Re-embracing physical activity after COVID-19: What is the physician’s role?

Globally, populations have experienced increased sedentary behavior, decreased physical activity, and increased social isolation as a result of COVID-19.[1] Canada is no exception. Canadian adults have been found to use more sedentary activities and fewer physical activities to address the increased stress they are experiencing due to the pandemic.[2]

The detrimental impact of these behavior changes on general mental and physical health is clear.[1,3] There is also evidence that physical inactivity is one of the strongest predictors of severe disease from COVID-19.[4] This highlights the important role physical activity plays in overall well-being and disease prevention and mitigation.

New guidelines from the World Health Organization for physical activity and sedentary behavior were released in 2020. They provide evidence-based recommendations across the life course and for specific populations, including those living with chronic conditions or disability and pregnant or postpartum women.[5] The Canadian 24-Hour Movement Guidelines also provide specific recommendations for all age groups in relation to limiting sedentary behavior.[6]

Given the health benefits of physical activity and the increase in sedentary behavior among Canadians due to COVID-19, it behooves us to consider our roles in reversing unhealthy behaviors as we emerge from the pandemic. We need lenses of inclusion, diversity, and cultural sensitivity, recognizing that there are significant individual barriers to returning to normal activities and re-engaging with healthy behaviors.

During the pandemic, most people have had less contact with their primary care providers than normal, and contact has often been via telemedicine. Physicians have an opportunity to help their patients emerge from the pandemic with goals and incentives to reverse unhealthy pandemic trends and to initiate new, healthy habits for the long term.

Below are some suggested approaches for encouraging physical activity during consultations with your patients:

• Introduce the topic from a positive and preventive perspective that keeps the patient at the centre of the conversation.
• Ensure your patients are aware of the risks of physical inactivity and sedentary behavior and the benefits of physical activity.
• Collaborate with patients in developing goals, and encourage them from a realistic perspective that recognizes the patient’s barriers and local context. Ask the patient what they think they can do to increase their activity levels and decrease the amount of time they spend sitting. Note that any increase in physical activity will be beneficial. Start small and celebrate successes.
• Provide information for local opportunities and online resources. Consider using Doctors of BC info sheets with current physical activity resources and programs for children, youth, and older adults.[7,8]
• Consider using the physical activity record in the vital signs section of your EMR to monitor progress and follow up.
• Help your patients use step counters. Many people are not aware how sedentary they are until they actually measure their steps. This provides a tangible way to record progress and many people have mobile phones that can measure and record steps. Decreasing sedentary behavior can be approached from the perspective of limiting sitting.
• For older adults who have been housebound through the pandemic, consider doing a frailty screen or assessment.

Physicians can play a crucial role in promoting a societal return to physical activity, and that starts with engaging with our patients. To counter the long-term effects of pandemic-induced inactivity, we need everyone to come to the table.
—Anne Pousette, MD, MPH

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This article is the opinion of the Athletics and Recreation Committee, a subcommittee of Doctors of BC’s Council on Health Promotion, and is not necessarily the opinion of Doctors of BC. This article has not been peer reviewed by the BCMJ Editorial Board.

References

1.    Karageorghis C, Bird J, Hutchinson J, et al. Physical activity and mental well-being under COVID-19 lockdown: A cross-sectional multinational study. BMC Public Health 2021;21:988.

2.    Faulkner G, Rhodes R, Vanderloo L, et al. Physical activity as a coping strategy for mental health due to the COVID-19 virus: A potential disconnect among Canadian adults? Front Commun 2020;5:571833.

3.    Fuzeki E, Goneberg D, Banzer W. Physical activity during COVID-19 induced lockdown: Recommendations. J Occup Med Toxicol 2020;15:25.

4.    Sallis R, Young DR, Tartof SY, et al. Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: A study in 48 440 adult patients. Br J Sports Med 2021. doi: 10.1136/bjsports-2021-104080.

5.    Bull F, Al-Ansari S, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020;54:1451-1462.

6.    CSEP. Canadian 24-hour movement guidelines. Accessed 20 July 2021. https://csepguidelines.ca.

7.    Doctors of BC. Stay active, stay safe. Accessed 20 July 2021. www.doctorsofbc.ca/sites/default/files/stay_active_stay_safe_resources.pdf.

8.    Doctors of BC. Keep kids moving! Accessed 20 July 2021. https://be-active.ca/wp-content/uploads/2020/09/DocsBC_Activity_Guidelines_v4_DIGITAL-i.pdf.