The COVID-19 pandemic has brought about unprecedented challenges and disruptions to various aspects of daily life. It has resulted in widespread lockdown measures and social distancing guidelines, which have significantly limited individuals' opportunities for physical activity. Numerous studies have reported a decline in physical activity levels during the pandemic, with reductions in both moderate-to-vigorous intensity physical activity and overall sedentary behavior [13–15]. These reductions are concerning, as lack of adequate level of physical activity has been consistently linked to various negative health outcomes, including cardiovascular diseases, obesity, mental health disorders, and compromised immune function [9]. 4.2 million deaths from SARS-CoV-2 have been reported from the begging of pandemic until July 2021 in countries around the world [16]. The COVID-19 pandemic resulted in approximately 1 million excess deaths in 2020 in 29 high income countries analyzed by Islam et al. [17]. Researchers found that Poland was among the five countries with the highest number of excess deaths (over 60 000 excess deaths in 2020). The death rate in 2020 in Poland was the highest in 70 years and it was the highest in fourth quarter of 2020. It was estimated that deaths caused by COVID-19 were 9% of all deaths at that time. In all age groups, but especially in the older ones (over 60 years old), men were more likely to die than women [18]. In 2021 in Poland 42 thousand more people died compared to 2020. Almost every fifth death in that time was caused by the COVID-19 pandemic [19].
According to data gathered by Polish Central Statistical Office (Główny Urząd Statystyczny, GUS), in 2016 in Poland 21,7% of people engaged in regular physical activity. In 2021, this rate decreased to 20,6%. Big city inhabitants were more likely to exercise than people who live in the countryside. Interestingly, in 2021 4,2% of people in Poland claimed they were not exercising because of the restrictions caused by the COVID-19 pandemic. 1,2% refused to exercise due to the risk of infection [20]. In our study, we could observe that people who lived in big cities did in fact tend to engage in sport more frequently than those who lived in the countryside.
The NTZP results presented in this article show a general trend of improvement in the quantity of physical activity in the form of sport participation and walking between the two waves of NTZP study. The general trend in similar research has been the decline of physical activity and increase of sedentary time due to the pandemic [21]. A study from Brazil (N = 4 290) found that, compared to before the pandemic, there was a 72% reduction in physical activity related to commuting. At the same time, there was an increase of 145% in physical inactivity [22]. Interestingly, the authors also found that 14,8% of people who adhered to social-distancing measures during the pandemic was meeting the recommendations for daily amount of physical activity ( > = 150min/week). Out of those who did not comply with social-distancing measures, the prevalence of meeting physical activity recommendations was 26,9%. There was also a negative correlation between meeting the physical activity health recommendations and level of fear of the pandemic reported by the respondents- people less afraid of the pandemic tended to engage in sufficient level of leisure time and commuting physical activity more frequently. This tendency may partially explain the reason for the results of our study. It is possible that some people were not treating the social-distancing and other pandemic-related measures as they were not experiencing a great level of fear of the pandemic. Additionally, working from home was found to be a protective factor against physical inactivity, which was also seen in a study by Moura at al. [23]. What is more, in that study leisure-time physical activity levels declined the least when compared to other types of physical activity, such as commuting. Our study focused on engaging in sport as form of physical activity, which is a type of leisure-time physical activity. The authors of the mentioned study point to the fact that people who engaged in more leisure-time physical activity (who were more educated and had higher income) were also more likely to practice such activity even after the restrictions were imposed.
A group that is especially vulnerable to complications of COVID-19 infection is the elderly. This group is often characterized by insufficient levels of physical activity, as observed in a more in-depth analysis of physical activity in the elderly who completed the NTZP survey [12]. Older group of people was also a focus of the Swedish study (N = 624, 65–99 years old), results of which were described by Sjöberg et al. [24]. They found that older individuals with psychiatric illnesses, physical dysfunctions or poor social support were more likely to experience a reduction in light and higher-intensity physical activity due to the pandemic. Interestingly, current smokers and those with impaired balance were less likely to reduce their levels of higher-intensity physical activity. Authors suggest that these results could be explained partially by the nicotine increasing risk seeking behaviors in people [25] (in this case a risky behavior is for example going to the gym, where risk of infection is greater), however due to a relatively low number of smokers in the study it is suggested that this finding should be interpreted with caution and that there is a need for verification in future studies. A study of an Italian population of older people (N = 939, mean age = 75,9) found that over half of the male respondents reported their physical activity level to be equal to that before the pandemic and in 5,7% of those respondents it increased. Men were also found to be more engaged in leisure-time activities (such as sport), than women who engaged more in household activities [26]. In our study the oldest group of respondents (over 65 year old) showed an increase by 2% of those engaging in at least 2 hours of sport per week (from 19,9% to 21,9%). This percentage of active older people is, however, still very low.
Joseph et al. noticed a decrease in the level of physical activity in respondents in the Wave 2 of their study, which was conducted mid-May to early June 2020 and included mostly middle-aged, non-Hispanic white and female subjects [27]. Wave 3, conducted mid-June to early July 2020 showed, however, a slight increase in moderate- and vigorous-intensity PA, remaining significantly below pre-pandemic levels, which were reported by the respondents in Wave 2. Authors suggest that this increase may have been caused by more information being available to the public on how the novel coronavirus was being transmitted as well as on the ways to minimize the risk of infection. Our study was conducted in waves separated by a year (mid-January to mid-March 2020 for NTZP 1 and the same time in 2021 for NTZP 2). During that first year of pandemic, the amount of information presented to the public regarding the SARS-CoV-2 virus was increasing every week. As news of the vaccine started to be published, there is a possibility that for some people it resulted in more willingness to engage in behaviors directed on improving their health, such as sport participation.
A British qualitative study (N = 40) [28] conducted using phone interviews between May and July 2020, showed that participants who engaged in unhealthy behaviors (such as comfort eating due to stress and increased alcohol intake) in the early days of lockdown, tried to consciously decrease these behaviors when the restrictions lasted longer than they first anticipated. What is more, the switch to remote work and more flexible working times allowed for more physical activity for some respondents. It was also reported that physical activity acted as an opportunity for social interaction during these times. Some participants claimed the willingness to continue choosing less sedentary means of social interaction even after the restrictions were lifted. The authors suggest that for some people the pandemic possibly exposed the need for staying active as an important factor to support physical and mental health, especially during difficult times.
Alfawaz et al. [29] observed an increase in the number of people who reported engaging in swimming during the time of pandemic-related restrictions, such as lockdown. In contrast, the number of people who never exercised at home with weights increased during the lockdown. It is possible that even though exercising at home seems like a widely available form of physical activity, for some it is the opposite as they may lack the knowledge, equipment and space for such workouts. Additionally, their home-life affected by lockdown and chores may have an impact on the possibility and willingness to engage in this sort of physical activity. This study was included in the review by Evenson et al. [30], which found that in Saudi Arabia there was a general tendency for physical activity levels to decrease and inactivity levels to increase in the short-term with conjunction with lockdown and stay-at-home restrictions.
Strain et al. [31] compared levels of physical activity in people over 16 years old in England in 2016-19 and during mid-April to mid-May of 2020. This study showed an increase in people choosing to engage in walking for leisure and gardening as forms of physical activity, while team and racket sport participation was lower during the lockdown. This was caused by the need to limit physical interactions between people, therefore sports that required two or more people were significantly more difficult to engage in during that time.
In South Korea, a general population–based and repeated cross-sectional study including over 2,7 million Korean adults found that a stable level of physical activity before the onset of the pandemic decreased in 2020 and 2021, particularly among groups of those with increased risk of negative outcomes (older adults, women, urban residents and people with a history of depressive episodes), but also healthy individuals [32]. Interestingly, younger individuals (19–39 years old) showed an initial decrease in their PA prevalence in 2020, but a subsequent increase in 2021, returning to pre-pandemic levels.
Effects of home Confinement on multiple Lifestyle Behaviours during the COVID-19 outbreak (ECLB-COVID19) project used an online survey that was completed by over five thousand respondents from Europe, North-Africa, Western-Asia, and the Americas [33]. The survey was made available to fill-out on April 6th 2020 and included the short form of the International Physical Activity Questionnaire. Respondents were asked to answer questions regarding the time before and during the confinement period. Results showed a significant difference between the claimed level of physical activity between the two time periods, with a decrease during lockdown. These findings refer to the time of early-pandemic lockdowns, which were the most strict and restrictive. In contrast, our study includes two waves of survey, separated by a year. Responses in the second NTZP were collected almost a year after the onset of COVID-19 pandemic in Poland.
As Czyż and Starościak [34] pointed out, moderate physical activity tends to be over-estimated by respondents in questionnaires, which may affect the results as this kind of activity is usually the most common. These authors have also hypothesized that the increase in physical activity during the pandemic could have been caused by people starting to be more active at home doing renovations, as do-it-yourself stores remained opened during lockdowns. There have also been reports on the impact COVID-19 has on physical activity in recovering patients [35]. The article describes findings from online long-COVID-19 peer support groups. A reduction in self-reported walking time among participants six months after the onset of symptoms has been observed. However, in contrast, there was an increase in the proportion of participants who reported engaging in indoor walking or cycling during the same six-month period after the onset of symptoms. This may be another reason for the increase in physical activity despite the pandemic-related restrictions: people switched to at-home sport activities, therefore their overall physical activity increased. Another reason for the increase in time spent on sport and walking observed in our study may be the switch to remote work that many companies made in the pandemic. Schools and universities also started implementing remote solutions. For many people this resulted in added time during the day that would normally be spent on commuting to and from work or school. This saved time could then be spent on engaging in physical activity.
Walking, a simple and accessible form of exercise, has gained increased attention due to its potential benefits for both physical and mental health during the COVID-19 pandemic. It has been widely observed that time spent walking has decreased due to pandemic-related restrictions [33]. Our study has found that respondents tended to spend more time on walking a year after the first pandemic restrictions were put in place in Poland, compared to before. These findings may be an effect of over-estimation of the time spent on walking by the respondents. However, the largest part of respondents in both waves claim they spend less than 30 minutes a day on walking (either in the form of walks or as a means of getting from one place to another). As walking is one of the most accessible forms of physical activity, there should be an effort to promote it among the general population, along with ensuring appropriate infrastructure enabling people to participate in such activity [36].
Engaging in regular physical exercise has been shown to have positive effects on mood, self-esteem, and stress reduction, primarily through the release of endorphins and other neurotransmitters [37]. Existing literature indicates that physical activity plays a significant role in preventing and treating COVID-19 as well as helping in the recovery of physical function and alleviating symptoms of post-acute COVID-19 syndrome [38]. It has also been proposed that physical activity may be a coadjuvant treatment to the COVID-19 vaccinations, boosting antibody responses [39]. Additionally, physical inactivity in people that were later infected by the COVID-19 was connected with greater probability of hospitalization, admission to the intensive care unit, and death as a result of this disease [40]. Thus, promoting physical activity during the pandemic could serve as an essential strategy to mitigate the detrimental effects on mental well-being. Efforts focused on promoting physical activity and active lifestyle have been made during the COVID-19 pandemic in Poland. Videos with exercises to perform at home were published on the National Nutrition Education Center’s YouTube profile, financed by the Ministry of Health. Also Medonet, the Internet platform that conducted the NTZP study, published a number of articles encouraging readers to remain active during the lockdown. It cannot be denied that these efforts reached a number of people, possibly encouraging them to improve their lifestyle.
The advantage of National Test for Poles Health, as an online survey conducted by Medonet, one of Poland's largest health-oriented Internet platforms, is its accessibility for potential participants, which provides a substantial sample size. Over 300 000 people took part in the 2020 and 2021 edition of NTZP. To the best of our knowledge there is the largest study devoted to physical activity level during COVID-19 pandemics in Europe, probably also in the whole world. What is more, the respondents groups were highly representative of the Polish population in age, sex, place of dwelling and employment status, which makes it one of the biggest sources of valuable information on the population’s health. Respondents groups were also highly similar between the two waves of NTZP study. Interpreting results of survey studies with large sample sizes should always be exercised with caution as also minor changes in percentages, while statistically significant, are frequently observed. The questionnaire was constructed to be easy to understand for any respondent, avoiding specialized language. However, there are also limitations associated with this approach, such as the inability to verify the credibility of respondents' identities and their responses. While the questions have been designed to be easily understandable for all, there is a possibility that some respondents may not fully comprehend them, potentially impacting their answers. The form of questions may have also limited the accuracy of responses. This test focused on the two most common physical activities: sport participation and walking. It did not however include domestic physical activity such as doing house chores. During the COVID-19 pandemic, online surveys were the safest means of gathering information from a large group of respondents due to the necessary restrictions and social-distancing measures. The authors also acknowledge the fact that the validity of the questionnaire was not measured. Furthermore, a limitation of the study was that the questionnaires were self-administered, and there was no supervision to ensure the accuracy of responses. Additionally, the questionnaire did not include a measure of the intensity of physical activity.
Contrary to most research in this area, our study found that there was a small, but statistically significant, increase in time spent on sport participation and walking in all groups of the respondents. However, overall level of physical activity in Poland remains too low and is not sufficient. Most Polish people do not meet the recommended level of physical activity, which is one among important reasons for a high number of many non-communicable diseases in this country [41]. The National Test for Poles’ Health published results of the third and fourth wave, conducted in 2022 and 2023. Unstandardized results of these surveys show that sport participation decreased and started to reach similar levels to those from before the pandemic. This is however a subject for further analysis that the authors of this article are working on. Insufficient level of physical activity is a problem for public health and there is a need for efforts to combat this. Overall, our study provides valuable information on the effect the COVID-19 may have had on selected health behaviors and habits of the Polish population, which could serve as a guide in health promotion during challenging times of pandemic.