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Background
The COVID-19 pandemic has entailed a significant socio-economic impact on various layers of the population. In many countries, attempts to control viral dissemination involved lockdown measures that limited citizens' overall mobility and professional and leisure activities.

Objective
This systematic review investigates the impact of COVID-19-induced lockdowns on university student physical activity and sedentary behav-ior, as these relate to physical and mental well-being.

Methods
Data was collected through PubMed/MEDLINE, Embase, SCOPUS, and APA PsycInfo databases until January 2021.

Results
Seven studies conducted in five different countries (United States, Spain, Italy, China, and United Kingdom) were included in the final review. Overall, most studies reported a significant decrease in mild physical activity (i.e., walking) among undergraduate students but not among graduate students. Consistently, most studies reported a significant increase in sedentary time (i.e., sitting time on weekdays) in undergraduate students but not in graduate students. We observed that students who were more sedentary previous to lockdown, increased or did not change their moderate and/or vigorous physical activity. In contrast, those who were less sedentary previous to lockdown decreased their moderate and/or vigorous physical activity.

Conclusions
COVID 19 induced lockdowns appear to have negatively affected walking and sedentary behavior among undergraduate students but not among graduate students. Our results highlight the importance of promoting the World Health Organization recommendations for physical activity and sedentary behavior among university students to improve health outcomes.

Authors: Paola Andrea Rivera[1], Bojan Luc Nys[2,3], Fabián Fiestas[1]

Affiliation:
[1] Escuela de Posgrado, Universidad Privada Antenor Orrego, Trujillo, Peru
[2] Faculty of Arts, KU Leuven, Leuven, Belgium
[3] Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium

E-mail: priverar2@upao.edu.pe

Author address:
[1] 3145 América Sur Avenue, Trujillo,
Peru

Citation: Rivera PA, Nys BL, Fiestas F. Impact of COVID-19 induced lockdown on physical activity and sedentary behavior among university students: A systematic review. Medwave 2021;21(8):e8456 doi: 10.5867/medwave.2021.08.8456

Submission date: 21/4/2021

Acceptance date: 8/8/2021

Publication date: 2/9/2021

Origin: Not commissioned

Type of review: Externally peer-reviewed by four reviewers, double-blind

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1. World Health Organization. Coronavirus disease 2019 (COVID-19): Situation Report, 51. Geneva: WHO; 2020. [On line]. | Link |
2. Johns Hopkins University. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. JHU; 2021. [On line]. | Link |
3. Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020 Jun 27;395(10242):1973-1987. | CrossRef | PubMed |
4. Caristia S, Ferranti M, Skrami E, Raffetti E, Pierannunzio D, Palladino R, et al. Effect of national and local lockdowns on the control of COVID-19 pandemic: a rapid review. Epidemiol Prev. 2020 Sep-Dec;44(5-6 Suppl 2):60-68. | CrossRef | PubMed |
5. Haider N, Osman AY, Gadzekpo A, Akipede GO, Asogun D, Ansumana R, et al. Lockdown measures in response to COVID-19 in nine sub-Saharan African countries. BMJ Glob Health. 2020 Oct;5(10):e003319. | CrossRef | PubMed |
6. World Health Organization. WHO Guidelines on physical activity and sedentary behaviour. Geneva: WHO; 2020. [On line]. | Link |
7. World Health Organization. #HealthyAtHome - Physical activity. WHO; 2021. [On line]. | Link |
8. World Health Organization. Stay physically active during self-quarantine. WHO; 2021. [On line]. | Link |
9. Smith L, Jacob L, Yakkundi A, McDermott D, Armstrong NC, Barnett Y, et al. Correlates of symptoms of anxiety and depression and mental wellbeing associated with COVID-19: a cross-sectional study of UK-based respondents. Psychiatry Res. 2020 Sep;291:113138. | CrossRef | PubMed |
10. Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen Psychiatr. 2020 Mar 6;33(2):e100213. | CrossRef | PubMed |
11. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health. 2020 Mar 6;17(5):1729. | CrossRef | PubMed |
12. Zhang Y, Zhang H, Ma X, Di Q. Mental Health Problems during the COVID-19 Pandemics and the Mitigation Effects of Exercise: A Longitudinal Study of College Students in China. Int J Environ Res Public Health. 2020 May 25;17(10):3722. | CrossRef | PubMed |
13. Schlichtiger J, Brunner S, Steffen J, Huber BC. Mental health impairment triggered by the COVID-19 pandemic in a sample population of German students. J Investig Med. 2020 Dec;68(8):1394-1396. | CrossRef | PubMed |
14. Rogowska AM, Pavlova I, Kuśnierz C, Ochnik D, Bodnar I, Petrytsa P. Does Physical Activity Matter for the Mental Health of University Students during the COVID-19 Pandemic? J Clin Med. 2020 Oct 29;9(11):3494. | CrossRef | PubMed |
15. Maher JP, Hevel DJ, Reifsteck EJ, Drollette ES. Physical activity is positively associated with college students' positive affect regardless of stressful life events during the COVID-19 pandemic. Psychol Sport Exerc. 2021 Jan;52:101826. | CrossRef | PubMed |
16. Xiang MQ, Tan XM, Sun J, Yang HY, Zhao XP, Liu L, et al. Relationship of Physical Activity With Anxiety and Depression Symptoms in Chinese College Students During the COVID-19 Outbreak. Front Psychol. 2020 Nov 20;11:582436. | CrossRef | PubMed |
17. Coughenour C, Gakh M, Pharr JR, Bungum T, Jalene S. Changes in Depression and Physical Activity Among College Students on a Diverse Campus After a COVID-19 Stay-at-Home Order. J Community Health. 2021 Aug;46(4):758-766. | CrossRef | PubMed |
18. Aslan I, Ochnik D, Çınar O. Exploring Perceived Stress among Students in Turkey during the COVID-19 Pandemic. Int J Environ Res Public Health. 2020 Dec 2;17(23):8961. | CrossRef | PubMed |
19. López-Valenciano A, Suárez-Iglesias D, Sanchez-Lastra MA, Ayán C. Impact of COVID-19 Pandemic on University Students' Physical Activity Levels: An Early Systematic Review. Front Psychol. 2021 Jan 15;11:624567. | CrossRef | PubMed |
20. Gallè F, Sabella EA, Da Molin G, De Giglio O, Caggiano G, Di Onofrio V, et al. Understanding Knowledge and Behaviors Related to CoViD-19 Epidemic in Italian Undergraduate Students: The EPICO Study. Int J Environ Res Public Health. 2020 May 16;17(10):3481. | CrossRef | PubMed |
21. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009 Jul 21;6(7):e1000097. | CrossRef | PubMed |
22. Mascha EJ, Vetter TR. Significance, Errors, Power, and Sample Size: The Blocking and Tackling of Statistics. Anesth Analg. 2018 Feb;126(2):691-698. | CrossRef | PubMed |
23. Mendeley Desktop, version 1.19.8. London, UK: Mendeley Ltd [Software].
24. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016 Dec 5;5(1):210. | CrossRef | PubMed |
25. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016 Oct 12;355:i4919. | CrossRef | PubMed |
26. Barkley JE, Lepp A, Glickman E, Farnell G, Beiting J, Wiet R, et al. The Acute Effects of the COVID-19 Pandemic on Physical Activity and Sedentary Behavior in University Students and Employees. Int J Exerc Sci. 2020 Sep 1;13(5):1326-1339. | PubMed |
27. Romero-Blanco C, Rodríguez-Almagro J, Onieva-Zafra MD, Parra-Fernández ML, Prado-Laguna MDC, Hernández-Martínez A. Physical Activity and Sedentary Lifestyle in University Students: Changes during Confinement Due to the COVID-19 Pandemic. Int J Environ Res Public Health. 2020 Sep 9;17(18):6567. | CrossRef | PubMed |
28. Luciano F, Cenacchi V, Vegro V, Pavei G. COVID-19 lockdown: Physical activity, sedentary behaviour and sleep in Italian medicine students. Eur J Sport Sci. 2020 Dec 6:1-10. | CrossRef | PubMed |
29. Gallè F, Sabella EA, Ferracuti S, De Giglio O, Caggiano G, Protano C, et al. Sedentary Behaviors and Physical Activity of Italian Undergraduate Students during Lockdown at the Time of CoViD-19 Pandemic. Int J Environ Res Public Health. 2020 Aug 25;17(17):6171. | CrossRef | PubMed |
30. Yang S, Guo B, Ao L, Yang C, Zhang L, Zhou J, et al. Obesity and activity patterns before and during COVID-19 lockdown among youths in China. Clin Obes. 2020 Dec;10(6):e12416. | CrossRef | PubMed |
31. Savage MJ, James R, Magistro D, Donaldson J, Healy LC, Nevill M, et al. Mental health and movement behaviour during the COVID-19 pandemic in UK university students: Prospective cohort study. Ment Health Phys Act. 2020 Oct 1;19:100357. | CrossRef |
32. Meyer J, McDowell C, Lansing J, Brower C, Smith L, Tully M, et al. Changes in Physical Activity and Sedentary Behavior in Response to COVID-19 and Their Associations with Mental Health in 3052 US Adults. Int J Environ Res Public Health. 2020 Sep 5;17(18):6469. | CrossRef | PubMed |
33. Biswas A, Oh PI, Faulkner GE, Bajaj RR, Silver MA, Mitchell MS, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Ann Intern Med. 2015 Jan 20;162(2):123-32. | CrossRef | PubMed |

World Health Organization. Coronavirus disease 2019 (COVID-19): Situation Report, 51. Geneva: WHO; 2020. [On line]. | Link |

Johns Hopkins University. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. JHU; 2021. [On line]. | Link |

Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020 Jun 27;395(10242):1973-1987. | CrossRef | PubMed |

Caristia S, Ferranti M, Skrami E, Raffetti E, Pierannunzio D, Palladino R, et al. Effect of national and local lockdowns on the control of COVID-19 pandemic: a rapid review. Epidemiol Prev. 2020 Sep-Dec;44(5-6 Suppl 2):60-68. | CrossRef | PubMed |

Haider N, Osman AY, Gadzekpo A, Akipede GO, Asogun D, Ansumana R, et al. Lockdown measures in response to COVID-19 in nine sub-Saharan African countries. BMJ Glob Health. 2020 Oct;5(10):e003319. | CrossRef | PubMed |

World Health Organization. WHO Guidelines on physical activity and sedentary behaviour. Geneva: WHO; 2020. [On line]. | Link |

World Health Organization. #HealthyAtHome - Physical activity. WHO; 2021. [On line]. | Link |

World Health Organization. Stay physically active during self-quarantine. WHO; 2021. [On line]. | Link |

Smith L, Jacob L, Yakkundi A, McDermott D, Armstrong NC, Barnett Y, et al. Correlates of symptoms of anxiety and depression and mental wellbeing associated with COVID-19: a cross-sectional study of UK-based respondents. Psychiatry Res. 2020 Sep;291:113138. | CrossRef | PubMed |

Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen Psychiatr. 2020 Mar 6;33(2):e100213. | CrossRef | PubMed |

Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health. 2020 Mar 6;17(5):1729. | CrossRef | PubMed |

Zhang Y, Zhang H, Ma X, Di Q. Mental Health Problems during the COVID-19 Pandemics and the Mitigation Effects of Exercise: A Longitudinal Study of College Students in China. Int J Environ Res Public Health. 2020 May 25;17(10):3722. | CrossRef | PubMed |

Schlichtiger J, Brunner S, Steffen J, Huber BC. Mental health impairment triggered by the COVID-19 pandemic in a sample population of German students. J Investig Med. 2020 Dec;68(8):1394-1396. | CrossRef | PubMed |

Rogowska AM, Pavlova I, Kuśnierz C, Ochnik D, Bodnar I, Petrytsa P. Does Physical Activity Matter for the Mental Health of University Students during the COVID-19 Pandemic? J Clin Med. 2020 Oct 29;9(11):3494. | CrossRef | PubMed |

Maher JP, Hevel DJ, Reifsteck EJ, Drollette ES. Physical activity is positively associated with college students' positive affect regardless of stressful life events during the COVID-19 pandemic. Psychol Sport Exerc. 2021 Jan;52:101826. | CrossRef | PubMed |

Xiang MQ, Tan XM, Sun J, Yang HY, Zhao XP, Liu L, et al. Relationship of Physical Activity With Anxiety and Depression Symptoms in Chinese College Students During the COVID-19 Outbreak. Front Psychol. 2020 Nov 20;11:582436. | CrossRef | PubMed |

Coughenour C, Gakh M, Pharr JR, Bungum T, Jalene S. Changes in Depression and Physical Activity Among College Students on a Diverse Campus After a COVID-19 Stay-at-Home Order. J Community Health. 2021 Aug;46(4):758-766. | CrossRef | PubMed |

Aslan I, Ochnik D, Çınar O. Exploring Perceived Stress among Students in Turkey during the COVID-19 Pandemic. Int J Environ Res Public Health. 2020 Dec 2;17(23):8961. | CrossRef | PubMed |

López-Valenciano A, Suárez-Iglesias D, Sanchez-Lastra MA, Ayán C. Impact of COVID-19 Pandemic on University Students' Physical Activity Levels: An Early Systematic Review. Front Psychol. 2021 Jan 15;11:624567. | CrossRef | PubMed |

Gallè F, Sabella EA, Da Molin G, De Giglio O, Caggiano G, Di Onofrio V, et al. Understanding Knowledge and Behaviors Related to CoViD-19 Epidemic in Italian Undergraduate Students: The EPICO Study. Int J Environ Res Public Health. 2020 May 16;17(10):3481. | CrossRef | PubMed |

Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009 Jul 21;6(7):e1000097. | CrossRef | PubMed |

Mascha EJ, Vetter TR. Significance, Errors, Power, and Sample Size: The Blocking and Tackling of Statistics. Anesth Analg. 2018 Feb;126(2):691-698. | CrossRef | PubMed |

Mendeley Desktop, version 1.19.8. London, UK: Mendeley Ltd [Software].

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016 Dec 5;5(1):210. | CrossRef | PubMed |

Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016 Oct 12;355:i4919. | CrossRef | PubMed |

Barkley JE, Lepp A, Glickman E, Farnell G, Beiting J, Wiet R, et al. The Acute Effects of the COVID-19 Pandemic on Physical Activity and Sedentary Behavior in University Students and Employees. Int J Exerc Sci. 2020 Sep 1;13(5):1326-1339. | PubMed |

Romero-Blanco C, Rodríguez-Almagro J, Onieva-Zafra MD, Parra-Fernández ML, Prado-Laguna MDC, Hernández-Martínez A. Physical Activity and Sedentary Lifestyle in University Students: Changes during Confinement Due to the COVID-19 Pandemic. Int J Environ Res Public Health. 2020 Sep 9;17(18):6567. | CrossRef | PubMed |

Luciano F, Cenacchi V, Vegro V, Pavei G. COVID-19 lockdown: Physical activity, sedentary behaviour and sleep in Italian medicine students. Eur J Sport Sci. 2020 Dec 6:1-10. | CrossRef | PubMed |

Gallè F, Sabella EA, Ferracuti S, De Giglio O, Caggiano G, Protano C, et al. Sedentary Behaviors and Physical Activity of Italian Undergraduate Students during Lockdown at the Time of CoViD-19 Pandemic. Int J Environ Res Public Health. 2020 Aug 25;17(17):6171. | CrossRef | PubMed |

Yang S, Guo B, Ao L, Yang C, Zhang L, Zhou J, et al. Obesity and activity patterns before and during COVID-19 lockdown among youths in China. Clin Obes. 2020 Dec;10(6):e12416. | CrossRef | PubMed |

Savage MJ, James R, Magistro D, Donaldson J, Healy LC, Nevill M, et al. Mental health and movement behaviour during the COVID-19 pandemic in UK university students: Prospective cohort study. Ment Health Phys Act. 2020 Oct 1;19:100357. | CrossRef |

Meyer J, McDowell C, Lansing J, Brower C, Smith L, Tully M, et al. Changes in Physical Activity and Sedentary Behavior in Response to COVID-19 and Their Associations with Mental Health in 3052 US Adults. Int J Environ Res Public Health. 2020 Sep 5;17(18):6469. | CrossRef | PubMed |

Biswas A, Oh PI, Faulkner GE, Bajaj RR, Silver MA, Mitchell MS, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Ann Intern Med. 2015 Jan 20;162(2):123-32. | CrossRef | PubMed |