Perspectives of the Saudi medical students toward the impact of lockdowns on their physical activity level and lifestyle during the COVID-19 pandemic

Introduction

Physical activity (PA) is defined as any bodily movement that is performed by skeletal muscles and requires energy expenditure that is measured in kilocalories (World Health Organization, 2022). Engaging in PA promotes multiple benefits such as improving cardiorespiratory fitness and muscle movements, maintaining healthy bones and skeleton systems, and improving individuals’ mental ability and overall quality of life (AlTamimi et al., 2021; World Health Organization, 2022).

According to the World Health Organization (WHO) guidelines, adults are recommended to engage in at least 150–300 min of moderate-intensity aerobic PA or 75–150 min of vigorous-intensity PA, or a combination of both, throughout the week (World Health Organization, 2022). It has been reported that about 5.3 million deaths annually are directly related to the lack of PA (Wen & Wu, 2012). Furthermore, previous research found a significant association between physical inactivity and the development of various diseases including cancers, weight gain, cardiovascular disease, endocrine disease, and elevated levels of cholesterols and triglycerides (Alahmed & Lobelo, 2018; Stubbs et al., 2018; Joy, Vincent & Vincent, 2020; An et al., 2020; AlTamimi et al., 2021).

Globally, the level of PA reported among university students was low and insufficient (Rejali & Mostajeran, 2013; Janampa-Apaza et al., 2021). This may be due to some factors including smoking, overweight and, unhealthy eating habits, and a sedentary lifestyle (Jiang et al., 2019; Lavie et al., 2019). University students try to cope with the stress associated with their lifestyle and academic routine (Ruiz, Ontoso & Guillén-Grima, 2019; Bashatah, 2020; Samreen, Siddiqui & Mothana, 2020; Althumiri et al., 2021). However, in Saudi Arabia, university students are not active to meet the required guidelines for moderate PA (Al-Hazzaa, 2018).

Lifestyle has been defined by the Oxford English Dictionary as “the way in which one lives” (Veal, 1993). A healthy lifestyle means practicing a number of habits including regular PA, a balanced diet, and refraining from smoking and excessive alcohol consumption (World Health Organization, 1999).

A global pandemic was triggered by the 2019 coronavirus disease (COVID-19) (Barkley et al., 2020). It has reached most countries around the world. According to the WHO, since it is becoming increasingly difficult to stop the spread of the virus, countries must take strict steps to contain the pandemic (Gallo et al., 2020). Physical distance guidelines have altered social experiences during the pandemic, leading to the closure of non-essential businesses and public facilities such as gyms, outdoor parks, restaurants, and reduced opportunities for leisure time activities (Barkley et al., 2020). These measures lead to minimizing both PA frequency and duration, not only for traditionally active individuals who are no longer able to join gyms and health clubs but for those who incidentally obtain appropriate levels of activity by walking or cycling to work or study. This is especially relevant to university students attending a major campus who usually walk many times a day between classes (Gallo et al., 2020). When the world was battling with one of the biggest health crises caused by novel COVID-19 educational institutions around the world such as universities had to shift rapidly to online and distance learning (Almaiah, Al-Khasawneh & Althunibat, 2020).

The impact of the lockdown on PA levels due to COVID-19 was investigated in different populations around the world. For example, a previous study conducted among population in Italy showed that the PA level significantly decreased during and after the lockdown (Mauro et al., 2022). Moreover, another study conducted among young Kosovan population reported that the PA level decreased due to the COVID-19 restrictions (Gjaka et al., 2021). In addition, the impact of the COVID-19 pandemic on PA level was also investigated among the students’ population specifically, and the results showed a negative impact (Barkley et al., 2020; Galle et al., 2020; Luciano et al., 2020; Grasdalsmoen et al., 2020; Osipov et al., 2021). A previous systematic review was conducted to analyze the impact of the COVID-19 lockdown on PA level of university students, and the results showed a significant reduction in the PA level. However, these results may not be generalizable to other populations, as each country had a different system and level of restrictions during the pandemic (López-Valenciano et al., 2021).

According to the existent literature, the medical students have a high prevalence of depression, anxiety, and psychological distress level than the general population (Dyrbye, Thomas & Shanafelt, 2006). In addition to that, the students might be exposed to higher psychological distress due to the stress caused by the pandemic. The current study aimed to evaluate the impact of the COVID-19 pandemic lockdown on PA levels and other lifestyle aspects (e.g., reducing compliance to exercise and gaining body weight) among the Saudi medical students, and to explore their perspectives toward it. It was hypothesized that the lockdown due to COVID-19 has a negative impact on the Saudi medical students’ PA levels and other aspects of lifestyle.

Materials and Methods

Results

Discussion

This study aimed to describe the impact of the lockdown on PA levels as well as other aspects of lifestyle among the Saudi students of medical specialties during the lockdown and to describe their perspectives toward it. According to the findings of this study, approximately 80% of students were categorized as inactive. These results were consistent with the results of previous studies conducted on students which reported that during the COVID-19 pandemic the student population showed decreased PA levels (Barkley et al., 2020; Galle et al., 2020; Luciano et al., 2020; Grasdalsmoen et al., 2020; Osipov et al., 2021). Moreover, a previous systematic review that aimed to analyze the impact of COVID-19 lockdown on the PA levels among university students reported a significant reduction of PA levels (López-Valenciano et al., 2021).

A recent study conducted among health college students reported a lower percentage compared to our results, which was approximately 63% of students classified as physically inactive (Mahfouz et al., 2020). The resulting home restraint due to COVID-19 may have limited students’ abilities to attend their classes as well as reduced their access to community and environments in general. Lack of time and academic pressure might also be considered as possible reasons for the decreased PA levels (Zain et al., 2021). This is a problematic as physical inactivity was reported as a public concern among the Saudi Arabian population before the pandemic and people may become less and less active during the pandemic (Al-Hazzaa, 2018). Physical inactivity is a major public concern with a substantial impact on both individual and socioeconomic levels (Grasdalsmoen et al., 2020). The findings of the current study have important public health implications. As such and in response to the Saudi vision 2030, universities should consider promoting their students to take part in sports and physical activities and integrate this into the university environment (Grasdalsmoen et al., 2020). For example, PA-based interventions using active videogames might be of more interest to students and seem to be enjoyable and motivating (Viana & de Lira, 2020).

Perspectives of students toward the impact of the lockdown on their PA level and other lifestyle aspects were also explored. There were 53% of students agreed that they were exercising regularly in the gym before the lockdown. However, approximately 47% of students agreed that the lockdown and the transition to online learning impacted their compliance to exercise. This result agrees with a previous study conducted on university students which revealed that PA level decreased, and the sedentary behavior increased significantly during the pandemic period compared to the pre-pandemic period (Jalal et al., 2021). Furthermore, our results found that students perceived that online learning did not help them to increase their PA levels. This might be explained by the fact that students did not move to and from classes or clinical visits which might have decreased the PA levels even further (Luciano et al., 2020).

Nearly all the of the students’ perspectives toward their lifestyle showed the influence of shifting to online learning on their weight. Approximately, 42% of participants agreed that online learning made them gain weight. This might be as a result of the decreased amount of PA and a worsening diet. A previous study demonstrated that the meal patterns and types of food were unhealthier during the confinement period (Ammar et al., 2020).

Moreover, 54% of participants agreed that online learning had a negative impact on their psychological status. Our results are consistent with a previous study which found that moderate-high level of impact of COVID-19 was associated with a higher psychological distress and lower health-related quality of life (Alzahrani et al., 2021). However, the study of Alzahrani et al. has demonstrated that the relationship between COVID-19 impact and psychological distress was moderated by the PA level; where psychological distress for people reporting high-level impact was lower in participants who met PA guidelines than those who did not. Furthermore, moderate and high levels of PA, were protective factors against anxiety or depression among the Chinese college students (Xiang et al., 2020). Hence, current PA recommendations should be promoted during future pandemics to enhance healthy lifestyles.

The current study has few strengths. This study reported a higher level of physical inactivity levels among the Saudi medical students compared to previous findings which needs a call for action. Further, this study reported the perspectives of medical students on how these high levels of physical inactivity impacted some aspects of their lifestyle negatively (i.e., compliance with exercise and gaining more weight). However, this study has also some limitations. One major limitation is that PA level was measured using a self-report questionnaire which might result in a bias and could cause inaccurate estimation of PA amount and consequently misclassification of PA level. Nevertheless, this inaccurate estimation might be decreased to some degree by the convergent validity shown by the IPAQ questionnaire when it is compared with the accelerometery device in the measuring of PA.

Conclusions

This study found that approximately 80% of students were categorized as inactive during the COVID-19 pandemic concurring with lockdown measures. This study also reported the perspectives of the medical students about the negative influence of the lockdown on their PA level and other lifestyle aspects, for example lower compliance to their exercise and gaining more weight. This study suggests that there is a need to promote PA in the universities context to improve students’ wellbeing during pandemics.

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