Worldwide Effect of COVID-19 on Physical Activity: A Descriptive Study

Abstract

Letters29 June 2020Worldwide Effect of COVID-19 on Physical Activity: A Descriptive StudyFREEGeoffrey H. Tison, MD, MPH, Robert Avram, MD, MSc, Peter Kuhar, BS, Sean Abreau, MSc, Greg M. Marcus, MD, MAS, Mark J. Pletcher, MD, MPH, and Jeffrey E. Olgin, MDGeoffrey H. Tison, MD, MPHUniversity of California, San Francisco, and Bakar Computational Health Sciences Institute, San Francisco, California (G.H.T.)Search for more papers by this author, Robert Avram, MD, MScUniversity of California, San Francisco, San Francisco, California (R.A., S.A., G.M.M., M.J.P., J.E.O.)Search for more papers by this author, Peter Kuhar, BSAzumio, Redwood City, California (P.K.)Search for more papers by this author, Sean Abreau, MScUniversity of California, San Francisco, San Francisco, California (R.A., S.A., G.M.M., M.J.P., J.E.O.)Search for more papers by this author, Greg M. Marcus, MD, MASUniversity of California, San Francisco, San Francisco, California (R.A., S.A., G.M.M., M.J.P., J.E.O.)Search for more papers by this author, Mark J. Pletcher, MD, MPHUniversity of California, San Francisco, San Francisco, California (R.A., S.A., G.M.M., M.J.P., J.E.O.)Search for more papers by this author, and Jeffrey E. Olgin, MDUniversity of California, San Francisco, San Francisco, California (R.A., S.A., G.M.M., M.J.P., J.E.O.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-2665 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: On 11 March 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) to be a global pandemic (1). To curb the spread of the disease, various regional and national governments advocated for social distancing measures with varying degrees of enforcement, ranging from unenforced recommendations to quarantine and business closures. Physical activity is an important determinant of health (2) and is likely affected by social distancing measures. Daily step count, a proxy for physical activity, has been associated with all-cause mortality (3). Beyond physical activity, regional step count trends may also provide a proxy for adherence to social distancing, providing real-time insights to inform public policy decisions. Because prolonged social distancing is considered to contain infection, it will be important to gauge adherence to these measures and their effect on other aspects of health, such as physical activity.Objective: To examine worldwide changes in step count before and after the announcement of COVID-19 as a global pandemic.Methods and Findings: In this descriptive study, we used deidentified, individual-level data from 19 January to 1 June 2020 that were collected from a convenience sample of users of the free, popular health and wellness smartphone app Argus (Azumio). Daily step counts were determined using smartphone accelerometers and Apple or Android algorithms for step counting (4). User location was determined by smartphone IP address. The COVID-19 pandemic declaration date used was 11 March 2020. Regional mean steps were calculated daily, and percentage of change in steps was calculated daily as a percentage of the regional mean from 19 January to 11 March 2020. Displayed figure regions were selected to achieve half less-affected and half more-affected regions with regard to both COVID-19 and social distancing and greater than 1000 and 700 users at the country and city levels, respectively. This study was exempted by the University of California, San Francisco Institutional Review Board.A total of 19 144 639 daily step count measurements were provided by 455 404 unique users from 187 unique countries during the study period; 92% of smartphones were Apple, and 8% were Android. Worldwide, within 10 days of the pandemic declaration, there was a 5.5% decrease in mean steps (287 steps), and within 30 days, there was a 27.3% decrease in mean steps (1432 steps). There was wide regional variation in average step count change and in the timing and rate of that change (Figures 1 and 2). For example, Italy declared a nationwide lockdown on 9 March 2020 and exhibited a 48.7% maximal decrease, whereas Sweden, to date, has primarily advocated for social distancing and limitations on gatherings and showed a 6.9% maximal decrease. Samples from countries such as Italy and Iran, which had earlier regional COVID-19 outbreaks, exhibited earlier step count decreases from their relative baselines. Samples from different countries varied widely in the number of days after pandemic declaration that a 15% step count decrease was seen: Italy (5 days), Spain (9 days), France (12 days), India (14 days), the United States (15 days), the United Kingdom (17 days), Australia (19 days), and Japan (24 days). Step count trends in samples from U.S. cities exhibited similarities, although there was wide international variability (Figure 2).Figure 1. Mean dai