Physical Activity During Lockdowns Associated with the COVID-19 Pandemic: A Systematic Review and Multilevel Meta-analysis of 173 Studies with 320,636 Participants

Background: Many countries have restricted public life in order to contain the spread of the novel coronavirus (SARS-CoV2). As a side effect of related measures, physical activity (PA) levels may have decreased. Objective: We aimed (1) to quantify changes in PA and (2) to identify variables potentially predicting PA reductions. Methods: A systematic review with random-effects multilevel meta-analysis was performed, pooling the standardized mean differences in PA measures before and during public life restrictions. Results: A total of 173 trials with moderate methodological quality (modified Downs and Black checklist) were identified. Compared to pre-pandemic, total PA (SMD − 0.65, 95% CI − 1.10 to − 0.21) and walking (SMD − 0.52, 95% CI − 0.29 to − 0.76) decreased while sedentary behavior increased (SMD 0.91, 95% CI: 0.17 to 1.65). Reductions in PA affected all intensities (light: SMD − 0.35, 95% CI − 0.09 to − 0.61, p = .013; moderate: SMD − 0.33, 95% CI − 0.02 to − 0.6; vigorous: SMD − 0.33, − 0.08 to − 0.58, 95% CI − 0.08 to − 0.58) to a similar degree. Moderator analyses revealed no influence of variables such as sex, age, body mass index, or health status. However, the only continent without a PA reduction was Australia and cross-sectional trials yielded higher effect sizes (p < .05). Conclusion: Public life restrictions associated with the COVID-19 pandemic resulted in moderate reductions in PA levels and large increases in sedentary behavior. Health professionals and policy makers should therefore join forces to develop strategies counteracting the adverse effects of inactivity