JMIR Publications

ABSTRACT

Background:

Public health restrictive measures adopted during the COVID-19 pandemic led to significant changes in lifestyles. A global decline in physical activity (PA) and increase in sedentary behavior were noted. These trends were observed within different regions of the world, pointing towards potential long-term implications for PA behaviors.

Objective:

The present mixed-methods study aims to objectively assess variations in daily step counts in Qatar throughout all three COVID-19 waves (February 2020 to February 2022) compared to a full PRE-COVID-19 year. In-depth interviews were further conducted with randomly selected participants to get better insights into determinants, perceptions and barriers of PA during the pandemic.

Methods:

A total of 362 participants (16.6% females) from the Step Into Health community-based program met inclusion criteria and reported their daily step count using either a pedometer (47%) or a mobile phone application (53%). Linear mixed models were used to examine changes in daily step counts over all the 19 studied time phases of implementation and lifting of restrictions, based on independent factors such as sex, age, BMI classification, nationality and device used.

Results:

Compared to PRE-COVID-19, significant declines in daily step counts ranging from 689 to 1,1013 steps were observed at the start of each wave (p < 0.001), with the largest decreases noted at wave 2. The lifting of restrictions at each wave was associated with a recovery of step count (i.e., increase of 609 to 1,147 steps). Different patterns of change in step count emerged within sex (p = 0.030), age (p = 0.027), and BMI (p = 0.010) groups, where larger variations were seen among males (compared to females), pedometer users (compared to mobile users), and normal weight participants (as compared to individuals with overweight and obesity). Major themes emerging from the qualitative analysis concerned disruptions in PA routines and reluctance to return to PRE-COVID routines, lack of support and motivation, influential role of social media, barriers to PA such as limited access to outdoor or dedicated exercise spaces.

Conclusions:

The largest drops in daily step count coincided with increased severity, criticality and fatality of cases in Qatar (rather than the number of daily confirmed cases) and the month of Ramadan. Findings emphasize the need for caution when interpreting step count data from mobile devices, as measurement accuracy varies according to age, sex, BMI, user behavior, and activity preference. These factors should be considered when addressing PA behaviors during public health crises such as the COVID-19 pandemic. Interventions should aim at encouraging outdoor PA and access to reliable PA and exercise recommendations on social media.