Outlook: Newsletter of the Society of Behavorial Medicine

Fall 2020

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Physical Activity Interventions During the COVID-19 Pandemic: Ethos of a Problem.

Yves Paul Mbous, MEng✉ and Rowida Mohamed, MSc✉; Health Decision Making SIG


The heightened emphasis on physical activity (PA) promotion stems from the vast array of advantages it confers but also from the  burden of physical inactivity. Recent evidence among PA benefits include: improved bone health, better cardiovascular health, increased cognitive functioning, decreased cancer, diabetes, anxiety and depression risks, reduced risk of mortality, and better quality of life.1 Weekly minimums of 150 minutes of moderate PA or 75 minutes of vigorous PA are necessary to achieve these benefits. Conversely, in the United States, physical inactivity increases mortality and additionally warrants healthcare spending worth at least $117 billion.2, 3 Herein lies the utility of evidence-based interventions. For when products of research are used effectively in communities, they can bring forth changes in intention and behavior necessary to engage and adhere to regular exercise.4 However, research endeavors in this field have been radically upended since the outset of the COVID-19 pandemic. The enforcement of social distancing measures has inadvertently favored auspicious conditions for sedentary behavior and physical inactivity. Ironically, the growing incidence of mental health conditions5 during this phase has warranted renewed calls for research to provide appropriate evidence guidelines for effective community-based PA interventions.6

Researchers are faced with many problems that hamper the conduct of objective work. The nature of these issues is mostly tied to participants’ recruitment, study design, logistics, and general attitudes. Typically, recruitment takes place at public avenues such as hospitals, primary care clinics, workplaces, churches, barbershops, health clubs and via door-to-door visits. Since the shutdown, most of these avenues have been intermittently closed as a result of enforcement measures and reluctance of people to engage with the outside world where they could be at risk of infection. Although coming in contact with potential participants is still possible via the Internet or mail, initiating contact via the former is not always guaranteed in rural areas or other regions of restricted access. Study design is impeded through the mechanisms of the intervention. Researchers must now frame exercise types, plans and regimens adapted to indoor spaces but that also meet the recommended duration and intensity. Parallelly, there is also a shortage of adequate measurement tools. Accelerometers and pedometers, already limited in the information they can provide (accuracy and reliability)7, 8, use sensors that best record ambulatory exercise. In limited spaces, objective measurement of “sedentary” PA is not always feasible; the same can be said about compliance and adherence patterns. Subjective measures carry an even greater unreliability as they rely on the appreciation of the participants and their proclaimed compliance to the program. Further, it is also easy to notice how logistics (indoor space, Internet access, equipment) would render home-based interventions less appealing for communities of low economic status. Avoidance of social interactions as well as different priorities (job search amidst increasing furlough) could lessen the incentive to partake in PA research intervention especially for high-risk groups and vulnerable populations with limited resources.

These are some of the issues that need to be addressed to strengthen PA research. Recent works are making use of cell phone applications (GoToMeeting platform) to guide interventions.9 However, the objective remains to conceptualize research that would subsequently lead to adequate behavior uptake during this pandemic. Vulnerable populations seem more at risk: an invitation for policymakers to act where they are most needed. To ensure equitable access to physical activity opportunities, the American College of Sports Medicine, among other researchers, has proposed to improve access to public parks and green spaces and to create built environments in close proximity to all but primarily vulnerable populations.10, 11 This call for action is directed to policymakers, stakeholders, and researchers to actively evaluate and implement policies pertaining to these recommendations.

 

References

  1. Piercy, K. L., Troiano, R. P., Ballard, R. M., Carlson, S. A., Fulton, J. E., Galuska, D. A., … Olson, R. D. (2018). The physical activity guidelines for Americans. JAMA - Journal of the American Medical Association. doi:10.1001/jama.2018.14854
  2. Carlson, S. A., Adams, E. K., Yang, Z., & Fulton, J. E. (2018). Percentage of Deaths Associated With Inadequate Physical Activity in the United States. Preventing chronic disease. doi:10.5888/pcd18.170354
  3. Carlson, S. A., Fulton, J. E., Pratt, M., Yang, Z., & Adams, E. K. (2015). Inadequate Physical Activity and Health Care Expenditures in the United States. Progress in Cardiovascular Diseases. doi:10.1016/j.pcad.2014.08.002
  4. Brownson, R. C., Ballew, P., Dieffenderfer, B., Haire-Joshu, D., Heath, G. W., Kreuter, M. W., & Myers, B. A. (2007). Evidence-Based Interventions to Promote Physical Activity. What Contributes to Dissemination by State Health Departments. American Journal of Preventive Medicine. doi:10.1016/j.amepre.2007.03.011
  5.  Rajkumar, R. P. (2020). COVID-19 and mental health: A review of the existing literature. Asian Journal of Psychiatry. doi:10.1016/j.ajp.2020.102066
  6. Sallis, J. F., Adlakha, D., Oyeyemi, A., & Salvo, D. (2020). An international physical activity and public health research agenda to inform coronavirus disease-2019 policies and practices. Journal of Sport and Health Science. doi:10.1016/j.jshs.2020.05.005
  7. Goode, A. P., Hall, K. S., Batch, B. C., Huffman, K. M., Hastings, S. N., Allen, K. D., … Gierisch, J. M. (2017). The Impact of Interventions that Integrate Accelerometers on Physical Activity and Weight Loss: A Systematic Review. Annals of Behavioral Medicine. doi:10.1007/s12160-016-9829-1
  8. Aparicio-Ugarriza, R., Mielgo-Ayuso, J., Benito, P. J., Pedrero-Chamizo, R., Ara, I., & González-Gross, M. (2015). Physical activity assessment in the general population; instrumental methods and new technologies. Nutricion hospitalaria. doi:10.3305/nh.2015.31.sup3.8769
  9. Thombs, B. D., Kwakkenbos, L., Carrier, M. E., Bourgeault, A., Tao, L., Harb, S., … Varga, J. (2020). Protocol for a partially nested randomised controlled trial to evaluate the effectiveness of the scleroderma patient-centered intervention network COVID-19 home-isolation activities together (SPIN-CHAT) program to reduce anxiety among at-risk scleroderma patients. Journal of Psychosomatic Research. doi:10.1016/j.jpsychores.2020.110132
  10. Rebecca Hasson PD. F, Jim Sallis PD. F, Nailah Coleman MD. F, Navin Kaushal PD., Vincenzo Nocera MS., NiCole Keith PD. F. The missing mandate: Promoting physical activity to reduce disparities during COVID-19 and beyond. American College of Sports Medicine Blog. https://www.acsm.org/blog-detail/acsm-blog/2020/06/03/promoting-physical-activity-reduce-disparities-during-covid-19. Published June 30, 2020. Accessed September 19, 2020.
  11. Slater SJ, Christiana RW, Gustat J. Recommendations for keeping parks and green space accessible for mental and physical health during COVID-19 and other pandemics. Prev Chronic Dis. 2020;17(17). doi:10.5888/PCD17.200204