

Abstract

Background: Despite the health benefits associated with moderate-to-vigorous physical activity (MVPA), physical inactivity continues to be a significant public health problem in the United States. Physical inactivity contributes to the development and exacerbation of many chronic health conditions increasing morbidity and mortality. Personal, social, and environmental factors are associated with increasing the frequency at which individuals perform physical activities. Access to facilities, equipment, and spaces is essential. The COVID-19 pandemic led to significant barriers to this access. To limit the spread of the infection throughout communities, state and local governments enacted policies to restrict individuals access to non-essential businesses and congregations, including recreational facilities. Meanwhile, past literature has indicated that MVPA may act as a mediator of acute respiratory infection severity. As the infection continues to persist in communities, regular engagement in MVPA could act as an additional measure to reducing the severity of the illness alongside the current pharmaceutical interventions. The overall aim of the research of this dissertation is to examine the direct and indirect impacts of the COVID-19 pandemic on MVPA engagement, and the potential protective effect of MVPA on COVID-19 illness severity among participants of the Arizona CoVHORT, a prospective cohort of Arizona residents. Aims Aim 1. Examine changes from pre-pandemic moderate-to vigorous intensity physical activity among CoVHORT participants during the pandemic and after pandemic-associated restrictions on non-essential businesses were lifted in Arizona. Aim 2. Identify barriers and facilitators to engaging in physical activity during the first year of the SARS-CoV-2 pandemic in Arizona. Aim 3. Determine the contribution of level of pre-infection MVPA to acute-COVID-19 illness severity. Methods: Aim 1. We examined how average weekly MVPA changed from prior the pandemic to during the first year of the pandemic and after pandemic-associated restrictions on non-essential businesses had been rescinded in Arizona among individuals without a history of SARS-CoV-2 infection. We utilized Wilcoxon Sign-Rank tests and t-tests to examine changes in weekly MVPA between each period for inactive and active participants, respectively. Aim 2. We developed a supplemental physical activity survey composed of open-ended questions and invited Arizona CoVHORT participants who did not report a history of SARS-CoV-2 infection before March 25, 2021, and provided weekly MVPA estimates corresponding to before the pandemic (before March 2020) and during the first year of the pandemic in Arizona (between March 2020 and March 2021). An inductive thematic analysis was conducted to identify barriers and facilitators to engaging in physical activity during the first year of the pandemic. Aim 3. We utilized data from Arizona CoVHORT participants who were 18 years of age and older, reported a SARS-CoV-2 infection, and had non-missing weekly MVPA estimates corresponding to before their infection. Ordinal regression models were used to examine the associations of asymptomatic, mild, and moderate and greater COVID-19 with prior weekly MVPA along with other risk factors for COVID-19 severity identified a priori. Results Aim 1. We observed a significant difference between weekly MVPA frequencies prior to the pandemic, during the first year of the pandemic, and after restrictions on non-essential businesses were lifted in Arizona, particularly among participants who engaged in any MVPA prior to the pandemic. Among participants who were inactive prior to the pandemic, we only observed a significant difference between weekly MVPA prior to the pandemic and during the first year. Aim 2. We identified many common barriers and facilitators to engaging in physical activity during the first year of the pandemic. Common barriers included problems in access to recreational facilities, alternative equipment and safe areas, fear of infection, and declines in motivation. Common facilitators identified included access to alternative equipment, facilities and safe areas to be active, social support, a desire to maintain physical health and fitness, a desire to maintain or establish a routine during the pandemic, and an increase in work flexibility. Aim 3. We observed null associations between severity of illness and MVPA. For every 75 minutes of MVPA performed a week, participants had 1.05 (95% CI=0.98-1.12) times the odds of experiencing a mild or moderate or greater COVID-19 illness compared to an asymptomatic illness. When evaluated dichotomously, participants who met or exceeded the 150 minutes/week of MVPA recommendation had 1.13 (95% CI=0.77-1.65) times of the odds of experiencing a mild or moderate or greater COVID-19 illness compared to participants performed less than 150 minutes/week. Discussion Aim 1. Individuals’ physical activity behaviors were significantly impacted during the first year of the pandemic and continued to be impacted even after restrictions on access were lifted. Follow-up studies should be conducted to further identify barriers to physical activity that could be addressed and mitigated during the next pandemic. Aim 2. Despite the many logistical barriers that led to decreasing physical activity, such as reduced gym access, changes in work policies provided more flexibility which facilitated some to have more time. Individual psychosocial factors such as a perceived mental and physical health benefit of activity motivated individuals more significantly to maintain or pursue more physical activity. Aim 3. Among our study sample of mostly less severe COVID-19 illnesses, we did not observe any meaningful associations between MVPA and illness severity, suggesting that MVPA may have little to no effect on the severity of the illness in cases with symptoms that do not require medical intervention. To support these results, analyses should be conducted to examine the relationships between MVPA and indices of severity among non-hospitalized COVID-19 patients. The results of this research characterize, and provide context for, the changes in physical activity behavior as a result of the COVID-19 pandemic, as well examine the impact that physical activity has on the illness itself, and further highlight the wide-ranging impacts that the pandemic has had on individuals’ wellbeing aside from the direct health impacts of the infection.