In a recent study published in JAMA Network Open, researchers in Tennessee investigated whether the coronavirus disease 2019 (COVID-19) pandemic altered daily step counts among individuals participating in All of Us (AOU) research programs.
Study: Daily Step Counts Before and After the COVID-19 Pandemic Among All of Us Research Participants. Image Credit: FotoAndalucia / Shutterstock
Background
The global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak has impacted mental, social, and physical health. Studies conducted during the initial pandemic indicated a global regular activity level drop. However, factors associated with the lowering step counts in the COVID-19 scenario are not well-characterized and require further investigation.
About the study
The present study compared daily step counts before and after the SARS-CoV-2 outbreak in the United States (US).
The study, using the AOU program-controlled dataset (released in June 2022), comprised individuals who wore digital devices to track step counts for ≥10.0 days per month. Daily activity (averaged per month) was assessed over four years, between January 2018 and December 2021.
The counterfactual analyses were performed based on two years of regular activity data from pre-COVID-19 for estimating daily step counts in the post-SARS-CoV-2 pandemic.
Surveys were distributed to assess sociodemographic variables, location, deprivation index, and mental well-being at enrollment. Linear mixed-effects modeling was performed to determine the relationships between SARS-CoV-2 vaccination status, comorbidities, mental health, and sociodemographic factors, and the differences in the observed and predicted daily step counts in the post-SARS-CoV-2 pandemic period.
Data adjustments were made for age, gender, deprivation index, region, and income. The period between 1 January 2029 and 31 January 2020 was considered the pre-SARS-CoV-2 pandemic period, and between 1 June 2020 and 31 December 2021 was considered the post-SARS-CoV-2 pandemic period.
Results
Data of 5,443 individuals who wore digital tracking devices for ≥6.0 months before and after COVID-19 were analyzed, among whom 72% (n=3,903) were female, 86% (n=4,681) were White, 54% received ≥1.0 COVID-19 vaccine doses, and the median participant age was 53 years. In total, 100 SARS-CoV-2 infections were documented during the study period.
The median income in the study cohort was 61,193 dollars. Concerning comorbidities, 12%, 3.3%, 3.2%, 38%, and 23% of the participants suffered from obesity, diabetes, coronary artery disease, hypertension, and cancer, respectively. The mean values for the deprivation index, impact of event scale (IES) scores, patient health questionnaire (PHQ) scores, and perceived stress scale (PSS) scores were 0.3, 1.2, 2.0, and 11.5, respectively.
The median values for the observed daily steps taken before and after the SARS-CoV-2 pandemic were 7,808 and 7,089, respectively. Counterfactual analysis estimates indicated 575 fewer daily steps in the post-SARS-CoV-2 pandemic period.
The differences between observed and predicted steps taken in the post-SARS-CoV-2 pandemic period could be explained significantly by lower age, north-eastern regions, and greater deprivation index. In addition, the number of steps taken in the post-SARS-CoV-2 pandemic period could be explained by the status of SARS-CoV-2 vaccination, psychological stress, and depression.
There were no significant associations between the reduced number of steps and gender or comorbidities, including diabetes, obesity, hypertension, cancer, or coronary artery disease. The reduction in daily step counts post-COVID-19 remained persistently significant even post-relaxation of most SARS-CoV-2 pandemic-associated restrictions, indicating that the COVID-19 pandemic affected behavior in the long run term. Modest, long-term reductions in physical activity associated with COVID-19 could increase cardiovascular disease risks.
Differences in observed and predicted (counterfactual) regular physical activity post-SARS-CoV-2 pandemic period for males (versus females), north-eastern regions (versus all other regions), midwestern regions (versus other regions), southern regions (versus other regions), western regions (versus other regions) and vaccinated (versus unvaccinated individuals) were -84.6, -288.1, 24.8, 98.6, 164.8 and 48.0, respectively.
Age differences (10 years), the median income (10,000 dollars), deprivation index (tenths), obesity, diabetes, coronary artery disease, cancer, and hypertension were 243.4, -194.7, -477.1, -190.9, -241.3, 34.4, -64.1, and 13.7, respectively. Concerning mental health outcomes, estimated step differences for IES, PHQ, and PSS scores were -177.9, -36.4, and -13.4, respectively.
Conclusion
Overall, the study findings showed a widespread, consistent, and statistically significant reduction in daily step counts following the SARS-CoV-2 outbreak in the United States.
Individuals with lower socioeconomic status and poorer mental health during the initial pandemic were highly vulnerable to the risk of lowered physical activity.
Cardiovascular risks post-COVID-19 vaccination: Key findings