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Differential Effects of the COVID-19 Pandemic on Physical Activity Involvements and Exercise Habits in People With and Without Chronic Diseases: A Systematic Review and Meta-analysis

Published:April 09, 2022DOI:https://doi.org/10.1016/j.apmr.2022.03.011

      Abstract

      Objective

      To conduct a systematic review and meta-analysis to summarize evidence regarding differential changes in physical activity (PA) involvements and exercise habits in people with and without chronic diseases during the COVID-19 outbreak.

      Data Sources

      MEDLINE, Embase, SPORTDiscus, Cumulative Index to Nursing and Allied Health, PsycINFO, Cochrane Library, and Physiotherapy Evidence Database were searched from November 2019 to May 2021.

      Study Selection

      Two reviewers independently screened cross-sectional and longitudinal studies that investigated changes in PA-related outcomes in people with and without chronic diseases during the pandemic.

      Data Extraction

      PA-related outcomes and sedentary time were extracted from the included studies. Relevant risk of bias were assessed. Meta-analyses were conducted for each PA-related outcome, if applicable. Quality of evidence of each PA-related outcome was evaluated by Grading of Recommendations Assessment, Development, and Evaluation.

      Data Synthesis

      Of 1226 identified citations, 36 articles (28 with and 8 without chronic diseases) with 800,256 participants were included. Moderate evidence from wearable sensors supported a significant reduction in pooled estimates of step count (standardized mean differences [SMD]=−2.79, P<.01). Very limited to limited evidence substantiated significant decreases in self-reported PA-related outcomes and significant increases in sedentary behaviors among people with and without chronic diseases. Specifically, pooled estimates of metabolic equivalent-minute per week (SMD=−0.16, P=.02) and PA duration (SMD=−0.07, P<.01) were significantly decreased, while sedentary time (SMD=0.09, P=.04) showed significant increases in the general population (small to large effects). Very limited evidence suggested no significant PA changes among people in a country without lockdown.

      Conclusions

      During the pandemic, objective and self-reported assessments showed significant reductions in PA in people with and without chronic diseases globally. This mainly occurred in countries with lockdowns. Although many countries have adopted the “live with the coronavirus” policy, authorities should implement population-based strategies to revert the potential lockdown-related long-term deleterious effects on people's health.

      Keywords

      List of abbreviations:

      IPAQ (International Physical Activity Questionnaire), MET (metabolic equivalent task), MVPA (moderate to vigorous physical activity), PA (physical activity), SMD (standardized mean difference), T2D (type 2 diabetes), WHO (World Health Organization)
      The COVID-19 pandemic posed a menacing threat to global public health. After the first COVID-19 case reported in Wuhan, China, in December 2019,
      • Umakanthan S
      • Sahu P
      • Ranade AV
      • et al.
      Origin, transmission, diagnosis and management of coronavirus disease 2019 (COVID-19).
      the disease has rapidly plagued the globe, inflicting unprecedented negative effects on the global socioeconomic and health care systems. As of September 2021, a total of 221 countries had been struck by COVID-19, resulting in more than 248 million infected cases and over 5 million deaths.

      World Health Organization. Weekly epidemiological update on COVID-19 - 7 September 2021. Available at: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19—7-september-2021. Accessed September 15, 2021.

      Countries with lower national income and suboptimal medical services are more vulnerable to the negative consequences of the COVID-19 pandemic, including changes in health behaviors such as physical activity (PA) participation.
      • Bashir MF
      • Ma B
      • Shahzad L.
      A brief review of socio-economic and environmental impact of COVID-19.
      Given the escalating number of confirmed COVID-19 cases and overburdened health care systems, the World Health Organization (WHO) declared the COVID-19 outbreak as a pandemic.

      World Health Organization. Weekly epidemiological update on COVID-19 - 7 September 2021. Available at: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19—7-september-2021. Accessed September 15, 2021.

      Most governments implemented stringent measures, including travel ban, nationwide quarantine, social distancing, and lockdowns to suppress the outbreak.

      World Health Organization. Weekly epidemiological update on COVID-19 - 7 September 2021. Available at: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19—7-september-2021. Accessed September 15, 2021.

      Approximately 4 billion people were confined to their homes, while more than 90 countries or regions had imposed lockdowns by April 2020.

      Alasdair S. Coronavirus: half of humanity now on lockdown as 90 countries call for confinement. Available at:https://www.euronews.com/2020/04/02/coronavirus-in-europe-spain-s-death-toll-hits-10-000-after-record-950-new-deaths-in-24-hou. December 7, 2021.

      Prolonged lockdowns have a negative effect on people's physical, psychological, and social health.
      • Al Fagih A
      • Al Onazi M
      • Al Basiri S
      • et al.
      Remotely monitored inactivity due to COVID-19 lockdowns potential hazard or heart failure patients.
      • Ammar A
      • Trabelsi K
      • Brach M
      • et al.
      Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insights from the ECLB-COVID19 multicentre study.
      • Arturo Hall-López J
      Physical activity levels in physical education teachers before and during school suspension brought by the COVID-19 quarantine.
      • Barrea L
      • Pugliese G
      • Framondi L
      • et al.
      Does SARS-CoV-2 threaten our dreams? Effect of quarantine on sleep quality and body mass index.
      • Chague F
      • Boulin M
      • Eicher JC
      • et al.
      Impact of lockdown on patients with congestive heart failure during the coronavirus disease 2019 pandemic.
      • Cooper JA
      • vanDellen M
      • Bhutani S
      Self-weighing practices and associated health behaviors during COVID-19.
      • Deng CH
      • Wang JQ
      • Zhu LM
      • et al.
      Association of web-based physical education with mental health of college students in Wuhan during the COVID-19 outbreak: cross-sectional survey study.
      • Di Renzo L
      • Gualtieri P
      • Pivari F
      • et al.
      Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey.
      • Di Sebastiano KM
      • Chulak-Bozzer T
      • Vanderloo LM
      • Faulkner G.
      Don't walk so close to me: physical distancing and adult physical activity in Canada.
      • Đogaš Z
      • Lušić Kalcina L
      • Pavlinac Dodig I
      • et al.
      The effect of COVID-19 lockdown on lifestyle and mood in Croatian general population: a cross-sectional study.
      • Duncan GE
      • Avery AR
      • Seto E
      • Tsang S.
      Perceived change in physical activity levels and mental health during COVID-19: findings among adult twin pairs.
      • Dunton GF
      • Do B
      • Wang SD.
      Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S.
      • Gallè F
      • Sabella EA
      • Da Molin G
      • et al.
      Understanding knowledge and behaviors related to COVID-19 epidemic in Italian undergraduate students: the EPICO Study.
      • Hu Z
      • Lin X
      • Chiwanda Kaminga A
      • Xu H
      Impact of the COVID-19 epidemic on lifestyle behaviors and their association with subjective well-being among the general population in mainland China: cross-sectional study.
      • Jia P
      • Zhang L
      • Yu W
      • et al.
      Impact of COVID-19 lockdown on activity patterns and weight status among youths in China: the COVID-19 Impact on Lifestyle Change Survey (COINLICS).
      • Keel PK
      • Gomez MM
      • Harris L
      • Kennedy GA
      • Ribeiro J
      • Joiner TE.
      Gaining “the quarantine 15:” perceived versus observed weight changes in college students in the wake of COVID-19.
      • Lehtisalo J
      • Palmer K
      • Mangialasche F
      • Solomon A
      • Kivipelto M
      • Ngandu T.
      Changes in lifestyle, behaviors, and risk factors for cognitive impairment in older persons during the first wave of the coronavirus disease 2019 pandemic in Finland: results from the FINGER Study.
      • Lesser IA
      • Nienhuis CP.
      The impact of COVID-19 on physical activity behavior and well-being of Canadians.
      • Minsky NC
      • Pachter D
      • Zacay G
      • et al.
      Managing obesity in lockdown: survey of health behaviors and telemedicine.
      • Orlandi M
      • Rosselli M
      • Pellegrino A
      • et al.
      Gender differences in the impact on physical activity and lifestyle in Italy during the lockdown, due to the pandemic.
      • Paltrinieri S
      • Bressi B
      • Costi S
      • et al.
      Beyond lockdown: the potential side effects of the SARS-CoV-2 pandemic on public health.
      • Pépin JL
      • Bruno RM
      • Yang RY
      • et al.
      Wearable activity trackers for monitoring adherence to home confinement during the COVID-19 pandemic worldwide: data aggregation and analysis.
      • Persiani P
      • De Meo D
      • Giannini E
      • et al.
      The aftermath of COVID-19 lockdown on daily life activities in orthopaedic patients.
      • Rodríguez-Nogueira Ó
      • Leirós-Rodríguez R
      • Benítez-Andrades JA
      • Álvarez-álvarez MJ
      • Marqués-Sánchez P
      • Pinto-Carral A.
      Musculoskeletal pain and teleworking in times of the COVID-19: analysis of the impact on the workers at two Spanish universities.
      • Rowlands AV
      • Henson JJ
      • Coull NA
      • et al.
      The impact of COVID-19 restrictions on accelerometer-assessed physical activity and sleep in individuals with type 2 diabetes.
      • Ruíz-Roso MB
      • de Carvalho Padilha P
      • Matilla-Escalante DC
      • et al.
      Changes of physical activity and ultra-processed food consumption in adolescents from different countries during COVID-19 pandemic: an observational study.
      • Sonza A
      • da Cunha de Sá-Caputo D
      • Sartorio A
      • et al.
      COVID-19 Lockdown and the behavior change on physical exercise, pain and psychological well-being: an international multicentric study.
      • Stanton R
      • To QG
      • Khalesi S
      • et al.
      Depression, anxiety and stress during COVID-19: associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults.
      • van Bakel BMA
      • Bakker EA
      • de Vries F
      • Thijssen DHJ
      • Eijsvogels TMH.
      Impact of COVID-19 lockdown on physical activity and sedentary behaviour in Dutch cardiovascular disease patients.
      • Vetrovsky T
      • Frybova T
      • Gant I
      • et al.
      The detrimental effect of COVID-19 nationwide quarantine on accelerometer-assessed physical activity of heart failure patients.
      • Wang Y
      • Zhang Y
      • Bennell K
      • et al.
      Physical distancing measures and walking activity in middle-aged and older residents in Changsha, China, during the COVID-19 epidemic period: longitudinal observational study.
      • Weaver RH
      • Jackson A
      • Lanigan J
      • et al.
      Health behaviors at the onset of the COVID-19 pandemic.
      • Yamada M
      • Kimura Y
      • Ishiyama D
      • et al.
      Effect of the COVID-19 epidemic on physical activity in community-dwelling older adults in Japan: a cross-sectional online survey.
      • Zhu Q
      • Li M
      • Ji Y
      • et al.
      "Stay-at-home" lifestyle effect on weight gain during the COVID-19 outbreak confinement in China.
      • Zorcec T
      • Jakovska T
      • Micevska V
      • Boskovska K
      • Cholakovska VC.
      Pandemic with COVID-19 and families with children with chronic respiratory diseases.
      Reduced PA or exercise participation, alongside increased sedentary behaviors, could compromise the physical and mental health of many individuals.
      • Biddle S.
      Physical activity and mental health: evidence is growing.
      ,

      Centers for Disease Control and Prevention. Lack of physical activity. Available at: https://www.cdc.gov/chronicdisease/resources/publications/factsheets/physical-activity.htm. Accessed May 1, 2021.

      The WHO recommends adults to perform 150-300 minutes of moderate intensity or 75-150 minutes of vigorous intensity aerobic PA every week.
      • Bull FC
      • Al-Ansari SS
      • Biddle S
      • et al.
      World Health organization 2020 guidelines on physical activity and sedentary behaviour.
      People with chronic diseases, who are recommended to do regular exercises to delay their disease progression,
      • Dempsey PC
      • Friedenreich CM
      • Leitzmann MF
      • et al.
      Global public health guidelines on physical activity and sedentary behavior for people living with chronic conditions: a call to action.
      ,
      • Rausch Osthoff AK
      • Niedermann K
      • Braun J
      • et al.
      2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis.
      may be more susceptible to the adverse effect of reduced PA. Reduced PA in these patients not only may affect their disease progression but also increases their risk of developing additional inactivity-related diseases. Regular moderate to vigorous PA (MVPA) can boost immunity against community-acquired infectious diseases and increase potency of vaccination. Although an earlier systematic review has summarized the preliminary effects of the COVID-19 pandemic lockdown on PA changes of the public,
      • Stockwell S
      • Trott M
      • Tully M
      • et al.
      Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review.
      it was limited by small representative samples and lack of assessments of evidence or meta-analyses regarding the effects of the pandemic on various PA-related outcomes among people with and without chronic diseases in countries with or without lockdowns. Because PA changes measured by wearable sensors may differ from those collected from self-reported PA questionnaires, comprehensive meta-analyses of various PA-related outcomes can better inform policy makers in developing tailored strategies to revert the adverse effects of physical inactivity in vulnerable subgroups during and after the pandemic. The current systematic review and meta-analysis addressed this gap to summarize the evidence regarding effects of the COVID-19 pandemic on PA-related outcomes in the people with and without chronic diseases who did not contract COVID-19.

      Methods

      The study protocol was registered on PROSPERO (CRD42021234936). The Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines
      • Page MJ
      • McKenzie JE
      • Bossuyt PM
      • et al.
      The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
      were adopted to report this review.

      Search strategy

      A systematic literature search was conducted on 7 databases (MEDLINE, EMBASE, SPORTDiscus, Cumulative Index to Nursing and Allied Health, PsycINFO, Cochrane Libraries, Physiotherapy Evidence Database) to identify articles published between November 1, 2019, and May 31, 2021, without any language restrictions. We searched these databases using a combination of 2 sets of keywords: [‘COVID’ OR ‘cov*’ OR ‘corona*’ OR ‘severe acute respiratory syndrome coronavirus 2’ OR ‘SARS*’] AND [‘physical activit*’ OR ‘activity level’ OR ‘exercise habit*’ OR ‘exercise routine*’ OR ‘lifestyle’] (appendix 1). Additional relevant articles were searched from the reference lists of the included studies. Forward citation tracking was conducted using Scopus. The corresponding authors of the included articles were contacted by emails to identify any additional relevant publications.

      Selection criteria

      Cross-sectional and longitudinal studies that investigated PA-related outcomes during the COVID-19 pandemic were included. Articles were excluded if the participants were actively or previously infected with COVID-19. Commentaries, letters to editors, reviews, conference proceedings, and qualitative studies were also excluded.

      Study selection

      All citations identified from database searches were exported to EndNote X9 (Clarivate).a After removing duplicates, 2 reviewers (K.Y.N., K.H.W.) independently screened the titles and abstracts following the selection criteria. They piloted on 100 abstracts to align discrepancy. They then independently screened the remaining references. Abstracts deemed relevant were included for full-text screening. The process was repeated for the full-text screening. Reviewers met to reach a consensus about the eligible articles. If disagreements persisted, a third reviewer (K.C.K.) arbitrated the disagreements. The interrater agreement was calculated using Cohen's κ.
      • Landis JR
      • Koch GG.
      The measurement of observer agreement for categorical data.

      Data extraction

      Two independent reviewers (K.Y.N., K.H.W.) used a standardized form to extract data related to authors, year of publication, study location, study design, data collection methods, response and attrition rate, participants’ demographics, definitions of PA and sedentary behaviors, changes in PA-related outcomes, and the corresponding statistics.

      Risk of bias assessments

      Two independent reviewers (K.Y.N., K.H.W.) used 2 separate tools to assess the quality of the included studies. Specifically, the methodological quality of cross-sectional studies was assessed by the 20-item Appraisal Tool for Cross-Sectional Studies.
      • Downes MJ
      • Brennan ML
      • Williams HC
      • Dean RS.
      Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS).
      The tool only provides descriptive assessments without numeric scores. It is flexible for researchers to use it based on their priorities. Therefore, we rearranged the items into 6 domains: objectives and design, study participation, handling of nonrespondents, outcome measures, statistical analysis, and reporting.
      • Wong CK
      • Mak RY
      • Kwok TS
      • et al.
      Prevalence, incidence, and factors associated with non-specific chronic low back pain in community-dwelling older adults aged 60 years and older: a systematic review and meta-analysis.
      Similar to our previous reviews,
      • Wong CK
      • Mak RY
      • Kwok TS
      • et al.
      Prevalence, incidence, and factors associated with non-specific chronic low back pain in community-dwelling older adults aged 60 years and older: a systematic review and meta-analysis.
      ,
      • Wong AYL
      • Chan LLY
      • Lo CWT
      • et al.
      Prevalence/incidence of low back pain and associated risk factors among nursing and medical students: a systematic review and meta-analysis.
      each domain was ranked as low, moderate, or high based on the criteria listed in appendix 2. The Quality in Prognosis Studies tool was used to assess the methodological quality of longitudinal studies.

      Cochrane Prognosis Methods Group. Review tools. Available at: https://methods.cochrane.org/prognosis/tools. Accessed December 7, 2021.

      ,
      • Hayden JA
      • Cote P
      • Bombardier C.
      Evaluation of the quality of prognosis studies in systematic reviews.
      The Quality in Prognosis Studies tool comprises 6 domains: study participation, study attrition, prognostic factor measurement, outcome measurement, study confounding, and statistical analysis and reporting.
      • Hayden JA
      • Cote P
      • Bombardier C.
      Evaluation of the quality of prognosis studies in systematic reviews.
      Each domain was rated as low, moderate, or high.
      • Hayden JA
      • Cote P
      • Bombardier C.
      Evaluation of the quality of prognosis studies in systematic reviews.
      From the quality of each domain, the overall methodological quality was graded as low, moderate, or high
      • Hayden JA
      • Cote P
      • Bombardier C.
      Evaluation of the quality of prognosis studies in systematic reviews.
      (see appendix 2).

      Data synthesis

      PA-related outcomes extracted from the included studies were categorized into 2 pairs of subgroups: (1) the people with and without chronic diseases and (2) countries with and without lockdown. If 2 or more included studies reported changes in a particular PA-related outcome during the pandemic in a given subgroup, the respective standardized mean differences (SMDs) were pooled for a meta-analysis using a random-effects model. All meta-analyses were performed using the Comprehensive Meta-analysis Version 3.3 software.b Statistical heterogeneity of the included studies was assessed by I² statistics and classified as low (I²<40%), moderate (I²=40%-59%), substantial (I²=60%-74%), and considerable (I²>75%) heterogeneity.
      The potential sources of heterogeneity of each meta-analysis were explained if substantial or considerable statistical heterogeneity was observed.

      Quality of evidence

      The quality of evidence of each PA-related outcome was rated by the Grading of Recommendations Assessment, Development, and Evaluation.
      • Huguet A
      • Hayden JA
      • Stinson J
      • et al.
      Judging the quality of evidence in reviews of prognostic factor research: adapting the GRADE framework.
      The Grading of Recommendations Assessment, Development, and Evaluation framework consists of 7 domains, 5 of which could downgrade the quality of evidence regarding the estimated effect size, while the other 2 domains could increase the confidence in the estimated effect size. The synthesized data was ranked as very limited, limited, moderate, or high quality of evidence regarding how the true effect lays close to the estimated effect (see appendix 2).
      • Schünemann HJ
      • Oxman AD
      • Brozek J
      • et al.
      Grading quality of evidence and strength of recommendations for diagnostic tests and strategies.

      Results

      The literature search identified 1226 publications, while 13 records were identified through other sources (fig 1). After removing 103 duplicates, 1136 studies were eligible for the title and abstract screening. Of the 95 screened full-text articles, 36 articles were included.
      • Al Fagih A
      • Al Onazi M
      • Al Basiri S
      • et al.
      Remotely monitored inactivity due to COVID-19 lockdowns potential hazard or heart failure patients.
      • Ammar A
      • Trabelsi K
      • Brach M
      • et al.
      Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insights from the ECLB-COVID19 multicentre study.
      • Arturo Hall-López J
      Physical activity levels in physical education teachers before and during school suspension brought by the COVID-19 quarantine.
      • Barrea L
      • Pugliese G
      • Framondi L
      • et al.
      Does SARS-CoV-2 threaten our dreams? Effect of quarantine on sleep quality and body mass index.
      • Chague F
      • Boulin M
      • Eicher JC
      • et al.
      Impact of lockdown on patients with congestive heart failure during the coronavirus disease 2019 pandemic.
      • Cooper JA
      • vanDellen M
      • Bhutani S
      Self-weighing practices and associated health behaviors during COVID-19.
      • Deng CH
      • Wang JQ
      • Zhu LM
      • et al.
      Association of web-based physical education with mental health of college students in Wuhan during the COVID-19 outbreak: cross-sectional survey study.
      • Di Renzo L
      • Gualtieri P
      • Pivari F
      • et al.
      Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey.
      • Di Sebastiano KM
      • Chulak-Bozzer T
      • Vanderloo LM
      • Faulkner G.
      Don't walk so close to me: physical distancing and adult physical activity in Canada.
      • Đogaš Z
      • Lušić Kalcina L
      • Pavlinac Dodig I
      • et al.
      The effect of COVID-19 lockdown on lifestyle and mood in Croatian general population: a cross-sectional study.
      • Duncan GE
      • Avery AR
      • Seto E
      • Tsang S.
      Perceived change in physical activity levels and mental health during COVID-19: findings among adult twin pairs.
      • Dunton GF
      • Do B
      • Wang SD.
      Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S.
      • Gallè F
      • Sabella EA
      • Da Molin G
      • et al.
      Understanding knowledge and behaviors related to COVID-19 epidemic in Italian undergraduate students: the EPICO Study.
      • Hu Z
      • Lin X
      • Chiwanda Kaminga A
      • Xu H
      Impact of the COVID-19 epidemic on lifestyle behaviors and their association with subjective well-being among the general population in mainland China: cross-sectional study.
      • Jia P
      • Zhang L
      • Yu W
      • et al.
      Impact of COVID-19 lockdown on activity patterns and weight status among youths in China: the COVID-19 Impact on Lifestyle Change Survey (COINLICS).
      • Keel PK
      • Gomez MM
      • Harris L
      • Kennedy GA
      • Ribeiro J
      • Joiner TE.
      Gaining “the quarantine 15:” perceived versus observed weight changes in college students in the wake of COVID-19.
      • Lehtisalo J
      • Palmer K
      • Mangialasche F
      • Solomon A
      • Kivipelto M
      • Ngandu T.
      Changes in lifestyle, behaviors, and risk factors for cognitive impairment in older persons during the first wave of the coronavirus disease 2019 pandemic in Finland: results from the FINGER Study.
      • Lesser IA
      • Nienhuis CP.
      The impact of COVID-19 on physical activity behavior and well-being of Canadians.
      • Minsky NC
      • Pachter D
      • Zacay G
      • et al.
      Managing obesity in lockdown: survey of health behaviors and telemedicine.
      • Orlandi M
      • Rosselli M
      • Pellegrino A
      • et al.
      Gender differences in the impact on physical activity and lifestyle in Italy during the lockdown, due to the pandemic.
      • Paltrinieri S
      • Bressi B
      • Costi S
      • et al.
      Beyond lockdown: the potential side effects of the SARS-CoV-2 pandemic on public health.
      • Pépin JL
      • Bruno RM
      • Yang RY
      • et al.
      Wearable activity trackers for monitoring adherence to home confinement during the COVID-19 pandemic worldwide: data aggregation and analysis.
      • Persiani P
      • De Meo D
      • Giannini E
      • et al.
      The aftermath of COVID-19 lockdown on daily life activities in orthopaedic patients.
      • Rodríguez-Nogueira Ó
      • Leirós-Rodríguez R
      • Benítez-Andrades JA
      • Álvarez-álvarez MJ
      • Marqués-Sánchez P
      • Pinto-Carral A.
      Musculoskeletal pain and teleworking in times of the COVID-19: analysis of the impact on the workers at two Spanish universities.
      • Rowlands AV
      • Henson JJ
      • Coull NA
      • et al.
      The impact of COVID-19 restrictions on accelerometer-assessed physical activity and sleep in individuals with type 2 diabetes.
      • Ruíz-Roso MB
      • de Carvalho Padilha P
      • Matilla-Escalante DC
      • et al.
      Changes of physical activity and ultra-processed food consumption in adolescents from different countries during COVID-19 pandemic: an observational study.
      • Sonza A
      • da Cunha de Sá-Caputo D
      • Sartorio A
      • et al.
      COVID-19 Lockdown and the behavior change on physical exercise, pain and psychological well-being: an international multicentric study.
      • Stanton R
      • To QG
      • Khalesi S
      • et al.
      Depression, anxiety and stress during COVID-19: associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults.
      • van Bakel BMA
      • Bakker EA
      • de Vries F
      • Thijssen DHJ
      • Eijsvogels TMH.
      Impact of COVID-19 lockdown on physical activity and sedentary behaviour in Dutch cardiovascular disease patients.
      • Vetrovsky T
      • Frybova T
      • Gant I
      • et al.
      The detrimental effect of COVID-19 nationwide quarantine on accelerometer-assessed physical activity of heart failure patients.
      • Wang Y
      • Zhang Y
      • Bennell K
      • et al.
      Physical distancing measures and walking activity in middle-aged and older residents in Changsha, China, during the COVID-19 epidemic period: longitudinal observational study.
      • Weaver RH
      • Jackson A
      • Lanigan J
      • et al.
      Health behaviors at the onset of the COVID-19 pandemic.
      • Yamada M
      • Kimura Y
      • Ishiyama D
      • et al.
      Effect of the COVID-19 epidemic on physical activity in community-dwelling older adults in Japan: a cross-sectional online survey.
      • Zhu Q
      • Li M
      • Ji Y
      • et al.
      "Stay-at-home" lifestyle effect on weight gain during the COVID-19 outbreak confinement in China.
      • Zorcec T
      • Jakovska T
      • Micevska V
      • Boskovska K
      • Cholakovska VC.
      Pandemic with COVID-19 and families with children with chronic respiratory diseases.
      ,
      • Blom V
      • Lönn A
      • Ekblom B
      • et al.
      Lifestyle habits and mental health in light of the two COVID-19 pandemic waves in Sweden, 2020.
      Fifty-nine full-text articles were excluded because they did not investigate PA changes (n=40); they included confirmed COVID-19 cases (n=6); or they were commentaries, letters or reviews (n=13). Our κ coefficients showed substantial (κ=0.75) and almost perfect (κ =0.93) agreements between the 2 reviewers (K.Y.N., K.H.W.) during the title/abstract screening and full-text screening, respectively.
      • Landis JR
      • Koch GG.
      The measurement of observer agreement for categorical data.
      Fig 1
      Fig 1Flowchart of the systematic review according to Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines.
      Abbreviations: CINAHL, Cumulative Index to Nursing and Allied Health; PEDro, Physiotherapy Evidence Database.

      Characteristics of the included studies

      The 36 included studies recruited 800,256 participants from Asia, Africa, Australia, Europe, and North and South America. Thirty-five studies were conducted in countries or regions with lockdowns,
      • Al Fagih A
      • Al Onazi M
      • Al Basiri S
      • et al.
      Remotely monitored inactivity due to COVID-19 lockdowns potential hazard or heart failure patients.
      • Ammar A
      • Trabelsi K
      • Brach M
      • et al.
      Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insights from the ECLB-COVID19 multicentre study.
      • Arturo Hall-López J
      Physical activity levels in physical education teachers before and during school suspension brought by the COVID-19 quarantine.
      • Barrea L
      • Pugliese G
      • Framondi L
      • et al.
      Does SARS-CoV-2 threaten our dreams? Effect of quarantine on sleep quality and body mass index.
      • Chague F
      • Boulin M
      • Eicher JC
      • et al.
      Impact of lockdown on patients with congestive heart failure during the coronavirus disease 2019 pandemic.
      • Cooper JA
      • vanDellen M
      • Bhutani S
      Self-weighing practices and associated health behaviors during COVID-19.
      • Deng CH
      • Wang JQ
      • Zhu LM
      • et al.
      Association of web-based physical education with mental health of college students in Wuhan during the COVID-19 outbreak: cross-sectional survey study.
      • Di Renzo L
      • Gualtieri P
      • Pivari F
      • et al.
      Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey.
      • Di Sebastiano KM
      • Chulak-Bozzer T
      • Vanderloo LM
      • Faulkner G.
      Don't walk so close to me: physical distancing and adult physical activity in Canada.
      • Đogaš Z
      • Lušić Kalcina L
      • Pavlinac Dodig I
      • et al.
      The effect of COVID-19 lockdown on lifestyle and mood in Croatian general population: a cross-sectional study.
      • Duncan GE
      • Avery AR
      • Seto E
      • Tsang S.
      Perceived change in physical activity levels and mental health during COVID-19: findings among adult twin pairs.
      • Dunton GF
      • Do B
      • Wang SD.
      Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S.
      • Gallè F
      • Sabella EA
      • Da Molin G
      • et al.
      Understanding knowledge and behaviors related to COVID-19 epidemic in Italian undergraduate students: the EPICO Study.
      • Hu Z
      • Lin X
      • Chiwanda Kaminga A
      • Xu H
      Impact of the COVID-19 epidemic on lifestyle behaviors and their association with subjective well-being among the general population in mainland China: cross-sectional study.
      • Jia P
      • Zhang L
      • Yu W
      • et al.
      Impact of COVID-19 lockdown on activity patterns and weight status among youths in China: the COVID-19 Impact on Lifestyle Change Survey (COINLICS).
      • Keel PK
      • Gomez MM
      • Harris L
      • Kennedy GA
      • Ribeiro J
      • Joiner TE.
      Gaining “the quarantine 15:” perceived versus observed weight changes in college students in the wake of COVID-19.
      • Lehtisalo J
      • Palmer K
      • Mangialasche F
      • Solomon A
      • Kivipelto M
      • Ngandu T.
      Changes in lifestyle, behaviors, and risk factors for cognitive impairment in older persons during the first wave of the coronavirus disease 2019 pandemic in Finland: results from the FINGER Study.
      • Lesser IA
      • Nienhuis CP.
      The impact of COVID-19 on physical activity behavior and well-being of Canadians.
      • Minsky NC
      • Pachter D
      • Zacay G
      • et al.
      Managing obesity in lockdown: survey of health behaviors and telemedicine.
      • Orlandi M
      • Rosselli M
      • Pellegrino A
      • et al.
      Gender differences in the impact on physical activity and lifestyle in Italy during the lockdown, due to the pandemic.
      • Paltrinieri S
      • Bressi B
      • Costi S
      • et al.
      Beyond lockdown: the potential side effects of the SARS-CoV-2 pandemic on public health.
      • Pépin JL
      • Bruno RM
      • Yang RY
      • et al.
      Wearable activity trackers for monitoring adherence to home confinement during the COVID-19 pandemic worldwide: data aggregation and analysis.
      • Persiani P
      • De Meo D
      • Giannini E
      • et al.
      The aftermath of COVID-19 lockdown on daily life activities in orthopaedic patients.
      • Rodríguez-Nogueira Ó
      • Leirós-Rodríguez R
      • Benítez-Andrades JA
      • Álvarez-álvarez MJ
      • Marqués-Sánchez P
      • Pinto-Carral A.
      Musculoskeletal pain and teleworking in times of the COVID-19: analysis of the impact on the workers at two Spanish universities.
      • Rowlands AV
      • Henson JJ
      • Coull NA
      • et al.
      The impact of COVID-19 restrictions on accelerometer-assessed physical activity and sleep in individuals with type 2 diabetes.
      • Ruíz-Roso MB
      • de Carvalho Padilha P
      • Matilla-Escalante DC
      • et al.
      Changes of physical activity and ultra-processed food consumption in adolescents from different countries during COVID-19 pandemic: an observational study.
      • Sonza A
      • da Cunha de Sá-Caputo D
      • Sartorio A
      • et al.
      COVID-19 Lockdown and the behavior change on physical exercise, pain and psychological well-being: an international multicentric study.
      • Stanton R
      • To QG
      • Khalesi S
      • et al.
      Depression, anxiety and stress during COVID-19: associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults.
      • van Bakel BMA
      • Bakker EA
      • de Vries F
      • Thijssen DHJ
      • Eijsvogels TMH.
      Impact of COVID-19 lockdown on physical activity and sedentary behaviour in Dutch cardiovascular disease patients.
      • Vetrovsky T
      • Frybova T
      • Gant I
      • et al.
      The detrimental effect of COVID-19 nationwide quarantine on accelerometer-assessed physical activity of heart failure patients.
      • Wang Y
      • Zhang Y
      • Bennell K
      • et al.
      Physical distancing measures and walking activity in middle-aged and older residents in Changsha, China, during the COVID-19 epidemic period: longitudinal observational study.
      • Weaver RH
      • Jackson A
      • Lanigan J
      • et al.
      Health behaviors at the onset of the COVID-19 pandemic.
      • Yamada M
      • Kimura Y
      • Ishiyama D
      • et al.
      Effect of the COVID-19 epidemic on physical activity in community-dwelling older adults in Japan: a cross-sectional online survey.
      • Zhu Q
      • Li M
      • Ji Y
      • et al.
      "Stay-at-home" lifestyle effect on weight gain during the COVID-19 outbreak confinement in China.
      • Zorcec T
      • Jakovska T
      • Micevska V
      • Boskovska K
      • Cholakovska VC.
      Pandemic with COVID-19 and families with children with chronic respiratory diseases.
      while a Swedish study was conducted without lockdown.
      • Blom V
      • Lönn A
      • Ekblom B
      • et al.
      Lifestyle habits and mental health in light of the two COVID-19 pandemic waves in Sweden, 2020.
      The participants’ mean ages ranged from 7.3-74.0 years. Table 1 summarizes participants’ demographics in the included studies. Twenty-three studies adopted a cross-sectional design,
      • Ammar A
      • Trabelsi K
      • Brach M
      • et al.
      Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insights from the ECLB-COVID19 multicentre study.
      ,
      • Arturo Hall-López J
      Physical activity levels in physical education teachers before and during school suspension brought by the COVID-19 quarantine.
      ,
      • Chague F
      • Boulin M
      • Eicher JC
      • et al.
      Impact of lockdown on patients with congestive heart failure during the coronavirus disease 2019 pandemic.
      • Cooper JA
      • vanDellen M
      • Bhutani S
      Self-weighing practices and associated health behaviors during COVID-19.
      • Deng CH
      • Wang JQ
      • Zhu LM
      • et al.
      Association of web-based physical education with mental health of college students in Wuhan during the COVID-19 outbreak: cross-sectional survey study.
      • Di Renzo L
      • Gualtieri P
      • Pivari F
      • et al.
      Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey.
      ,
      • Đogaš Z
      • Lušić Kalcina L
      • Pavlinac Dodig I
      • et al.
      The effect of COVID-19 lockdown on lifestyle and mood in Croatian general population: a cross-sectional study.
      ,
      • Duncan GE
      • Avery AR
      • Seto E
      • Tsang S.
      Perceived change in physical activity levels and mental health during COVID-19: findings among adult twin pairs.
      ,
      • Gallè F
      • Sabella EA
      • Da Molin G
      • et al.
      Understanding knowledge and behaviors related to COVID-19 epidemic in Italian undergraduate students: the EPICO Study.
      ,
      • Hu Z
      • Lin X
      • Chiwanda Kaminga A
      • Xu H
      Impact of the COVID-19 epidemic on lifestyle behaviors and their association with subjective well-being among the general population in mainland China: cross-sectional study.
      ,
      • Lehtisalo J
      • Palmer K
      • Mangialasche F
      • Solomon A
      • Kivipelto M
      • Ngandu T.
      Changes in lifestyle, behaviors, and risk factors for cognitive impairment in older persons during the first wave of the coronavirus disease 2019 pandemic in Finland: results from the FINGER Study.
      • Lesser IA
      • Nienhuis CP.
      The impact of COVID-19 on physical activity behavior and well-being of Canadians.
      • Minsky NC
      • Pachter D
      • Zacay G
      • et al.
      Managing obesity in lockdown: survey of health behaviors and telemedicine.
      • Orlandi M
      • Rosselli M
      • Pellegrino A
      • et al.
      Gender differences in the impact on physical activity and lifestyle in Italy during the lockdown, due to the pandemic.
      • Paltrinieri S
      • Bressi B
      • Costi S
      • et al.
      Beyond lockdown: the potential side effects of the SARS-CoV-2 pandemic on public health.
      ,
      • Persiani P
      • De Meo D
      • Giannini E
      • et al.
      The aftermath of COVID-19 lockdown on daily life activities in orthopaedic patients.
      ,
      • Rodríguez-Nogueira Ó
      • Leirós-Rodríguez R
      • Benítez-Andrades JA
      • Álvarez-álvarez MJ
      • Marqués-Sánchez P
      • Pinto-Carral A.
      Musculoskeletal pain and teleworking in times of the COVID-19: analysis of the impact on the workers at two Spanish universities.
      ,
      • Ruíz-Roso MB
      • de Carvalho Padilha P
      • Matilla-Escalante DC
      • et al.
      Changes of physical activity and ultra-processed food consumption in adolescents from different countries during COVID-19 pandemic: an observational study.
      • Sonza A
      • da Cunha de Sá-Caputo D
      • Sartorio A
      • et al.
      COVID-19 Lockdown and the behavior change on physical exercise, pain and psychological well-being: an international multicentric study.
      • Stanton R
      • To QG
      • Khalesi S
      • et al.
      Depression, anxiety and stress during COVID-19: associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults.
      ,
      • Yamada M
      • Kimura Y
      • Ishiyama D
      • et al.
      Effect of the COVID-19 epidemic on physical activity in community-dwelling older adults in Japan: a cross-sectional online survey.
      ,
      • Zhu Q
      • Li M
      • Ji Y
      • et al.
      "Stay-at-home" lifestyle effect on weight gain during the COVID-19 outbreak confinement in China.
      ,
      • Blom V
      • Lönn A
      • Ekblom B
      • et al.
      Lifestyle habits and mental health in light of the two COVID-19 pandemic waves in Sweden, 2020.
      while 13 adopted a retrospective design.
      • Al Fagih A
      • Al Onazi M
      • Al Basiri S
      • et al.
      Remotely monitored inactivity due to COVID-19 lockdowns potential hazard or heart failure patients.
      ,
      • Barrea L
      • Pugliese G
      • Framondi L
      • et al.
      Does SARS-CoV-2 threaten our dreams? Effect of quarantine on sleep quality and body mass index.
      ,
      • Di Sebastiano KM
      • Chulak-Bozzer T
      • Vanderloo LM
      • Faulkner G.
      Don't walk so close to me: physical distancing and adult physical activity in Canada.
      ,
      • Dunton GF
      • Do B
      • Wang SD.
      Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S.
      ,
      • Jia P
      • Zhang L
      • Yu W
      • et al.
      Impact of COVID-19 lockdown on activity patterns and weight status among youths in China: the COVID-19 Impact on Lifestyle Change Survey (COINLICS).
      ,
      • Keel PK
      • Gomez MM
      • Harris L
      • Kennedy GA
      • Ribeiro J
      • Joiner TE.
      Gaining “the quarantine 15:” perceived versus observed weight changes in college students in the wake of COVID-19.
      ,
      • Pépin JL
      • Bruno RM
      • Yang RY
      • et al.
      Wearable activity trackers for monitoring adherence to home confinement during the COVID-19 pandemic worldwide: data aggregation and analysis.
      ,
      • Rowlands AV
      • Henson JJ
      • Coull NA
      • et al.
      The impact of COVID-19 restrictions on accelerometer-assessed physical activity and sleep in individuals with type 2 diabetes.
      ,
      • van Bakel BMA
      • Bakker EA
      • de Vries F
      • Thijssen DHJ
      • Eijsvogels TMH.
      Impact of COVID-19 lockdown on physical activity and sedentary behaviour in Dutch cardiovascular disease patients.
      • Vetrovsky T
      • Frybova T
      • Gant I
      • et al.
      The detrimental effect of COVID-19 nationwide quarantine on accelerometer-assessed physical activity of heart failure patients.
      • Wang Y
      • Zhang Y
      • Bennell K
      • et al.
      Physical distancing measures and walking activity in middle-aged and older residents in Changsha, China, during the COVID-19 epidemic period: longitudinal observational study.
      • Weaver RH
      • Jackson A
      • Lanigan J
      • et al.
      Health behaviors at the onset of the COVID-19 pandemic.
      ,
      • Zorcec T
      • Jakovska T
      • Micevska V
      • Boskovska K
      • Cholakovska VC.
      Pandemic with COVID-19 and families with children with chronic respiratory diseases.
      Table 1Characteristics of the included studies
      AuthorCountry; Lockdown PolicyStudy Sample Characteristics; % Male; Age (y)Study PopulationDefinitions of PA or ExercisesPA-Related VariablesOutcome Measurement Tools (Validation)Statistical Test
      Cross-sectional studies
       Ammar et al
      • Ammar A
      • Trabelsi K
      • Brach M
      • et al.
      Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insights from the ECLB-COVID19 multicentre study.
      Multiple countries; lockdownN=1047; 46% men;

      Age: 18-35 y: 55.1%

      36-55 y: 35.1%

      >55 y: 9.8%
      Healthy adultsPA as defined by IPAQ
      Definition of PA according to IPAQ: refer to appendix 3.
      IPAQ scoreIPAQ-Short Form (validated)Paired t test
       Arturo et al
      • Arturo Hall-López J
      Physical activity levels in physical education teachers before and during school suspension brought by the COVID-19 quarantine.
      Mexico; lockdownN=37; 59% men;

      Age: 27.8 y±6.1
      Healthy adults (Teachers)PA as defined by IPAQ
      Definition of PA according to IPAQ: refer to appendix 3.
      PA in MET-min/wk

      Change in PA levels in participants
      IPAQ (validated)Student t test

      Descriptive statistics
       Blom et al
      • Schünemann HJ
      • Oxman AD
      • Brozek J
      • et al.
      Grading quality of evidence and strength of recommendations for diagnostic tests and strategies.
      Sweden; no lockdownN=5599; 50% men;

      Age: 46.3 y±11.0
      Healthy adultsDaily activity and exerciseProportion of participants reported change in PA levels

      Proportion of participants reported change in exercise

      Proportion of participants reported change in sedentary time
      Customized questionnaire

      (unvalidated)
      Descriptive statistics
       Chague et al
      • Chague F
      • Boulin M
      • Eicher JC
      • et al.
      Impact of lockdown on patients with congestive heart failure during the coronavirus disease 2019 pandemic.
      France; lockdownN=124; 60.5% men;

      Age: 71.0 y±14.0
      Patients with congestive heart failureNot defined

      Proportion of participants reported change in PA levels

      Proportion of participants reported change in sedentary time
      Customized questionnaire

      (unvalidated)
      Descriptive statistics
       Cooper et al
      • Cooper JA
      • vanDellen M
      • Bhutani S
      Self-weighing practices and associated health behaviors during COVID-19.
      United States; lockdownN=1607; 43% men;

      Age: 38.0 y±12.9
      Healthy adultsOverall PA, walking for at least 30 min/d, PA as defined by IPAQ
      Definition of PA according to IPAQ: refer to appendix 3.
      Proportion of participants reported change in PA levels

      Proportion of participants reported change in sedentary time
      IPAQ-Short Form (validated)Descriptive statistics
       Deng et al
      • Deng CH
      • Wang JQ
      • Zhu LM
      • et al.
      Association of web-based physical education with mental health of college students in Wuhan during the COVID-19 outbreak: cross-sectional survey study.
      Wuhan, China; lockdownN=1607; 64.8% men;

      Age: <18 y: 1.2%

      18-22 y: 97.9%

      >22 y: 0.9%
      Healthy students (university and college)Regular exercise as defined as ≥3 times/wk and ≥60 min each timeProportion of participants reported change in PA levels

      Proportion of participants reported change in exercise habit
      Customized questionnaire

      (unvalidated)
      Descriptive statistics
       Di Renzo et al
      • Di Renzo L
      • Gualtieri P
      • Pivari F
      • et al.
      Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey.
      Italy; lockdownN=3533; 23.9% men;

      Age: 40.0 y±13.5
      Healthy adults (internet users)Sports training eg, walking; gym/run/swimming/soccer/volleyball/basketball/CrossFit/dance/yoga/aerobic fitness/martial arts/tennis/aerial gymnasticsProportion of participants reported change in exercise habitCustomized questionnaire

      (unvalidated)
      Descriptive statistics
       Đogaš et al
      • Đogaš Z
      • Lušić Kalcina L
      • Pavlinac Dodig I
      • et al.
      The effect of COVID-19 lockdown on lifestyle and mood in Croatian general population: a cross-sectional study.
      Croatia; lockdownN=3027; 20.3% men;

      Median age: 40 y
      Healthy adultsNot definedDuration of PACustomized questionnaire

      (unvalidated)
      Paired t test
       Duncan et al
      • Duncan GE
      • Avery AR
      • Seto E
      • Tsang S.
      Perceived change in physical activity levels and mental health during COVID-19: findings among adult twin pairs.
      United States; lockdownN=3971; 30.8% men;

      Age: 50.4 y±16.0
      Healthy adults (identical and same-sex fraternal twins)Not definedProportion of participants reported change in PA levels

      Customized questionnaire

      (unvalidated)
      Descriptive statistics
       Galle et al
      • Gallè F
      • Sabella EA
      • Da Molin G
      • et al.
      Understanding knowledge and behaviors related to COVID-19 epidemic in Italian undergraduate students: the EPICO Study.
      Italy; lockdownN=2125; 37.2% men;

      Age: 22.5 y±0.1
      Undergraduate studentsNot definedProportion of participants reported change in PA levelsCustomized questionnaire

      (unvalidated)
      Descriptive statistics
       Hu et al
      • Hu Z
      • Lin X
      • Chiwanda Kaminga A
      • Xu H
      Impact of the COVID-19 epidemic on lifestyle behaviors and their association with subjective well-being among the general population in mainland China: cross-sectional study.
      China; lockdownN=1033; 51.7% men;

      Age: 18-30 y: 61.7%

      31-40 y: 27.2%

      >41 y: 11.1%
      Healthy adultsExercise (such as running and dancing)

      Proportions of participants reported change in exercise habit

      Proportion of participants reported change in sedentary time
      IPAQ (validated)Descriptive statistics
       Lehtisalo et al
      • Lehtisalo J
      • Palmer K
      • Mangialasche F
      • Solomon A
      • Kivipelto M
      • Ngandu T.
      Changes in lifestyle, behaviors, and risk factors for cognitive impairment in older persons during the first wave of the coronavirus disease 2019 pandemic in Finland: results from the FINGER Study.
      Finland; lockdownN=613; 51.2% men;

      Age: 67.9 y±4.6
      Older adultsLeisure time physical activity, housework or cleaning, gardeningProportion of participants reported change in PA levelsCustomized questionnaire

      (unvalidated)
      Descriptive statistics
       Lesser et al
      • Lesser IA
      • Nienhuis CP.
      The impact of COVID-19 on physical activity behavior and well-being of Canadians.
      Canada; lockdownN=1098; 19.6% men;

      Age: 42.0 y±15.0
      Healthy adultsWalking/jogging/running/biking/cycling/weight training/online video/classes/yoga/home workout/hiking/home/yard work/otherProportion of participants reported change in PA levelsBehavioral regulations in exercise (validated)

      Godin Leisure Questionnaire (validated)
      Descriptive statistics
       Minsky et al
      • Minsky NC
      • Pachter D
      • Zacay G
      • et al.
      Managing obesity in lockdown: survey of health behaviors and telemedicine.
      Israel; lockdownN=279; 30.8% men;

      Age: 53.0 y±13.0
      Adults with obesityNot definedProportion of participants reported change in PA levelsCustomized questionnaire

      (unvalidated)
      Descriptive statistics
       Orlandi et al
      • Orlandi M
      • Rosselli M
      • Pellegrino A
      • et al.
      Gender differences in the impact on physical activity and lifestyle in Italy during the lockdown, due to the pandemic.
      Italy; lockdownN=2218; 34.3% men;

      Age: 38.2 y±14.9
      Healthy adultsPA as defined by IPAQ
      Definition of PA according to IPAQ: refer to appendix 3.
      PA in MET-min/wk (converted from PA in MET-h/wk)IPAQ (validated)Paired t test
       Paltrinieri et al
      • Paltrinieri S
      • Bressi B
      • Costi S
      • et al.
      Beyond lockdown: the potential side effects of the SARS-CoV-2 pandemic on public health.
      Italy; lockdownN=2816; 23.2% men;

      Age: 18-44 y: 44.8%

      45-64 y: 44.0%

      >65 y: 10.6%
      Healthy adultsNot definedProportion of participants reported change in PA levelsCustomized questionnaire

      (unvalidated)
      Descriptive statistics
       Persiani et al
      • Persiani P
      • De Meo D
      • Giannini E
      • et al.
      The aftermath of COVID-19 lockdown on daily life activities in orthopaedic patients.
      Italy; lockdownN=292; 49% men;

      Age: <35 y: 10.3%

      35-50 y: 23%

      50-70 y: 57.2%

      >70 y: 9.6%
      Patients with musculoskeletal painNot definedChange in PA levels in participants

      Proportion of participants reported change in sedentary time
      Customized questionnaire

      (unvalidated)
      Descriptive statistics
       Rodríguez-Nogueira et al
      • Rodríguez-Nogueira Ó
      • Leirós-Rodríguez R
      • Benítez-Andrades JA
      • Álvarez-álvarez MJ
      • Marqués-Sánchez P
      • Pinto-Carral A.
      Musculoskeletal pain and teleworking in times of the COVID-19: analysis of the impact on the workers at two Spanish universities.
      Spain; lockdownN=472; 40% men;

      Age: 46.4 y±11.2
      Healthy adultsAerobics, strength exercise, and othersChange in PA levels in participantsStandardized Nordic Questionnaire (validated)Descriptive statistics
       Ruíz-Roso et al
      • Ruíz-Roso MB
      • de Carvalho Padilha P
      • Matilla-Escalante DC
      • et al.
      Changes of physical activity and ultra-processed food consumption in adolescents from different countries during COVID-19 pandemic: an observational study.
      Italy; lockdownN=726; 39.8% men;

      Age: 10-15 y: 45.7%

      16-19 y: 54.3%
      AdolescentsActive: PA ≥300 min/wkChange in PA levels in participantsIPAQ (validated)Descriptive statistics
       Sonza et al
      • Sonza A
      • da Cunha de Sá-Caputo D
      • Sartorio A
      • et al.
      COVID-19 Lockdown and the behavior change on physical exercise, pain and psychological well-being: an international multicentric study.
      Brazil and Europe; lockdownN=3194; 32.9% men;

      Age: 38.4 y±13.6
      Healthy adultsAerobics, resistance and strength exerciseChange in PA levels in participants

      Proportion of participants reported change in sedentary time
      Physical exercise level before and during social isolation questionnaire (validated)Descriptive statistics
       Stanton et al
      • Stanton R
      • To QG
      • Khalesi S
      • et al.
      Depression, anxiety and stress during COVID-19: associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults.
      Australia; lockdownN=1491; 32.6% men;

      Age: 50.5 y±14.9
      Healthy adultsPA as defined by Active Australia Survey
      Definition of PA according to Active Australian Survey: refer to appendix 4.
      Duration of PA

      Proportion of participants reported change in PA levels
      Active Australian Survey (validated)Descriptive statistics

      Wilcoxon signed-rank test
       Yamada et al
      • Yamada M
      • Kimura Y
      • Ishiyama D
      • et al.
      Effect of the COVID-19 epidemic on physical activity in community-dwelling older adults in Japan: a cross-sectional online survey.
      Japan; lockdownN=1600; 50% men;

      Age: 74.0 y±5.6
      Older adultsPA as defined by IPAQ
      Definition of PA according to IPAQ: refer to appendix 3.
      Duration of PAIPAQ-Short Form (validated)Wilcoxon signed-rank test
       Zhu et al
      • Zhu Q
      • Li M
      • Ji Y
      • et al.
      "Stay-at-home" lifestyle effect on weight gain during the COVID-19 outbreak confinement in China.
      China; lockdownN=889; 39% men;

      Age: 31.9 y±11.4
      Healthy adultsStep countsStep counts

      Duration of sedentary time
      Customized questionnaire

      (unvalidated)
      Paired t test
      Retrospective studies
       Al Fagih et al
      • Al Fagih A
      • Al Onazi M
      • Al Basiri S
      • et al.
      Remotely monitored inactivity due to COVID-19 lockdowns potential hazard or heart failure patients.
      Saudi Arabia; lockdownN=82; 64.6% men;

      Median age: 65 y
      Patients with heart failureDefined by algorithms of a cardiac implantable electronic deviceDuration of PACardiac implantable electronic devicesWilcoxon signed-rank test
       Barrea et al
      • Barrea L
      • Pugliese G
      • Framondi L
      • et al.
      Does SARS-CoV-2 threaten our dreams? Effect of quarantine on sleep quality and body mass index.
      Italy; lockdownN=121; 33.5% men;

      Age: 44.9 y±13.3
      Healthy adults≥30 min/d of aerobic exerciseChange in exercise habit in participantsDichotomous questions (unvalidated)χ2 test
       Di Sebastiano et al
      • Di Sebastiano KM
      • Chulak-Bozzer T
      • Vanderloo LM
      • Faulkner G.
      Don't walk so close to me: physical distancing and adult physical activity in Canada.
      Canada; lockdownN=2338; 9.8% men;

      Age: 18-65 y: 92%

      >65 y: 8%
      Healthy adultsMVPA: defined by a device specific definition, or ≥100 steps/min

      Light PA: <100 steps/min
      Duration of light PA

      Duration of MVPA

      Step counts
      Wearable devices or smartphone inbuilt accelerometer1-way repeated-measures ANOVA
       Dunton et al
      • Dunton GF
      • Do B
      • Wang SD.
      Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S.
      United States; lockdownN=211; 47.4% men;

      Age: 8.7 y±2.6
      Healthy children11 types of school-based PA enlisted in Active Where surveyProportion of participants reported change in sedentary timeActive Where survey (validated)Descriptive statistics
       Jia et al
      • Jia P
      • Zhang L
      • Yu W
      • et al.
      Impact of COVID-19 lockdown on activity patterns and weight status among youths in China: the COVID-19 Impact on Lifestyle Change Survey (COINLICS).
      China; lockdownN=10,082; 28.3% men;

      Age: 19.8 y±2.3
      High school, college, and graduate studentsPA as defined by IPAQ
      Definition of PA according to IPAQ: refer to appendix 3.
      Duration of MVPA

      Duration of sedentary time
      IPAQ (validated)Paired t test
       Keel et al
      • Keel PK
      • Gomez MM
      • Harris L
      • Kennedy GA
      • Ribeiro J
      • Joiner TE.
      Gaining “the quarantine 15:” perceived versus observed weight changes in college students in the wake of COVID-19.
      United States; lockdownN=90; 12.2% men;

      Age: 19.45 y±1.3
      Undergraduate studentsNot definedProportion of participants reported change in PA levelsCustomized questionnaire

      (unvalidated)
      Descriptive statistics
       Pépin et al
      • Pépin JL
      • Bruno RM
      • Yang RY
      • et al.
      Wearable activity trackers for monitoring adherence to home confinement during the COVID-19 pandemic worldwide: data aggregation and analysis.
      Multiple countries; lockdownN=742,200; 62% men;

      Mean age: 43.4 y
      Healthy adultsStep countsStep countsWearable pedometerWilcoxon signed-rank test
       Rowlands et al
      • Rowlands AV
      • Henson JJ
      • Coull NA
      • et al.
      The impact of COVID-19 restrictions on accelerometer-assessed physical activity and sleep in individuals with type 2 diabetes.
      United Kingdom; lockdownN=165; 55% men;

      Age: 64.2 y±8.3
      Patients with T2DDefined by accelerometerDuration of MVPA

      Step counts (converted from acceleration in milligravitation units)
      Interpretation of acceleration in milligravitation units: refer to appendix 5.


      Frequency of continuous PA

      Duration of sedentary time
      Wearable accelerometerPaired t test
       Van Bakel et al
      • van Bakel BMA
      • Bakker EA
      • de Vries F
      • Thijssen DHJ
      • Eijsvogels TMH.
      Impact of COVID-19 lockdown on physical activity and sedentary behaviour in Dutch cardiovascular disease patients.
      Netherlands; lockdownN=1565; 73.1% men;

      Age: ≤65 y: 756

      >65 y: 677
      Patients with cardiovascular diseaseMVPA determined by work, transportation, household, and leisure timeDuration of MVPA

      Duration of sedentary time
      Short Questionnaire to Assess Health-enhancing Physical Activity (validated)Mann-Whitney U test
       Vetrovsky et al
      • Vetrovsky T
      • Frybova T
      • Gant I
      • et al.
      The detrimental effect of COVID-19 nationwide quarantine on accelerometer-assessed physical activity of heart failure patients.
      Czech Republic; lockdownN=26; 69.2% men;

      Age: 58.8 y±9.8
      Patients with heart failureStep countsStep countsWearable accelerometerPaired t test
       Wang et al
      • Wang Y
      • Zhang Y
      • Bennell K
      • et al.
      Physical distancing measures and walking activity in middle-aged and older residents in Changsha, China, during the COVID-19 epidemic period: longitudinal observational study.
      China; lockdownN=3544; 65.4% men;

      Age: 51.6 y±8.9
      Healthy adultsStep countsStep countsSmartphone inbuilt accelerometerGeneralized Estimating Equation
       Weaver et al
      • Weaver RH
      • Jackson A
      • Lanigan J
      • et al.
      Health behaviors at the onset of the COVID-19 pandemic.
      United States; lockdownn=362; 47.8% men;

      Age: 46.5 y±16.0
      Healthy adultsPA as defined by IPAQ
      Definition of PA according to IPAQ: refer to appendix 3.
      PA in MET-min/wk

      Duration of sedentary time
      IPAQ-Short Form (validated)Paired t test
       Zorcec et al
      • Zorcec T
      • Jakovska T
      • Micevska V
      • Boskovska K
      • Cholakovska VC.
      Pandemic with COVID-19 and families with children with chronic respiratory diseases.
      Macedonia; lockdownN=72; 12.5% men;

      Age: 7.3 y±2.9
      Children with chronic respiratory diseasesNot definedChange in PA levels in participantsCustomized questionnaire

      (unvalidated)
      Descriptive statistics

      Abbreviation: ANOVA, analysis of variance.
      low asterisk Definition of PA according to IPAQ: refer to appendix 3.
      Definition of PA according to Active Australian Survey: refer to appendix 4.
      Interpretation of acceleration in milligravitation units: refer to appendix 5.
      Twenty-eight studies investigated changes in PA in people without chronic diseases.
      • Ammar A
      • Trabelsi K
      • Brach M
      • et al.
      Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insights from the ECLB-COVID19 multicentre study.
      • Arturo Hall-López J
      Physical activity levels in physical education teachers before and during school suspension brought by the COVID-19 quarantine.
      • Barrea L
      • Pugliese G
      • Framondi L
      • et al.
      Does SARS-CoV-2 threaten our dreams? Effect of quarantine on sleep quality and body mass index.
      ,
      • Cooper JA
      • vanDellen M
      • Bhutani S
      Self-weighing practices and associated health behaviors during COVID-19.
      • Deng CH
      • Wang JQ
      • Zhu LM
      • et al.
      Association of web-based physical education with mental health of college students in Wuhan during the COVID-19 outbreak: cross-sectional survey study.
      • Di Renzo L
      • Gualtieri P
      • Pivari F
      • et al.
      Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey.
      • Di Sebastiano KM
      • Chulak-Bozzer T
      • Vanderloo LM
      • Faulkner G.
      Don't walk so close to me: physical distancing and adult physical activity in Canada.
      • Đogaš Z
      • Lušić Kalcina L
      • Pavlinac Dodig I
      • et al.
      The effect of COVID-19 lockdown on lifestyle and mood in Croatian general population: a cross-sectional study.
      • Duncan GE
      • Avery AR
      • Seto E
      • Tsang S.
      Perceived change in physical activity levels and mental health during COVID-19: findings among adult twin pairs.
      • Dunton GF
      • Do B
      • Wang SD.
      Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S.
      • Gallè F
      • Sabella EA
      • Da Molin G
      • et al.
      Understanding knowledge and behaviors related to COVID-19 epidemic in Italian undergraduate students: the EPICO Study.
      • Hu Z
      • Lin X
      • Chiwanda Kaminga A
      • Xu H
      Impact of the COVID-19 epidemic on lifestyle behaviors and their association with subjective well-being among the general population in mainland China: cross-sectional study.
      • Jia P
      • Zhang L
      • Yu W
      • et al.
      Impact of COVID-19 lockdown on activity patterns and weight status among youths in China: the COVID-19 Impact on Lifestyle Change Survey (COINLICS).
      • Keel PK
      • Gomez MM
      • Harris L
      • Kennedy GA
      • Ribeiro J
      • Joiner TE.
      Gaining “the quarantine 15:” perceived versus observed weight changes in college students in the wake of COVID-19.
      • Lehtisalo J
      • Palmer K
      • Mangialasche F
      • Solomon A
      • Kivipelto M
      • Ngandu T.
      Changes in lifestyle, behaviors, and risk factors for cognitive impairment in older persons during the first wave of the coronavirus disease 2019 pandemic in Finland: results from the FINGER Study.
      • Lesser IA
      • Nienhuis CP.
      The impact of COVID-19 on physical activity behavior and well-being of Canadians.
      ,
      • Orlandi M
      • Rosselli M
      • Pellegrino A
      • et al.
      Gender differences in the impact on physical activity and lifestyle in Italy during the lockdown, due to the pandemic.
      • Paltrinieri S
      • Bressi B
      • Costi S
      • et al.
      Beyond lockdown: the potential side effects of the SARS-CoV-2 pandemic on public health.
      • Pépin JL
      • Bruno RM
      • Yang RY
      • et al.
      Wearable activity trackers for monitoring adherence to home confinement during the COVID-19 pandemic worldwide: data aggregation and analysis.
      ,
      • Rodríguez-Nogueira Ó
      • Leirós-Rodríguez R
      • Benítez-Andrades JA
      • Álvarez-álvarez MJ
      • Marqués-Sánchez P
      • Pinto-Carral A.
      Musculoskeletal pain and teleworking in times of the COVID-19: analysis of the impact on the workers at two Spanish universities.
      ,
      • Ruíz-Roso MB
      • de Carvalho Padilha P
      • Matilla-Escalante DC
      • et al.
      Changes of physical activity and ultra-processed food consumption in adolescents from different countries during COVID-19 pandemic: an observational study.
      • Sonza A
      • da Cunha de Sá-Caputo D
      • Sartorio A
      • et al.
      COVID-19 Lockdown and the behavior change on physical exercise, pain and psychological well-being: an international multicentric study.
      • Stanton R
      • To QG
      • Khalesi S
      • et al.
      Depression, anxiety and stress during COVID-19: associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults.
      ,
      • Wang Y
      • Zhang Y
      • Bennell K
      • et al.
      Physical distancing measures and walking activity in middle-aged and older residents in Changsha, China, during the COVID-19 epidemic period: longitudinal observational study.
      • Weaver RH
      • Jackson A
      • Lanigan J
      • et al.
      Health behaviors at the onset of the COVID-19 pandemic.
      • Yamada M
      • Kimura Y
      • Ishiyama D
      • et al.
      Effect of the COVID-19 epidemic on physical activity in community-dwelling older adults in Japan: a cross-sectional online survey.
      • Zhu Q
      • Li M
      • Ji Y
      • et al.
      "Stay-at-home" lifestyle effect on weight gain during the COVID-19 outbreak confinement in China.
      ,
      • Blom V
      • Lönn A
      • Ekblom B
      • et al.
      Lifestyle habits and mental health in light of the two COVID-19 pandemic waves in Sweden, 2020.
      Notably, 20 of them focused on adults,
      • Ammar A
      • Trabelsi K
      • Brach M
      • et al.
      Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insights from the ECLB-COVID19 multicentre study.
      • Arturo Hall-López J
      Physical activity levels in physical education teachers before and during school suspension brought by the COVID-19 quarantine.
      • Barrea L
      • Pugliese G
      • Framondi L
      • et al.
      Does SARS-CoV-2 threaten our dreams? Effect of quarantine on sleep quality and body mass index.
      ,
      • Cooper JA
      • vanDellen M
      • Bhutani S
      Self-weighing practices and associated health behaviors during COVID-19.
      ,
      • Di Renzo L
      • Gualtieri P
      • Pivari F
      • et al.
      Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey.
      • Di Sebastiano KM
      • Chulak-Bozzer T
      • Vanderloo LM
      • Faulkner G.
      Don't walk so close to me: physical distancing and adult physical activity in Canada.
      • Đogaš Z
      • Lušić Kalcina L
      • Pavlinac Dodig I
      • et al.
      The effect of COVID-19 lockdown on lifestyle and mood in Croatian general population: a cross-sectional study.
      • Duncan GE
      • Avery AR
      • Seto E
      • Tsang S.
      Perceived change in physical activity levels and mental health during COVID-19: findings among adult twin pairs.
      ,
      • Hu Z
      • Lin X
      • Chiwanda Kaminga A
      • Xu H
      Impact of the COVID-19 epidemic on lifestyle behaviors and their association with subjective well-being among the general population in mainland China: cross-sectional study.
      ,
      • Lesser IA
      • Nienhuis CP.
      The impact of COVID-19 on physical activity behavior and well-being of Canadians.
      ,
      • Orlandi M
      • Rosselli M
      • Pellegrino A
      • et al.
      Gender differences in the impact on physical activity and lifestyle in Italy during the lockdown, due to the pandemic.
      • Paltrinieri S
      • Bressi B
      • Costi S
      • et al.
      Beyond lockdown: the potential side effects of the SARS-CoV-2 pandemic on public health.
      • Pépin JL
      • Bruno RM
      • Yang RY
      • et al.
      Wearable activity trackers for monitoring adherence to home confinement during the COVID-19 pandemic worldwide: data aggregation and analysis.
      ,
      • Rodríguez-Nogueira Ó
      • Leirós-Rodríguez R
      • Benítez-Andrades JA
      • Álvarez-álvarez MJ
      • Marqués-Sánchez P
      • Pinto-Carral A.
      Musculoskeletal pain and teleworking in times of the COVID-19: analysis of the impact on the workers at two Spanish universities.
      ,
      • Sonza A
      • da Cunha de Sá-Caputo D
      • Sartorio A
      • et al.
      COVID-19 Lockdown and the behavior change on physical exercise, pain and psychological well-being: an international multicentric study.
      ,
      • Stanton R
      • To QG
      • Khalesi S
      • et al.
      Depression, anxiety and stress during COVID-19: associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults.
      ,
      • Wang Y
      • Zhang Y
      • Bennell K
      • et al.
      Physical distancing measures and walking activity in middle-aged and older residents in Changsha, China, during the COVID-19 epidemic period: longitudinal observational study.
      ,
      • Weaver RH
      • Jackson A
      • Lanigan J
      • et al.
      Health behaviors at the onset of the COVID-19 pandemic.
      ,
      • Zhu Q
      • Li M
      • Ji Y
      • et al.
      "Stay-at-home" lifestyle effect on weight gain during the COVID-19 outbreak confinement in China.
      ,
      • Blom V
      • Lönn A
      • Ekblom B
      • et al.
      Lifestyle habits and mental health in light of the two COVID-19 pandemic waves in Sweden, 2020.
      2 on older people,
      • Lehtisalo J
      • Palmer K
      • Mangialasche F
      • Solomon A
      • Kivipelto M
      • Ngandu T.
      Changes in lifestyle, behaviors, and risk factors for cognitive impairment in older persons during the first wave of the coronavirus disease 2019 pandemic in Finland: results from the FINGER Study.
      ,
      • Yamada M
      • Kimura Y
      • Ishiyama D
      • et al.
      Effect of the COVID-19 epidemic on physical activity in community-dwelling older adults in Japan: a cross-sectional online survey.
      4 on students,
      • Deng CH
      • Wang JQ
      • Zhu LM
      • et al.
      Association of web-based physical education with mental health of college students in Wuhan during the COVID-19 outbreak: cross-sectional survey study.
      ,
      • Gallè F
      • Sabella EA
      • Da Molin G
      • et al.
      Understanding knowledge and behaviors related to COVID-19 epidemic in Italian undergraduate students: the EPICO Study.
      ,
      • Jia P
      • Zhang L
      • Yu W
      • et al.
      Impact of COVID-19 lockdown on activity patterns and weight status among youths in China: the COVID-19 Impact on Lifestyle Change Survey (COINLICS).
      ,
      • Keel PK
      • Gomez MM
      • Harris L
      • Kennedy GA
      • Ribeiro J
      • Joiner TE.
      Gaining “the quarantine 15:” perceived versus observed weight changes in college students in the wake of COVID-19.
      and 2 on children and adolescents.
      • Dunton GF
      • Do B
      • Wang SD.
      Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S.
      ,
      • Ruíz-Roso MB
      • de Carvalho Padilha P
      • Matilla-Escalante DC
      • et al.
      Changes of physical activity and ultra-processed food consumption in adolescents from different countries during COVID-19 pandemic: an observational study.
      Eight studies investigated changes in PA among people with chronic diseases.
      • Al Fagih A
      • Al Onazi M
      • Al Basiri S
      • et al.
      Remotely monitored inactivity due to COVID-19 lockdowns potential hazard or heart failure patients.
      ,
      • Chague F
      • Boulin M
      • Eicher JC
      • et al.
      Impact of lockdown on patients with congestive heart failure during the coronavirus disease 2019 pandemic.
      ,
      • Minsky NC
      • Pachter D
      • Zacay G
      • et al.
      Managing obesity in lockdown: survey of health behaviors and telemedicine.
      ,
      • Persiani P
      • De Meo D
      • Giannini E
      • et al.
      The aftermath of COVID-19 lockdown on daily life activities in orthopaedic patients.
      ,
      • Rowlands AV
      • Henson JJ
      • Coull NA
      • et al.
      The impact of COVID-19 restrictions on accelerometer-assessed physical activity and sleep in individuals with type 2 diabetes.
      ,
      • van Bakel BMA
      • Bakker EA
      • de Vries F
      • Thijssen DHJ
      • Eijsvogels TMH.
      Impact of COVID-19 lockdown on physical activity and sedentary behaviour in Dutch cardiovascular disease patients.
      ,
      • Vetrovsky T
      • Frybova T
      • Gant I
      • et al.
      The detrimental effect of COVID-19 nationwide quarantine on accelerometer-assessed physical activity of heart failure patients.
      ,
      • Zorcec T
      • Jakovska T
      • Micevska V
      • Boskovska K
      • Cholakovska VC.
      Pandemic with COVID-19 and families with children with chronic respiratory diseases.
      Specifically, 4 focused on patients with cardiovascular diseases,
      • Al Fagih A
      • Al Onazi M
      • Al Basiri S
      • et al.
      Remotely monitored inactivity due to COVID-19 lockdowns potential hazard or heart failure patients.
      ,
      • Chague F
      • Boulin M
      • Eicher JC
      • et al.
      Impact of lockdown on patients with congestive heart failure during the coronavirus disease 2019 pandemic.
      ,
      • van Bakel BMA
      • Bakker EA
      • de Vries F
      • Thijssen DHJ
      • Eijsvogels TMH.
      Impact of COVID-19 lockdown on physical activity and sedentary behaviour in Dutch cardiovascular disease patients.
      ,
      • Vetrovsky T
      • Frybova T
      • Gant I
      • et al.
      The detrimental effect of COVID-19 nationwide quarantine on accelerometer-assessed physical activity of heart failure patients.
      1 on type 2 diabetes (T2D),
      • Rowlands AV
      • Henson JJ
      • Coull NA
      • et al.
      The impact of COVID-19 restrictions on accelerometer-assessed physical activity and sleep in individuals with type 2 diabetes.
      1 on musculoskeletal pain,
      • Persiani P
      • De Meo D
      • Giannini E
      • et al.
      The aftermath of COVID-19 lockdown on daily life activities in orthopaedic patients.
      1 on adults with obesity,
      • Minsky NC
      • Pachter D
      • Zacay G
      • et al.
      Managing obesity in lockdown: survey of health behaviors and telemedicine.
      and 1 on children with chronic respiratory diseases.
      • Zorcec T
      • Jakovska T
      • Micevska V
      • Boskovska K
      • Cholakovska VC.
      Pandemic with COVID-19 and families with children with chronic respiratory diseases.

      Risk of bias assessments

      One study was rated as having low risk of bias,
      • Rowlands AV
      • Henson JJ
      • Coull NA
      • et al.
      The impact of COVID-19 restrictions on accelerometer-assessed physical activity and sleep in individuals with type 2 diabetes.
      31 as moderate,
      • Ammar A
      • Trabelsi K
      • Brach M
      • et al.
      Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insights from the ECLB-COVID19 multicentre study.
      • Arturo Hall-López J
      Physical activity levels in physical education teachers before and during school suspension brought by the COVID-19 quarantine.
      • Barrea L
      • Pugliese G
      • Framondi L
      • et al.
      Does SARS-CoV-2 threaten our dreams? Effect of quarantine on sleep quality and body mass index.
      • Chague F
      • Boulin M
      • Eicher JC
      • et al.
      Impact of lockdown on patients with congestive heart failure during the coronavirus disease 2019 pandemic.
      • Cooper JA
      • vanDellen M
      • Bhutani S
      Self-weighing practices and associated health behaviors during COVID-19.
      • Deng CH
      • Wang JQ
      • Zhu LM
      • et al.
      Association of web-based physical education with mental health of college students in Wuhan during the COVID-19 outbreak: cross-sectional survey study.
      • Di Renzo L
      • Gualtieri P
      • Pivari F
      • et al.
      Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey.
      • Di Sebastiano KM
      • Chulak-Bozzer T
      • Vanderloo LM
      • Faulkner G.
      Don't walk so close to me: physical distancing and adult physical activity in Canada.
      • Đogaš Z
      • Lušić Kalcina L
      • Pavlinac Dodig I
      • et al.
      The effect of COVID-19 lockdown on lifestyle and mood in Croatian general population: a cross-sectional study.
      • Duncan GE
      • Avery AR
      • Seto E
      • Tsang S.
      Perceived change in physical activity levels and mental health during COVID-19: findings among adult twin pairs.
      • Dunton GF
      • Do B
      • Wang SD.
      Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S.
      • Gallè F
      • Sabella EA
      • Da Molin G
      • et al.
      Understanding knowledge and behaviors related to COVID-19 epidemic in Italian undergraduate students: the EPICO Study.
      • Hu Z
      • Lin X
      • Chiwanda Kaminga A
      • Xu H
      Impact of the COVID-19 epidemic on lifestyle behaviors and their association with subjective well-being among the general population in mainland China: cross-sectional study.
      • Jia P
      • Zhang L
      • Yu W
      • et al.
      Impact of COVID-19 lockdown on activity patterns and weight status among youths in China: the COVID-19 Impact on Lifestyle Change Survey (COINLICS).
      • Keel PK
      • Gomez MM
      • Harris L
      • Kennedy GA
      • Ribeiro J
      • Joiner TE.
      Gaining “the quarantine 15:” perceived versus observed weight changes in college students in the wake of COVID-19.
      • Lehtisalo J
      • Palmer K
      • Mangialasche F
      • Solomon A
      • Kivipelto M
      • Ngandu T.
      Changes in lifestyle, behaviors, and risk factors for cognitive impairment in older persons during the first wave of the coronavirus disease 2019 pandemic in Finland: results from the FINGER Study.
      • Lesser IA
      • Nienhuis CP.
      The impact of COVID-19 on physical activity behavior and well-being of Canadians.
      • Minsky NC
      • Pachter D
      • Zacay G
      • et al.
      Managing obesity in lockdown: survey of health behaviors and telemedicine.
      • Orlandi M
      • Rosselli M
      • Pellegrino A
      • et al.
      Gender differences in the impact on physical activity and lifestyle in Italy during the lockdown, due to the pandemic.
      • Paltrinieri S
      • Bressi B
      • Costi S
      • et al.
      Beyond lockdown: the potential side effects of the SARS-CoV-2 pandemic on public health.
      • Pépin JL
      • Bruno RM
      • Yang RY
      • et al.
      Wearable activity trackers for monitoring adherence to home confinement during the COVID-19 pandemic worldwide: data aggregation and analysis.
      ,
      • Rodríguez-Nogueira Ó
      • Leirós-Rodríguez R
      • Benítez-Andrades JA
      • Álvarez-álvarez MJ
      • Marqués-Sánchez P
      • Pinto-Carral A.
      Musculoskeletal pain and teleworking in times of the COVID-19: analysis of the impact on the workers at two Spanish universities.
      ,
      • Stanton R
      • To QG
      • Khalesi S
      • et al.
      Depression, anxiety and stress during COVID-19: associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults.
      • van Bakel BMA
      • Bakker EA
      • de Vries F
      • Thijssen DHJ
      • Eijsvogels TMH.
      Impact of COVID-19 lockdown on physical activity and sedentary behaviour in Dutch cardiovascular disease patients.
      • Vetrovsky T
      • Frybova T
      • Gant I
      • et al.
      The detrimental effect of COVID-19 nationwide quarantine on accelerometer-assessed physical activity of heart failure patients.
      • Wang Y
      • Zhang Y
      • Bennell K
      • et al.
      Physical distancing measures and walking activity in middle-aged and older residents in Changsha, China, during the COVID-19 epidemic period: longitudinal observational study.
      • Weaver RH
      • Jackson A
      • Lanigan J
      • et al.
      Health behaviors at the onset of the COVID-19 pandemic.
      • Yamada M
      • Kimura Y
      • Ishiyama D
      • et al.
      Effect of the COVID-19 epidemic on physical activity in community-dwelling older adults in Japan: a cross-sectional online survey.
      • Zhu Q
      • Li M
      • Ji Y
      • et al.
      "Stay-at-home" lifestyle effect on weight gain during the COVID-19 outbreak confinement in China.
      • Zorcec T
      • Jakovska T
      • Micevska V
      • Boskovska K
      • Cholakovska VC.
      Pandemic with COVID-19 and families with children with chronic respiratory diseases.
      ,
      • Blom V
      • Lönn A
      • Ekblom B
      • et al.
      Lifestyle habits and mental health in light of the two COVID-19 pandemic waves in Sweden, 2020.
      and 4 as high.
      • Al Fagih A
      • Al Onazi M
      • Al Basiri S
      • et al.
      Remotely monitored inactivity due to COVID-19 lockdowns potential hazard or heart failure patients.
      ,
      • Persiani P
      • De Meo D
      • Giannini E
      • et al.
      The aftermath of COVID-19 lockdown on daily life activities in orthopaedic patients.
      ,
      • Ruíz-Roso MB
      • de Carvalho Padilha P
      • Matilla-Escalante DC
      • et al.
      Changes of physical activity and ultra-processed food consumption in adolescents from different countries during COVID-19 pandemic: an observational study.
      ,
      • Sonza A
      • da Cunha de Sá-Caputo D
      • Sartorio A
      • et al.
      COVID-19 Lockdown and the behavior change on physical exercise, pain and psychological well-being: an international multicentric study.
      Of the 23 cross-sectional studies, the most common risks of bias were no sample size justification
      • Ammar A
      • Trabelsi K
      • Brach M
      • et al.
      Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insights from the ECLB-COVID19 multicentre study.
      ,
      • Arturo Hall-López J
      Physical activity levels in physical education teachers before and during school suspension brought by the COVID-19 quarantine.
      ,
      • Chague F
      • Boulin M
      • Eicher JC
      • et al.
      Impact of lockdown on patients with congestive heart failure during the coronavirus disease 2019 pandemic.
      • Cooper JA
      • vanDellen M
      • Bhutani S
      Self-weighing practices and associated health behaviors during COVID-19.
      • Deng CH
      • Wang JQ
      • Zhu LM
      • et al.
      Association of web-based physical education with mental health of college students in Wuhan during the COVID-19 outbreak: cross-sectional survey study.
      • Di Renzo L
      • Gualtieri P
      • Pivari F
      • et al.
      Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey.
      ,
      • Đogaš Z
      • Lušić Kalcina L
      • Pavlinac Dodig I
      • et al.
      The effect of COVID-19 lockdown on lifestyle and mood in Croatian general population: a cross-sectional study.
      ,
      • Duncan GE
      • Avery AR
      • Seto E
      • Tsang S.
      Perceived change in physical activity levels and mental health during COVID-19: findings among adult twin pairs.
      ,
      • Hu Z
      • Lin X
      • Chiwanda Kaminga A
      • Xu H
      Impact of the COVID-19 epidemic on lifestyle behaviors and their association with subjective well-being among the general population in mainland China: cross-sectional study.
      ,
      • Lehtisalo J
      • Palmer K
      • Mangialasche F
      • Solomon A
      • Kivipelto M
      • Ngandu T.
      Changes in lifestyle, behaviors, and risk factors for cognitive impairment in older persons during the first wave of the coronavirus disease 2019 pandemic in Finland: results from the FINGER Study.
      • Lesser IA
      • Nienhuis CP.
      The impact of COVID-19 on physical activity behavior and well-being of Canadians.
      • Minsky NC
      • Pachter D
      • Zacay G
      • et al.
      Managing obesity in lockdown: survey of health behaviors and telemedicine.
      • Orlandi M
      • Rosselli M
      • Pellegrino A
      • et al.
      Gender differences in the impact on physical activity and lifestyle in Italy during the lockdown, due to the pandemic.
      • Paltrinieri S
      • Bressi B
      • Costi S
      • et al.
      Beyond lockdown: the potential side effects of the SARS-CoV-2 pandemic on public health.
      ,
      • Persiani P
      • De Meo D
      • Giannini E
      • et al.
      The aftermath of COVID-19 lockdown on daily life activities in orthopaedic patients.
      ,
      • Ruíz-Roso MB
      • de Carvalho Padilha P
      • Matilla-Escalante DC
      • et al.
      Changes of physical activity and ultra-processed food consumption in adolescents from different countries during COVID-19 pandemic: an observational study.
      • Sonza A
      • da Cunha de Sá-Caputo D
      • Sartorio A
      • et al.
      COVID-19 Lockdown and the behavior change on physical exercise, pain and psychological well-being: an international multicentric study.
      • Stanton R
      • To QG
      • Khalesi S
      • et al.
      Depression, anxiety and stress during COVID-19: associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults.
      ,
      • Yamada M
      • Kimura Y
      • Ishiyama D
      • et al.
      Effect of the COVID-19 epidemic on physical activity in community-dwelling older adults in Japan: a cross-sectional online survey.
      ,
      • Zhu Q
      • Li M
      • Ji Y
      • et al.
      "Stay-at-home" lifestyle effect on weight gain during the COVID-19 outbreak confinement in China.
      ,
      • Blom V
      • Lönn A
      • Ekblom B
      • et al.
      Lifestyle habits and mental health in light of the two COVID-19 pandemic waves in Sweden, 2020.
      and no description of nonresponders’ characteristics
      • Ammar A
      • Trabelsi K
      • Brach M
      • et al.
      Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insights from the ECLB-COVID19 multicentre study.
      ,
      • Arturo Hall-López J
      Physical activity levels in physical education teachers before and during school suspension brought by the COVID-19 quarantine.
      ,
      • Chague F
      • Boulin M
      • Eicher JC
      • et al.
      Impact of lockdown on patients with congestive heart failure during the coronavirus disease 2019 pandemic.
      • Cooper JA
      • vanDellen M
      • Bhutani S
      Self-weighing practices and associated health behaviors during COVID-19.
      • Deng CH
      • Wang JQ
      • Zhu LM
      • et al.
      Association of web-based physical education with mental health of college students in Wuhan during the COVID-19 outbreak: cross-sectional survey study.
      • Di Renzo L
      • Gualtieri P
      • Pivari F
      • et al.
      Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey.
      ,
      • Đogaš Z
      • Lušić Kalcina L
      • Pavlinac Dodig I
      • et al.
      The effect of COVID-19 lockdown on lifestyle and mood in Croatian general population: a cross-sectional study.
      ,
      • Duncan GE
      • Avery AR
      • Seto E
      • Tsang S.
      Perceived change in physical activity levels and mental health during COVID-19: findings among adult twin pairs.
      ,
      • Gallè F
      • Sabella EA
      • Da Molin G
      • et al.
      Understanding knowledge and behaviors related to COVID-19 epidemic in Italian undergraduate students: the EPICO Study.
      ,
      • Hu Z
      • Lin X
      • Chiwanda Kaminga A
      • Xu H
      Impact of the COVID-19 epidemic on lifestyle behaviors and their association with subjective well-being among the general population in mainland China: cross-sectional study.
      ,
      • Lehtisalo J
      • Palmer K
      • Mangialasche F
      • Solomon A
      • Kivipelto M
      • Ngandu T.
      Changes in lifestyle, behaviors, and risk factors for cognitive impairment in older persons during the first wave of the coronavirus disease 2019 pandemic in Finland: results from the FINGER Study.
      • Lesser IA
      • Nienhuis CP.
      The impact of COVID-19 on physical activity behavior and well-being of Canadians.
      • Minsky NC
      • Pachter D
      • Zacay G
      • et al.
      Managing obesity in lockdown: survey of health behaviors and telemedicine.
      • Orlandi M
      • Rosselli M
      • Pellegrino A
      • et al.
      Gender differences in the impact on physical activity and lifestyle in Italy during the lockdown, due to the pandemic.
      • Paltrinieri S
      • Bressi B
      • Costi S
      • et al.
      Beyond lockdown: the potential side effects of the SARS-CoV-2 pandemic on public health.
      ,
      • Persiani P
      • De Meo D
      • Giannini E
      • et al.
      The aftermath of COVID-19 lockdown on daily life activities in orthopaedic patients.
      ,
      • Rodríguez-Nogueira Ó
      • Leirós-Rodríguez R
      • Benítez-Andrades JA
      • Álvarez-álvarez MJ
      • Marqués-Sánchez P
      • Pinto-Carral A.
      Musculoskeletal pain and teleworking in times of the COVID-19: analysis of the impact on the workers at two Spanish universities.
      ,
      • Ruíz-Roso MB
      • de Carvalho Padilha P
      • Matilla-Escalante DC
      • et al.
      Changes of physical activity and ultra-processed food consumption in adolescents from different countries during COVID-19 pandemic: an observational study.
      • Sonza A
      • da Cunha de Sá-Caputo D
      • Sartorio A
      • et al.
      COVID-19 Lockdown and the behavior change on physical exercise, pain and psychological well-being: an international multicentric study.
      • Stanton R
      • To QG
      • Khalesi S
      • et al.
      Depression, anxiety and stress during COVID-19: associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults.
      ,
      • Yamada M
      • Kimura Y
      • Ishiyama D
      • et al.
      Effect of the COVID-19 epidemic on physical activity in community-dwelling older adults in Japan: a cross-sectional online survey.
      ,
      • Zhu Q
      • Li M
      • Ji Y
      • et al.
      "Stay-at-home" lifestyle effect on weight gain during the COVID-19 outbreak confinement in China.
      ,
      • Blom V
      • Lönn A
      • Ekblom B
      • et al.
      Lifestyle habits and mental health in light of the two COVID-19 pandemic waves in Sweden, 2020.
      (appendix 3). All the 13 retrospective studies did not provide information regarding the dropout participants nor accounted for potential confounders (appendix 4).
      • Al Fagih A
      • Al Onazi M
      • Al Basiri S
      • et al.
      Remotely monitored inactivity due to COVID-19 lockdowns potential hazard or heart failure patients.
      ,
      • Barrea L
      • Pugliese G
      • Framondi L
      • et al.
      Does SARS-CoV-2 threaten our dreams? Effect of quarantine on sleep quality and body mass index.
      ,
      • Di Sebastiano KM
      • Chulak-Bozzer T
      • Vanderloo LM
      • Faulkner G.
      Don't walk so close to me: physical distancing and adult physical activity in Canada.
      ,
      • Dunton GF
      • Do B
      • Wang SD.
      Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S.
      ,
      • Jia P
      • Zhang L
      • Yu W
      • et al.
      Impact of COVID-19 lockdown on activity patterns and weight status among youths in China: the COVID-19 Impact on Lifestyle Change Survey (COINLICS).
      ,
      • Keel PK
      • Gomez MM
      • Harris L
      • Kennedy GA
      • Ribeiro J
      • Joiner TE.
      Gaining “the quarantine 15:” perceived versus observed weight changes in college students in the wake of COVID-19.
      ,
      • Pépin JL
      • Bruno RM
      • Yang RY
      • et al.
      Wearable activity trackers for monitoring adherence to home confinement during the COVID-19 pandemic worldwide: data aggregation and analysis.
      ,
      • Rowlands AV
      • Henson JJ
      • Coull NA
      • et al.
      The impact of COVID-19 restrictions on accelerometer-assessed physical activity and sleep in individuals with type 2 diabetes.
      ,
      • van Bakel BMA
      • Bakker EA
      • de Vries F
      • Thijssen DHJ
      • Eijsvogels TMH.
      Impact of COVID-19 lockdown on physical activity and sedentary behaviour in Dutch cardiovascular disease patients.
      • Vetrovsky T
      • Frybova T
      • Gant I
      • et al.
      The detrimental effect of COVID-19 nationwide quarantine on accelerometer-assessed physical activity of heart failure patients.
      • Wang Y
      • Zhang Y
      • Bennell K
      • et al.
      Physical distancing measures and walking activity in middle-aged and older residents in Changsha, China, during the COVID-19 epidemic period: longitudinal observational study.
      • Weaver RH
      • Jackson A
      • Lanigan J
      • et al.
      Health behaviors at the onset of the COVID-19 pandemic.
      ,
      • Zorcec T
      • Jakovska T
      • Micevska V
      • Boskovska K
      • Cholakovska VC.
      Pandemic with COVID-19 and families with children with chronic respiratory diseases.

      PA and sedentary time

      The included studies used diverse definitions of PA (appendices 5-7, table 2). Five studies used accelerometers and/or pedometers to quantify PA levels.
      • Di Sebastiano KM
      • Chulak-Bozzer T
      • Vanderloo LM
      • Faulkner G.
      Don't walk so close to me: physical distancing and adult physical activity in Canada.
      ,
      • Pépin JL
      • Bruno RM
      • Yang RY
      • et al.
      Wearable activity trackers for monitoring adherence to home confinement during the COVID-19 pandemic worldwide: data aggregation and analysis.
      ,
      • Rowlands AV
      • Henson JJ
      • Coull NA
      • et al.
      The impact of COVID-19 restrictions on accelerometer-assessed physical activity and sleep in individuals with type 2 diabetes.
      ,
      • Vetrovsky T
      • Frybova T
      • Gant I
      • et al.
      The detrimental effect of COVID-19 nationwide quarantine on accelerometer-assessed physical activity of heart failure patients.
      ,
      • Wang Y
      • Zhang Y
      • Bennell K
      • et al.
      Physical distancing measures and walking activity in middle-aged and older residents in Changsha, China, during the COVID-19 epidemic period: longitudinal observational study.
      Eight studies used the International Physical Activity Questionnaire (IPAQ) to categorize PA into different levels.
      • Ammar A
      • Trabelsi K
      • Brach M
      • et al.
      Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insights from the ECLB-COVID19 multicentre study.
      ,
      • Arturo Hall-López J
      Physical activity levels in physical education teachers before and during school suspension brought by the COVID-19 quarantine.
      ,
      • Cooper JA
      • vanDellen M
      • Bhutani S
      Self-weighing practices and associated health behaviors during COVID-19.
      ,
      • Hu Z
      • Lin X
      • Chiwanda Kaminga A
      • Xu H
      Impact of the COVID-19 epidemic on lifestyle behaviors and their association with subjective well-being among the general population in mainland China: cross-sectional study.
      ,
      • Jia P
      • Zhang L
      • Yu W
      • et al.
      Impact of COVID-19 lockdown on activity patterns and weight status among youths in China: the COVID-19 Impact on Lifestyle Change Survey (COINLICS).
      ,
      • Orlandi M
      • Rosselli M
      • Pellegrino A
      • et al.
      Gender differences in the impact on physical activity and lifestyle in Italy during the lockdown, due to the pandemic.
      ,
      • Weaver RH
      • Jackson A
      • Lanigan J
      • et al.
      Health behaviors at the onset of the COVID-19 pandemic.
      ,
      • Yamada M
      • Kimura Y
      • Ishiyama D
      • et al.
      Effect of the COVID-19 epidemic on physical activity in community-dwelling older adults in Japan: a cross-sectional online survey.
      Fourteen studies had miscellaneous definitions of PA (eg, regular exercise for different durations or different leisure time PA),
      • Al Fagih A
      • Al Onazi M
      • Al Basiri S
      • et al.
      Remotely monitored inactivity due to COVID-19 lockdowns potential hazard or heart failure patients.
      ,
      • Barrea L
      • Pugliese G
      • Framondi L
      • et al.
      Does SARS-CoV-2 threaten our dreams? Effect of quarantine on sleep quality and body mass index.
      ,
      • Deng CH
      • Wang JQ
      • Zhu LM
      • et al.
      Association of web-based physical education with mental health of college students in Wuhan during the COVID-19 outbreak: cross-sectional survey study.
      • Di Renzo L
      • Gualtieri P
      • Pivari F
      • et al.
      Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey.
      • Di Sebastiano KM
      • Chulak-Bozzer T
      • Vanderloo LM
      • Faulkner G.
      Don't walk so close to me: physical distancing and adult physical activity in Canada.
      ,
      • Dunton GF
      • Do B
      • Wang SD.
      Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S.
      ,
      • Hu Z
      • Lin X
      • Chiwanda Kaminga A
      • Xu H
      Impact of the COVID-19 epidemic on lifestyle behaviors and their association with subjective well-being among the general population in mainland China: cross-sectional study.
      ,
      • Lehtisalo J
      • Palmer K
      • Mangialasche F
      • Solomon A
      • Kivipelto M
      • Ngandu T.
      Changes in lifestyle, behaviors, and risk factors for cognitive impairment in older persons during the first wave of the coronavirus disease 2019 pandemic in Finland: results from the FINGER Study.
      ,
      • Lesser IA
      • Nienhuis CP.
      The impact of COVID-19 on physical activity behavior and well-being of Canadians.
      ,
      • Rodríguez-Nogueira Ó
      • Leirós-Rodríguez R
      • Benítez-Andrades JA
      • Álvarez-álvarez MJ
      • Marqués-Sánchez P
      • Pinto-Carral A.
      Musculoskeletal pain and teleworking in times of the COVID-19: analysis of the impact on the workers at two Spanish universities.
      ,
      • Ruíz-Roso MB
      • de Carvalho Padilha P
      • Matilla-Escalante DC
      • et al.
      Changes of physical activity and ultra-processed food consumption in adolescents from different countries during COVID-19 pandemic: an observational study.