Physical activity and health during the SARS-COV-2 pandemic : the effectiveness of an online physical activity intervention

Abstract

Regular physical activity (PA) is known to have several benefits in terms of physical and mental wellbeing. Researchers in the field of public health have investigated these benefits for several years with the general consensus that regular PA has immense potential to maintain health, prevent the development of non-communicable diseases and to contribute toward overall well-being. The last years have seen the emergence of online PA programmes as an option for increasing PA and this continues to increase with the evolution of technology and development of resources. The overall concept of online PA has been shown to provide PA opportunities for individuals who may not be able to, or may not desire to, access traditional PA establishments such as gyms, sports centres and clubs, among many others. It also provides an additional option for the accumulation of PA. In March 2020, South Africa became integrated in the fight against the SARS-CoV-2 pandemic. The pandemic was an unpredictable time for the global population, with this highly contagious virus creating a state of disaster around the world. SARS-CoV-2, otherwise known as COVID-19, left the health sector in a state of turmoil. The high mortality and hospitalisation rates associated with the virus rapidly depleted healthcare resources. Government officials around the world were forced to impose lockdown restrictions in an attempt to control the spread of the virus, decrease mortality and hospitalisation rates and conserve healthcare resources. The lockdown restrictions were implemented according to WHO guidelines and allowed for individuals to move around only when considered essential. These restrictions may have assisted in managing the pandemic, however, the isolation created an underlying concern with regards to PA, particularly as a result of the closure of most public spaces, including sport establishments. Consequently, this necessitated a dire need for online PA programmes to become a more focused mechanism for promoting the accumulation of PA and minimising the impact of the reduced conventional PA opportunities, during the pandemic. Aims & Objectives This study aims to interrogate existing online PA programmes and their effects on physical and mental outcome measures and to evaluate the effectiveness of an online physical activity intervention programme during the SARS-CoV-2 pandemic. Objective 1 To conduct a PROSPERO registered systematic review and meta-analysis pertaining to online PA interventions and its effectiveness in healthy individuals with regard to physical and mental outcome measures. Objective 2 To conduct a re-focused analysis of and report on the South African data from an international online population-based survey. Objective 3 To lead the South African cohort of a multicentred, two-armed, randomised-controlled trial and specifically re-analyse and report on the South African specific data obtained from this trial. Objective 4 To provide guidelines and recommendations for future online PA programmes based on the research findings. Methods Systematic Review and Meta-analysis A literature search was conducted on PubMed, Cochrane and Google Scholar. RCTs that were 4-weeks or longer in duration which investigated the effectiveness of online exercise (OE) versus no exercise (NEX) controls or face-to-face (FFE) exercise in healthy adults were included. A quality rating of each study included was conducted using the PEDro scale. Relevant data from each study were then extracted for a meta-analysis. The effect sizes were pooled using robust variance estimation. South African Survey A focused analysis of the SA statistics from the global Activity and health during the SARS- CoV-2 Pandemic (ASAP) study was conducted. This descriptive study consisted of an online cross-sectional questionnaire that was administered from 3 April 2020 to 9 May 2020. The questionnaire used the Nordic Physical Activity Questionnaire-short (NPAQ-short), and a five- point Likert scale to quantify changes in PA levels and WHO PA guideline compliance respectively. The data were analysed according to age and gender categories. Logistic regression was performed to identify significant themes emerging from the data. South African Analysis of a Global Randomised Controlled Trial A multicentred RCT was conducted to assess the effects of an 8-week trial (4-weeks of active intervention and 4-weeks of recorded sessions), with live-streaming exercise sessions provided by professionals in the field of sports and exercise medicine. Measures of physical and mental wellbeing were evaluated by means of weekly digital surveys. These measures included the NPAQ-short for PA levels, Generalised Anxiety Disorder Scale-7 (GAD-7) for anxiety, WHO- 5 for mental wellbeing, Medical Outcome Study Sleep Scale (MOS sleep scale) for sleep, Chronic Pain Grade Scale (CPGS) for pain and disability and Self-Concordance Scale (SKK) for exercise motivation. The thesis includes a focused analysis of SA data from the global study, to assess SA-specific changes in PA levels and exercise motivation during the initial 4 weeks (live-streaming sessions) of the intervention. Guidelines for Future Online Physical Activity Interventions Specific recommendations for future online PA programs, have been formulated based on the findings of the various parts of this thesis. Findings Systematic Review and Meta-analysis A total of 18 moderate to high methodological quality studies (PEDro scale) were included. OE improved more than NEX in measures of strength (Standard Mean Difference (SMD) =0.61), balance (SMD=0.52), endurance (SMD=0.85), PA (SMD=0.46), depression (SMD=1.08), mood/emotion (SMD=0.47), mental wellbeing (SMD=0.79), and self-efficacy (SMD=1.1). OE was less effective than FFE in all outcomes. GRADE classification revealed a low-moderate evidence certainty. South African Survey The analysis of 456 adult participants questionnaire responses revealed that, moderate (MPA) and vigorous (VPA) PA were reported to have reduced by 53.5% and 58%, respectively. The SA reductions in PA were higher than the those noted in the overall global study where reductions were reported as 41% in MPA and 42.2% in VPA. Approximately one third (30%) of the SA sample recorded a reduction in WHO PA guideline compliance during lockdown restrictions. South African Analysis of a Global Randomised Controlled Trial The analysis of the data from 105 participants (65 intervention; 40 control), that completed the initial 4-weeks active phase of the RCT showed a reduction in MPA in both the intervention group (IG) and control group (CG) of 32.6% and 16.1% respectively. VPA also reduced in the IG (42.1%), however, increased in the CG. Scores for exercise motivation increased by 13.1% and 16.9% IG and CG, respectively. Conclusion The systematic review and meta-analysis conducted in this thesis, indicates that there is a moderate level of evidence to support the use of online PA, when attempting to improve markers of physical and mental health. The SARS-CoV-2 pandemic, placed further emphasis on the need for effective online PA protocols, that allow for an increase in PA engagement as shown by the results of the survey analysed in this thesis. This need is exaggerated in instances when individuals are unable to access face-to-face PA facilities, especially since literature analysis indicated there is merit to online PA programs. However, the RCT analysis revealed that, in order for specific populations like South Africans, to benefit fully from such programs, there needs to be a level of customisation in the program planning. This customisation should carefully consider the context, strengths and limitations that are population specific. Notwithstanding this, there is great potential in the field of online PA intervention research, particularly considering that existing online PA interventions have been reported as effective in not only improving PA levels but also towards supporting overall wellbeing. Future online PA interventions should therefore consider the identified key focus aspects during the development and implementation, to maximise uptake outcomes and overall impact of such programmes.