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      Physical Activity During Lockdowns Associated with the COVID-19 Pandemic: A Systematic Review and Multilevel Meta-analysis of 173 Studies with 320,636 Participants


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          Many countries have restricted public life in order to contain the spread of the novel coronavirus (SARS-CoV2). As a side effect of related measures, physical activity (PA) levels may have decreased.


          We aimed (1) to quantify changes in PA and (2) to identify variables potentially predicting PA reductions.


          A systematic review with random-effects multilevel meta-analysis was performed, pooling the standardized mean differences in PA measures before and during public life restrictions.


          A total of 173 trials with moderate methodological quality (modified Downs and Black checklist) were identified. Compared to pre-pandemic, total PA (SMD − 0.65, 95% CI − 1.10 to − 0.21) and walking (SMD − 0.52, 95% CI − 0.29 to − 0.76) decreased while sedentary behavior increased (SMD 0.91, 95% CI: 0.17 to 1.65). Reductions in PA affected all intensities (light: SMD − 0.35, 95% CI − 0.09 to − 0.61, p = .013; moderate: SMD − 0.33, 95% CI − 0.02 to − 0.6; vigorous: SMD − 0.33, − 0.08 to − 0.58, 95% CI − 0.08 to − 0.58) to a similar degree. Moderator analyses revealed no influence of variables such as sex, age, body mass index, or health status. However, the only continent without a PA reduction was Australia and cross-sectional trials yielded higher effect sizes ( p < .05).


          Public life restrictions associated with the COVID-19 pandemic resulted in moderate reductions in PA levels and large increases in sedentary behavior. Health professionals and policy makers should therefore join forces to develop strategies counteracting the adverse effects of inactivity.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s40798-022-00515-x.

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          Most cited references42

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          Statistical Power Analysis for the Behavioral Sciences

          <i>Statistical Power Analysis</i> is a nontechnical guide to power analysis in research planning that provides users of applied statistics with the tools they need for more effective analysis. The Second Edition includes: <br> * a chapter covering power analysis in set correlation and multivariate methods;<br> * a chapter considering effect size, psychometric reliability, and the efficacy of "qualifying" dependent variables and;<br> * expanded power and sample size tables for multiple regression/correlation.<br>
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            World Health Organization 2020 guidelines on physical activity and sedentary behaviour

            Objectives To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. Methods The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. Results The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150–300 min of moderate-intensity, or 75–150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. Conclusion These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018–2030 and to strengthen surveillance systems that track progress towards national and global targets.
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              Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy.

              Strong evidence shows that physical inactivity increases the risk of many adverse health conditions, including major non-communicable diseases such as coronary heart disease, type 2 diabetes, and breast and colon cancers, and shortens life expectancy. Because much of the world's population is inactive, this link presents a major public health issue. We aimed to quantify the eff ect of physical inactivity on these major non-communicable diseases by estimating how much disease could be averted if inactive people were to become active and to estimate gain in life expectancy at the population level. For our analysis of burden of disease, we calculated population attributable fractions (PAFs) associated with physical inactivity using conservative assumptions for each of the major non-communicable diseases, by country, to estimate how much disease could be averted if physical inactivity were eliminated. We used life-table analysis to estimate gains in life expectancy of the population. Worldwide, we estimate that physical inactivity causes 6% (ranging from 3·2% in southeast Asia to 7·8% in the eastern Mediterranean region) of the burden of disease from coronary heart disease, 7% (3·9-9·6) of type 2 diabetes, 10% (5·6-14·1) of breast cancer, and 10% (5·7-13·8) of colon cancer. Inactivity causes 9% (range 5·1-12·5) of premature mortality, or more than 5·3 million of the 57 million deaths that occurred worldwide in 2008. If inactivity were not eliminated, but decreased instead by 10% or 25%, more than 533 000 and more than 1·3 million deaths, respectively, could be averted every year. We estimated that elimination of physical inactivity would increase the life expectancy of the world's population by 0·68 (range 0·41-0·95) years. Physical inactivity has a major health eff ect worldwide. Decrease in or removal of this unhealthy behaviour could improve health substantially. None.

                Author and article information

                Sports Med Open
                Sports Med Open
                Sports Medicine - Open
                Springer International Publishing (Cham )
                11 October 2022
                11 October 2022
                December 2022
                : 8
                : 125
                [1 ]GRID grid.7839.5, ISNI 0000 0004 1936 9721, Institute of Occupational, Social and Environmental Medicine, , Goethe University Frankfurt, ; Frankfurt/Main, Germany
                [2 ]GRID grid.449681.6, ISNI 0000 0001 2111 1904, Department of Sports Science, Institute of Health, Nutrition and Sports Science, , Europa-Universität Flensburg, ; Flensburg, Germany
                [3 ]GRID grid.412268.b, ISNI 0000 0001 0298 4494, Masters and Doctoral Programs in Physical Therapy, , Universidade Cidade de São Paulo (UNICID), ; São Paulo, Brazil
                [4 ]GRID grid.509540.d, ISNI 0000 0004 6880 3010, Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, , Amsterdam University Medical Centers – Vrije Universiteit Amsterdam, ; Amsterdam, The Netherlands
                [5 ]GRID grid.27593.3a, ISNI 0000 0001 2244 5164, Institute of Biomechanics and Orthopaedics, , German Sport University Cologne, ; Cologne, Germany
                [6 ]GRID grid.440974.a, ISNI 0000 0001 2234 6983, Department of Mechanical and Process Engineering, , Offenburg University of Applied Sciences, ; Offenburg, Germany
                [7 ]GRID grid.413815.a, ISNI 0000 0004 0469 9373, Department of Sport and Exercise Medicine, , Changi General Hospital, ; Singapore, Singapore
                [8 ]GRID grid.461732.5, Institute of Interdisciplinary Exercise Science and Sports Medicine, , MSH Medical School Hamburg, ; Am Kaiserkai 1, 20457 Hamburg, Germany
                [9 ]GRID grid.412114.3, ISNI 0000 0000 9360 9165, Department of Basic Medical Sciences, , Durban University of Technology, ; Durban, South Africa
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                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                : 21 April 2022
                : 2 September 2022
                Funded by: MSH Medical School Hamburg - University of Applied Sciences and Medical University (5121)
                Systematic Review
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                coronavirus,confinements,inactivity,sedentary behavior,public life restrictions


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